Ep. 117: Do You Need a Treatment Coordinator?
When does it make sense to hire a Treatment Coordinator? And if you already have one, how should you best utilize them? And should you considering adding another? This week, Jeff answers those questions and discusses what you can do to increase patient volume to the point where adding a Treatment Coordinator is worth the investment.
Links:
Treatment Coordinator Training Course - https://ddssuccess.com/p/treatment-coordinator-training-course
Overview of the Treatment Coordinator job - https://www.youtube.com/watch?v=QYot0vTsSyc
Free Consultation - https://www.mgeonline.com/free-practice-analysis
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Questions From This Episode
What's the actual statistic a treatment coordinator should be measured against, and why?
Income, since a treatment coordinator is really the sales department of the practice, responsible for getting patients to actually accept and start the treatment plans a doctor diagnoses. Every position in a dental practice has a specific measurable outcome, a schedule coordinator by production, an associate by their own clinical production, and a treatment coordinator specifically by the income that results from closed cases.
Beyond sitting in on treatment presentations, what other core part of the job does a treatment coordinator handle?
Outgoing follow-up, working the incomplete treatment list to get patients with previously diagnosed treatment back onto the schedule, whether that means an overdue recall patient, someone who needed to consult a spouse, or a patient the doctor simply wants to check on to confirm things are staying stable. That outreach is just as essential to the role as the in-office financial and treatment discussions.
What's the actual signal that an office manager has outgrown handling treatment coordination themselves?
Once an office manager is spending three to four hours a day, roughly half their day, sitting with patients on financial and treatment discussions, they're no longer actually managing the practice, since they can't respond to what's happening around them while they're locked into that conversation. At that point, especially with two hygienists and two to three new patients a day, it's time to bring in a dedicated treatment coordinator.
In the episode's worked example, why does a practice bringing in 40 new patients a month for five years likely need three full-time hygienists and possibly an associate?
Assuming a typical 20 percent attrition rate, 40 new patients a month over five years works out to roughly 1,920 retained patients, and factoring in two recalls a year per patient, plus soft tissue management and new patient exams, that adds up to nearly 12 days of hygiene a week, three full-time hygienists on a four day schedule. If a practice with that same new patient volume doesn't actually need that much hygiene capacity, that's a clear sign of a retention problem, not evidence the math is wrong.
Why can a hygiene schedule look genuinely full while still hiding almost no real treatment presentation opportunity?
Without active reactivation efforts, the only patients who reliably keep themselves on the schedule are the naturally compliant top tier of the patient base, people who rarely need much treatment because they never let anything go untreated in the first place. The majority of any patient base sits somewhere in the middle and has to be proactively chased back in, and until that outreach happens, a hygiene schedule that looks full can still be almost entirely made up of patients with no outstanding treatment to present.
Episode Transcript
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Do you have a treatment coordinator in your dental practice? If not, do you think you might need one? And if you do have one, is it possible you might actually need more than one, with a proper division of labor? In a dental practice, every position has a specific, measurable outcome.
Take a schedule coordinator, for instance. What you want from that role is a full, properly scheduled, efficient, productive schedule, and you'd measure their performance by production. If you have an associate doctor, you'd expect well done, high quality clinical treatment, and you'd measure that by their own individual production.
So what would you expect from a treatment coordinator? In essence, your treatment coordinator is the sales department of your business. You'd expect patients who've accepted treatment plans and actually started them, and ultimately you'd measure a treatment coordinator's performance by income. Since income is so vital to any business, it's critical that someone genuinely owns that job.
In a smaller practice, that job might fall to the office manager on top of their existing duties, but at some point, as the practice grows, you're going to need a dedicated, full-time treatment coordinator. And believe it or not, with continued growth, you may eventually need more than one, I've seen practices with four.
So at what point would you actually know it's time to make that call? That's what I want to talk about in this week's episode. My name is Jeff Blumberg, and I'm your host.
I think the primary confusion around the whole subject of treatment coordinators comes from how new the role actually is in the industry. I remember the first time I heard the term treatment coordinator, probably back in the early to mid nineties, and at the time, the only practices I saw with one were orthodontic practices. As time went on, that position started migrating into general dental practices too. So this is really only a role you've seen widely in general dentistry for maybe the last 15 or 20 years.
