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09.29.05 Issue #186  
Tackling Overhead Takes More than the Usual "Routine"

Sally McKenzie, CEO
The McKenzie Company

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It will weigh you down, wear you out, and pull you under. Many practices feel burdened by overhead, and managing it goes well beyond bargain hunting or purchasing supplies in bulk.

Dental teams often become preoccupied with reducing expenses, and understandably so since costs have an obvious and direct impact on overhead. However, curbing overhead lies not just in reducing the money going out, but in increasing the dollars coming in as well – specifically through production. I’m not suggesting that you work harder or cram more patients into your day. However, I am suggesting that you look carefully at how you are handling the day-to-day “routine.”

How many “routine” prophies, how many routine procedures, how many routine checkups are scheduled for today? One, two, three, probably many more? Dental teams become complacent and trap themselves in the routine mindset. They are going through the motions. The patient comes in, gets their routine cleaning, leaves, and you check another routine appointment off the list. The dental appointment becomes as ordinary and mundane as the routine oil change.

Dental teams often take it for granted that patients are aware of the dental opportunities available or will raise questions if they have them. They simply assume that if patients were interested in certain procedures they would ask, consequently teams take the “if they don’t ask, we don’t tell approach.” Yet patients are just as likely to make certain assumptions about the doctor and the practice. For example, if the team doesn’t educate the patient on services offered, such as whitening, veneers, or implants the patient simply assumes that either they’re not offered at this practice, or the doctor doesn’t believe the patient is a good candidate for the procedure, or, worse yet, the doctor thinks the patient can’t afford it.

Take the following steps and get out of the money losing “routine”.

  • Ask the patient how they feel about their smile. If you don’t regularly ask patients about their oral health goals, you are denying them treatment opportunities.
  • Ask several broad questions and listen to the responses. For example, “How do you feel about your smile?” “How well can you chew with your partial?” “How would you like it if your teeth were straight?” “Have you ever thought you would like to have a brighter smile?” “How do you feel about the spaces between your teeth?” And so on … 
  • Use the questions to better understand the value your patient places on oral healthcare and how they perceive their individual oral health condition.
  • Encourage the patient to talk.
  • Use the “Trident Rate Your Smile” brochure. If you are not comfortable asking patients specifically how they feel about their smile, instruct your front desk team to hand patients the Trident Rate Your Smile brochure when they check in. This is an excellent and tremendously simple tool to get the patient thinking about their oral health and the appearance of their smile before you ever utter a word.
  • Educate the patient about treatments that are offered in the practice. Provide patients with professionally written and designed materials that educate them about services and procedures. Many of these are readily available through the American Dental Association.

How are your patients supposed to know what you can do if you don’t tell them? How are you supposed to know what treatments your patients are interested in if you don’t ask? Stop assuming and start educating. Take more time to create a new routine for your patients, and you’ll likely spend less time sweating your overhead numbers.

If you have any question 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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A Strength Overused Becomes a Weakness

Dr. Nancy Haller
Executive Coach
McKenzie Management

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This leadership ‘formula’ can be applied to any trait.

For example, being precise and exacting leads to success, especially in a profession such as dentistry. But when it is ‘overused’, this personality style becomes mired in unnecessary details and misses the ‘big picture’. A case of seeing the trees but not the forest.

What’s important for effective leadership is keeping the right balance. That requires an awareness of your stylistic tendencies, and a knowledge of when to adjust behavioral preferences.

Below is a brief description of four common styles. It is important to remember that no style is “right” or “wrong” and that you can “flex” your style depending on the task, the people, and the situation.  You may discover that you have more than one style. The strongest is called your “dominant” style; the secondary is called your “back-up” style.



  1. Accepts challenges and likes to challenge others

  2. Clear, direct, and to the point
  3. Confident and comfortable in managing problems

  4. Focuses on immediate results/actions
  5. Takes charge of difficult situations through strong initiatives


  1. May be overwhelmingly accomplishment-driven, burning others out with constant “urgencies”
  2. May be too brief, blunt, or “cold”
  3. May dominate conversations (one way communicator), frequently interrupt, and/or be a poor listener
  4. May be overbearing, and inspire fear
  5. May be impatient with “slower learners” and/or unfairly expect immediate responses from others (who need time to think)



  1. Very friendly and engaged with employees

  2. Generates optimism and enthusiasm

  3. Is persuasive, convincing, and positive
  4. Gives the impression of success and confidence

  5. Shows tenacity in dealing with problems and challenges


  1. May be too sensitive, too agreeable, too trusting, too flexible, and/or personally attached (trying to be “a friend”)
  2. May make or imply “promises” just to be liked and/or to make an employee happy
  3. May talk too much and oversell ideas
  4. May miss facts and details, and speak without adequate preparation
  5. May give more information than necessary, causing confusion or more problems



  1. Patient, listens actively and probes for an empathic understanding

  2. Is easy going and creates a relaxed atmosphere

  3. Is a steady and calm teacher/coach
  4. Is loyal and trustworthy with employees

  5. Shows genuine sincerity and interest in others


  1. May be taken advantage of by being too quiet or passive

  2. May avoid confrontations, especially with “strong personality types”
  3. May give too much “slack” time for others to adjust
  4. May need too much personal attention or security/comfort in situations
  5. May be too forgiving of others’ shortcomings or hold a grudge when “burned”



