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  05.26.05 Issue #168

Oral Hygiene - Managing Supply and Demand

Sally Mckenzie, CEO
The McKenzie Company

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With summer just around the corner, last winters flu vaccine shortage is barely a vague and distant memory. But you can be sure the companies that produce the vaccine haven't forgotten. Each year they face the challenge of anticipating which strain is likely to hit and then developing an adequate supply of the correct vaccine for distribution. Of course, there are any number of variables that can dramatically impact supply and demand of the flu vaccine, such as a contaminated lot that results in a severe shortage inducing mass hysteria and creating increased demand or a mild flu season that leaves supplies sitting in storage destined for disposal.

Although few practices would characterize it as such, dental offices encounter supply and demand challenges of their own, particularly when it comes to oral hygiene days and given their track record at predicting the number of days necessary, many would acknowledge they might have better luck trying to guess which flu bug we'll be battling next winter.

While you won't prompt mass hysteria if you run short on available hygiene days, you will be encouraging the disgruntled patients who are forced to wait to take their dental needs to the practice down the street. And when the number of hours available outpaces the number of patients booked, you have not only a supply and demand concern you have a dollars and cents issue as well. All of which can have the bottom line looking pretty sickly.

Where most practices get into trouble is in their insistence that they schedule to meet perceived rather than actual patient demand. Many dental teams are convinced that they must schedule hygiene six months in advance. Consequently, the days, weeks, and months to come appear to be booked solid.

So it can become quite puzzling - given this huge demand - why hygiene would not be delivering a larger share of practice production. But while the schedule appears packed, no one is accounting for the multiple cancellations and no shows that are filtering through. Nor is anyone paying attention to the dollars that are slipping away during the 10 minutes here and the 20 minutes there between appointments.

So how do you adjust supply to meet actual demand? Fortunately, you have reliable data and information readily available to make predicting the necessary number of hygiene days much easier than health officials appear to have in anticipating next year's virus.

First look at what your hygiene department is producing. It should account for 33% of your total practice production. If the hygienists receive guaranteed salaries regardless of their production, the expectation must be that they produce three times their salaries. To determine how much the hygienist is producing, divide the hygiene salary for the past year by her/his production. If production is falling short, take a careful look at the schedule. The hygienist must be scheduled to produce at 3x her/his daily wage. Achieving that requires you adjust your supply to meet demand and allot the right number of hygiene days - enough to keep patients happy and not having to wait an inordinate amount of time for an appointment, yet not so many that the schedule is riddled with holes and hygiene salaries tip above 33% benchmark.

While you're figuring the percentage that hygiene contributes to your total production, take a look at fee schedules as well. If the hygienist is paid $35 per hour and the cost for the prophy, not including the dentist's exam, is $70, the hygienist is making 50 cents on the dollar. In addition, one-third of hygiene production should be in interceptive periodontal therapy. Require the hygienist to measure the total number of dollars produced through interceptive perio and divide it by their total production. Review hygiene production each month during the team's monthly meeting.

Next week, the five-step formula for supply and demand hygiene scheduling.

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 .

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If You Entered a Leadership Tournament, Would You Make the 'Cut'?

By Nancy Haller, Ph.D.

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The sports world is abuzz with the new...Tiger Woods missed the cut at last week's Byron Nelson Championship, ending the longest streak in PGA Tour history - 142 straight. Woods went seven years without missing a tournament he entered. It's akin to merging the records of Cal Ripken Jr. with Joe DiMaggio. In golf perspective, Ernie Els now has the longest active cut streak on tour - 20!

But what is most remarkable about Woods is his relentless drive for continuous improvement. No matter how good he is, he always keeps working on his game. At the top of his field, he can still be seen hitting buckets of balls until dark - even if he's just won. Such prolonged consistency is the mark of an elite athlete. It's also the foundation of being an effective leader.

What binds leadership competencies and core values together is consistency. Without uniform application, leadership characteristics lose their value. Inconsistency breeds confusion, frustration and anger. And when leaders send inconsistent messages to employees, the result is inconsistent performance.

Consistent leadership is based on a shared system of beliefs and values that are understood by all members of a team. In turn, employees are more committed because controls that are based on internalized values are much more effective than external-controls that rely on explicit rules and regulations. Internalized values provide a clear set of "do's" and "don'ts".

The power of leadership consistency is particularly important when team members encounter unfamiliar situations. Because everyone understands the core principles of the practice, actions are consistent with those values. As a leader, when you emphasize those principles, employees react in predictable ways to unpredictable circumstances.

So how consistent are YOU? Answer the following 10 questions yourself. If you are courageous, ask your staff and compare responses.

  1. Do you change your mind or behavior based on your mood?
  2. Do you play favorites?
  3. Do you do different things in parallel situations?
  4. Do you hold employees to different standards?
  5. Do you shoot for effect?
  6. Do you exaggerate?
  7. Do you push your statements to the extreme to make a point?
  8. Do you overstate negative views?
  9. Do you ‘walk the talk’?
  10. Would others know your values if they listened and watched you?

Even if you only had one 'Yes', you can improve. Every leader has an approach that is unique to them. Don't change your personal style radically. After all, it got you into a leadership position. Modify the rough spots but take care not to confound your staff by displaying inconsistency. The business world is confusing enough without you adding unwelcome surprises into the mix. Keep things simple and consistent.

Communicate positive messages, in your words and in your actions. Whether you realize it or not, your staff watches you. What you do...and what you don't do...send strong messages to your employees about your values. Just as laughing, yawning, and crying are infectious, 'attitude' is infectious. Without saying a word, you can infect the people who see you with the same behavior. When you operate from a useful attitude, such as enthusiasm, curiosity, and humility, your body language sends out unmistakable signals about what you value.

