There is an endless number of ideas or “pearls” or “tips & tricks” out there about how to run your practice. Not only can this be overwhelming, but some of these ideas can actually be highly destructive to practice if you try to implement them! So this week, Jeff tackles five of the biggest myths you’ll hear around the industry that you should avoid adopting at all costs.
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Questions From This Episode
Why is being booked out far in advance a bad idea?
A full schedule feels secure, but it limits productivity and hurts case acceptance. Patients who need treatment have to wait weeks, and new patients from marketing have only a thread-thin connection to your practice, so they may book elsewhere. Jeff says you should be able to get a new patient in within 24 to 48 hours and fit a case you sold on Monday in within three to four days. He cites the ADA Health Policy Institute's Q1 2024 survey, where the average new patient waited 14.6 business days.
Should you deactivate patients you have not seen in two years?
No. Jeff calls chart purges one of the worst ideas in the industry. In most businesses a customer stays on record unless they ask to be removed, and people already expect to see a dentist twice a year. He says the only good reasons to deactivate a chart are that the patient passed away, moved, asked not to return, or was released by the practice. A returning patient who needs a lot of work is usually easier to convert than a new patient, because they already know you.
Why should the doctor discuss fees with patients?
Jeff says the doctor owner is the doctor, the executive, and the salesperson, and a salesperson who cannot talk about price is not closing. Staff will also tell you patients listen to the doctor most, so a fee quoted by the doctor carries more weight. Nine times out of ten no one objects, and he has seen close rates rise simply from the doctor giving the fee and handing the patient to the treatment coordinator.
Are new patients the best measure of a general practice's health?
Not for a general dentist, although it is true for specialists such as endodontists and oral surgeons. Jeff recommends tracking the number of recall patients seen each month or week, because it measures retention. He compares two practices doing the same $1 million and says he would buy the one where hygiene produces $500,000, because it shows steady patient flow. He also says 60 to 70% of revenue should come from patients of record.
Why is it a myth that you should try to join every insurance plan?
Jeff says it comes down to math. With cumulative consumer price inflation of about 21% over the last four years, a practice that cannot raise its fees in line with inflation falls behind, and you cannot move fees when you are in network. He says getting out of network is easier than most doctors think, and MGE is offering a free Roadmap to a Fee for Service Practice consultation for a limited time.
Episode Transcript
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How many practice management ideas have you accumulated over the course of your career? Take a minute to think about it. Some of these ideas may have come from personal experience, lessons from the school of hard knocks. Something goes wrong, and you know what not to do next time.
And then there are the ideas you begin hearing as far back as dental school, about what you should or shouldn't be doing when you start practicing. These ideas continue to accumulate as you talk to colleagues, read articles, go to seminars, and so on. Hopefully you can think of a few that you applied and that worked out well.
And while it might be a little harder to remember, you could probably think of some that really didn't pan out. We usually like to forget these. With all this in mind, there are a few often-repeated basic concepts about practice management that have been floating around the industry for years, as far back as when I started out in the 1990s, that are complete garbage. They're just not very good. They're the exact opposite of what you want to do. A nice way of saying it is that they're practice management myths.
When I came into the industry, I came from the business world, and I remember hearing some of these things and thinking they were completely counterintuitive. They were the polar opposite of what I had learned to do in the business world. But being new to the industry, I decided to reserve judgment, see how these panned out when they were applied. Well, my initial assessment was right. In most cases these ideas not only did not work, they could be damaging to the business. Nonetheless, too many doctors accept these concepts, or actions, or myths, for lack of a better word, as if they were almost natural laws of dental practice management.
They're bad. If you want a stress-free, profitable dental practice, these are the things you absolutely do not want to do, yet they're written up in articles, repeated often, and delivered with a sage, wise look, as if they actually have value. So what are some of these ideas? What are the absolutely terrible, in some cases business-killing, practice management concepts, so that you know not to do them?
