2.19.10 Issue #415 Forward This Newsletter To A Colleague

Two Dentists: One of You Will be Embezzled
by Sally McKenzie CEO
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As small businesses, dental practices are prime targets for fraud and embezzlement. Why? Because (a) controls tend to be very lax and there’s little staff accountability and (b) there tends to be a close relationship between doctors/owners and employees. They become trusted friends, and that trust, sadly, encourages a dishonest employee to take advantage of them. It also makes the crime all the more devastating for the doctor.


It is estimated that one out of two dentists is embezzled, and the average loss is $50,000. In the dental practice, the most common methods of embezzlement involve stealing cash, checks, and supplies. So how do you protect your business from a fraudster? Read on.

First and foremost, practice owners must divvy up the financial duties. Second, the doctor must be actively involved in monitoring the finances. Yes, you may want to only do the dentistry, but this attitude is inviting disaster. One of the greatest deterrents to theft is when a prospective perp knows s/he is being watched. 

Separating billing, collections, and delinquent account responsibilities is critical. The employee making the bank deposit should not be the same employee responsible for checking the deposit slip that is returned from the bank. Consider rotating the responsibility for making bank deposits among employees, and monitor deposits for unexplained increases or decreases. Trust but verify, particularly when it comes to confirming daily deposits and collections recorded.

Review your daysheet daily as well as the deposit. Pay attention to route slips. Compare the appointment schedule to procedures actually posted. Pay close attention to adjustments and make sure you know why they are being made. If there are increases in refunds or write-offs or missing documents – check it out. Print and review an audit trail report daily or at least weekly. It reflects every transaction that has transpired in the office since the last printed audit trail. In addition, generate a monthly report listing all patients that have had changes made to their accounts. This helps to identify a recurring problem or detect a discrepancy. Routinely conduct random checks of different accounts.

Each month, review accounts payable and purchasing functions. Examine bank statements and credit card statements carefully. In addition, periodically check out Explanation of Benefits and track treatment and payment through the practice ledgers and patient records. Sit down with your accountant and review financial statements. Watch for trends that appear irregular as compared to other dental practices.

The doctor must take an active role in monitoring the financials. Ideally, the doctor should write all the checks and do his/her own payables. The doctor should reconcile the bank statement monthly and cancelled checks should be sent, along with the bank statement, to the doctor’s home. In addition, monthly credit card statements should be received unopened and compared with original receipts of purchases. Mark all invoices as paid so that they cannot be submitted twice. These steps enable the doctor to know exactly where the money is going. 

Checks received should be immediately stamped on the back with the practice’s bank deposit endorsement stamp. Periodically check the account number to ensure it is the practice account. Do not use signature stamps. Make it office policy that all employees take at least one week’s vacation every year, particularly those in charge of practice finances. And, most importantly, don’t let the work pile up. During that time, the vacationing employee’s duties should be carried out by someone else.

Take complaints seriously. Nearly half of the cases in the Association of Certified Fraud Examiners’ (ACFE) 2008 Report to the Nation on Occupational Fraud and Abuse were uncovered by a tip or complaint from an employee, customer, vendor, or other source. If patients claim that they’ve paid but didn’t receive credit, investigate it. If an employee tips you off that something isn’t right, check it out. If you sense that things just aren’t adding up, don’t dismiss it. Ignorance could cost you thousands if not millions of dollars.

Consider running credit checks on current and prospective employees. According to ACFE these may be the least common form of background checks, but they can be the most useful in identifying individuals under financial pressure and/or those living beyond their means, which are key motivating factors for those who commit fraud. Periodically conduct surprise audits. And above all else, pay attention. Do not turn over your practice finances to one “trusted” employee.

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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Frustrated with HIRING the WRONG people? Remove the guesswork. Employee Testing On-Line

Belle DuCharme CDPMA
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Developing an Incredible Telephone Personality

Dress for success is a catch phrase referring to the classy business suit of black or navy blue with matching shoes and accessories worn by the polished business administrator.  Much time and energy is spent preparing to exude the professional business appearance with the goal of making a positive impression on the boss, staff and patients that come to the practice.

Few people take as much pride in developing their telephone image. Because dentistry is a service industry, people will spend more time listening to you than looking at you - therefore time and effort must be spent developing a professional telephone personality. Keeping a smile in your voice despite what is happening around you is a must have skill for the Business Assistant and does not come naturally to anyone under stress.

When face-to-face in a conversation, nonverbal cues are apparent and the volume and tone of the voice can be adjusted based on what you are reading in the face and body language. If your voice is loud, a person may back away or frown causing you to lower your voice and speak slower. If you are loud on the phone, a person will hold the receiver farther away from the ear and you will not be able to detect that the person is uncomfortable with the loudness of your voice. 

Excellent listening skills are necessary to communicate effectively on the telephone, and this too does not come to you naturally and must be practiced with discipline. The minute the phone is answered, 100% attention must be given to the caller. This is a challenge in a busy practice. But being effective on the telephone requires more than just a smile in your voice. The following are also essential:

  • Answer calls promptly or by the third ring
  • Be attentive and discreet
  • Be friendly and responsive
  • Ask questions tactfully
  • Speak distinctly
  • Take messages courteously
  • Transfer calls carefully
  • Avoid placing callers on hold
  • Be considerate of the caller
  • Engage listening skills and avoid distractions

Your speaking voice reflects your personality and immediately sends a message to the caller as to whether a successful telephone contact has been made. The elements of a good speaking voice are: loudness, pitch, rate and quality.

