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1.25.08 Issue #307 Forward This Newsletter To A Colleague
Associate Dentists
Case Study
Treatment Acceptance

Look Before You Hire the Associateó2 Rules to Follow
by Sally McKenzie CEO
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Busy: It’s the number one motivator for many dentists. “I’m too busy. I have more patients than I can handle. I’m tired of working this hard. I have plenty of patient records on file to support another dentist. That’s it, I’m hiring an associate.” Now we’ve talked about illusions on many occasions and certainly “busyness” is among the more convincing of practice fantasies.

Doctors will be the first to throw more people at a problem if they think it will help them control the whirling dervish of perpetual activity. Crazy days and a slew of practice records lining the files and they have all the proof they need that this associate idea is a good one. Unfortunately, oodles of patient records don’t translate into oodles of living, breathing, “active” patients. Without enough active patients in the practice, the chances of the doctor building a successful partnership with an associate are somewhere between none and zero.

Rule #1 before hiring an associate: Measure the number of truly “active” patients. Start with key computer reports, including the past due recall report, the missed appointments report, and the unscheduled treatment report.

  1. Generate a report of patients due for recall from today’s date to one year from today. Indicate that you are seeking to identify all patients with and without appointments on the report. 
  2. Count the number of charts in the file and divide that by the number of patients on the recall system. For example, if there are 4,759 patient records on file and 1,737 patients in the recall system. Patient retention would be at 36%.
  3. Now subtract the number of active patients from the number of total patient records in the files. Using the example above that number would be 3,022.
  4. Divide that number by the number of months the charts represent. For example, if you believe that active charts represent the period from 11/04 through 2/08 that would be 39 months.  In this scenario, the practice is losing 78 patients per month.

Obviously the patient base is shrinking. Now what? Don’t hire a full-time associate for starters.  It is time to kick in a patient retention program and implement Rule #2.

Rule # 2 before hiring an associate: Look carefully at clinical efficiencies. Is the “busyness” issue a symptom of the need for better systems or more people? When it comes to clinical efficiency it can never be compromised, but it can almost always be enhanced. For example, how much time is added to a procedure when an assistant doesn’t anticipate what instrument the doctor needs next? How much time is wasted when the doctor has to repeatedly adjust the light? How much time is lost when the assistant can’t see clearly into the patient’s mouth? How much does it cost the practice when the assistant is not given the responsibilities she is legally allowed to carry out? How much does it cost the practice when the doctor is performing procedures or explaining matters to patients that the assistant or other staff members should be handling?

Dentists are legendary perfectionists. It’s both a great strength as well as a major weakness but if you feel you are run ragged day after day, take a close look at the tasks you are performing that should be the responsibility of other team members. Delegate every procedure, patient interaction, and staff matter legally allowable in your state. For example, most states allow dental assistants to remove a temporary crown, clean the tooth and try the permanent crown. However, often the dentist is performing these procedures, which is clinically inefficient. Sealants provide an even clearer example of a procedure that should be delegated completely to the hygienist.

Improving clinical efficiency never involves compromising care. Rather the focus is on improving delivery of that care as well as fully maximizing each hour of doctor and staff time.

Ultimately, you may come to the conclusion that it is time for an associate in your practice. If you’ve stepped back and carefully analyzed key practice systems, you can move forward with confidence knowing that you’ve confirmed in black and white that you have enough “active” patients to support the new hire, enough new patients coming in to keep the practice thriving, clinical efficiency, and practice management efficiency to ensure that your new partnership is the most successful of your career.

Interested in speaking to Sally about your practice concerns? Email her at
Interested in having Sally speak to your dental society or study club? Click Here.

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Nancy Caudill
Senior Consultant
McKenzie Management
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Who is Carrying the Football?

Dr. Ronald Pace – Case Study #167

Dr. Pace’s practice concerns:

Dr. Pace was very anxious as he expressed his concerns regarding his team’s performance.  “I feel like no one is working except for me.  I am so tired by the end of the day and no one seems to care if we met our practice goals or not.”

Dr. Pace’s practice facts:

  • 5-year old practice in the same location
  • $70,000 a month in net collections
  • 15 new patients a month
  • 1 hygienist working 4 days a week
  • 2 business team members and 2 chairside assistants
  • Wages are at 21% of collections
  • No internal marketing


  • There is a practice goal for the day but not a specific goal for the doctor or the hygienist.  It is vital that the providers have their own goal so one doesn’t assume that the other is carrying the load.  It also makes it impossible for the Hygiene and Schedule Coordinator to schedule their providers to a goal when they don’t know the goal.
  • There are no morning or monthly meetings.  This means that there isn’t any communication going on in the office regarding how the practice is performing.
  • There are no job descriptions for the business team.  Both team members are running on auto-pilot and just “doing what needs to be done”.
  • Dr. Pace doesn’t feel comfortable discussing concerns with his team members. His temperament type is ISFJ so he avoids confronting his employees. They don’t know if he is pleased with their performance or not. It is difficult for him to implement new ideas or systems, even when he feels there is a better way of accomplishing a task.


