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Why do we change? The evolving dental model for the 21st century must address shortfalls of past systems in the oral care delivery. One of the greatest challenges for a practicing dentist is to manage a staff of individuals with various job descriptions as one cohesive unit.
For decades, doctors have been relying on a receptionist to answer incoming phone calls, an administrator to handle insurance claims, and another employee to assist with dental procedures and X-rays.
If the practice was busy enough, a hygienist was hired to handle prophies. This was the classic model of providing patients with the best care available.
On any given day, unforeseen circumstances can lead to breakdowns in the flow of services, creating dilemmas that expose the vulnerability of the operating system and the inefficient ways it addresses them.
For example, a typical practice that employs one receptionist, one hygienist, and one dental assistant often experiences partial paralysis when one of the team members is unable to report to work. The common solution for this impediment is to hire additional front- and back-office personnel to ensure a continuum, just in case an essential employee is absent. However, this practice of hiring additional employees, while allowing the practice to continue to function, can also create a situation of high overhead and inefficiency.
Another shortcoming in the current system is the tendency to rely on specific employees to specialize in one area of the practice or another. In an effort to maximize the staff’s impact, the doctor identifies a team member’s specific talent with a corresponding duty.
The one with the best phone skills is delegated to front-office duties, the assertive one with a strong sense of persuasion is assigned financial arrangements, and the one with the best dexterity and motor skills is in charge of making models and fabricating temporaries.
The downside to this strategy is that most dental practices stifle their own growth and never allow team members to develop and flourish to their full potential. Furthermore, the absence of one such specialized employee can cause the quality of care to suffer dramatically, bringing a well-running practice to a screeching halt. Oftentimes, no treatment can be delivered until financial agreements are made, and when financial managers fall behind, the clinical team finds itself idle and waiting.
Ultimately, patients become victims of this oversimple style of management. How often have we seen these offices assign all their bleaching procedures to just one trained team member, all their temporary fabrication to another, and all insurance duties to a third? Thus, they inadvertently compartmentalize their staff, and without meaning to do so, they fall into the trap of “putting all their eggs into one basket.”
Perhaps nothing is more telling then the daily routine of the typical dental assistant. Most practitioners cater to their receptionist under the assumption that this person is the gatekeeper to the success of the business. We often acknowledge our hygienist as the only income generator besides us. We bestow accolades on our office manager for his or her savvy relationship with our patients, and we act helpless without the business manager, who makes sure to keep accounts receivable in check.
The most often overlooked team member is the dental assistant and his or her potential contribution to the practice. Our assistant always felt underpaid, at a dead end position that was not challenging and often conveniently marginalized.
The new digital practice
Very few of us are now aware that we are on the cusp of a new golden age in health care in general and in dentistry in particular. Today, digital technology is revolutionizing the dental profession like never before. It is a bona fide game-changer that ranks right up there with the introduction of the high-speed handpiece, adhesive dental material, and osseous implants.
As calls for a green world become louder, dentistry is spearheading this revolution. We are eliminating the darkroom and its chemicals, dental models with their gypsum byproducts, and patients’ charts with all their paper waste. We are embracing the digital revolution in earnest. Digital dentistry will be the foundation of the dental practice of the future, and we are already witnessing how digital dentistry is transforming the foundation of dental care.
Digital technology is creating an opportunity for the average practice to become twice as profitable, half as wasteful, and infinitely more efficient than its predecessors. In this article we will explore the anatomy of tomorrow’s dental practices. This is not a theory and there is nothing virtual about it, for practices like this are already springing up across the country. At the heart of such practices is the evolution of the dental assistant. This is the dawn of the patient coordinator.
The patient coordinator
Tomorrow’s dental practice will see the metamorphosis of the dental staff into a genuine team. We will explore a clinical model that includes the physical layout of the facility, the job description of the patient coordinator, the manner in which a patient is processed, and how the management is paid. We will explore a breakthrough in management as well as philosophy and a genuine paradigm shift that guarantees a transformation in how a dental practice conducts its daily affairs. In order for practitioners to take their practices to the next level, a new delivery model is required. It must address all the shortcomings of the current delivery system and resolve the stress that is rooted in the current systems.
