Jeff Santone joins us this week to discuss the most pressing issues currently impacting the dental industry. From rising costs and limited access to care, to the challenges posed by new technologies and shifting patient expectations, we explore the three biggest problems in dentistry today. Join us as we break down these critical issues and discuss how they’re shaping the future of dental practice. Tune in for an informative and thought-provoking conversation!
Episode 141: Ep. 141: State of the Dental Industry 2024three
Jeff Santone – jeffs@mgeonline.com
DDS Success (coupon code MGE269) - https://ddssuccess.com/
Free Fees & Plans Analysis – https://www.mgeonline.com/fees-and-plans
Art of Scheduling Productively DDS Course – https://ddssuccess.com/p/art-of-scheduling-productively
Scheduling for Production Seminar - Art of Scheduling Live Stream – MGE: Management Experts Inc
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Questions From This Episode
What are the top three problems dentists are facing right now?
Jeff Santone, MGE's Vice President of Expansion, names insurance and profitability first, then hiring and staffing, then scheduling. His team hears these from more than 5,000 dentists a year. Jeff Blumberg notes that scheduling was the surprise, since new patients, profitability, and staff have usually been the top issues.
How can a practice tell whether it can afford to drop an insurance plan?
Santone says to start with the numbers: the gap between your full fee and what the plan pays, and how many patients are on it. If a plan discounts you by 50%, you only need to keep about half of those patients to bring in the same revenue, and you would work less with lower material, lab, and labor costs. MGE offers a free fees and plans analysis, and recommends starting with your smallest plans to learn the process before tackling the largest.
Why is it so hard to find staff, and what can a practice do about it?
Santone says practices are competing with employers like Starbucks, Whole Foods, and Target, which offer better pay, benefits, and consistency, and that many offices are understaffed at the front desk without realizing it. Jeff Blumberg suggests checking current local pay on Indeed, dropping unnecessary requirements and filters from ads, training assistants where the law allows, and considering other metro areas or moving costs in place of signing bonuses. Santone adds that you should always be hiring.
What does an understaffed front desk cost a practice?
A front desk that only keeps up with incoming calls cannot reach out to inactive patients or work the incomplete treatment list, so the practice slowly loses patients. Santone offers to bet any doctor $500 that at least 40% of the patients seen in the past year have no future appointment. Both hosts say a practice may be losing as much as half its potential income this way.
Why does the schedule fall apart, and how do you fix it?
Santone says about 80% of the practices he talks to have no written policy for how the schedule should run, so open slots get filled with whatever fits and procedures are booked for less time than they take. The fix is a written policy, realistic time blocks, and doable steps from where you are now. MGE offers a free seminar called The Art of Scheduling Productively, a version on its DDS Success platform, and a two-day seminar called Scheduling for Production.
Episode Transcript
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Jeff Blumberg: What's happening in the dental industry right now? I could hit you with a bunch of facts, figures, and statistics, which I did back in Episode 141, on the state of the dental industry, where I went over dental demographics, the supply of dentists between dental school and so on, the labor market, and how inflation was affecting offices as well as corporate dentistry. But with all of these things, how does it affect the individual doctor in private practice? To know that, you'd have to talk to individual doctors in private practice, and funnily enough, this is something we do quite a bit of. We speak to at least 5,000 dentists a year here at MGE, through our expansion division, and that doesn't even count the doctors attending all of our lectures. We've been doing this for over 20 years, so we keep our finger on the pulse, so to speak, of what's actually going on out there and what the biggest problems are.
So what are the biggest problems individual doctors are having right now, and, more importantly, what should you do about them, or what should they do about them if you don't count yourself among those having problems? That's what I want to talk about in this week's episode. My name is Jeff Blumberg, and I'm your host. I'm joined this week by Jeff Santone, our Vice President of Expansion. Jeff has been a guest on the podcast several times, so if you've been listening for a while, you know Jeff. A little bit about him: he's been our Vice President of Expansion since 2019, so it will be six years in January. He also owned two practices and was a client before he came to MGE, so he's been on both ends. He's seen it from the client end as well as the MGE end. You guys are the ones leading the charge, speaking to over 5,000 doctors per year, and I know you've started keeping track of what the biggest problems are. We were talking about this the other day, which is why I thought it would make a great episode when you brought it down to the top three. One of them surprised me a lot, and one did not, but it's become a bigger problem. I thought it would be a great episode for us to sit here and talk about these, as well as give the people listening some suggestions about what to do about them, because chances are one of these three things is negatively affecting them. Welcome back.
Jeff Santone: Thanks for having me. I love being here. It's a lot of fun.
Jeff Blumberg: Let's go down each problem individually rather than throwing all three out at the beginning, which would just make people have to keep listening. I'm kidding. What's the number one issue these folks are running into right now?
Jeff Santone: Right now, number one is insurance and profitability.
