We have all been there and I don’t know anyone who enjoyed it. I set out to purchase a vehicle with the mindset that I had done my homework, looked at features, compared prices, and determined availability, as well as taking a stroll through Consumer Reports. I knew what I wanted and there was a dealership right down the street. I had even purchased vehicles there before and knew the owner well. I assumed that I could do this and drive out in about an hour. They even knew I was coming and what time I would be there. Reality check: It took almost four hours for me to buy something I wanted and pay cash for it. OMG! The kicker, the real crux of where I am going, is that the owner, who I knew, insisted that I use a particular salesman, and I was assured that he would not dicker around and would give me the best price. But everything fell to wayside when they sat me in a room with “the closer”. The deal should have been done. I thought I was done and just needed the keys so I could leave. Oh, no. They sent me to the final step in a long line of handoffs, closing tactics, and blame shifting as the humble sales person tried to appear consternated by always having to check with the sales manager, etc. As I soon learned, the closer had one more shot to push this sale into the books. There were extended warranties, added accessories that I shouldn’t be able to live without; financial options (I had a check that I later found they couldn’t take since it couldn’t be verified because the banks were now closed), and finally, they would have to prep the new car for delivery. Yikes. How could one purchase be so convoluted? Result: I decided to walk away and go somewhere else to buy a truck.
So, what does this have to do with dentistry? Possibly, everything. It has become the rage over the last 10 years with “guru” consultants and those in the know that we need layers upon layers of staff for even minor tasks in our offices. No one pointed out that doing this decreased the commitment and even the culture of a consistent “team” and effective results. This only leads to compliance without commitment. While you could look at dozens of instances of all the popular management structures and titles (office manager, team lead for assistants, hygienists, front desk, toilet cleaners, and hall monitors) none is more pervasive than the supposed need for you to have a dedicated “patient coordinator” at the front desk. Someone, in his or her infinite wisdom, decided that your payroll, as high as it was, needed one more mouth to feed. Like most things in dentistry, these positions, titles, and strategies came from some other retail sales based business and this knowledgeable, never owned a practice before consultant tells you that you need the “closer” in the form of a patient coordinator. I consider this just one more Band-Aid for a poorly run office without a committed, well-trained team.
I guess my practice (that always collected what we charged and had a case acceptance of over 90%, with an 80% plus direct referral percentage) needed one more thing to stay up with the Jones’s. Perhaps having my assistant (with emergency patients) or my hygienist (with recall and new patients) just didn’t have the smarts or people skills to help patients want what they needed without adding one of the worst things about sales and closing tactics: The Closer. The actual title of “patient coordinator” doesn’t rub me wrong. But by doing this, we deny the fact that case acceptance and follow through by the patient starts at the first phone call. That each contact by any member of the team continues to either impress and strengthen or diminish our final results. Assuming that case acceptance is a singular place in time, or that it never takes place until the “closer” stamps the purchase order is ludicrous. I would argue that having great people in any/every position always trumps one good person at the end of the assembly line. The patient should, for all practical purposes, know what they want and what they need to do to get it long before appearing at the front desk as they leave the office.
I think all of you, if you take a step back and stop thinking like a dentist, can see the error in thinking that if the hygienist/assistant or doctor cannot get to the point of finding out what the patient wants and coming to a consensus of what we can do to help, that starting all over from scratch with a third person in a tiny cubicle will not finally win the day. In a way, no one likes to be “sold”. “Closing” shouldn’t be something that gets done to your patients. Instead, we should move towards a mutually agreed-upon outcome that’s a natural byproduct of a helpful, educational, individualized treatment plan that fits the budget of your patient. Hence, we need to know from the very beginning what a patient wants, what their dental IQ is, and what they can afford.
It is now time to tip up a mirror and take a long hard look at your results. It is accountability time and the clock never stops when you are an owner of a business. Things should come down to doing things that are part of the solution, or part of the problem. The trick is to distance yourself from anything that continues to hinder your success.
Regardless of how you look at this, be sure and check your key performance indicators. Ask these four questions and make sure you understand the underlying causes of mediocre performance.
