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11.28.08 Issue #351 Forward This Newsletter To A Colleague

Nancy Caudill
Senior Consultant
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Avoid These Dental Traps In Managing Your Practice

Dr. Sam Causey—Case Study #211

“My office runs me—I don’t run it!” was Dr. Causey’s cry for help when he called McKenzie Management.

Upon further investigation it was determined that Dr. Causey was caught in five very common traps and did not know how to spring himself from them. This is what he heard:

  1. From the front desk team: “We need another hygienist!”
  2. From the hygienist: “I need to work more days!”
  3. From the front desk team: “We need more help!”
  4. From the entire team: “We want more money!”
  5. From the doctor to himself: “I want a larger facility!”

In order to make sound decisions about these 5 declarations, information is necessary. An analysis of practice systems revealed the following details:

Practice Information

  • Hygiene patients are pre-booked in advance
  • 3 days of hygiene per week
  • 2 full-time front desk business team members
  • Last salary increase for the entire team was 18 months ago
  • Facility has 4 operatories; the hygienist uses 1 treatment room and Dr. Causey uses 3 each day

Periodontal Screening and Recording. The periodontal screening procedure involves concepts that are different from traditional periodontal examinations.

  • The mouth is divided into sextants.
  • For each sextant, only the highest screening score is recorded.
  • The probe that is utilized during PSR is different than a traditional probe. It has a rounded tip. The color-coded band extends from 3.5 to 5.5 on the shank of the probe. (PSR probes can be ordered from several manufacturers.)
  • Pocket depths are not measured. Only relationship of the gingival margin to the colored band is assessed.
  • The codes determine the need or lack of need for a comprehensive periodontal exam.

Practice Statistics

  • Doctor sees 20–25 patients per day
  • Hygienist sees 6–8 patients per day
  • Average daily doctor production is $5,500
  • Average daily hygiene production is $850 (not including doctor’s exams)

After analysis, Dr. Causey learned how to address each trap with the following “Practice Standards”:

Need another hygienist? Because all the hygiene patients were pre-scheduled without the use of pre-blocking, there appeared to be no openings for new patients, periodontal scaling and root planings, or past-due hygiene patients.

By reviewing the previous days’ hygiene schedule, it was obvious that the hygienist was averaging two cancellations or “no-shows” per day.

When the recall report was generated for the next 12 months, and the number of appointments needed based on their recall intervals (along with new patient, past-due and periodontal appointments) was reviewed, it was determined that the practice did not need another hygienist, nor did the practice need additional hygiene days. It actually proved the contrary. The practice was doing 12 new comprehensive exams per month and the past-due recall showed a loss of 23 patients per month. This is a net loss of 11 patients per month. Dr. Causey’s practice was in decline.

More help in the business office? It appeared that the business staff was overworked and overwhelmed with the influx of 30 patients per day. What was lacking in order for them to work effectively and efficiently was job descriptions. They were duplicating each other’s tasks, repeating to one another information taken from phone calls and actually spent more time taking personal phone calls, texting their friends and checking e-mail than they did working for the practice. Job descriptions that divided tasks resulted in directing the incoming phone calls to the person in charge. Two business team members can check in and check out 44 patients per day effectively; Dr. Causey was averaging 30 a day. These team members actually had too much time on their hands!

More Money? Dr. Causey did not conduct performance reviews, let alone salary reviews. He perceived these two tasks as being one in the same. This is NOT correct. A performance review is held periodically (minimum of once a year) to discuss with an employee the performance of job duties based on the job description. A salary review is conducted to inform the employee of a salary increase based on the performance AND the gross wages to collections percentage of the practice. As noted above, Dr. Causey was running at 25% of the total. Standard in the industry for a general practice is 19–22 % (not including benefits). He couldn’t afford to give salary increases based on the practice statistics.

New Facility? Standard in the industry is that no more than 5% of the practice’s monthly collections should go towards the expenses associated with the facility, such as rent, utilities, etc. With an average monthly collection of $74,775, as long as Dr. Causey stayed within a monthly facility expense of around $3,750 a month, he would be within the standard. However, his current lease payment was $5,100 including utilities, so he was already at a 6.8% overhead. He couldn’t afford a larger facility!

With a thorough analysis and implementation of systems, Dr. Causey and his dental team were educated about healthy practice statistics and learned to share information about the practice that affected them as a whole. Their previous perception was that Dr. Causey pocketed every cent and was profiting daily.

These “traps” would never have caught Dr. Causey if the team had been informed monthly of the practice performance and expense overhead relative to operating the practice in the black.

Contact McKenzie Management today to keep yourself from getting caught in the traps.

If you would like more information on how McKenzie's Practice Enrichment Programs can help you IMPLEMENT proven strategies, email

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