The other issue is that the treatment coordinator job description varies enormously from office to office, it isn't standardized. If you tell me someone's a dental assistant, I have a pretty good idea what that means. Same with a dental hygienist. But in some practices the treatment coordinator also runs the schedule, in others they only work with new patients, and in others they're purely the salesperson I'm describing here. It genuinely varies by practice. So when we're talking about whether you need a treatment coordinator, the definition you have in mind might be completely different from mine, I could look at your practice and say you absolutely need one, and you might have no idea what I'm even referring to.
To give you an idea, we covered the treatment coordinator position specifically back in episode five, what they're actually supposed to do. We've also made several YouTube videos on it, I'll put links on the episode webpage, and on our online platform, DDS Success, we have a full treatment coordinator course, worth having anyone in your practice filling that role watch.
But in a nutshell, from our perspective, the treatment coordinator is the sales department. They're responsible for practice income, that's their statistic. Their job is getting patients to accept and start treatment that will actually make them healthy, restoring health, function, and aesthetics.
A lot of people boil that down to simply sitting with the doctor when a treatment plan gets presented. I've done numerous episodes on sales, and ideally the doctor is genuinely participating in that process, they absolutely should be. But generally, the doctor isn't going to sit down and run a finance company application or process a credit card themselves. That's exactly what a treatment coordinator is for, making sure the patient ends up on the schedule, especially once the financial discussion happens.
If you're only looking at it from that angle, sitting with patients, telling them what they need, getting them to sign up and scheduled, that gives you a fairly limited view of the position. There are also outgoing actions that go along with the job. Following up with patients who didn't accept treatment, maybe they needed to talk to a spouse, or were in the middle of refinancing their house and couldn't commit right then. We're following up with those people too.
Every practice also has an incomplete treatment list, and most offices genuinely don't know what to do with it. Some look at it and feel a strange sense of comfort, there's all this treatment sitting there we could still do. Others look at it with real dread, wondering why so many patients haven't accepted treatment. But there's something you're actually supposed to be doing with that list. Ideally, your treatment coordinator is following up with these patients and, depending on their specific circumstances, getting them scheduled. That's what they're doing when they're not sitting with you presenting a treatment plan directly.
Say I'm your treatment coordinator and you hand me that incomplete treatment list. You'll have patients from every time period represented on it. Some are overdue for their cleanings entirely, we'll have a whole batch of those. If I'm the treatment coordinator, I'm most likely just following up and getting them back onto the recall schedule. Maybe it's been four years and they need a new initial exam, or maybe I'm just getting them in for a regular hygiene visit. I'm bringing these people back in because once they're actually seen again, the whole process starts over and we can represent that treatment plan, and chances are, if they haven't been in for a while, that treatment plan has only gotten bigger.
Or say we have patients who aren't due for recall, but the doctor and I presented a treatment plan four months ago and the patient didn't accept at the time. I want to get them back in, since I have a much better shot at closing that case in person than trying to do it over the phone. I might have them come back in, telling them the doctor wants to check that everything's staying stable. Either way, these outgoing actions are a genuine, integral part of the job, especially if you have a large incomplete treatment list. I should be actively following up to get these people back in, because that's ultimately why the practice exists in the first place, to get patients healthy. These patients aren't healthy yet. So that piece of the job is just as critical as the face-to-face treatment presentation. A treatment coordinator needs real time for both.
Here's normally how this plays out in a dental practice: usually the office manager ends up becoming the first treatment coordinator, once they've divested themselves of other front desk duties, scheduling patients, answering the phone, and so on, they start picking up treatment coordinator functions instead. The real signal that it's time to bring in someone dedicated to that role is when your office manager is spending three to four hours a day, roughly half their day, in treatment or financial discussions with patients.
While they're doing that, they're sitting in a room at a desk, they're not seeing what's happening around the rest of the practice, they don't know a big cancellation just happened tomorrow, and they can't do anything about it, since all their attention is on the patient in front of them. At that point, they're genuinely no longer managing. If that's happening for several hours a day, and we haven't even mentioned the outgoing calls a treatment coordinator is also supposed to be making, it's probably time to bring someone in.
Say you have two hygienists and you're getting two to three new patients a day, that's five to six treatment discussion encounters happening daily, with no time left for phone outreach, you probably need to bring someone on.
