12.6.13 Issue #613 info@mckenziemgmt.com 1-877-777-6151 Forward This Newsletter

Generational Differences: Fact and Friction
By Sally McKenzie, CEO

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From Time Magazine, to the Wall Street Journal, to USA Today, to The Economist, it seems everyone is talking about the conundrum that three generations in the workplace is creating. While the generalizations are many and certainly not always accurate, in working with hundreds of dental practices, there’s no denying that we are witnessing a clear shift in priorities and career philosophies as Gen Xers (born 1965-1980), and Millennials (born 1981-2000) take their places alongside Boomers (born 1946-1964). The question is, how do you manage the differences? It begins with taking some time to understand them and ends with solid management strategies, as well as the recognition that each generation brings its pros and cons, strengths and weaknesses to the dental office.

Boomers, as a rule, are widely seen as the workaholic generation. Work has always been the center of their lives. They have devoted themselves to their practices, often at the expense of their families. Boomer divorce rates are higher than any other generation. Conversely, Gen Xers commonly insist on flexibility to achieve work/life balance. Many are raising young children and want to be actively involved parents. They don’t have any interest in putting in the hours that Boomers do. And therein lies part of the challenge when a boomer practice owner brings on an associate Gen Xer. Consider this scenario between “Dr. Betty Boomer” and “Dr. Frank Flex.”

Dr. Betty has built her practice, patient by patient. She has worked early mornings, late evenings and Saturdays to accommodate the demanding schedules of her busy patient base. At 60, she’s ready to enjoy the fruits of her labors. Having worked hard while her children were young, she wants to spend more time with her grandchildren.

Dr. Frank, age 33 and the son of Dr. Betty’s friend, was brought on as an associate in her practice. The doctors shook hands on a 50/50 financial split. Dr. Betty believed this meant she could finally start scaling back. Dr. Frank believed this meant he could finally earn what he deserved and be available for his two young children. The arrangement went south in no time.

 Dr. Frank blocked his schedule so that his days would not begin until 9 a.m. He explained that he needed to be home in the mornings to help get the kids ready and drop them off at school. During baseball season, he was out of the office by 4 p.m. and at the ball diamond for every T-ball game that his boys played. His dedication to his family was admirable, unless you were a patient who needed an early morning or late afternoon appointment. Some weeks, Dr. Frank’s family obligations only allowed him to put in about 20 hours at the office. But he reasoned that while there, he was highly productive, always looking for ways to improve processes and procedures, and seldom stopping to take a break. Thus, he reasoned, he more than earned his share of practice profits.

Gen Xers and Millennials are frequently said to have a strong sense of entitlement. And expectations such as Dr. Frank’s are not uncommon. It is a frequent point of contention with their Boomer bosses and colleagues who are more apt to think, “I paid my dues, it’s time for you to pay yours.”

After six months of this arrangement, Dr. Betty bulldozed Dr. Frank’s work/life fairytale, and pulled the plug on their 50/50 financial arrangement. His pay would be based on what he produced, and he was expected to log more hours in the office. Dr. Frank was furious. And Dr. Betty wasn’t much happier. After all, she had counted on this arrangement to work as much as he did.

It’s an unfortunate situation that could have been avoided had both sides expressed upfront their needs and expectations. Dr. Betty assumed that Dr. Frank would have the same work habits as she did at that stage in her career. Dr. Frank went into dentistry in part so that he could enjoy a certain lifestyle and have a life. That too is a common refrain heard again and again among both Gen Xers and Millennials. Bottom line, regardless of the generation, every practice must have solid management systems, job descriptions, measurements and clear expectations - especially when it comes to hiring, whether the position you’re filling is an associate dentist or part-time helper. Clear expectations must be set forth from the beginning.

Next week, managing Millennials - friends, phones, and feedback.

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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Scheduling Traps That Trip You Up!
By Nancy Caudill

Dr Graham was at the end of his patience when he announced, "My schedule is killing me! I am working harder and making less money. What am I doing wrong?” Hygiene

Dr. Graham’s practice statistics:
- 1 doctor and 2 assistants working 4 days a week
- 20 year old practice at the same location
- 7 hygiene days per week
- 2 business assistants working 4 days a week
- $2,800 doctor daily gross production currently
- $3,300 doctor daily gross production last year
- Collections at 98% of net production

Dr. Graham enjoyed a slower pace and dedicated time to chat with his patients. His patients liked him and paid for their dental services. All "appeared" to be normal, including his schedule, because at first glance it was full. The entire left column was filled from 8:00am until 5:00pm with an hour for lunch, and the adjacent column had patients sporadically scheduled throughout the day. However, upon further scrutiny, there were many scheduling mishaps that were probably the root of Dr. Graham's feelings of being trapped. They were identified as the following:

Scheduling Traps:
1. The combined practice goal was $6,000 but Dr. Graham did not have a specific goal.
2. Procedures were scheduled in both columns that are "doctor only" procedures.
3. Too much time was scheduled for procedures, leaving unused time units.
4. Too many non-productive appointments were scheduled in one day.
5. There was a need for more dental assistants!

What was discovered in Dr. Graham's practice was that Sharon, his Schedule Coordinator for seven years, resigned to start a family. Dr. Graham then hired Kathy who had 3 years of dental experience. Dr. Graham assumed she knew how to orchestrate a productive schedule - therefore no time was spent giving Kathy the proper training she needed, and she “didn't know what she didn't know.” How hard could it be to put names on a schedule and keep the holes filled? Kathy could do that.

