This episode is all about the capacity of your practice — what’s on your mind for growth, as well as components in your practice that might surprise you in boosting your production.
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Transcript:
Tiff (00:01)
Hello, Dental A Team listeners. We are so excited to be here with you today. Like we say every single time, we truly, truly do love podcasting and we love what we do. I think getting into it, ? Dana and I, we just spent some time figuring out what this podcast was going to mean and how we were gonna take it. So sometimes it can be like a little daunting, I feel like. But once we get started, ? I think it just flows and and we love it. So, Dana, thank you for workshopping this title and this
project with us today and how are you doing? It's like full blown summer in Arizona. ? it's hot and it's beautiful. And I know we chatted last week and I said are sports done and I was like, yeah, that's right. Sports are never done. So Dana, how are you? How's life down there in the Tucson area?
DAT-Dana (00:48)
It's doing really good. Like you said, summer's in full swing, so sunshine's out, kids are, yep, back at sports. ? I just feel like I don't know. I am a su I always say I'm like a lizard. I like to soak up the Arizona sunshine, but I do feel like as the older I get, sometimes these summers get a little bit more brutal every year.
Tiff (01:07)
I
agree. I keep saying, is it actually is it getting hotter? Is it getting harder? Or am I getting older and less tolerant? Because I'm the same. I'm a lizard. My ? my family calls me the the lizard because I we even went to the pool yesterday and I was like, no, I don't wanna actually be in the water. Like I just want to be in the sun, feeling it on my body. It makes me feel good. But I'm the same way that I'm like I'm just I'm getting so much less tolerant. I really do think that Yeah. Yeah. I know.
DAT-Dana (01:25)
And so.
Yeah. Yeah. fun fine.
Tiff (01:36)
I know. Well,
today's content I think ? I'm excited about. Like I said, we workshopped it and I think we came up with some really solid solid pieces here because I think this is something, especially at this time of year, actually, that a lot of doctors and practice owners, one, you get that like itch mid year that you're like, Am I doing enough? Do I need to do something else? And then we see a lot of doctors kind of like sideswipe their team and really just undercut and be like, We're adding something different or we're changing everything up or
Whatever. ? and also at this time of the year, I know for us, at least with our clients, it's a time of year that we really start thinking about next year. I know that seems kind of wild, but that like June, July, August, September timeframe, we're really starting to project, okay, what's left of this year, how are we going to make those goals and exceed those goals? And then what is that gonna roll into for the following year? So this kind of subject that we have today, this this chat, I think falls right into that. And what we want to chat through is capacity.
I love that word. I love the word capacity because it can mean so many different things. I think there's like capacity of our mind. And I talk with with practices in Dana, I know you do too of capacity for team members a lot. Like what is their capacity and not just their time capacity and what they're able to do, but also like their brains, right? How much, how much pivoting can they do in one day? How much how much different subjects can they take on in one day? And what's that capacity? But really today I want to chat capacity of your
Practice and your numbers. And Dana, you spoke really eloquently about this a second ago. And I want to I want to bring that back around to the capacity of the practice because I think first and foremost, when a practice owner thinks about growth, they think, okay, I need more operatories. I need a second practice. And I need, I need, I need. And it's like, yeah, we sometimes we do have to invest to recoup.
benefits, right? So we do have to invest and we have to we have to grow the physical space. ? and I and I think for so long in dentistry it was like how many practices do you have like the first question people asked and how big is your practice? What's your revenue? How many patients do you have? And those questions still swim around and it can make a practice owner feel like they're reaching and grasping for something that they're not even really sure that they want yet. And I know Dana you've seen that too and something that I love watching
our team work with their practices in is really growing within the capacity of the the physical capacity that they have within their practice without having to make that initial investment. But also Dana, I've watched you like grow into that. So projecting and saying, cool, then at this point or in one year, in two years, in three years, this is the capacity, the physical capacity that we want to get to. So I want to really dispel the fact that capacity means we have to
actually grow the physical space because I think Dana there's so much to be grown within the space that we have. And I want to talk through those pieces so that a lot of our listeners here today might pick up something that they're like, gosh, I never thought about that or ? I forgot to do that. There's a lot of those, I forgot to do that piece. So when a doctor comes to you, Dana, and they're like, Dana, I need to grow but I have no more hours. I have
I'm tapped, I don't know what to do. What are some of the first places as a dental consultant that you look at with those practices?
