Almost four decades ago, I began working every Saturday in order to increase my number of new patients and practice production. Keep in mind that my little town back then had a ratio of one dentist to about six thousand potential clients (1:6,000). How would you like those odds now? I was young and stupid: Who in their right mind would work Saturdays? In fact, I waited tables for two years after graduating from dental school because it paid more. In addition, I worked two full days at McKinney Job Corps, and did lab work for other doctors on the side. I definitely had on my “whatever it takes” T-shirt. I have no excuse for doing all of this other than a secret fear of dying broke. Bad news is, I never out grew it.
I won’t harp on consumerism and doing what it takes to stave off insurance companies, corporate practices, Obama care, and the locust horde of 5,200 new graduates every year, but I would like to take some time and see if I can help soften your resistance to actually having your office open during hours that people would find convenient. If we look at when people spend money on elective purchases, we find that 80% of what we spend our discretionary income on is done after 5PM and on Saturdays. Why would you and I avoid the malls on Saturday and Sundays? Because most people are off weekends and everybody and their dog is shopping and spending money at the malls and restaurants and “big box” stores. Why don’t we see this on Monday through Thursday from 8-5? The answer is: They are working. Just this alone should be a wakeup call when we consider that most of our patients have to pass thirty other dentists to even come to see us. Convenience, or giving our patients what they want, when they want it, at a price they can afford is huge and not having our practices available on Fridays and Saturdays is a huge hurdle to growth.
So what are 95% of the doctors saying?
1. “Nobody wants Saturday hours: We’ve tried that before once a month and my staff says nobody wants to schedule on a Saturday.” One bit of advice for the Doctor in denial: If your staff doesn’t want to do something, they will find a way to sabotage it. In fact, for those doctors who have asked, yes, if their lips were moving they were lying to you about no one wanting a Saturday appointment. Patients are just like us. In our fast paced lives, it is almost impossible to fit in everything we need to do. Add kids and it multiplies the problem. Consider that most young families are dual income and there isn’t any time except Saturdays and Sundays to get the things done that they know they should but don’t have the time to do.
2. “Everyone will cancel and no show.” Cancellations and no-shows are not a problem. They are a symptom of a poor system of scheduling and financial arrangements. For almost 35 years, we had no difference in our cancellation and no-show rate on any day of the week. I fact we got and kept it below 8% and because Saturdays were so desirable, they were the easiest to fill. Practices that have problems with this on Saturdays have the same problem every other day of the week. Yes, you have to have a plan and have a system. In fact, if you will just email Max at [email protected] he can help you get a copy of our thirty-page report on Cancellations and No-Shows.
3. “I can’t get anyone to work Saturdays.” Heard this too. With unemployment and layoffs running rampant, finding people to work is not going to be a problem. Our last associate leading to partnership that came in worked 8-5 Wednesday, Thursday, Friday, and Saturdays 8-2 with no lunch. We paid the staff on Saturday as if they work eight hours when in fact it was only 6. Our hygienists worked three ten-hour days each week plus one Saturday per month, which averages out to be about a 32-hour work week. Imagine this, Dr. Markham worked that schedule and had a half a day off Saturday and all day Sunday, Monday and Tuesday. The staff that worked with him loved it and would never consider going back to the weekday schedule of the other doctors.
4. “My patients would never leave me.” Wrong. Fortune magazine did a survey last year in which 1000 people were asked about loyalty to their Physicians: 87% said they would change for a $5.00 difference in co-pay. Just in case you have not had your coffee and this slipped by you, in this new economy it seems that loyalty is taking a back seat to price. This started about 15 years ago when insurance companies and commercials began convincing us that everything is a commodity so the only reason to select a product or location should be price. It evidently is working. Every one of us has gotten letters from patients that said we were too expensive or didn’t have the services they needed. Reread what they said about the $5 and you will realize that they had insurance and they wanted to use it. Still think it’s a great idea not to accept their insurance? It’s called the “threshold effect”: How many obstacles do you put in the way of having someone become your patient? Bottom line, your patients have become more fickle and will leave for anything. Add to this the fact that even if you did impress them, our society is more mobile and 20% of the population moves each year. That means that you have to replace 20% or more of your patients each year to just stay even.
