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Inside Dentistry

March 2008, Volume 4, Issue 3
Published by AEGIS Communications


What Your “Simple Test” Result Says About How You Could Improve Your Practice

Harry A. Long, DMD

The practice of modern dentistry as a “well-defined” profession began in a mechanistic age.1 When touring a dental museum or historical dental exhibit, the most striking part of the exhibit is the sheer number of mechanical dental devices present. Extraction instruments, pedal-operated drills, non-aspirating injection syringes, and even a mortar and pestle surround the old dental chair. Truly, the first paradigm of dental practice was mechanical. During this mechanistic age, dentists were paid based on how much work they performed. If they wanted to increase their income, the mechanistic paradigm would find the dentist working more hours and seeing more patients.

The contemporary dental practice paradigm, on the other hand, emphasizes communication and service with the goal of providing optimal care after educating patients about the possibilities for improving their oral health.2 The successful dental practice is less about teeth and more about relationship building, as well as creating opportunities for patients to actively participate in their dental healthcare decisions.3 A successful practice will present a variety of treatment options that patients may choose from based on their needs—physiological, emotional, and financial. Successful, service-oriented practices will offer an expanded mix of services that can preserve and improve the dental and overall health of the patient.4 The present paradigm for dentistry has abandoned the mechanistic practice model in favor of comprehensive, patient-oriented care, whether necessary or elective.

Unfortunately, many dentists and their practices still cling to the mechanistic practice model in response to problems with production. They automatically look for ways to increase new patient flow. According to the mechanistic model, if 50 new patients per month are good, then 100 new patients per month must be better.

Let us explore this concept a little deeper. If you were to work 32 hours per week, that would allow about 128 hours every month to see patients. If you gave each new patient only 15 minutes, that would total 12.5 hours for meeting and examination time, which is nearly one tenth of the time you have to devote to patient care. Using the same numbers, just doubling the number of new patients to 100 would require 25 hours for you to meet and examine each new patient, which is almost 1 week out of your month. Now, add to this schedule the examinations you must do for your recare patients, and the total will probably approach 30% to 35% of your in-office time spent not producing at the chair, but instead meeting and examining new patients.

Meeting new patients is a very significant activity that contributes to the growth of your practice. However, if you want to have a very successful practice, 15 minutes of new-patient meeting time is not sufficient to communicate and begin relationship building; perhaps 45 minutes would be a better amount of time to devote to those visits so that patients will feel you truly have an interest in them. Longer new-patient visits will also enable you to listen to the patient’s story and get to know his or her needs, wants, and experiences.

By following this mechanistic model, the death of the practice would surely ensue. It is clear that increasing the new patient visit to 45 minutes would ultimately amount to more than half of your monthly time, eventually contributing to your own and your staff’s unhappiness. The time spent meeting, examining, and trying to build relationships with all of the new patients leaves very little time to provide treatment for these patients; production would go down and stress would skyrocket.5

This example demonstrates that improving the bottom line in a modern practice is not as simple as just increasing new patient flow. Increasing the number of new patients seen by a practice may only create more stress for everyone involved with the practice. To determine the best route to take when you decide it is time to enhance the way your practice operates, consider first taking the “simple test.”

THE “SIMPLE TEST”

The “simple test” will help you to determine those areas of your practice—as well as your skill set—that should be worked on to reach the next level. Possible changes include: improving communication skills or marketing; changing your staff or updating your equipment; using the services of a practice-management consultant or participating in a hands-on experience; and attracting higher-quality patients to your practice or spending more time finding out what patients really want, among others.

If you must think mechanistically, the “simple test” could also help you to determine the minimum number of new patients you need to attract each month to have a successful practice. Some of the most successful and highest-producing solo practices receive fewer than 30 new patients per month. These practices left the mechanistic paradigm behind long ago in favor of relationship building, communication, and providing a variety of treatment options and services that enable the new patient to realize new possibilities for their dental healthcare.

This “simple test” has been used by clinicians for many years.6 By using and analyzing the numbers from the test, dental practitioners can better determine their best plan for continued practice growth.

To take the test, calculate your total production for any given period of time and divide that figure by the number of new patients you saw for the same period of time. The result may range anywhere between 500 to more than 10,000. Lower numbers indicate that practices are operating from the mechanistic paradigm and are not offering many services; others are simply repairing single broken teeth or decayed teeth. No quadrant dentistry is even diagnosed. Higher numbers indicate that practices are operating from a communication, relationship-building, and service-oriented practice model in which patients are given many opportunities to choose from a wide variety of services and treatment options to enhance their oral health and their appearance.

EXAMPLE NUMBER 1—THE SLOW PRACTICE
Annual Production: $400,000
Total New Patients: 180
400,000 180= 2,200
The “simple test” number: 2,200

This practice receives about 15 new patients every month. The “simple test” number is about 2,200, which suggests that the dentist has the time to meet, greet, and listen to the concerns of the new pa-tients, but not a wide variety of services or treatment options to offer them. The fact that the “simple test” number is over 2,000 indicates that the dentist has time to present good treatment plans but does not offer comprehensive services (eg, smile design or Invisalign, [Align Technology Inc, Santa Clara, CA]).7 This dentist performs simple “bread-and-butter” dentistry, such as basic restorative treatments, and may not offer third-party payment plans. The staff is small and ineffective in the slow practice.