Jeff Blumberg: Now is it profitability and insurance or profitability or insurance
Jeff Santone: I think they're kind of connected. Look at what we've seen over the past four years: 22% inflation. That's on a basket of goods, which isn't all that important to most people, but they do know that when I talk to a lot of guys and ask, "What are you paying your hygienist? What were you paying them before the pandemic?" it's $30. "What are you paying them now?" $45. I've seen worse. I've seen $65.
Jeff Blumberg: I've seen worse. I've seen $65. What percentage of the folks you talk to take insurance, or at least participate to some degree?
Jeff Santone: I would say 80%.
Jeff Blumberg: So if they're in insurance and they're seeing no increase in reimbursement, or a reduction in reimbursement, they're obviously feeling that 22% inflation. How has this affected them personally?
Jeff Santone: They've had to give up that money from their own pocket. So they're stressed. They don't see how they can move forward, and they're scared of dropping the insurances, so they don't see a way out.
Jeff Blumberg: Has anybody you've talked to tried and succeeded?
Jeff Santone: Yes. They're trying, and some guys have just gotten so fed up that by the time I talk to them, they say, "We've already written our letters. We need a way of handling our patients' concerns." Good for them for doing that. It's not the way I would have suggested doing it, but some of them are so fed up with the discounts and their increased costs that they have no choice at this point. They've given up as much money as they possibly can of their own. It's gotten to their break-even point personally for them and their families, and they say, "I can't go any lower, so I have no choice but to drop some of these insurances." We've seen that happen, and a lot of times I'll talk to a doctor when they're already in the process of writing their letter and waiting out their 90 days or 60 days.
Jeff Blumberg: Do you catch guys at the other end, saying "I dropped it and oh my gosh, what am I going to do now, my patients don't want to come back"?
Jeff Santone: I've only had one or two of those, where they said, "Oh my goodness, we dropped it and it's been a disaster." Typically I don't hear from many guys who have dropped it.
Jeff Blumberg: So, more or less it's, "Hey, Jeff,” “What's your biggest problem or source of stress?” “I just can't handle these insurances. My costs are going up."
Jeff Santone: Yes, it’s insurance and that leads to their profitability issue, but it's funny when you talk to them: they don't see that it's possible to get out. They're still talking to me about negotiation and raising their fees. For example, we just had a brand new doctor, a great couple, about to open their start-up practice. They said, "Hey, we're getting credentialed, can you take a look at this?" I said sure, send it to me. I'm not going to name the insurance. It's a big insurance. They're all big insurance.
Jeff Santone: Some are bigger than others.
Jeff Blumberg: And we know you're a big Delta fan.
Jeff Santone: I'm a huge Delta fan.
Jeff Blumberg: Don't ever ask Jeff about Delta. He'll go off for an hour about the nonprofit's executive compensation.
Jeff Santone: It's a nonprofit, and the executive compensation is insane. Anyway, they hired a company to do negotiations. I thought, okay, that doesn't really work, but that's fine, send me the data. And I thought, wow, this is so interesting. These sneaky insurance companies sent the doctor their first offer, and what they didn't do was attach the UCR. They gave a random list of codes, not all of them, and then totaled them at the bottom, and it was something like $6,500 for these 10 codes.
Jeff Blumberg: That was the new offer?
Jeff Santone: That was the first offer.
Jeff Blumberg: What were they currently getting for those codes?
Jeff Santone $12,000.
Jeff Blumberg: The full fee was $12,000. They weren't participating yet, because they were just opening the practice. So the insurance's proposal was almost a 50% haircut.
Jeff Santone: The negotiation company goes back and forth, and they send it again with their new proposed offer compared to the original offer, which was about $8,500 now.
Jeff Blumberg: So it went from $6,500 to $8,000, full fee was $12,000.
Jeff Santone: Yes, and since they're leaving the full fee out, it looks like, "Look, we got you a 25% increase in the fee." It was still a 38% discount off their fee schedule. It was insane. From an insurance company's point of view, I thought it was very smart. It really does make them look good: "Look, we just got you this 25% increase in your fee."
Jeff Blumberg: The fact that there's an industry that does that now is something. That industry did not exist when I started in this industry, during the first Clinton administration. Back then, PPO proliferation was minimal. They were just starting to come on. The idea that there'd be a company that would be the intermediary between you and the insurance company, I'm not saying it's bad business. It's fine. You also have companies now that will file your insurance for you. One of those got bought a couple of years ago by Shine, and Shine also bought a fee negotiation company. The big fish are gobbling up the little fish. The fact that there has to be a company to do that just shows you. I'm not saying that's wrong or bad. I think we even have a couple of those companies in our GPO, our buying group, that do fee negotiation. It's shameless plug time: MGE has an excellent buying group, by the way, called DDS Overhead Management. I'll put a link to it on the episode webpage. It's for MGE clients only, with great discounts and quality products.
Jeff Santone: You had to throw it in there.
