Case Studies of Dental Practices

June 1, 1997
Case Profile: The doctor, a general practitioner, has been in practice for 13 years in a mid-sized city in the mid-Atlantic states. Socioeconomic level of patients in the area is above average.

Sally McKenzie, CMC

Case Profile: The doctor, a general practitioner, has been in practice for 13 years in a mid-sized city in the mid-Atlantic states. Socioeconomic level of patients in the area is above average.

Symptoms: The doctor`s schedule had been booked out six weeks in advance. Crown preparations were being put off for seven weeks. Even a simple filling had to wait at least five weeks. Patient patience was wearing thin, as were the doctor`s defenses.

Considering his patient load, the doctor bit the bullet and hired an associate dentist about a year ago. Now the associate is scheduled one week in advance and the doctor/owner`s schedule hasn`t opened up at all. Although the practice is realizing a flow of 30 new patients per month, patient retention is at an all-time low of 76 percent.

Observations: This practice is housed in what used to be a residential dwelling. There are four treatment rooms, two of which are utilized by the hygienists, one by the doctor/owner, and the last by the associate. The doctor`s private office is located in the living room.

The doctor/owner sees eight patients per day, while the associate generally sees about six patients daily. Each doctor has one assistant. Each assistant stays an average of 30 to 45 minutes past the time the last patient is to be dismissed.

Staffing the business office are two women, both full-time, long-term employees. Neither have had previous experience in a dental practice. Working without job descriptions, they `help` each other out with answering phones, checking patients in and out, and scheduling appointments. Appointments are scheduled in 15-minute units in a two-column, week-at-a-glance book.

Discussion: Consulting on-site in practices across the country, my team and I are witnessing a sharp rise in the number of practice schedules being booked out six weeks or more. Unfortunately, this is less the result of popularity among certain dentists than it is evidence of a new fact of life ... in the last two years, dentistry has seen more dentists dying and retiring than graduating from dental school. As the pendulum moves away from the 1980s - when every management seminar trumpeted new ways to get new patients - we`re now encountering a scant supply of dentists, resulting in too many patients.

While on the surface that might appear to be a welcome problem, take my word that it does not equate into a more successful practice. A too-full waiting room or booked-out schedule can be insulting, and often is the catalyst responsible for pushing patients out the door - permanently.

With a 76 percent retention rate, this practice can`t afford to take any chances, and it must take immediate action to bring the `delay` to no more than three weeks (patients will not wait much longer than that to purchase dental treatment).

Treatment Plan: The first step in improving practice efficiency, was for my clinical consultant to train the doctors and their assistants in four-handed dentistry, along with the `artistry` of working out of two treatment rooms simultaneously. When these are handled well, such increased efficiency can be a boon to not only the doctors` schedules, but to overall patient satisfaction.

Next, we needed to juggle office space to accommodate a second treatment room for Doctor #1. (In time, another room will be needed for Doctor #2 but we`ll wait until her schedule is booked out solid for three weeks.)

Where to put the second treatment room, however, presented a bit of a challenge since there was no obvious place. Adding on to the existing structure was suggested by the doctor/owner. But that would take too long and we needed an immediate solution. By moving the doctors` private office upstairs, we could place the two hygiene rooms in this one larger room and, at the same time, open up two treatment rooms.

The doctor/owner now has two treatment rooms side by side, but only one assistant. Since his payroll to income already is beyond the 22 percent recommended maximum, it would be premature to add another assistant for him. After the patient efficiency training, however, he should be able to increase his eight patients per day to between 10 and 12 by overlapping the first and last 10 minutes of each patient. We will recommend adding another dental assistant and training her on all duties which can be delegated to an assistant (consistent with state laws), such as making temporary crowns. As a result, the 1.5 hours that he now needs to do a crown prep will be reduced to approximately 30 minutes of doctor time.

As for the two ladies in the business office, it`s time for very specific job descriptions. One will now be the financial coordinator, in charge of collecting fees and billing. The other one will be the scheduling coordinator, responsible for the phones, checking patients in, and scheduling for the doctors. She will receive professional training in computerized scheduling, switching from 15-minute units to 10-minute units to allow for more flexibility.

She will learn to generate a production analysis report to determine how many units of crown and bridge the doctor does on a weekly basis. Based on this history, blocks of time will be reserved in the weekly schedule (varied each day for the best in customer service) for that number of crown and bridge units.

During beginning-of-the-day meetings, the day`s schedule will be discussed, including where the scheduling coordinator should place emergency patients. These meetings also are a good forum for discussing which hygiene patients might be receptive to being checked by the associate dentist.

The author is a certified management consultant and president of McKenzie Management, Inc., a full-service, in-office dental-management consulting company with clients across the U.S. and Canada. The company can be reached by calling (800) 288-1877; e-mail [email protected]; or visit her web site at:

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