DAT-Dana (05:03)
Yeah, I think a couple things. I think that I look at like how comprehensive are we treating the patients within your practice? So are there things that we're letting walk out the door that we are skilled and know how to do that we can keep within the practice, which helps us, I think, just more comprehensively treat patients, which naturally will grow production.
? I love that you said yes, we're at maximum hours, but I do think that's always a place to look before you look at more space, before you look at expanding. Can you just add hours somewhere? and oftentimes those early morning, those evening hours, patients really, really like too. So we feel like those can stay full. I also will look at insurance participation. Can we change insurance participation and again be able to maybe even lessen our capacity but keep growing our practice with patients?
who align a little bit more with what we're looking for as far as like patient avatar ideal patient.
Tiff (06:00)
Yeah, I love that I have a lot of practices that are doing that right now in this like June, July, August timeframe. So that in September, October, we can start at least sending those letters that say, Hey, will you increase our fee schedules? Because there are so many that are out of line. And I think that's a huge discussion ? that's been going around really for the last like two to three years. But I think very, very soon it's not even gonna be a discussion anymore. It's just gonna be a thing of the past. So we are approaching that, I think.
You're totally spot on the fee schedules, fee schedule analysis too for your practice. And I think, Dana, understanding I have a practice I understand that you can do this at any point. You can analyze your fees, you can request fee schedule increases. It doesn't depend on your contract with the insurance company. Just request those fee schedule increases because the worst that they can do is say no. And then you evaluate your contract obligations with them and what you want to do for your practice. We get so scared of like, well,
When can we? It's like they're they don't actually tell you. You just do it. You just do it and then they tell you yes or no. I have a practice that actually increases their fees ? during the summer. And so a lot of practices will wait and they're like, it needs to be January because that's like a fresh start. And I think for me, Dana, it makes me think of like I'll start my diet on Monday. ? no, it's fine, I'll just I'll do it on Monday. And then we get to like December, January, and they're like, Well, wait, we didn't tell the patients yet. And then they hold back, they hold back, and then it's a whole nother year again.
before we do fee schedule increases. And it just doesn't have to be that dramatic. And that can significantly increase the dollar amounts coming in, which is ultimately our end goal, right? And I think it's like in dentistry it's hard because we're healthcare professionals. So focusing in on those dollars and being like, gosh, you know, charging $1200 for an implant
seems crazy because we came from a spot where we were charging six forty two not that long ago, right? It feels like not that long ago in dentistry dentistry is so progressive and it changes so constantly. We have to stay up on on our fees and we have to stay up on the times where dental insurance doesn't do that. It can hold us back from making sure that we're increasing those fees to where they should be and that we're you guys are making the
the dollar amounts, the overhead structure that you want to and that you should. So making sure that you're looking at those is massive. And then Dana, you also said that the patient avatar, and I have I have some the clients that have, gosh, like thousands upon thousands upon thousands of patients and evaluating the actual patient base. So active patient base is, you know, whomever's been seen within the last 18 months. And then looking at are those patients even our ideal
avatar. I've had clients that have had to basically dismiss patients because their patient base was too clean. So it was like we either we either keep clean patients and don't have dentistry to do or we reevaluate our patient base and start restructuring for the structure that we actually want to do. And that for you, Dana, I think was kind of twofold because you said the patient avatar and then you also said the dentistry like that we want to do and that things that we can keep
in the practice. So what have you seen with your your clients when they do that patient avatar and they're like, gosh, actually this is the ideal patient. This is my patient demographic, because it can't we can't live in the middle of I don't know, retirement community and be like, we're gonna do Botox, the whole like we're gonna do all the Botox, right? We've got to make sure that we're dealing with the patients that we also have. So what do you see as far as capacity and being able to grow financially?
within those constraints.
DAT-Dana (09:42)
Yeah.
I think that it it like you said, it like the creating your ideal patient allows you to kind of see, like, are you serving the people in the community that you want to be serving? And are you doing the type of dentistry that one they need and two that also you like to be doing? And sometimes those things can be, you know, you have to figure out how they work within the community that you have if it's the dentistry that you love. But I think taking a look at your patient avatar allows you to see, like, are we currently serving the patients who like really
align with what we're looking for in our practice. And when you don't, right, then you can start to say, hey, okay, let's put some systems in place. Just try to get our patient base a little bit more aligned with what we like to do as far as the type of dentistry. And to just like the patients that we feel like we best serve and we can best impact. And I think when you start to do these things, I always say, yeah, we've we get to a point in our patient base where patients get healthy. And it might not be all of our patient base, but certainly some of our patient base. That's the goal of recares, right?
