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6 Steps To Consistently Maximize Your Productivity by Dr. Derek S. Williams

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Categories: Practice Management, HR and Accounting;
6 Steps To Consistently Maximize Your Productivity 

A multistep approach to grow your business by at least 10%

by Dr. Derek S. Williams

For several years, I have worked to find the balance between providing quality care to my patients and increasing the amount of dentistry I can do each day. I know this can be a touchy subject, so I’m going to focus on concepts and steps, rather than sharing specific numbers that I have reached or that you should be reaching for.


 1. Set a goal.

When I purchased my practice, I remember the first production goal that I had in my office with three team members. At the time, it was something that really stretched me, but at this point in my career, if I had a day of hitting that number, it would likely be a painfully slow day. But isn’t that the point? We’re all different—we have different backgrounds, and different ideas of what a dental practice should look like. The exciting part is the growth that comes with time and pushing ourselves.

Most dentists don’t have a goal for their daily production and collections. Without a goal, you’re not aiming at anything and you’re less likely to push yourself.

How do you set a goal? First, don’t get hung up on comparing yourself to others. Start by finding your average daily production and add 10%. If you’re currently averaging $5,000 per day, make your goal $5,500. When you start hitting your goal, increase it by another 10% and do it again! Growing by 10% is achievable by taking the steps I’ll outline in this article.


2. Properly diagnose patients and improve case acceptance.

DIAGNOSIS

Other than getting patients into your chairs, diagnosis will always be the first step toward case acceptance; you can’t perform dentistry on something you haven’t diagnosed. Over the years I’ve worked with, and consistently see, dentists who don’t diagnose what they see when examining patients. It’s understandable—we’ve all heard horror stories from patients who were told they needed $20,000 worth of work and thought that sounded crazy. However, it is our job to diagnose what we see and provide options.

Too many dentists fear patients’ reactions. Thoughts circle around in our heads like:
  • “Will they think it’s too expensive?”
  • “Will they think I’m just trying to sell them treatment they don’t need?”
  • “Will they get upset and leave?”
Although it can be difficult, it is completely possible to be upfront and honest while not coming off as a high-pressure salesman. When discussing treatment with patients, I normally say something like: “It’s totally up to you what you want to do. These are your teeth, not mine. My goal is to show you what I’m seeing, let you know what your options are and help you make the best decision for yourself.”

When you can communicate that you’re their ally and working with them to find the best solution, it relieves the pressure patients can feel and they will more readily communicate with you by sharing their concerns and asking questions.

Here’s another phrase I use: “We can work through this however you want to. We can get it all done at once, or we can create a plan to just work on the most urgent things first.” This helps patients decide if they’re ready for comprehensive work or if they’d like to approach their treatment plan in phases.

Some patients want to complete everything at once! Don’t assume that all patients want to do only a small amount of treatment. Give them the option and let them choose. I had a patient just last week who I assumed, just by looking at her, couldn’t afford much and would opt for a small amount of work. But I went through my routine, gave her the options, and she opted to get started that day and complete all the work that we presented to her! If I had followed my initial instinct, thinking that she could only do a little, I would have presented treatment differently and recommended she start with just a thing or two—and I’m guessing she would have followed my recommendation.

Patients who are overwhelmed when presented with large amounts of work will feel relieved knowing that they can pursue their treatment plans one step at time. This will help them commit and begin treatment.

CASE ACCEPTANCE

Do you have commonly used phrases? Have you written them down? Have you practiced them in the mirror or with a family member or friend? Have you asked for feedback from your staff?

Doing this can be difficult and slightly uncomfortable, but only those who are willing to go out of their comfort zones can reach new levels of success in their practice. So get out of your comfort zone! Write down, word for word, how you present treatment. Write down your responses to common objections. Then practice with friends or family and get their feedback.

INTRAORAL PICTURES

All dentists should be using an intraoral camera; there is no better way to communicate the current situation of a patient’s mouth than with a picture of their tooth or teeth blown up on a big-screen TV.

There are certain aspects in life where we have to trust others to inform us of unseen issues and hope that they can take care of it. For me, it’s my car: I understand the basics, but when my car has an issue, I have to heavily rely on the shop to tell me what the issue is, how much it will cost and what it will take to fix.

Have you ever had an auto shop take pictures of the problem and show you what a normal functioning part would look like? I have, but only once. I still remember it to this day, even though it was more than 10 years ago! It made me feel like I understood what was going on and that I could trust them.

This is what we’re trying to do in dentistry when we show patients pictures of their teeth, warning them of possible scenarios if left untreated. If you explain things to patients without using pictures, your case acceptance will be significantly lower.

