Recare systems

Dec. 20, 2016
My practice is in a suburb of a large city, and my practice management program tells me I have about 1,300 active patients. I employ two full-time hygienists, but we're finding it difficult to keep their schedules full. What should I do?

Dear Dianne,

My practice is in a suburb of a large city, and my practice management program tells me I have about 1,300 active patients. I employ two full-time hygienists, but we're finding it difficult to keep their schedules full. What kind of recall system do you recommend? What are your thoughts about the proper number of hygienists for this group of active patients?

- Dr. Dave

Dear Dr. Dave,

It takes from 800 to 1,000 patients to keep one full-time hygienist busy. If you truly have only 1,300 active patients, it's easy to see why you're having problems keeping two full-time hygienists busy. It's a "demand and capacity" issue. You have more capacity (appointments) than demand for services.

You have two choices: (1) reduce hygiene capacity to one full-time and one part-time hygienist, or (2) downsize to one full-time hygienist. Let the hygienist work an assisted hygiene model using both hygiene operatories, and hire a dedicated assistant to help her. Either of these choices will allow you to better balance the demand and capacity in your practice.

For recare or continuing care (I dislike the term "recall" because it reminds me of defective cars), I'm a proponent of preappointing most patients. Many offices preappoint all hygiene patients for their next visit. However, if a patient has a history of disappointment or late cancellation, it might be more prudent not to allow such a patient to preappoint. Preappointing is a privilege that should not be extended to everyone. You need to be discriminating in whom you allow to reserve time several months in advance. Your patient conversation would be: "Mrs. Jones, since we've had a problem in the past coordinating your busy schedule and ours, I believe it would be best if we contact you when it's time for you to return."

If your patient insists on prescheduling, you have to be sure to make your point with grace and tact: "We know you're a busy person, and we're a busy office. If you reserve time, there is a commitment on your part to keep the appointment and a commitment on our part to provide you with the best care. We'll keep our commitment if you will too."

Patients with a history of disappointment should be handled differently than other dependable patients. A message on voicemail is not an acceptable way of reminding such patients. If the patient cannot be reached during regular business hours, someone has to take the number home and call after hours. Such patients should be called two days ahead of their appointment with this message: "Hi, Mrs. Jones. This is Mary at Dr. Smith's office. I'm calling regarding your appointment on Wednesday, May 5, at 10 am. It's imperative that I speak with you directly. Could you please return my call by tomorrow, Tuesday, May 4, at 10 am? The number is (555) 555-5555. Thank you for your consideration."

When patients preappoint, inform them that they will be receiving a reminder card three to four weeks prior to their appointment. Then ask if they would like to receive a reminder e-mail, text message, or phone call. These reminders are not confirmations. Our mindset is that when the patient accepts an offer to reserve time for dental care in our schedule, the appointment is confirmed. When we say, "I'm calling to confirm ...," the message we're sending is that we're not sure the patient is coming so we're trying to confirm that the patient will really be there for the appointment.

So, to recap my advice, make staffing modifications to adjust capacity, be discriminating about who is allowed to preappoint, and stop making "confirmation" calls.

All the best,


Dianne Glasscoe Watterson, MBA, RDH, is a consultant, speaker, and author. She helps good practices become better through practical on-site consulting. Please visit Dianne's website at For consulting or speaking inquiries, contact Dianne at [email protected] or call her at (336) 472-3515.

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