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Enhancing Efficiencies by Dr. Daniel Bird

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Categories: Practice Management, HR and Accounting;
Enhancing Efficiencies 

A look at one practice’s blueprint and how it could prove beneficial for other general dentists

by Dr. Daniel Bird
photography by Justin Fox Burks

See even more of Dr. Bird’s office in our online slideshow

We profiled Dr. Daniel Bird and his high-tech practice in an Office Visit feature in August 2020:
To see the story and a slideshow of photos, head to dentaltown.com/bird.

I started practicing dentistry in an office that opened in 1983. The patient base was established, as were the practice protocols and systems. The office was traditional, with hygiene operatories and treatment operatories, each designed for specific tasks. There was the usual waiting room and the usual front desk.

The longer I practiced, though, the more I noticed the stress of having a waiting room full of people. It frustrated me to find broken teeth or ones that needed fillings during hygiene visits, because I wasn’t set up properly and didn’t have the flexibility in my schedule to deal with them then and there.

Even though the patient had to take off work for their cleaning, I couldn’t manage to find the time to help them; instead, I had to reschedule them for a later date.

I know this is what most dentists do every day and it’s just business as usual. But just because that’s how nearly every dentist does it doesn’t mean that’s how it had to be. I promised myself that when I had my own practice, I’d design it around concepts that allowed for greater flexibility, less stress and enhanced efficiency.

I got my chance when I started a new practice in 2017, a 4,000-square-foot space that’s part of a 12-acre parcel that was once a Sears distribution center. I share the space with a wide variety of other businesses, including galleries and eateries, and I match my practice to the tempo of today’s instant-gratification-seeking consumer without sacrificing clinical quality by focusing on having a no-wait policy, offering same-day treatments (including crowns) and making some other fundamental changes that make my practice—and could make yours—an efficiency lover’s dream.

No-wait policy

In this day and age, nobody wants to wait for anything. They especially don’t want to be nervously sitting in a waiting room, getting more stressed out from the anticipation of their appointment. This was an opportunity where I could improve the patient experience.

We built the office around the concept. There is no waiting room in my practice; instead, every operatory chair is equipped to do any procedure at any time, and the hygienists use customized carts that allow them to roll up to any chair available and get to work. So if your appointment is at 9 a.m., you show up, are greeted by a patient coordinator, sign in on a tablet, and are then taken directly to an open chair. All paperwork is done online before the appointment, which eliminates hanging around filling out paper on a clipboard.

Before we numb them, every patient speaks with one of our patient coordinators. The coordinator will go to the operatory so the patient never gets out of the chair. If they need a crown, they’ll discuss how much their insurance will cover, what their portion will be and how they intend to pay for it. Generally, a patient will hand over a credit card and their portion is paid before we prep the teeth.

For the average visit, we allow enough time for a cleaning, exam, X-rays, etc., and if we find that any fillings need to be done, the patient is already in the chair and the space has all the stuff we need to do the filling(s). So we just go ahead and do it right then and there.

That works well enough with fillings, sure. Those are simple enough. But you might ask, “What about crowns or implants?” Well, the crown problem was easy to fix. That’s what Cerec was designed to do: prep, design, mill and seat. Any patient who has had a crown done the traditional way (usually a two-week turnaround) before stepping into my practice loves the fact that they get their crown the same day as the prep.

Meanwhile, the hygienists don’t care about which room they’re in because every operatory is the same. Each hygienist uses a rolling cart from Ikea that we’ve loaded up with everything they’d need for an appointment, including their own Cavitron. We also have two portable Nomads and sensors for their X-rays. It’s this kind of “ready-to-roll” attitude that I’ve worked hard to permeate through the rest of the office.

Create a same-day attitude

Many dentists don’t do same-day treatment, for a variety of reasons, but patients appreciate the ones who do.

This isn’t a novel concept, either. Same-day treatments make perfect sense for most patients, who have to take time off work just to come see us. And we need to face that the reality of today’s culture is that some patients can’t understand doctors who don’t offer same-day treatments.

When it comes to same-day treatments in my office, I give most of the credit to my wife. Before I had my own practice, she was a teacher, and if she needed to make a dental appointment, she’d have to use her paid time off. She’d usually take a half-day off, because she never knew how long her appointment might take.

My wife often asked me why, if she was taking a half-day off work, the dentist couldn’t do more during that time. The usual way things were scheduled and set up, she’d be seen and diagnosed … then have to make another appointment to get the work done, which meant she’d have to take another half-day off to get her work completed. It’s a ridiculous way to treat patients, and it can be avoided.

When I opened my practice, I kept in mind my wife, and the countless number of patients who, like her, have to take off (at minimum) half a day of work just to be seen, and more time somewhere down the road to actually have work done.

Now, part of the trick is that I’m fast enough to do work on the fly. When I was a young dentist learning the trade, I spent way too long on techniques that could be done much faster. As I got better clinically, I also tried to reduce useless steps and the number of instruments used, and I honed the techniques to be faster while achieving the same clinical results. The more efficient I can get with my techniques, the more confidence I have in being able to do the treatment while patients are in the office.

Another tip is hiring hygienists who can numb on their own. This is a huge deal. We often see people as new patients for a hygiene visit. During that visit, if the hygienist sees a cavity or a broken tooth, she can discuss it with the patient, and if they want it fixed, she will numb them at that time. When I come to do their check, they’re already numb in that area and I can sit down and fi x issues on the spot.

Many patients wait to schedule an appointment until they have a problem they think needs to be addressed. They show up in pain or discomfort; sending them home and asking them to come back a different day is a disservice. We are not naive to the fact that people hate the dentist, and don’t want to make them spend more of their time off than is absolutely necessary.