What is your percentage of direct referred new patients? If you are not at least 50% plus, something is very wrong.
What is the average production per new patient? If it is not in $2,500 to $3,500 range, then there is a huge problem with case presentation and financial arrangements.
What is the production per employee per month? If it is not approaching $20,000 to $25,000 you are overstaffed and/or underproducing. This would be a direct result of the systems, protocols, and excellence of your staff and culture.
What is your overhead average per month? If it is not in the lower fifties to maybe sixty three percent, then you are processing too few new patients, spending more on things that do not have a reasonable ROI, or you are over staffed or underproducing, while failing to treat a dental practice as a business that must create a profit.
Now, back to the “patient coordinator”. When you depend on a closer, you have altered a more simplistic, consistent protocol to case acceptance and follow through by postponing answering the tough questions that an educated consumer will always want to know. The simpler track would be for the hygienist/assistant to find out what the patient wants while helping them see and understand what they currently need. In a way, it is just a discovery process couched in the form of a natural discussion. You are not trying to sell or close, but just getting to know the patient while the patient is getting to know his or her mouth. It is a form of self-discovery as your staff member and the patient simply talk to each other. The value of this is that not only does everyone find out why the patient is there and what they want and expect, but also we can measure their dental IQ and what their budget will allow. This sets the stage for a win-win solution to all of the patient’s needs and challenges in case acceptance. The actual impact is being made by the hygienist(s) and assistant(s) by being the first person the patient really interacts with, the one that has spent the most time with them, and hopefully the interaction that causes the patient to bond with the office due to the people skills and communication that has gone on between the two. Done well, when the doctor comes in 90% of the patient’s mind is made up and there is already a consensus of what they want along with what their investment might be. They can already be trusted friends with your staff even before you, the doctor, walks in. The patient has asked dozens of questions and had them answered well. This is the most consistent way to move patients through the discovery, case presentation, and having them follow through with treatment. In fact, the patients, once they arrive at the front desk, need only find out the options available to paying for the treatment. Anyone at the front desk can simply explain how we can fit this into the patient’s budget. They have agreed on what they want while still in the op, they understand what they will have done at each subsequent appointment, there is an order to the treatment plan based on doing what they want first, and the only thing left to do is for the front desk to help them fit this into their budget. The only negative to this simplistic approach is that you have to be a leader, the staff have to be committed, and both of you must partner to help the patient want what they need while not overwhelming them or allowing any action that would minimize your attention to the patients’ needs and desires.
Done the other way with a patient coordinator/closer, you are faced with a patient that has made no firm decisions on treatment because no one cared whether or not they understood their options. Because someone else was responsible for that, the patient has not had their questions answered by their new friend the hygienist/assistant and confirmed by the doctor with no pressure. They meet another unknown, untried, and untested staff member, placed in a tiny room, and it starts all over with subliminal pressure and a feeling of being “processed” or “sold” or “closed”. Rarely does this strategy work as well, as smoothly, or as consistently to achieve having 90% plus of your patients say “YES” to the recommended treatment.
So, before you start giving people titles, replacing the common-sense strategies with a more convoluted system involving more people with a diminishing return, simply step back, stop thinking like a dentist, and embrace the mind set of the consumer. What would you want? The ripple effect of setting up the closing step at the end means that you have set in motion a more complicated, less than ideal protocol that makes little if any consumer sense, while you continue to experience diminished direct referrals, high overhead, and stress in your daily work. Turn from the dark side and take a whole new look at becoming incredibly good at the simple things. Common sense will rule the day, and commonplace (what the majority do, but fail to succeed at) will fall away as you take back your future by not thinking like a dentist. Keep your eye on the consumer and watch the trends to stay well ahead of the average dentist.
This is how you Summit.
Michael Abernathy, DDS
PS. Don’t forget that we will host a live Zoom meeting on Tuesday, April 6, at 7:00pm Central time. Just let us know you’re interested via email and you will be sent the link. No cost for this and no further commitment required. Just a time of interaction with other dentists interested in achieving more in this great profession.