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2.17.06 Issue #206  
A McKenzie Management Case Study
Are You Kidding? Where Did All My Patients Go? Quicksand?

Nancy Caudill
McKenzie Management
Senior Consultant
McKenzie Management

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This case study is an illustration of a family dental practice that may be similar to yours.  The names have been changed to protect the guilty!

Dr. Murray’s story:

Dr. Murray called to inquire about how to determine when to add another day of hygiene to the schedule since his hygienist was so busy and there was no place to put new patients.  He remarked, “My phones are ringing, patients are paying and I am busy for the next two weeks.  My hygienist is working two days a week and is booked for the next six months – Life is Good!”

“Kathy, my schedule coordinator is asking me to add more hygiene days because she can’t get appointments for the new patients that we see.” he explains.  “Do you have any guidelines on when the correct time is to add additional hygiene days?”  My first thought is:  Dr. Murray has another problem going on that needs to be addressed first and he isn’t even aware of it!

Let’s review some facts:

Practice History:

  • Dr. Murray has been practicing in the same location for 10 years
  • The practice is seeing 20 New Patients a month
  • Sandra (the hygienist) works 2 days a week and 50 weeks per year

Get out your calculator…this formula can be applied to your practice just as it was applied to Dr. Murray’s.  It is very simple. 

The formula:

Sandra sees 8 patients per day
She works 100 days a year (2 days a week x 50 weeks)
= 800 appointments per year available

Dr. Murray said that he sees 20 New Patients a month and has been averaging this for the life of the practice (10 years).

20 NP x 12 months x 10 years = 2400 patients

(Dr. Murray’s practice was a start-up so he had no existing patients in his practice.  Obviously, if you have purchased an existing practice, you will have your new patients plus the patients that were established prior to your purchase.)

Let’s apply some additional math:

800 hygiene appointments available for the year
2 (the minimum # of recalls per year per patient)
= 400 active patients

What this is saying is that Sandra can only provide regular hygiene visits to a maximum of 400 active patients per year, based on her working schedule.  What happened to the other 2000 patients that are in Dr. Murray’s practice?

Quicksand got them!  All those patient charts on Dr. Murray’s shelves were giving him a false sense of security because only portions of them are “active” patients.  An “active” patient is a patient that is being seen on a regular basis in his hygiene department.  It is not a patient that was seen on an emergency basis or a patient that hasn’t been seen in over two years.  These patients have no effect on the growth of his practice.

Recommendation to Dr. Murray:

  • Determine how many “active” patients are in the practice by using the McKenzie Management’s methodology and use this number as your baseline.
  • Monitor the # of new patients that are seen vs the # of patients that are inactivated to determine the growth of the practice.
  • Track the # of patients that are “lost in quicksand” through the hygiene department by running past due recall reports and assign an employee to “dial for dollars”.
  • Add additional hygiene days as needed by using the McKenzie Management’s methodology to avoid adding hygiene days unnecessarily and discovering that your hygienist is now not busy enough!
  • Work with McKenzie Management for 12 months to help him grow his practice and implement new systems to monitor his growth.


Providing consulting services across the country, we find that small country town practices as well as large metropolitan practices suffer from this deep hole of lost patients. 

The loss of hygiene patients = loss of practice growth

It is true that the hygiene department is the lifeblood of a practice.  Calculating properly the # of hygiene days needed on a quarterly basis and adding additional days as required is a direct result of a healthy retention of patients.  If your practice is like Dr. Murray’s and you have maintained the same number of hygiene days for the past 12 months…your practice is sinking in quicksand!

If you have any questions about this information or would like to share your solutions, feel free to contact me at or call me toll-free at 1-877-777-6151 x 31.

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