Visit our website at
12.16.05 Issue #197  
Pull Fees out of the Deep Freeze

Sally McKenzie, CEO
The McKenzie Company

Printer Friendly Version

There you sit in line at the drive-up window waiting for your morning mocha. With the arrival of 2006, the cost of your favorite cup of specialty joe will probably increase, but you have no plans to change your routine. Tuition is going up at the out-of-state university your daughter attends, but you won’t be insisting she enroll at the local community college. The fees are scheduled to increase at the state park you intend to visit with your family next summer, but you wouldn’t consider canceling the trip. A few of your favorite materials will be increasing in price, but these are quality products and you don’t plan to stop using them.

Salaries and benefits are going up, supplies are going up, equipment and maintenance are going up, personal expenses are going up. But what about your fees? 

When was the last time you examined, let alone raised, your fees? You value that cup of specialty coffee. You value the quality of education that is purportedly delivered at that expensive university. You value the materials and supplies you know work best for your procedures. You value the dentistry you provide your patients daily, but you fear that your patients don’t value you enough to continue investing in your care should you increase your fees. 

Fees are not just a fact of life and work, they are a statement of the quality of care provided. What message does it send patients when the charges for dental services seldom change? Is it your goal to be perceived as the cheapest dentist? What is the price of that monitor? For starters, you’re most likely attracting the cheapest patients who place very little importance on quality oral care.

What’s worse, if you’re compromising your fees, you’re most likely compromising other things as well – your salary, your retirement, continuing education, new equipment, etc. Establish a fee schedule that is a reflection of your values as a practitioner and is fair to both you and your patients.  Here’s how.

First, look at the realities of providing quality care. Evaluate how much time is needed for each procedure. Next, add up the fundamental expenses of the office. These would be fixed costs, rent, utilities, salaries/benefits, etc. and variable expenses such as supplies, lab fees, and income required per hour to compensate you, the dentist. 

Now take a good look at where your expenses are as compared to where they should be. It’s imperative that you establish a goal so that expenses come within striking distance of the following industry standards: laboratory 10%, dental/office supplies 5%, rent 5%, employees’ salaries 19-22%, payroll taxes and benefits 3-5%, miscellaneous 10%.

Next consider the value that you place on your time. How many hours do you want to spend at the office each week? How much money do you want to make each year?  Determine the number of days per week you will see patients and the number of hours you will spend on treatment. If your annual production goal is $950,000, you work 48 weeks a year, 36 hours per week, your hourly production goal is $550.

Next, take a look around the neighborhood. Study the fees of other dentists in your area as well as the income demographics of your patients. Consider your own practice – the quality of work you provide and the quality of your team, which may be far above the skills and quality of the practice down the street.

Now that you have real data and solid information, structure your fee schedule based on that, not gut feelings. And remember the fundamentals of fee psychology. Consumers/patients are more accepting of fees that end with the following: $1, $2, $3, $4, $6, $7, and $8.

Establish a plan to adjust your fees on a consistent schedule. In most cases, this will be 5% once a year. In some instances, you may prefer to break that down into two adjustments during the year, perhaps 3% in January and 2% in July.

Once you’ve established your fees, charge them! No backpedaling. Just because Mrs. Antonio likes to bring you pizzelles does not mean she’s entitled to discount dentistry.  She may well be the millionaire woman next door.

Next week, the value of your care doesn’t hinge on your fees.

If you are interested in having a comparative fee analysis detailing 216 of the most often performed procedures compared to your existing fee schedule compiled for your zip code.  Please email

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

Forward this article to a friend.

When Are You at Your Best? Give yourself a gift by focusing on strengths.

Dr. Nancy Haller
Executive Coach
McKenzie Management

Printer Friendly Version

Did you know that when people are asked to recall important emotional events they remember four negative memories for every positive? We’re hard-wired to pay more attention to negative information. Survival instinct.

You’ve heard the saying, ‘You catch more flies with honey than you do with vinegar’. Behavioral psychology has proven that humans respond better to praise (honey) than criticism (vinegar).

Now think about your ratio of positives to negatives, from the things you say to your employees to the silent messages you give yourself. If you want to develop your leadership skills, research tells us that you are more likely to gain ground by leveraging your natural skills than trying to fix your weaknesses.