The practice would benefit from marketing to increase new-patient flow, and the dentist should enlist the services of a practice-management consultant to facilitate new patient flow and the staff training necessary to enable the team to handle the increasing patient load.8 The dentist will need to enhance his or her communication skills and add services and treatment options that enable patients to choose from among the new possibilities presented to them.

This practice could easily double its “simple test” number with very little effort and, as it becomes more successful (ie, “simple test” level of 5,000), the dentist would need to enlist the help of a mentor and take a series of hands-on courses to further develop the smile-design aspects of the practice.

Adding to the service mix, enrolling a third-party payment option, and enhancing dentist and staff communication skills could help this practice achieve a “simple test” result over 8,000 in a very short time.

EXAMPLE NUMBER 2—THE BUSY PRACTICE
Annual production: $1,200,000
Total new patients: 1,200
1,200,000 1,200 = 1,000
The “simple test” number: 1,000

Every dentist considers the million-dollar practice the benchmark of success. But as this example demonstrates, the million-dollar practice is not always successful. The “simple test” number tells us that if this practice is receiving 100 new patients per month, but only achieving a “simple test” number of 1,000, it must have a very large staff with high turnover. Stress must be present at all times, communication is probably poor, and the mix of services offered is limited. To maintain this level of production, the dentist is probably working more than 40 hours per week and is likely experiencing burnout. This “busy practice” may participate in many insurance programs but probably does not offer third-party financing. The dentist in the “slow practice” probably has a higher income than the dentist in the “busy practice.” Having a full schedule and high stress may give the feeling that you are doing as much as you can, but often, being selective and doing less is the path to greater effectiveness and higher productivity.9

The practice indicated here is in trouble and may need the services of a practice-management consultant. The dentist will need to drop some insurance programs and increase the fee-for-service part of the practice. Adding an external marketing program to attract more fee-for-service patients, as well as increasing the number of services and treatment options offered, will help this practice turn the corner and begin to cut the level of stress for the dentist and staff.

This dentist may have to do some serious soul searching if he or she is afraid to cut ties to the insurance portion of the practice. Therefore, the services of a well-respected practice-manage-ment consultant may definitely be beneficial to save this practice from itself. In a short time, this “busy practice” could achieve a “simple test” result of 3,500, and the staff and dentist could be far happier and the patients could have a greater number of care options for both necessary and elective treatments.

This is how the busy practice’s “simple test” could look:

Annual Production: $1,200,000
Total New Patients: 360
1,200,000 360 = 3,500
The “simple test” number is: 3,500

The dentist would now be working only 32 hours per week, the staff would be smaller and more stable, and the stress level would be much lower. For this practice to continue its new trend of growth, the next step would be to work on both dentist and staff communication skills. The dentist needs to learn to delegate to the staff, as well as how to effectively conduct staff meetings. The dentist must be the visionary and lead the practice to new projects and services for the patients.10 Getting involved with a hands-on experience would enable the dentist to develop new skills, such as marketing, practice development, creating a vision, and clinical/presentation techniques for increasing the smile-design portion of the practice. In just a few short years, this practice could then achieve a “simple test” result of over 7,500 without adding additional staff or incurring additional expense.

Consider the following example:

Annual Production: $2,300,000
Total New Patients: 300
2,300,000 300 = 7,700
The “simple test” number is: 7,700

To reach the present practice model, the “once-busy” practice would have to undergo a great deal of change. It would need to develop from receiving 100 new patients every month and experiencing lots of stress and staff turnover, into a practice with high levels of communication, more services to meet patient needs, a smaller and more stable staff, and a more-than-doubled production rate while cutting new patients by more than 60%. This scenario may seem contrived, but it demonstrates a typical example of how practices move from the mechanistic paradigm to the communication, relationship-building paradigm to become highly successful.

It is normal for practices that receive many new patients to rush them through the diagnosis phase and provide the patient with the most expedient services. It is almost counterintuitive to believe that decreasing new patient flow by more than 60% would result in an increase in total production of more than 100%. However, this is how successful practices function in the modern paradigm. More services and treatment options and greater communication skills and relationship building enable the modern dentist to provide enhanced levels of care and more choices by which patients can achieve their goals of optimum oral health and cosmetic rejuvenation.

EXAMPLE NUMBER 3—THE PRACTICE IN TRANSITION

The practice in transition is usually one in which the dentist has made a choice to receive fewer new patients per month, and the new patients attracted to the practice have a higher dental IQ and want services beyond just routine cleanings and tooth repair. This practice will provide more service choices from which these more demanding patients may choose. Invisalign and/or implant dentistry will be among its services, and this practice will offer third-party financing. This practice has probably spent time working on itself and witnessed vast improvement in both patient satisfaction and its overall production numbers.

