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4.4.08 Issue #317 Forward This Newsletter To A Colleague

Nancy Caudill
Senior Consultant
McKenzie Management
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Are You Playing with a Pair or a Full House?

Dr. Jane Morgan—Case Study #47

“I am not making any money! I think my overhead is too high and I feel that the office is not organized. Maybe I need more team members but I don’t want to incur any more salary expense!” lamented Dr. Jane Morgan.

 Practice Statistics

  • 60 new patients a month
  • 1 full-time Hygienist with a Hygiene Assistant and 1 part-time Hygienist
  • 2 Associate Dentists (Dr. Morgan has a very limited patient base)
  • 4 full-time Clinical Assistants
  • 3 full-time Business Coordinators
  • Overhead 76% (goal is 55%)
  • Gross salary overhead (not including associates) 27%

Practice Facts

  • She has almost 2,000 “active” patient records. However, when reviewing the continuing care report or recall report for the next 12 months, there were 860 patients that were due with or without appointments. This means that the true “active” patient base was only 860 patients! All those patient records on the shelves create a false sense of security. 
  • Assisted Hygiene—The Hygiene Assistant was not performing her primary responsibility, which was to maintain the hygiene recall system. A successful hygiene department will be demonstrated in the growth of the practice. If you aren’t adding more hygiene days to your practice, your practice is not growing and, even worse, could be shrinking. Every 3 to 6 months you should evaluate how many “active” patients you have versus how many patients you are losing through your current recall system. Reports indicated that this practice was losing as many patients per month as were coming in! No growth! 
  • Four days a week there were 2 Associate Dentists working 8 hours. There wasn’t a daily production goal per doctor—only a daily practice goal. By not having a provider goal, there were no guidelines for the Patient Coordinator and the Scheduling Coordinator to follow when scheduling patients. These key people were filling “holes”—without considering the individual provider’s efficiency and productivity. The scheduled number of patients, the speed of the doctor and the type of procedures dictate how many assistants are needed per doctor. Because there wasn’t a system for a specific assistant to be assigned to a doctor it was difficult for the doctors and the assistants to become confident with each other’s style of working. Every doctor performs differently and uses different materials and instruments for the same procedures. Therefore, many times it was chaotic in the clinical areas with no continuity among clinical team members.
  • The business area was working without systems. There were 3 full-time employees without definitive job descriptions. A review of the typical day revealed that there was repetition of tasks because there was no system for accountability. Many important tasks were not being performed on a regular basis, causing a rising accounts receivable.


  • Dr. Morgan agreed to analyze the Hygiene Department with the thought of making the necessary changes. The Patient Coordinator’s role was changed to focusing on maintaining the recall system and managing all the follow-up. An additional full-time hygienist was hired to allow time for the hygiene department to perform periodontal therapy, freeing up the Associate Dentists to do treatment. This also allowed more attention to building patient relationships by the hygienists instead of the patients feeling like they were being “driven” through the department. More importantly, the continuity between the hygienist and the doctor regarding patient needs has improved considerably and more treatment is being diagnosed and accepted.
  • Each doctor was assigned one specific assistant so they could learn to work together as a team in unison with one another. The 3rd assistant, the Clinical Coordinator, was responsible for ordering dental supplies and inventory, assisting where needed and managing general patient flow in the clinical area, making sure that patients weren’t kept waiting and that rooms were set up and taken down. The 4th assistant (who was in training) was dismissed 
  • The business team was taught how to run computer-generated reports, reduce manual paperwork and be more efficient with time. This resulted in a reduction in staff with the two remaining team members in agreement that a part-time person was all that was necessary to complete the front office team.

Gross wage overhead for team members should be no more than 19 to 22% of net collections for the same time period. By educating Dr. Morgan and the team about what is “standard in the industry” for a family dental practice and by giving them the tools and empowering them to be able to make a difference, the team became involved in reducing the overhead. What was in it for the team?

  • A sense of ownership
  • Knowing that they were productive and goal-oriented
  • A better sense of self-worth in the practice
  • The possibility for revenues to fund future raises

There are times in a dental practice when less than a full house equals more! Are you playing with a full house?

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