03.13.09 Issue #366 Forward This Newsletter To A Colleague
Hygiene Pay And Production
Case Acceptance
Hygiene Consultant

Is Hygiene Pay Outpacing Production?
by Sally McKenzie CEO
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There you are sitting in your office across from the hygienist. She wants more money. You want to be fair. You believe in compensating your employees well. But you don’t want to send overhead into the stratosphere. You know she works hard; there are days when she doesn’t have a minute to rest her hands. Yet there are other days when she is kicking back in the break room with the latest issue of People magazine. How do you find a balance?

First, take a look at how you are compensating your hygienist currently. If hygiene salaries are beyond 33% of collections, consider paying the hygienist on a commission basis of 33%. If a hygienist is making $300/day, production/collections need to be three times her salary or $900 at a minimum. But remember, the hygienist doesn’t have total control of her schedule, and the scheduling coordinator needs to understand that she/he is responsible for keeping the hygiene schedule full.

Another option would be to pay a guaranteed base wage plus commission. For example, if the hygienist works10 days a month and makes $300/day her monthly earnings are $3000. She must produce $9,000. If she produces $10,000 for the month the doctor could pay her commission of 15-33% on the $1,000 over her monthly goal. Next year, if her performance warrants a raise, she would get a percentage increase on the commission, provided it’s less than 33%, which is the maximum.

Don’t let the dollars slip through during non-production time. The hygienist should be paid 50% of her production salary for staff meetings, continuing education, and other non-production activity. But don’t spring it on the individual. Ideally, this should be spelled out during the hiring process.

In addition, the practice should be continually monitoring hygiene supply and demand and adjusting for it. You want to ensure that you have an adequate supply of hygiene days so that new and existing patients do not have to wait weeks or, worse yet, months for hygiene appointments and you want enough patient demand to ensure that the hygiene department accounts for 33% of your total practice production and your hygienist is producing 3x her/his daily wage. Follow this formula to ensure that your supply meets demand:

  1. Count the number of active patients – those seen in the past 12 months for oral health evaluations.
  2. Multiply that figure by two, since most patients come in twice a year for  hygiene appointments.
  3. Add the number of new patients receiving a comprehensive exam per year. For example: your practice has 1,000 active patients + 300 new patients = 1,300 x 2 = 2,600 possible hygiene appointments.
  4. Now take that number and compare it to the hygienist’s potential patient load. If the hygienist works four days a week, sees 10 patients per day, and works 48 weeks a year there are 1,920 hygiene appointments available.
  5. Subtract that total from 2,600. You are losing nearly 700 appointments per year – 680 to be exact – or 14 patients per week.

If your practice schedules patients when they are due rather than pre-scheduling appointments, examine how far ahead patients are booked for appointments. If there are no openings in the hygiene schedule for a solid three-week period and some patients are being bumped into the fourth week, begin increasing the hygiene department’s availability in half-day increments. If you find there is more hygiene time than necessary develop a patient retention strategy and focus greater attention on filling those extra days.

Keep in mind that your hygienist cannot do this alone. She/he is going to need assistance achieving the goal of 33% of practice revenue. That help comes in the form of a solid recall system and a trained patient/scheduling coordinator to ensure that the hygiene schedule is full. But this team effort doesn’t stop there.

As we’ve all come to realize, in these economic times more and more patients are very concerned about their financial situation, if they don’t perceive the importance of keeping their hygiene appointment, they won’t. Use your recall system to do more than just remind patients of a “regular check-up,” educate them and emphasize the importance good dental health and how it relates to overall health. And, most importantly, doctor, assistant, and hygienist need to stress the value and importance of hygiene care every time a patient sits in the dental chair for dental treatment or the routine hygiene appointment.

Interested in speaking to Sally about your practice concerns? Email her at sallymck@mckenziemgmt.com.

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

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Scott McDonald
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Psychographics and Case Acceptance: A Scientific Approach

A patient sits in front of you in the chair. You have performed an examination, aided by radiographs. You know what the patient needs. Now comes the hard part: can you get the patient to want what he needs?

