Time to make over your schedule?
DENTISTS ARE dedicated, skilled, and talented professionals who put in tremendous effort each day in the office. Not only does dentistry require physical activity, but it has an even larger component of mental fatigue. Providing excellent care in a small-space environment while managing patient perceptions and expectations can be challenging, especially if a practice’s systems are outdated, inefficient, or non-existent. Any given day in a dental practice can be further complicated by challenging patients, untrained staff, team absenteeism, or a host of other issues.
Understanding practice potential
The first step in building a successful dental practice is to understand its potential. Dental practices can be highly successful businesses, but they will not reach the size of Microsoft or IBM. They will never produce $100 million a year, and few, if any dentists will have multiple homes on several continents. Dentists are not rock stars, professional athletes, or Broadway performers.
Nevertheless, dentistry can provide an outstanding living with an excellent quality of life and high levels of security. There is, however, a ceiling for production. While that may sound like bad news, the good news is that more than 90 percent of practices have not reached that ceiling.
Almost every day, Levin Group works with clients in eight divisions - general practice, oral maxillofacial surgery, periodontics, orthodontics, endodontics, prosthodontics, large group, and implants - on the best ways to implement data-driven systems in their practices. Scheduling is one of the key operational systems where significant improvements can be made for most dental practices. We believe significant management change must begin with the schedule. Our 20 years of experience and research show that more than 90 percent of practices are producing at least 30 percent below their capacities. Some dentists find this difficult to believe because they go to work every day, face full schedules, and perform what they perceive as high volumes of dentistry. Because they are so busy, they think there is no way to increase the volume without putting forth more hours or sacrificing patient care.
Many dentists believe the more patients, the better, yet this type of high-volume, low-profit activity actually leads to elevated stress, high overhead, decreased profitability, and a focus on smaller, quicker cases rather than comprehensive care. For example, a practice that relies on single-tooth dentistry may be inundated with patients but have little profit to show for the dentist’s efforts compared with practices that emphasize comprehensive care. Remember, a full schedule is not always an indicator of a profitable practice. In fact, many chaotically run, high-stress practices have full schedules from morning to late afternoon. Treating a high volume of single-tooth patients also is more physically and mentally fatiguing for the dental team. Practices can avoid this type of high-stress scenario altogether by designing a schedule for a reasonable volume of patients who receive excellent care based on comprehensive examination and diagnosis.
Designing the ideal schedule
A schedule based on valid mathematical formulas allows the practice to operate at the proper volume and with a pace the dentist can enjoy. Many practices appear to be at full capacity and yet are underproducing dramatically relative to other practices of similar size and type.
As an example, Gene is a dentist from Illinois who enrolled in a Levin Group consulting program. He was working four and a half days a week with a high-volume practice and did not believe he could see any more patients. He no longer enjoyed dentistry and simply tried to make it through every day. He had been confronted with recent staff turnover and patient complaints, and he could not schedule a new patient for six weeks. Eighty-seven percent of all his appointments were single-tooth treatment vs. the national average of 81 percent. This indicated that his production - $575,000 a year - was being created with a high-volume operation and contributing to lower overall production and a stressful environment.
The first step - after helping him write a vision statement and set clear goals - was to create an ideal schedule. Gene was asked whether he wanted to work one day less a week or increase his production by 25 percent to 35 percent. He chose the 25 percent to 35 percent growth option as he was happy working four and a half days a week, but he was unhappy with the way he was working during those four and a half days.
The next step was to analyze Gene’s schedule. Patients were being placed wherever there were openings at any time of the day. Emergencies were being told to come right over to the practice regardless of how many other patients were already scheduled or waiting. The practice no-show rate and last-minute cancellation rate exceeded 5 percent, which meant that for every 20 years in practice, Gene would lose one entire year of production. This is one of those hidden statistics that many dentists fail to recognize despite that it means working many more years to achieve financial independence.
Gene and his staff used the Levin Group Method™ of standard mathematical formulas to determine an ideal schedule based on his situation. The steps included:
1)Determine the annual production desired during the next 12 months. In Gene’s case, this was to increase production by 31 percent without adding any more hours to the schedule.
2)Determine the number of days Gene wanted to work. At this point, Gene was only taking two weeks of vacation despite that his three children wanted to travel more. A goal was set for six weeks of vacation to be taken during the year and still achieve the 31 percent production growth rate.
