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  Sally McKenzie's
 Weekly Management e-Motivator
  8.06.04 Issue #126

Increase Fees, Enhance Care

Sally Mckenzie, CEO
McKenzie Management

       If you sat down and thought about the last time you raised your fees, could you actually remember that far back? Too many dentists are reluctant to adjust their fees. They box themselves into providing discount dentistry year after year. Consequently, the practice is idling. The doctor and team are burning energy and getting no where. Worse yet, it’s not just the practice that is suffering. Read on.

Fees are a statement of the quality of the work provided. What message does it send patients

when the charges for service never change? More importantly, what message does it send patients when the old equipment is never updated; when that dinosaur of a computer system continues to limp along; when new diagnostic technologies and services aren’t offered year after year? Doctors agonize over how patients might respond to fee increases, but they give little or no thought to what they are denying patients in the way of enhanced and expanded services. Ultimately, practices that do not increase fees on a regular schedule are compromising both the practice and the patients.

As a matter of routine, fees should be increased 5% annually or 2% and 3% twice a year. If you’re finding yourself quaking at the mere mention of any increase, it’s time for a shift in your fee paradigm: Fee increases ultimately benefit the patient. As revenue increases there is far more opportunity to expand and enhance services, to improve equipment, to implement diagnostic technologies. When financial pressures are reduced the team is more cohesive, therefore there is less staff turnover. And, most importantly, the doctor’s stress is reduced significantly.

Consider what you would like to do to improve patient care if you only had the money, then take these 10 steps to establish a fair and reasonable fee structure:

  1. Increase income even before you increase fees. Overlap patients during the first and last 10 minutes of each appointment.
  2. Evaluate the time required for each procedure, the fixed expenses necessary to run the office, variable expenses including supplies and lab fees, income required per hour to compensate you, the dentist.
  3. Look at where your expenses are as compared to where they should be. Examine gross income and establish a goal to rein in expenses so they line up according to the following benchmarks: Laboratory expenses – 10%, dental supplies – 7%, Rent 5%, Employees’ salaries – 19-22%, payroll taxes and benefits – 3-5%.
  4. Consider how much you would like to work per week and how much you want to earn per year. Determine the number of days per week you will see patients and the number of hours you will spend on treatment. If your annual production goal is $350,000, you work 48 weeks a year, 36 hours per week, your hourly production goal is $203.
  5. Establish a solid fee for each service and no waffling. The receptionist’s second cousin Bob does not get a break based on bloodline!
  6. Know your neighbors. Study the fees of other dentists in your area as well as the income demographics of your patients.
  7. Base your fees on the quality of your work and the overall quality of your team, which may be far different than the skills and quality of the practice down the street.
  8. Adjust your fees on a consistent schedule
  9. Provide payment options. Establish a relationship with a patient financing company, such as CareCredit™.
  10. Don’t Panic. When Mrs. Cartwright calls you up and chews you out because you had the audacity to actually adjust your fees. She probably doesn’t pay her bills on time, and if she is representative of the very few who will actually leave your practice, you just might consider that a welcome departure.

Finally, use a little fee psychology. Consumers/patients are more accepting of fees that end with the following: $1, $2, $3, $4, $6, $7, and $8. Remember, improve your practice’s financial health and you improve care for your patients.

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

Interested in having Sally speak to your dental society or study club?
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"Please Don’t Give Your Valuable Services Away”

Belle M. DuCharme
RDA, CDPMA, Director
The Center for
Dental Career Development

         As the Director of Training for The Center for Dental Career Development here in beautiful La Jolla, California, it has been my pleasure to have had as students some of the best people I have ever met in my life. The Center offers an advanced Business Administrator Course, Treatment Coordinator Course, and Scheduling and Financial Coordinator Courses but of all the courses we offer, my favorite is the Practice Start-up Course. This is an empowering course for the new dentist about to open the doors for the first time or the transitional dentist going solo from a partnership or associate relationship. I

act as a guide through rough waters. As a mentor who has worked in the dental environment for the last thirty-four years my sole purpose is setting the foundation for a successful and fun practice.

