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07.29.05 Issue #177
Order from Chaos - Forget Busy, Take Six Steps to Productive

Sally McKenzie, CEO
The McKenzie Company

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Too often dentists and their teams are stealing minutes here, working on borrowed time there, and constantly feeling that when it comes to the sands in the hour glass, there are never enough. Tensions are high, tempers are short, and in spite of the persistent sense of busyness, production continues to lag and profits don't measure up. So how do you make time your opportunity to seize rather than your obstacle to overcome?

First, consider what will make you happy. In other words how much does the practice need to produce to meet your needs and wants - i.e. financial goals? How many hours per day and days per week do you want to work? How much vacation time do you want to take? How much do you need to pay your staff and yourself, the mortgage, utility bill, etc. Identifying your practice's financial demands and objectives enables you and your team to understand the importance of scheduling to meet daily production goals. It provides the Scheduling Coordinator with clear scheduling objectives, and it allows you, the doctor, to focus on diagnosing the best dentistry for patients.

Second, don't leave the schedule to creative interpretation. Scheduling time should be communicated clearly to the Scheduling Coordinator. This basic, yet commonly overlooked, detail ensures the person in charge of making or breaking your day isn't forced to guess how much time a procedure will require.

For example, the doctor examines a hygiene patient and determines she needs three fillings. The doctor tells the Hygienist exactly how much time is necessary. The Hygienist, in turn, communicates to the Scheduling Coordinator via computer or route slip specifically how much doctor time and assistant time to book. The doctor's time should be scheduled in one color on the computer and the assistant's in another. This simple strategy ensures that the doctor is not double-booked.

In addition, the doctor should never be scheduled out more than three weeks, so curb the urge to schedule all of the appointments for large treatment plans immediately. Scheduling the entire plan can overwhelm both the patient and the schedule. Worse yet, "bread and butter" patients often are forced to wait several weeks for routine procedures - not something that many of them will accept on a regular basis.

Third, maximize your time, your talent, and your staff. Give your employees the opportunity to achieve their full potential. Provide necessary training to prepare your staff to perform procedures that they are legally allowed to carry out in your practice. If you do not have the confidence that your assistant or other team member can handle the additional responsibility, even with proper training, then she/he should be replaced. They are holding you and your team back - plain and simple.

Fourth, keep communications flowing between the clinical staff and business employees throughout the day. Start by reviewing the schedule as a team first thing during the huddle. The clinical staff can advise the Scheduling Coordinator where to place any emergency patients. If there are cancellations, the team can discuss which hygiene patients may be able to receive immediate treatment and which restorative patients may be able to be worked into any openings in the oral hygiene schedule. The dental assistant also can review specifically what procedures are scheduled and set up the treatment rooms accordingly.

Fifth, avoid the tendency to engage in "wishful scheduling" in which more time is reserved for the doctor's "ideal" treatments than the practice has a history of delivering. Rather, calculate the number of crown and bridge units - or other procedures - over the last six months and divide by the number of days worked. Then you can reserve time in the schedule based on the number of units actually performed.

Sixth, don't lie to prospective patients. If you say you are accepting new patients, make sure there is room in the schedule to accommodate them. 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 . Remember, new patient slots should always be reserved during prime time.

Institute this six-step process and start scheduling to be productive, not just busy.

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"Selling" Quality Care

Jean Gallienne RDH BS
Hygiene Consultant McKenzie Management

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I often considered going into a sales position in dentistry. However, most of the distribution and manufacturing companies want prior sales experience. The interesting thing is that they were talking about selling copy machines, cars, or cell phone services. Well, as a Hygienist I have always considered myself as the closer when it comes to "selling" the treatment plan the doctor has presented to the patient. I have experience in sales. I sell dentistry. Something that many people are afraid of and do not really "want" to have.

Do you view "selling" dentistry as unprofessional? Do you find it hard to reinforce your doctor's treatment plans? If so, the first thing we need to do is work on your way of thinking. Encouraging your patients to get the treatment needed is the best thing you can do for them as a clinician. Walking around with decay on the mesial of #8 is not helping the oral health of your patient. Therefore it is your professional, ethical, and moral responsibility to reinforce and "sell" the dentistry that has been diagnosed by the doctor.