The Harvard Business Review recently dedicated space to the concept of "Reflected Best Self" (RBS) as a method of developing executives. By having a sense of their ‘personal best’, executives are more likely to increase their leadership potential. Organizations are finding the results yield big pay-offs in the bottom-line.

The RBS exercise is not intended to stroke your ego or ignore problem areas. The purpose is to develop a plan for more effective action. This requires commitment, diligence, and follow-through. It helps to have a coach to keep you on track. To obtain the most useful feedback necessitates some planning. Here’s how it works.

First identify approximately 10-15 people in your office and outside of work who know you well (a minimum of 10 people is needed in order to make this useful) – employees, vendors, colleagues, friends, family, church or synagogue members. By soliciting input from a diverse group, you’ll gather a richer understanding of yourself.

Ask them to provide you with at least two examples, stories, and/or incidents of you at your best. The request should be in writing so they can think about their answers. Email works great. The more specific or detailed those descriptions the more impactful the feedback. Explain that the goal of this exercise is to increase your understanding of how others see you when you are at your best as a basis for strengthening your leadership effectiveness.

The Questions.

1a. One of the greatest ways that you add value is:
1b. For example, one that was most meaningful to me was a time when:


One of the greatest ways that you add value is:
Providing clear expectations about what you want, and explanations about why those tasks are important.

I think of a time when:
Last Monday in the morning huddle, you reviewed the schedule and the time problems as a result of two emergency walk-ins. These kinds of days usually get everyone stressed out. You reminded us that while we wanted to get through the schedule, more importantly, we wanted to serve our patients and do good work. You reminded us of what we were capable of doing and how each of us could contribute to a better outcome. As a result, we saw everyone that day and we all felt proud of how we worked together.

The third step is to collate all the feedback. Look for ‘common themes’ or patterns. In most of the executive coaching I have done, the uniformity is remarkable despite the diversity of the feedback givers. Once you have identified those strengths, write a two- to four- paragraph narrative beginning with the phrase, “When I am at my best, I…” Think about this as your self-portrait, or your “possible self”.

Last but not least, share your when-I-am-at-my-best portrait with staff and others who participated. Ask them for ideas on how you could better exploit your talents and strengths. Consider using this model to develop your staff. When each person discovers who they are when they are at their best, it’s a gift to everyone. Happy Holidays!

Dr. Haller can be reached at  She provides Executive Coaching for McKenzie Management and conducts one-on-one leadership training.

Forward this article to a friend .

Periodontal Disease and the Existing Patient

Jean Gallienne RDH BS
Hygiene Consultant McKenzie Management

Printer Friendly Version

Treating periodontal disease is more than just diagnosing four quadrants of root planing, performing the treatment needed, and then putting the patient on a recall interval.

We were all taught in college that when the disease is limited to the gingiva, the possibility of reversal is considered first when creating a plan of care. On the other hand, chronic periodontitis has slow to moderate rates of progression, but may even have rapid progression. Arresting the progression of periodontitis is done by altering or eliminating the microbial etiology and risk factors that contribute to the disease process. Except, in cases of advanced periodontitis, the need for additional treatment after initial non-surgical interceptive periodontal therapy is rarely possible to predict. In order to do this, we as clinicians are constantly challenged with reassessing the treated tissues every time our patients are in our chairs. Knowing when more or less treatment is required in order to alter or eliminate the microbial etiology is our responsibility to our patients.
Looking back many years ago at the way periodontal disease was treated, we only progressed with treatment if the pockets got deeper. Well, if you think about it, this is like saying we should only have our oil changed in our cars if it breaks down, or do fillings if something hurts. We all know that this is not the best way to prevent break down in the future, and in order to prevent break down you have to stop it before it happens. So, why would we wait for a pocket to get deeper before moving ahead with treatment? Dentistry became preventive oriented years ago when it comes to providing restorative treatment. However, it seems it moved a little slower when it came to the treatment of periodontal disease.