So how would you actually find someone for this role? Ideally, you promote from within. There's nothing better than promoting someone who already knows your practice culture, already gets along with the team, and already knows how things are done. A dental assistant, for instance, can make a genuinely great treatment coordinator, provided they're a good communicator, since they're already familiar with dentistry, the terminology, what different procedures actually mean, and they've watched the doctor deliver those procedures, so they already have confidence in the doctor's clinical skill.
From there, you'd get them properly trained, that's exactly why we built training courses like the one on DDS Success, I'll put the link on the episode webpage, and then apprentice them. They might sit in with you while you're handling treatment presentations as the office manager, and you'd start handing them the easier pieces, we're going to run a financing application now for a smaller treatment plan, and once they can do that comfortably, you keep feeding them more, until eventually they're closing the larger treatment plans too.
One thing worth saying here, as the office manager, closing a larger treatment plan has such an immediate, visible impact on the practice, there's a real bit of excitement or credit that comes with it. It's genuinely exciting. But remember, your job as manager is to manage. Ideally the practice grows enough that management becomes your full-time job, with dedicated people handling each individual role. Don't get stuck personally doing an individual job just because you enjoy it, your actual job is getting other people doing those jobs well.
So that's roughly when you'd bring someone on. Ideally you hire internally, if that's not possible, you go outside the practice. And on your busiest days, you might still need to step in as a backup treatment coordinator yourself if the primary one is genuinely locked down finishing up with a patient.
So when might you need to add a second treatment coordinator? It really comes down to traffic, the actual volume that person is having to handle. I can give you a rough thumbnail assessment, though I wouldn't treat it as an absolute law, but I'd say five or six patient encounters a day is about right for a single treatment coordinator, assuming they still have time to make outgoing calls. If they're not getting to those calls, that part of the job simply isn't happening.
It really comes down to traffic though. Say a practice just launched a large marketing campaign and jumped from 40 new patients a month to 100. On a 16 day working month, that's six-plus new patients a day, which is probably a full-time treatment coordinator just to handle new patients alone, possibly more than one, especially once you factor in the additional hygiene volume that naturally comes with that many new patients.
Or you might have a specialized marketing situation, say an implant funnel, where most leads today come in as form submissions rather than phone calls, meaning someone actually has to follow up on them. If you're generating a lot of leads daily and spending real money to get them, you don't want just anyone handling that follow-up, especially since those leads, if they pan out, can turn into genuinely large cases, all-on-X treatment plans and similar. You'd want someone genuinely sharp making those calls, and depending on volume, that might mean two people working it.
What about your hygiene department specifically? If you have a lot of hygienists, you may need someone dedicated just to keeping up with that volume. But traffic in a dental practice usually has as much to do with the patients you're not seeing as the ones you are.
If we look at the average dental practice across the US and Canada, generally speaking, the two biggest problems tend to be case acceptance and retention. Those are consistently the largest issues, and part of why they're problems is that it's one thing to have a problem and know it, it's another thing entirely to have a problem and have no idea it exists. Say you believe you're genuinely good at case acceptance and treatment presentation, but you actually aren't, that's worse than simply knowing you need improvement in that area. Maybe you tell yourself all your patients do whatever you recommend, when really they're only accepting whatever insurance happens to cover. You're not actually good at sales in that scenario, you have real treatment plans slipping away, and beyond the financial impact, these are patients not getting the full treatment you diagnosed, which makes your own career less fulfilling and your patients less healthy.
Similarly, you might believe you don't have a retention problem, when in reality most practices do. This is a genuine, ongoing issue across the dental industry. Let's walk through an example. Picture a practice that's been seeing 40 new patients a month for the last five years, which happens to be roughly the US average, generally cited as 30 to 40 a month. My first question would be, how many of those patients do you think you're actually losing, the ones who simply never come back? The average answer I get is somewhere between 10 and 20 percent.
Let's use 20 percent for this example. At 40 new patients a month, that's 480 a year, or 2,400 over a five year period. If you lose 20 percent of those, you're left with 1,920 patients out of that 2,400, and this doesn't even count patients you'd already had before that five year window. Multiply that 1,920 by two for the minimum number of recall visits those patients will need annually, and you get 3,840 recall appointments a year. If you work 50 weeks a year, taking two weeks off, that's 76.8, call it 77, recall appointments a week, which works out to 9.6 days of hygiene a week just to cover recall alone.
