How to successfully integrate endodontics in general practice
Roger P. Levin, DDS
Endodontic procedures present special challenges for general practitioners. Root canal problems often come up suddenly (and painfully), resulting in emergency appointments, which can be extremely disruptive and costly when not properly handled. Adding to this inefficiency, endodontic procedures allow for very little delegation. They place heavy demands on the doctor’s personal time and attention, which can lead to further inefficiencies, such as taking more than one appointment to complete treatment or underutilization of dental assistants and other staff members.
The First Question for the GP
In the interest of ensuring the best clinical outcomes as well as achieving the highest possible level of efficiency, GPs who diagnose and treat root canal problems must first decide whether the case should be referred to an endodontist. When referral is the best option, they should explain their diagnosis and decision to patients—and indicate that the endodontist will confirm the need for root canal therapy. To provide excellent, efficient customer service, the general practice should make the appointment and share information about the case with the endodontic office. This will enable the endodontist to provide better care. Effective communication is always beneficial to both the patient and the endodontist.
Creating Efficiency for Root Canals
If emergencies are managed poorly, an unscheduled patient in need of immediate attention will result in loss of production, lower profitability, and increased stress. Any practice that treats root canal patients must have a schedule that can properly accommodate emergencies without forcing other patients to wait for service.
Upon receiving phone calls from patients who are in pain, most practices simply squeeze them in as soon as possible. This disruption inevitably lowers overall practice productivity. Scheduling coordinators should be trained to triage endodontic patients based on their level of pain. Patients in extreme distress should be seen as quickly as possible. Other patients with milder discomfort should be managed appropriately and scheduled for an open appointment time.
Creating a highly efficient schedule is a mathematical process—one that begins with quantifying the number of root canal procedures to be performed annually. This can be used to project the likely number of endodontic cases that the practice will need to accommodate in their daily, weekly, and monthly scheduling. Few schedules are truly maximized.
After designing a new schedule and training the front desk staff to make sound decisions about when to see emergency patients, the next step is diagnosis. The author finds that the vast majority of root canal cases can be identified properly by a well-trained dental assistant. Though this team member cannot perform actual diagnoses, he or she can gather all information, identify the affected tooth or teeth, take any necessary x-rays, and be fully prepared to brief the doctor. The assistant’s focus on facilitating the doctor’s diagnosis will save a considerable amount of time.
If an emergency case is not in an optimal place in the schedule, the assistant can say that “the x-ray will be read by the doctor within 20 minutes,” allowing more time for the doctor to finish other procedures. Typically, patients are less disturbed about experiencing wait times if they know when toexpect the next step in the process, and they appreciate being informed.
Endodontic Case Acceptance
Once the GP identifies the affected tooth or teeth, diagnoses the problem, explains the need for root canal therapy, indicates that he or she can perform the treatment at the practice, and confirms acceptance, well-trained team members can take over. With scripting to guide them, they can educate the patient about root canal therapy, answer questions, and review fees—all while the GP treats other patients. This reliance on teamwork greatly enhances a practice’s efficiency and productivity.
In the 1980s, progressive doctors began performing root canals in one appointment. Initially controversial, it is now widely accepted. While there may be certain clinical circumstances that necessitate a second appointment, the goal should be to complete treatment during a single visit. Unfortunately, many doctors still follow the old pattern, alleviating emergency patients’ pain during the first visit but then scheduling them to return for the completion of treatment. Practices do this to minimize schedule disruptions, but it ends up wasting more time and increasing the overhead for the procedure. Front desk staff should be trained in analyzing the schedule and identifying the best opening for emergency appointments, allowing time for completing the endodontic procedure in one appointment if possible.
The following tips will help you improve efficiency while providing care for endodontic patients:
• General practices may need to allow more time than they think for endodontic patients. Scheduling coordinators sometimes get locked into a rigid concept of time, but emergency patients may need more time to enable the doctor to diagnose and treat while moving back and forth between patients. This scheduling technique minimizes disruption and eliminates the need for a second appointment.
• Emergency patients should be given extraordinary service. The staff needs to make patients feel that they are receiving priority treatment, rather than feeling like they are causing a problem. Scripting is a critical tool in training team members to say things like: “I am so glad you called! We’re going to take care of you!” rather than “Hold on a minute. Let me see if we can find a time for you.
• Root canal cases come in varying levels of complexity. The discussion about treatment for every patient should include an explanation that it’s difficult to predict the amount of time root canal therapy will take. Front desk staff should avoid giving time estimates to emergency patients. If treatment turns out to be relatively easy and quick, patients will appreciate it taking less time than they thought it would.
• Be attentive to patients who will be in the office for an extended period. No one enjoys spending hours going through diagnosis and treatment. To give patients a more pleasant experience, staff members should be trained to check in on patients regularly to see how they are doing, talk with them, make sure they’re comfortable, etc.
General practices that perform root canal therapy can have difficulty managing these unpredictable and complex cases. Using some of the principles presented here—mathematically designed scheduling systems, more reliance on staff for pre-diagnostic and case presentation assistance, and a single-appointment treatment goal—practices can increase efficiency significantly. This will also result in higher levels of patient satisfaction.
About The Author
Roger P. Levin, DDS, is a third-generation general dentist and the founder and chief executive officer of Levin Group, Inc.