I recently talked to a client who just purchased a practice. He told me the previous owner didn’t like using intraoral cameras because he believed it made patients think the dentistry was urgent and they wanted to get things completed quickly. However, this was opposite of how he liked to practice. Does that tell you anything? A dentist not wanting to use an intraoral camera because it made his case acceptance higher than he wanted?

If you’re not using an intraoral camera, order one today and get started. You can get an affordable one for around $150.

CO-DIAGNOSIS

Have you ever been in a discussion with someone who had a different viewpoint than you, then had someone else join in and second that viewpoint? Did that make you more likely to consider what they were saying?

When we hear multiple people saying the same thing, it usually adds credibility and builds our trust. This is what we should be doing in our offices: The team needs to be on the same page as far as what dentistry can do for patients and what we recommend.

Ideally, a hygienist would take the intraoral pictures and discuss possible recommendations, which would help the patient begin considering things before you enter the room. As a dentist, your responsibility is to stay on top of the science and research to know how you can best help your patients, but you can help only the patients who understand the benefits and decide to move forward with treatment. Having your team on board will increase your case acceptance.

How do you accomplish this? Provide your team with summaries of research you’ve found. Talk about it with each other. Roleplay and think of common objections that patients give and how you would respond. Have a training meeting and go through intraoral pictures and ask your team what they see and what options could be offered to improve the patient’s dentition. Again, the more you get your team on the same page and can sing the same tune together, the more your patients will recognize the importance of getting treatment done.


 3. Increase same-day treatment.

MAXIMIZING PRODUCTIVITY

Would you be surprised to find out that more than 30% of my daily production comes from same-day dentistry? I also find this is the case with my highest-producing clients.

Why is this? Well, for one, our schedule is very unpredictable. As predictable as we would like it to be, it’s just not. There are too many variables—some fillings are quick and straightforward, while others require more time. Some extractions are easy; others take longer and make us sweat more.

Opportunities for same-day treatment can be worked in when you have the time. When you don’t have availability, they can be scheduled for another day.

Have you heard the analogy about sand and rocks? It’s about prioritizing: If you put the sand in a jar first, you won’t be able to fit in the rocks. But if you put the rocks in first, the sand will fill in the spaces between them. Think of same-day treatment as the sand. When we have a good schedule and work as hard as possible to make it productive (the rocks), that’s great. But try as we might, we will likely still have bits of time where we could fit things and make it even more productive! This is where the sand, or same-day treatment, comes in.

This takes work. But like I said earlier, if you have no goal, you’re unlikely to be shooting for anything or have a direction. Have a daily goal for how much same-day production you want to add to the schedule. Train your team on how to work patients into the schedule. Work on how you word things when asking patients if they want to stick around to get work done. Make it sound as easy as possible. “You know what? We just had an opening pop up. If you want, we can go ahead and get that done and save you a trip!”

MINIMIZING CANCELLATIONS

There aren’t many things worse in your day than when you’re pushing to reach your goals and see a patient fall off the schedule, leading to a big hole in your day. There are several ways to decrease cancellations, which I’m not going to go into much detail here, but consider this: I’ve never had a same-day treatment patient no-show or cancel, because they’re already in the office!

The more of your production that you can get from same-day treatment, the less you have to depend on people showing up for their appointments. Make an effort to convert some of your appointments that would normally be rescheduled for a later date into same-day treatment. When you do this, your cancellation rate will go down because fewer of your restorative appointments will depend on patients showing up.

IMPLEMENTING A “FLUID SCHEDULE”

Now, I’m going to share something with you that I’ve started doing in my office over the past few years that I haven’t heard anyone else doing. It comes down to developing a more fluid schedule with your team.

Let me explain. If a patient comes in with a toothache, we diagnose and give a treatment plan. I let them know the cost and ask if they’d like to get it done that day. If they do, I let them know that we already have a full schedule but we will make it a priority to complete their treatment that day. I also let them know that I’ll get them numb. While we’re letting the anesthesia begin to work, the assistant will set up for the procedure and help the patient check out and pay. When they’re finished, they can walk right out the door.

I am rarely going to reschedule someone if they are ready to pay and get the work done that day. So the question becomes: How can we work this patient into our schedule? If the schedule is light enough that we can simply work it in, then great. If the schedule is already pretty full, I’m going to look at ways that we can rearrange things to make it work. If there is more space later in the day, the front desk will call the next patient and see if they can come a little later. If other patients are coming for small amounts of treatment like a filling or adjustment, the front desk will call and let them know that we had to work in an emergency patient, are running behind quite a bit, and that the best thing would be to reschedule for another time.