We have recare patients, we bring them back, they continue to occasionally have things pop up, but for the most part, we've gotten them steady and stable. And then I think then it's the next layer. Okay, they're steady and stable, but do they love their smile? And if they don't love their smile, what do you have in your toolbox, right? That can help do that next layer. I think sometimes we get into like, hey, you know, I am getting a lot of new patients, but they're just healthy patients, right? They've been seen every six months. That doesn't mean there's nothing we can do for them. And sometimes creating your patient avatar and
Tiff (10:55)
Yeah.
DAT-Dana (11:12)
looking at your services helps expand like your way of thinking and the things that you can do for them to continue honestly and truly to continue doing dentistry on either your patient base or we've got to make a switch, right? And we've got to start to transition some of our patient base so that it is more ideal.
Tiff (11:24)
Yeah.
Yeah, I love that. So something to consider as we were talking, I was thinking about like metrics and the metrics that we like to utilize within our ? consulting to really help be able to account for capacity, right? Actual physical space capacity and patient patient-based capacity. And something we love to do is to consider the number of patients per hygiene day.
Now this can get a little confusing because you think just day of the week, right? There's seven days of the week. There's typically five days that are worthy of being open. ? sometimes six if you're Saturday, and most of you are probably four days a week. Well, within those four days, you could have exponential amounts of hygiene days. So if Monday you've got three hygienists, that's three hygiene days. So per hygiene day per week, we really want to see 200 hygiene.
Active patients per hygiene day. So if on Monday you've got three hygienists working the full day, that's 600 active patients per that day. So you multiply that by every day of the week, and that tells you how many recare patients we tip we like easy numbers. You guys, 200 is an easy number. We love that. So we typically are going to use some formula to that capacity that will tell us how many active patients per hygiene day you should have.
And if you reverse engineer that, Dana, I love this because it tells us the capacity of our hygiene department, meaning, do we need more hygienists? Because doctors are always like, Do I should I want to hire? It's hard to hire. I've got a hygienist on the books, or I think I have I need more hygiene hours. I'm booked out this far. And honestly and truly, I feel like when we wait for that space where we're like, gosh, I'm at capacity, I can't fit any more patients, I'm booked out too far. That's when we're scrambling and trying to fix the space issue. And we get into this like frenzy.
Whereas if we're watching our our hygiene numbers, we're watching our active patient count and our new patients plus attrition, we can see what our capacity is going to be and we can better project when do I need to hire another hygienist and do I have the space for that? So if you if you work those numbers, you can start to see, okay, I have enough patients in my patient base right now to supply X amount of hygienists with X amount of working days. Now, given my
new patient count coming in and my attrition meaning how many am I losing on the back end, which should be very, very, very small. You guys, it should be patients moving or losing patients. I'm not gonna say why. you guys can understand. I don't like saying that. They just they're gone. So they didn't leave us for another dental practice. They moved away somewhere. ? So that's your attrition. But taking those into consideration you can start to do the math and see okay with this new patient inflow,
I'm getting a positive net of new patients of X per month. This is how long it's gonna be that I'm gonna need another hygienist. So then Dana, I would say like probably two months ahead of that ish, maybe three, start looking for a hygienist. It's starting to get like finding an associate dentist anymore. So two to three months ahead of when you might need them, I would really start projecting and looking at.
hiring them. Now capacity-wise, Dana, that slides into, okay, this doctor that's listening now is like, cool, well, my I don't have an operatory. Okay, great. Well, now we look at some other options. And Dana, when there's ? an option and not an option of another operatory, what do you like to look at for when you do ? add in those hygienists for capacity wise?
