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1.25.08 Issue #307 Forward This Newsletter To A Colleague

Look Before You Hire the Associate—2 Rules to Follow
by Sally McKenzie CEO
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Busy: It’s the number one motivator for many dentists. “I’m too busy. I have more patients than I can handle. I’m tired of working this hard. I have plenty of patient records on file to support another dentist. That’s it, I’m hiring an associate.” Now we’ve talked about illusions on many occasions and certainly “busyness” is among the more convincing of practice fantasies.

Doctors will be the first to throw more people at a problem if they think it will help them control the whirling dervish of perpetual activity. Crazy days and a slew of practice records lining the files and they have all the proof they need that this associate idea is a good one. Unfortunately, oodles of patient records don’t translate into oodles of living, breathing, “active” patients. Without enough active patients in the practice, the chances of the doctor building a successful partnership with an associate are somewhere between none and zero.

Rule #1 before hiring an associate: Measure the number of truly “active” patients. Start with key computer reports, including the past due recall report, the missed appointments report, and the unscheduled treatment report.

  1. Generate a report of patients due for recall from today’s date to one year from today. Indicate that you are seeking to identify all patients with and without appointments on the report. 
  2. Count the number of charts in the file and divide that by the number of patients on the recall system. For example, if there are 4,759 patient records on file and 1,737 patients in the recall system. Patient retention would be at 36%.
  3. Now subtract the number of active patients from the number of total patient records in the files. Using the example above that number would be 3,022.
  4. Divide that number by the number of months the charts represent. For example, if you believe that active charts represent the period from 11/04 through 2/08 that would be 39 months.  In this scenario, the practice is losing 78 patients per month.

Obviously the patient base is shrinking. Now what? Don’t hire a full-time associate for starters.  It is time to kick in a patient retention program and implement Rule #2.

Rule # 2 before hiring an associate: Look carefully at clinical efficiencies. Is the “busyness” issue a symptom of the need for better systems or more people? When it comes to clinical efficiency it can never be compromised, but it can almost always be enhanced. For example, how much time is added to a procedure when an assistant doesn’t anticipate what instrument the doctor needs next? How much time is wasted when the doctor has to repeatedly adjust the light? How much time is lost when the assistant can’t see clearly into the patient’s mouth? How much does it cost the practice when the assistant is not given the responsibilities she is legally allowed to carry out? How much does it cost the practice when the doctor is performing procedures or explaining matters to patients that the assistant or other staff members should be handling?

Dentists are legendary perfectionists. It’s both a great strength as well as a major weakness but if you feel you are run ragged day after day, take a close look at the tasks you are performing that should be the responsibility of other team members. Delegate every procedure, patient interaction, and staff matter legally allowable in your state. For example, most states allow dental assistants to remove a temporary crown, clean the tooth and try the permanent crown. However, often the dentist is performing these procedures, which is clinically inefficient. Sealants provide an even clearer example of a procedure that should be delegated completely to the hygienist.

Improving clinical efficiency never involves compromising care. Rather the focus is on improving delivery of that care as well as fully maximizing each hour of doctor and staff time.

Ultimately, you may come to the conclusion that it is time for an associate in your practice. If you’ve stepped back and carefully analyzed key practice systems, you can move forward with confidence knowing that you’ve confirmed in black and white that you have enough “active” patients to support the new hire, enough new patients coming in to keep the practice thriving, clinical efficiency, and practice management efficiency to ensure that your new partnership is the most successful of your career.

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