I am not talking about high-pressure sales. I am talking about honest, compassionate, knowledge sharing and relationship building sales. Treating your patients like they are friends or family. Which I have to say that having worked with many of my patients for fifteen plus years, they are my friends. Therefore, if I did not take the time to educate and verify that they understand the diagnosed treatment, I would think that I was being unprofessional, unethical, and not providing the quality of care that has always been the most important thing to me.

The first question and comment I say to a new patient when they sit in my chair are, "What questions, comments, or concerns do you have about the treatment the doctor has recommended? I would love to explain anything that you may want to know about. That is why I am here. Part of my job is to educate you as much as I can. So, you will be able to take your knowledge with you if you should move to another state at some time."

During treatment, if they are having root planing done, I will think and talk out loud. The first thing I check after updating the health history is what treatment is needed and what fillings need to be done. While working in the upper right quadrant, I will say, "You have decay on the mesial of #8. I will be careful while working around this tooth. That will need to be taken care of by the doctor once we are done with your periodontal therapy." This is reinforcing the treatment diagnosed without pressuring the patient.

Once the patient is done with the treatment in hygiene, I remind them, "We need to set up an appointment for you to do that filling on the mesial of #8." I even ask them if they can do it in the next week if the doctor has the time. If so, I write on the route slip that the patient would like to have an appointment in the next week, how much time is needed, and what work will be done at that appointment.

Now, when I take the patient up to the front desk the first thing the front desk person should say is, "What time of day would you like me to make that appointment for you to get that filling done on tooth #8?" This is said while I am still standing there. The patient has already committed to me in my room that they would like to get the work done in the next week. We are merely providing what they requested.

The patient is improving their oral health by getting the work done that the doctor has prescribed. I have helped them by educating them and reminding them of the treatment that was diagnosed by the doctor. It is my job to help the patient understand why they WANT to have the dentistry done and why they need it.

"Selling" dentistry is part of providing quality care. It is ethical for you as a healthcare provider to educate, motivate, and communicate the needs of your patients to them, making sure they are well informed of all risks, benefits, and alternatives. All the while you will be reinforcing and "selling" the treatment plan given by the doctor.

Jean conducts 2 day Hygiene Performance Enrichment Programs for The Center for Dental Career Development and McKenzie Management in La Jolla/San Diego, CA. Contact her at or call 1-877-777-6151 for more information on her Advanced Hygiene Training Programs.

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

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Best City, U.S.A.

Scott McDonald

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So where EXACTLY is the best place to practice?

That is a question that no one can answer. They cannot answer it because the question is too broad. The better question would be:

Where EXACTLY is the best place to practice FOR YOU?

That is precisely why Sally McKenzie offers demographic reports on her web site.

We get calls every day from doctors around the United States . Some are excited about the prospects for practice growth and are trying to figure out how to take advantage of all the great fee-for-service patients they are receiving as they scout for a second and third office site. Others weep bitter tears that their once fertile garden of patients has grown barren. The most interesting thing is, many of them are calling from the same neighborhood.

What makes a practice location good or bad does not depend upon an entirely objective set of criteria but upon the specific definition of "best place" in the mind of the dentist.

There is a company, OnBoard, Inc ., that compiles ways of looking at cities primarily from the standpoint of relocating one's home. They have about 1,300 cities in their database that rank cities in many ways. They recently published their list of the Best Cities in Which to Live. Here they are, in their order of rank (the City that follows is the Metropolitan Statistical Area with which the community is associated):

  1. Moorestown, NJ 20,700 Philadelphia
  2. Bainbridge Island, WA 21,600 Seattle
  3. Naperville, IL 163,900 Chicago
  4. Vienna, VA 61,700 Washington , DC
  5. Louisville, CO 32,400 Boulder
  6. Barrington, RI 16,800 Providence
  7. Middleton, WI 21,400 Madison
  8. Peachtree City, GA 35,800 Atlanta
  9. Chatham, NJ 17,600 New York City
  10. Mill Valley, CA 29,200 San Francisco
  11. Larchmont, NY 18,200 New York City
  12. Greenwich, CT 62,000 Stamford
  13. Westwood, MA 14,500 Boston
  14. Blue Bell, PA 19,700 Philadelphia
  15. Princeton, NJ 48,700 Trenton
  16. Chanhassen, MN 22,100 Minneapolis
  17. Gaithersburg, MD 132,500 Washington , DC
  18. Powell, OH 30,300 Columbus
  19. Mequon-Thiensville, WI 23,400 Milwaukee
  20. Ellicott City, MD 72,000 Baltimore
  21. Yorba Linda, CA 64,400 Los Angeles
  22. Delmar, NY 16,300 Albany
  23. Papillion, NE 27,400 Omaha
  24. Fishers, IN 48,900 Indianapolis
  25. Coronado, CA 23,800 San Diego