  • The providers (doctor and hygienist) must have their own daily production goal.  Hygiene industry standard production needs to be 3x the hygienist’s salary. PPO reduced fees, low fees, openings in the schedule; poor hygiene treatment acceptance and not enough periodontal services can affect the ability of the hygienist to meet her daily goal. 
  • Job descriptions are to be established for the business team.  Sue will be the Schedule Coordinator.  She will answer the phones, check the patients in and out and is responsible for scheduling doctor to goal.  Jane will be the Hygiene and Financial Coordinator, responsible for the recall system, scheduling hygiene to goal and the financial tasks of the practice.
  • Morning and monthly meetings must be put in place in order to get everyone “on board”.  It is necessary that all the team players know how the team is doing…are we winning or losing? 
  • Dr. Pace was encouraged to communicate with his team members.  Because he didn’t want to “hurt anyone’s feelings” he was jeopardizing the success of his practice and the cohesiveness of his team.  Employees need feedback, positive or negative.  The morning and monthly meetings are the perfect time for him to start “calling the plays” and communicating with his team regarding his concerns. An agenda was established for the meetings with an established format.


Dr. Pace was carrying the weight of the practice on his shoulders because he was unsure as to how to communicate his concerns. Systems were absent that would have allowed his team members to be accountable, and he had no “play board” for his practice with no roadmap for the journey.  By empowering him to become the “quarterback” of his team, call the plays and keep score, his employees became a viable part of the team and every day each player knew what the score was.

If you feel that you are the only player carrying the ball, contact McKenzie Management to learn how to develop systems to make your employees team players for a winning team!

If you would like more information on how McKenzie's Practice Enrichment Programs can help you IMPLEMENT proven strategies….. email

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Belle DuCharme CDPMA
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Listening Techniques for Treatment Plan Acceptance

A new patient represents an opportunity to do more dentistry.  The dental practice has the clinical skills, the team, and the equipment. The patient has the need and the desire. After all, the patient called the office to schedule an appointment.  Why do we assume that every patient would accept the total treatment plan, when only 60% of treatment proposed is actually performed?

Ongoing monitoring of the treatment proposed and treatment accepted is crucial to understanding where the practice can improve its treatment presentations and delivery techniques.

Studies show that few dental practices have provided formal training to those responsible for communicating dental treatment plans to patients.  The responsibility usually falls on the Dentist because he/she is the only person licensed to diagnose treatment and present the best options based on the overall health and estimated long-term success for the patient.  After the patient is given treatment plan options and has made a choice as to what course of action to take, he /she is escorted to the front office to schedule appointments and discuss financial options.  The Business Administrator has a treatment plan in front of her/ him but has not heard a word that the dentist has said to the patient.  Usually what transpires is “Let’s get you appointed and how would you like to pay for this?”

Questions arise because the patient was, in many cases, unable to absorb all the information necessary to make an informed decision and perhaps was embarrassed to ask the dentist to repeat.  How the questions are answered by a very busy not so clinically educated business administrator who just wants to “get them booked” can determine whether the patient makes a qualified appointment or wants to “think about it” or “call you back after he/she checks the schedule or asks the wife/husband, accountant, spirit guide, etc.”

Time necessary for the patient to take notes, probe for understanding, get clarity of the situation and get empathy must be worked into the appointment time and a qualified, trained team member such as a Treatment Coordinator needs to facilitate this process.

The process of presenting the treatment involves patient education and can be provided by video, flip charts, drawings, models, radiographs, computer imaging etc.  The patient must be able to take some of this education with him/her to fully “digest” the phases of the treatment.  Often, a patient leaves with just a computer generated treatment estimate that is not phased to show the order of the treatment, length of appointment times, post-op period, or estimated healing time between phases, any specialists that will be involved and a person they can count on to answer their questions without “bothering the dentist.”  The old school way of “do what I say, I am the doctor” is no longer valid in this information driven world.

For practices ready to “take it to the next level”, training in treatment presentation techniques is essential.  Being a good listener is not just letting someone else talk. Precision listening is more than getting the “gist” of what was said but represents the recording of the speakers’ exact words.  In paraphrasing what was said during the dentist’s presentation, the patient may lose the meaning of what was said to them.  Studies show that there are limits to short term and long term memory.  When a patient has not fully understood what was presented to him/her the chances of remembering why having this treatment is so important to them becomes diluted quickly. If a patient leaves the office without securing an appointment it could be due to this lapse in communication.

 Studies show that when patients call to schedule an appointment they need to be seen within a week to two weeks. The motivation is there and they want to buy.  If the practice can not accommodate with an appointment, they may call another office.

 Active or precision listening during the new patient interview will give insight as to what the patient wants from the dental practice. Writing down “exact” or key words and then repeating back to the patient will enforce the patient’s belief that you are truly “listening” to what is being said. The patient knows that there isn’t any way that you can remember what he/she said without taking notes. After all, you see many patients in a day.

Interested in tuning up your listening skills? Call for information about the Treatment Acceptance Training today.

 Why not improve your performance in 2008 by increasing your treatment acceptance:  Email or call 877.777.6151
Interested in having Belle speak to your dental society or study club? Click Here.

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