January 22-25
Panamanian Dental Congress
Panama

January 30-31
Sacramento Dental Society
Sacramento, CA

February 14
University of Nebraska College of Dentistry
Lincoln, NE

February 20-23
Chicago Mid-Winter
Chicago, IL

March 1
Arizona State Dental Association
Phoenix, AZ

March 8
West Virginia AGD
Charleston WV

March 19
Big Apple Meeting
Terrytown, NY

April 9
Michigan State
Grand Rapids, MI

April 10
Corydon-Palmer
Warren, OH

April 13
State College Meeting
State College, PA

April 25
Laurel Area Dental Society
Laurel, MS

Myth #1: Ideal patient retention is 85%. Let's look at a small, suburban dental practice in the Midwest that has around 200 patients on recall each month. Their patient retention is exactly 85%. Bingo, right? Better take a closer look. With 200 patients at 85% retention, this practice is only keeping 170 patients . . . and losing 30. Worse yet, they're bringing in only 15 new patients a month. That means a 15 patient deficit month after month! To neutralize such a deficit, they'll need to bring in more new patients and/or raise their retention rate significantly. Obviously, there is no "ideal patient retention" rate that is applicable to every practice. Not only must it be figured individually for every office, I also recommend recalculating your retention goal every three months, as the number of new and recall patients may fluctuate. Here's the formula we use:

1. Go back six months and calculate the monthly average of recall patients treated.
2. Calculate the monthly average of comprehensive exams for the same period.
3. Take 50% of the answer in 2.
4. Divide the answer in 3 by the answer in 1.
5. Subtract the answer of 4 from 100%.

This then becomes your ideal patient retention. However, just as important as the percentage retained is this: The total number of patients who don't come in due to cancellations and failed appointments should never exceed the number of new/comprehensive exams.

Myth #2. You need one front desk person for every $20,000 worth of production. This ratio spelled disaster for a client of mine in the southwest. Upon reaching $40,000 a month, a second business assistant was hired according to the prescribed one/$20,000 ratio, even though they were seeing only fifteen patients per day. A quick look at the numbers will make the picture very clear: 10 minutes x 15 patients = 150 minutes. Now divvy-up the responsibilities between two business assistants who each worked 480 minutes a day. Talk about cushy jobs! These gals had all the time in the world to make personal phone calls, catch up on community gossip, and really get to know each other. No surprise that the payroll expenditure far exceeded the recommended 20% of monthly collections! Now the other extreme: A client near Cape Cod was doing $40,000 a month, seeing 35 patients a day, and was struggling along with one business assistant. Even by mainlining caffeine from nine to five, the assistant was destined to fall far short of her responsibilities. Do the math with me: 10 minutes x 35 patients = 350 minutes tied up just in patient processing. Working a 480 minute day, she had little time left to answer the phone, confirm appointments, send out statements, fill cancellations, and pull or file charts. Clearly the patient load of this particular $40,000 a month practice necessitates having two business assistants. Although this might appear to substantiate Myth #2, it is actually the right answer for the wrong reasons. The rule of thumb to be used instead is: No more than half a business assistant's day should be used for patient processing, leaving the other half for non-patient tasks.

Myth #3. You need one clinical assistant for every treatment room you work out of. Typically, the scenario is: Two rooms, two assistants. But let's think this through. An 8:00 a.m. patient is scheduled for fillings for one hour. The next patient is scheduled at 8:50 for a crown preparation for 1.5 hours, and another patient is scheduled at 9:50. Patients are scheduled in two chairs, with two columns in the schedule overlapping the first and last ten minutes of each patient. Sounds good so far, right? Actually not. In our clinical analyses, we often observe the second assistant either trying to look busy or searching for something to do from 8 to 8:50 since the fillings require one doctor, one assistant--and from 9 to 9:50 since the crown preparation requires the same. Believe me, there are only so many instruments to prepare, supplies to stock, and drawers to clean. Through extensive time and motion studies in the clinical area, we have determined that one assistant can assist approximately 12 to 13 patients a day. Only when you exceed this patient load does another assistant become necessary. Again, implementation of Myth #3 without regard to number of patients seen can push your payroll expenditure beyond the limit.

