Ep. 158: Setting and Reaching Productivity Goals in Your Practice
When creating goals for your company, how do you measure them? Are there tangible steps your team can take to actually hit these goals? In this week’s episode Jeff goes over the exact steps you can take to immediately improve your productivity and reach your goals in your practice.
Links:
The MGE Power Program – https://www.mgeonline.com/power-program
Morning Production Meeting - https://mgeonline.com/morning-production-meeting-download
Download the Hygiene Formula Spreadsheet - https://www.mgeonline.com/hygieneformula/
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Questions From This Episode
What's actually missing from most goal-setting advice for a dental practice?
Breaking a monthly number down by day and by provider is useful, but it stops short of the real question: where is that production actually going to come from, and what specific actions have to happen to make it materialize, rather than just leaving a gap between setting the number and actually hitting it.
What is the cycle of production, and how does it apply to a dentist's schedule?
Working backward from the final result, a patient sitting in the chair getting treatment done, to every step that had to happen first: the treatment being diagnosed, presented, accepted and paid for, and scheduled. Since a production goal is really a goal for the last step in that chain, hitting it means deliberately managing every step that leads up to it, not just tracking the final number.
Why is it dangerous to count on new patients to salvage a slow production month?
A typical new patient found through Google, Facebook, or a postcard is an unknown quantity, they might just want a cleaning or might need significant work, and there's no way to predict which. For a general practice, the majority of revenue should come from patients of record instead, hygiene patients and previously diagnosed treatment that hasn't been accepted yet, since that volume is at least somewhat predictable.
How much treatment should actually be presented in a month relative to the production goal, and why?
Roughly two to three times the actual production target, since not every patient is going to accept every treatment plan presented. A practice trying to produce $135,000 in a month should realistically be presenting somewhere in the range of $270,000 to $400,000 worth of treatment to have a real shot at hitting that number.
If hygiene looks fully booked and there's no outstanding treatment to present, what's actually going on, and what should be checked?
The patients showing up regularly for hygiene tend to be a practice's most compliant patients, not a representative sample of the full patient base. Pull the total chart count against how many patients actually have a future appointment on the books, since it's common to find a large share of the patient base, sometimes 70 to 80 percent, sitting inactive with nobody actively working to bring them back in.
Episode Transcript
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There's a lot that could be said about how to set and reach productivity goals in a dental practice, or any business for that matter. Most of what you'll find on this subject has to do with how to actually set these goals, we want to produce a certain amount this month or this quarter, and then break that down by day, maybe even by provider, and so on. There's a method to that, but it's not especially complex.
The bigger issue is what comes after that. Say I set a goal to collect $180,000 this month in the practice. I could look at the fact that we have 18 working days and figure out the practice needs to collect $10,000 a day. I could break that down further by provider too. That in itself can be useful for someone who either doesn't set goals at all, or doesn't drill down enough to know exactly what needs to happen in a given week or day. But once you've set that $180,000 goal, how are you actually supposed to get there? What are the specific, tangible actions you should focus on? And what do you do if you're six days into an 18 day month where you're supposed to be averaging $10,000 a day, and you're only at $30,000?
Something is clearly missing here, a bridge between setting a goal and actually achieving it. That's something we teach MGE clients directly, and it's what I want to cover in this week's episode: the specific management actions you should be taking to make sure your goals actually materialize in the real world. My name is Jeff Blumberg, and I'm your host.
I think the best way to walk through this is by continuing the example I just started. We've got our number for the month, $180,000 in collections. I'll use collections and production somewhat interchangeably here, I know they're technically different, and you won't always collect everything you produce, but I'd expect them to land pretty close together, somewhere around 97 percent, assuming you're not deeply tangled in managed care and you're actually collecting close to what you're producing.
So we have $180,000 across 18 working days, one owner doctor, one part-time associate, and two hygienists. Let's break this goal down the way a lot of you may already be doing, and if you're not, you should be. We're expecting $45,000 of that $180,000 to come from hygiene, which is a bit under the 30 percent it ideally should be, but let's work with it for this example. That leaves $135,000 to come from the doctors. Say the owner doctor is projected to produce $95,000 of that, and the associate the remaining $40,000, which brings us to our $180,000 total.
