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12.12.08 Issue #353 Forward This Newsletter To A Colleague
Change Your Practice For '09
Consultant Case Study
Treatment Acceptance

Create Your Own Positive Change In '09
by Sally McKenzie CEO
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There’s been a fair amount of talk about change in recent months. Change in our elected officials, change in our country’s policies, change here, change there. For some practices, change can’t come soon enough, but I’m not talking about external change (the stuff you’ve been reading about in the newspaper or watching on television). I’m talking the internal change that only you can make in your practice—the change that many should have made early in 2008.

For months, practices have been suffering from a serious case of tunnel vision. You’ve been so busy doing the same thing with the same people the same way that, even when economic shifts demanded new approaches and strategies, you were so far into the tunnel of doing things the way they’ve always been done that you couldn’t see a way of doing anything different.

It’s easy to get lost in being busy when the next task, procedure or problem waiting for you to address is the single most important item on your list. Perhaps you’ve known some things could be improved, updated, maybe even overhauled, but up until recently you told yourself you didn’t have the time to think about it. So the team just scurried along, enduring the same old problems.

Enough is enough, Doctor. If the struggles of 2008 taught us anything it’s that problems ignored become crises with potentially disastrous effects. Certainly many practices have suffered their share of no-shows and cancellations in the past year, but have you suffered them because your employees never considered changing how they talk to patients?

The goal is to use verbal skills to control the schedule by guiding patients to specific openings. Avoid asking the patient, “When would you like to come in?” The Schedule Coordinator should know when the next available appointment is for the procedure required and guide the patient to that time. For example, say, “Mrs. Jones, we can see you on Tuesday the 4th at nine o’clock or Thursday the 6th at 3:00 p.m. Which would you prefer?”

In addition, take steps to discourage patients from canceling appointments. Last-minute cancellations are a source of frustration and significant stress for everyone, and they can quickly undermine daily production goals.

When patients call to cancel, ask for permission to put them on hold, access their files and try to find something that will motivate them to keep their appointments. If a patient is coming in for a crown prep and the doctor has a note on the treatment plan that the decay was deep or the tooth was fractured, the Schedule Coordinator should mention it to the patient. For example, say, “Mrs. Jones, I’m looking at the doctor’s notes and she indicated that there is significant decay in that tooth. I know it is very important that you keep the appointment; would you reconsider?” A patient may still cancel, but some will be convinced to keep it. Moreover, calling specific attention to the patient’s need for the appointment further underscores the value and importance of pursuing the recommended treatment.

Beyond that, practices need a mechanism to follow up with patients who cancel. Many practices are seriously lacking any type of follow-up system. Patients will cancel and it will be months before anyone in the practice even thinks to try to contact them again.

Routinely emphasizing the value of ongoing oral hygiene care has never been more critical, particularly because many patients view such visits as optional rather than necessary treatment. Hygienists should take the time to verbalize exactly what they see clinically. At the end of an appointment, remind the patient about findings, such as the pocketing on the lower left that is of more concern now than it was at a previous appointment.

The “everything looks great, see you in six months” approach is the best way to ensure production shortfalls for both doctor and hygienist. If everything does not look great, remind patients about the areas of concern and document the findings. When confirmation letters are sent a few months later, the findings can be noted again in them, as well as mentioned by the Appointment Coordinator when confirmation calls are made to the patients.

With the dawn of a New Year just a few days away, there is no better time to ensure that you create your own positive change when the sun shines on 2009!

Next week, solve the #1 practice puzzle in ’09.

Interested in speaking to Sally about your practice concerns? Email her at
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Nancy Caudill
Senior Consultant
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Scheduling Traps That Trip You Up!

