Ep. 121: How Far Out Should the Doctor’s Schedule be Booked?
Being solidly booked out weeks (or even months) into the future can give you a feeling of security…but it can also severely limit your schedule flexibility and growth potential. So, what’s the right balance? When are you booked out too far—or not far enough? That’s the topic that Jeff tackles in this week’s episode!
Links:
Live scheduling seminar - https://mgeonline.com/scheduling-livestream
Online scheduling course - https://ddssuccess.com/p/art-of-scheduling-productively
Case acceptance seminars - https://mgeonline.com/mge-communication-and-sales-seminars
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Questions From This Episode
What's the actual benchmark for how far out a productive procedure should be reachable on the doctor's schedule?
Regardless of how busy or productive a practice already is, a patient should always be able to get on the schedule for a productive procedure within one to three days. Being booked further out than that isn't a sign of success, it's usually a sign of an underlying problem worth investigating.
What are the three most common reasons a doctor's schedule ends up booked out too far?
No real scheduling pattern, primary procedures scattered randomly instead of concentrated in a consistent block, improper double booking, often mistakenly attempted with only one assistant instead of one assistant per chair, and a weak case acceptance or sales process, where treatment gets spread across multiple smaller visits instead of being closed and completed in one appointment.
Why does spreading a large treatment plan across multiple visits actually hurt schedule efficiency, even though it can look like more activity?
Each additional visit means bringing the patient back in, seating and numbing them again, and discharging them again, multiplying the number of encounters for the same total treatment instead of closing and completing it in a single, longer appointment. It makes the practice look busier without actually being more productive.
Before deciding a practice genuinely needs an associate, what two things should be checked first?
PPO participation, since a heavily insurance dependent schedule may just need its plan involvement reduced before adding another provider, and actual new patient and hygiene volume, since a schedule that looks maxed out may really be a symptom of new patients being turned away due to long wait times rather than genuine lack of capacity.
What's the ideal ratio of hygiene days to doctor days, and why does exceeding it become counterproductive?
Roughly one to one and a half hygiene days per full-time doctor day. Go much higher than that, two hygienists to one doctor, for example, and the doctor ends up spending more time on hygiene checks and new patient exams than on actual dentistry, while a hygiene department that's too small relative to doctor volume means new patients are being brought in and immediately lost out the back door instead of retained.
Episode Transcript
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Let me give you a scenario. You, the doctor, have a schedule so busy that you're booked out two to three weeks in advance. If a patient called today for an appointment, your first available slot would be two Wednesdays from now at 10:40 in the morning, nineteen days out to be exact. This has you feeling pretty content. You feel secure knowing you have plenty of future production locked in, and after all, the further out the doctor's schedule is booked, the better, right?
That really depends on who you ask. If you ask me, I'd say not really, and I'll take it a step further. Regardless of how productive you are, you should always be able to see a productive procedure on your schedule within one to three days. If you're not especially busy right now, that statement might not seem like much of a challenge. But if you're busy and booked out a week, ten days, or two weeks or more, you may be wondering how you're supposed to see somebody that quickly, or whether it's even that important.
That's what I want to cover in this week's episode: specifically, how far out is too far when it comes to your doctor's schedule, and more importantly, why you may be booked out too far in the first place, along with some ideas about what to actually do about it. My name is Jeff Blumberg, and I'm your host.
Before I get into why your schedule may be booked out too far, I want to cover three quick points. First, being busy and being productive are not the same thing. I've seen plenty of busy schedules that aren't productive, and plenty of productive schedules that aren't especially busy. Ideally you want both to be true at once, busy and productive.
Second, I'm mainly focusing on the doctor's schedule in this episode, not the hygiene schedule, which I think deserves its own dedicated episode, and you'll likely see one from me in the coming weeks. I may touch on hygiene briefly here, especially when it comes to new patients being seen through hygiene, but that's not the main focus today.
Third, I'll be going over a number of ideas here, but you're operating your own practice your own way, and as with anything you learn or study, you have to apply what's genuinely real and useful to your specific situation. I firmly believe everyone is responsible for their own circumstances, so take what's useful here and use it, but understand you're applying it on your own judgment, not simply because you heard it on a podcast.