3)A scheduling template was created with clear policies to be followed by the dental team. Large cases were to be scheduled in the morning, with mid-sized cases in the early afternoon, followed by consults and new patients, and ending the day with minor procedures. The schedule was designed to address Gene’s fatigue pattern in order to allow him to perform larger cases when he had the most energy and minor procedures at the end of the day. Managing appointments this way also allowed the staff to set up for the next day and check out, ending the day on time. Several staff members had mentioned they were unhappy with regularly leaving anywhere from 15 minutes to an hour late. This was immediately cleared up using the newly designed schedule that Gene and his staff agreed would better suit their needs.
4)Scripts were given for all types of patient interactions so the staff knew exactly how to manage patients. The scripts focused on using power words to generate patient enthusiasm and improve customer service. Team members also were trained on using benefit statements to help patients understand the new schedule as well as practice policies and protocols. One example was to help enlighten crown and bridge patients as to why morning appointments were important, explaining that all impressions and records could be sent to the laboratory by the 1 p.m. daily cut-off time, thus ensuring quicker results for patients.
5)A daily production goal was established based on improvements to the schedule. Front-desk coordinators understood that their main job was to achieve this goal, which was 31 percent higher per day than the average day of the previous 12 months. The difference was that the practice was now well paced - the schedule was running smoothly with similar production on most days rather than a peak-and-valley type schedule that elevated stress, decreased productivity, and lowered profitability.
6)Another goal was to change the service mix by promoting comprehensive dentistry and elective procedures. The practice undertook a systematic and mathematical analysis of the services provided during the previous 12 months, including fees and insurance adjustments where applicable. These were then analyzed again to build a model of more productive and profitable services and how these would be scheduled. Extensive training in the Five-Phase Comprehensive Exam (this will be described in a later article) and how to influence patients to accept treatment with excellent customer service was integrated into all other systems in the practice. Gene was able to enhance his case-presentation skills as noted by specific measurements on a daily, weekly, and monthly basis. The level of case acceptance based on the number of patients and the total production presented was monitored carefully to help Gene improve his performance and know when he was improving or declining. Levin Group has found that the doctor must use these new skills for approximately three months to begin to improve case acceptance. It requires up to one year for these skills to become ingrained in the natural and daily behavior of the doctor and team members.
These steps can be implemented into almost any practice, resulting in increased production and profitability. This was especially true for Gene’s practice. At the end of 12 months, practice production had increased 27 percent to $730,250. This growth was right in line with the new schedule that allowed for 31 percent production expansion based on existing services as well as the addition of new services.
Although significant growth can be achieved simply by redesigning the schedule based on mathematical formulas, improving the service mix will significantly increase practice production as well.
A problem arises when many dentists take extensive clinical continuing education only to find they are not using their new skills as often as they thought. This scenario frequently occurs either because the practice did not change the schedule to accommodate the new services, which often require longer appointment times, or the case presentation skills and the service mix were never upgraded.
Any practice can be analyzed for scheduling potential. Many dentists will be surprised to learn that an ideal schedule can increase production by 20 percent to 30 percent. In addition to redesigning the schedule, changing the service mix can lead to greater production and profitability. Frequently, as I present weekly seminars throughout the United States, dentists think they have to work harder to increase production. This is probably based on many years of hard work that most dentists invested in college, dental school, and getting their practices up and running. However, businesses rarely have to work harder to increase production or profit - they have to work smarter.
New patients are critical to practice success, but most practices can increase profitability by 20 percent to 30 percent without adding patients. Most practices can achieve this type of growth by addressing key schedule issues.
Additional growth also can be achieved by changing the service mix, which may require training from a clinical and technological standpoint. Nevertheless, adding clinical services and technology alone is not a guarantee of increased production or profitability for a practice. Think of the schedule as the command control center for all other systems, which will control and determine success of business changes. Remember, no practice can out perform the production built into its schedule.
Failure to address the schedule using a mathematically designed approach will significantly limit the potential of any practice. According to Levin Group research, many dentists will practice between seven and nine years longer than necessary to achieve financial independence because of poor schedules. Fixing your schedule can unlock your practice potential.
Dr. Roger Levin is founder and CEO of Levin Group Inc., a leading dental-management consulting firm that specializes in implementing documented business systems into dental practices. Levin Group is dedicated to improving the lives of dentists via proven dental-practice management and marketing consulting programs to achieve success and profitability. Reach Levin Group at (888) 973-000 or at www.levingroup.com.