What I want to talk about this week is what I've isolated as the top five. My name is Jeff Blumberg and I'm your host, and I say we just jump right in.
We'll start with the first one on the list: you should always be booked out way in advance. For some people this is a month in advance, for some people two months. I'm talking about the doctor's schedule here, but the same concept applies to hygiene. Why is this a bad idea? I actually did an episode on this, how far the doctor should be booked out. When you're booked out way in advance, there's security in that. Your schedule is full, you have production on the schedule, everything's good. But you're actually limiting your productivity in a couple of different ways.
I want you to take the viewpoint of the consumer experience for a second. Say I'm a patient of record, I come into your practice, and I need three crowns, and the first opening on your schedule is six weeks from now. Number one, that's just bad customer service. I should be receiving service as quickly as possible. Now take a new patient who needs three or four crowns. That's what you've just diagnosed, and they're going to have to wait six weeks. This is extremely dangerous with a new patient, because you have very little connection with this person. Maybe you really hit it off during the examination and they trust you. But maybe you've just told them they need all this work, and you don't have that much of a connection. Making somebody wait to get this work done is very limiting from a productivity perspective. It's just not a good idea. You're limiting your growth.
When you go to the hygiene schedule, it's even worse. To give you an idea of how bad this can get, there was a recent survey done by the ADA Health Policy Institute. They do it quarterly, and it's called the economic survey of dentist owners and DSOs. One of the first questions was: currently, how many business days does the average new patient have to wait for an initial appointment, excluding emergencies? This is the Q1 2024 economic survey of dentist owners. The average answer of all respondents was 14.6 days. That is terrible.
I know I'm talking about three things here: the doctor's schedule, the hygiene schedule, and the new patient schedule. But let's pick up the new patient piece for a second. You should be able to get a new patient in within 24 to 48 hours. 14.6 days is a terrible thing, because it really depends on how you're getting the new patient. If you're my dentist and I really like you and I refer my wife to your office, she may be happy to wait 14 or 15 days, whatever it is, because I trust you and, by extension, she trusts you. The same is true if I refer a friend.
But if you're getting this new patient from marketing, say you sent out a postcard or a newsletter, or you have a pay per click campaign, and they click or they call you, their connection to you is extremely fragile. It's thread thin. They don't know you from anybody. They call your office, they're new to the area, they want to get their teeth cleaned, and they have to wait 15 days. I don't have metrics on this, but I would bet they're now looking at the next name to call. Depending on how urgent it is to them to get their teeth cleaned, they may schedule an appointment with somebody else and forget to call you back, or they may call you back. They don't have enough of a connection to you to make them wait that long.
That's just bad service as a dentist, especially if it's going to kill your sales. We use the words "case acceptance" for that, because you're not getting me in soon enough to get my work done. Ideally, if you're selling a case on Monday, you should be able to get the patient in that week. At worst, if it's later in the week, you should be able to get them in early next week. You should have openings on your schedule where you can fit productive appointments within the next three to four days, always. Yes, it's living a little more on the edge, but it makes you potentially more productive.
One last thing I'll say on this. You may be wondering where you're going to put people when you're booked out a month in advance and have nowhere to fit anybody. Then your schedule may be the problem. I'd approach this in sequence, ratcheting up each action. Certain things may be in place and certain things may not. Let's say your schedule's crammed and you can't fit anybody in on the doctor's schedule for the next month. The first thing I would look at is how you're scheduled. Are you using a proper system to schedule your practice, where you're on a 10-minute book and you're properly double booking? Maybe you're working with one assistant out of two chairs, which really isn't double booking. That's basically just going from one chair to the other, and you're saving yourself maybe five minutes. Proper double booking means there's an assistant in each room.
