4.26.13 Issue #581 info@mckenziemgmt.com 1-877-777-6151 Forward This Newsletter

Practice Fantasy #1 - "I Need an Associate"
By Sally McKenzie, CEO

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So, you think you need an associate. As far as you’re concerned, it’s obvious. You are too busy. You have more work than you can handle. You are tired of putting in so many hours. You have plenty of patient records in the system to support another doctor. In fact, you are so ready you’re considering hanging a “Now Hiring” sign on the front door.

Slow down, doctor. It’s more likely that you’re living an illusion. “Busyness” is among the most compelling practice fantasies. When doctors are “so busy” they can barely keep up, they start dreaming up all kinds of imaginary scenarios. They convince themselves that it’s time to build a new office, finish the extra operatories, hire the associate, buy the Porsche, and start livin’ the dream.

However, employing an associate is unlike any other practice hire. This is one of the most important career choices you will make. It’s a marriage of sorts, as this person may become your practice partner. Let there be no illusions, this is a decision that has your financial, professional, and emotional wellbeing riding on it. You will pour thousands of dollars into this arrangement; you want some assurance that it will work.  Sadly, many of them don’t. But, why?

Oftentimes, it boils down to unclear or mismatched needs and expectations. The hiring dentist may feel s/he is so busy that the only answer to the perpetual pandemonium is another clinician. Or the senior doctor may be nearing retirement, and wants to offload the less pleasant work to the new dentist so s/he can focus on preferred procedures. In some cases, hiring dentists view associates as extensions of themselves. They assume that the new person will come in, fall in line, produce, and keep their mouth shut. It’s yet another grand illusion.

The associate doctor, meanwhile, is likely entering the practice with a huge amount of dental school debt - $250,000 or more is not uncommon. The economic realities are such that most new dentists are not in a position in which they can take many risks. They require profitability and security. Therefore, they are looking for an established base of patients. They want to work with a trained staff that functions well as a team. And they’re looking for mentoring from the senior dentist in the management of the practice as well as in the diagnostic and treatment aspects of the dentistry. There’s a lot riding on this opportunity and they want to get the most out of it. And that is often where things start to fall apart.

In the “too busy” practice, the hiring dentist convinces him/herself that the new dentist can just step in and help control the chaos. Unfortunately, as I’ve often said, the “too busy” practice is often an indicator of key management systems run amok rather than too many patients to treat.

The associate, looking for a stable environment, instead walks into swirling mayhem. The office is operating in a perpetual state of crisis because the senior doctor will not address the problems, refuses to delegate, wastes valuable production time on tasks that the assistant should be handling, and so on. The senior doctor isn’t too busy; the practice management systems are too weak to function effectively. Aside from trying to put out fires, there’s not enough real work to keep the new dentist busy.

In other cases, the senior dentist has been cutting back in preparation for retirement. The doctor might have had a thriving practice that was bringing in $800,000 a year, but whittled it down to $300,000. However, overhead remained unchanged, and the senior doctor mistakenly believed that the associate would boost revenues right away, an expensive and incorrect assumption that neither could afford.

When it comes to determining the need for an associate, you must know without a doubt that there are enough patients to not only keep doctor and associate busy, but support the two of you as well as the practice. How much is enough? Generally speaking, industry data recommends that for a solo practice to remain healthy it should have a monthly new patient flow of 25, and 85% of those new patients should be accepting treatment. If you’re eyeing potential associates, you should be seeing new patient numbers in the area of 30-35 per month.

Next week, associates and their illusions.

For more information on this topic, visit my blog: The Lighter Side

Interested in speaking to me about your practice concerns? Email sallymck@mckenziemgmt.com
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Nancy Caudill
Senior Consultant
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Going Chartless - Not As Scary As You May Think!
By Nancy Caudill

All those paper records that are sitting on your shelves…what to do about them? It’s a daunting task just thinking about where to start. Since I don’t sell software or hardware, I am writing this article from a practice management standpoint to hopefully eliminate some of the fears that this project brings to dentists.

Reason to Go Chartless #1 - Better Use of Employee Time
Let’s do some simple math: 15 doctor patients + 18 hygiene patients (1 doctor and 2 hygienists) = 33 charts per day that must be located and placed in a pile somewhere, waiting for the day to arrive that these patients will be seen. Let’s say that, at best, it takes 2 minutes to locate and 2 minutes to file back on the shelves = 132 minutes/ 60 minutes = 2.2 hours/day for someone to do this task. Multiply that by 200 days/year = 440 hours or 55 days. Let’s say that you are paying someone $15/hr x 440 hours = $6,600 in manpower alone. If your practice is larger, the cost increases. A better use of 440 hours would be calling past due recall patients, unscheduled treatment, outstanding insurance claims or unpaid account balances. Would you agree?

Reason to Go Chartless #2 - Instant Access to Information
Instant access to the patient’s clinical information without having to locate a paper record. Can you imagine how great that would be? No need to ask Susie at the front desk to pull a chart for you. Susie needs to call the patient to schedule an appointment and she has information at her fingertips with a few key-strokes, as opposed to locating a chart and having the chart sitting on the desk.

Reason to Go Chartless #3 - Reduction of Clutter
Reduction of clutter - no matter how “pretty” your paper charts look, if you were to walk around your office, they are like rabbits. They are everywhere! And let’s not even think about all the employees that have touched these paper records with less than sanitary hands. Walk up to your front desk and see how many charts are sitting around taking up valuable counter space. Many offices choose to pull their patients’ charts a week in advance - although I am not sure why since the schedule changes so much. These charts are sitting around somewhere taking up space.

