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It seems like every time I read an article, somebody has something to sell us in the form of some great strategy. Just send them $199.00 or attend some thousand dollar seminar and they will reveal this closely kept secret guaranteed to turn your struggling practice into a top producing super star practice that everyone will envy and patients will line up around the block to get into. This must be true because I see this in Dental Economics, the bastion of truth in advertising. Now I don’t have anything to sell you, but I would like to revisit an oft-ignored opportunity that each of us sees every day we work and fail to capitalize on: The Emergency Patient.

Every day we should be scheduling at least 60% of our day in “substantial cases”: Appointments that yield production of approximately what you would charge for a crown. For example: If your goal was $5,000/day for the doctor, you would need to schedule at least 60% of that day, or $3,000, in substantial cases. If you charge say, $1000 for a crown that would be three crowns or its equivalent: Dentures, implants, braces, root canal and build up, quadrants of fillings, etc. Do this and you are guaranteed a productive day. Make every day productive, and you create choices and financial security for you and your team.

The next step is to always schedule at least 10-15% above your goal. For example, if you wanted to produce $5,000/day you would need to schedule $5,500-$5,750. In this way we compensate for and act to eliminate the adverse effect of possible cancellations. The average practice will have about 15% of their day fall apart. If it happens to be a crown or two it could be devastating. Think of it this way: The average dentist works 200 days a year. If we had one crown a day cancel at $1000/crown, we just flushed $200,000 down the toilet for the year, and this could have been pure profit. On the other hand, if we could eliminate cancellations and no-shows while adding an emergency patient that ends up being a substantial case, we could add $400,000 to the bottom line.

The final step is to look at the Emergency Patient (EP) as an opportunity. I can’t remember a time when I didn’t add a couple of thousand dollars a day to my production, every day. This is what I want to talk to you about.

Keep in mind that I always ran on time and you should too. If you can’t run on time, you will not be able to add production through EPs. In fact you will consider them, like many of you wrongly consider hygiene checks, as an interruption in your day that stresses you and throws you off your game, when in fact they could be the number one strategy in dentistry to increase production and lower overhead. If you constantly run behind, you need to go back and look at how you treatment plan and schedule. Same day dentistry is the dirty little secret that every high producing practice utilizes every day.

A couple of months back (April 2012) we published three articles that described the basis for every Summit strategy: The Purpose Driven Practice, the Doctor Led Practice, and the Staff Owned Practice. If you missed them, go back and read them. Without these you won’t get to first base at adding same day dentistry and processing EPs effectively. Here’s how we did it day in and day out.

An EP calls in with some problem. The patient is asked: “How quickly can you be here?” This doesn’t commit you to anything. If it’s 9:00am and the caller says she can be there at 4:30, it is not an emergency. We always had one more chair than we normally needed all day long. In this way we had the “physical capacity” to add that one more crown a day or several EPs that may have some productive dentistry to add to our already full schedule.

The initial contact is done by my assistant and she triages the patients by talking and finding out the chief complaint, taking necessary x-rays, taking a photo of the problem area, medical history, prior dental experiences, determining the patients dental IQ, along with what they would like to do and what they can afford. This can take as long as is needed to make sure that the patient has plenty of time to ask questions, be given supplementary information, check the schedule, and the patient’s finances prior to involving me, the doctor.

Once the assistant has everything in order, she decides if we have the time to work in the treatment that the patient wishes to do. My staff made sure that every base was covered: We had the time in order not to upset our existing schedule, the patient understood and was able to make an informed consent based on what the problem was, and what the doctor would most likely recommend once the assistant had triaged the patient.

At this point the assistant comes and gets me. Based on all of the factors in the previous paragraph, I would be told to either numb the patient or write prescriptions. I didn’t need to ask if we had time or if the patient could afford it. I didn’t even need to ask what we would be doing if she said numb it. I had the faith and the past history to know that my “staff owned practice” was at the top of their game and working for the common good of the practice to take care of everything. Believe me, they were doing this to insure their bonus system yielded maximum checks to each member of the team.

As I walked down the hallway with the assistant she would tell me what I needed to know. Based on this, I would come in and introduce myself and usually (99.9% of the time), just confirm what the assistant had discussed as a possible option for treatment. I would then write a prescription or numb them based on what the assistant told me to do. For patients of record, the patient would already have the nitrous on, temporary impression taken, topical applied, headphones on, and the room set up to go.
Boom. It’s that easy and that predictable. I was just a pair of hands and an equal staff member while working during the day. We staged every patient encounter to ensure that they would be inspired by our actions and systems to show up, pay for their treatment, and refer everyone they knew. So why is the article titled “ASAP”? Easy!

1. ASAP: Add physical capacity so that you always have one more chair than you really need in order to fit that patient in as seamlessly as possible.

2. ASAP: Get the emergency patient into the office as soon as possible. It has to be the same day they call.

3. ASAP: Don’t keep them waiting once they arrive. You accomplish this by having that one more chair and enough staff to spend the time with them to garner their trust and help them make a decision on treatment.

4. ASAP: Do what your staff directs you to do in order to smoothly integrate same day dentistry and emergency treatment. This takes systems, a super team, and common goals to make today as productive as possible.

5. ASAP: Stop reading and start to use this system today. Stop wasting your day by analyzing this simple system and start now to reap the bounty of integrating emergency patients and other same day dentistry into your schedule.

It’s all about doing it “as soon as possible”.

Michael Abernathy, DDS
[email protected]