So maybe organize your schedule a bit and set proper procedure times, with the doctor and assistant time broken out. We talked about this in an episode a couple of years ago, and we also do seminars on scheduling here at MGE. I'll put a link to it on the episode webpage. Putting a scheduling system in place and having yourself properly staffed, rather than running the day linearly, one appointment after the other without using two chairs, can alleviate the pressure on your schedule and create some openings.
But let's say you're already doing that. You are double booking and you can't fit any more patients in. Is it possible to up your assistant's skill set? Maybe if somebody were an EFDA, they could do more of the procedure than your current assistant is doing. Or maybe your assistant could learn some new things that would create a little more free time for you. That's usually not a huge problem, but it's something to think about.
But let's say your assistants are maxed out. They're doing everything they're allowed to do according to the Dental Practice Act in your state, you're running a really efficient schedule, and you can't fit anybody else in. There's a really good chance you need an associate doctor. That's something to think about, and then your schedule gets cleaned up a bit. You don't have to start that associate full time. If you have questions about this, we're happy to help.
In relation to the hygiene schedule, if you can't get somebody in for four to six weeks, that is extremely dangerous. I'm not even talking about new patients. If that's how you're seeing initials through hygiene, here's the problem: hygiene schedules tend to get a bit stale. Let me explain what I mean. The people who tend to populate your hygiene schedule easily are your best patients. I came in, I really cared about my teeth and my oral health, you did the treatment I needed, and I've been on your hygiene schedule ever since. I always keep my appointment unless something drastic is happening in my life. You never have to remind me very much. I'm just really good about my dental health. So when you do my exam a year from now, or three years from now, I don't really need any treatment, because I'm taking great care of my teeth and I already did the treatment you recommended when I first came in.
In your view, you may have a hygiene schedule full of people like me who need no work, because we're your best patients. The patients who need the work are the patients you are not calling in. A simple metric, a very easy thing you can do, is go into your software, look at how many charts you have, and then look at how many of those patients have a next appointment date after today. What's common to see is 3,000 or 4,000 active charts, with only six or 700 of those patients having an appointment after today. That tells you the majority of your patient base is becoming stale, or inactive. "Stale" is probably not the best adjective, but they're becoming inactive. You spent all the money getting those patients in as new patients, and now you're letting them waste away.
I'll get into this in the next myth. Because you have no hygiene openings for the next six weeks, no one is chasing these patients or calling them to get them back on the schedule, so they become more and more inactive. Your hygiene schedule becomes "cleaner and cleaner." You're not getting any work out of the hygiene schedule. Worse, you have all these patients whose health you're not maintaining or improving because they're not being called in, and why? Because you have zero availability on the hygiene schedule. If you're booked out that far, and assuming your schedule is run correctly and you don't have a ton of cancellations and no-shows, you probably need to add a hygienist or two. So it's something to think about and something to look at. The idea that you should be booked out forever and a day, to where you can't fit anybody in, is just bad business.
Myth number two relates to what I was just talking about with regard to hygiene. When you have a patient you haven't seen for two years, that patient should be deactivated. The word I used to hear a lot was "purged," as in chart purges. I think that word lost its effectiveness after the movie "The Purge." It has a bad connotation now anyway. But that's what people used to do in the nineties. You'd hear, "We're doing chart purges. Patients who haven't been in for two years, we're just getting rid of these charts." If I had to pick one myth, that's probably one of the worst ideas. It is the complete opposite of what you would do in the business world.
Why? Say I came into your practice, we did whatever treatment we were going to do, and I was put on your hygiene schedule for six months from now. I didn't show, and then you called me all the time over the next year and a half to try to get me to schedule, and then two years came by after all these phone calls and all this follow-up, and then you wanted to deactivate me. That still wouldn't be right, but I would understand it more. That's not usually what happens. Usually you go crazy getting me in as a new patient, you do my work or not, and I end up on your hygiene schedule. I miss my appointment, and then I maybe get one or two phone calls, a text, or an email. A year and a half goes by and nobody has really called me.