Reason to Go Chartless #4 - Storage Space
How many old patient records do you have in your garage, attic or a rented storage building somewhere? Hopefully, your practice continues to grow so you have more active patients, requiring more inactive charts to be removed from the shelves to make room. This makes it more difficult to retrieve an inactive chart that is not on the premises.

Reason to Go Chartless #5 - Supply Cost Savings Over Time
The investment that you make annually for all the paper that makes up a paper chart, not including the expensive alphabetic and numeric tabs, is eliminated. No need to inventory these supplies, as well.

These are a few of the primary reasons. Let’s review what it takes to make the move, keeping it simple. I am not going to discuss the investment that is needed, since this involves hardware and software.

Steps to Go Chartless - Software Training
After the hardware and software is installed, training must take place before you make the change. Training for the business team is minimal. Clinical training in order to use the clinical aspect of the software is essential. The clinical team, including you, would continue to use the paper charts and start entering the clinical notes into the computer and in the chart for a week or two until everyone is comfortable. 

Steps to Go Chartless - Digital X-ray Training
If you are not already digital, evolving from film to digital carries a learning curve for the clinical team. If you have already made the change, then the rest of the conversion is rather easy.

Steps to Go Chartless - Set a Date to Stop Pulling Charts
Do not “throw away the charts.” Your patient charts will remain on the shelves and are readily available if you need one. What will happen, however, is that on the date that you set, no more charts will be pulled. Everyone will implement all that they have learned and will rely on the computer for their information. All new patients will have their information scanned (if applicable) and saved in the patient’s digital record.

This step does require some preliminary work. Fast and small scanners are needed to make the scanning of existing information quick and easy. It is not necessary to scan everything that is in the patient’s record. Sit down with your team and determine what historical information you need access to in the patient’s digital record - these are the papers that are scanned. Some offices scan the last page of their clinical notes that are in the chart for reference. Scanning the medical history may be necessary unless you update all the patients’ medical history in the computer when they check in (depending on the software).

If you have not already implemented the use of routing forms, now is the time. Your routing form is like a small temporary chart and contains valuable information that is readily accessible so you don’t have to retrieve if from the digital record.

In conclusion, please don’t be scared that all your charts are going to suddenly disappear. You should keep them on the shelves for a period of time until you feel comfortable removing them from the office. I find this is a piece that is always missing from the doctor thinking of going chartless - letting go of that piece of paper!

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

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Belle DuCharme, CDPMA
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What Do Dentists Want When Hiring Business Coordinators?
By Belle DuCharme

Dear Belle,

I was recently sent on a temporary assignment in a dental office from a dental employment agency. It was made clear that they wanted someone proficient at Dentrix software. That was it. I was there one hour and the doctor pulled me into his office and said “When can you start?” I was floored. Is that all it requires to get a dental office job these days? 

Bee Perplexed, Job Seeker

Dear Bee,

I would have to answer yes and no to that question. It definitely increases your odds of employment if you are computer savvy and proficient at one of the major software programs. Many dentists think you must know their office software or you will not be able to do the required work. Experience shows that if you know one well enough, you can pick up any of the other programs within a week or less. Usually dentists do not have the time to train new staff, nor do they have the knowledge of the systems to demonstrate skills in scheduling, posting insurance checks, doing treatment estimates, and the many other tasks driven by the dental software. If there isn’t a staff member who has the time or the knowledge to teach, then the doctor has to decide whether to get the software trainer back in for a couple of days or just keep looking for someone already trained. Software training is costly, especially if the job candidate doesn’t work out.

When the dentist is faced with hiring suddenly, panic causes the focus to lie on the software skill more than anything else. Qualified job seekers proficient at Eaglesoft are overlooked for employment in favor of the applicant who is skilled at the office software, Dentrix. Job seekers today should be prepared to counter this request by offering to pay for the software training and be reimbursed after six months of employment. Keeping up on the current versions of software systems is also important, just as it is to keep up with CPR and OSHA training. Proof by testing is even more important today, with software being the driver of the systems and managing the important practice data. Set up a test patient and then let the applicant make an appointment, enter insurance information, and post a check. If the applicant has used dental software programs in the past, they will be looking for the icons and the keystrokes to get them where they need to go in the system. Test the applicant for keyboarding skills also. If you are a busy practice you do not want someone “hen pecking” the keys to enter data.

Dentist employers today want someone who is dependable and self-motivated. In the dental practice this means being on time to work and being prepared. Have the treatment plan prepared in time to speak to the patient at dismissal, and know how to collect fees or help patients to secure financial arrangements. “Self-motivated” means being able to schedule to production goals and adhere to scheduling protocols for efficient time management. Self-motivation comes from taking initiative to get the job done without being told or micromanaged.

Dentist employers want team players with positive attitudes. Because this is the most overlooked quality in hiring, it becomes the biggest reason employees give notice. The employee who steps up to the plate every time to stay through lunch or work overtime or clean up after other employees is eventually the one to leave. Feed positive attitudes with praise and demonstration of appreciation. Make each employee accountable for being part of the team and taking on extra responsibility.

When dentists need to replace staff, the focus should be on what the practice needs. This is evident when you read online job postings. The ad is written to address the needs of the practice, but little is said about what the employee will be provided to ensure their job success in the practice environment. You are not ensuring the job success of a very important member of your team if you don’t provide ongoing software training and business systems training. Dental software is always being updated with new features that the Business Coordinator must be trained to use. This ongoing training can be provided through online training webinars and online support as an alternative to paying for a trainer to come in.

Consider software training as an ongoing practice expense designed to improve the performance of the practice. Want to improve the business skills of your Business Coordinator or Office Manager? Call McKenzie Management today to learn about training for your employees.

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

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