Unfortunately for the doctor, Kathy was getting caught in these scheduling traps, as many Schedule Coordinators do, because of lack of training. Here are some tips for avoiding dangerous scheduling traps:

1. The doctor must have a daily production goal. This goal can be based on many different criteria, such as a general overall increase of 20%, establishing a 55% overhead, gross wages overhead of 20%, etc. Remember that the hygiene goals must be established first after the practice goal is established. The remainder of the production must be produced by the doctor.

2. Understand doctor procedures versus assistant procedures. Most dental software programs allow you to set up default times for procedures as well as whether each unit of time is doctor or assistant time. Take the time to set up your procedures with the accurate assistant/doctor/assistant time to make it easier for the Schedule Coordinator to properly utilize both doctor columns of the schedule. Educate your scheduler about why it is impossible to perform a root canal procedure in one treatment room and prep a quadrant of composites in the other treatment room at the same time.

3. Schedule the proper amount of time for each procedure. How does the Schedule Coordinator know? Because the information is given to her on the routing slip by the assistant when the patient is "passed off" to her at the front desk. Yes, default times are set up in the computer to make it easier, but it is important that customized time be assigned to each patient. Only the doctor and assistant know how difficult the 1-surface resin filling is going to be on Mrs. Jones or how quick and easy a 3-surface posterior restoration will be for Mr. Smith. Sometimes the default time is not applicable to each patient. This information is crucial to proper and productive scheduling.

4. Limit the number of non-productive appointments per day. Dr. Graham had one day that had 4 crown cementations. When the doctor says, “Mrs. Jones, Kathy will schedule an appointment for you in two weeks to get that new crown placed for you,” don't take him literally. If he prepped 4 crowns that day, don't give him 4 crown seats in two weeks, spread them out a day or two apart. Pre-determine exactly how many crown seats you are willing to do in a day, as well as other non-productive appointments such as wax try-ins, final impressions, etc. All these procedures eat up doctor time and create no production. The daily goal will not be reached with too many of these appointments.

5. If the schedule is properly managed, there is no need for additional assistants. Doctors sometimes feel they can produce more if they have one more assistant and can open up one more treatment room. Wrong! No matter how many treatment rooms and assistants you have, YOU can only be in one place at one time.

Dr. Graham was happy to call recently and report that after professional training of his new Schedule Coordinator, his daily production is reaching almost $4,000 a day and he is only seeing 8-10 patients instead of 15-17. He is now working smarter instead of harder.

Contact McKenzie Management at 877-777-6151 to learn how to rescue your business team from scheduling traps with professional dental training.

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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28 Reasons For Patients to Return
Belle DuCharme, CDPMA

Stopping cancellations and failed appointments on the hygiene side of the schedule is an ongoing challenge for many dental practices. Having more than 30 minutes of cancellations per hygienist per day is not acceptable to be productive. Many factors influence this problem, but one that does not get the attention it deserves is the message that patients leave with at the end of the appointment. In practices that pre-schedule all dental hygiene appointments, the assumption is that all of these patients will keep their appointments.  It does not happen this way, but the practices keep on doing it even when they get the same result. It does not matter so much how the patient is confirmed because even that does not stop failures and last minute cancellations. If you must pre-appointment everyone, you have to give a better reason than “See you in 6 months.”

The full adult dentition is 32 teeth. Most healthy adults have 28 teeth because the third molars have been removed. Other than the professional teeth cleaning and exam, there are 28 reasons to return to your dentist on a recommended basis - yet most patients think of the dental hygiene visit as a “teeth cleaning.”

The reason to return that is given on most reminder cards or emails is “because you are due.” Yes, you said that they are due - but perhaps it is not clear as to why. Most everyone can “clean” their teeth and if they were told they were “doing a great job” with their home care, why should they return in six months? Realistically it wouldn’t hurt to go to eight or nine months, right? The patients who are pre-appointed also get a message that says “If you need to cancel or reschedule please call us.” Isn’t this understood, do you really need to invite them to cancel?

The message to return starts in the chair in the clinical examination portion of the dental hygiene visit. Pre-existing restorations that are showing signs of breaking down, unresolved pocket depths that could get worse, areas of gingival irritation or recession are all reasons to return for further monitoring and possible repair or treatment.

If the patient suffers from bruxism and doesn’t want to purchase a night-guard, he/she is at risk for further joint damage, broken teeth and restorations. Information regarding keeping the recommended schedule to monitor this condition would be valuable for the patient to understand. If a patient is on medications that cause dry mouth, more frequent visits to monitor the effects on the teeth and mouth would be advisable. Old crowns with open margins; large, old and receding amalgam restorations; old, large, chipped, washed out and stained composite restorations all are worthy of mention as to why the patient needs to keep the regularly scheduled hygiene appointment.

Sometimes during the hygiene visit the dentist comes in to do the examination, and the dental hygienist has usually noted some areas of concern. This is a critical time to bring value and reason to return for future hygiene visits. Eliminate the words “we will watch that” and instead say “I am noting that there is a breakdown in this tooth or teeth (show patient with mirror) and I want to see you in six months to monitor this condition.” Other scripting may say: “Jane, you have improved your home care and it is evidenced in the healthy tissue I see. It is important that we keep you on the six month schedule to ensure that you stay in good shape, and I also want to monitor the lower left molar where there is gum recession and the upper left molar where there is wear on the cusp” (show in mirror).    

Notes of the dentist’s findings during the examination are important for the front office team to see, especially if they have to call this patient in the future to get them to schedule their recall/recare appointment. Inform the entire team to educate the patient that the appointment is more than just a “check-up and cleaning.”

Add value to the message and the patient will be less likely to cancel the appointment. Need help with creating a practice that exceeds your expectations? Call us today to schedule a professional training course customized to your practice business needs.

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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