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12.24.08 Issue #355 Forward This Newsletter To A Colleague
Treatment Acceptance
Consultant Case Study

Managing The Practice Micromanager
by Sally McKenzie CEO
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It is said that the number one fear for most people is public speaking. That may be true unless you happen to be a dentist/practice owner. In that case, I would argue that for many of these types, what they fear the most is loss of control. They are accustomed to doing it all themselves and handing over responsibility for even those seemingly insignificant tasks can be a struggle.

Consequently, these micromanaging doctors are stressed out, working and working, yet never able to actually get ahead. Forget quality of life, forget balance, these docs are living their jobs. Meanwhile, the employees working in these practices are operating in misery mode. They are treated like children; therefore, they act like children. They’ve learned that the doctor won’t be happy unless he/she does it his/her way. Don’t do anything unless you’re told. Don’t make a decision on your own. Don’t take the initiative to address an issue yourself. And, if at all possible, please don’t think unless directed to do so. It’s not an environment that quality employees will tolerate for long, which would be why they seem to change with the seasons.

Dentists by their nature are high achievers and thus more likely to be micromanagers. They didn’t get through dental school by leaving the details to someone else. Most are intense, focused perfectionists. In fairness, oftentimes the micromanaging doctor feels a strong sense of responsibility. He/she may well have built the practice from the ground up and may feel that she/he must control all aspects of it.

2 Weeks

However, like most micromanagers, they tend to confuse activity with accomplishment and consequently create bottlenecks of inefficiency. Even more frustrating for these dentists and their staffs is the fact that they are quite capable of thinking strategically, but they simply cannot bring themselves to relinquish control. They will not allow others to problem solve, and they consistently second-guess decisions, yet if the practice is going to grow and truly succeed, the doctor simply must let go. But how do you bring your micromanaging dentist to relinquish a few of those tightly held responsibilities?

Number one: Don’t try to change them, only they can do that. Instead, work with what you have. One of the greatest needs your micromanager has, outside the need to feel needed, is the need to know. Try to understand where the dentist is coming from. How can you help your doctor achieve the goals and objectives that he/she has for the entire practice. Where does he/she want to take the business? What matters most to this person in terms of their goals? What can you do to help?

For example, perhaps your micromanaging dentist really wants more time for treatment planning to encourage greater case acceptance, but at the same time insists on giving all patients their post-op instructions, which only puts everyone behind schedule.  Develop a detailed step-by-step plan that outlines how you could help the doctor with this duty. Explain to the doctor that you would like to handle this for her/him in a way that she/he will be completely comfortable and confident that patients receive the post-op information they need.

Trust is critical to the micromanager. Take steps to build it by keeping him/her informed from the beginning and at every step along the way. Even though you are perfectly capable of completing the task without their direction, be open to their input and suggestions. Most importantly, be completely dependable. If you drop the ball on responsibilities that you’ve committed to, your micromanaging dentist will not feel that he/she can trust you and will swoop in and take over yet again.

Stay one step ahead of your micromanaging boss by updating him/her regularly. You cannot communicate too much with this type of person, but it is very easy to fall into the trap of thinking that you’ve done everything you need to keep them informed. If they have to ask you about the status of something you have agreed to complete for them, you’re not holding up your end of the bargain in their eyes.

Next week, doctors, live and let go.

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Belle DuCharme CDPMA
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What Are Your Patients Really Thinking?

How do we really know what our patients are thinking of our practice? Consider that only four out of one hundred people who stop being your patient will ever tell you why they left. Often a formal patient survey will reveal some reasons patients leave but not all. Making every attempt to improve your front office customer service and the quality of clinical services are certainly ways to limit your losses but what about the other reasons that patient’s leave like the reason illustrated in the following scenario.

Why would a dentist need a coach? Learn to be a better leader. Click Here

At a business training session, ( McKenzie Management) with Dr. Smith and his Business Coordinator, Millie,(not real names) Dr. Smith communicated that he wanted to increase treatment acceptance numbers and felt that his presentations were excellent.  At break time, Millie pulled me aside and said that patients leave the practice because they do not like Dr. Smith’s personality.  “He is very abrupt and impatient when patients do not understand the treatment”, she said. She went on to say that Dr. Smith used the “fear factor” to motivate patients to accept treatment but instead it frightened many of them into leaving without appointments.  She had not discussed this patient feedback with Dr. Smith for fear that he would be upset. Interestingly, Dr. Smith pulled me aside, when Millie stepped out of the room, and expressed concern that the treatment acceptance stopped at Millie’s desk. “I think she talks the patient out of the treatment because she thinks they don’t need it,” he said.

This miscommunication created the “blame game” as to who is at fault and was distracting from the goal of creating value for the patient to buy services.  Creating value requires that we raise our standards about how we interact with our patients, our own character and integrity and the value we place on the doctor/patient and staff patient /relationships.  In other words, there are times when we have to do some “soul searching” to acknowledge the responsibility each of us has in building these relationships. If Millie had communicated the patient feedback to Dr. Smith, he may have realized that his presentation was not getting the result that he had anticipated and would have altered his approach. Dr. Smith’s perception of Millie’s attitude toward diagnosed treatment should have been addressed as soon as he thought she was discouraging patients from having treatment.  What is Millie’s dental IQ?  Does she value the benefits of a healthy mouth?  Dr. Smith had never taken the time to find out how Millie feels about dentistry. 

Patients accepting treatment cannot be the responsibility of one member of the team.  Even if Dr. Smith presented a detailed dental diagnosis that contained a measure of urgency, it would be of benefit to Millie to understand why he believed this and to “buy” into his practice philosophy.  Some patients will tell the assistant, hygienist or, in this case, the Business Coordinator things they won’t tell the dentist. Sometimes the patient will look to the auxiliary personnel in making decisions and therefore the team member with great selling skills can be a tremendous asset to the practice. Patient acceptance of treatment will often depend upon the ability of the team member to communicate the benefits of the treatment. They must understand and believe in the treatment. If they are less than enthusiastic or they don’t believe the treatment is necessary, it will be communicated to the patient either verbally or nonverbally.

