2.19.10 Issue #415 Forward This Newsletter To A Colleague

Nancy Caudill
Senior Consultant
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One Of My Assistants Is Leaving – Should I Replace Her?

Dr. Sherry Staples – Case Study #233

It is interesting… many dentists really have no idea how many assistants they need.  Dr. Staples had two and was losing one due to a relocation. Should she replace her?


  • How many doctor patients do I see a day and what types of procedures?
  • How much time is scheduled for the various procedures?
  • How many treatment rooms do I use?
  • How far out am I booked in my appointment book?
  • How many hygiene days do I have?
  • Do I have digital radiography?
  • How many assistants and business team members do I have presently prior to the change?
  • What type of procedure mix do I have?

Number of Doctor Patients and Procedures
Dr. Staples sees on average 12-14 patients a day. Some appointments are restorative procedures, some endo, and some C&B. She uses a local lab to fabricate her crown and bridge cases. She averages only 1-2 crown preps per day and 60% of her procedures are fillings.

Time Scheduled for Procedures
Typically, 90 minutes is scheduled for crown preps and an hour for composites 1-2 teeth with 1-2 surfaces. Crown cementations are scheduled for 40 minutes to allow for adjustments. If they are bonded, she schedules 50 minutes. Endo can be anywhere from 90 minutes for anteriors to 2.5 hours for molars.

Number of Treatment Rooms and Radiography
Dr. Staples works out of 3 treatment rooms. The 3rd room is used for “emergencies and other non-productive procedures.” She indicates that she feels rushed throughout the day. Each room in the practice is equipped with digital radiography and computers.

Appointment Book
Her schedule is booked out about 6 working days, with slots blocked for new patients and “high production.”

Hygiene Days
The practice works 4 days a week with 1 hygienist each day. There is not a designated “hygiene assistant” but an assistant may assist in taking an FMX or Pano if the hygienist is delayed.

Total Number of Employees
She has 2 full-time front desk personnel, 2 assistants with 1 relocating to another state, and 1 hygienist.

Now you see a snapshot of her practice – it’s not unlike many dental offices across the country. The big question is: does she hire another assistant to replace the assistant that is leaving?

Dr. Staples thought that since she had three treatment rooms, she should be using all three. This is NOT the case! The number of treatment rooms that are used by one doctor depends on the workload, how many days the doctor is scheduled in advance, how many assistants, the service mix of procedures, and does the doctor enjoy wearing “roller skates,” “tennis shoes” or “bedroom slippers?”  They are all correct, and the appointment book must be scheduled to match the style of the doctor.

Dr. Staples had already indicated that she felt rushed and stressed all day, running from room to room and checking the hygiene patients. And yet she was only booked out a week and a half!  This tells me that the demand for her services are not such that she needs to feel the pressure of a busy schedule – simply schedule the patients further out.  Ask if they would like to be on a “priority list” and contacted if there is a change in the schedule.


  • Overlap each patient 10 minutes at the beginning and end of each appointment - assuming that she is okay with giving injections alone - and finish the last 10 minutes with the patient while the assistant seats the next patient. If she is NOT – then don’t overlap the appointments but schedule one after the other with no breaks. Be sure that the correct amount of time is scheduled for each patient.
  • Since she only performs 1-2 crown preps a day, she can easily fabricate the temp chairside with the new materials that are available now. This will also reduce the amount of time needed for the appointment.
  • Only work out of two treatment rooms, assuming that the appointments are overlapped 10 minutes.  A doctor can only be in one place at a time. She still needs time to check her hygiene patients. Patients don’t like to wait and it is poor customer service as well as stressful for the dentist.
  • If necessary, build in 30 minutes a day of admin time for the assistant to order supplies, conduct equipment maintenance, etc.
  • Seek the assistance of a business team member for seating patients when needed.
  • If overhead is within the normal limits of 19-22% and the reduction of an employee lowers it even more, work with one less employee for more efficiency and pay the remaining team members more.

Three months later and with one assistant now instead of two, each day is more productive and less stressful. The remaining assistant is much more efficient now because she knows everything that is going on with the doctor. There are less openings in the schedule because the schedule is now booked out almost three weeks, and it is much easier to fill cancellations from the “Priority List.” Also, everyone received a nice increase in their hourly wages! Who would have thought that the sad news of losing an assistant would make such a difference in the practice?

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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