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3.21.08 Issue #315 Forward This Newsletter To A Colleague
Economic Downturn
Case Study
Multitasking Myths

Take Action During Tough Times
by Sally McKenzie CEO
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Well, here we go again. It seems as though most of the country had barely recovered from the last recession only to be facing yet another economic downturn. Negative economic news is virtually everywhere. Although there are pockets around the nation that seem to be skirting the worst of the latest economic woes, many dentists are feeling the pinch.

When the economy takes a turn for the worse, consumer focus shifts from luxury to necessity, from elective care to need-based care. It’s going to be tougher to sell those high-dollar cosmetic cases. Patients will be less inclined to stay with your practice if you are not on their company’s insurance plan. You will likely feel the pain of more no-shows and cancellations. But this is not the time to wallow in despair.

You may not be able to completely recession-proof your practice, but you can certainly minimize the impact if you follow what I consider to be the Four Tenets of Tough Times.

Tenet #1 – Be Flexible
This isn’t the time for hardliners. Tough times require a willingness to be flexible and an openness to do things a little differently, at least temporarily. For example, you may be philosophically opposed to participating in insurance plans, but patients are paying much closer attention to who is on their plans and who isn’t. If you’re losing patients or fewer new patients are scheduling, it’s time to reconsider your hard-line approach. Research the major employers in your area and find out what type of insurance they offer. What companies do the patients you’ve lost work for? Did they leave because you’re not on their plan?

If you do begin to accept assignment of benefits, send a letter to all your patients including those that have left your practice. You’ll likely find that the defectors never really wanted to abandon your office in the first place and would be glad to return.  

Look at your schedule and adjust for down times. If the office is a tomb from 2:00 to 4:00 p.m. this is a drain on the dollars. Consider condensing your schedule, working a longer morning shift and a shorter afternoon shift, such as from 8:00 a.m. to 1:30 p.m. and 3:00 to 5:00 p.m. This will make it easier for working patients to see you during their lunch hours, and staff won’t be sitting around. Or, if you can keep three days full but the fourth is riddled with holes, cut back to three days. 

Tenet #2--Get Real & Get Paid
Look at your fees. Are yours higher than your competition? You may feel your practice is worth the extra money, but unless patients are buying into your high-dollar philosophy, you’ll have a tough time keeping patient flow. It’s simply the realities of the current marketplace.

Consider foregoing an increase in fees this year. Send a letter to your patients thanking them for their loyalty to your practice. Take the opportunity to tell them that you are sensitive to the fact that many patients are experiencing difficulties as a result of the current economy. And in an effort to be responsive to the needs of your patients, your office is going to hold the line on fees this year, even though costs have increased for everyone, including your practice.

Next, make it easy for patients to pursue treatment. You may not be providing as much elective dentistry, but patients still have dental needs. Continue to diagnose based on what the patient needs to ensure the greatest level of oral health. Don’t fall into the trap of diagnosing just what you believe the patient can afford. The recession will be temporary, but dental needs and wants will remain. The patient may not pursue an entire treatment plan at this point, but as the economy improves so too will the opportunities to provide both necessary and elective care. 

That being said, you do have an obligation to make it as easy as possible for patients to pursue treatment immediately. Provide treatment financing options, such as CareCredit, that will help the patient afford recommended care. A cash-based practice is a worthy goal to pursue when the economy is thriving, but there are times, such as now, when you simply have to get real in order to get paid. 

Next week, avoid the #1 recession mistake.

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Nancy Caudill
Senior Consultant
McKenzie Management
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Seeing is Believing

Dr. Charles Gurney – Case Study #211

Dr. Gurney was concerned with an apparent plateau in practice production, no accountability for team performance and no systems in place to measure where the practice was heading. Dr. Gurney was averaging about 25 new patients a month but his production figures were not going up. With so many new patients, surely there should be higher production.