With those three things out of the way, I think the best place to start is why it's important to actually have availability on your schedule in the first place. The first reason: if you don't have availability, you have no real room for growth, you stay essentially static. I've seen doctors fall into a mindset where they know they need to become more productive, but they're already very busy and aren't sure what to do about it, so they start taking on larger, more involved procedures purely to raise the dollar value of an already packed schedule. That can work to a degree, but it isn't sustainable long term. It's a bit like being maxed out at $80,000 a month, so you shift toward more involved procedures and become maxed out at $100,000 instead. That doesn't create room for continuous growth. Whereas if your schedule genuinely has room and you're managing it the right way, you have real capacity to keep growing.
The second reason has to do with quick service. It's become something of an oversight today, but between Amazon and food delivery apps, people expect things quickly across nearly every part of life. I don't think a dental patient necessarily expects treatment the way they expect a same-day delivery, those aren't really comparable. But I do think the ability to deliver quickly matters. The faster you can deliver, the better, that's always been my view. If a patient expects to wait three weeks and you can get them in within a week instead, that sets a genuinely good precedent. Fast service is always a positive.
The third reason is that making people wait can actually become counterproductive. Say you're talking with a patient about needing four or five crowns, and they agree to move forward. If your financial arrangements aren't great, meaning the patient isn't putting any money down or prepaying, they simply go on the schedule two weeks out because that's your earliest opening. That gives them two full weeks to think it over, and for life to happen in the meantime. The following week something comes up, they redirect those funds elsewhere, and they call to cancel. The longer you make someone wait, the more prone you are to cancellations and potential no-shows.
The same issue shows up even with prepayment. Say a patient needed four crowns at $1,200 each, and you offered a 5 percent prepayment discount, so they paid $4,800 up front and saved a bit of money. If you can't actually get them on the schedule for a week and a half or two weeks, they go home, mention it to their spouse, who wasn't thrilled about that much money going out, and something else comes up in their life. A week later they're calling for a refund. It also sets a poor precedent from a business standpoint: if I'm asking someone to pay right now, and they do, it's a little anticlimactic to then tell them I'll see them in two weeks. I demanded immediate payment, so the patient would reasonably expect close to immediate service in return. If you pay today, I'll see you tomorrow, that's far better, or the day after tomorrow, that's still considerably better than two weeks out.
There's another issue too: if it's genuinely taking a while for patients to get onto your schedule, that delay can end up covering up other real problems in the practice. You might have issues with your case presentation and treatment acceptance process that are being masked simply because the schedule looks full. You might actually need an associate and not realize it, because things are booked out far enough that the underlying strain isn't obvious. Being that tightly booked also makes it harder to find real time to present treatment effectively. And if you're booked two or three weeks out and something goes wrong, an unexpected wave of cancellations, the schedule suddenly empties out and it takes noticeably longer to recover, since everyone's grown used to operating a certain way and has to reset.
So if you are booked out too far, what's actually going on, and what would I be looking at if I were sitting down with an MGE client whose schedule was backed up ten days or two weeks? Here's where I'd start.
First, I'd look at their scheduling pattern. Is there any real rhyme or reason to how the schedule fills, or is it just whoever grabs the next open slot? If one day brings in $1,000 in production, another brings in $400, and another brings in $8,000, with no consistent pattern behind any of it, that's a real problem. The moment you establish an actual pattern, you start seeing consistent production, and you start noticing exactly where problems are showing up.
The generally accepted, and in my view preferred, way to schedule a practice is doing your larger procedures in the morning, what we'd call primary procedures, crowns, veneers, implants, and so on. There are good reasons for this: you've hit your production quota by lunch, and you're not sitting at three in the afternoon wondering where the rest of your day's production is going to come from. Those procedures also tend to be more involved, often surgical in nature, and things naturally get busier as the day goes on. I wouldn't actually say this to patients, but I've heard some practices use it as a scheduling line, telling a patient the doctor wants to see them for this procedure in the morning because that's when they're freshest. I'd avoid that specific phrasing, since inevitably one of those same patients ends up being seen in the evening at some point and starts wondering whether the doctor is fresh enough then. But structurally, getting your primary work done early and coasting through the rest of the day is simply the better approach. Without that kind of structure, and if people are just filling whatever opening happens to be available, you can walk in and find yourself back to back to back across three operatories while producing almost nothing.