Dr. George Graham—Case Study #224

Dr. Graham’s Practice Statistics:

  • 1 doctor and 2 assistants working 4 days a week
  • 20-year-old practice at the same location
  • 7 hygiene days per week
  • 2 business assistants working 4 days a week
  • Doctor daily gross production currently—$2,800
  • Doctor daily gross production last year—$3,300
  • Collections at 98% of net production

Dr. Graham enjoyed a slower pace and dedicated time to chat with his patients. His patients liked him and paid for their dental services. Everything appeared to be normal, including his schedule, which at first glance was "full." The entire left column was filled from 8:00 until 5:00 with an hour for lunch and the adjacent column had patients sporadically scheduled throughout the day. Upon further scrutiny, however, there were many scheduling mishaps that were probably the root of Dr. Graham's feelings of being trapped. They are identified below.

Scheduling Traps:

  1. The combined practice goal of $6,000 did not include a specific goal for Dr. Graham.
  2. “Doctor Only” procedures were scheduled in both columns.
  3. Too much time scheduled for procedures resulted in unused time units.
  4. Too many non-productive appointments were scheduled in one day.
  5. There was an apparent need for more dental assistants!

What was discovered in Dr. Graham's practice was that Sharon, his Schedule Coordinator for seven years, had resigned to start a family. Dr. Graham then hired Kathy, who had 3 years of dental experience. Dr. Graham assumed that she knew how to orchestrate a productive schedule, so therefore spent no time giving Kathy the proper training that she needed. How hard could it be to put names on a schedule and keep the holes filled? Kathy certainly knew how to do that!

Unfortunately for the doctor, Kathy was getting caught in these scheduling traps, because she didn’t even know what she didn’t know.

How to Avoid these Dangerous Scheduling Traps:

  1. Set a daily production goal for the doctor. This goal can be based on many different criteria, such as a general overall increase of 20%, establishing a 55% overhead, gross wages overhead of 20%, etc. Remember that the hygiene goals must be established first (after the practice goal is established). The remainder of the production must be achieved by the doctor.
  1. Understand doctor procedures versus assistant procedures. Most dental software programs allow you to set up default times for procedures, as well as designate each unit of time as doctor time or assistant time. Set up your procedures with the accurate assistant/doctor time to make it easier for the Schedule Coordinator to properly utilize both columns of the schedule. Educate your scheduler about why it is impossible to perform a root canal procedure in one treatment room and simultaneously prep a quadrant of composites in the other treatment room.
  1. Schedule the proper amount of time for each procedure. How would the Schedule Coordinator know? Because the information is provided on the routing slip by the assistant when the patient is "passed off" to her at the front desk. Yes, default times can be set up in the computer to make it easier but it is important that customized time be assigned to each patient. Only the doctor and assistant know how difficult the 1-surface resin filling is going to be on Mrs. Jones or how quick and easy a 3-surface posterior restoration will be for Mr. Smith. Sometimes the default time is not applicable to a patient. This information is crucial to proper and productive scheduling.
  1. Limit the number of non-productive appointments per day. Dr. Graham had one day with 4 crown cementations. When the doctor says, "Mrs. Jones, Kathy will schedule an appointment for you in two weeks to get that new crown placed for you," it’s just a guideline. If he prepped 4 crowns that day, don't give him 4 crown seats in exactly two weeks—spread them out a day or two apart. Pre-determine how many crown seats you are willing to do in a day, as well as other non-productive appointments, such as wax try-ins, final impressions, etc. All these procedures eat up doctor time and do not create additional production. The daily goal will not be reached with too many of these appointments.
  1. If the schedule is properly managed, there is no need for additional assistants. Doctors sometimes feel that they can produce more if they have one more assistant and can open up one more treatment room. Wrong! No matter how many treatment rooms and assistants you have, YOU can only be in one place at one time.

Dr. Graham was happy to call recently to report that after professionally training his new Schedule Coordinator, his daily production is reaching almost $4,000 a day and he is only seeing 8 to10 patients instead of 15 to 17. He is now working smarter instead of harder.

Please contact McKenzie Management to learn how to rescue your business team from scheduling traps.