Across 18 days, that's roughly $5,300 a day for the owner doctor. The associate is only working 10 days that month, since they're part-time, so that's $4,000 a day from them. The hygienists are working all 18 days, so that's $2,500 a day combined from hygiene, or $1,250 per hygienist. It could be a cleaner set of numbers, but I'm keeping it simple for the example.
Usually someone breaks a goal down exactly this far, and this is where it ends. Great, let's all go produce $180,000. And this is exactly where the problems begin. Hygiene is actually the simple part, as long as hygiene stays full, the hygienists should hit that $45,000. Where it gets genuinely tricky is the doctor's schedule, because how do you actually make sure that $135,000 gets produced, and where is it supposed to come from? Obviously it has to come from patients who actually need dentistry, but we have to figure out exactly how that happens, and this comes back to something we call the cycle of production.
Let me give you a couple of examples before applying this directly to a doctor's schedule. What is the cycle of production? If I want more of something, I have to figure out all the smaller things that have to happen to produce that bigger thing. Say I manufacture tables and want to make a thousand of them this month. I need to figure out every action that feeds into making a table, and make sure each of those happens in the right volume to get me to a thousand finished tables. How much raw material do I need? How many legs need to be made? How many surfaces? How many people do I need doing sanding and finish work, and if they're wood, how many people staining them? You figure out every small step that leads to the final result.
What tends to happen instead is that we set a goal for the final step alone. Take new patients as a simpler comparison. Say I want 50 new patients a month and I'm currently getting fewer than that. I could look at the cycle of production behind a new patient. If the final result is a new patient sitting in the chair, walk that backward: I had to schedule them, which means they first had to actually reach out to the practice, through a Google ad, a Facebook ad, whatever channel, and I had to convert them once they called. And before that, I needed enough incoming calls in the first place to generate the number of new patients I actually want.
Some basic math: say my conversion rate is 50 percent and I want 50 new patients, that means I need 100 incoming calls or inquiries. If I'm only getting 75 calls a month right now, I need to get that number up to 100, whether through more marketing, more referrals, or some other channel. Where would I focus first? I could always work on improving the conversion rate, but the more direct lever is usually increasing the number of incoming calls, since more calls, assuming we can actually handle them well, should translate directly into more new patients at that same 50 percent rate.
So what's the cycle of production for actual dental production, meaning patients getting treatment done? Let's walk it backward. Say you're about to do an inlay and five onlays on a patient sitting in your chair right now. How did that patient get there? Before they were in the chair, you had to present that treatment plan, and they had to accept it and pay for it. Before that, the treatment had to actually be diagnosed in the first place.
Walk that forward instead, and you get the full cycle: a patient, new or existing, has treatment that needs to be diagnosed, that treatment gets diagnosed, it gets presented, it gets accepted and paid for, it gets scheduled, and it finally lands on your book with the patient physically sitting in the chair. When you set a production goal, you're really only setting a target for that very last step in the chain. So to actually hit it, you have to work backward and figure out what needs to happen at each of the earlier steps to get you there, specifically the $95,000 target for the owner doctor and the $40,000 target for the associate.
Here's the first real implication of that: if I want to produce $135,000 worth of dentistry this month, I probably need to present considerably more than $135,000 worth of treatment, since I'm not going to close every patient on every treatment plan. That's genuinely rare, sure, you'll have the occasional day or week where everyone says yes, but you're not going to sustain 100 percent acceptance over a full month. So to be reasonably safe aiming for $135,000 in actual production, I'd want to be presenting at least twice that, roughly $270,000 worth of treatment, and if you want real safety margin, closer to three times that, $400,000 or more.
But where is all of that treatment actually going to come from? It has to be genuine, valid treatment, either things we diagnose this month or things we've already diagnosed previously. This is exactly where I see this go wrong most often: the instinct is, well, we need to produce more this month, so the first move is getting a lot more new patients. New patients absolutely matter, I'm not suggesting otherwise. But counting on new patients to salvage a slow production month is genuinely risky, unless you're working a very specific type of new patient funnel, an implant funnel, for instance.
