Visit our web-site at
  02.17.05 Issue #154


How Much Will That Raise Really Cost? You'd Be Surprised!

Sally Mckenzie, CEO
The McKenzie Company

Print this article

So, you're feeling the pressure again. It's time for you to give another raise to your long-term employee. "What's another buck-fifty an hour? Right?" She's a loyal, hardworking staff member. That may well be the case, and you may feel that you want to give the raise but is $1.50 too much or fifty cents not enough? Before you let those highly impulsive altruistic tendencies of yours take total control, take a deep breath instead and 10 minutes to conduct a Salary Review.

Here's why: every increase in salary, no matter how seemingly small and insignificant has a direct impact on your overhead. The Salary Review is a clear and simple mathematical tool that you can access immediately to determine exactly how much more money you'll need to collect each month to cover that "itty bitty" increase.

To ensure that salaries do not exceed 20% of monthly collections, tipping your overhead costs into the danger zone, you must have a plan to increase revenues to balance the impact of the raise. If the team wants to make more money, the practice must make more money, and every employee plays a vital role in accomplishing that.

If giving a raise is going to take your healthy payroll overhead of 20% beyond the limit, then just think what Carol's, Tina's, Becky's, and Tonya's will do. The practice is going to need to have a NEW plan to present, gain acceptance, treat and collect on more services.

Have you developed new strategies to boost hygiene production and treatment acceptance? What steps will you take to increase collections? Is rent going down anytime soon? What about equipment repairs? Don't fool yourself into thinking that any raise is so small its impact won't be felt. Soon this little raise here and that minor increase there will come ripping through your profits, and I guarantee you'll be stunned at the thundering impact.

First, take a look at collections. Make one employee accountable for collecting money, generating accounts receivable reports, and following up on delinquent accounts. Your financial coordinator should achieve daily collections of 45% or higher if you are accepting insurance assignment and 100% if you are insurance free. If you don't already have one, establish a collection policy and follow it. Expect full payment at the time of service for all procedures. Also consider extending credit to patients who can't afford to pay now. Partner with a patient financing company, such as CareCredit.

Reinforce the recall system which in turn reinforces new patient referrals. Delegate responsibility for the recall system to the patient coordinator, and expect:

  • A specific number of patient phone calls each day in a specific amount of time.
  • A specific number of appointments to be scheduled.
  • A specific number of patients to complete treatment.
  • A schedule that ensures the hygienist achieves a specific daily or monthly financial goal - at 3x his or her daily wages.
  • Unscheduled time units in the hygiene schedule to not exceed 0.5.

Consider your fees. Increase fees 3-5% each year and expect a minimum of 5 outgoing treatment plan retrieval calls every day.

If you feel strongly that you want to raise employee compensation, by all means do so, but conduct a Salary Review so you know exactly how much it will take to cover the additional expense and have a plan to offset the increase.

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

Interested in having Sally speak to your dental society or study club? Click here.

Our Patients ARE Our Practice

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

"From the reception room I could hear my current dentist, whom we'll call "Dr. X," alternately coaching and chastising his new assistant. I found this amusing from a distance and felt a mixture of sympathy for the assistant and mild annoyance at my extended wait. When it was finally my turn, I climbed into the chair, offered polite greetings and tried to relax. The assistant had a great deal of trouble adequately pulling my lip away from my teeth and simultaneously operating the two-button air and water line. As Dr. X rapidly fired admonishments her way, his consternation growing, my face and mouth were moved in unnatural ways, as though I had the pliability of Gumby. Any remaining shred of comfort I had disappeared as Dr. X barked, "You almost jammed it down her throat. That wouldn't be good."

This is an excerpt from "A Dental Visit Filled with Anxiety" by Debbie Hall, a licensed psychologist for the San Diego Union-Tribune newspaper. It was disheartening for me to read this article. As a dental educator whose goal is to teach systems that bring professionalism and harmony to the dental team promoting patient acceptance and retention, an article such as this certainly causes us to lose ground in those areas.

