“I’m too busy!! I’m booked out three months, and my hygienist is booked out four months. We don’t have any openings for new patients or emergencies. If I diagnose crown and bridge or a cosmetic case, I have to schedule the patient out into the future and hope for a cancellation so that we can move them forward. I like the income and don’t want to see that drop. But, I don’t want to be booked so heavily or so far out. The stress is wearing me to a frazzle. What do I do?”
I hear this kind of statement and question often. There is much written about building a practice: increasing a patient base, marketing to attract new patents, etc. This kind of instruction and information is imperative for most practices.
However, I am seeing more and more of the flip side of this issue. Many practices are too busy. And I’m talking about quality comprehensive, fee-for-service practices.
You may relate to the opening statement: “I’m too busy! What do I do?” If you do, first of all, let me congratulate you. You are to be complimented for your success and for your popularity. People wouldn’t be coming to you if you weren’t doing a lot of things right!! So pat yourself and your team on the back.
However, you do have a problem. It’s a good problem to have, being too busy. But if you don’t control your growth, your number of patients, the management of your practice and your success, you run the risk of the success becoming an overwhelming and consuming problem.
So let’s look at 7 steps to take to get in control of your business. It may take one or all of these steps to smooth things out for you. However, if your goal is to have a smoothly running practice in which you are able to give patients your full, undivided attention and have not more but all the time you need to provide care in an ultimate manner, then bite the bullet, and take the necessary steps to gain control again. If you don’t control your practice, your practice will control you! This is true whether your issue is being too busy or not being busy enough. But for the purposes of this article, I will address being too busy.
Manage Your Schedule. Scheduling, or appointment control, may be the most difficult and stressful of all the management systems in a dental practice. I don’t believe there will ever be a practice that can honestly say that their scheduling is perfect. This system demands improvement. The way you schedule will evolve as your dentistry evolves.
Identify areas of stress related to scheduling, and one by one, make concerted effort to work through those issues until resolution is achieved. Two of those “stresses” or “stressors” of scheduling are a.) seeing too many patients per day or b.) being booked out too far.
During your treatment planning, plan to do a quadrant or a half-mouth per appointment. Try to treat a patient in as few appointments as possible. Both you and the patient win.
For example, if a patient has decay in all four quadrants, you might schedule four one-hour appointments. That’s only four times that the patient has to take off from work, come to your office, four times to be anesthetized, etc. Or, you could schedule two appointments for approximately one and a half hours each and do half of the mouth at each appointment. Ask your patients which they would prefer. At least nine out of ten will say, “Get me in. Do as much as you can.” You do the patient a tremendous service.
And for you? Three hours versus four hours. (These are approximate numbers, but you get the idea.) You just opened up an additional hour, and this was one example with one patient. Think this through. How many times per day could you conserve time by doing as much dentistry as possible per patient when and where appropriate, of course. With the extra time you could:
Spend more time with the patient.
Not have to run between room so much because there would be fewer patients per day.
Produce a higher amount (and probably always would).
Have more time for other appointments because you aren’t seeing so many patients for so many small appointments
Efficiently control the cost to you for each appointment: less anesthesia, fewer room turnarounds, etc.
Consolidate your appointments. Control your appointment book.
Delegate. In direct relation to scheduling is delegation of responsibility. A key to business control is to delegate when and where possible, according to the laws of your state. The doctor should do the things that only a doctor can do and should delegate all else. Again, scheduling carefully is imperative as you refine the delegation of responsibility. Delegation is not only essential for business control, but it is also a key to improved productivity.
Dovetailing your appointment book is amazing. Defining when the doctor is or is not occupied during a procedure is step one. Then, when an aspect of a procedure is delegated (for example, temporization in many states) the doctor can be carefully scheduled into another treatment room with another assistant, or into a consultation, etc. No one should ever be booked opposite themselves—obviously! But dovetailing maximizes the time and talent of all providers.
Most practices can add one to two hours of available treatment time per day by engineering the appointment book more effectively. Delegation is a major part of effective scheduling.
Patient Financing Programs. Many patients ask for “one tooth at a time” dentistry, or many practices find themselves offering this kind of treatment because of the investment. You do the “one tooth at a time” dentistry because the patient (or you) thinks that is all they can afford.
Get involved with, promote and use a patient financing program. If you present a case based on fewer, longer appointments, but the patient says, “Can I just do one tooth at a time? I’m on a tight budget.” Ask the patient the following question: “Ms. Patient, if we were able to make the financing of your dental care comfortable, and you were able to spread the payments out over a period of time so that they were small and fit into your financial situation, would that make it possible for us to get your mouth totally healthy in a few visits? In other words, Ms. Patient, we could spread the payments out rather than spreading the treatment out. You would come to the practice for fewer visits, get off work less, receive anesthesia fewer times, get all your treatment completed, but not be financially stressed. Would that work for you?”
Most people would say yes if you had done a good job of explaining, presenting, educating and motivating.
In order to do more dentistry per patient on fewer patients per day and see the patient for fewer visits, a patient financing program is a major asset. Most people don’t care as much about the total investment as they do about how much it costs per month. Most families are on a budget (some high, some low). But whatever the budget, being able to fit the payments for their dental care into that budget can pave the way for a patient to not only accept treatment, but to go ahead with the timely scheduling that you recommend.