Say it's a four day a week practice, you'd need more than two full-time hygienists just to cover recall. Now add scaling and root planing, soft tissue management appointments, say two a day on the hygiene schedule, and you're up to 10.6 days of hygiene. Add new patients being seen through hygiene too, and you're close to 12 days of hygiene a week total. On a four day week, that's three full-time hygienists needed for this practice alone. If you're a solo practitioner at that point, you likely can't keep up with three hygienists on your own, so you'd probably need an associate too, and this is all based on just 40 new patients a month.
So if that's you, and 30 to 40 is the national average, if you don't currently have three full-time hygienists and likely an associate to support that volume, what that tells you is you have a retention problem. Now say you did have three full-time hygienists and maybe a part-time associate, since you've genuinely gotten that busy, how many treatment coordinators would that actually require? You'd have one treatment coordinator trying to keep up with three hygienists and two to three new patients a day, things would start to strain there, and your office manager would likely find themselves backing up that treatment coordinator regularly, purely from the sheer volume.
Add even two or three more new patients a day on top of that, and you'd absolutely need a second treatment coordinator, most likely with one working recall and outstanding treatment specifically, and the other working new patients exclusively. Say you had three full-time hygienists and five new patients a day, you'd probably want one treatment coordinator dedicated purely to new patients and another handling everything coming out of recall, since between recall patients and three full-time hygienists, you're looking at five or six encounters a day with patients who have outstanding treatment.
A lot of it depends on volume and how things actually flow in your specific practice. But here's the bigger issue in a scenario like this: what you're not seeing. A lot of practices bringing in 40 new patients a month have only two hygienists and one doctor, and they're lucky to keep those two hygiene schedules full. So if you're evaluating whether you need more treatment coordinator time, you have to look honestly at both the traffic you are seeing and the traffic you're not seeing.
There's something else worth understanding here too. Every practice ends up with, for lack of a better way to put it, a top tier of patients and a broader middle group. I don't love rating patients this way, since what counts as a good patient is somewhat subjective, someone might be perfectly nice and simply not especially compliant. But let's define a good patient here as someone dentally aware, who wants to take care of their problems and doesn't tend to delay. That's your top tier, and it's never going to represent the majority of your patient base, no matter how much you might wish it did.
There are also patients you genuinely don't want in your practice, the ones who cause real problems and wear down your staff, but that's also a small minority. The vast majority of people fall somewhere in the middle, they're just normal people. The real issue with most hygiene schedules is that the top tier tends to dominate them by default. Picture a genuinely dentally aware patient, health conscious, comes in as a new patient, does everything recommended without delay, and ends up with a checkup appointment every three months that they never miss, aside from the occasional family emergency or being out of town. You don't have to chase that person onto the schedule, they chase you if they don't have an appointment booked. That's your top tier.
If there's no active follow-up in the practice to catch the majority of your patient base, the people who aren't in that top tier, they're simply not the ones calling you. These are the patients who need to be proactively followed up with, and they make up more than half of any patient base. So if your whole office has no real retention effort, the only patients reliably showing up on your hygiene schedule are going to be that top tier.
Here's the actual problem that creates. Going back to that same scenario, 40 new patients a month, 480 a year, 2,400 over five years, only a small percentage of those are genuinely top tier, reliable patients. That might fill two or three days of hygiene, maybe just one full-time hygienist a week. So when you go into that hygiene schedule looking for treatment to present, the majority of those patients are top tier, they don't need any treatment, they already did everything you told them to the first time. Maybe someone wants Invisalign now, but for the most part, you end up focusing entirely on new patients instead, since those are the ones who actually need something. Meanwhile, the bulk of your hygiene schedule, if it isn't where it genuinely should be, consists of patients who are already fully compliant with no outstanding work.
So someone needs to be actively going out and reengaging the majority of your patient base, the ones who need a bit of a reminder, for lack of a better word, need to be chased a little to get them back in. How much effort does that actually take? Say you have 4,000 inactive charts, not an unusual number at all, some practices have far more, I spoke with a doctor recently with 8,000 inactive charts, and another a few months back with 20,000, and these weren't patients from twenty years ago, these were patients seen within the last five to ten years.
If you had 4,000 inactive charts and genuinely wanted to reactivate them, how would you actually do it? Because beyond excellent dentistry and a great patient experience, what fuels real growth, and what eventually drives the need for more treatment coordinators, hygienists, or associates, is more patients actually on the hygiene schedule, both retaining who you have and bringing in new ones.
