The Hurrier I Go, the Behinder I Get!
How to Turn a Practice Plateau into a
By: Sally McKenzie, CMC, President,
The Hurrier I Go, the Behinder I Get!
Don’t you just want to pummel a punching bag when you hear
about practices doing over a million dollars a year per doctor?
Meanwhile your production numbers remain frozen on some
primeval plateau month after month. What’s wrong with this
Well, just because your practice has hit a plateau doesn’t mean
you’re doomed to live in the shadow of the high flyers. You might
just need to reengineer your practice systems, personnel, or
structure, but the sun is ready to shine on your practice.
Gaining Ground, Losing Face
Unfortunately, some practices wait till year-end to take a really
good look at their practice performance only to discover that
they’ve been stuck on a plateau for the whole year! Those that
review their numbers every month will see the plateau as it’s
approaching and can put a program of recovery into place right
away. More often than not, a practice will slide into a plateau
because both the doctor and the staff have exhausted their
knowledge of how to make the practice grow.
The only way to avoid the practice plateau is to find flaws in your
systems and then constantly monitor the practice for those flaws.
Following is what McKenzie Management has found over the last
22 years as the most prevalent causes of the practice plateau:
• Business staff turnover
• Lack of training of business staff
• No expectation levels of systems
• Lack of practice performance measurements
• Unclear job descriptions resulting in no accountability
• Decreased patient retention
• Unscheduled treatment not being tracked and scheduled
• New treatment services not added to the practice mix
• Not being clinically efficient
• Not reviewing fees for increase
• No practice vision
Which Came First, the Egg…or the Turkey?
The trouble is, all these causes and indicators are interdependent.
Why is business staff turnover such a problem? For starters,
compulsive hiring decisions are often made, placing a person
whose temperament or skill level is not conducive to the job that
needs to be done. Then again, without a clear job description, it’s
impossible to determine the exact right fit between a job
candidate and a staff position, accountability for practice systems
or measurements for job performance.
To regain control we need to stop and see where we are. Let’s start
with expectations. If you do not have specific expectations of a
particular system, you cannot communicate those expectations to
58 DentalTown Magazine
your employee. It should come as no surprise, then, that the
employee doesn’t quite know what to deliver. Once an employee
has been given the necessary training and understands how the
expectation for a particular system fits into the practice vision,
they’ve got the tools to deliver that level of performance. Don’t
worry about the appearance of being a demanding boss. You are
actually doing your staff a favor and making it easier for them to
succeed at their jobs.
Taking this idea a step further, the practice needs to have systems
in place whose success is not dependent on any one person, but
on the system itself. It is critical that doctor and staff understand
how systems should be performing, compared with not only
industry standards but with the practice vision. Such goals would
include 95% patient retention; 98% collection ratio; 85% case
acceptance; 33% hygiene to practice production; 75% emergency
patient conversion to comprehensive exam; and less than .5 hygiene
openings per day.
Take Charge or Take Cover!
Discussing the issue of accountability–or the lack thereof–we are
reminded of a rather distressing situation: recall is the principle
vehicle for patient retention, but it is the most neglected
management system in a dental practice. As a result, the incidence
of patients not being retained often exceeds that of new patients
coming into the practice. If the doctor in this practice had hired
a patient coordinator for an average of 15 hours a week, she would
have been able to handle a recall system of up to 1,000 patients.
At the rate of $15 an hour, it wouldn’t have taken many recall
appointments to make her salary a profitable investment.
If recall is the weakest link, then unscheduled treatment runs a
close second. Using the Unscheduled Treatment Plan Report only
for filling holes in the schedule, the scheduling coordinator is
being reactive instead of proactive. She needs to be taught to
think of this report as a record of unproduced revenues. Now, give
her a definitive script that will likely result in her being able to
schedule treatment. Your scheduling coordinator should make at
least five ‘sales’ calls a day, and should report at your monthly
meeting how much unscheduled treatment has been added to the
list that month, and how much has been scheduled and taken off.
Speaking of valuable tools, the Production by Provider Report
from your computer system is a dynamic means of determining
the number of each type of procedure you performed over a
specified period of time. Your business assistant should be
accountable for generating this year-to-date report every month
for each doctor and hygienist, so they can determine how their
production compares with the same time periods last year as well
as with production goals that have been established for this year.
Case in point, in the past six months Holly Hygienist has taken
319 bitewings and done 1,039 prophys. If the practice philosophy
is to take bitewings once a year on recall patients, then the number
of bitewings is 20% below practice expectations.
According to Dr. Allan Monack, Consultant and Hygiene Clinical
Director of McKenzie Management, 33% of hygiene production
should be derived from periodontal therapy...namely the 4000
insurance codes such as #4910 and #4341. Holly was averaging a
Before we leave the clinical area, let’s take a look at new treatment
services not being added to the treatment mix. Practices that have
stagnated may have been doing the same-old thing, i.e. crowns,
fillings, and prophys year after year. Dentists who are doing
interceptive perio, root canals, veneers, bleaching, and implants
become recharged and their enthusiasm is infectious.
Efficient time use, as a treatment service, often falls casualty to
inefficient planning. Dr. Phil Devore, Consultant and Clinical
Director of McKenzie Management states that some doctors may
reuse the same bur five times, alternating it with other burs during
a single preparation instead of using each bur until finished with
it. They also get up from their chair numerous times during
patient procedures, or have their assistants leave the treatment
room to retrieve items that should have been set up in the first
place. Clinical time and motion studies reveal three more reasons
for a production plateau: 1) slow treatment room turnaround; 2)
underutilization of chair-side assistants; and 3) poor planning for
armentaria and procedural protocols.
While you’re sitting on top of a practice plateau, give some
thought to your fees. What you need to do is calculate your
production per hour (PPH) along with a PPH analysis of every
procedure you offer. This is much easier to figure out than you
think. Just take your fee, divided by the amount of time it takes to
do the procedure=production per minute x 60 minutes=pph.
Once a year you should implement fee increases following an
analysis of comparative fees in your area. Finally, you may want to
challenge yourself to reduce your procedure time.
Remember, the door to success has two signs, PUSH and PULL.
The trick is to recognize when to do which.
Sally McKenzie, Certified Management Consultant, is a
nationally-known lecturer, author. She is President of
McKenzie Management, which provides in-office analysis
of the business, clinical, and hygiene department;
conducts on-site staff training; and offers a full line of
educational management books, audiotapes, and videos.
To receive Sally's FREE weekly and monthly email newsletter,
email her at sallymckenziemgmt.com or call Sally toll-free
at 877-777-6151, or sign up at her website
Is Owning a Practice more than you Bargained for?
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do Dentistry and go Home?(on time)
The McKenzie Management TEAM makes your
Sally McKenzie, CMC
DentalTown Magazine 59