And if someone is doing chart audits because the office isn't busy, I always get the phone call, because my last name starts with B. Sometimes people will call A through D, and then you get busy again because you're making all those phone calls, and then you say, okay, let's try Z. You start calling Z, you get up to R, and nobody ever calls L, M, and N because they're in the middle, and there's not enough work to actually retain this patient. If all that work were being done, I'd understand this more, but there's very little to no work being done in a dental practice. So what happens is I haven't been in for two years, and everybody assumes I've found another dentist. No one has talked to me, mind you. Or they assume I don't care about my teeth, and I need to be made inactive.
In the business world, this would make people laugh. It does make people laugh. If you go to any store, or you get your auto repaired, or you go to Nordstrom or Restoration Hardware, or somewhere you give them your identity, meaning your email address or your name, you're on record. They never get rid of your name unless you tell them, "Please stop contacting me," or you pass away. Once a customer, potentially always a customer. For that matter, most businesses would kill for what you have built into your business model if you're a general dentist. People expect to see you twice a year. That's built into the mentality of everybody in the United States. Ask anybody in the US how often they see the dentist, and they'll tell you twice a year. Thanks, Crest and Colgate. This is built into people's mentality, you have it built into your model, and you're not using it.
So here's my reality on this. You may need to do some follow-up, some phone calls, and some reactivation, which is a whole separate matter. But unless a patient has either A, passed away, or B, moved out of state, there is no good reason to deactivate a chart. Even the second one doesn't always apply, because I know people who live in one state and see a dentist in another every six months. I guess that's a problem if they have an emergency, but they love their dentist and they go back and see them when they visit their hometown. So moving doesn't always apply. Other reasons are that they tell you, "Look, I never want to come back to your practice again," or that you don't want the patient back and have deactivated them for cause. Those are reasons to deactivate a chart. There is no other good reason.
To that end, I'm sure you've seen this. A patient comes in whom you haven't seen in five years, and you say, "Wow, Bill, it's been five years since you've been in here." And they say, "Five years? No, it hasn't been this long." "Yes, the last time we saw you was 2019." "Wow, time really flies. Okay, well, I'm here now." In their mind, you were always their dentist. So if anything, I would maintain continuous communication with these folks. I wouldn't purge their chart and I wouldn't deactivate it. Sure, it's depressing, especially when your total chart number is 4,000 and you're having trouble filling three days of hygiene a week. But that's your software giving you a message, folks.
One question I get often is what to do with somebody whose HMO you've dropped. That gets a bit more difficult than with PPO patients, where you can retain a ton of them. But here's what I would do if I dropped an HMO and a patient says, "I can't be a patient here anymore because you're no longer in my plan." I'd take them off the active recall schedule if they've left the practice, but I would still send them my newsletters and any seasonal mailings that I send out. Why not? If you've been in an HMO before and dropped it, I guarantee this has happened to you: patients went to the other HMO doctor and said, "I hate this. I'm going back to my old dentist and paying full fee." That happens, so I'd at least continue to communicate with them. You worked hard to get these people to come to your practice in the first place. Why do nothing to keep them?
As a matter of fact, if you have a patient you haven't seen in five years who needed a lot of work and they come back into your practice, that patient is usually a lot easier to convert for their treatment than a new patient, because they know you. So the idea that you should get rid of a chart just because the person hasn't been there for two years is a horrid idea. I've heard it for years, and it's one of the worst I've heard. So that's myth number two.
What's myth number three? If you've been listening to this podcast for any length of time and you've heard me talk about case acceptance, you'll know this one: the doctor should never discuss money with patients. That is a total myth. The doctor should absolutely be willing to discuss finances with patients. There are a couple of reasons.
