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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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Should You Invest in Executive Coaching?

Dr. Nancy Haller
Executive Coach
The McKenzie Company

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I am interested in knowing more about coaching. How are coach's fees determined, and what are they per hour? Also, how is success measured and what are the time parameters....specifically when does a coaching relationship end?

Sincerely, JC, DDS

Coaching is much more quantifiable than counseling or therapy. Coaching is oriented to bottom-line results, to increased revenue. That’s easier to measure than whether someone is happier or feeling better work-life satisfaction.

A report on coaching was published recently in Fortune Magazine. Executive and upper level managers who had six to twelve months of coaching were polled. They were asked to give a conservative estimate of the monetary payoff from the coaching they received. The survey demonstrated that the recipients valued the executive coaching at six times the cost paid. Not a bad return on investment (ROI) at all! Sixty percent of the executives in the study were 40-49 years of age. Half the group held positions of vice president or higher. A third earned more than $200,000 per year.

Although this particular study did not include dentists, I think it is safe to make the extrapolation. Most people still think leaders are born not made. This cannot be further from the truth. Most people have the potential to become good leaders. But learning to lead is not like a diet pill. Like most learned skills, it takes time, training and practice.

How does coaching lead to so much value?

  1. A client and his/her coach forge a partnership. This starts with a discussion. Like any relationship, it begins with simple conversation. The coach takes the time to get to know you and to find out more about your interests and concerns. How long have you been in dentistry? Tell me about your practice. What do you enjoy the most about your work…what frustrates you the most?
  2. Although coaching is oriented to achieving business results, the process does not happen in a vacuum. Coaching is built on a relationship and it is sustained on the foundation of that connection. It is important for the coach to get a sense of you as a whole person as well as a dentist. What were those ‘shaping’ experiences that formed the person you are today? Where were you born and raised? Who did you look up to as a child/teen/young adult? Tell me about your greatest accomplishment.
  3. Coaching is built on partnering and fueled by listening. It enables you to chart a course with a clear vision for your team to follow. The process begins with the most important and immediate needs. If you had a ‘magic wand’ how would you use it? What would you change?
  4. One of the key aspects of coaching is to identify your strengths and weaknesses equally so you understand how to operate positively and negatively. In turn, you can leverage your strengths to grow skills and manage weaknesses in strategic career areas. Between coaching sessions, there are assignments. These are mutually agreed upon goals with specific action steps. Meet with front office person to review scheduling procedures. Observe how you treat your staff and how they respond to you.
  5. Coaching provides the structure to help you to motivate staff to excel. The emphasis is placed on learning about the strengths and contributions of everyone who works for you and with you. This includes patients. Converting diagnosis into treatment is crucial. What do each of your employees do well? If I were a new patient, what would I experience during my initial visit? How effective are you at selling services?
  6. Coaching helps you to be resilient, tenacious and to stay accountable. The coach provides support and encouragement because it’s hard to change habits. Dentists also tend to be high achievers who don’t recognize the benefits of small successes. Congratulations on taking the first step! This was hard for you. What will you need to do to continue the momentum?
  7. Coaching generally ends when goals are achieved. The time frame varies but four to six months is a good estimate. In general this involves one-two hours per month. Fees vary but generally are around $200.00 per hour. If you apply the Fortune Magazine survey, the return is $1200.00 per hour spent in coaching!

Although there are people who seem to lead easily and flawlessly, much of what goes into being an effective leader is learned behavior. But for every natural, there are just as many top-notch leaders who got that way by developing their skills. They understand that we all have innate traits that make us good leaders. Coaching can help you to hone your traits to their utmost.

For more information on Executive coaching, e-mail

The Digital Radiographic Explosion

Dr. Allan Monack
Hygiene Clinical Director
The McKenzie Company

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Digital radiography is galloping forward in replacing the traditional dental x-ray systems in dental offices today. Digital radiography in dental offices was introduced in France more than fifteen years ago. The first systems were cumbersome, expensive, and not very reliable. They did not integrate with existing dental software and had to be stored separately on a computer.

