04.17.09 Issue #371 Forward This Newsletter To A Colleague
Mid-Career Squeeze
Holes in Hygiene?
Email Etiquette

Suffering the Mid-Career Squeeze?
by Sally McKenzie CEO
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Mid-career, mid-life, mid-term. You’ve reached the middle, the halfway point. It can be a time of great prosperity and satisfaction or one of significant anxiety. For some dentists it means they are hitting their stride and are right in the middle of the excitement, the challenge, and the thrill of their chosen profession. They are at the top of their game, enjoying the fruits of their labors, and looking forward to what the future holds. For others, mid-career feels more like being stuck in midstream, floundering somewhere in between the beginning and the end. It’s too late to turn back, but there’s not much promise in what lies ahead.

Behind them is the first 15-20 years of their dental career. They’ve invested a fortune in time and money in both dental and continuing education. They should be reaping the rewards, but they’re not. They are burdened by the monetary pressures. The lean months are growing more frequent, and it feels as if the financial tightrope they are tiptoeing across could snap at any time. They are supposed to be the leaders of their practices, yet the personnel struggles, the revolving door, the sheer challenge of just keeping a group of people together, let alone building a team is wearing them down.  Is it any wonder that they find themselves asking, “Is this all there is?” Where’s the excitement, the enthusiasm, the career satisfaction!

Consider your position on this mid-career path. Are you enjoying the view from the pinnacle of success? Or are you frozen in place, stuck somewhere between merely average and truly excellent? And, if you’re not where you want and feel you should be, are you willing to take the necessary steps to change it? Look at it this way, if the roof were leaking, you would have it repaired. If your car weren’t running properly, you would take it to the mechanic. It stands to reason that if the area of your life that has the greatest impact on your personal and professional happiness and satisfaction isn’t delivering what you expected, you wouldn’t hesitate to fix it. Right? The question then becomes where to start? 

Bridge The Gap

You’ll need to look at key systems starting with the two critical areas that are most likely to be sending your practice, and consequently you, into a mid-term slump: patient retention and poor customer service.

We see this routinely in mid-career practices. Everyone is busy. The schedule appears to be bursting at the seams. Hygiene is typically booked out six months. A couple thousand patient records are on file. Therefore, the doctor is convinced that patient retention is perfectly fine. “Busy” is as “busy” does, and busy is one of the great illusions of the dental practice, a perception that is not only deceiving but also costly. In fact, most dental teams are stunned to learn that 80% of dental practices are losing more patients than they are bringing in new. But upon hearing such statistics the crew will simply turn and tell each other that they must be in that select 20% group because, well, you know, they are crazy with work. Just how crazy? Find out.

If the number of inactive records is enough to open a second practice, you have patient retention problems. If you have not increased hygiene days, you have patient retention concerns. If your hygienist’s salary is more than a third of what she produces and if you haven’t converted 85% of your emergency patients to loyal patients, you have more patients leaving your practice than you have new patients coming in.  

While misery loves company, it doesn’t require you hang around this pity party indefinitely. Patient retention is an area in which you can take prompt steps to improve and see immediate results. In most cases, patients have simply drifted away because the recall system, if it exists, is weak.  Put recall to work and patients in the chair.

Generate a report from your computer of all patients past due for recall appointments in the last twelve months. Your objective is to reconnect with these patients using a defined strategy that will enable you to set goals and track the results of your efforts.

First, assign a member of the business team, typically the patient coordinator, to take the following steps:

  1. Contact a certain number of past due patients each day. The coordinator should use a specific script that she/he uses as a guide in making the calls. In addition, she/he should check the patient records to identify a treatment concern noted in the patient’s chart that she/he could reference in the phone call.
  2. Everyone needs goals, and beyond just making calls, the coordinator should be expected to schedule a specific number of appointments, and follow-up with patients to ensure that a specific number of patients complete treatment.
  3. The coordinator also assists the hygienist in meeting production objectives by scheduling the hygienist to achieve daily or monthly goals as well as managing a specific number of unscheduled time units in the hygiene schedule per day.
  4. Finally, the patient coordinator monitors and reports on recall monthly at the staff meeting. 

You will find many patients who are more than willing to schedule an appointment. They do so because you’ve demonstrated to them that you value this patient relationship and want them to return.  Next week…improving your customer/patient service.