Now instead of waiting for there to be a difference in the pocket depth or radiographic changes for the worse, why not look for changes towards the better. By this I am saying that if the patient has had root planing and has been on a periodontal maintenance interval of 3 months, and the clinician is not seeing any improvement, it may be time to intervene and progress further with treatment.
The next step may be to refer to a Periodontist for surgical intervention. However, many times it may be appropriate to advance with more non-surgical treatment. Some patients may refuse periodontal surgery or cannot undergo these procedures because they are medically compromised or fearful of surgery. These patients may understand treatment has limited success but may be able to prolong retention of their remaining dentition with aggressive non-surgical therapy.
Whenever existing patients are not making progress, or if they are regressing because of their home care, this is the time to intervene. Do not wait for that pocket to get deeper. This is another time your hygiene department may want to come up with a specific protocol. Not only when to refer the patient out to a Periodontist, but when to implement non-surgical therapy for the first, second, or third time.

Below are just a few clinical signs that you may want to utilize when determining if root planing needs to be done again.

  • Heavy hemorrhaging during instrumentation
  • Sub gingival calculus
  • Patient refuses to see Periodontist
  • No progression towards better health
  • Bleeding upon probing
  • You have already shortened the recall interval and there is still no sign that the health of the tissue is improving
  • Systemic problems
  • Overdue for periodontal therapy and their oral hygiene is less than acceptable

These are just a few of the red flags that may be flying in patients’ mouths that will help in determining if more aggressive care is needed. That is, until the health of their mouth stabilizes allowing their immune system to become strong enough to keep the destructive bacteria under control. Our goal is to help the patient achieve and maintain their oral health.

The care may be anywhere from one quadrant of root planing to four quadrants of root planing, and then possibly a referral to the Periodontist. The patient may also only warrant the use of the code 4342, which is one to three teeth of scaling and root planing instead of a 4341 which is four or more teeth per quadrant of scaling and root planing. Additional therapy may even be site specific to one tooth.
Even in the Parameter of Care Supplement, Parameter on Periodontal Maintenance, in the Journal of Periodontology, Volume 17, Number 5, May 2000 it states, “Despite adequate periodontal maintenance and patient compliance, patients may demonstrate recurrence or progression of periodontal disease. In these patients, additional therapy may be warranted.” Therefore, it is imperative as clinicians that we constantly monitor and evaluate the patient’s condition when it comes to periodontal disease. The challenge of knowing when more or less treatment is required will continue every time we as clinicians have a patient sit in our chairs.

If you are interested in enhancing your skills as a hygienist email

Forward this article to a friend.

Missed Past Issues of Our e-Management Newsletter?

Want to Know More About McKenzie Management?

This issue is sponsored
in part by:
McKenzie Management's Seminar Schedule
2006 Location Sponsor Information Topic Speaker
Jan. 26-28 Dallas, TX Dallas County Dental Society* 877-777-6151 Top Issues Sally McKenzie
Feb. 9-10 Santa Barbara, CA The Art of Endodontics 800-528-1590 Max. Prod. Sally McKenzie
Mar. 9 Vancouver, BC Pacific Dental Conference 604-736-3781 Overhead Sally McKenzie
Mar. 24 West Branch, MI Northland Dental Study Club 989-345-7750 Breakdown Sally McKenzie
Mar. 29 Long Island, NY Suffolk County Dental Society 312-440-2908 Breakdown Sally McKenzie
Mar. 31 Las Vegas, NV Dental Town Meeting 877-777-6151 TBA Sally McKenzie
* The McKenzie Company will be exhibiting at this location

McKenzie Management
A Division of The McKenzie Company, Inc.

3252 Holiday Court, Suite 110

La Jolla, CA 92037

For more information, email
or call 1-877-777-6151

The McKenzie Company Newsletter Information:
To unsubscribe:
To discontinue receiving the Sally McKenzie eManagment newsletter,
click on the link at the very bottom of this page for instant removal,
To report technical problems with this newsletter or to request technical help,
please send a descriptive email to:
To request services, products or general inquires about The McKenzie Company activities
please send a descriptive email to:
If you would like to have any of your dental practice concerns answered personally by Sally McKenzie,
please send a descriptive email to her at:
Copyrights 1980-Present The McKenzie Company - All Rights Reserved.