All of the theories of human persuasion have a single truth at their core. Simply put it says, “If you know enough about the person you are trying to persuade, you can find the key to opening their decision making process to accept your position.” In order to understand them, doctors can turn to a branch of demographics called “Psychographics.”

Before going further, it is wise to remind ourselves that individuals are always going to be much more complex than any shorthand we apply to understanding groups of people. But broad rules and trends CAN be made upon groups of people. Common experiences, backgrounds, demographics, and patterns of behavior (including consumption patterns) can allow us to make general policies regarding communications and persuasion, case presentation and fee consultations.

There are several “models” of psychographic groupings such as the Stanford Research Institute (SRI) who started with 9 or ESRI’s “Tapestry” system with 66 segments.

  • High Society
  • Solo Acts
  • Senior Styles
  • Upscale Avenues
  • Scholars & Patriots
  • Factories and Farms

The same segments are also divided into 11 Urbanization Groups(t) which are descriptive of the type of community in which they are found. These include:

  • Urban Outskirts
  • Suburban Periphery
  • Small Towns
  • Metro Cities
  • Urban Outskirts
  • Principle Urban Center

The 66 segments themselves reflect the values, demographics, consumer patterns, and “lifestyles” of the groups within them. These include groups such as:

  • Boomburbs
  • Laptops and Lattes
  • Prosperous Empty Nesters

Each group is distinct. So, if one has many Boomburbs in the practice (or more importantly, in the vicinity of the practice), what does that mean?

Boomburbs have a median age of 34 years. Most are between 35 and 44. They almost always have children present in the home (about 49% are married couples with children). More than 10% have a preschooler. They are racially White. The vast majority of these households have two income earners in the household and make about twice the national Median Household Income. They are strong believers in using pedodontists and orthodontists who are specialists rather than having those services offered by their general dentist. To them, the ideal dental practice is going to be close to home (and BEST if it is next to their local supermarket). College educated, they are much more included to prefer a newsletter and brochure about the practice than a post card or Val-Pack coupon. They like their case presentations written out and prioritized. Boomburbs are users of cosmetic dental services in all price ranges but they tend to be impatient to get things started once they have decided on treatment.

Laptops and Lattes are a little different. They live alone or with a roommate. The media age of the population is 38. Most of them are White with an above average representation of Asians. They are affluent with a median income of about $84,000. Most hold professional and management positions. Employment of both men and women in this group is high. They are well-educated with 37% having Bachelor’s degrees and 32% having graduate degrees. They love the city life and prefer to live in major metropolitan areas. Only 38% own a home. The are considered “high-end renters.” As the title would imply, they depend upon technology to get them through their day. If your “site” does not come up on their Google Search for a dental office with a link to your web page, you do not exist. They prefer making their appointment through the Internet as well. Recall is best done via Text Messaging, IM, or E-mail (which seems rather old fashioned to them). If they don’t own a Blackberry, they own an I-Phone. While the Boomburbs prefer cosmetic care to help them in their careers, the Laptops and Lattes prefer it to help their social lives. The prefer practices close to their work who offer extended hour schedules.

The Prosperous Empty Nests are another group entirely. Their median age is 46.1. A little more than half of their households are headed by someone 55 or older. They are out of their childrearing years and are headed for a prosperous retirement. They love travel and home improvements. Roughly 37% collect Social Security income and 58% collect on investments and dividends. Well educated, about 20% hold college degrees with 30% have attended college. The live in single-family detached homes. Generally they do not live in new neighborhoods. In need of endodontists, periodontics, and even some prosthodontics, they are beginning to feel their age. Their primary motivation for dental care is function although “recapturing youth” is a theme that resonates with them. Their ideal dental practice is one located near “big box” stores where they do daily shopping. This would include locations near Costco or Sam’s Club. High Impact post cards have a good effect on getting their attention although word-of-mouth is still their preferred method of finding a dentist.

We have described only three of the 66 groups in this system of population segmentation. Some doctors prefer to know what their current market looks like in order to promote their practices effectively. This type of research can help in deciding what services to offer, hours of operation, practice promotion activities, treatment planning, and staff selection.

