8.14.15 Issue #701 info@mckenziemgmt.com 1-877-777-6151 Forward This Newsletter

4 Reasons Bonus Plans Don’t Work
By Sally McKenzie, CEO

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You want to reward your team members for their hard work. They play an important role in your practice’s success, after all, and you want to keep them both motivated and happy to come to work each day. That’s why you decided to implement a bonus plan in your practice.

The problem is, bonus plans simply don’t work. In fact, they can actually harm both your practice and your employees. Over the more than 30 years I’ve worked as a dental consultant, I’ve seen dentists pay out bonuses when total employee costs were already beyond 27% of practice income (gross salaries 19.22%, payroll taxes and benefits 3.5%). Not only is this fiscally irresponsible, it jeopardizes your practice and your employees’ job security.

If you use a bonus system to reward your team members, I suggest you stop and turn to other techniques instead. Here’s why.

1. Not all employees contribute equally. The fact is, you have some employees who contribute more to your practice’s success than others, which is why bonus plans are simply unfair. Through bonus plans, everyone on the team usually gets the same reward, even if they weren’t directly involved in bringing in 10 new patients last month, or reducing accounts receivable by 10%.

If everyone gets the same reward no matter what, it could lead to resentment. The team members who are actually responsible for the practice’s success get the same recognition as employees who do the bare minimum when they come to work each day.

Another reason bonus plans aren’t fair? Sometimes practice success is simply good fortune. Here’s an example. A new business moves to town, and many of the employees become patients, mostly because your practice is so close to the office. That means your production and collections go up, yet your team members did nothing extra to generate that business. Does it make sense to give employees bonus money for that increase in business? No. You’ve absorbed all the practice’s financial risk, so it's unfair for the employees to benefit from this good fortune.

2. Bonus plans put the focus on money. Offering your employees extra money will not improve their performance. In fact, it actually takes the focus away from their job’s performance indicators.

Let me give you an example of what I mean. I recently consulted with a practice that held weekly meetings to discuss how close they were to making that month’s bonus. At the time, long-term patient retention had dropped from 95% down to 90%, but short-term production was increasing. That meant the team still got a bonus, sending the message that a downturn in job performance is OK, as long as more money is being made.

3. The doctor becomes resentful. Often times, an increase in business is a direct result of something the doctor has done, whether it’s investing in continuing education to improve skills and offer more services, or purchasing new equipment that attracts more patients. Even though the team has really done nothing to increase business, they benefit. The doctor, who’s been performing all the extra dentistry, becomes resentful, yet keeps the bonus plan in place because he/she’s afraid of how employees will react if it is taken away.

4. Bonus plans make doctors and employees financial adversaries. Bonus plans paid on the practice’s profitability keep you from taking full advantage of tax laws to minimize annual tax payments. This creates conflict between you and your team members. As the business owner, you want to minimize profits to avoid paying taxes, but your team members want you to report as much profit as possible. Why? It increases their bonus.

To avoid this, some doctors pay bonuses based on production. This is also a bad idea. You can produce $500,000 a year, but it might have cost you $550,000 to produce it. Paying bonuses on production, irrespective of production costs, makes no sense at all. 

When team members go above and beyond, you want to reward them for their efforts, but bonus plans just aren’t the best method. Employees end up receiving bonus money for practice successes they had nothing to do with, leading to resentment and sending the message that performance really doesn’t matter. This doesn’t motivate your employees to excel in their roles. In fact it does the opposite, putting the focus on money and how they can ensure they get that next bonus.

There are other ways you can reward your employees for a job well done. Next week, I’ll give you more reasons to avoid implementing bonus plans in your practice, and I’ll follow up with two articles that outline both monetary and non-monetary ways you can reward your team members individually.

Next week, 3 more reasons not to give out bonuses.

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

Interested in speaking to me about your practice concerns? Email sallymck@mckenziemgmt.com
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Belle DuCharme, CDPMA
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Late to Arrive and Late to Seat Patients = Time to be Accountable
By Belle DuCharme, CDPMA

Dear Belle,
We have three hygienists on our staff. Two are always on schedule, get the patients out on time and work a fifty minute schedule. Our other hygienist, who has been with us the longest, is always running behind and thus seats patients late. We gave her a sixty minute schedule to help her, but she is still late. She is the topic of gossip and other Front Office Training members of the staff have complained, but I just stick my head in the sand and wish it would go away. What can I do to keep her on time?
Dr. Bee Fuddled

Dear Dr. Bee Fuddled,
I have heard this same story many times, and it is perplexing that some people are habitually late and others are on time and prepared. Sometimes it is a difference in personality that drives this behavior. The personality that is late doesn’t see or understand that it is a “big deal” and they feel their behavior doesn’t hurt anyone. Some personalities are highly extroverted so the time is wasted in talking to patients, which they feel is important to their work. More introverted types will avoid the idle chatter to give the patient what they came for – a thorough teeth cleaning. 

Some hygienists will claim they have more periodontal maintenance patients than the other hygienists, and thus need more time. Some say they fall behind when having to take x-rays, etc. Sometimes blame will be placed on the doctor for not coming in for the examination on time or for talking too much. In this situation, however, the other hygienists are on time which leaves room to doubt the excuses.

Establishing a breakdown of what should occur in the normal fifty minute hygiene appointment is recommended to see where the time is spent and where it can be managed better. The following is a look at the hygiene appointment without use of an assistant.