Before joining me for the Start-Up Program I ask that the doctor bring a list of items with him or her for the training. One of the items I ask the doctor to bring is a vision of the future practice. This vision must be in line with the demographics of the neighborhood where the practice will be located. If the practice is in a middle to low income area perhaps the vision of full mouth Empress crowns on the schedule routinely may be an unrealistic expectation. A demographic survey showing the average age of the populace, the average income, location of schools, businesses, retirement communities, housing tracts and projected growth of the community will be helpful in determining marketing strategies for the type of dentistry desired in the area. What kind of an “image” do you want to create for yourself? This is often referred to as “your niche.” In other words, how will you set yourself apart from all of the other dentists in the area? Bringing in samples of your advertising, brochures, welcome letters, business cards, signs and logo for examination is recommended. If the dentist hasn’t designed these items yet then we can “brainstorm” together.

Recently, I had the pleasure of training a very bright and enthusiastic dentist and her office administrator. One of her ideas for attracting new patients was to offer free initial examinations. She wanted to print this offer on her brochures. I advised against it and explained my reasons. Never give away a specific service, especially examinations. You devalue the service and give the impression that it should be “free” anyway. The initial exam and any examination to follow is the key procedure to solidifying a patient to your practice. The examination is where you use the skills that you have honed as a diagnostician. The examination is where you define who you are both as a professional service provider and as a caring person. If you must offer a get acquainted incentive, then offer a one time voucher for $50.00 off of any service. Never print this offer on a permanent piece such as a brochure or welcome letter. Print it as a voucher so that you can discontinue it latter without having to reprint thousands of brochures or letters.

In the Practice Start-up Program, we cover a tremendous amount of material including complete business systems training backed by books, workbooks and CDs covering all of the systems in detail.

For more information please call THE CENTER FOR DENTAL CAREER DEVELOPMENT at 877-777-6151.

Belle M. DuCharme, RDA, CDPMA


Does Fluoride Benefit Adults?

Dr. Allan Monack
Hygiene Clinical Director
McKenzie Management

        Now that we are living longer how can we protect our teeth for a lifetime? The beneficial effects of fluoride were noted in the early 1700’s. However it had a major side effect of mottling and discoloration. In 1936, Lt. Trently Dean, D.D.S. of the U.S. Public Health Service, discovered that 1.0 ppm in drinking water could give the maximum protection in reducing the incidence of tooth decay without the side effects. The first community water supply that was

artificially fluoridated began in Grand Rapids, Michigan in 1945.


  1. It reduces the solubility of enamel in the presence of acid.
  2. It exerts an effect on bacterial plaque by reducing their ability to produce acid.
  3. It promotes remineralization of tooth enamel.


When fluoride is ingested throughout life it is incorporated in enamel and dentin as it is formed. In communities that do not have fluoridation, the population relies on fluoride tablets during tooth development. Unfortunately, fluoride daily intake is usually discontinued by age 10. This is the age pediatricians and dentists feel the crowns of the 2nd molars have formed. The roots do not get adequate fluoride incorporated in the dentin matrix. There is a constant ebb and flow between demineralization and remineralization of exposed teeth. Fluoride improves the remineralization and prevents the loss of tooth structure from the effects of the acid produced by the bacterial plaque.


Applying topical fluoride directly to the erupted teeth allows the penetration of fluoride into the enamel and exposed dentin. It provides localized protection of teeth not treated with ingested fluoride and replaces fluoride leaching out of the tooth surface. Topical fluorides include toothpastes, mouth rinses, and professionally applied fluoride solutions and gels.


A 1998 study by the U.S. Department of Health and Human Services has shown a dramatic increase in tooth loss among adults age 35-44. The study shows that 78% of adults 35-44 have at least one tooth lost because of tooth decay. 84.7% over the age of 18 have at least one area of tooth decay per year. Data from the 1988-1991 National Health and Nutrition Examination Survey showed that 6.9% of 18-24 adults and 56% of all adults over the age of 75 have root decay. As we age, there is a decreased salivary flow, exposed root surfaces, and poorer home care. This greatly increases our risk for root decay. There is data that shows individuals who have consumed fluoridated water continuously from birth have a 31% reduction in tooth compared to adults with no exposure to water fluoridation.