If you are not actively involved with a patient financing program, get that way. If you are not maximizing your existing program, seek further training or access training material (i.e., Collect What You Produce, by Cathy Jameson. PennWell Books.)
Again, your scheduling will be more efficient, production will go up, costs will go down, stress will be relieved.
Fees. If your scheduling is fabulous, as good as it can get; if you are delegating when and where possible and are dovetailing your appointments; if you are able to do quadrant or half-mouth dentistry because your patients can afford to do this, and if you are still too busy and booked out too far, then raise your fees. Or, if you’ve already raised them within the last three months, raise them again. Raise your fees by 10% (minimum) across the board.
More than likely, most people won’t even notice the fee increase. But the law of supply and demand indicates that if you are well organized and are still too busy to take care of people as you desire, then raising your fees is appropriate. If you do lose some people from your practice, you will have more time—and better quality time—with the patients who remain. You will have more time to do great new patient experiences and consultations and can do quadrant, half-mouth, arch or full-mouth cases, whether restorative or cosmetic. Your fees will be higher and will offset any losses of patients. According to studies by Dr. Charles Blair, if you have a 65% overhead, and you raise your fees 10% across the board, your margin of profit would increase by 28.6%. However, you would have to lose 22.3% of your “sales” before the bottom-line profit of the practice would be negatively impacted.
Let me assure you that if you raise your fees by 10%, 22.3% of your patients will not leave you. We have coached over 1000 practices in the U.S. to excellent success. We have seen these practices increase their fees consistently, but we have never seen those fee increases cause a mass exodus of patients, nor have we seen a reasonable fee increase have a negative effect on a practice.
However, if you are “too busy”, you probably want to eliminate some of the numbers of patients. If you increase your fees by 10% and do not see patients leaving, go up another 10%. Push the envelope on your fees. But always make sure that the fee you are changing is equitable for the service you are rendering. If you have higher fees and fewer patients, you will be able to give quality, focused attention to your patients. Your profit margin will increase, and you can afford the equipment, materials, the lab, the team and the coaching that are essential for continued, prosperous excellence.
Associate. If the first four suggestions have been met or exceeded, you may need to consider an associate. This is a major decision and needs much consideration, planning and advice. This can be a wonderful situation, or it can be the worst. However, the additional doctor can:
Be a fabulous way to serve your patients.
Take care of your ““busyness””.
Help you see patients more expediently.
Increase your productivity.
Relieve you of some of the pressure of feeling like you have to see all of the patients.
Create the position of associate as carefully as you would create any other position in your practice. Then, if your associate does not become a partner and leaves to start his or her own practice, you will fill the position with another doctor. Do the best you can to make the position and the relationship fabulous and successful for all parties, but if one associate leaves, that doesn’t have to mean that the position should go away. If your hygienist moved, you wouldn’t eliminate the position. You would fill it.
Refer. As a doctor/practice that is too busy, consider referring as much as possible. Carefully define your vision of your ideal practice. What kind of dentistry do you love the most? Focus and concentrate on this, and refer everything else.
For example, if you want to focus your practice on comprehensive, restorative and cosmetic treatment, then refer everything else, nurture your relationships with your specialists. Let them know what you are doing. Invite them to dinner or to your practice, or go to theirs. Show them examples of your dentistry. Let them know which kind of results you are achieving. And send them patients. They will reciprocate. So, you will not be “losing” patients or productivity, but rather will be able to focus, organize and concentrate on what you do best and love most.
Referring patients appropriately will prove to be stress controlling and will be financially beneficial.
Insurance. If you are too busy, and if you are on any managed care programs, this may be the time to decide whether or not you wish to remain a provider.
List all of the programs you are presently a part of, from the one that generates the most revenue to the one that generates the least revenue. As you build the fee-for-services part of your practice, start eliminating the managed care programs starting with the least productive and going up from there.
Or, if you are totally fee-for-service and are too busy and cannot focus on the care or the patients as you wish, and if you have done all of the things of which I have spoken thus far, then you could consider not accepting assignments of benefit of insurance any longer.
This is not an easy choice or an easy decision, nor is it appropriate for all practices. You have to decide.
I can promise you that this will be a sure way to lose patients!! Will you lose all patients? No. Will you lose so many patients that you will destroy your practice? Not if you handle the transition properly and carefully plan the change.
I can also promise that you will have time to plan and organize excellent cases. You will be able to orchestrate outstanding case presentations. You will be able to spend quality time with your patients providing optimum care. You can reduce many of your operating expenses and have a profitable business.
Please know that I am not telling you to drop assignment of benefits of insurance. I am simply noting that this is a way to reduce ““busyness””. If you choose to make the decision to drop insurance, let me strongly recommend that you do so with care and planning. If this step is executed poorly or without a strategic plan, the results can be disastrous. Done well, however, it can be successful. You must be clear on your vision and on your goals. You must be confident. You must be an excellent manager and leader.
In Summary These are the seven steps to take to gain control of your “out of control” schedule. Each step will help by itself. A combination of one or more of these steps will make a significant difference.
I have moved from conservative to liberal suggestions to take into account the wide variety of visions and differences among dental professionals. The choices you make will, as always, be your own. The critical factor is to make a choice. As previously stated, being too busy is a compliment to you, but it can be problematic. Lack of control leads to chaos, chaos breeds stress. Learning to control your “busyness” can lead to control of stress.