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  03.10.05 Issue #157


More Staff Doesn’t Mean More Productivity

Sally Mckenzie, CEO
The McKenzie Company

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Uh-oh. Take a look at the clock, doctor. Have you kept your team working into their lunch hour … again? Have you squeezed an extra 15-20 minutes out of them at the end of the day, … again? Have you and your assistant spent the last several hours tearing between treatment rooms. Have you been cornered by your business team for the third time this week threatening to punch the delete key on all your patient records unless they can hire a “helper?

Does “busyness” have you feeling stressed out day after day after day? It is an uncompromising master that consistently makes demands and gives little in return. Many teams perceive they’re so busy, in fact, that they don’t have time to address the growing insurance claim backlog. Someone else should be brought in to help with that tedious duty. They don’t have time to “waste” reminding patients of their appointments. A lowly underling should be hired to take care of this unseemly chore. They don’t have time to scrub those dirty instruments; the hygienist can do that with all her free time from those no-shows and cancels.

And, who are you to question, doctor? You see the team rushing through the day, beads of sweat on their brows. Cans of power shakes line the fridge ready to be called into service for the daily ten-minute lunch break. All indicators are that you need to add staff. Just one question, however, before you place that classified ad or tell Wanda she can start training her niece on the computer system next week. Have you considered how this will impact your overhead?

How much will that “helper” hurt your budget? Look at wages paid in your practice including the hygienist’s but excluding the doctor’s. They should be no more than 19% to 22% of gross income, except payroll taxes and benefits. If the current gross salary expense is around 22%, adding another person will increase gross wages to 27%. Are you willing to take a 5% pay cut, doctor? Before the thought of such a drastic notion causes you to nix the idea entirely, consider that the person you hire just might - and I emphasize might - be a worthwhile investment that will ultimately boost production numbers.

For example, if the new hire is a patient coordinator who will increase practice revenues by making sure appointments aren’t lost or if the individual is a hygienist who will enable your practice to meet the demands of a growing hygiene schedule – provided it’s not riddled with no-shows and cancellations, the negative financial impact should only last for about 60 days. Beyond that, production should increase, and the wage percentage of gross income should return to the 19%-22% range. If it doesn’t, you have hired the wrong person or filled the wrong position.

Often, however, teams feel they are stretched beyond capacity because systems – or lack thereof – are inefficient causing them to put forth double the effort for half the return. It’s the old are you working harder or working smarter? So just exactly how do you objectively determine if you need more staff? Work your way from “front” to “back."

According to ancient dental practice mythology, you need a front desk person for every $30,000-$40,000 worth of production each month. If you believe that, I hope you also are tight with that Greek god, Poseidon, because you’ll be drowning in a sea of red ink soon. One of the best indicators of the need for additional front desk help is not the dollar water mark, it’s the amount of time spent with patients.

Check in and check out takes approximately 10 minutes per patient. There are 480 minutes in an eight-hour workday. If your practice is seeing 15-22 patients per day, which would total 150-220 minutes of patient contact, one person should be able to handle front desk duties.

If the doctor has 14 or more scheduled patients a day, not including hygiene exams, he/she needs a second assistant. However, if the procedures are streamlined, one assistant can efficiently maintain two treatment rooms for a general dentist using two operatories and seeing 13 or fewer patients a day.

Patient dismissal should take two minutes, while disinfection of treatment rooms and cleaning/sterilization of instruments should take less than five minutes. Moreover, if your state allows for expanded functions for assistants start maximizing those resources.

Next week, is this a staffing issue or a productivity concern?

If you have any questions or comments, please email Sally McKenzie at

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