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6.27.08 Issue #329 Forward This Newsletter To A Colleague
Dental Helpers
Keeping Your Job
Case Study

Helpers - Practice Necessity or Luxury?
by Sally McKenzie CEO
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It’s the end of yet another long and stressful day. Madison had to take the afternoon off unexpectedly because her son developed a fever. Last week, Sarah’s car broke down on the freeway and she was three hours late getting in. Recently, Joe’s basement flooded and he had to take two days off to deal with the mess. Yes, life is riddled with unexpected situations that can leave you stressed out and struggling for some way to prepare your practice for the impact of everyday life and work. Having someone who could just step in and take over in a pinch would help tremendously, you reason.

After all, even when the office is fully staffed and things are running smoothly, it seems it’s still a struggle to try to get everything done. Collections are dropping because there isn’t time to follow up with patients. Appointment confirmation calls are always an afterthought. Instruments aren’t ready when you need them. You are starting to think seriously about bringing on just one more person—a floater or helper, if you will. This person would be cross-trained, ready and waiting to manage those unexpected situations as well as help ensure that day-to-day tasks stay on track. Gosh, that sounds good! It’s a simple answer; you just need a little more help. Sure, it will require a bit of an investment, but it can’t be that much.

STOP. Before you take this dreamland fantasy one single step further, splash some cold water on your face, run a few numbers and take a look at a few benchmarks. Don’t make a major decision, such as hiring more staff, based on a gnawing gut feeling. It’s not a reliable indicator. Read on.

First, check out your check in. It takes approximately 10 minutes to check in and check out each patient. There are 480 minutes in an 8-hour workday. If your practice is seeing 15–22 patients per day, which would total 150–220 minutes of patient contact, one person should be able to handle front desk duties.

If the doctor has 14 or more scheduled patients a day, not including hygiene exams, he/she needs a second assistant. However, if procedures are streamlined, one assistant can efficiently maintain two treatment rooms for a general dentist who uses two operatories and sees 13 or fewer patients a day.

Patient dismissal should take two minutes, while the disinfection of treatment rooms and cleaning/sterilization of instruments should take less than five minutes. Moreover, if your state allows for expanded functions for assistants, start maximizing those resources.

Next, assess the attitudes. Does your team include a “not-my-jobber” or two who are inflexible, refuse to step up to the plate, yet constantly make demands? You know the type; they wouldn’t answer the phone if it were the White House calling and the President had a dental emergency. Scrub instruments? You must be kidding! Their favorite phrases are, “I don’t have time to do her job,” and “The doctor doesn’t pay me to do that,” or, “That’s not my job.”

Could your existing team actually handle current demands as well as the unexpected situations that are bound to occur if you addressed the “not-my-jobbers” who are pulling your productivity down?

If you still contend that another warm body is the answer to all that ails your practice, make sure you know exactly what the financial impact is going to be or I guarantee you’ll be trading in the occasionally stressful day for many a sleepless night as you lie awake wondering how you’re going to pay for it all.

Let’s say your current monthly collections are $42,325 per month and your existing salaries are $9,353; you are already at 22%. The benchmark is 20%, not including taxes/benefits, which is typically another 3–5%. A $12 per hour helper working 30 hours per week will increase salaries to $10,793. That will put you at 25.5% of collections and well above the standard.

Obviously a new helper is a potentially major expenditure that requires careful and deliberate consideration. Before you spend more money, make sure you have clearly defined job descriptions and goals for everyone on staff. And, most important, develop a plan to bring in more revenues by shoring up recall, making sure patients follow through with diagnosed treatment, improving treatment presentations, enhancing new patient communication skills, etc.

Otherwise, you’ll likely find that a little helper is a luxury your practice simply cannot afford.

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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Belle DuCharme CDPMA
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Recession - Proof Your Job

A relationship isn’t meant to be an insurance policy, a life preserver, or a security blanket. —Diane Crowley

Weary of the latest economic headlines? Wonder when it will end? Dentists have rising overhead costs for equipment, products and supplies and also bear the burden of rising shipping costs. Patients reading the newspaper or watching television may decide to cut back on spending everywhere and that includes the dental office.

Dentists who own their practices cannot be fired but they can take a pay cut. If production and collection statistics fall below the ability of the practice to pay for necessities, action has to be taken. There is an old saying that no one is irreplaceable—especially if that person doesn’t visibly contribute to the practice success.

What can you do to make yourself an asset that the dental practice cannot operate without? Key business personnel are necessary to operate the successful growing practice. True, the dentist may be able to answer the phone, file insurance, collect fees, answer questions about financing, research unpaid insurance claims, send out new patient packets, check email, post insurance checks and send statements, but not while doing dentistry.

What does it mean to be a key person to the practice success? First, look to your job description and make sure you are doing the complete list of duties to the satisfaction of your employer. For instance:

  • When was the last time you called inactive accounts to get them back in for a professional cleaning and exam?
  • What is the treatment acceptance rate compared to the treatment presented?
  • Are you enthusiastically recommending diagnosed treatment and motivating patients to make appointments or are you telling patients to just call when they are ready?
  • Are you taking the extra time to educate patients on the value and benefit of recommended dental procedures or are you telling them to just read over a brochure and call back if they have questions?
  • Are there any unpaid dental claims past 31 days on the insurance report that you haven’t researched and responded to?
  • Is the 90 days past due on the Accounts Receivable report less than 12%? If it is higher, are you making collection calls and getting payment commitments?
  • Are you collecting the co-pays and deductibles at the time of service every day to result in a 45% over-the-counter collection rate (for practices that accept assignment of benefits)? Unpaid claims and overdue monies represent practice revenue not collected and possibly the difference between a layoff and a retained position for you.
  • Are you making at least 5 calls a day to unscheduled recall? Results of this practice have shown a 20 to 30% increase in patient retention. Even in the worst of times, people need professional teeth cleanings and exams, basic restorative, endodontic and oral surgery, and periodontics to stay healthy. Cosmetic bleaching and purely elective restorations can wait but don’t stop suggesting to those who may benefit.