Scott McDonald is the largest provider of dental marketing research to dental practices. For more information, email demographics@mckenziemgmt.com.

To order a demographic study of your practice, Go Here

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Angie Stone
Angie Stone RDH, BS
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Is the Gauze Helping the Cause?

“Please stick out your tongue so I can look underneath it.” These words have been heard many times a day in dental offices for at least the last 25 years.

It seems no matter how many times patients are asked to perform this task, they always cringe when the gauze is wrapped around their tongue and the tongue is pulled from side to side.  Every time this screening is executed the clinician feels the need to explain what they are doing because sticking out the tongue and having it grabbed by gauze is such an odd exercise.  Patients are told things like:

  • I’m making sure there are no areas that look suspicious
  • I am looking to be sure you do not have oral cancer
  • Oral cancer can begin on the sides of the tongue
  • Oral cancer can begin on the floor of the mouth

Once a suspicious lesion is seen, a referral is made to an oral surgeon and quite possibly the referral comes too late.   Until relatively recently, gauze and the naked eye were the only tools available to screen patients for oral cancer.

Medicine has already moved away from visual detection of disease and is embracing the use of screening tools. Examples include mammograms and PAP exams for women and the screening of PSA levels in men. These screening tools are utilized for early detection which results in the saving of lives. While such screening tools are second nature to patients in the medical world, screening tools for oral cancer are not as well known however, the standard of care for detection of oral cancer has begun to shift. 

If a cancerous lesion can be seen, anywhere on a body, the cancer is likely in an advanced stage. This is typically true of oral cancer.   Consider that, according to the American Dental Association, more than 25% of the approximately 30,000 Americans who get oral cancer annually will die of the disease and on average, only half of those diagnosed with the disease will survive more than five years.  Breast cancer was estimated to claim the lives of 22% of those diagnosed with the disease in 2008 and prostate cancer was estimated to claim the lives of 15% of those diagnosed with that disease in 2008, according to the American Cancer Society. It is shocking that the percent of deaths occurring from those diagnosed with oral cancer is higher than those diagnosed with breast or prostate cancer!    Those statistics make it evident earlier detection is a must!

Currently there are screening tools available to assist in the early detection of oral cancer. Two of the more popular tools utilize lights to peer below the surface of the mucosa.  One tool (Velscope) shines the blue excitation light into the patient’s oral cavity.  The clinician views the oral cavity through the hand piece of the device.  Normal tissue produces florescence and the tissue appears as an apple green glow.  Abnormal epithelial tissue and underlying stromal disruption causes loss of fluorescence resulting in the appearance of a dark area.  The other screening tool (VisiLite) uses views the oral cavity under chemiluminescent light, after the patient rinses with a dilute acetic acid solution.  Areas of, abnormal squamous epithelium tissue will appear distinctly white. 

Offices need to do their own research to determine which of the available tools fit into their practice the best.  Regardless of the choice, awareness of the dangers of oral cancer will increase and early detection and referral may follow.

There is some support for screening patients annually, especially those who have an increased risk for oral cancer.  This would include patients who:

  • Use tobacco products (includes cigarettes, cigars, pipes, and smokeless and chewing tobacco).
  • Use alcohol heavily. .
  • Are infected with a certain type of human papillomavirus (HPV).
  • Are exposed to sunlight (lip cancer only).
  • Are male
  • Are 45 years old  or older
  • Are African American

An annual screening may not only save the life of a patient, it can be a revenue generator for the office.  Consider an office that has 1, 500 active adult recall patients.  Let us say half of them are identified to have an increased risk and receive an annual screening.  If the charge is $50, the result is an increase in production of $37,500 annually simply by providing a service to the patients. Some insurance companies are beginning to pay for oral cancer screening which takes the increased cost to the patient out of the equation. Patients may even be thankful for no longer needing to have their tongue lassoed in gauze and tugged on by the clinician! 

Need help with implementing new systems and products in you hygiene department? Email hygiene@mckenziemgmt.com.
Interested in having Angie speak to your study group or at your next seminar? Click here.

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