8.03.07 - Issue # 282 Forward This Newsletter To A Colleague

Nancy Caudill
Senior Consultant
McKenzie Management
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Does Too Busy = Hiring an Associate?

A McKenzie Management Case Study

Dr. Jim Wilkins – Case Study #63

“My schedule is out of control!  We are always working into lunch, patients are waiting and we work late.  I have to work out of three operatories and I am conducting exams in two hygiene rooms.  It makes me tired just thinking about it.  I need an associate!”

Dr. Wilkins’ practice facts:

  • 15 year old General Dentistry practice
  • His patients are scheduled 4 weeks into the future
  • 22 new patients per month
  • Orthodontics are performed

Dr. Wilkins, indicated that he is considering an associate or maybe even a partner, even though it was never his plan to work with another dentist.  He felt that sharing the workload would reduce his stress and allow for improved customer service to his patients.

“Dr. Wilkins, it’s important to know that you do have options.  You have numerous business systems that need to be repaired in order to get the practice working properly.  Let’s refurbish your systems first and then see where you are.’

Dr. Wilkins is assuming that seeing the symptom of being booked out far in advance in his schedule would automatically mean an associate. However, areas such as scheduling and utilization of an assistant, by state law, has to be taken into consideration.


  • The Schedule – It was obvious that Dr. Wilkins was not performing quadrant dentistry.  Every patient was scheduled for 60 minutes regardless of the procedures that were scheduled.
  • Orthodontic Patients – These patients were haphazardly scheduled and interfering with general dentistry production.
  • No morning or monthly meetings – There was very little communication among the doctors and team members regarding the patients.  No one in the office had any idea about how well or how bad the practice was performing statistically.
  • Lack of daily production goals – Every day was like riding a roller coaster.  Some days they produced $1,200 and saw many patients. Other days they produced $5,000 with only a few patients.
  • New Patients – The practice averaged 22 new patients per month.  Keep in mind that “new patients” are those patients that are seen for a comprehensive exam and are also seen in hygiene and go into the recall system.

McKenzie Recommendations

The Schedule
When possible, perform quadrant dentistry for the patients.  Longer appointments are more productive than several short appointments.  It is also better customer service because it reduces the number of visits for the patients..

Patients should be overlapped on the schedule according to what the assistant can do without a doctor and captured doctor time. The doctor must not be scheduled in more than one treatment room at any given time.

Daily production goals must be established for the doctor and the hygienists based on the practice overhead.  By scheduling to a specific goal each day, it reduces the roller coaster effect and allows for productive days every day.

New Patients must be scheduled within one week for good customer service.
Those practices that schedule the new patient for what they are requesting have a higher rate of new patient retention than those offices that schedule the patient for something different than what they requested.

The Orthodontic patients should be scheduled together for time efficiency. Evaluate the amount of time that is taken per week for ortho and then condense this time into blocks of 1/2 day segments at diversified times and days.  This eliminates the continual interruptions during the day.

The hygienists need to notify Dr. Wilkins as soon as they have taken x-rays or completed their visual assessment so he can perform his exam anytime while the patient is in the hygiene room.  (Please check your state law.) Waiting until the end of the hygiene appointment is not good time management.

Extend his morning schedule until 1:00 to allow for more production prior to breaking for lunch.  In many cases, the daily goal can be met prior to lunch.  This allows the afternoon to be scheduled with non-productive appointments. However, customer service is the priority should the patient not be able to come in the morning.

Inter-Office Communication
In order for the day to run smoothly, it is imperative that Dr. Wilkins meet with the team in the morning prior to the start of the day. This 15-minute meeting allows everyone to review the schedule and discuss any “traffic jams” they foresee.  Patient concerns are discussed as well as looking at the production for the previous day and today to see if the doctor and hygienists reached their daily goals.  A morning meeting also gets everyone started off “on the same page” and focused on the day.

Two hour monthly meetings gives everyone the opportunity to understand the “mechanics” of the practice.  Practice statistics are discussed, such as production, collections, adjustments, outstanding insurance claims, accounts receivables, lab and dental supply expenses and the overall practice overhead for the month.  Team members want to be informed of how the practice is doing.

The Associate
The practice cannot support two dentists with 22 new patients per month.  Dr. Wilkins would need to be willing to “give up” some of his production to the associate in order to keep him/her busy.  Yes….the associate would be busy initially, helping to “catch up” those patients that are being scheduled four weeks out.  But, once the catch up is completed the reality of not enough new business sets in.
After six months of implementing the various changes in Dr. Wilkins’ systems, it was obvious that he would have made a mistake by incorporating an associate into his practice.  As soon as his Schedule Coordinator started scheduling to a daily goal and learning how to schedule for Doctor/Assistant time, he took back control of his practice again…and his life.

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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