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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Speaking The Language Of Treatment Acceptance

Dentists have always been concerned about whether a patient schedules for treatment after the initial comprehensive exam. “Did I convince them with the overkill of diagnostic information and the need to get the work done?” The need for treatment can be easily demonstrated, so why isn’t there 100% acceptance? Often after presenting a comprehensive treatment plan, the dentist is dismayed to hear that the patient did not schedule and wonders what went wrong.

Most of the time, the dentist presents the treatment and the assistant charts and enters the treatment plan in the computer. The patient is then released to the Scheduling Coordinator to set appointments.

In many practices, a Treatment Coordinator presents the treatment options, secures financing and schedules appointments after the patient receives the diagnosis from the dentist. In either situation, unless there are ways to measure the success of the system, it is unknown as to how to improve it. There isn’t a system of checks and balances to monitor whether the presentation was poor, satisfactory or excellent. Without a system of critiquing the presentation, nothing is done to work on perfecting it or identify ways to improve the communication. There are assumptions made about the patient’s refusal, such as whether or not the patient can afford it, and the matter is usually not investigated beyond that. To create a system to critique treatment presentations, ask yourself the following questions:

  • How much did you get to know about your patient prior to presenting treatment?
  • Did you acknowledge the “chief concern” and the motivation of the patient to seek treatment?
  • Did you give the patient your undivided attention?
  • Did you inspire confidence by sincere enthusiasm, eye contact and body language?
  • Were you able to relate the proposed treatment to the patient’s motivation?
  • Did you engage in active listening and allow the patient to co-diagnose?
  • Do you know the psychographics of the dental community where you practice and the dental implications of the patient in relation to their ZIP code?
  • Were there absent decision makers who should have been involved?
  • Did you gain agreement on each phase before going on to the next?
  • Did you achieve informed consent in your education process?
  • Were you able to demonstrate your skills with a polished case book?
  • Did you ask the patient to accept the treatment plan

In the Treatment Acceptance Training course offered at McKenzie Management, the focus is on building relationships with patients after first understanding that personality types, demographics and psychographics of patients are critical to them accepting treatment.

Trust is a reason patients choose one dentist over another, and building trust requires time with the patient to communicate the level of care and attention they will receive. In the process of building trust you will uncover hidden objections that would not have been communicated otherwise. Once the proper foundation for presenting treatment has been established, it is time to work on the actual presentation or verbal exchange between the treatment presenter and the patient.

Take, for example, the story of Tabitha, a Treatment Coordinator (not her real name). She attended the Treatment Acceptance Training to polish her presentation and to improve her acceptance of larger cases. Tabitha was known as the “closer” or the “money person” in her practice and it showed in her style of treatment presentation. She came in at the end of the doctor’s diagnosis and did not hear anything that had been said to the patient. Tabitha also did not meet the patient prior to going in to “close” the sale. Her approach was to quickly ask if the patient understood what was presented and to explain the financial policy and get an appointment. Though it usually worked in smaller cases, the larger cases or multiple phase cases were left on the table. She was convinced that those patients could not afford the treatment.

After hearing her three recorded treatment presentations, she became aware that her main focus was the money; she did not spend any time with patients to address questions or concerns that they might have about their treatment plans. Her vocal speed sounded rushed and her tone was impatient. She talked over patients when they raised objections, forcing them to become quiet. Tabitha said that she always felt rushed because she had administrative tasks to complete before the end of the day.

The instructor used a point-by-point critique form to evaluate her presentation and give her feedback on improving what was said and how the patient responded to the presentation. Without this information, Tabitha would not have learned where she needed to improve.

Tracking the numbers of treatment acceptance is also necessary to accurately measure success. Salespeople who do not learn ways to improve their efforts will repeat the same business year after year. Salespeople that have been selling for ten years or more and haven’t improved sales quotas really don’t have ten years’ experience. Rather, they only have one—they haven’t increased their knowledge in ten years. Improve your presentations by signing up today for McKenzie Management’s one-day customized Treatment Acceptance Training. The course is designed to improve the performance of any team member that presents treatment.

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

Interested in having Belle speak to your dental society or study club? Click here.

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