Creating the change
Implementing the necessary steps to create a digitally based dental practice guarantees a quantum leap in profit, satisfaction, and joy in the way we practice dentistry. The practice is frontless and paperless. It features one or more doctors, one or more hygienists, and a supervisor to monitor and assure accountability of the staff. The rest of the staff are patient coordinators.
The concept is simple, the expectations are high, and talent is mandatory. The patient coordinator must possess the suaveness of a phone operator, the tactfulness of a financial facilitator, and the meticulous attention to detail of the elite clinician, for she will be called upon to be truly cross-trained in all phases of the job in the office. A typical dental practice will require the training of at least three patient coordinators. These caregivers are entrusted with a set of patients who will be their sole responsibility.
The role includes:
- Greeting patients and guiding them through their office experience
- Developing and implementing treatment plans
- Assignment of financial responsibility for treatment
- Collection of monies owed to the practice
- Delivering treatment using the doctors and hygienists when appropriate
- Maintaining supportive therapy
- Getting to know the patients, including remembering special occasions
Each coordinator is assigned one day to field calls; the rest of the week is devoted to caring for her patients. The patient base is divided equally among all coordinators. New patients are randomly assigned to each coordinator in a rotating order so each receives an equal number of patients.
The structure of office visits to the digital practice
A typical new-patient experience begins with the coordinator’s greeting as the patient enters the reception room. The coordinator is already prepared to meet the patient and lead a standardized office tour ending in her personal treatment room. The tour begins with a visit to the beverage bar, and as the patient enjoys a favorite treat, he or she is familiarized with the philosophy, protocols, and unique features that set the practice apart.
Once seated, great care is taken to avoid having the patient fill out a single form. Instead, each operatory is equipped with its own digital station where relevant patient information, medical history, and the necessary diagnostic information are collected. This often includes digital photography and a CAT scan.
In the schedule, this coordinator has already requested the services of a hygienist and dentist at a specific time during the visit. The hygienist assists the coordinator in classifying the patient’s periodontal condition, as well as recording general findings. It is during this time that patient education begins.
On-screen illustrations as well as working models are shared with patients to elevate their awareness of their oral condition and treatment needs. The doctor meets the patient, reviews findings, and concurs or edits as necessary. The doctor can spend more time building the relationship and getting to know the patient, and less time demonstrating the need for treatment or the technicalities involved.
Upon the doctor’s exit, the burden shifts back onto the coordinator to answer any remaining questions, obtain a commitment from the patient, and secure finances. She proceeds to schedule the patient in a manner consistent with the doctor’s availability. On the day of treatment, the same coordinator whisks the patient to the treatment room and seats him or her. A prescheduled hygienist delivers anesthesia, and then the doctor renders the planned treatment for the day.
At the conclusion of the visit, the coordinators collect the funds, file necessary insurance forms, schedule the patient for the next visit, and escort the patient back to the reception room. The coordinator then proceeds to break down the treatment room, sterilize instruments, and prepare for the next patient, then repeat the process all over again.
In essence, each coordinator retains his or her own accounts and becomes the custodian of those patients’ oral care. They are the coordinator’s clients to care for, and it is his or her responsibility to secure the doctor and hygienist services to assure that the patients receive a high standard of care in an ongoing, seamless fashion.
A dental practice can have one or as many coordinators as patient volume requires. The doctor and the hygienist rotate from one coordinator to the other rendering service. Each coordinator retains his or her own practice, contracting the services of a professional for the patients.
The practice supervisor’s main responsibility is to ensure that all coordinators uphold the philosophy and protocol of the practice and assure the accountability of each coordinator. The administrator tracks the productivity and revenues generated by each coordinator in a manner similar to tracking sales representative productivity in a corporate setting. The coordinator’s compensation is based on a base salary or a percentage of the revenues collected from his or her clients, whichever is greater.
The digital revolution has already taken hold in many dental practices. Facilitating the growth of the dental assistant to the broad and challenging position of patient coordinator will provide for significantly more satisfaction for the assistant and pay handsome dividends to the practice.
Mickel Malek, DDS, is in private practice in Tucson, Ariz. He is devoted to extensive training in periodontics, orthodontics, oral surgery, implantology, and esthetic full-mouth rejuvenation. He is a member of the American Dental Association, Arizona Dental Association, Southern Arizona Dental Association, Academy of General Dentistry, and American Orthodontic Society. Reach him at [email protected].