Say you wanted to contact those 4,000 inactive patients once a month, frequent enough to show you mean it, without becoming a nuisance. Working 16 days a month, that's 250 outgoing calls a day. Now, this isn't a telemarketing operation running 100 to 150 dials a day purely for volume, this is a healthcare office, so say you're realistically doing 75 calls a day, and you'd hope you're actually reaching and speaking with a real share of these people, not simply dialing at random. At 250 calls needed per day, you'd likely need two or three people working the phones full time just to genuinely reactivate that list.
You have to actually think in these real numbers, because the longer inactive patients sit untouched, the greater the chance you never see them again. This is exactly why I'd recommend sending a practice newsletter at least once a quarter to your entire mailing list, including patients from plans you've since dropped. Say you were heavily in a batch of HMOs, decided you were done with them, and lost a number of those patients as a result, they should still be receiving your newsletter.
You might wonder why bother, since you're obviously not calling them for recall specifically. But in a lot of cases, these patients may genuinely dislike wherever their HMO plan sent them, they loved your office, and they might come back and simply pay cash instead. At minimum, they're still someone you had a real relationship with, worth continuing to communicate with. Yes, it costs something to mail that newsletter, but they may also know someone who'd genuinely love your practice and refer them your way, even if they themselves feel locked into that HMO practice for now. You want to maintain enough communication that these people genuinely have a real shot at coming back.
So that's the real scale involved if you want to seriously tackle an inactive patient list, potentially 250 calls a day. I know that might sound completely unmanageable, but it's considerably better than making calls only occasionally, whenever things happen to be slow. Start with one person if that's all you can manage, understanding that one person alone likely can't keep up with the full volume. Do this math for your own practice, how many inactive patients do you actually have, how many calls per month would that require, and how many people would you genuinely need to cover it.
There are other tools worth using too, texting, letters, email. You should absolutely be using recall or reactivation software that supports this. The issue is that these channels alone tend to capture only the low-hanging fruit, the patients who are already easy to schedule. Ideally, if I get a text from your practice while inactive, it includes a link, and a lot of software now integrates directly with Eaglesoft, Dentrix, or Open Dental, letting me click through, pick a hygienist, and choose an available slot myself. You'll get some appointments that way, and you absolutely should be using it, but if you expect that alone to handle your entire reactivation effort, that's not realistic. Use texting and email as a genuine assist to a real, driven human effort, not as a replacement for it.
If you don't do this work, your hygiene schedule ends up full of patients who need no treatment, and you become entirely dependent on new patients instead.
So bringing this back to treatment coordinators specifically, since that's really what this episode is about: yes, you'll need more of them based purely on volume, and I'd say five or six encounters a day, allowing enough time for genuine phone outreach, is a reasonable amount of traffic for one treatment coordinator to handle well. Some days will run busier, of course, but if you want them fulfilling everything the role is actually supposed to cover, including helping drive that reactivation effort I just described, especially getting patients with incomplete treatment back in, that's roughly the right volume for one person.
What ultimately drives your need for more treatment coordinators, or more doctors for that matter, is the amount of genuine expansion happening in your practice, and that expansion runs through hygiene, retention, and new patients. So what I'd recommend is taking an honest look at where you currently stand. How many patient encounters is your treatment coordinator actually handling? How much real outreach are they doing on a given day? If they're calling four to six patients a day and you're sitting on 800 patients on your incomplete treatment list, that isn't going to be enough.
I'd also look honestly at whether your office manager is currently functioning as your treatment coordinator, and how much of their time that's genuinely consuming, since you may need to bring someone in to take that over before the management side of the practice starts to suffer. And I'd look at whether you've recently seen a spike in new patients or launched a new type of marketing campaign, and whether your staffing has actually kept pace with that.
Personally, I don't mind spending money, and I don't mind putting in real effort, but I genuinely hate waste, and you see it constantly, I know that's a generalization, but it's true. If you're going to go out and market for a wave of new patients, I want to make sure every one of them is being taken care of at the same level you were providing before you scaled up. That means making sure you actually have the personnel in place to deliver on that.
This was a bit of a unique topic to cover, but I hope it genuinely helps. I've got the links to the YouTube videos on treatment coordinators I mentioned earlier, along with the DDS Success treatment coordinator course, on the episode webpage. If you have any questions, you can always email me directly at jeffb@mgeonline.com, or come visit us online at mgeonline.com, or call us at (800) 640-1140. Folks, have a great week, and we'll see you at the next episode.