Introduce yourself or give salutation to patient 1 minute
Update medical history and HIPAA 1 minute
Issue or concern/chief complaint/notation 2 minutes
Check vitals 1 minute
X-rays/intra oral photos or other diagnostics 5 minutes
Prepare patient: place bib, eyewear, chair, and headrest 1 minute
Periodontal assessment and oral cancer screen 5 minutes
Adult Prophy Normal 15-20 minutes
Polish and floss 4 minutes
Doctor Examination (if necessary) 5 minutes
Treatment plan entry/clinical notes 1 minute
Fluoride/Oral hygiene instructions 4 minutes
Set appointment complete/schedule next visit 2 minutes
Dismissal and escort patient to front office 1 minute
Tear down and set up room for next patient 2 minute
TOTAL TIME 50-55 minutes

Of course there will be variables according to individual patient needs, hygienists’ speed and whether there is use of an assistant. Appointments for scaling and root planing will be structured differently to include delivery of anesthetic. By analyzing the appointment it will be easier to address the areas where time needs to be adjusted.

The morning huddle or daily business meeting is the time to discuss where a hygienist may have a time management issue. It can be decided when the hygienist may need assistance from another team member to keep them on time. During the meeting, each hygienist reports whether they stayed on time or not and why from the day before. Reporting this information will help illustrate who is on time or not. When one member of the team suddenly has to explain why they aren’t on time this can be an incentive to change behavior.

McKenzie Management offers a Free Hygiene Assessment and Hygiene Consulting Program that can take your team to a more productive and less stressful work environment, eliminating the drama and increasing individual accountability. Give us a call today. Want custom team training for your Office Manager or Front Office? We have you covered there as well.

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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Nancy Caudill
Senior Consultant
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How Many Patients are Supporting Your Practice?
By Nancy Caudill, Senior Consultant

How much “business” do you actually have? This can certainly be interpreted in many ways, oftentimes to ease the discomfort of the owner. When consulting and coaching with practices, the definition of what constitutes “active” patients - and therefore how many active patients they have in their practice - is varied across the board. Doctors and teams alike will ALWAYS say they have more active patients than what is reality.

Unfortunately, hearing the actual number is usually disheartening to the practice owner, especially if the practice is mature. At the same time, however, the practice might only have one full-time hygienist working four days and one hygienist working two days. This is when we have to get out the calculators and do some simple math.

Many practices average eight hygiene patients per day. However, when asked why eight, the typical answer is that for an 8-hour day, one patient every hour = eight.  When confronted about patients who don’t need an hour, the response is usually, “If we scheduled everyone at different times, we would have holes in the schedule.”

If you read McKenzie Management E-newsletters regularly, you already know we encourage offices to schedule their day to a specific dollar production goal, not to a specific number of patients.

Let’s Do the Math:
So, let’s agree that a hygienist working an 8-hour day sees eight patients per day. If the practice works 48 weeks a year, taking into consideration holidays and vacations, the full-time hygienist works 192 days. If the hygienist sees eight patients each day, she/he has the capability of managing 1,536 appointments. If all of your hygiene patients come every six months or twice a year, 1,536 potential appointments divided by two appointments per year = 768 patients that your hygienist can support. Your part-time hygienist would see half that many, or 384 patients, for a grand total of 1,152 patients!

Suppose you have a very successful interceptive periodontal therapy program and one third of your patients come every three or four months…you would then be able to support even less patients.

Practice is 10 Years Old or More?
Let’s do some additional simple math and “guess” how many potential hygiene patients you would have over the past ten years.

An average solo doctor practice should average 20-25 new patients seen in hygiene per month. Let’s say for discussion purposes that you average 20 new hygiene patients per month x 12 months x 10 years = 2400 potential active patients. However, if you are only supporting one full-time hygienist and a part-time hygienist, statistically your practice could not support 2400 patients, as illustrated in the previous paragraphs.

Where Did All Your Patients Go?
No dentist likes to think that, after ten years of practice, half of their hygiene patients have been lost. However, we know they are not being seen in your practice if you only have six days of hygiene per week. Where are these lost patients? The first answer is that they aren’t lost at all, they are just waiting for someone in your office to contact them. Answer #2 is they are probably going to another dentist because no one from your office contacted them. Answer #3 is they relocated, changed insurance carriers or passed away. However, this third reason should only be about 10% of your active patient base.

You Prefer NOT to Grow?
You may say, “I prefer to not have more than six days of hygiene”, which means that you prefer not to grow. Okay, that’s an option. Every doctor has their own practice goals. However, I would propose that you don’t control your practice growth by not retaining your patients. How about controlling your growth by better management of the PPO plans that you accept, reviewing your fees or a combination of these strategies?

You Want to Grow?
If growth is your practice goal, you can see from this article that you must get control of your “back door” and increase the number of potential hygiene patients in order to add more days of hygiene to your work week. At the same time, you do not want to simply add more hygiene days without evaluating your current active patient base, or you will have hygienists who are not busy.

If you would like to learn more about evaluating your active patient base, the number of hygiene days that you can support and how you can add additional hygiene days, contact McKenzie Management today at 877-777-6151 and take our FREE Practice Assessment at http://www.mckenziemgmt.com/cons-practiceassessment.php.  

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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