Typical “simple test” numbers for a practice in transition may be the following:

Annual Production: $1,500,000
Total New Patients: 300
1,500,000 300 = 5,000
The “simple test” number is: 5,000

This practice has definitely turned the corner and is becoming more efficient and productive. In this practice, a practice-management consultant may have played a significant role in its current success. Communication between the dentist and the staff is at a high level, and the dentist and staff both communicate well with new and existing patients.

To move this practice to a “simple test” number of 7,500 or above will be very easy. To reach the next level, this dentist and staff will need to participate in a hands-on experience to learn how to create new possibilities for new and existing patients, as well as how to develop the optimal office environment that will encourage communication between patients and dentist/staff. They may also learn how to market the practice to attract a greater number of the types of patients they like to work with. Such hands-on courses may also demonstrate the use of the digital camera and how to prepare a PowerPoint presentation of proposed smile-design possibilities for patients.

After such training, communication skills will soar and the practice will reach new heights of success and satisfaction. The happiness level of staff, dentist, and patients will reach a new plane. Turnover will be very stable, and the staff will not need to be very large.

EXAMPLE NUMBER 4—THE HIGHLY EVOLVED COSMETIC PRACTICE

The highly evolved cosmetic practice is a thing of beauty. For the solo practitioner, this practice will typically have a very small staff consisting of an office manager, a concierge, a dental assistant for the dentist, and one or two dental hygienists. This staff of four or five will typically produce between $2.5 million and $3 million per year and see no more than 300 new patients per year.

That means the “simple test” result ap-proximates 10,000. Practices with “simple test” results over 9,000 are doing everything right. Communication is at its highest level among staff, dentist, and patients. A full range of dental services are offered, the dentist freely recommends the optimal services for his or her patients, and patients are encouraged to take an active role in their diagnosis and treatment planning.

Third-party payment plans are readily available, and patients are encouraged to partake in this helpful option. The dentist and staff have had the benefit of im-proving the practice with the help of a practice-management consultant, and they have enthusiastically participated in the hands-on experience.

The office environment itself also speaks to the new patient. Clean floors and windows and a pleasant, supportive, and caring staff say a lot to a patient without using a single word. The patient bathroom should always be spotless, with a wide variety of skin care and hair care products available, along with luxurious, soft towels. The bathroom mirror should be very big and well-lit, providing patients every opportunity to view themselves after their treatment. This mirror should always be spotless. Every aspect of the highly evolved cosmetic practice speaks quality and commitment and confirms the ability of the dentist to deliver optimal dental healthcare and discretionary cosmetic services.

CONCLUSION

Remember, the lower your number (eg, 1,000 to 2,500), the closer you are to working from a mechanistic practice model. You may be very busy, but you are simply repairing broken teeth. As you progress on the scale (eg, 3,500 to 5,000), you are beginning to do quadrant dentistry and are improving your communication skills, offering more elective services, and learning to delegate to your staff. As you approach higher numbers (eg, 7,000 to 8,500), you are offering a full range of cosmetic services and are more interested in finding out what your patient wants than you are about telling your patient what they need. Practices with “simple test” numbers over 9,000 have mastered staff relations, communication skills, and offer a full range of necessary and elective dental services and treatment options.

Analyzing your “simple test” result can help you identify your location on your journey toward success. It is easy to use the “simple test” for a 1- or 3-month interval to gauge how you are progressing after following the suggestions described here. Use the “simple test” number to help you decide which steps you need to follow so that you can formulate a plan to take you to the next level.


1. Harris RR. Dental Science in a New Age. A History of the National Institute of Dental Research. Rockville, MD: Montrose Press; 1989:3-5.

2. Kadi G. Million Dollar Dentistry. 3rd ed. Scottsdale, AZ: Next Level; 2006.

3. Michelli, Joseph A. The Starbucks Experience. Columbus, OH: McGraw-Hill; 2007:28.

4. Levin RP. Expand your service mix. Contemporary Esthetics. 2007;11(4):46-47.

5. Levin RP. How to reduce practice stress. Compend Contin Educ Dent. 2006;27(4): 230-233.

6. Gerber M. E-Myth Worldwide. Available at: www.e-myth.com. Accessed on September 26, 2007.

7. Levin RP. The myth of income and the economy. Compend Contin Educ Dent. 2004;25(1):10-13.

8. Levin RP. Team empowerment: myth or reality? Compend Contin Educ Dent. 2004;25(2): 84-85.

9. Wintersteen L. Marketing with a patient focus. J Am Dent Assoc. 1997;128(12):1657-1659.

10. Ferriss, T. The 4-Hour Work Week: Escape 9-5, Live Anywhere, and Join the New Rich. New York, NY: Crown Publishers; 2007:72-73.

About the Author
Harry A. Long, DMD
Private Practice
Wayne, New Jersey

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