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07.08.05 Issue #174
Collection Phobia Still Scaring Profits

Sally McKenzie, CEO
The McKenzie Company

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Dangling hundreds of feet above the ground, suspended in the air by wires, cables, and a small seat board, window washers in major cities go about their business day-after-day. They are the urban mountaineers of sorts, scaling and rappelling up and down these glass and steel structures to ensure that the view from the other side of the pane is free of city soot and grime. While I'm not sure what the specific criteria are for becoming a window washer, I suspect that a fear of heights would be one of those insurmountable obstacles to landing a job in the profession. It's pretty obvious that skyscraper window washing is not an occupation for just anyone.

Although few dentists give it much thought, the same is true for the individual responsible for collections in your practice. It's not a job for just any warm body. Certainly this person isn't dangling from the rooftop, but a slip here and there can make a serious mess of your practice finances. And having someone who is afraid to ask for money in charge of your collections is like having a window washer who suffers from acrophobia. It simply doesn't work.

Not only do practices routinely hire or assign someone poorly suited for the job of collecting payment, they frequently provide zero training . In fact, 99.9% of all employees who work at the front desk have not had one day of professional training. Yet these individuals have the practice's financial health hanging in the balance while they teeter between too timid to ask for payment and too flexible to insist that patients follow practice financial policies.

Although we've seen marked improvements in practice collections over the past 20 years, this is largely the result of patients becoming much more comfortable using various payment options that are available to them including credit cards and patient financing programs, such as CareCredit. Nonetheless, skyrocketing accounts receivables are leaving many practices poised to take a serious financial spill.

The majority of those responsible for ensuring the fiscal health of the practice are very feeling in their temperament type. In other words, they are those warm, fuzzy individuals who really want to be liked by everyone. There is nothing wrong with this temperament type; in fact, they tend to be very good with patients. However, asking for payment or handling a patient who balks at the office financial policies can be extremely challenging - if not impossible - for these employees. Without proper training in effective collections, the employee just agrees to whatever terms the patient offers. "How about $10 a month?" says Mrs. Smith whose about to start a $1200 treatment plan. "Uh, sure. No problem," says no-collection-training Carol.

In other cases, financial policies are simply non-existent because the doctor fears that patients will be offended by payment requirements . In still others, the doctor performs treatment without any regard for whether the patient can pay, leaving the collection "problem" for the front desk to handle.

Stop allowing your financial health to dangle without a safety net. Start with a basic collection expectation. For example, your accounts receivables should be no more than one month of what the practice produces. In other words, if production is $80,000 per month, there should be no more than $80,000 owed to the practice. You should also see a 98% collection ratio every month - that's 98 cents on every dollar. In some situations, the collection ratio needs to be higher, particularly in offices whose percentage of accounts receivable over 90 days past due is more than 12% of total accounts receivable .

If the office is collecting assignment of benefits from insurance companies, the front desk should be collecting from patients 45% of the monies that were produced that day. If the dentist is not accepting assignment of benefits then the dentist should expect the front desk to be collecting in the high 90's over the counter because it is considered a cash practice.

Next week, five expectations to financial freedom.

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

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If You're Mad as Hell, Don't Take it Anymore: Turning Anger into Constructive Action

Dr. Nancy Haller
Executive Coach
McKenzie Management

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Do you remember the 1976 movie Network ? The story centers on actress Faye Dunaway who plays a ratings-hungry programming executive who is willing to do anything for better numbers. Peter Finch plays a character named Howard Beale, a 'mad prophet' of the airwaves. You might recall the classic scene in which he's dressed in a soaking-wet raincoat, hair plastered to his forehead, shouting, "I'm mad as hell and I'm not going to take this anymore." Even if you didn't see the film, the phrase has become a part of our cultural language.

In my coaching work, I hear a lot of anger.

"I went to school to be a dentist. I don't want to lead people!"

I enjoy coaching people who are angry. I know that they're in a position to really improve their life. You see, anger is the most energizing emotion a human being can experience . Intense, focused, and determined, angry people are poised to take action. The problem is that many people act impulsively rather than mindfully - the action taken to fix the problem makes it worse, and then there's a real crisis.

If the problem isn't a fire, flood or earthquake, if there is no imminent life-and-death danger, there is no need to take immediate action.

Face facts.if you're fed up with employees, you have two choices.