Identify your Achilles Heel and develop daily routines to overcome obstacles. Include some realistic contingencies to reward yourself for taking action. Remember, there is no failure, only learning. Feedback means that you are more likely to be flexible rather than rigid in your dealings with yourself and your staff. Successful people don't cry over spilt milk. The next time you make an error, stop blaming yourself or others. Think about what happened and decide what you will do differently for a better result next time.

Leaders make the difference between mediocre performance and the great performance of a team! Employees don't quit companies, they quit bosses. And winners strive to keep improving. When Tiger Woods' swing is off, he heads to his coach. Call me if you're struggling to make the leadership cut.

Dr. Haller is available to coach you to higher levels of performance in your practice. Contact her at

Interested in having Dr. Haller speak to your dental group? Email us at or call 1-877-777-6151

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Everybody Makes Mistakes

By Susan Gunn

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Mistakes happen. Some can be corrected. Especially in QuickBooksT. With QuickBooksT being the number one recommended software for dental practice accounting, I have seen hundreds of mistakes made in dental practices. Here are just a couple.

Not separating deposits for easier banking account reconciliation.
Because dental practice software manages all the accounts receivables, creating deposits in QuickBooksT is easy. You will enter the deposits into QuickBooksT just as they are entered in to your bank. For bank reconciliation purposes, credit cards deposited separately into your banking account, need to be a separate deposit line item (i.e. Mastercard/VISA, Discover, American Express, etc.). This mistake occurs primarily due to other's manuals and training classes not geared towards professional practices. Both guide users to enter one daily deposit, lumping payments from customers into split lines. Since payments are not received through QuickBooksT but your practice software, follow these suggestions:

  • Create a main income type of "Deposits" and create subaccounts for "Checks & Cash", "M/C & VISA", "Discover", "American Express", and any others.
  • When entering deposits from the practice software's day sheet, enter each of these deposits separately, with the date from the day sheet or the physical deposit date.

Each piece of information should be verified with your daysheet. The MC/VISA total should match the MC/VISA total from the day sheet. The Checks & Cash total on the physical deposit slip should match the Checks & Cash total from the day sheet. Each one of the deposit totals should be verified with the day sheet. This is accountability. For easy reference, staple the physical check deposit slip & credit card terminal summary to the day sheet. This way, if you have any future questions regarding deposits, the information is all together.

Patient Reimbursements are not expenses.
Because your accounts receivable is maintained in your practice software, when you enter income into QuickBooksT, your accounting becomes cash basis. Long after the patient has written a check and it has been deposited, the insurance company often pays more than what was estimated. When writing a reimbursement check, the account chosen under the expenses tab is actually an income account, "Patient Reimbursements", not an expense account. This deducts the patient reimbursement from what was previously entered as income, keeping your true income accurate. After all, you really don't want to pay taxes on income you can't spend, right?

Opening balance to reconcile the bank statement is not correct.
When a bank statement is reconciled, a check mark is placed in each reconciled transaction's entry in the check register. For whatever reason, sometimes those transactions are deleted or unreconciled. There is a QuickBooksT warning that says "Are you sure you want to delete this reconciled transaction?" Or, if voiding, the warning says, "You have changed a transaction that has already cleared." If you delete or void a transaction after these warnings, it will add the amount of the transaction (a previously reconciled amount) to the opening balance for your next reconciliation. If this has happened to you, beginning with QuickBooksT 2004 editions, there is a bank reconciliation discrepency tool. This tool creates a report that will show deleted, voided or changed transactions. The QuickBooks In Your Practice Primer has detailed information regarding using this tool when your opening balance is incorrect.

At a recent ADA Meeting, I was talking with a dentist who confirmed a couple of these common mistakes in her QuickBooksT. After reassuring her she was not alone in these mistakes, I showed her where in the Primer workbook I cover these mistakes in detail. After all, a bigger mistake is to believe you already know everything about QuickBooksT.

If you found problems in your QuickBooksT, don't distress! Everyone makes mistakes, they are a part of learning and are easy to fix in QuickBooksT ! Happy Accounting!

To order Susan's QuickBooksT 2005 In Your Practice Primer.go Here

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Sally's Mail Bag

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Dear Readers,

Last week's article on the ROI for Digital Radiography brought many comments from readers that I would like to share.

At every opportunity I tell my colleagues my own experience (I went digital 2 1/2 years ago when my AT-2000 died, and it was going to cost $2200 to repair it). It was installed 48 hours after I called the sales rep (for PA's) and the Ceph, Pan, TMJ equipment arrived about a week later.

One thing you did not mention in your article, and that is the tremendous diagnostic advantage of digital; first you have instant results and can retake the XR immediately if needed; second, the ability to change contrast and intensity with the move of the mouse provides a thousand times more diagnostic capability than standard film; and of course the size of the image compared to a PA Film. The part of the equation you forgot: the investment in computers/monitors in every operatory. But I have gone completely computerized; no more paper charts, every note is typed into the computer, every XR and Photo included!


I found your email to be very one-sided and simplistic. You left out many considerations including the costs associated with printing digital images, the cost of maintenance policies after the warranty period, the cost of sensor replacement which generally is not fully covered by warranties, the costs associated with disinfection of the sensors and the time associated with both learning and using the software.


Let me add more cost savings to the digital newsletter. Immediate knowledge of retakes needed. So, by the time the doctor sees the x-ray, it's perfect. Procedures that require multiple x-rays (endo) cut visit time by up to 25-30 minutes per endo. Seating an implant or implant impression copying too. I have a list of many more, but the BIG savings is ENORMOUS time savings in appointment length or when things aren't going well, not running late.

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