Publisher's Page by Howard Farran DDS MBA MAGD

We all get lucky with a purchase now and then, but the majority of us also all have a dental museum in the back of the practice with all the crap we bought and never used. Labor Day weekend 2000, we closed down our Today’s Dental family practice in Phoenix and installed Trophy in all eight treatment rooms. We knew it was something we had to do on our journey to going paperless. Now, a year after we took the plunge, I can honestly tell you it was one of the best decisions we’ve ever made. It has significantly affected our practice’s bottom line.

Before digital radiography
Efficient operations and logistics are crucial to the successful operation of any business. My dad, an extremely successful entrepreneur, would probably use an analogy of a train to describe our operations before and after going digital. Each train car is a procedure. If any part of the train broke down, the entire train would come to a screeching halt.

With that in mind, let’s run through the steps of a patient calling with a broken tooth for an emergency appointment. The patient calls and the front office finds a free hour and schedules an appointment. The patient arrives at the office. The dental assistant takes approximately five minutes (one train car) to set up the operatory and another five minutes to seat the patient. Another five minutes are used to take a periapical and bitewing radiograph of the broken tooth. Now, the assistant has to leave the patient alone, and develop the x-rays on our old and trusty AT-2000 developer. If no one else is using the developer, it will take another ten minutes (5 minutes to develop, 5 minutes to mount, identify and date the slides) before the assistant can return to the operatory with the radiographs. Now, 20-25 minutes later, the assistant finally has everything ready for you, the dentist, to begin.

You review the x-rays, go to the operatory (another five minutes) and explain to the patient that tooth #3 needs a build-up and crown. The patient immediately asks, “How much is this all going to cost?” The dental assistant begins entering the treatment plan into the chart and heads to the front office to find one of those rare people that can actually talk and collect money. After explaining everything to the patient and checking insurance coverage, the front office person says to the dental assistant, “If they want to have it fixed today, do you have time?” The dental assistant promptly says, “No, sorry.” Because it’s already taken over 35 minutes to get to this point and the open time slot was only an hour. And you say you can’t afford digital radiography? In the old world of film, the staff immediately starts thinking with their brakes on. Slow down, reschedule, we’ll run out of time! By simply switching out the old film and developer process with digital, here’s how that same procedure plays out.

The efficiency of digital x-rays
The patient is seated and the dental assistant begins taking digital x-rays. The image immediately comes up on the flat-screen monitor, right next to the patient. No guessing if the shot was good. Now, with the digital images on the screen, the dental assistant beeps me using our Director light system by Comlite that the patient is ready. I go into the operatory, make my diagnosis, explain the problem to the patient, who sees clear magnified images on the monitor. The entire process, including fees and approval takes about 15 minutes. With 45 minutes left, I immediately start the build-up and crown. Now, let’s go back to the analogy of the train. Do you see how the addition of digital radiography has enabled the entire train to move much faster? You must increase your efficiency if you want to increase your bottom line. Just because you always do a root canal in two, one-hour appointments, doesn’t mean you can’t do it in just one.

Other time savers
Try making the temporary with the dental assistant before you take the impression. Faster! No more reduction copings––you figured out the clearance issue with the temporary. Every time the dental assistant has to leave the treatment room to get something, stop and write it down. Later go back and order gobs of whatever the assistant is only storing in one place, and store whatever it is in every operatory. Move to a self-etching bonding agent like Clearfil, manufactured by Kuraray and available through J. Morita, and eliminate the acid etch step. Switch to Rembrandt’s Sapphire light and cure five millimeters of light shade composite in nine seconds. Time is money and operations and logistics rule everywhere from Wal-Mart to Southwest Airlines.

My dad always said, “The only secret to lower prices is to know your costs.” So, the only secret to more profit is to know your costs. But, do you really know your costs? The greatest curse in healthcare is that 80% of our costs are variable costs. Variable Costs (VC) are the costs that go up and down in direct relationship to how much dental activity goes on. This is labor, lab bills and supplies. Fixed Costs (FC) are the remaining 20% of our costs. Fixed costs are the bills you pay each month whether you see one patient or a hundred. They include rent/mortgage, equipment, build-out, computer updates, professional dues, continuing education, insurance, utilities and phone bills. Our staff labor is 25%. We pay our dentists (including myself) 25% of production, straight off the top. (I don’t deduct my salary from the bottom line profit zone.) Our equipment costs usually roll in at about 3%. So, if our labor alone is 50% and our equipment is 3%, we should be buying every piece of equipment known to man to make our staff just a little more efficient.

So, if you’re thinking you simply can’t afford the initial costs of implementing digital radiography into your practice, think again. I honestly can’t see how you can afford not to!