I know I had you fill out the Growth Analysis Spreadsheet as well as tracking down a year to date Profit and Loss Statement and a printed copy of one week’s schedule. Today, we are going to delve into your schedule in general terms. Obviously, without actually looking at your specific schedule I am not going to be able to comment in depth on it, but I would like to take this week and point out the top mistakes I see in most doctors’ schedules. Since this will be the final Diagnose Yourself topic, I want to extend an offer for you to send me your comments along with a copy of your spreadsheet, schedule and Profit and Loss statement, and I will be glad to go even deeper with each one of you on how to reverse any challenge you may have discovered and the steps necessary to actually achieve your vision.
Just like the TV show Family Feud, our topic is “A great Dental Schedule should…” and the survey shows…?
- Always have the first couple of columns assigned to the dentist. The dentist’s production is always the number one production strategy in the entire office. I want the doctor’s schedule to be everyone’s first priority. Keep in mind that 60% of his or her production day needs to be from substantial cases (something at or about the fee of a crown). This is the only way to have consistent growth and a worthy goal for productivity.
- Don’t schedule the operatory. Schedule the operator. As you look down the schedule realize that the first column for the doctor does not represent Op 1. The actual treatment could occur in any of the doctor’s Ops. By scheduling the doctor or hygienist regardless of which Op is used allows you to engineer the amount of time, production, and service you deliver. It is all about the game plan for the day.
- Guard your Peak Demand Times. These are the times that new patients and productive cases will always demand. They are 7AM to 9AM, 3PM to 5PM, and Saturdays. Block these for new patients and special productive appointments and either fill them or release them within a few days of them coming due.
- The first column for the doctor is always the most productive cases. 60% of any single producer’s schedule has to be in substantial cases. A substantial case should be at or about the fee you would receive from a crown if we are talking about a doctor. (NOTE: It works the same for a hygienist. 60% of their day needs to be in substantial cases that are usually new patients and scaling and root planing. For a hygienist’s schedule, a substantial case is not at the value of a crown fee. It just represents the highest dollar per hour production that they have the ability to deliver.) The second column for the doctor would only have the small stuff like denture adjustments, single fillings, checks, emergencies, follow ups, etc. That first column is like the bricks of our schedule: High production and more complicated services. The second column is the mortar: The smaller, quicker to deliver, less productive treatment that fills in around the bricks. This is how you build a solid schedule.
- Try to alternate captured and free appointments times. Captured times would be procedures where you absolutely have to complete the entire process. A crown would be an example. You can’t really stop halfway through. Free appointments might be multiple fillings where you could do more or less than scheduled. This builds in a planned buffer of a variety of services with some latitude in their timing. It prevents burnout while giving you options to stay on time and still be productive.
- Treatment Plans: Should be aggressive in the sense that if there might be a root canal, be sure and give yourself the time. If it turns out that you don’t need the time, you can fill it with a same day dentistry patient or someone from the hygiene side with a simple procedure so they don’t have to come back. Staying on time and never ever keeping patients waiting is the key to consumer friendly scheduling.
- Do not schedule all of your appointments on the hour. Almost every time I look at a schedule, I see every recall schedule based on an hour per appointment. Are you kidding me? No one needs exactly an hour for every recall patient. You might need 63 minutes, 53, 44 but you rarely, if ever, need exactly an hour. Doctors do the same thing and front desk schedulers often times will lengthen a 50 minute or 70-minute appointment to finish off the day or just before lunch. Each minute you squander diminishes your productivity. If you look and find that you are in fact having a lot of appointments start and finish on the hour, consider the effect on the front desk. They are doing very little for 50 minutes of every hour and then boom, 4 to 6 patients need to be checked out and 4 or more need to be checked in. You will always look hurried and incompetent when this happens. No one could juggle the chaos with a schedule like this. Schedule the exact time you require for each individual patient.
- Never ever keep a hygienist waiting for a check. It upsets the patient, your hygienist, and your assistant. Running behind is the number one complaint that patients have with dentists. Running behind is the chief symptom of poor diagnosis, lack of systems, and poorly trained staff.
- Hygienists should never wait to ask for a check until they are finished with the cleaning. It should occur the minute they finish recording existing and needed treatment followed by helping the patient want the treatment they need. If you have not read “The Hygiene Factor” or “100% Case Acceptance”, contact Summit and get a copy of both. They will change everything in your practice. Failing this you will consistently have underperforming hygienists because they spend productive time waiting on the doctor and your case acceptance will suffer with an upset patient. Yes, keeping people waiting encourages them to not like you or accept your recommendations.
- New patient appointments should take about 80-90 minutes for an adult including cleaning, cancer exam, full mouth probing, recording of existing conditions, needed services, and the doctor’s time to do case presentation. Doing less will not inspire your patient. Doing more is a waste of time and diminishes your case acceptance percentage.
- Every hygiene patient should be scheduled for their recall appointment by the hygienist. Never accept anything less than an 80%-90% recall schedule.
- Take lunch at 1-2. There is a secondary demand time from 11-1 that patients who work will want and need. They come in at their lunch time. You need to be there and ready to work on them. You also will find that you work hard for 5 hours, take lunch and come back to just 3 hours to finish the day.
- Work the same number of hours you currently work but please move to more consumer driven hours. Keep in mind that patients, and especially new patients, want “peak demand times”. You should have at least 8 peak demand segments every week. More would be better.
- Cancellation and No-Show policy for scheduling. When you call about getting a copy of The Hygiene Factor and/or 100% Case Acceptance, also get the one on Cancellations and No-Shows. This is a small investment and these 3 documents can turn your practice around.
Your schedule is the key to your growth and a reflection of your systems. Every great practice has a great schedule. Whether you do $600,000 or $6,000,000 a year, that production is reflected in your schedule. I can’t tell you how many times that I overheard doctors who visited our office say, “If I had your schedule, I could produce $$$$$$ a day like you do”, and they were right. What they did not have was everything else that we have spoken about during this series of Diagnose Yourself articles. A great schedule is the result of everything else you do. An average or poor practice is also the result of everything you do. Great practices and great overheads don’t just happen, they are created. A Super General Dental Practice is not an accident. You each hold the power to claim any level of success. It only takes one part commitment from you and your staff, one part acting on the facts and strategies that we present in our articles and coaching, and one part accountability for you and your staff. I want to send you a copy of the newest expanded and updated book: The Super General Dental Practice. I assure you that you cannot find the information anywhere else but this book. It will serve as a finishing touch to add action to what you uncovered following the Diagnose Yourself series. If after all of this you are to a point of total commitment, I would like to invite you to join our Summit Practice Solutions dental coaching group. Make another level of commitment, to ensure that you can finally have the practice you always thought you would have. When you’re ready, you will find that coaching is not an expense, but really an investment where you can get multiples of hundreds of times of what you might invest. This is how you Summit.
Michael Abernathy, DDS