The plan of action was to role play a treatment plan with Dr. Smith. Using a voice recording device the presentation was recorded. The next step was to record Millie presenting the treatment options to the patient, securing financing and scheduling appointments.  Uncomfortable as it was for both, the playback of their presentations created a platform where an analysis could be performed. From the playback we were able to point out to Dr. Smith how he created fear in the patient with his strong verbal attack. He was quite surprised to hear this in his voice and made a promise to work on his delivery.  Because the line of communication had opened up, Dr. Smith was able to communicate his concern to Millie about discouraging patients to have necessary care.  Millie admitted that she had told some patients that they could “wait” on some treatment after they had asked her if it was absolutely necessary to do it now. She had done so without consulting Dr. Smith for fear of his reaction. With a new understanding it was time to focus on improving the lines of communication between Dr. Smith and Millie.  A monthly meeting to discuss treatment acceptance statistics and ways to improve treatment presentations was put on the calendar along with scheduled follow-up calls to McKenzie Management for support and guidance.  Improve your lines of communication today by enrolling in one of our advanced training courses and start the New Year off right.

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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Nancy Caudill
Senior Consultant
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Is Your Overhead Over Your Head?

Dr. Sam Blackwell – Case Study #134

Have you looked at your overhead percentages lately?  A healthy general practice should be running around 55-60% of collections. Consider this scenario and see if this might apply to you:

Dr. Blackwell’s practice statistics:

  • 1 doctor, 2.5 assistants, 2 part-time hygienists and 2 business employees
  • Doctor purchased this 20-year old practice 6 years ago.  The office sees patients 4 days a week - 192 days per year
  • 4 hygiene days per week
  • 2 Business assistants working 4 days a week
  • Doctor daily gross production - $4,000
  • Hygiene daily gross production - $1,175
  • Collections at 99% of net production

Dr. Blackwell enjoyed a steady pace and was not interested in seeing more patients or increasing his production. 

Currently, his overhead is at 69%, 9-14% higher than industry standards.  After scrutinizing his fixed expenses monthly, it was determined that the following areas would need to be reduced:

Bridge The Gap

Overhead Reductions:

  • Staff benefits - He was currently at 6% of collections - 1-3% higher than industry standards.  He had no ceiling on the amount the practice was paying for health premiums, which was currently costing the practice $300-400/month per employee.  He was also reimbursing his staff for "sick days" that were unused at the end of the year at their regular daily pay.
    His 3 part-time employees were also getting a full range of benefits, including paid medical premiums, vacation, sick and holiday pay.

    A bonus system was in place based on production and collections.
  • Employee reductions - one part-time assistant was working as a "hygiene assistant".  However, when adding her salary to the salary of the hygienist, instead of the hygienist producing 3x their combined salary, she was only producing 2.5x. This shortage in her production was equivalent to the salary of the assistant; therefore, assisted hygiene was not profitable, especially considering that the practice was also incurring benefit expense for the assistant.
  • Accounting expenses - The office manager was keeping excellent records and managing the accounts payables.  The practice could save expenses by changing the accounting services to quarterly instead of monthly.
  • Continuing Education Courses - Necessary but can be costly if not getting a return on the investment.
  • Dental Supplies - The doctor was "new product" addicted.  Anything new that hit the market he had to buy. His dental supply overhead was 9%. Industry standards are 5-6%%.


Staff benefits: No more benefits for "part-time" employees.

  • A ceiling was placed on the medical premiums of $200/month per full-time employee.
  • Unused "sick days" were reimbursed as a courtesy at $50/day
  • The bonus system was removed until the gross salary overhead was 22% or less of net collections

Employee reductionsBecause the "assisted hygiene" was not profitable, the part-time hygiene assistant was dismissed with a nice letter of recommendation to assist her in finding new employment.

Accounting expenses: The accounting services were reduced from monthly to quarterly, with the office manager providing monthly P&L reports to monitor the practice overhead.

Continuing Education: The doctor determined that in the future, CE courses would be "hands-on" courses that would reflect an ROI, such as orthodontics or aesthetics. 

Dental Supplies: An assistant was assigned to "manage" the ordering of disposable supplies in the clinical area. The new practice rule was that no new product was ordered until the existing product was used. She also worked closely with the supply rep to help keep her expenditures to 5% of the practice collections.

Work Smarter and not will he do it?
There was no doubt that with a practice of 20 years, there should be at least 2 hygienists working full time in order to provide care for the retained patients. In Dr. Blackwell's case, at the time the practice was purchased, there were only 4 days of hygiene and it remains so today.

# of practice years

# of new hygiene patients/yr

Retention of 50% of total patients

Recall intervals of 6 months

Appts.needed currently to maintain patients






The above figures indicate that Dr. Blackwell's practice should have a minimum of 4,800 appointments available per year to service his patient base. 

Appointments needed

/ # patients seen per day

= # of days needed

/ # of weeks worked

= # of hygiene days per week






If an average hygiene visit produces $125, then 4,800 appointments is equal to $600,000!  Currently, Dr. Blackwell has 1,536 hygiene appointments that are equivalent to $192,000.  That is a difference of $408,000….and this is income lost in one year!

By implementing recall systems to improve patient retention to 90% based on the # of new hygiene patients coming into the practice, Dr. Blackwell will enjoy the income produced by his hygiene department, as well as increase revenue from the exams and treatment that is recommended.  How would an additional $400,000 a year affect your bottom line?

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

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