Initial training of clinical staff should never be done at the chair on unsuspecting patients. Communication between doctor and staff should be coded or quietly conveyed so as not to upset patients in the treatment or reception rooms.

The following is a list of PATIENTS' RIGHTS:

  1. To be treated with consideration and respect in regards to their dental needs.
  2. To be provided with informed consent and information regarding their dental treatment, materials and appointment time obligation.
  3. To be provided with fees that are reasonable and fair in writing for approval.
  4. To be provided reasonable access to appointment times relating to the nature of their dental care.
  5. To be provided with a thorough evaluation of their oral health needs in terms that they can understand.
  6. To be provided with the security that their private health information is not shared with anyone other than those with a "need to know."
  7. To be treated by all members of the team with respect and courtesy.
  8. To be informed of any changes in their treatment plan before the treatment is completed and be informed of any change in fees.
  9. To be given appropriate referrals to specialists in a timely manner.
  10. To be given the opportunity to seek a second opinion.
  11. To receive instructions on effective home oral health care to prevent disease or further decline of dental health.
  12. To be treated as a partner in dental care and have a choice in determining the course of treatment.
  13. To be informed of the doctor's participation in third party payment.

As dental professionals we must remember that dentistry is a service organization.

After reading Ms. Hall's newspaper article, I was left asking, "Where was the Front Office Business Administrator?" Her job was to inform the doctor that he could be heard in the reception area. Her job was to inform the doctor that the schedule was now behind because of the training session with the new assistant. Her job was to inform the patient waiting in the reception room of the delay and offer some comfort or an opportunity to reschedule. Perhaps, she too was a trainee.

For information regarding Dental Business Training for your staff, please contact:

Good Doctor, Bad Doctor: Perception vs. Reality

From the Patient’s Perspective
Positive, negative, caring, neglectful, sympathetic, unfeeling, respectful, disrespectful, which of those adjectives would your patients use to describe their most recent interactions with you and your practice? You might be surprised to learn that the patient's perspective of an exchange and your perspective of that same communication may be quite different. As is often said, perception is reality, and frequently it's not what is said but how it is said. Consider these scenarios in which the patient's and the doctor's perceptions may be quite different.

The doctor is running late because of two emergencies. He assumes the receptionist will explain things to the other patients. After all, from the doctor's perspective, it's the receptionist's job to handle communication with patients as they check in.

The receptionist tells the patients that the doctor is running late. Understandably, the patients are annoyed. From their perspective they are wondering why they weren't called in advance and told that the doctor was behind so that they could adjust their schedules or reappoint. The patients perceive the doctor is disrespectful of their time. Meanwhile, the doctor is focused on the emergency cases he is dealing with and doesn't consider how the information that is delivered by the receptionist will be perceived by those patients that are left waiting.

Take the same scenario and change the doctor's approach. He walks into the waiting room and personally explains that two unexpected emergencies have arisen. Although, the receptionist attempted to contact the patients, they were already en route. The doctor hands each patient a coupon for a specialty drink at the coffee shop down the street and offers a sincere apology for the inconvenience. He tells the patients that they will be seen within a specific time frame and if they cannot wait they are welcome to reschedule. The exchange takes just a few minutes, but the impact is significant. The patients feel valued, and they appreciate the doctor's effort to speak to them personally about the situation.

Perception also is often influenced by vague, interpersonal nuances - the cock of an eyebrow or the inflection of the voice. For example, in the following scenario, the patient has what the doctor considers to be a ridiculous concern over radiographs. The patient informs the doctor that she has been reading information on the Internet about the dangers of radiation and the potential for cancer. The doctor, thinking her dismissal of the concern will put the patient at ease, rolls her eyes, chuckles, and comments about all the misinformation that's just a click away on the computer. "My staff and I work with radiographs all day. If there were any danger, we wouldn't use them." The patient bristles at what she considers a flippant remark and feels her concerns have been summarily dismissed. Of course that wasn't what the doctor intended, but that is how the patient perceived the communication.