Adults should have fluoride treatments! The dental profession should lobby the insurance industry to include fluoride treatments for adults in their preventive benefits. You should encourage your adult patients to have fluoride treatments at their recall appointment. As our adult population continues to live longer active lives, we need to help them maintain their teeth for a lifetime.

If you have any questions concerning your hygiene program submit them to me at allan@ and I will answer them in future articles.

Interested in having Dr. Allan Monack speak to your dental society or study club? Click here

McKenzie Management’s Hygiene Clinical Practice Enrichment Program is designed to improve Hygiene Clinical Skills and develop and implement a step-by-step Interceptive Periodontal Therapy Program that will immediately bring greater productivity, with enhanced patient care. For more information...GO HERE




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Sally's Mail Bag

I’d like some advice on scheduling new patients to bring up at my monthly meeting. Can you help?
Dr. Colorado

Dear Dr. Colorado,
Never underestimate the expectations of prospective new patients. From the first phone call a new patient makes to a practice, they are sizing up the professionalism of the doctor and the staff. Consciously or subconsciously, they are determining whether this practice deserves their ongoing business. Patients expect to be treated with respect and professionalism. They expect their concerns and needs to be addressed expeditiously. And they expect doctor and staff to have their acts together. Like it or not, the quality of the doctor is judged by the quality of his or her staff.

Manage the new patient’s expectations through excellent phone communication and even better written information. Make sure that the first point of contact a patient has with your office –the phone call- is not their last. Develop a script for the scheduling coordinator to use when handling a new patient phone call. Her voice should convey warmth, understanding, and good judgment. She should come across as unhurried and cheerful. Patients calling the office for the first time will be either discouraged or encouraged to make an appointment, depending on how well the call is handled. If the receptionist answers the phone with a curt, hurried, or exasperated tone, the caller is immediately put off. If the receptionist is sincere and empathetic, the caller responds accordingly.
New patients are calling because they want your services now, not next month. Be prepared to handle the demand. First, determine how much time you need to allocate in the schedule to accommodate new patients. Look at new patient activity over the last six months. If you saw 60 new patients, that would be 10 per month and 2.5 per week. Reserve at least that much time in your schedule to handle immediate new patient demand. Second, monitor new patient activity each week while you are marketing externally. If demand increases, block additional new patient time in your schedule, even if it means extending hours for a period. Third, new patient slots should be reserved during prime time. Those are the hours in which your practice experiences the greatest demand for appointments, and, typically, they are in the late afternoons, evenings, and on Saturdays.
Good luck,

Office Managers
Financial Coordinators
Scheduling Coordinators
Treatment Coordinators
Hygiene Coordinators

For a FREE
Educational Video
e-mail us at:
The Center for Dental Career Development
Advanced Business Education for Dental Professionals
737 Pearl Street, Suite 201
La Jolla, CA 92037

This issue is sponsored
in part by:
The Center for Dental Career Development
San Diego Workshop Series
Summer Schedule
 Date Seminar Instructor(s)  
 August 27
 9:00 - 4:00
How to Become an EXCEPTIONAL Front Office Dental Employee Belle DuCharme, RDA, CDPMA  

The Center for Dental Career Development has been approved under the Academy of General Dentistry, Program Approval for Continuing Education (PACE). Starting 10/19/03 through 10/18/07 members of the Academy of General Dentistry can receive AGD credits for all seminars and workshops sponsored by the Center for Dental Career Development.

Please visit to view a list of upcoming seminars and workshops.

To Register 877-877-6151 or
McKenzie Management Upcoming Events
Date Location Sponsor Speaker
Aug 7 San Diego, CA Dental Manufacturers Association Sally McKenzie
Sep 10-12 San Francisco, CA California Dental Association Exhibiting
Sep 30 - Oct 3 Orlando, FL American Dental Association Exhibiting
Oct 8-9 Hackensack, NY Endo Magic Root Camp Sally McKenzie
Oct 22 San Antonio, TX American Orthodontics Society Sally McKenzie

For more information, email
or call 1-877-777-6151

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