It is interesting to note that only 4 are found on the West Coast. Four of the fastest growing states are entirely left off ( Nevada , Arizona , Georgia , and Texas .) We have done very few demographic reports for those locations. And yet, OnBoard recommends these as the top 25 cities in which to live. But will they work as good places to practice ? Not necessarily.

In another survey, they found the top ten fastest markets in job growth are:

  1. Castle Rock, CO 244.43%
  2. Parker, CO 244.43%
  3. Boerne , TX 157.91%
  4. Cumming , GA 157.70%
  5. Ashburn , VA 132.66%
  6. Leesburg , VA 132.66%
  7. Sterling , VA 132.66%
  8. Mcdoungh , GA 130.12%
  9. Henderson , NV 107.82%
  10. Las Vegas , NV 107.82%

Dentists are told by classmates, professors, equipment salespersons, friends, and family information about where to practice. "This area is doing GREAT!" they will say enthusiastically, And darned if the Chamber of Commerce doesn't agree!!! But the sobering reality is that a single set of statistics, however, true, may have nothing to do with how well YOU will do in practice at any given location.

There is also a signficant disconnect between what makes a location a great place in which to live and a great place in which to practice according to this company's priority list. Competition ratios (the number of dentists practicing per resident or per household in a given market geography) are not to be ignored. Neither is the historic as well as the projected rates of growth. Unfortunately, your friends and family, classmates and teachers usually operate from only a limited set of data.

The bottom line is that no single set of statistics should be relied upon in order to find the best place to practice. And even a location that seems not to do very well may have simply changed in its demographic character. People are, after all, a moving target. So as a practice ages and local populations shift, grow, decrease, or increase, so the doctor must learn to use demographic information to target the NEW target market that has just moved in.

Scott McDonald is the former Marketing Manager for the California Dental Association, national lecturer and author and provides demographic marketing and site analysis recommendations for The McKenzie Company. For more information email or visit our website.

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Sally's Mail Bag

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Hi Sally,
I am an office manager in a dental office. My bosses and I have a completely different opinion of what an office manager should be. I work at the front desk with multiple duties. I am not allowed to make even the smallest decisions. What I am allowed to do is make notes of all the discrepancies of all my fellow coworkers. I have been told I am not to be their buddy. I think I can effectively manage this office by being both a mentor and a friend. I would very much like to know what your opinion is with the little information that I have given.

Best regards,

Dear Betty,
The term “office manager” has no set definition by industry standards. You can have one person at the front office which is your case, that is not “managing” anything. On the other hand you can have an office manager that over sees 25+ employees. I think it was probably a mistake to bestow that title on you without a defined job description. I would suggest that you go to your employer(s) and ask for a defined job description. The title is not the job but the job description is the job. From that list of duties and responsibilities you can then decide if this is a job you want to keep.

Hope this helps,

This issue is sponsored
in part by:
McKenzie Management's Seminar Schedule
2005 Location Sponsor Information Topic Speaker
August 13 Topeka, KS Delta Dental Plan of Kansas 800-733-5823 Breakdown Sally McKenzie
Sept. 9-11 San Francisco, CA California Dental Association 916-443-0505 Successes Sally McKenzie
Sept. 22 El Paso, TX El Paso Dental Society 877-777-6151 Breakdown Sally McKenzie
Oct. 14 Riverside, CA Riverside Implant Study Group 951-279-7847 Top Issues Sally McKenzie
Nov. 18-19 Griffin, GA Endo Magic Root Camp 877-478-9748 Top Issues Sally McKenzie
Dec. 1 Cincinnati, OH Cincinnati Dental Society 513-984-3443 Breakdown Sally McKenzie

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