Change the approach to one in which the doctor displays empathy and uses the opportunity to educate the patient. This time the doctor looks the patient in the eye and says, "Mrs. Jones, I appreciate your sharing your concern with me. I want you to know that we take every precaution to reduce the patient's exposure during X-rays. In fact, the modern digital X-ray equipment that we use is programmed to minimize the amount of radiation emitted. As an added precaution, we cover every patient with a lead apron. We also use positioners to take more accurate radiographs, and all of our dental assistants are certified in radiography. You might be interested to know that scientific studies have revealed that if you received 18 dental X-rays you would be exposed to 800 times less radiation than you would from a single chest X-ray.

"What's more, X-rays are vital in our ability to properly diagnose dental problems and determine the appropriate course of treatment. An X-ray examination may reveal small areas of decay between the teeth, infections in the bone, abscesses or cysts, and other potential problems. May I suggest that if you would like further information on X-rays you visit the American Dental Association's website at" The doctor has respectfully addressed the patient's concern with empathy and factual information. In addition, she has directed the patient to a credible resource.

Demonstrate in each interaction that you understand your patient's situation and feelings by showing empathy and respect and you'll steer clear of what can become the great divide between perception and reality.

Will Giving Raises Take Your Payroll Beyond 22% Of Revenues?

Employee Salary Review

This form will help you to mathematically determine how much of a raise your practice can afford while keeping your total salary overhead in line with the industry. Instead of making an emotional decision, make an informed decision of how much the practice has to collect in order to give a raise.


Missed Past Issues of Our e-Management Newsletter?

Sally's Mail Bag

Dear Sally,

I'm struggling with how to take a new patient in the front door and back out in an efficient way.  We give office tours, see hygiene for X-rays and I come in and do the exam. When it's a simple Tx plan, there is no problem. When it's involved, then we get behind.  We seem to rush through and Tx doesn't get accepted. Would a consultation room help?  I'm looking for the proper way to handle a new patient for the best treatment plan acceptance.


Dear Townie,

Yes, a consultation room would help but I would like for you to review new patients that came to you in the past 60 days and find out how many have not followed through with treatment. If you find more than five, then I would recommend you consider your approach rather than the flow. We see this many times in our consulting work patients wanting their teeth cleaned and checked and dentists hit them on the first visit with a large treatment plan. They didn't think anything was wrong, they just met you and you have not allowed any time for building trust and rapport. My suggestion would be to try and find something small, ideally cosmetic and not a high fee on the next visit and at that time go over the recommended treatment. So in other words, it is done at the second appointment and not the first. This can be done chairside while waiting for anesthetic if you are the one presenting treatment. If you implement a treatment coordinator, the consultation room is the place.

Hope this helps.


Want to Know More About McKenzie Management?

This issue is sponsored
in part by:
The McKenzie Company Upcoming Events
Date Location Sponsor Speaker
Feb. 22 Chicago, IL Bisco International Sally McKenzie
Feb. 24-27 Chicago, IL Chicago Mid-Winter Meeting Sally McKenzie & Exhibit
Mar. 3 Rochester, NY Monroe County Dental Society Sally McKenzie
Mar. 10 La Jolla, CA Southern CA Orthodontic Symposium Sally McKenzie & Exhibit
Mar. 14 Santa Rosa, CA Redwood Empire Dental Society Sally McKenzie
Mar. 17-19 Atlanta, GA Hinman Dental Society Sally McKenzie & Exhibit

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

The McKenzie Company Newsletter Information:
To unsubscribe:
To discontinue receiving the Sally McKenzie eManagment newsletter,
click on the link at the very bottom of this page for instant removal,
or simply click Reply to this email with the word "Remove" as the only word in the subject line.
To report technical problems with this newsletter or to request technical help,
please send a descriptive email to:
To request services, products or general inquires about The McKenzie Company activities
please send a descriptive email to:
If you would like to have any of your dental practice concerns answered personally by Sally McKenzie,
please send a descriptive email to her at:
Copyrights 1980-Present The McKenzie Company - All Rights Reserved.