I would call these four reasons not to work Saturdays, the great myths of dentistry. Kind of like the final words of a redneck: “Hey Bubba, watch this!”
Let’s spend a moment discussing the “WHY” of Saturday appointments.
1. You will increase your number of new patients at least 20%. In our office we averaged 15 new patients a week just because we were open Fridays and Saturdays. This statistic was gathered when the patient said that they were so appreciative of us seeing them even though they were not patients of ours (they couldn’t even reach their dentist on Friday or Saturday). Is there any question why your patients don’t come back to you when we were there and took care of their emergency or need and they couldn’t even find you.
2. You can add about 15-20% capacity (the ability to see more patients and hence more production). Your goal should be to produce about $25,000-$30,000 of production per operatory per month and $20,000-$25,000 of production per employee per month. When you get close to these benchmarks, you should consider adding a doctor and/or another hygienist. Associates and hygienists are easy to find for Fridays and Saturdays which would eliminate any backlog of appointments, add valuable peak demand times, and utilize a facility that is just lying dormant during those hours.
3. Differentiate your office from the competition. Heard this lame excuse the other day: “Why would I want to do Saturdays and Fridays when no one else is doing it in my area?” Dr. Phil says it best: “You just can’t fix stupid.” Today we are either remarkable in what we do or we are invisible. If you just do the minimum and follow the lead of the other mediocre dental offices, why would you ever expect to catch the patient’s eye? Services, hours, marketing, systems, staffing — they all make a difference.
4. Saturdays and Fridays are the best days to do same day dentistry. If you think about it, why do you think that dental offices get more calls on Fridays and Monday mornings? The answer is that no one wants to go through the weekend or start the week with a tooth problem, so they call. If you have the systems and staff, capacity, and where with all to bring them in while always staying on time and adding same day dentistry to your menu, you will be able to print money. There was never a day that we couldn’t add an extra $2,000-$3,000 dollars of collections to our bottom line. The neat thing about Saturdays is that every emergency was something that they had put off for years. It was almost always root canals, crown and bridge, and the need to make a new partial or denture. Literally they were mostly the sweet spot of productive dentistry. This treatment that magically appeared on Saturdays was always something the patient “wanted” to fix, not something we just told them they “needed” to fix. They had the money, the time, and the desire to fix it. The surprising thing that we noticed is that even though they came in on a Saturday, in almost every case they ended up being a repeat customer during all of the days we were open. It was that first visit where we inspired them and exceeded their expectations that gained the trust and had the patient bond to our practice. The ripple effect of this is that these desperate patients (seemingly unwanted by some practices) became our best referral sources. We have a very intentional way of handling emergencies so that they feel welcomed, cared for, and find that we spent a lot of time to find out what they wanted, what they could afford, and give them a solution that fit their time table. When you ride into town and save the day, people talk about it and this increases more referrals.
5. Saturdays are great special event days. Almost every August and December we found ourselves overwhelmed with the need for more hygiene capacity. Parents would put off the recall visit and then at the last moment would call expecting to get in the next day. Our solution was to have all 10 of our hygienists and even a couple of hygienists from a temp service come in and occupy all of our chairs for six hours. The doctors were there, schmoozing the parents while we knocked out 150 pedo cleanings in one day. The goal was to get back to where we could see a new patient in hygiene within 2-4 days (not working days) during peak demand times (7-10 and 3-6) from the time that they called in for the appointment. Note: Blockages are subtle and we need to be preemptive about providing a solution so that our momentum is not affected. We even had Santa at our offices during the holidays for our patients and their friends to come in and meet Santa, get a picture and a goody bag for the kids, and have the opportunity to tell 200 or their closest friends what a great office we were.
I hope this gives you a moment to pause and reflect on just how “not sensitive” most of us are to our potential patients. If you have not read my new book, The Super General Dental Practice”, be sure and down load it today (it’s free) before the next book on transitions comes out. Each book builds on the previous one.
Michael Abernathy, DDS