Most patients are very understanding. Almost all of them have been in a doctor’s office where they’ve waited for long periods, so they appreciate getting a heads-up before they make their way to the office. If they still want to keep the appointment, we will let them know that we will do our best, but there will likely be a longer wait time.

Try these different ideas out and see what works best in your office—I guarantee that your daily production will increase if you make a big push for same-day production.


 4. Train your team.

In Eliyahu Goldratt’s book The Goal, he explains how in every business, every process has one step that is the slowest. This step is the “rate-limiting step.” In our practices, ideally, the rate-limiting step should be the dentist, which would mean the dentist is being used as efficiently as possible. For example, if a dentist had to work out of only one operatory, she couldn’t jump straight from one patient to another, because she has to wait for the room to be turned over and set up for the next procedure. In that case, the single operatory would be the rate-limiting step.

The same thing happens all the time in a different way. Dentists often perform treatment that could easily be done by other team members. We have dental assistants and hygienists so they can perform tasks that will allow us to do more productive things. We could take impressions and X-rays, make temporary crowns and turn over rooms ourselves, but that would be a poor use of our time.

Use your employees as much as possible. Most dentists don’t take advantage of the opportunities that are right in front of them; the two most common objections are that they’re afraid to allow their team members to do more and that they don’t have the time to train them.

If you’re concerned about your team members’ abilities to perform tasks to a specific competency level, think back to where you started. What did your first crown prep look like? Your first surgical extraction? Obviously, your team members won’t be doing those procedures, but I bring those up to show that we all have to start somewhere. It won’t be perfect in the beginning, but we can all learn, improve and grow. And if you have a team member who is given the opportunity and can’t take on more, it is possible that they aren’t the right team member.

Some will say that there’s not enough time to train your staff. I would say it’s the opposite. If there’s not enough time, this means we need to focus on things that are going to free up your time! Every minute that you spend training your staff on clinical skills will pay back dividends over and over in the future. By allowing them to take on more responsibility, you have more time to do more procedures.

I am in Texas, a state where we have no expanded-function assistants and hygienists are still not allowed to administer anesthesia. I can only imagine the increase in productivity if we could do some of the things that are available in other states! Maximize as much as possible. Learn the limitations in your state and spend time with your team, training them to be the best that they can be.


 5. Raise your fees.

When you read “raise your fees,” I know many of you thought, “Well, duh.” But very few dentists know where their fees lie as far as percentile. Many don’t remember the last time they raised their fees. Go to FairHealth’s website, click “Dental” and look up a few of your most common procedure codes. The search engine will tell you what the 80th percentile is. In general, shoot to be in the 80th percentile or higher across the board as far as your UCR fees go.

INSURANCE

There are entire books written about insurance participation, reimbursements, claims, etc. There is no one right way to do things. You can be a poor dentist who is fee-for-service, a rich dentist who accepts every insurance under the sun or vice-versa. Don’t get hung up on trying to do what other dentists are doing or what you think you should do based on what you’ve been told. Weigh out all your options, make a decision and move forward.

If you are in-network with insurances, find an exceptional company to negotiate or renegotiate your fees for you. You should almost never accept the first fee schedule they send you.

A great insurance negotiating company is going to get substantial results that are better than you could get on your own. Ask around and find the best one for you and start the process. Once this is done and you get an increase in fees, you pocket the money from that increase and your overhead stays the same. So if your fees get bumped up 5% on a practice that does $1 million per year, that’s an extra $50,000 for you that you had to do no extra work for.


 6. Hire expert help.

One of the biggest factors that separate those who lead an industry instead of just keeping up is a willingness to hire experts to help you get ahead. When you look at the top athletes in any sport, you’ll find dedicated trainers and coaches. Those top athletes prioritize getting the best help and support out there. It’s no different in business and in dentistry. The highest-performing dentists I know all use coaches, consultants and experts to help them get to where they want to be. They know that they’ll get there faster than if they were to try and figure it out on their own.


Conclusion

Many dentists look at their schedules and production and get frustrated because they’re not what they want them to look like. This is understandable. But where dentists fall short is in thinking they have very little control.

In reality, the opposite is true. By implementing the steps above, you’ll find that the more involved you are in the process, the more you’ll consistently see growth in your productivity.
Author Bio
Dr. Derek Williams Dr. Derek S. Williams graduated from Creighton University College of Dentistry. He maintains a private, solo doctor practice in East Texas. Williams is co-owner of The Lifestyle Practice, where he works with other dentists to take their practices to the next level, increasing production while taking more time off. Email: derek@thelifestylepractice.com

 

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