Myth #4. You need an associate dentist when you have reached a level of 2000 active patients. For starters, the joke is: "How can you determine when you've reached the 2000 mark if there's no clear definition of an active patient?" What may appear to be 2000 patients, represented by charts in the file cabinet, may on closer inspection reveal hundreds of patients who haven't been seen for two to three years. The true definition of an active patient is one who is on the recall system, due to return during the next 6 to 12 months.

Back to the myth. A Connecticut dentist who works out of two chairs with one assistant, sees 10 patients a day, and schedules only one column in the appointment book is limited to the number of patients that can be treated per day. With 2000 active patients, he's scheduled out solid for 2-3 months . . . in marketing terms, that's suicide. Is he in dire need of an associate, or just some magic applied to the schedule? Now look at a dentist in Ohio, where expanded duties for dental assistants are legal. This doctor works 3 chairs, has 3 assistants, treats as many as 25 patients a day, and might have as many as 3000 active patients before he'll need to bring in an associate. So much for Myth #4.

Myth #5. Prescheduling recall patients is the best system to retain your patients. Baloney! Our analyses reveal a 42% higher loss of patients in those offices that preschedule than those that do not. Recall appointments made 2-3 weeks prior reflect a much higher rate of retention. But in all too many practices, nobody wants to be--or is assigned to be--accountable for the recall system . . . and prescheduling is instituted by default. Regrettably, this often results in a schedule booked out so far that additional hygiene days are tacked on to accommodate the apparent need. Thanks to the high cancellation and no-show rate, systems that preappoint 6 months in advance yield 2.8 openings per day per hygienist. This can mean $160-$250 in lost production, which further results in the hygienist getting 45% of her production in salary instead of the industry standard of 33% . . . not to mention over-the-top payroll expenditures once again. By the way, there's a value-added benefit of having a well-oiled recall system with high patient retention . . . maximum numbers of patients speaking well of your practice and generating ever greater numbers of new patients. If anyone on your staff rattles off Myth #5, they're probably looking for the "easy way out" . . . so show them the door.

Myth #6. Financial bonus plans work. Okay, maybe short term they do, like 3 months. But how will your employees feel when they reach a plateau and there's no more bonus, or how will you feel when you're writing bonus checks month after month and your overhead is hovering around 70%. Just try to get out of a bonus plan once you start it. In fact, that's one reason their popularity is waning. If you're considering a bonus plan to increase production, consider this: Wouldn't it burn you up that your employees knew all along how to help increase production, but just held back until you dangled the money carrot in front of them? Never thought of it that way, huh? Through our consulting work we have found that employees who are rewarded over-and-above for performance over-and-above will continue to repeat that performance . . . but using "bribery" to get an employee to meet or exceed job expectations negates both the expectations and the salary. The bottom line on Myth #6 is this: An employee who brings in 10 new patients next month had better be rewarded . . . and it doesn't need to be with money. A gift or gift certificate is often appreciated even more.

Myth #7. Once a patient has bought into the entire treatment plan that has been presented, schedule the entire thing. Uh-oh, your schedule's out of control . . . booked out almost two months because whenever a patient accepts a treatment plan that involves multiple appointments, all of those appointments are being scheduled up front. Do you really believe that prescheduling will "marry" your patient to the plan? This system is no different than prescheduling recall patients, and from the looks of the appointment book, you may start thinking about an associate dentist long before you actually need one. What's worse is getting a reputation like: "He/She's good, but it takes forever to get an appointment." Doctor, stop shooting yourself in the foot! Myth #7--preappointing entire treatment plans--creates a scheduling nightmare. Put it to sleep.

Myth #8. Preblock the schedule for your ideal day. Okay, here I am in an office in sunny North Carolina. The doctor's ideal day has been formulated to included 3 hours of crown and bridge each morning with ancillary treatment, such as fillings, in the afternoon. Oh, the difference between the ideal day and reality! While his schedule for crown and bridge could realize an appointment within two days, a patient who lost a filling has a two month wait! When formatting your schedule, you'll need to factor in past history or it will be a formula for failure. Here's how to do it: Generate a production analysis report from your computer, count the number of crown and bridge units done in the past 6 months and divide by the number of days you worked. Now format your schedule to reflect this equation. If the allotted time is causing you to schedule treatment out farther than 3 weeks, go back and recalculate. Although Myth #8 sounds alluring, you'll get far more satisfaction out of accommodating reality than you will with wishful thinking.