DAT-Dana (15:04)
Yeah. I think it is. It comes to are there days that we can add? Are there hours that we can add anywhere to be able to serve the patients? And again, I mean, yes, we're getting new patients in this scenario, but sometimes it's just to serve the patients who've been with the practice, right? Or just our recare patients. So how can we manipulate hours? How can we manipulate days? Is there any room anywhere ? to be able to
see more patients within the allotted space. And you know, I will say I've got a practice in on the East Coast and it's just a three operatory practice, right? So we're constantly, constantly trying to game plan this capacity thing because there is no room for expansion. There is no and like they love the location. They and so we do you have to get a little bit creative. And sometimes it means like we do have a part-time hygienist that comes in on Saturdays. We do have a part-time hygienist that comes in on Fridays. We do we've expanded hours, we've done some kind
Tiff (15:38)
yeah.
DAT-Dana (15:58)
of
like split shift. And ? again, I know sometimes offices hesitate with that, but like honestly and truly just ask your team, right? Your team will tell you like what they're willing and what they're not willing to do. And sometimes you'll be surprised how even manipulating shifts actually helps team members in their personal lives, right? We have those moms that maybe want to drop their kids off at school in the morning. So not starting until 10 is great for them. Right. And so until we have these conversations with team and we look at all these avenues and all the doors that we could open
the levers that we could pull to really be able to continue to grow even if we are at max capacity. I think that there are a number of things to look at before having to find a new building or add a second location or ? those types of things. And so it can be a mix of changing hours, it can be a mix of adding providers, it can be a mix of adding days, all the things before it has to go to that point.
Tiff (16:41)
Mm.
Yeah. That was a great ? that was a great visual. The office, the three pr the three op practice. I definitely have I have one that's a four op and three hygienists. ? so I I totally agree. And I love also in your mix there, you're talking about like adding hours and working. I they added hours there they're expanding by hours, but also something that I love doing is that smart scheduling.
Right. Block scheduling is wonderful. I know other people who love it. There are people who hate it. There are people who don't understand it. But block scheduling can truly, truly make it so that you can see your capacity so you can better schedule for one, but then also better prep and better like move forward. Something that I love doing is really looking at when you've got a smaller operator when you have 11 and you're like, I need the twelfth. You're like, cool, that's fine too. Take a day, look at your schedule and say, Okay, maybe on Wednesdays.
My doctor's gonna do like heavy, heavier appointments on doctor side. So we've got, you know, high production, high value production all day. Maybe there's some assistant driven stuff so they can still do some exams, but then I've got a hygienist that's running just SRPs. So like Wednesday is she's in doctor's operatory. So doc loses an operatory, doc is doing heavy in one column, doc loses an operatory, and I've got heavy SRPs. So we're not losing the production.
We're gaining the production and able to do the recares on the other days so that we can project out or Fridays. I have a lot of hygienists that will do that'll love to come in on a half day on Friday for like four hours and just bust out SRPs because back-to-back SRPs is hard, but it's when you've got a half a day of it, it's kind of like quick, easy production, get it done, and it makes it more valuable coming in for on a Friday. Yeah. And
Outside of that, so not even outside of that, I would say all of this combined. If your fee schedules are in alignment, if you know your capacity of your patient base, meaning how many patients do you have, how many hygienists do you need for that, how many doctors do you need for that, the capacity of your time, right? How how long are you working and are you being super effective and efficient within those hours? I've seen a lot of doctors as well. This is something we haven't mentioned yet. I did mention like block scheduling and eff efficient scheduling and hygiene.
But I've also seen a lot of doctors that are like willy-nilly doing a couple fillings here and there or the the front office ? scheduling team is really just scheduling them to fill the schedule so there's no white space. I but it's not effective scheduling. And so we're really not producing what we should be, but we're also not using our chair time effectively. So when we have those smaller appointments, we're turning that room over so much. And if you think about it, Dana, I'm like, gosh, there's ten minutes at the beginning minimum.
DAT-Dana (19:23)
I see.
Tiff (19:47)
10 minutes at the end minimum that an assistant is turning over that room. And so we're losing 20 minutes every appointment that's non-productive time. And within that, if we've got filling, filling, filling, filling, filling, and docs having to get up to go do exams, our our filling appointment, our filling appointment is longer because he, she has to get up and go do exams. Plus, we're losing that turnover time every single time. So if we can
utilize something like blocked scheduling or smart scheduling, however you want to do it, to not back to back to back the little appointments. They're gonna happen. I'm not saying overdiagnose and over-treat to not have little appointments. I'm saying let's butt those up against longer appointments so we're not losing that time. Is that something that you often see Dana within that with your with your client base of really restructuring the schedule to get the capacity up.