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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In 30 days, you could be depositing more money. What are you waiting for?

Nancy Caudill
Senior Consultant
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Holes in Hygiene?…How to Avoid Them

Dr. Gary Shipyard – Case Study #114

It appears that a primary concern from doctors contacting our office is too many openings in hygiene.  It is surprising that they are not also concerned about their own production, as 50% of the doctor’s production comes from returning patients through the hygiene department. Dr. Shipyard was concerned about his Hygiene Department.  Let’s take a look at his practice stats:

  • 4 days of hygiene per week
  • Practice is 8 years old
  • Averaging 18-22 new patients a month
  • % of periodontal services performed was 15%
  • Average daily hygiene production was $791
  • Hygienist salary was $350 per day

What is Considered “Healthy”?
A practice that is 8 years old and averaging 20 new patients a month should need 7.5 days of hygiene if the patient retention was 80-90%.  Here is the math:


8 years x 12 months = 96 months x 20 NP/mo = 1,920 new patients. 
If 85% of the patients were retained and each patient was seen 2x a year = 3,264 appts needed
3,264 appts/9 appts per day seen = 362 hygiene days/48 weeks of work = 7.5 days of hygiene

This indicates that Dr. Shipyard had a retention problem even before this difficult economy…he just didn’t notice it.  He should have had 7.5 days of hygiene and only had 4.

Also, based on the nationwide statistics of estimated persons with periodontal disease, an average general practice should be seeing about 33% of their patient base needing periodontal therapy and subsequent 3-4 month periodontal maintenance.  Again, Dr. Shipyard was only posting around 15% of periodontal service by his hygienist.

Lastly, his hygienist should be net producing 3x her daily salary.  Several reasons were keeping her production at less than optimal:

  • Not enough periodontal procedures
  • Too many openings
  • Radiographs not taken as often as necessary based on guidelines
  • Scheduling too much time for each appointment, reducing her hourly production rate.  Her hourly production should be $150 and instead, hers was $98.88

In order to address Dr. Shipyard’s primary concern of “too many openings in hygiene”, first we must determine what is considered “too many”.  If his Hygiene Coordinator was scheduling his hygienist to her daily goal of $1,200 ($350 x 3) and allowing a15% increase for PPO adjustments) it is not necessary to have all the openings filled.  With an increase in periodontal services, it is possible to observe openings in the hygiene schedule and still be scheduled to goal.  Therefore, more important than “filling the holes”, is scheduling to a daily goal.

5 Monthly Hygiene Follow-up Steps
After interviewing Dr. Shipyard’s Hygiene Coordinator, it was noted that she did not have a specific protocol that she followed for following up on recall patients.  Truthfully, she didn’t even realize that this was her primary objective, as she didn’t really have a Job Description.  Her understanding was that she was supposed to help the other business employee do everything in the business area.

In order to be responsible for a department in a dental practice, the team member must have a clearly defined job description to follow and is held accountable to the doctor for her performance.

These five monthly tasks were defined for her:

  1. Send out the monthly notices with the hygienist’s personal notes on each one to add value.  These notices are sent two weeks in advance of the first due date and are for patients with and without appointments. 
  2. Print a 30-day past due recall report and call each patient.  If the contact is with voice mail, leave a message indicating who is calling and ask the patient to return the call.  Try to contact the patient again during the month at a different time of the day or during the early evening.
  3. Print a 60-day past due recall report and send each patient a “we miss you” letter signed by the doctor.  Include an educational brochure regarding the importance of their appointment.  Use the mail-merge feature of the dental software to make this task simple.
  4. Print a 6-month past due recall report and contact the patient again, either by phone or letter.
  5. Print a 12-month past due recall report and send a “reactivation” letter.  This is the last attempt to invite this patient back into the practice.  Consider offering a “free” service, such as an oral cancer screening using one of the new screening methods, or even whitening.

“Dialing for Dollars”
The number one most important task that maintains a hygiene schedule that is productive (scheduled to goal) is the effort that must be applied by the Hygiene Coordinator by using her most valuable tool – her telephone!  On average, 10 calls must be made in order to make 1 appointment.

