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11.11.05 Issue #192  
What to do When You're Called on the Cash Carpet

Sally McKenzie, CEO
The McKenzie Company

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It’s one of the most awkward situations you can be confronted with. An employee pops into your personal office, asks to speak to you, sits down, and with these words puts you on the hot seat: Doctor, I need a raise. Just thinking about such a situation can cause a terrific case of anxiety; having to respond under those circumstances can have you making any number of promises you’ll likely regret.

So what do you do to preserve the good will of the employee and the sound financial standing of the practice? Ideally, you manage the situation well before it ever occurs by spelling out the parameters for giving raises the day the employee starts on the job.

However, if you find yourself called on the cash carpet, you take a deep breath and explain to the employee that you would like to take their request under consideration, but you will need more information. I recommend this approach: Mary, to help me make an informed decision I would like you to provide me with sound business reasons for paying you more. I would like a written list of the contributions you have made to the practice.

Mary should be able to document a list of recent problems or critical issues in the practice that she has resolved. She should also be able to point to new responsibilities that she has taken on since her last raise. In addition, she should be able to spell out what she has done to increase practice revenues and/or cut costs or save time. For example, has Mary taken the initiative to get patient treatment out of the charts and into the schedule? Has Mary instituted a patient education program to inform patients about new or existing treatments that may benefit them? If Mary is the Scheduling Coordinator, what proactive steps has Mary taken to curb last-minute cancellations and no shows?

Conversely, Mary should be able to expect a few things from you, the doctor. Number one: a clear, results-oriented job description. If Mary is your dental assistant, her job description should include things like attending beginning of the day meetings, completing case presentations, reinforcing the quality of care delivered, directing the doctor to check hygiene patients, completing post treatment care calls, converting emergency patients to new patients, turning the treatment room around promptly, etc.

Mary should also know what quantifiable measurements will be used to gauge her performance. For example, she needs to know that you expect her to achieve an 85% case acceptance, that she is to give a daily report on her post-treatment calls, that she should be converting 75% of emergency patients to comprehensive exams, and that she should be able to keep the cost of dental supplies at no more than 5% of practice collections. In addition, you should be able to see the distal of the cuspid on every bitewing X-ray, you should never have to reach for an instrument on any setup, and the molds Mary pours should be free of defects. Get the idea? When you and Mary both know what is expected you can better assess if Mary is just doing her job or truly making a difference in the practice.

The other critically important factor in giving a raise is determining if the business can actually afford it. Wages should be in the 19- 22% range of gross collections, not including taxes/benefits, which is typically another 3-5%.

If your current monthly collections are $48,325 per month and your existing salaries are $9,353 a $2 hourly raise for the dental assistant from $15 to $17 and working a 36 hr. week will increase existing salaries to $9,665, which is within the 20% industry benchmark. However, if your current monthly collections are $39,000, existing salaries are $9,353 that puts you at 24% of gross production and well above the standard. You better start bringing in more cash before you start doling out more money.  

Like every major expenditure and employee raises are a major expenditure –no matter how seemingly small – salary adjustments require a careful and deliberate approach that is clearly understood by everyone on the team.

If your payroll expenditures are out of control, it often times works best to have the “outside expert opinion” come into the practice and assess the situation. It can be caused by too many employees, unproductive job descriptions, long-term employees with no change in their performance, lack of training or an under-producing hygiene department. A statement of the facts as they exist takes emotions out of the equation and maintains a sense of goodwill.  If you are interested please email me at

Interested in having Sally speak to your dental society or study club? Click Here.

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Primary vs. Second vs. Satellite Locations

Scott McDonald

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It may seem like a subtle distinction to some but it can have a significant impact what will be your Best Site for a second office.  From a demographic standpoint, it is a vital difference. Here is how we define the alternatives.

Satellite Offices:

  1. a.  Most often within the same “market” as the primary practice facility
  2. b.  Open no more than two days per week
  3. c.  Referrals from the satellite to the primary office are not uncommon

Second Offices:
      a.  Outside of the “market”
      b.  Are open at least two days per week
      c.  Do no “poach” patients from the primary office

The first consideration in determining “how far is too far” is the doctor’s drive time. Some dentists do not mind an hour drive to and from the office each day. For others, this is a terrible burden. We have found that a 30 minute drive from the doctor’s home to be a reasonable alternative and very common. We often find that drive time is a better measurement for where to look for an office than distance.