So pattern is the first thing I look at. The second is whether they're attempting to double book with only one assistant, which is really a contradiction in terms, that's physically impossible. Proper double booking requires an assistant in each chair running each room. We cover this in depth in our Scheduling for Production seminar, one of our free introductory online events, and in the Art of Scheduling Productively course on our online platform, DDS Success, I'll link both on the episode webpage. I also covered this back in episodes 49 and 50 a while back.
Here's the basic idea: if you took five or six hours of procedures and booked them linearly, one after another, that's five or six hours of chair time. But if you properly double book those same procedures, with a clear division of doctor time versus assistant time, you can often complete that same volume of work in three to three and a half hours. That frees up real time. Without that structure, you'll look very busy while actually operating far less efficiently than you could be.
So those are the first two things I look at: is there a real pattern, and is double booking being done properly. Now say both of those check out, there's a solid pattern and proper double booking in place. The next thing I'd look at is what kind of procedures they're actually doing, and what their sales process looks like.
Generally speaking, practices with stronger acceptance of full treatment plans are naturally more productive, that's fairly intuitive, but their schedules also end up more efficient. If I come into your practice needing six crowns, and you're able to close me on all six at once, whether I do them all this year or all right now, you're only seeing me once for that entire case. You've only numbed me up once. I'm not coming back for two this year, two next year, and two the year after, three completely separate appointments where I have to be brought in, seated, numbed, and discharged each time. Bringing me in once to do all six is simply more efficient than doing two at a time, and I don't think that defies anyone's intuition.
So acceptance rate plays directly into schedule efficiency, and it can show up in a couple different ways. Sometimes a doctor is simply a bit hesitant, especially with a brand new patient who needs a lot of treatment, not wanting to drop a $10,000 or $12,000 treatment plan on someone they just met. So they start with the periodontal component, taking time to explain why the patient needs soft tissue management for, say, $900 to $1,200, and the patient agrees. Then, during that same visit, say the patient also needs a few crowns and an implant, the doctor holds back again, starting only with the teeth showing active disease, presenting just those crowns, and the patient agrees to one or two of them. Then, while doing those crowns, the doctor mentions the implant they should really also get. What could have been a single 20 or 30 minute sales conversation covering everything gets stretched out past an hour, across multiple separate encounters. That's not necessarily a bad thing in every sense, but it's genuinely inefficient, and it makes the practice look busier than it actually is.
So it can show up as a doctor being a little hesitant to tell a patient everything they need up front, something I've discussed in prior episodes, where I'd simply recommend telling people what they actually need. That's what I'd want if I were the patient, and I imagine that's what you'd want too. Some people are genuinely going to be upset no matter how kindly you deliver that information, and honestly, some people can be upset about almost anything. I wouldn't build my entire approach around avoiding that possibility. If a patient needs X, Y, and Z, I'm going to tell them they need X, Y, and Z, not unkindly, but clearly, and I'll be glad to answer their questions, because I genuinely want them to get the care they need. If someone's put off by that, they may simply not be the right fit for the practice, and that's fine.
But if your sales process is holding back the full treatment plan on a patient's first visit, or you're defaulting to whatever insurance happens to cover this year, two crowns this year, two the year after, two after that, you're going to see real inefficiency in your schedule. You've probably heard the general advice that you should be doing quadrant dentistry, getting a lot accomplished in a single appointment. I agree with that entirely, you could even do multiple quadrants in one visit. The real gap in that advice is that nobody actually explains how to sell quadrant dentistry. Everyone agrees it's a good idea, but you still have to get the patient to actually accept it. We do a fair amount of training specifically on this, I don't want to turn this into a string of plugs, but if you want to work on raising your treatment acceptance, we cover it on our DDS Success platform, link on the episode webpage, or through the MGE Communication and Sales Seminars.
