Time Management Tips for Busy Dentists by Alun Rees BDS

Time is the only thing we all share equally. Each of us is allocated the same 24 hours every day.

One of the first self-help books, How to Live on 24 Hours a Day, was published in 1908. Its writer, Arnold Bennett, made the point that, ‘We shall never have any more time, we have all the time that there is’. It’s well worth a read if only to remind yourself that the challenges faced then apply equally now—it’s just that life has got faster.

All problems in business revolve around the triad of time, people and money. Solutions are rarely clear-cut or simple, involving the messy interface or overlap among the three.

Every dentist knows those days where you fall over the finish line, shattered, feeling as if you have been rushing from start to finish, are often unprofitable whilst those that seem quieter and controlled produce the higher turnover. In his book Flow, Mihaly Csikszentmihaly described the feeling of having the optimal experience as ‘helping to integrate the self because in that state of deep concentration consciousness is unusually well ordered’.

A common complaint from new clients is that ‘the book is out of control’. The work schedule can make or break any business. It brings order or creates chaos and causes rows, resentment and ill feeling. When I ask why things are as they are, the responses are ‘That’s the way we’ve always done it,’ ‘That’s how my old boss did it’ or ‘I daren’t try and change things—the team doesn’t like change’.

Success happens when we start with the end in mind and look at the big picture first. Yet how many of us have designed a work schedule starting with the questions, ‘What do we want to happen?’, ‘What results are we seeking?’ or ‘How will we make that happen?’

If we accept that a business is there to be a profitable enterprise—if you disagree, stop reading here—by ensuring that patients have the best possible care provided in a pleasant, relaxed environment where everyone can give their best, then we need to ask some more questions.

First the money: How much do you want to earn, to have the life that you desire and to invest in yourself, your team and your business (£)? How many clinical hours a week will you work (W), and how many weeks a year (H)? The calculations to reach an amount required as turnover is easy: Divide £ by (H x W) to calculate a desired hourly rate.

Hours are too short and you really need at least three hourly rates to reflect different treatment complexities. What really matters is the yield, day upon day.

Communication
Whoever manages the book must understand that they control the practice income. In 1994 my receptionist, Max, and I went to listen to Dr. Ken James speak. The Seattle-based James understood the pressures and had taken the time to address them and to ensure his front-of-house team saw things from his point of view.

During the drive home, Max and I decided to keep a running total of every future day showing how much I would gross. Max vowed to keep a running total of every future day showing how much I would earn. It became her chosen duty to ensure that I hit the agreed targets. If a day was looking patchy, she moved patients around and ensured that high-value treatments were booked appropriately. That started the most productive period of my clinical life, because it was orchestrated.

I was able to give her feedback on how the day had felt and how it could be enhanced. When she eventually moved to pastures, new the systems were in place to ensure continuity.

Stephen Covey wrote of the concept of rocks, stones and sand around which every day must be built. The rocks are our long appointments; the ones that carry the most need for concentration (deep work) and also the highest price tariff. Examples include advanced restorative work, crown and bridge, implants, molar endo, ortho bond-ups, surgery, etc.

The stones are routine conservation visits of 40–60 minutes and new-patient appointments.

The sand is the rest—the stuff that fills in the space around those appointments, so dental health reviews, appliance checks, visits to see patients in the hygienist or therapist surgery. The number of slots depends on two things—how much of each you want to do and the sort of practice that you have.

Delegation
Dentists should only do what only dentists can do; everything else should be delegated. Dental therapists and hygienists can and should be doing what they are trained to do. Good therapists offer a lot more than ‘hygiene plus kids’, as I have heard it described. Celebrate and deploy their skill sets and do what only you can do.

If there is some element of dentistry that you find a life-shortening exercise, find someone else who’s good and does enjoy it. When I stopped making full dentures in 1996 it was liberating; the practice owner a couple of miles away to whom I sent them reciprocated by referring me his phobic patients for sedation.

Start well
Ensure that you have a morning meeting or huddle each and every day. There is an opportunity to learn from any problems during the previous 24 hours and to anticipate any difficulties lying ahead. It’s a chance for the team to start the day on a high and on time.

Determine your optimum time
If you’re a morning person, schedule your biggest, most challenging cases in the morning and save yourself for the less-intense work later (or vice-versa). Explain to patients why it’s important that they attend at the times offered to get the best from you—it’s in their interest, after all.

Question traditional hours
Why are you working a 9 a.m.–12:30 p.m., 2–5:30 p.m. day? Might an 8 a.m.–3 p.m. with a couple of short breaks work better for you? Or how about 2–8 p.m.? Modern theories of sports training show that we perform better in short, focused bursts.

Minimize distractions
Read Cal Newport’s book Deep Work for proof about that feeling of attention being dragged in different directions by interruptions, and what you can do about it. Minimise distractions so that you can give your best.

Practice
Every clinical procedure should be practiced, analysed and revisited to improve it. That doesn’t mean faster, but smarter. Aim to complete everything with as few movements as possible with a smooth, flow where everybody is in the zone. This means having fully supported four- or six-handed dentistry so the surgeon is not distracted from the job in hand. Success becomes predictable with high concentration and reduced fatigue.

Reflect
Take a few minutes every day to think about what worked well and what didn’t. How could your time have been used better? What changes, even small tweaks, can you introduce to make your day smoother?

Management
Establish systems for everything which are well documented, reviewed regularly and understood. Only do the things that you absolutely must. Don’t spend time loading figures into accounts, paying bills, doing payroll or writing your own referral letters. If necessary, outsource; there is plenty of help in the virtual world.

Ring fence time at least half a day a week to work on, rather than in, your business. Applying the same micromanagement required for excellent dentistry to the running of a business will lead to problems. Trying to run the business on the hoof, squeezed in between patients or at the end of a long day, will fail.

To just sit and wait to see what sort of a day turns up is to invite failure. You and your agenda builder can create days that are not only profitable financially but also rewarding mentally and enjoyable.

Alun K Rees BDS is ‘The Dental Business Coach’, an experienced dental practice owner who changed careers and now works as a coach, consultant, troubleshooter, analyst, speaker, writer and broadcaster. Rees brings the wisdom gained from his and others’ successes to help his clients achieve the rewards their work and dedication deserve.
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