The key to same-day treatment is having every chair set up and ready to go. Most practices have separate chairs for hygiene and operative procedures, but my office was designed so any procedure can be done in any chair. It might take some work, but I suspect your office can be switched up in a similar manner and you’d be better off for it. We don’t shuffle patients around to fi nd the right chair and we’re never waiting for a specific spot to open up. Any chair a patient sits down in is the right chair for whatever needs doing.

Go all-in on tech

When I built my practice, I decided to embrace and implement technology such as Cerec. More than that, I built a dental lab, giving us the ability to cheat a little by using lab techs, though dental assistants can be trained to do it just as well.

Let’s say a patient shows up to a hygiene appointment but also asks the hygienist to look at a broken tooth. The hygienist looks at it and takes an X-ray. I walk by and consult the X-ray and confirm the diagnosis. (Sometimes I’ll look in the mouth, but other times it’s obvious from the X-ray.) My hygienist can numb up the tooth and continue with the appointment.

When I’m free, I will sit down and prep the tooth. My assistant scans and sends the file to the lab to be designed. The lab guys get a text and pull up the scan. They design the crown and start it milling right then. By the time the hygiene visit is finishing up, the crown is usually ready. We optimize the design and milling time by continuing the patient’s scheduled cleaning while we wait on the crown to finish.

Doctors who are not willing to invest in technology are going to have a harder climb when it comes to upping production and kicking cases out faster. I went all-in with my practice and I haven’t had a single regret. That being said, not every positive change in my office came from a high-dollar item. Those carts, for instance, that my hygienists use, and having my operatories identical, were details and changes that certainly didn’t break the bank.

Pump up production

Production increases with efficiency. Patients love when we’re efficient with their time and show them we understand that their schedule matters too.

If we have a new patient who needs a deep cleaning, we generally reschedule that appointment because it takes longer than a prophy and it costs more than a prophy. We like to let patients prepare mentally for the fact that the cleaning they wanted will cost more and take longer than they expected.

However, we do a full exam on the initial visit. That way, if the patient needs any fillings, crowns, etc., we can do them just after the SRP appointment. The patient is getting numbed for the SRP, so we go ahead and do all the work needed in that quadrant when we have them in the chair. That saves them multiple trips to the office as well.

The only limitations in my office are patient finances or the rare case of needing something specific that I don’t have in back stock (such as an implant of a particular size). When it comes to scheduling, there should always be a free chair.

All of this takes planning and thinking ahead. I have one lead assistant responsible for knowing everything going on throughout the week. For example, if someone calls in with a broken crown that we made, we have the lab remake it right away so it’s ready when the patient arrives.

With the right commitment and mindset, most practices can turn what is now a multivisit appointment for a root canal and a crown into an hour-and-a-half procedure. Many practices—especially ones where dentists don’t do their own root canals—may see the patient for a toothache (one visit), send them to an endodontist (second visit), the endodontist has them back for a second appointment (third visit), then the patient goes back to the first dentist for a crown prep (fourth visit), and then, finally, back to that same dentist two weeks later, when the crown comes back from the lab (fifth visit). We see the patient, diagnose the problem, prep and scan the crown, do the root canal while the crown is in the mill, and then seat the crown once the root canal is completed. Total time? About an hour and a half. Not five visits for the patient, not five days the patient has to potentially miss work. This sort of thing is life-changing for most patients, who don’t have freedom or flexibility in their schedules.

I really don’t have a typical, set schedule. I have three hygiene columns going, so lots of work is found each day. I do as much as I can at a patient’s first appointment whenever possible. Some people want to reschedule, but most want things taken care of right away. I do a few crowns every day, maybe half a dozen root canals each week, and one implant case a week. I work fast as long as I have enough dental assistants. I can see a lot of people in a short time.

When it comes to creating a functional, f lowing schedule, I prefer not to book appointments out weeks in advance. Things happen, life happens, and cases scheduled too far out tend to fall through more often than not. About half of my work is scheduled cases, while the other half is same-day cases that I fit into the day—something I attribute to the culture I’ve created in my practice, my clinical speed, and the variety of tools and technologies under my roof. I have noticed that whatever the number of appointments is at the morning huddle, it usually doubles by the end of the day, and those additions are all same-day cases.

Parting thoughts

There are all kinds of opportunities out there if you’re looking to get more efficient in your practice. You don’t have to do everything I did, either. Maybe start with streamlining how patients are treated when they walk in the door by getting all paperwork moved online and completed before they arrive. Have a chair open and ready so the patient can be seated immediately and avoid the stress and anxiety of the waiting room. If you don’t have a patient coordinator who can work on financials with the patient while they’re in the chair, ask yourself what’s stopping you. Likewise, can you train your hygiene team and get them comfortable numbing patients?

Create more uniform operatories or adopt my cart system to keep your clinical team portable and flexible. You might not be ready to pull the trigger on Cerec or CAD/CAM, but there are systems you have in place that can be retuned and recalibrated to increase your efficiencies. I hope you find some methods that not only create a more efficient practice but also give you a fresh or renewed love for this great profession.

Author Bio
Author Dr. Daniel Bird graduated from the University of Tennessee College of Dentistry in 2003. After jumping directly into practice ownership, Dr. Bird honed his skills at a small practice in West Memphis, Arkansas, until selling the practice in June 2014. He worked for one year for the group under contract, then did some consulting, helping transition older practices into a group model, then moved on to create Crosstown Dental Group. The first practice opened in September 2017, and the second location opened in September 2020.
 

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