The Importance of Same-Day Dentistry by Howard Farran, DDS, MBA, publisher, Dentaltown magazine

If you were doing a cleaning and discovered that a patient needed two fillings, the response in almost every U.S. dental office would be: “OK, let’s go up front and see if we can get you scheduled for treatment sometime in the future.” I find that bizarre.

We know from data that only 38 percent of diagnosed cavities ever get treated. People are busy, they’ve got a lot going on—jobs, families, pets, sleep, etc. If you send patients up front to schedule a future appointment to treat something that’s not “want” dentistry (like bleaching, bonding or veneers), they might not ever come back. If they’re not in pain, they might cancel their appointment.

One of the greatest ways you can increase your case presentation is getting your whole office operating in the mindset of, “Let’s do it right now.” You need to be ready for same-day dentistry.

Same-day dentistry is everything
The No. 1 cost of dentistry is accepting PPOs. (I count Delta Dental in there, too, because the company gives you a fee schedule, just like a PPO.) The average PPO effects a 42 percent reduction in price. That’s your top overhead cost—42 percent. (Your other overhead costs should be, in order: labor, which should be 25 percent; lab fees, which should be 8–10 percent; and supplies, 4–6 percent; and rent, about 5 percent.)

Why can’t you do same-day dentistry? Don’t say you can’t afford the extra space and chair—by the time you put in a dental operatory, for as long as a chair lasts, it costs you about a can of soda per hour.

And don’t say you don’t have the time. When new prospects call you on the phone, they’ve searched “dentist near me” and probably found a hundred dentists nearby. Your team needs to say, “Instead of talking about your toothache over the phone, let’s get you down here right now.” It doesn’t matter if you don’t have an “emergency room,” or if you have a root canal and a crown scheduled at the same time. Do you know if those scheduled patients will even show up?

Anyone in your office should be able to seat that new patient. Maybe your hygienist has a cancellation, and she can put on her dental assistant hat and take the X-rays and the exam. Or she can assist you during a root canal filling or a crown. (If she won’t, I’d say dismiss her and replace her with someone who will.)

Time is of the essence
If the patient at his 4 p.m. hygiene check needs a crown, but the office usually closes at 5, your team should work until 5:30 or 6 if that’s what it takes to make goal, because there’s nothing you can do at the end of the month to make up for all the days when you didn’t work in these “little emergencies.”

If someone calls at 11:30 a.m., your team should say, “Could you be here at noon?” It shouldn’t matter if that’s normally your team’s lunch hour, if that case helps your team make goal for the day. A scheduled lunch is a luxury. How many other businesses say, “We’re going to leave and turn the phones over from noon to 1 p.m.”? They’re definitely not the types of business that have daily production goals.

Plus, half the time, patients just want a diagnosis—they’re going down a line of dental offices, asking, “Hey, can you get me in?” The answer should be “Yes, come on down. Let’s take a look at you—get an X-ray and a diagnosis.” Work up a financial arrangement while the patient is marinating, after the hygienist has numbed him up.

There’s no excuse to be turning away same-day treatment! Your team should be optimizing every second, every minute they have, because once a patient walks out the door without scheduling a treatment, it’s really hard to get them back in. We named our practice “Today’s Dental” for a reason—today is right in the name.

It’s time to start catching the fish
General dentists average about $175,000 a year in net income. Oral surgeons and endodontists are around $400,000. There are several reasons for the difference, but one is that the highest-producing oral surgeons and endodontists have two emergency rooms.

The reason they do it, they tell me, is for the same reason I’m telling you to. If you refer patients to an endodontist but they can’t get in, you’ll start trying other endodontists instead. The specialists don’t want that! You’re an annuity, man, regularly sending them a couple of molars or a couple sets of wisdom teeth. The specialists would rather get double-booked than have empty chairs—which does happen to endodontists, too, because their patients have high anxiety about procedures like root canals or wisdom teeth. (The fees! The pain!) Or maybe they forgot they weren’t supposed to eat for at least four hours before the appointment.

When a new patient actually comes into the practice, it’s like you’ve reeled in a fish: They talked to you, they found your place, they came in, they filled out a chart, they went back to the operatory. If you absolutely cannot do the treatment that day, you can say, “This tooth is so infected, I need to put you on antibiotics until …” and look at your schedule for the next opening and say “until Tuesday at 2 p.m.” You’ve caught the fish, but you don’t always have to clean, cook and eat it right then and there. (However, if there’s any way to get them today, do it!)