For your average, run of the mill new patient who finds you through Google, Facebook, or a postcard, you have no real idea what's actually going on with them yet. They might have just moved to the area and want a routine cleaning, or want their kids' teeth cleaned, or they might genuinely need significant work. You simply don't know, which means you can't reliably predict what you'll actually produce off new patients alone, since you haven't seen them yet. That makes counting on new patients to make your month a genuinely dangerous strategy, unless you're a specialist, an endodontist or oral surgeon, for instance, where a very specific, predictable type of new patient is exactly what you live off of. If you're a general dentist, the majority of your revenue should actually come from patients of record: people already coming through your hygiene program, or people you've diagnosed treatment on, whether that's new treatment or treatment they haven't yet accepted from a prior visit.
I mentioned a couple episodes ago that at least 60 percent of your revenue should come from patients of record, excluding hygiene revenue itself. I'm not presenting 60 percent as a rigid rule, but using that figure, if we need to produce $135,000 on the doctor's schedule this month, roughly $80,000 of that should reasonably come from patients of record. Where does that come from specifically? Hygiene, and occasionally emergencies, which are inherently unpredictable, but you generally won't get second opinions from your own patients of record. So primarily this comes from your hygiene department, and from patients the doctor is already seeing who've accepted only part of a treatment plan, a smaller and less predictable source, but real. If someone accepted one crown out of a four crown treatment plan you presented, there's an opportunity to revisit the other three while they're already in for that first one.
That treatment is walking into the practice every single day. This is the bigger picture, and it's where you can start adjusting these different factors to figure out what actually needs to happen to hit your goal. This is also exactly why the morning production meeting, something I've discussed several times on this podcast, matters so much. I'll put a link to a handout on running one on the episode webpage.
In the morning production meeting, you're looking specifically at who's coming into the practice that day. On your hygiene schedule, you'll see patients with treatment plans you've already diagnosed, which gives you real predictability, you know you diagnosed three crowns on this patient three or six months ago and they didn't accept at the time, that's a known, workable opportunity. Compare that to a new patient coming in at one o'clock with a broken tooth, you genuinely don't know what you're looking at yet, it could be a small chip needing a simple composite, or it could turn into a crown or veneer. That's not predictable in the same way. Again, I'm not trying to diminish the importance of new patients, but the morning production meeting is where you look specifically at who's actually coming in that day, especially through hygiene, whether they have outstanding treatment, and who's going to present it to them and how. Maybe the primary doctor is tied up in a root canal at that point, so a second doctor presents it instead, with the treatment coordinator standing by to help close it.
So that's your major, predictable source of production. The only way this genuinely goes sideways is if you look at your schedule and find your two hygienists running, you and your part-time associate covered, and simply nobody with outstanding treatment on the hygiene schedule that day, leaving you completely reliant on new patients. If you find yourself in that situation, and it might not solve this particular month, but it's usually not actually the full story, here's what I'd recommend.
If the patients coming in with already diagnosed or soon to be diagnosed treatment aren't enough to carry your production this month, unless you're a genuinely new practice, there's a strong chance you actually have plenty of patients with diagnosed treatment who simply aren't coming in at all. We see this constantly: a practice where hygiene looks fully booked and nobody seems to need anything, because the people actually showing up are your most compliant patients. And by most compliant, I don't mean that as a character judgment, most patients aren't naturally that compliant. They're great people, they're just busy, life gets in the way, they forget it's been three to five years since their last visit, and they quietly end up on your incomplete treatment or inactive patient list instead.
So I'd attack this from three angles. First, obviously, keep bringing in new patients and taking care of them well. Second, look at the patients already coming through hygiene who have outstanding treatment. I mentioned this a couple episodes back, one of the recurring issues we see with newer clients specifically is a patient gets presented a treatment plan, doesn't accept it, comes back for their next hygiene or periodontal maintenance visit, and nobody brings it up again, simply because they already said no once. That's genuinely counterproductive, it's still outstanding treatment, and someone should be talking to that patient about it, ideally the doctor stepping in briefly even if that visit wasn't originally scheduled as an exam. Nobody accepts treatment that's never presented to them, that's a pretty simple concept to work with, and it's exactly what the morning production meeting is for.