Like Dr. Gurney, most dentists are not trained sales people. The profession of dentistry is scientific and clinical in focus. It is assumed that patients will be motivated by the evidenced need and make appointments for the treatment. More and more dentists find out, once they open the doors to their practice, that there is more to it than that. The reasons a person may choose the profession of dentistry may entail the following:

  • Make a fair income to support a family
  • Help people obtain optimum health
  • Become a business owner
  • Work in a respected profession
  • Work flexible hours that support a balanced lifestyle

“Selling” is not on the list. Dental school does not offer “Sales 101” in its curriculum. The assumption is that patients are shown what they need and they will then say, I am sold--when can we get started?” Though some patients will respond this way, it is not the norm.

Much of dentistry is elective. Even a patient that visits the dental office in pain can elect to wait or choose to go elsewhere. Dr. Gurney was fortunate enough to be able to consult with 25 new patients a month but was not able to “close the sale.”

What does a patient consider when “buying” dentistry?
Patients make decisions to accept or reject treatment based on the following agendas:

  • Perceived value
  • Time away from work or family
  • Discomfort/healing time
  • Cost/ long-term value

This article is addressing “perceived value”. After evaluating Dr. Gurney’s chairside presentation to the patient needing a crown, the follow-up conversation by the assistant and the exit interview by the Scheduling Coordinator, the following observations were noted.


  • No intra-oral camera
  • No digital radiography
  • No educational DVD presentations
  • No presentation models
  • No digital photos
  • Poor “closing” statements
  • Lack of involvement by the patient

His conversation with the patient went something like this:
“Mrs. Jones, on tooth #31, I think that there is a small fracture of the distal cusp as well as recipient decay. I can probably place a crown on the tooth and that should hold you for a while. Good seeing you again. Take care.”
The diagnosis sounds skeptical at best, especially when the fee for the crown is $900.00.

Observations of Susan the Chairside Assistant:
“Mrs. Jones, I will walk you up to Jill, our Scheduling Coordinator, and she will schedule this appointment for you.”

  • No offer to acknowledge the patient’s concerns or answer any questions
  • No attempt to enhance the procedures’ benefits or explain the appointments necessary to make the crown

Susan’s primary goal was to get Mrs. Jones out of the chair and up to the front desk as quickly as possible so she could seat the next patient.

Observations of Jill, the Scheduling Coordinator:
“Hello Mrs. Jones. Would you like to schedule the appointment for your crown?” OK. Just call us when you are ready.”

Dr. Gurney’s Case Presentation
“Mrs. Jones, your tooth on the lower right side has an old silver filling that has served you well over the years.  However, there is a large break in the tooth now.  I also see a cavity as well.  Did you bite down on something hard recently?”

The appointment did not get scheduled because the patient was not given a professional treatment presentation by the doctor or the assistant. It is not the responsibility of the Scheduling Coordinator to “sell” the dentistry. His/her focus is to schedule the appointment and discuss the financial arrangements. Let’s review what should have happened by the doctor and assistant:

Dr. Gurney’s Case Presentation:
“Mrs. Jones, your tooth on the lower right side has an old silver filling that has served you well over the years. However, there is a large break in the tooth now. I also see a cavity as well. Did you bite down on something hard recently? The good news is that we can save this tooth! It won’t need to be removed! I will remove the cavity, reshape the tooth and place a beautiful porcelain crown on it.  It will last for a long time and look great.  How does that sound?

You will be here about 90 minutes.  I will make sure that you are comfortable at all times.  When your new crown returns from the lab, we will call you and schedule about 30 minutes to remove your temporary crown and place your new crown on the tooth.

What questions do you have for me?

I look forward to seeing you soon so we can save that broken tooth for you. I will turn you over to Susan for any additional questions you may have.”

Susan’s “Close”
“Mrs. Jones, I know that this was a lot of information. We want to make sure that you understand what has happened to your tooth and how we help you to save it. Do you have any questions for me that you need answered before we schedule your appointment?”

Jill’s Confirmation
“Mrs. Jones, I am so happy that Dr. Gurney will be able to save your tooth for you.  I understand that we need to make an appointment for you for about 90 minutes.  I have an appointment on Monday at 8:00 or Wednesday at 9:30; which one works best for you?”