  1. Provides precise expectations and standard operating procedures
  2. Approaches problems systematically and logically
  3. Is very well prepared and organized

  4. Reduces risks with thorough analyses and contingency plans
  5. Controls emotions, subjective thinking, and abrupt changes




  1. May impose unrealistically high standards on new learners

  2. May be too critical and fault-finding (e.g., a nit-picky perfectionist)
  3. May be excessively detailed and over-emphasize things in writing
  4. May be too cautious or over-analytical and miss “golden opportunities”
  5. May be slow to trust others and/or seen as an untrusting “worry wart”. Can be seen as withdrawn and personally evasive/rigid

Think of your personality style like a radio dial. If the volume is too soft or too loud, the music isn’t as pleasant as when the audio is adjusted correctly. To be an effective leader you need the right style at the right time so that it is at the right level for your patients and your staff.

If you need help adjusting the ‘volume’ on your leadership style, contact Dr. Haller at

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

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Let’s face it, when discussing treatment with patients, every time we mention a tooth number and a procedure, the dollars signs explode in the patients’ head like a fireworks show.  A patient will often say, “How much is this going to cost?” long before we have finished presenting the options.  It is as if the patient has stopped listening and just wants to get to the bottom line, money.  A typical examination requires the charting of existing restorations, periodontal probing, noting clinical conditions along with the oral cancer exam etc. all being announced for all to hear within earshot.  Then come the recommended treatment options and the exchange of questions between the assistant and the doctor as the treatment plans are defined and prioritized out loud as the patient listens mutely.  Terminology and language that may just as well be from an “alien planet” bouncing off the walls as the patient slowly sinks into the chair.  “All that is for me? I just wanted a cleaning.”

Having a clear understanding of what brought the patient into your office is the key to building a relationship based on trust.  That initial trust may start to disintegrate as the patient takes on a defensive demeanor after you have finished their examination. In embarrassment the patient has prepared several excuses as to why their mouth is in the condition that you have just described. Telling the patient that you have not lost sight of their initial concern is assuring.

After presenting treatment and payment options to patients for many years, I believe that the less the patient hears during the course of an examination the better.  A dental assistant can accomplish charting existing restorations and missing teeth without saying a word. The assistant records the findings in the chart (paper or computer).  While doing this they can be telling the patient about the newest and greatest services and products the office offers. Such as “Have you heard about the CadCam technique?”  They can also discuss the latest research on implants, composites, toothbrushes etc.  The assistant should also ask the patient for approximate dates of initial placement of existing crowns, bridgework, implants, dentures, etc. and notes that on the chart.  The technology to perio probe without calling numbers to an assistant is available but many offices do not have it.  A patient can become quite anxious after hearing the numbers 4,5,6 etc. Being discreet and “low key” in announcing these numbers is vital. I recommend not announcing trigger words such as bleeding, pus, mobility etc. Moving a patient into a state of anxiety is not the best way to have them primed to accept treatment but it will motivate the “flight or fight” response to get them out of the office as quickly as possible.

Taking intra-oral photos and x-rays (digital or otherwise) is necessary.  I do not advocate putting them up on the screen where the patient is left to stare at them without explanation while waiting for the doctor to arrive.  While the patient is waiting to see the doctor, educational CDs or Videos can be playing.  A Case Book showing before and after photos of your latest success with testimonials is another good marketing source to have patients look at if there is wait time.  Setting a positive stage for treatment acceptance is vital and showing respect for the feelings of our patients is paramount.

Accentuate the positive for your dental practice by enrolling in The Advanced Business Course offered at THE CENTER FOR DENTAL CAREER DEVELOPMENT.  For more information call 1-877-777-6151 or email

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Sally's Mail Bag

Dear Sally,

In the Sept. "Cover Story Survival Guide," in Dental Practice Report magazine you addressed high overhead (page 46) with the following: "Require Hygienists on guaranteed salaries to produce three times their salaries."

What are your suggestions as to how the hygiene staff should/can be involved in scheduling, confirmations, etc., in order "to produce”?


Hi Marsha,

The Hygienist is a producer the same as a Dentist, she/he should not be involved with scheduling or confirmations.  We don't burden Dentists with these tasks why Hygienist's?  The Hygienist in simple terms needs to have a prophy angle and sickle scaler in her/his hands, not a telephone.  These two functions are the responsibility of a designated business employee.  The Hygienist produces more by providing services when indicated such as adult fluorides, antimicrobial therapy, making sure bite wings are done according
to the philosophy of the practice, assessing and "selling" interceptive periodontal therapy to patients, etc.  Many of the things I mention, especially perio are huge missed opportunities in hygiene departments as we observe regularly through our consulting services in McKenzie Management.

This is why we have a two day Hygiene Performance Enrichment program that we offer. Let me know if you are interested.

Best regards,


Visit the Center for Dental Career Development

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