So those are the three main things I typically find, and usually one of these three is the actual culprit: scheduling structure, improper double booking, or a weak sales process. Between those, I can usually help free up a doctor's schedule fairly quickly. But in some cases, especially with a more experienced MGE client, none of those are actually the problem. Double booking is being done correctly, the scheduling policy is solid, and the sales process isn't bad at all. What does that mean at that point? Most likely, the doctor is genuinely maxed out and needs an associate.
I know reaching that point represents a real decision. Bringing on another doctor isn't like adding a part-time floater assistant, it's a significant commitment. How do you pay them, is now genuinely the right time, should you wait a bit longer? We can help walk through those specifics directly, but here's the first thing worth knowing: you don't have to bring someone on full-time right away. You can start with one or two days a week. It doesn't need to jump straight from where you are now to a full-time associate. When a practice actually reaches this point, it usually means the owner doctor is genuinely overwhelmed and stressed by their current volume. You might start an associate at one or two days a week, or a day and a half, and scale up gradually until, say, you're running a four day week and they're covering all four, effectively full-time. From there you might even look at adding a second associate eventually.
Before I'd actually recommend bringing on an associate, there are a couple things worth checking first, and this is exactly what I'd walk through with a client before agreeing that's genuinely the next step. First, I'd look at PPO involvement in the practice. If the practice is heavily PPO dependent, say 80 percent, collecting $800 or $900 a crown instead of the $1,200 or $1,300 they'd charge at full fee, I'd want to look at reducing that plan involvement before adding another provider. Done properly, you won't lose nearly as many patients as people tend to assume, though you will lose some, and it does take real, deliberate work.
This connects to something I've discussed at length in other episodes: dental practices tend to have an extraordinarily high churn rate. It's a term used constantly in subscription-based industries, tracking how many subscribers a company like Netflix loses over time. Dental practices experience something similar, and often worse, typically retaining only about 30 percent of the patients they've acquired over the prior five to ten years on any kind of routine basis. Three out of ten, when you actually sit with that number, is genuinely poor.
So if you're considering dropping PPOs, it isn't simply a matter of ramping up marketing for a burst of new patients, it also means genuinely reactivating the patients you already have sitting in your existing base. That takes real, deliberate work. So before adding an associate, I'd want to see that PPO involvement wound down first, with the practice either holding steady or genuinely growing as a result. Done correctly, you'll typically see no drop in profit at all in most cases, and often an immediate increase. That's the direction I'd want to move in before bringing on another provider, since an additional doctor represents real added expense.
The other thing I'd look at before adding an associate is new patient flow. Depending on how a practice currently handles new patient initials, some schedule them directly on the doctor's own schedule, others route them through hygiene with the doctor coming in to do the exam, there's no inherently right or wrong approach, it's a matter of preference with real trade-offs either way. But say hygiene has been genuinely slammed and the schedule has been packed. If a new patient calls and it takes one to two weeks to actually get them in, you may be artificially suppressing your own new patient numbers without realizing it.
You might think, we'd never suppress our new patients, but you likely are. This connects to a core principle in marketing: you have to be able to think from the perspective of the person you're actually marketing to, not from your own. Say you're running Google pay-per-click and I search dentist near me. Your ad catches my eye, I click it, I call your practice, and you can't see me for two weeks. Consider what kind of relationship actually exists between us at that point. Even assuming your receptionist is genuinely great and handles the call well, if the earliest opening is two weeks out purely because the schedule has zero availability, not because I personally can't make it sooner, that relationship is thin, essentially held together by a single thread. All I know about you is that I searched dentist near me and clicked your ad first, out of pages of other results. There's a real chance I click the next one instead, or I book with you and simply don't show up, or cancel later, or never book at all and call the next practice on the page.
So even if it doesn't feel like you're suppressing new patients, you likely are, whenever there's no availability. The only way to overcome that gap is if some form of real relationship already exists, your spouse and kids are already patients there, or a close friend strongly recommended the practice. Even then, you'd still ideally want to be seen sooner rather than later. As I've mentioned in other episodes, you generally want to be able to see a new patient within 24 to 48 hours.