Say even that isn't enough to close the gap. The third angle is your inactive patients, the ones who aren't showing up regularly at all. There are a couple ways to check this. We have something called the hygiene formula, a downloadable spreadsheet I'll put on the episode webpage, that calculates your actual hygiene compliance rate based on how many patients you have on the books and how many are actually showing up. Since inactive patients ultimately have to come back in through hygiene, that's the real starting point.
Another way to check: pull your total chart count and compare it against how many of those patients actually have a future appointment on the books. You could filter to patients seen in the last five years as a reasonable cutoff, even though some patients do come back after longer gaps. When we run this exercise with a client, the number of patients with an actual future appointment scheduled typically lands around 20 to 30 percent, often lower. So you might have 4,000 charts and only about 1,000 of those patients actually scheduled going forward. What about the other 3,000? Nobody's chasing them, because hygiene already looks full, so why would anyone call people who can't even get an appointment for another month anyway. But you already spent real money acquiring those patients the first time, and if you're doing any marketing at all, these are people who already know your practice. If I called a chunk of those inactive patients and asked who their dentist is, I'd bet most would still name your practice. It's not that they've switched practices, it's simply that nobody's been reaching out.
So the third prong here, alongside your morning production meeting and steady new patient flow, is actively keeping your existing patient base engaged. Most of these inactive or incomplete treatment patients are eventually going to land back on your hygiene schedule one way or another, so you can divide up the work involved. Start with hygiene availability itself, if you can't realistically fit a patient in for another month or two and you're sitting on several thousand inactive patients, you likely need to open up more hygiene capacity, maybe a third hygienist, which might eventually mean expanding your associate's hours too. Think of it like a funnel: a wide top full of inactive patients, and a narrow bottom, your actual hygiene schedule, that everything has to flow through. If that bottom opening is too narrow, you need to widen it before the rest of the funnel can actually drain.
For a larger inactive list, it may be worth hiring someone part-time or full-time specifically to call these patients and get them back onto the hygiene schedule. Otherwise, have your existing team spend an hour or two a week making these calls during slower stretches, though I wouldn't wait for a slow moment to do it, the goal is actively filling the practice, not just filling downtime. Your treatment coordinator, if you have one, is a natural fit for this work too. Unless you're presenting eight or nine treatment plans a day, they're not spending every minute working out financial arrangements, so that remaining time should go toward following up on patients who haven't yet accepted treatment, someone waiting on a home refinance before applying for credit, for instance, or anyone sitting on your incomplete treatment list.
I'd split that incomplete treatment list into two groups rather than just calling everyone with a flat, ready to move forward on that treatment plan? Most of the time the answer will be no, since they weren't closed the first time around, so a generic follow-up call rarely lands well on its own. Instead, if the patient is actually due or overdue for a hygiene visit, simply schedule them for that, even if it's been two or three years and they technically need a fresh initial exam, book them for an hour on the hygiene schedule and have the doctor pop in toward the end of the visit, however that works logistically in your practice. If the patient isn't yet due for hygiene, say they were in two months ago and didn't accept the treatment presented then, the call can simply be, the doctor mentioned wanting to check back in with you, could you come in briefly to make sure everything's staying stable? That creates another real opportunity to present and close treatment, since remember, we're aiming to present two to three times what we actually need to produce.
So realistically, that's where these presentation opportunities come from: new patients, hygiene, and inactive patients being brought back into hygiene, along with the occasional second opinion, which is really just another form of new patient. If you're not actively pushing toward presenting that $270,000 to $400,000 worth of valid treatment each month, and it does have to be genuine, appropriate treatment, you're going to struggle to actually produce that $135,000 target, because it has to come from somewhere real.
The real lesson here is that setting or making a goal isn't just about breaking down the numbers, it's about breaking down the actual actions that lead to those smaller steps, which in turn lead to the bigger goal. That's a core part of real management, and it's something we teach in depth in the MGE Power Program, I'll put a link on the episode webpage if you'd like to learn more. But it's genuinely something you can start applying immediately, taking real, tangible action toward your goal instead of simply writing a number down and leaving a gap where the actual plan to get there should be.
I hope this helps. I've got those downloads on the episode webpage. If you'd like to learn more about MGE, you can find us at mgeonline.com, or call us at (800) 640-1140. Folks, have a great week, and we'll see you at the next episode.