Let's talk about a doctor owner for a second, whether you own your practice or are a doctor who presents your own treatment. A doctor owner, whether they like it or not, has three basic jobs. The first is being a doctor, which you obviously already know. The second is that, as an owner, you are by default an executive. The third is that you're the salesperson. You're the salesperson, the executive, and the doctor. Most of us love being the doctor, hate being the executive, and really hate being the salesperson. It's tough, but this is your job whether you like it or not.
That being said, any job in a business has a specific outcome associated with it. For instance, say I had a schedule coordinator. Just from that title, what would you expect this person to do? You'd expect them to schedule patients well. What would the outcome be? Your first thought is probably a full schedule, but that's not totally correct, because you could have a schedule full of denture lines, and that doesn't work. We want a full, productive, efficiently run schedule, in accordance with whatever your scheduling policy is. You hire somebody, you pay them, they're a member of your team, and that is the outcome expected from that particular job.
Similarly, you have the salesperson, the executive, and the doctor jobs, and each has its own outcome. What would we expect of a doctor? Well-done treatment performed at a high level of clinical quality, and a healthy patient. How about an executive? We'd expect a growing, profitable business. What about a salesperson? If you hired somebody to sell treatment for you, you'd expect them to get closes. A salesperson closes, and part of closing is talking about finance.
If you go to buy a car, and I hate to compare car sales to this, there's obviously a sticker on the car with a price. But say there wasn't, and I asked the salesperson, "How much does this car cost?" and they said, "I have no idea. Let's go talk to that person over there, Sally." You would laugh. That would be ridiculous. Or say you were talking to somebody about buying a car, and they asked, "Did you like this car? Do you like how it drives? Did you enjoy the test drive? Okay, good. Are you interested in the car? Yes? Good. I'm going to have you talk to Joe." Then in your mind, who's the salesperson? Joe is. They aren't. So the salesperson talks finance. You have to talk money.
What's the second reason the doctor should talk finance, beyond the fact that they are the salesperson? Ask your staff who a patient is most likely to listen to in the practice. They will tell you, uniformly, the doctor. When you tell a patient something, it has more gravity and more meaning to them. So when you tell them, "This case is $10,000, and according to my treatment coordinator we're expecting $1,500 from your insurance company. How would you normally take care of a balance like this?", that has more meaning to them. It doesn't mean you have to take their credit card or fill out a finance application with them. It has more gravity, and it doesn't make you look like you're just after money or seeing dollar signs when you look at them. It means that you own a business.
The funny thing is that nine times out of 10, no one is going to give you a hard time about this. That one time out of 10, someone will, and you'll realize that person is the anomaly, not the nine out of 10 who didn't. You could start this on Monday. Start telling patients how much something costs. One may give you a hard time, but you'll notice most people don't, and you'll notice your close rate go up. I've seen it go up that simply, just by having the doctor give the patient the fee and doing nothing more, and then turning the patient over to the treatment coordinator, which you should do more of, as I've talked about in prior episodes.
So why don't doctors want to talk about money? People get a little bit loopy when it comes to money. If you don't believe me, ask your treatment coordinator. They've had patients they've been talking to where everything seemed great, and then they mention the fee and it's like they're talking to somebody different. There are all kinds of "reasons" why doctors aren't supposed to talk about finance, and I'm putting that in quotation marks. It lowers them in the patient's eyes. It's not very doctorly. They're all wrong. It doesn't degrade you in any way. It also helps you with the most important thing, which is treatment acceptance, and that's why we're there. As you present the treatment plan, have your treatment coordinator there, and realize that some people may still give you a hard time, but they're the anomaly. The majority of people won't.
That brings us to myth number four: the most important statistic, the most important health metric for how healthy your business is, is new patients. The idea is that how many new patients you're seeing tells you how healthy your practice is. This is a complete myth if you are a general dentist. If you are a specialist, this is absolutely true. If you're an endodontist or an oral surgeon, this is 100% true. If you are a general dentist, it is completely false. New patients are important, but they are not the growth statistic for your practice.