Second, consider going beyond your job description and getting the team involved in an internal/external marketing campaign to improve patient satisfaction. These are some things you can do:

  • Start a patient survey to get feedback from your patients.
  • Visit local businesses and leave cards and “dental care” packets for employees.
  • Offer economic incentives to people who work in your building or in the neighboring businesses, such as a special package of services, and then make sure to give them the best customer service they have ever had in a dental office.
  • Start a patient “Birthday Club” and send cards signed by the team.
  • Treat every patient like a VIP every day. Say, “We appreciate you and always look forward to seeing you.”
  • Ask your patients for referrals to their friends and family. They may think you are too busy or not seeing new patients.

We have experienced downturns in our economy in the past. The best way to counter the negativity is to remain positive and take action that will benefit all. For help turning the negative to the positive, consider ensuring that your business systems are operating at peak efficiency and enroll in one of McKenzie Management’s Advanced Training Programs. When you know that you have the tools to measure your practice growth and performance and have been taught what to do in slow times, it can be a source of comfort and confidence that you are doing all you can do to protect the practice and your job.

If you would like for McKenzie Management to train your Business Coordinators, please contact us at 877-777-6151 or, or visit our website at
Interested in having Belle speak to your dental society or study club? Click here.

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Nancy Caudill
Senior Consultant
McKenzie Management
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Where Is Your Lost Revenue?

Dr. Larry Short—Case Study #341

Dr. Short’s Concern:

With fewer new patients coming into the practice, production has slowed down alarmingly. What steps can be taken now to correct the situation?

Dr. Short’s Practice Facts:

  • 8-year old practice in a small town
  • $43,000 a month in net production
  • $43,000 a month in net collections
  • 11 new patients a month
  • 1 doctor working 4 days a week
  • 1 hygienist working 4 days a week
  • 1 business team member and 2 chairside assistants
  • No internal marketing


  • The morning meeting was ineffective and did not direct the entire team as to how each member would be participating during the day. The doctor conducted it by simply looking at the schedule and asking questions regarding the treatment that was scheduled for that day.
  • There weren’t any established production goals for the doctor or hygienist.
  • The hygienist was not reviewing the patients’ charts for diagnosed treatment that was not scheduled to be completed.
  • The chairside assistants were not seeing that the patients understood the recommended treatment after the doctor left the treatment room.
  • There were no dental presentation models, dental videos or other educational tools available to facilitate patient education and informed consent.
  • The doctor didn’t “close the sale” of his treatment recommendations but rather left it up to the Scheduling Coordinator.
  • Treatment presentations by the Scheduling Coordinator were presented as total treatment without the patient understanding the number of appointments and the time involved in each appointment.
  • The Scheduling Coordinator did not have a follow-up or tracking system in place to monitor patients that elected not to schedule recommended treatment.


  • The morning meetings were expanded to include reviewing any treatment that was recommended for a patient but not yet scheduled. Such information is available on the routing slip that is printed for each patient from the computer. The routing slips are reviewed by the Scheduling Coordinator with relevant information highlighted, including outstanding treatment. (Dr. Short’s practice is virtually paperless but the routing slips are used for communicating vital information between the business and the clinical team members at the morning meeting.)
  • Daily production goals were established for the doctor and the hygienist.

    Hygiene daily goal: 3x the hygienist’s daily salary
    Doctor’s daily goal: determined by reviewing the practice overhead percentages

    In Dr. Short’s practice, the hygiene goal was set at $840 and the doctor’s goal was set at $3035. It has since been increased to $864 and $3,091 respectively.
  • The hygienist and assistants were given scripts to use as guidelines to educate patients about recommended treatment. By increasing a patient’s perceived value you will usually increase case acceptance. Using models and educational videos assists in this process. Encouraging a patient to ask questions opens up the avenue to discuss concerns about treatment. Patients will say no to something they don’t understand or feel that they don’t need. It should be the team’s goal to alter the perception of the patient’s dental treatment from “need” to “want.”
  • Dr. Short changed his treatment presentations. After using the intra-oral camera and including the patient in his diagnosis, a decision was made by the patient AND the doctor regarding treatment options. The patient was no longer overwhelmed with too much information and rendered unable to make a decision. The treatment plan was then presented by the Scheduling Coordinator for only the next phase of treatment instead of the entire treatment plan. This approach makes treatment acceptance much easier for the patient, especially from a financial concern.

When the practice implemented recommended changes there was a considerable increase in the production and collection statistics as follows:

  • $71,000 in net production
  • $70,000 in net collections
  • 12 new patients a month
These numbers reflect a 65% improvement in net production and collections after the recommendations were implemented.

Dr. Short was diagnosing a complete treatment plan and then saying good-bye to the patient. It was left up to the Schedule Coordinator to sell the entire treatment plan and attempt to manage financial arrangements. Her acceptance rate was below 35%.

Now, Dr. Short asks the patient to “co-diagnose” their needs using the intra-oral camera and digital photos to determine what procedures are going to be addressed first. The most important question he asks is, “Mrs. Jones, do you have any questions for me regarding what we are going to do at your next visit?” If she indicates no, Dr. Short thanks the patient and tells her that he looks forward to seeing her at the next appointment.

Patients will complete their recommended treatment if they like and trust you and your 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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