Loudness refers to the volume of your voice. When stressed, most people raise their voices and sound like they are yelling or upset. If the background noise in the office is loud then the business administrator will speak louder, making the caller uncomfortable. That is why it is recommended that staff members not congregate at the desk for chit chat sessions and that treatment presentations are delivered in a consultation room or the operatory and not at the desk where incoming phone calls are received. If people ask you to repeat because they can’t hear you, most likely your voice is too soft or has dropped to a monotone. A too soft voice can communicate lack of confidence.

Pitch is the tone of your voice. Changing this quality is challenging because it is like breaking a well developed habit. A low, gravelly voice or a high, squeaky voice are hard on the listener and can be changed with a voice coach and practice.

Rate of speech can determine how well another person understands what you are saying.  The rate needs to be at a pace that does not detract from the message that you are trying to communicate.  If you are delivering information that is vital for the patient to understand about a treatment plan and this is new information, the rate needs to be slowed so that the patient can grasp and understand what is being said.

 Quality of your voice is affected by a combination of psychological and physical factors. If you are feeling ill or experiencing depression, patients can detect this in your voice. Patients don’t know if your voice is telling them that this job makes you unhappy or if you are just having a bad day. Either one of these can have a negative effect on how the patient perceives the practice. It often takes extra effort to inject enthusiasm, interest, naturalness and expressiveness in your voice. With proper coaching and training this can be easily achieved.

The Advanced Training Front Office or Office Manager Course through McKenzie Management offers the opportunity for you to script and role play scenarios to test your telephone skills and get the training and support necessary to improve your telephone personality and attract more patients to your practice.

If you would like more information on McKenzie Management’s Advanced Training Programs  to improve the performance of your team, email training@mckenziemgmt.com

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Nancy Caudill
Senior Consultant
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One Of My Assistants Is Leaving Should I Replace Her?

Dr. Sherry Staples – Case Study #233

It is interesting… many dentists really have no idea how many assistants they need.  Dr. Staples had two and was losing one due to a relocation. Should she replace her?


  • How many doctor patients do I see a day and what types of procedures?
  • How much time is scheduled for the various procedures?
  • How many treatment rooms do I use?
  • How far out am I booked in my appointment book?
  • How many hygiene days do I have?
  • Do I have digital radiography?
  • How many assistants and business team members do I have presently prior to the change?
  • What type of procedure mix do I have?

Number of Doctor Patients and Procedures
Dr. Staples sees on average 12-14 patients a day. Some appointments are restorative procedures, some endo, and some C&B. She uses a local lab to fabricate her crown and bridge cases. She averages only 1-2 crown preps per day and 60% of her procedures are fillings.

Time Scheduled for Procedures
Typically, 90 minutes is scheduled for crown preps and an hour for composites 1-2 teeth with 1-2 surfaces. Crown cementations are scheduled for 40 minutes to allow for adjustments. If they are bonded, she schedules 50 minutes. Endo can be anywhere from 90 minutes for anteriors to 2.5 hours for molars.

Number of Treatment Rooms and Radiography
Dr. Staples works out of 3 treatment rooms. The 3rd room is used for “emergencies and other non-productive procedures.” She indicates that she feels rushed throughout the day. Each room in the practice is equipped with digital radiography and computers.

Appointment Book
Her schedule is booked out about 6 working days, with slots blocked for new patients and “high production.”

Hygiene Days
The practice works 4 days a week with 1 hygienist each day. There is not a designated “hygiene assistant” but an assistant may assist in taking an FMX or Pano if the hygienist is delayed.

Total Number of Employees
She has 2 full-time front desk personnel, 2 assistants with 1 relocating to another state, and 1 hygienist.

Now you see a snapshot of her practice – it’s not unlike many dental offices across the country. The big question is: does she hire another assistant to replace the assistant that is leaving?

Dr. Staples thought that since she had three treatment rooms, she should be using all three. This is NOT the case! The number of treatment rooms that are used by one doctor depends on the workload, how many days the doctor is scheduled in advance, how many assistants, the service mix of procedures, and does the doctor enjoy wearing “roller skates,” “tennis shoes” or “bedroom slippers?”  They are all correct, and the appointment book must be scheduled to match the style of the doctor.

Dr. Staples had already indicated that she felt rushed and stressed all day, running from room to room and checking the hygiene patients. And yet she was only booked out a week and a half!  This tells me that the demand for her services are not such that she needs to feel the pressure of a busy schedule – simply schedule the patients further out.  Ask if they would like to be on a “priority list” and contacted if there is a change in the schedule.


  • Overlap each patient 10 minutes at the beginning and end of each appointment - assuming that she is okay with giving injections alone - and finish the last 10 minutes with the patient while the assistant seats the next patient. If she is NOT – then don’t overlap the appointments but schedule one after the other with no breaks. Be sure that the correct amount of time is scheduled for each patient.
  • Since she only performs 1-2 crown preps a day, she can easily fabricate the temp chairside with the new materials that are available now. This will also reduce the amount of time needed for the appointment.
  • Only work out of two treatment rooms, assuming that the appointments are overlapped 10 minutes.  A doctor can only be in one place at a time. She still needs time to check her hygiene patients. Patients don’t like to wait and it is poor customer service as well as stressful for the dentist.
  • If necessary, build in 30 minutes a day of admin time for the assistant to order supplies, conduct equipment maintenance, etc.
  • Seek the assistance of a business team member for seating patients when needed.
  • If overhead is within the normal limits of 19-22% and the reduction of an employee lowers it even more, work with one less employee for more efficiency and pay the remaining team members more.

Three months later and with one assistant now instead of two, each day is more productive and less stressful. The remaining assistant is much more efficient now because she knows everything that is going on with the doctor. There are less openings in the schedule because the schedule is now booked out almost three weeks, and it is much easier to fill cancellations from the “Priority List.” Also, everyone received a nice increase in their hourly wages! Who would have thought that the sad news of losing an assistant would make such a difference in the practice?

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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