10.21.11 Issue #502 info@mckenziemgmt.com 1-877-777-6151 Forward This Newsletter

Carol Tekavec, RDH
Hygiene Consultant
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A Penny Wise and a Dollar Foolish?
Carol Tekavec RDH

There is an ongoing argument in the dental world concerning time frames for hygiene appointments. At the heart of the argument lies the bottom line…office production. On one side are those who promote the shortest possible appointment slots for so-called prophys, and on the other side are those who advocate longer times to allow for “other services.” Let’s look at the main features of both.

Short Appointments
Short appointments (30-40 minutes) make it possible to see many patients during a day’s time. Short appointments create income for the practice. 10-15 patients a day in the hygiene schedule can generate fees for prophys, x-rays, and fluoride treatments. It is the hygienist’s job to work quickly and efficiently, and longer appointments foster a lazy approach to the task at hand. Patients are fine with fast appointments because they are busy and appreciate not being tied up at the dental office for long periods. Screening patients for perio and possible restorative issues should not take longer than a few minutes for a competent hygienist. With digital x-rays, a full mouth series can take as little as five minutes. Since production is one of the most important aspects of keeping an office in business, and the hygienist is usually the most expensive employee at the practice; it is the hygienist’s responsibility to pull her weight and work quickly.

Longer Appointments
Longer appointments (60 minutes) make is possible for the hygienist to perform more procedures in an atmosphere of personal concern and care. Eight patients a day generates fees for prophys, x-rays and fluoride treatments, plus it allows for more complete screening for perio and restorative patient needs. It is still the hygienist’s job to work quickly and efficiently, but a slightly longer appointment time fosters patient trust and provides a framework for the hygienist to connect with the patient concerning possible future patient care. Since the hygienist is not rushed, she has time to explain what she has found and set the stage for the doctor’s diagnosis and recommendations.

Even though digital x-rays shorten the time necessary to expose and view radiographs, patients are not mannequins. Sensors can be uncomfortable for some patients, and the hygienist needs time to find a way to take the needed views that provide the least discomfort. Patients appreciate not being rushed and like the chance to ask questions.  While an immediate measure of the hygiene department’s effectiveness can be the actual production generated “today,” the future production generated from treatment diagnosed, accepted, and scheduled can be many times more significant. The “recall” appointment is essential for long term practice viability. If future treatment is not scheduled from the recall appointment, when will it be “discovered” and scheduled? It is the hygienist’s responsibility to aid the dentist in screening for future treatment, and to do it in such a way as to facilitate his ability to gain the patient’s trust. It is another way hygienist’s “pull their weight.”

From these two descriptions, it is easy to see what side of the argument I lean toward. As a working hygienist myself, I consider one of the most important duties I perform to be setting the stage and fostering the framework the dentist needs to help patients receive the treatment that they need. I also believe that having time to explain treatment needs, whether it be scaling and root planing and subsequent periodontal maintenance, or possible Class III cracks in a molar likely necessitating a crown; having both the dentist and hygienist make a recommendation enhances the chance that a patient will agree. Hygienists do not diagnose - but they can observe and inform. Conditions that appear to need treatment can be identified, and then confirmed or “denied” by the dentist with notes in the record to keep an eye out at the next recall. Even when the recommendation is to “watch” the situation and re-evaluate at the next recall, it gives the patient another reason to come back in six months.

Speaking strictly in dollars and cents, hygienists who have the time to address a patient’s individual concerns add revenue to the practice. For example, if the hygienist recommends and the dentist confirms that a patient needs prophys three times a year rather than only twice, she has time to explain, and the patient will be more likely to accept.  Just 50 patients who go from twice a year prophys (at $80) to three times a year intervals adds $4000 to the practice’s bottom line!

If only 25 patients are identified who need scaling and root planing, and then go on to accept four periodontal maintenance appointments per year (at $125); instead of 2 prophys at $80= $160 x 25 = $4000 generated annually, these 25 patients will generate $125 x 4 =$500 x 25 =$12,500.  An increase of $8500!

Similarly, if the hygienist identifies and the dentist confirms necessary crown restorations on only 50 patients a year (at $1,100 each), $55,000 can be added to annual revenue.

There is great potential for the hygiene department to increase office revenue, without that potential being totally tied just to daily production. It makes sense not to be a “penny wise and a dollar foolish.” The hygienist’s contribution can extend far beyond what she produces directly at the chair.

Carol Tekavec RDH is the director of Hygiene for McKenzie Management.  Carol can improve your hygiene department in just one day of training “in your office.” Interested in knowing more about how to improve your hygiene department?  Email hygiene@mckenziemgmt.com.

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