  1. Terminate your staff, albeit legally, and work alone. Keep in mind that the reality of a one-man-band dentist just doesn't exist.
  2. Turn your anger into constructive action steps to resolve the problem. Train your employees to do what you ask of them.

If you choose the second option, you'll need to spend some time trying to figure out precisely what's triggering the anger. That requires self-reflection and clarity.which requires self-control. Managing the disequilibria of anger doesn't mean shutting down and burying emotions. Effective coping means acknowledging what you feel and taking responsibility to resolve it. To cope effectively means being aware of the physiological and psychological signals within you when something provokes irritation. It means channeling the tension that accompanies anger into calming strategies, such as exercise or writing.

Once you are clear about the triggers, it is often beneficial to get some perspective . Spouses and best friends are frequently the least objective. Talk with an unbiased resource to find out if your view of the situation is accurate.

Having identified the cause of your anger, you'll need to plan a course of action . Let's say the catalyst of your anger is an employee who's not doing her job. Make sure you have a detailed job description for that person. If not, write one. Be specific about what you expect her to do, and how you expect her to do it. Mentally rehearse the exchange . Anticipate her likely responses and how you will reply. Then talk privately with the employee to review expectations . Be curious about what she needs from you or others to meet her responsibilities. Agree to follow-up in a week or two.

Make no mistakes about it. Managing people is hard work, and it's constant. If you think you can tell an employee what to do and never have to revisit the issue, you're deluding yourself. If you're angry about that, go back to the two options above. Unless you can find a way to work alone, accept the fact that training, influencing, motivating, and leading your team of employees is a part of your job description. The sooner you embrace that reality, the better off you'll be.

Remember, anger is an invaluable emotion. Translated into logical terms, anger means, "I don't like what's happening.I want it to stop ". It's reasonable to feel angry about having to do things you don't like or want to do. But you'll be far better off if you l earn to harness the energy of anger and use it to improve your practice and your life.

If you're fed up, contact Dr. Haller at . She'll empower you to solve the problems facing you.

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How To Improve Team Relations

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

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As a Business Administrator in charge of office operations and patient relations you need to be reminded that you are not separate from the rest of the dental team. After meeting with the clinical team for the short morning huddle and even more briefly at each patient dismissal, the day goes on with little contact between doctors and clinical staff. This feeling of isolation is more noticeable as you hear laughter and the exchange of camaraderie floating up from the clinical area to the desk. As the patient is being checked out you are often reminded of your responsibilities when you hear remarks such as "Oh, this is the part that really hurts, when you extract money from my wallet." You smile and collect for services rendered.

To be part of the team is to stay connected to the team . Walk the clinical areas at least three times a day to check to see that the treatment areas are running smoothly and if there are any areas of concern voiced by dental assistants, hygienists and doctors. Make yourself visible, maintain a positive attitude toward other member's feedback and be an active listener to all that is happening .

To be an effective leader you need to "join the troops at the front line" to show your commitment to the practice. When you make yourself visible and accessible you bring cohesiveness to the team. You also learn things about the clinical area that you would not know if you never set foot there other than to inform them about a change in the schedule. Some of the observations you would make are as follows:

  • Are instruments stacking up and not being processed?
  • Are doctors or hygienists running behind due to a problem?
  • Are patients left unattended in treatment rooms for long periods of time without contact from a team member?
  • Are dental assistants educating the patients on products or services that would benefit them?
  • Are treatment rooms set up efficiently so that the doctor or assistant is not constantly up and down to get something?
  • Are lab slips filled out and signed and cases boxed up and ready for pick-up?
  • Are there cases in the lab that have not been delivered because the patient has not been scheduled?
  • Are there charts on the doctor's desk that need notes and review?
  • Is the dismissal of patients from treatment rooms to front desk smooth and efficient?
  • Are patients receiving post-op information and explanations about the next appointment?

I am not advocating abandonment of the front office area at critical times during the day. Time your "clinical walk through" between patient arrivals and patient departures. The clinical team should never feel that the Business Administrator (Office Manager) is unavailable or detached from the rest of the team. Being visible on a daily basis will eliminate this assumption and help to achieve respect from the clinical team.

Want to improve your business and leadership skills? Contact The Center for Dental Career Development at 1-877-777-6151, or email and sign up for the Business Administrator Training.

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