If the doctor lives between the two offices, this is not a significant issue because it allows a potential hour’s drive between the locations. On the other hand, it becomes extremely difficult if the doctor is trying to cover emergencies in each office on the same day.   The answer, then, has to depend upon the doctor’s preferences.  We cannot ignore the staff’s drive, however.

 For a Primary Practice (full time schedule of 4 days or more per week), we set a threshold of 1 dentist per 1,400 residents for a scratch practice (assuming this is a suburban area. Urban and Rural areas have different ways of calculating competition). For a Second Office Location (2.5 to 3.5 days per week), we look for at least 950 residents per dentist. For a Satellite Location (2 days or fewer per week), we look for a ratio of 1 dentist per 800 residents.

 Obviously, we would like to know how many Primary, Satellite, and Second offices there are in the area. It is worth noting that their numbers vary greatly from state-to-state. In fact, we have found that surrounding the Boston area, there are a very large percentage of offices that are Satellites (many with only 1 day open per week) while in Arizona, we find very few.

 Need suggestions on where you should consider putting a Primary, Second, or Satellite location?  Give us a call!

Want a SHORT Commute to the Office?

Hate that morning commute to the practice? Newly released data indicate where the shortest commute from home-to-office can be found. All of these communities have in common that they are a moderately growing community that is somewhat isolated from larger metropolitan areas. While these numbers do not imply anything about either competition ratios (population-per-dentist) or socioeconomic information, we note that most of these locations keep showing up on the "promising site" lists we review.

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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"Just Answer the Phone and Take a Message" A VERY EXPENSIVE STATEMENT, How is Your Phone Being Answered?

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

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Telephone skills are the lifeblood of a practice yet little if any time is spent teaching your staff to answer patients’ questions correctly.  If you are spending marketing dollars to make the phone ring and the people answering do not know the practice policies such as quoting fees, or for what insurance plans the doctor is a participating provider or what the patient can expect at the first visit or what to say when a patient cancels etc., then you need to take the time necessary to train all staff that will be answering the phone.  Typically the front office business manager in her hurried day does not see the need until she is ill or has to leave the office for emergency personal business.  “How much harm can they do in a couple of hours or days?”  She asks herself as she runs out the door. 

A potential patient who is calling your office and gets “I don’t know if the doctor takes your insurance.” Or “I don’t know how much the cleaning is, you will have to call back when the office manager is here.”  Or, ”I don’t work up here, I am the assistant, I can take your name and have our receptionist call you back.”  Does this sound like the office you would trust to provide the best dental care?   Unless they are highly recommended by a close friend I would move on to the next dentist on my list.

Adopting formal telephone answering protocol is not difficult and once in place, it alleviates stress on the team and the patient.  Knowing how to answer the everyday routine questions is fundamental.  Perfecting the listening and communication skills necessary to guide patients into appointments comes with practice and genuine care and concern for the patient.  Everyone who answers the phone should be cross-trained to set up an appointment on the computer.  If the initial appointment begins with taking radiographs, intra-orals and a Comprehensive Exam with the doctor, this appointment becomes the New Patient Appointment and is written into the Telephone Training Manual.  Writing your telephone protocols and placing them in a three ring binder for all to refer to is an excellent way to train new staff and refresh existing staff.  Having everyone trained as to what to say if someone is canceling is vitally important.  For instance, if you decide that you will say to anyone who is trying to cancel, “I am sorry that something came up, Mr. Brown, but you did not give me enough time to fill your appointment time, is there any way at all that you can make your appointment today?”  Mr. Brown replies, “I am sorry, but no.” “ Mr. Brown, I do understand how unexpected events can happen. In the future we would appreciate a 24 hour notice to cancel appointments.”  It is important to note in the patient’s record that the office policy was quoted to the patient.

Deciding how to handle emergency patients can save a schedule.  “We can see you at 11:30 this morning or 2:00 this afternoon.  The visit will be between $100 and $175.00 and will include diagnosing and relief of your discomfort.  Payment can be made by cash, check, Visa or MasterCard.  Which appointment time would you like?”  Emergency patients should not be allowed to dictate when they will come in and should understand that payment is expected that day.  Place this dialogue under Emergency Patient Appointment in your Telephone Training Manual.

When you have effective communication systems in place, patients are more compliant with keeping their appointments and more readily accept treatment recommendations.    Personal contact with you or your team whether positive or negative, is the most memorable part of the dental care experience. 

If you are interested in training to establish your Telephone Training Protocol, contact us at or visit our web site at or call 1-877-777-6151.

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