Seeking long-term care

March 1, 2000
Case Profile: Housed in what was once a regal home in historic Williamsburg, Va., this 22-year-old solo practice - with one chairside assistant and one business assistant - is in grave danger of becoming history itself.

Sally McKenzie, CMC

Case Profile: Housed in what was once a regal home in historic Williamsburg, Va., this 22-year-old solo practice - with one chairside assistant and one business assistant - is in grave danger of becoming history itself.

Symptoms: The doctor called us in because his revenues - which have never risen above mediocre - have now tanked beyond doubt. And Uncle Sam is breathing down his neck for back taxes.

Observations: Mitzi, the ditzy chairside assistant, calls the patient`s name and motions for him to follow her to the operatory. There is no introduction, no greeting, and no smile. Mitzi isn`t shy; she`s just dumber than dirt. Add to this a very timid doctor who is as reluctant to chat with patients as he is with staff. Doctor/patient bonding simply doesn`t happen here, nor does treatment presentation. After analyzing patient charts, I found that the doctor never writes up a treatment plan of any sort. His mindset is just drill, fill, and bill. Unless the patient talks, there`s dead silence.

In utter contrast to the two people working in the stillness of the clinical area, Midge covers the front desk. She`s a little rough around the edges, and not very successful at over-the-counter collections. When in doubt about what to say, she bulldozes her way through, getting louder as she goes. You can imagine her effect on the cash-flow crunch.

Discussion: Although this practice has a scant but steady stream of new patients, the overwhelming majority of them are one-timers. Why? Williamsburg attracts four million tourists every year, and you can count on a certain percentage of those visitors experiencing some kind of dental distress while they`re in town.

Some time ago, with gaping holes in his schedule and his wallet, the doctor began marketing his practice to these emergencies. His approach became "C`mon in. We`ll fix you up and get you right back to your travel itinerary."

I`m not going to pull any punches here. The doctor turned to emergency patients in an effort to save his practice, period. Their pain was his gain; end of story. But what he never considered is that not every emergency sitting in his chair is a tourist. Some are living, breathing prospects who might be converted to active patients and might accept his treatment plan if he had one. But, as you know, might is the operative word here.

Treatment: Over time, the focus of promotional efforts should move from the tourist audience of one-timers to patients who live in the local community.

A fundamental goal of the practice should be convincing emergency patients (local residents, not tourists) of the need for comprehensive exams and long-term care. In my experience, patients are more receptive to the dental assistant - rather than the dentist - trying to convert them. Therefore, the assistant needs to sit down with the dentist and develop a "conversion script" she can use. For example, holding a juicy set of X-rays - with a supernumerary tooth, an abscess, or an impacted tooth - the dental assistant explains to the patient "how pictures like these give us the information we need to make a diagnosis."

Dr. Timid and Ditzy Mitzi require training in verbal skills/ patient communications and treatment planning/presentation. The doctor also could benefit from training in staff management. In addition, Midge needs direction regarding expected demeanor in the office, plus explicit training in over-the-counter collections, as well as general customer service. This situation is by no means a quick-fix, but it doesn`t have to be terminal either.

Sally McKenzie, a proponent of advanced education for dental professionals, has recently launched The Center for Dental Career Development in San Diego. A Certified Management Consultant, nationally known lecturer, and author with more than three decades in the dental profession, Sally is a consultant to the Council on Dental Practice of the ADA. McKenzie Management and Associates, Inc. provides in-office analysis of the business, clinical, and hygiene department; conducts on-site staff training; and offers a full line of educational management books, audiotapes, and videos. Call her at (877) 777-6151, or e-mail her at [email protected], or visit her Web site at