Now that Dr. Shipyard’s Hygiene Coordinator has a better understanding of her responsibilities, she is focused on her primary job – scheduling the hygienist to her daily goal.  Where the hygienist was averaging 10 time units per day open, the Hygiene Coordinator has managed to reduce this to 4 time units per day, a great improvement.  More importantly, the daily production has increased 25% and is continuing to improve!

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

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Belle DuCharme CDPMA
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Email Etiquette To Improve Communication

A recent email from a former dental employee reads:

Dear Belle,
I recently quit my job via an interoffice email.  I was so upset with my employer, that I just couldn’t take it anymore and did not want to meet face to face, I just wanted to leave.  I feel now it was the wrong thing to do and I am sorry about it. What can I do?  Judy M.

Dear Judy,
Apologize in person.  Belle

Office Managers Training

I remember when I sent my first email.  Used to communicating over a telephone, it was difficult to word the email, so it was way too long and personal in nature.  It was like writing a letter except that you don’t seal it in an envelope and take it to the post office.  With a letter you have time to change your mind about sending it or you can rewrite it.  With email, once you press sendit’s a done deal in seconds and there is no taking it back.  

Today most people either email or text more than they telephone friends, family and co-workers.  It is an acceptable method of communication and for some people, an exclusive way to communicate.  After a conversation, we often forget some points that were made or if we aren’t listening forget the whole conversation.  Keeping the email thread as a record of communication protects you from those that say “You never told me.”  It is often said, about conversation, that “It isn’t what you say it’s how you say it.”  However with email “It is what you send, period!”  The subtle nuances of conversation do not translate over cyberspace.

With so many people using email at home and in the office, it becomes necessary to use certain professional standards to ensure that what we write is really what we intend to communicate.

Here are some pointers to consider before you hit the send button:

  1. Use the subject field to indicate content and purpose. Your email may be ignored if the subject isn’t clear or just says “Hi”.  The dental team should decide to use acronyms that quickly identify actions.  For instance the Business Coordinator may use PQ for Patient Question or MSR for Monthly Status Report.  The Dental Assistants might use TRT for Treatment Rendered Today.
  2. Don’t use smiley faces to diffuse words which may be taken as offensive.  It doesn’t work.
  3. Don’t use all caps unless you want the person to think that you are yelling at them or reprimanding them. All lower case just looks like you don’t want to take the time to communicate.
  4. Keep messages brief and focused on the objective. Use one subject per email.
  5. Don’t use email for a substitute for face-to-face contact.  Don’t send emotional content or very personal information because email is not private.  At work your email is considered property of your employer and can be retrieved.
  1. Don’t hit “Reply to All” as this can almost guarantee that someone will get the email that you did not intend to-- unless you are requiring a collective input with little variation from a group.
  2. DO NOT (I am yelling) send chain letters, virus warnings (they can be misleading) or huge files with cutesy pictures unless you have asked the recipient if it is okay to send them.
  3. Use a signature that has your mailing address, Website and phone numbers.
  4. Don’t use “texting” abbreviations in email especially if it is from your work. Your email message reflects not only you, but the company also.  Adhere to traditional spelling, grammar, and punctuation rules.
  5. When using CC, copy only to people who are directly involved.  Try not to use BCC to keep others from seeing who you copied unless there is a privacy issue at stake.
  6. Re-read before you send the email. Act as if you are reading it as the recipient and you may change your mind or catch a misspelled word or two.
  7.  Use a disclaimer to protect private information as part of your signature, such as: NOTICE OF CONFIDENTIALITY
    The information in this email, including attachments, may be privileged and may contain confidential health information. This email is intended to be reviewed only by the individual named as addressee.  If you have received this email in error, please notify the office of _________ immediately by return message to the____________ and destroy all copies of this message and any attachments. Confidential health information is protected by state and federal law, including,
           but not limited to, the Health Insurance Portability and Accountability Act (HIPAA) of 1996 and related regulations.
  8. Write an email protocol and place in your Business Office Procedural Manual and make sure that the entire team is trained to send proper emails.

For more information about McKenzie Management’s Advanced Training courses, email training@mckenziemgmt.com, call 1-877-777-6151 or visit our website at www.mckenziemgmt.com.
Interested in having Belle speak to your dental society or study club? Click here.

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