So if hygiene and the schedule overall have been genuinely packed and your new patient numbers haven't been especially strong because people simply couldn't get in, starting by winding down those PPOs and seeing whether your patient roster naturally starts filling back in can be a meaningful first step, before ever bringing on an associate. If you are looking seriously at an associate, there are two specific areas worth examining: do you have the new patient volume to actually support them, and do you have the hygiene volume to support them.
Here are a couple of basic benchmarks. For a full-time associate, or really any full-time provider, I'd want to see 20 to 30 new patients a month, with 20 as an absolute floor. So a solo practitioner should be seeing at least 20 to 30 new patients monthly. If you're seeing 40, 50, or 60, you can likely support two doctors. If you're stuck right at 20, that's worth addressing before adding anyone. If you're considering an associate, you want to either already be on the cusp of a marketing push you're confident will work, or already have strong new patient numbers, or real untapped new patient potential, so you know you can genuinely support that added provider.
How would you actually know if you're leaving new patient potential on the table? If you're not already reviewing this, you likely have some form of call recording or tracking software running through a cloud-based platform. Start listening to some of your actual new patient calls, and you may hear exactly the scenario I described earlier: a caller asking to become a patient, and being told they can't be seen for two weeks. That tells you either you're inadvertently turning new patients away and could fill up your roster simply by fixing that, or you genuinely need to get moving on new marketing.
The second area is hygiene, and this isn't some precise scientific formula, it's simply the best practice we've consistently seen work well. To properly support a doctor provider in a practice, you generally want one to one and a half hygiene days for every doctor day. So if you're running a four day week with one full-time doctor, let's say that's you as the owner, you'd want four to six days of hygiene weekly, meaning a full-time hygienist, or one and a half hygienists, to properly support that one full-time doctor. Once you go meaningfully above that 1.5 ratio, say two full-time hygienists supporting only one doctor, it can actually become counterproductive, since the doctor ends up spending more time on hygiene checks and new patient exams than on actual dentistry.
So somewhere around one to one and a half hygiene days per doctor day tends to be the right range. Some practices try to get around this, I've seen offices running three doctors against a single hygienist, while still pulling in 120 new patients a month. That might look impressive and genuinely productive on the surface, but if the hygiene schedule isn't growing alongside it, it tells you that practice is essentially operating like a specialty office, bringing in a large volume of new patients but not retaining any of them, since they're never coming back through hygiene. That's a real waste, given how much was spent to acquire each of those new patients in the first place, they may as well be retained and kept within the practice.
So if you're genuinely considering an associate, here's the order I'd walk through with you as a client: first, look closely at your PPO involvement. If we filter those plans down and you're still clearly maxed out, next I'd look at what your new patient flow actually looks like, and what your hygiene flow looks like, making sure both are growing at the same time you're bringing that associate on board. In some cases, we've even had that incoming associate work hygiene part-time initially, two days doing hygiene, two days functioning as a doctor, specifically to help correct that doctor-to-hygienist ratio while things scale up.
So the real takeaway here: don't rest your sense of security purely on the fact that your schedule looks busy two weeks out, because the truth is, those patients might simply never show up. It's really just a name written in a book at that point. If you're running a genuinely healthy practice, strong new patient flow, hygiene that's actually growing, a solid sales process, you're going to stay busy regardless. But if you find yourself booked out too far, check your own practice against the things we've covered in this episode and see whether any of it applies to what's actually happening.
If you have any questions, feel free to reach out to us here at MGE, we're always glad to help. I hope this was useful. If you have questions about anything covered in this episode, you can email me directly at jeffb@mgeonline.com, I'll put that on the episode webpage. I've also linked the scheduling seminar I mentioned, which is free, our scheduling course on DDS Success, the Art of Scheduling Productively, along with some of our sales training and the MGE Communication and Sales Seminar. If you'd like to reach us here at MGE, you can call us at (800) 640-1140, or find us online at mgeonline.com.
Folks, have a great week. This is technically the second episode of the year, so let's make it a great one, I think I said that last week too for the first one. I'll see you at the next episode.