Patient Education and the “Close”
Imagine how much easier it would have been for everyone if Mrs. Jones could “co-diagnose” her own treatment. She could SEE her broken tooth with a digital photo or intra-oral camera view. She could HEAR about a crown through an educational video and she could FEEL what a crown is by the dental model that she is given.

Seeing, hearing and feeling all increase the perceived value of any dental procedure, helping the patient to make an educated decision. 

When your patient says, “I need to think about it,” to the Scheduling Coordinator, the doctor and the chairside assistant did not “sell” the treatment to the patient. The patient still has questions that have not been answered.

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

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Belle DuCharme CDPMA
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What’s Wrong with Multitasking?

Multitasking is a necessity of every dental Business Coordinator. It is difficult sometimes and always unpredictable. The moment she/he enters the office, the phone is ringing with patients wanting appointments or questions to answer about billing or insurance. The computers need to be turned on, email and phone messages must be retrieved and cancellations dealt with immediately.The team members show up one at a time and want to be greeted or have a question to answer. The morning huddle is about to begin and he/she needs that first cup of coffee. Who has time to make it?  It is another task for the already frazzled Business Coordinator. 

According to a study done by University of Michigan psychologist David E. Meyer, PhD., multitasking does not increase efficiency, but actually slows you down and adds as much as 40 percent to the completion time compared to finishing one job at a time and then beginning another. Switching among tasks creates stress and divides your attention. Plus, it’s harder to remember where you left off and time is necessary to shift brain gears. With practice, the brain can become somewhat more efficient at handling multiple tasks, but usually performance suffers compared with doing one task to completion at a time.

According to Dr. Meyer, the brain is not designed to multitask. Computers, where the term “multitasking” originated, seem to process information simultaneously, but the brain appears to do it sequentially. Scientific studies show that the brain can’t double its processing capacity when it is multitasking. Multitasking is easier if one of the chores is automatic like listening to music while folding laundry. If a person is attempting to do two complicated tasks at once, success at either is not as good as it would have been when doing one at a time.

To work more productively, Dr. Meyer recommends that the multitasked take breaks between difficult tasks for a short walk or a deep breathing exercise. He also suggests intelligent time management, like scheduling difficult tasks during times when you can concentrate and saving routing duties for when interruptions may occur.

Time management is the key to successful multitasking as is delegation of tasks to other team members. Creating written job descriptions is a way to fairly disperse duties so that one team member is not overburdened with more than one task that requires uninterrupted concentration during the workday. For instance, the person posting the insurance checks daily should not be doing this chore while answering the phone and entering new patient data.

Treatment Coordinators or Business Coordinators who must present treatment to patients must not be checking other patients out or answering the phone simultaneously. Unfortunately, it is common to see one or two frantic front office people trying to do it all at once. Studies have shown that this method results in poor customer service, errors in scheduling, posting, billing and low treatment acceptance figures. 

For example, Mary is making an appointment for Mrs. Bonnie Jones at the front desk and is also about to enter her credit card payment. The phone rings and it is Brian Jones, who wants to discuss the balance of his account. Bringing up Brian Jones’s account, Mary accidentally enters Mrs. Bonnie Jones payment on his ledger. These mistakes are all too common in offices where operating systems are not efficiently managed and team members must multitask to get things done.

The preferable scenario would be for Mary to tell Brian Jones: “Mr. Jones, I will be happy to discuss your account balance with you; however, I must research it and give you a call back. Can I call you back between 2:30 and 3:00 pm today? What is the best phone number to reach you at?” The patient checking out at the desk takes priority over the patient calling in regard to his account balance.

Presenting treatment requires uninterrupted time with the patient. It takes time to know the patient’s style of communication, time to educate the patient on different treatment options and time to answer questions. Making good business decisions about the priorities of the work day would be to create a window of opportunity without the chaos of multitasking to address the most important purpose of the dental practice--to treat patients.  So often in dental practices, the focus comes off of the patient in favor of daily tasks. 

Creating efficient dental office systems is the driver of the Advanced Business Training offered at McKenzie Management. Want to learn how to create these successful systems? Call today us today and get started.

For more information about McKenzie Management’s Advanced Training courses, email, call 1-877-777-6151 or visit our web-site at
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