10.13.06 - Issue # 240 Forward This Newsletter To A Colleague

Nancy Caudill
Senior Consultant
McKenzie Management
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“Is Your Hygienist Reading People… People Magazine?”

Dr. Sam Snyder - Case Study #245

Dr. Snyder called our office so frustrated.  “My hygienist is driving me to drink!  She reads People Magazine more than she works!”

Dr. Snyder’s Office Facts:

  • 5 year old practice
  • 1 doctor – 1 hygienist – 1 business coordinator – 2 assistants
  • 15 new patients a month
  • $50,000 gross production per month
  • 98% collection rate

Dr. Snyder shared with me at dinner the first evening about his practice frustrations:

  • No practice growth in terms of # of new patients
  • No significant increase in practice production or collections
  • Not as busy as he would like to be
  • “Hygienist costs me more than she is worth”

I assured him that his practice was not unique.  His concerns are common in the dental community and he was not alone.  The good news is:  “These symptoms are curable.”

My first day in the office illustrated what I had suspected – no hygiene system in place.  Examples of this malady are:

  • Appointment confirmations made 1 day in advance
  • “Cutsy” computer-generated reminder cards mailed
  • No pre-blocked appointments for new patients and SRPs
  • No hygiene daily production goals set for scheduling

As you read through this list, I am sure that you don’t see any real issues here – appears to be “business as usual”.  Dr. Snyder thought the same thing and wondered what this had to do with his issues at hand…low production and a lazy hygienist!

First, I don’t believe in lazy hygienists…hygienists work the schedule they are presented with every morning, just as the doctor is.  If they have 5 patients on their schedule, that is how many they see.  If they have 10, they see 10, does this make sense?  Let’s review the symptoms above and see what the solutions are.

Appointment confirmations not being made…
Mrs. Jones has a hygiene appointment with Dr. Snyder on Monday morning.  Jane, his front desk person called and left a message on Mrs. Jones’ home answer machine on Friday to remind her of her appointment.  Johnny, Mrs. Jones’ teenage son, was expecting a message from his girlfriend so when he came home from school he checked the messages and, sure enough, there was the message from Jane reminding his mother of her appointment.  Guess what?  Johnny forgot to tell his mom.  Monday morning Mrs. Jones is guilty of “missing in action” at Dr. Snyder’s office.

“Cutesy” postcards…
Jane loves Garfield and has his picture on everything, including the hygiene reminder notices.  This says a lot about the value of professional cleanings in Dr. Snyder’s office, doesn’t it?  And because the cards are computer-generated, they are flimsy so they get lost inside the Penny Saver and tossed in the recycle bin without being discovered!

No pre-blocked appointments for New Patients or SRPs…
This becomes a non-issue when the hygiene schedule is not slammed with patients that aren’t coming!  There are enough openings in the schedule to accommodate the new patients and periodontal appointments within the next week.  Remember – new patients must be seen within 7 days or they will look elsewhere.  Periodontal therapy should be initiated and completed within 21 days according to the AAP.

No scheduling goals for hygiene…
What is the motivation for Jane to keep this hygienist busy?  She thought the hygienist should be calling “her” patients because Dr. Snyder told his hygienist to “stay busy”.  Jane will schedule a hygiene appointment if a patient calls but…no one is calling!  She even called everyone on her yellow legal pad but they were all busy.  The hygienist offered to help make phone calls but Jane told her that she had already called them all!

Now, I am not criticizing Jane.  She is following the guidelines that were given to her by the previous business person and Dr. Snyder has no idea what the system is that isn’t working!


  • Re-confirm hygiene appointments that were scheduled 6 months in advance 2 days prior to their appointment.  This would have given Jane an opportunity to follow up one more day if she had not heard from Mrs. Jones.
  • A professionally printed “announcement” with a personal note written by the hygienist in a self-addressed envelope that also includes information about Dr. Snyder’s new “cavity-detecting” laser actually survives being captured by the Penny Saver and gets opened.
  • If hygiene appointments are being scheduled 6 months in advance, appointments must be reserved for new patients and SRPs because when the time arrives 6 months from now, there will be no openings available to see these patients except all those patients that are going to cancel their appointments the morning of their appointment or just be MIA. 
  • Establish the daily hygiene scheduling goal to 3 times her daily salary.  Be sure to factor in any PPO adjustments if scheduling UCR fees instead of PPO fees.
  • Give the business coordinator the training tools to teach her how to keep the hygienist busy and scheduled to goal each day.  This is her responsibility – not the hygienist’s.

I have a saying…”if the hygienist doesn’t have her fingers in a patient’s mouth, she is not making money!”  You don’t want to pay your hygienist $45 an hour to send out recall cards!

Dr. Snyder will reap the rewards of increased production and grow his practice when his hygienist is productive.  The hygienist is happy because she doesn’t want to read People, she wants to treat patients.  Jane wants to achieve her goals, now that she has one, for a sense of accomplishment each day.  Everyone wins!

If you would like more information on how McKenzie's Practice Enrichment Programs can help you IMPLEMENT proven strategies….. email info@mckenziemgmt.com.

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McKenzie Management
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