There are other digital equipment tools making their way into dental offices. Some of them are digital microscopes, digital cameras, intra-oral cameras, digital translumination, digital periodontal probes, lasers, and caries detectors. Intra-oral cameras were the most popular digital apparatus in the dental office. However, digital radiographic equipment is the fastest growing segment in the dental office today.

Digital radiography is portable, user friendly, and affordable. Last month I discussed the cost of traditional radiography verses digital systems. The most expensive systems replacing existing equipment can be leased and maintained for approximately the same cost as the supplies and maintenance of traditional radiographic equipment in your office now. The systems that allow you to use your existing equipment, such as Dexis® with DEXpan®, will be less expensive over time. This includes leasing, maintenance, and adding or replacing the occasional sensor.

What are some of the advantages that make having digital radiography so exciting in your office?

  1. There are no more chemicals to use.
  2. X-ray film and mounts are not needed.
  3. You can eliminate the darkroom.
  4. It takes much less time to receive a diagnostic image.
  5. Images are easier to share with colleagues and insurance companies.
  6. There is much less patient radiation exposure.
  7. With the ability to magnify, enhance, colorize, and contrast the image, evaluation, treatment planning, and co-diagnosis with the patient is facilitated.
  8. Intra-oral sensors are usually more comfortable than traditional x-ray film.
  9. Less patient chair time is needed to wait for diagnostic quality radiographs to view.
  10. Systems are fully integrated with the dental software utilized in the dental office. You should look for the system that is compatible with almost every major software system.
  11. The ability to communicate and educate your patients is facilitated.

The last advantage is the most important benefit of having a digital radiography system in your office. This ability to communicate and educate your patients cannot be underestimated. The magnified and enhanced views available allow the doctor and staff to share information with the patient that was not easily seen by the patient on the small traditional x-rays.

Like almost every other system in the dental office it takes time to maximize the effectiveness of any new equipment. For instance, there are still dental offices that only use their dental software for production and accounts receivable. They still use a paper appointment book, do not use electronic claim submission, or track their patients continuing care. In order to get the most out of your digital x-ray system, understand all the features of this equipment. Make sure you have purchased a system that is fully supported with staff training and technical support.

The patients can understand the benefits to themselves only if you inform them about what digital radiographs have to offer. At the first visit the patient is introduced to digital radiographs, take the opportunity to explain about the benefits of digital radiography. Show them the enhanced features that help in evaluating their mouth. Point out normal and problem areas. Explain how the problems can be corrected. It is amazing how the patient responds to this simple method of communicating their needs. You will see a greater treatment acceptance and a greater appreciation of your diagnostic skills.

Make The Right Hiring Decision

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  • Salary and benefit requirements
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  • Provides space for applicants personal insight regarding career obstacles and best and least enjoyed duties.


Missed Past Issues of Our e-Management Newsletter?

Sally's Mail Bag

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Dear Sally,

My front office employee is struggling when patients need to schedule another appointment before they leave but don’t and tell her they will have to call her later to make the appointment. She had asked me what to say and I just don’t know how to advise her. Any suggestions?

Dr. Baton Rouge

Dear Dr.,

I would not insist or demand that the patient schedule an appointment before leaving the office. However, the patient’s required treatment, no matter how small, should be entered in the computer as a treatment plan and follow up done from that information. If you insist on scheduling an appointment, the message you send to the patient is you don’t trust them. If she says, “Well let’s just go ahead an make you an appointment and you can call if it’s not okay when you get home,” it says that the patient doesn’t have to be committed to the appointment time, it’s okay to change appointments. It’s okay to say, “That’s fine, you can call me later,” but you need to take responsibility to follow up with them.

Hope this helps.


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The McKenzie Company Upcoming Events
Date Location Sponsor Speaker
Mar. 14 Santa Rosa, CA Redwood Empire Dental Society Sally McKenzie
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