As a matter of fact, if I were to give somebody one number to keep to see whether their practice is growing or contracting, it would be the number of recall patients in a given period of time, whether you're keeping it monthly or weekly. How many recall patients are you seeing per month? By recall, I'm talking three-month recall, four-month recall, six-month recall, because that is a retention statistic.
Look at it this way. Say you were going to buy a practice that was doing a million dollars, and you had two options. One office is doing a million and the other is doing a million. In office number one, the doctor is producing $750,000 of that million and hygiene is doing $250,000, and the doctor is doing all types of advanced procedures. In office number two, hygiene is doing $500,000 and the doctor is doing $500,000, and they're both the same price. Which practice are you purchasing? If you're like me, you're purchasing the practice where hygiene is doing $500,000. Why? Because you have patient flow.
So if you want to take a look at how healthy your practice is, look at the number of recall patients. Naturally, if more and more recall patients are coming into the practice on a routine basis, your hygiene department is growing, which means the new patients you're getting, you're actually keeping. They're not just going into the inactive bin, so to speak. Otherwise, you're just wasting patients.
Ideally, 60 to 70% of your revenue should be coming from your patients of record, from a sales perspective, when you're presenting treatment. Of course, some of this will be emergencies, consults, or quick visits with the doctor, but the majority will be in your hygiene department. It's also predictable. If I had a bunch of patients coming into my hygiene department today and I wanted to look at my opportunities for treatment conversions, I could look at the treatment I'd already diagnosed on these patients, and I would have an idea of what I could potentially convert today. With new patients, it's completely and totally unpredictable.
That brings us to our last myth. I'm keeping these pretty brief, and I've covered some of this in prior episodes, but I wanted to throw it out there. I've heard this from a lot of MGE clients, something they heard when they first got into practice: you should join every plan you can to make sure your practice is busy. A lot of you hear this in dental school right before you graduate, or maybe from an old professor as you're looking for a practice.
I don't even need to get into this too heavily, as far as joining PPOs, HMOs, and various types of government plans. It's a simple matter of math, and I've talked about this a little bit in the last couple of episodes. In an inflationary environment, which we've had, it's been 21% over the last four years. I've had some people comment, "Well, 21%, how is that possible?" You are correct that in certain categories it's been higher, but the average, if you take all the categories in the consumer price index, is 21%. Things like apparel are only 8%, whereas gas is 52% and food is over 30%. But it's a simple matter of math: in an inflationary environment, you cannot be in a position where you cannot move your fees in relation to inflation, which you can't do if you are in network.
There are easy ways to get out of network. This is something we're really, really driving hard with our clients now, to get every last one of them out of network. It is not as difficult as you think it might be. In last week's episode I mentioned that, for a limited time, we're offering a free consultation, something we normally only do with MGE Power clients, called the Roadmap to a Fee for Service Practice, where we will analyze what's going on in your practice. I had Sabri on the podcast, and she spoke about exactly what happens when we do one of these. Every situation is different. There may be different levels of network involvement. Obviously, if you're in the United States, if you're in Canada, you're not in network. You may be in some type of different plan, and if you're listening to this in Europe, it may be different again. Everybody's situation is different, so we have to walk people out based on their expectations, what they're trying to achieve, and what would work best in their practice. If you'd like to take advantage of this roadmap, which is for a limited time only, I definitely recommend that you check it out. I'll put a link to it on the episode webpage.
Anyway, a little bit more of a fun episode this week. I had to do one of those top five things. They're nice and clickbaity, right? In next week's episode, we're going to start taking a look at current industry conditions and what's happening in the dental industry. There are some really surprising things going on, as well as some amazing opportunities that have opened up. I look forward to seeing you folks next week. Don't forget, I have the links to what I mentioned in this week's episode on the episode webpage. If you have any questions or need help from us here at MGE, you can find us online at mgeonline.com or call us at (800) 640-1140. Folks, have a great week, and I'll see you the next episode.