DAT-Dana (20:40)
Yeah, I do. And and I usually will tackle it from like that's when we actually feel the capacity restraint, right? That's when it's like, my gosh, we're so burnt out and we're so and sometimes it is like, hey, can we schedule a little bit better so that like yes, we can value our time, we can make our time more efficient. And I always joke around with practices and say, can I get you to goal with 31 surface fillings? Yes, but can I get you there with three crowns? And doesn't that feel different?
Tiff (20:46)
Mm.
DAT-Dana (21:06)
Right. So I also think it's like how much we feel our capacity, right? Because that is so many more check-ins and checkouts and insurance verifications and like the workload just like duplicates and replicates for everybody on the team. And just like you said, then doctor having to get up and and you know, all that room turnover that happens with
Tiff (21:06)
Yeah.
Yeah.
DAT-Dana (21:25)
The clinical team. So I do feel like when you schedule strategically too, it helps you not feel the capacity restraints as well as allows you to be super efficient with your time and making sure that we're using like every 10 minutes we have within the day to be able to take care of patients.
Tiff (21:43)
Yeah, I totally agree. I have a practice that just last week, ? one of the doctors was like, I'm over this. I'm done. I'm I'm burnt out. And like we're over here trying to like untangle ? financial stuff and and we're trying to untangle front office overload work overload and get things ? efficient in both those areas and understood and do all of these like willy nilly appointments and anyways, yes. It it was like that was the breaking point was the
capacity and feeling like something's gotta give. Well, it's probably within your scheduling. I completely agree. And I feel that way too. If I if I overload my personal schedule or my work schedule and I've got too much going on and they're like, gosh, like these little tiny errands or calls, if I do my 30 minute coaching calls back to back for an entire day, I am exhausted at the end of the day compared to if I can get a couple of big chunked hour coaching calls in between those 30 minutes, I'm much more productive.
And I feel so much better at the end of the day. And it makes me think how lucky I am that I have been in dentistry for as long as I have been. And then I'm able to look at a schedule and really, really create a productive schedule for myself. So I love it, Dana. I I think action item-wise, ? whether you're feeling capacity or not, I would constantly evaluate this area because the worst thing in my mind that I do for myself is wait until I'm burnt out to look at my capacity.
To wait until I'm burnt out to say something's got to give on my schedule. I really like looking at my schedule ahead and being like, that's gonna suck. Let me restructure, let me figure something out. Or like we do it too with our calls. You know, how many calls do we have? What does that look like? How can we get that done within the capacity of our timing? So I would say don't wait until it hurts to fix it. Make sure that you've got it ahead of time so that you cut the capacity doesn't burn you out. So
Evaluating the number of active patients you have, evaluating what you will have given your new patient influx and your attrition. Also, I really, really strongly advise ? reactivation campaigns so that you're grasping a lot of the people who maybe attritioned out before. Your hygiene team, I think, will love you for that. Dana can Dana can do a whole podcast on not forgetting about our recare patients and the patients we already have. That is one hygiene 101. So make sure you're doing your patients right.
so evaluating your patient base, making sure you know what you have, what you're going to need, and evaluating your schedule. So before you even add hours, before you add days, look at are you being the most efficient and effective with the time that you have? Don't take more time away. ? be super effective and efficient with the time that you have and be ? collecting the fees. One, be collecting the fees you're already charging. So look at your AR. Two, charge.
what you deserve and collect the fees that you should be and then look at opening hours, opening days, and then look at opening more space in your practice is how I would recommend looking at that before jumping straight into more, more, more, bigger, bigger, better. And I think Dana, we are getting to the point of life where we're understanding bigger isn't always better. I love it. Awesome.
DAT-Dana (25:03)
Yep, agreed.
Tiff (25:05)
Hey Dana, thank you so much for this podcast today. This was fun. I'm glad we workshopped it ahead of time. I loved your ideas. ? and everyone, thank you for listening. Drop us a five star review below. We love to hear your ideas, and that is an absolutely perfect place to put them. People read them. don't forget to subscribe and download these so that you'll always have them and you can go back. So when you're here driving, which I know many of you are, you can go back and listen to all those tidbits that
Dana dropped for you today. And Hello@TheDentalATeam.com is the easiest place to reach us. And we'll catch you next time. Thank you guys.