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Going From Four to Three

I was speaking to a senior doctor who had just begun our “Trial Partnership” strategy.  The young associate had just started a month or so back and was slowly getting better.  Somewhere in the conversation he mentioned that last year at this time he was producing about $80,000 on four days per week for the month without an associate, when this year, he cut back to three days a week but produced $60,000 while the trial partner did $20,000.  Yes his office produced $80,000 for the month, but he is taking home less income.  If you factor in the fact that he has raised fees and overhead costs to do business increase each year, the numbers are worse than they appear.  I asked if he had always planned to cut back or did he do it so the young doctor would have something to do?  It seemed to be a toss up.  He kind of liked the idea of cutting back, but I felt like he was avoiding the possible fact that he may have chosen the wrong doctor, he was not totally committed to doing whatever it takes to make this work, or really had not thought through his decision.

We won’t mention that he should have doubled his marketing with very good results, and added Fridays and Saturdays every week.  Let’s just concentrate on the four days to three.  Most of us could surely produce in three days what we do in four.  We all have cancellations, open appointments, and times where we just are not pushing ourselves.  If we could engineer our schedules every moment of the three days, there is no doubt that we could produce at, or more than a four day week.  There is a catch here and that’s what we need to consider.

All of us would love to cut back.  Problem is we usually need to maintain and sometimes exceed what we produced the year before if we are adding staff.  In the case of an associate, they will need twice the number of new patients to produce half the production.  It just takes time to become good at helping patients want what they need.  So does it make sense to go from 4 to 3?

The first month you will probably do OK.  The next month or so something happens.  Hopefully you will figure this out, but most don’t.  Convenience is huge to patients, so when you cut back, your associate is going to be more convenient to see.  Their production goes up and yours goes down.  Not being there creates a vacuum and this “sucks”.  The young associate will suck patients off your schedule and on to theirs with dire consequences.  The problem is that when our trial partner or associate sees the existing practice patients, they come off your schedule and at your expense.  What if the new doctor is more convenient?  In fact, the existing patient can only come in on that day,  but the young doctor fails to inspire the patient, and the patient decides to go elsewhere.  You will never know what happened.  All of a sudden you begin to get negative feedback about your office on the internet.  The bad thing about new staff members and even doctors is that they become the face and voice of your practice, and this may not be good.  You need to be there to make sure that what got you where you are is still in play.  Passive leadership is a slippery slope to poor results.

The next thing to consider is that even if you are going to multiple doctors or a solo practice going from 4 to 3 means that you now are no longer there one day a week to see those patients you once did, and it is these patients and the business it created that made you think you could cut back in the first place.  Going from 4 to 3 is a 25% reduction in face time with potential patients.  You could find that not having the patients that once came in during that 25% will break your momentum and recovery may be difficult.

When you go from 4 to 3 you will need to make a decision as to which days you will work.  If  you give up the most consumer friendly days (Monday morning, all day Friday, and Saturday), you accelerate or magnify the effect of your not being there because these are the days and times when new patients want to come in.  In this case when confronted with this, the doctor defended his choice by saying that he wanted the  young doctor to have the opportunity to grow their practice more quickly.  This makes a little sense, but in another way we are exposing our most important asset, the new patient, to a yet unproven doctor.  Once again, this could be disastrous, especially if we have a nonassertive senior doctor who in the worst case scenario fails to let the junior doctor go soon enough when he finds that this is not the right fit.  By being absent we abdicate our oversight and limit our productivity.

In this practice the doctor had used the Summit Bonus System for over a year and it was going great.  Problem was that he did not change the BAM or number they must reach before bonus when the young doctor came in.  This will be catastrophic.  We have increased our overhead but not tied the strategy to our bonus.  Without increasing your BAM, you are paying staff an increasingly greater bonus that they did not earn.  In this case it could be oversight or it could be a lack of assertiveness.  This should have been discussed with the staff prior to bringing anyone in to work.  They knew if we had added any other position that the BAM would be increased, why not the doctor position?

Bottom line:  Going from 4 to 3 is not as simple as it might seem.  You either have the practice and systems and right doctor or you don’t.  If you are considering this as a growth strategy you need to make sure that you are poised for growth, have unlimited ability to attract a never ending supply of patients, have your systems in order, staff  on board, a way to measure results, and have the right doctor.  Even with trial partners or associates, you should always involve the staff and hire slowly.  If  you have made a mistake or  the young doctor just can’t produce, free up their future quickly.  You do not have the luxury of babysitting a doctor that cannot cut it or produce enough without damaging your schedule.  Good luck, and call me earlier rather than later in the process.

Michael Abernathy, DDS
[email protected]