Jeff Blumberg: So I don't fault that business, but if I'm taking insurance, wouldn't it just be easier to say I'm just not going to take it? I can see that you're talking to guys who say, "I just can't see my way out of it." I should probably do another episode on getting out of plans, because we've had a lot of clients get out now. A more recent thing Sabri had clients doing that was really smart: where people are going to notice you've dropped their plan the most is with preventive and diagnostic procedures, so cleanings, x-rays, and exams. What she's had a few clients do is lower their hygiene fees to whatever the PPO fee was from the biggest PPO they had. Say it was cleaning, bitewings,and a periodic exam, let’s ay the out-of-network reimbursement is $212 and the full fee is $314. She had them set their hygiene fees across the board to $212. On the plus side for those patients, the procedures you do the most of are preventive and diagnostic, and nothing changed for them. If you're doing basic or major work, they're expecting to pay something. That's built into the mindset: if I'm going to get a crown done, I know there's going to be an out-of-pocket cost. Then she has them raise their basic and major fees up to normal fees for their zip code, so the crowns might go from $865 in network to $1,500, because that's what it really costs there. That's been pretty effective.
Jeff Santone: If people don't notice a difference and they want to stay with their dentist, and that's the other big thing, there's this fear that everyone's just going to walk out because you don't take their plan.
Jeff Blumberg: Most people won't. 70% of people stay, except with Delta, because Delta really goes after people.
Jeff Santone: They make it really obvious. You can play that game, and it's well worth it. In my opinion, negotiation companies exist for a reason, because somebody's doing it, but I've never seen anybody get a fee negotiated to an amount that's an acceptable discount.
Jeff Blumberg: I guess it comes down to what would an acceptable discount be? For me 10%.
Jeff Santone: And next year we're going to have inflation of another 5% or 4% or 3%, and they're not going to bump you again. You get this one time, and they pick and choose which fees. I've seen them say, "I'm going to bump you up here, but I'm going to lower this here, because I have to stay within my total of $8,000." I remember playing those games, and at the end of the day it isn't worth it.
Jeff Santone: A lot of the doctors we talk to say, "Hey, can we negotiate?" and I say, not really. Most of them don't negotiate, not to a level that's acceptable.
Jeff Blumberg: They will: $6,500 to $8,500 but they already knew they were going to $8,500.
Jeff Santone: Right they already knew what their top was, and it was still a 38% discount. It's an interesting conversation to have with a lot of owners, because they say, "Well, at least we're going to bump it up," and I say, yes, but you're still getting ripped off.
Jeff Blumberg: Obviously I know what we do with these folks, but maybe you could explain. If I call you and say, "I want to get out of network," what are you going to do with me?
Jeff Santone: We're going to have a conversation and grab some data. To me it's always about confronting the situation: what's your real risk exposure? That's all I'm trying to show a guy. I did this example with a doctor last week. We did a seminar, a pop-up called "Pennies for Premium Care," which was a lot of fun. We talked to a lot of guys, and I met one who was willing to go further. I ended up having a meeting with the doctor, and he said, "I'm getting out of Delta at the end of 2025." I said great, do you have all the data? He said yes, so we ran the numbers. On average, his discount across his preventive, basic, and major services was about 50%. That's where you came up with the insurance analyzer
Jeff Blumberg: I'm having you explain it.
Jeff Santone: If you can figure out how much money you gave away by having Delta, the difference between your UCR and what they pay, then you can calculate how many fee-for-service patients you'd need to make the same amount of money. It's simple math. If my maximum fee is $100 and my discount rate is 50%, then I only need one out of two Delta patients to stay with the practice to make the same amount of revenue. I'd actually be significantly more profitable. So we ran the numbers and he was blown away. He said, "So what you're telling me is half the practice that has Delta could walk, and I'd still be okay?" I said, in fact you'd be more profitable,
Jeff Blumberg: Because you'd be working less, with less material cost, fewer lab fees, and less labor. He said, "Oh my gosh, that's eye-opening. Maybe I should start with Delta." I said no, no, no, say that one for last. That's your big one. We're going to start with the little ones. But if you can confront the situation data-wise, he only had something like 514 Delta patients. At his worst-case scenario, if every Delta patient left, he'd only need about 250 fee-for-service patients. So if 30% of the practice leaves, you're actually doing pretty well, because your discount is 50%.
Jeff Blumberg: For those of you who are newer listeners, the average loss from a PPO is going to be about 30% when you drop them.
Jeff Santone: And if you do it right, you might only lose 20%. If you have the numbers, you can line them all up and see who your biggest risk exposure is, by dollar value and by patient. We sort that list, and then we say, this is where you should start. You start with your 1%, or 3%, or 9% insurance, whatever it is, and you learn a lot from that. You figure out the things you're not doing properly in handling it, and that makes you better on the next letter you write, and the next one, and the next one.
Jeff Blumberg: So you walked him through this. What do you call that?
Jeff Santone: An insurance analysis.
Jeff Blumberg: We can do this at no charge. I'll put a link to it on the episode webpage if you're interested. The problem a lot of guys have, I find, is that some people are pretty together and like figures and facts, and then there's a funny thing I don't know is limited to dentists and doctors. If all of a sudden our seminar attendance and course attendance were cut in half, yet our revenue remained the same, or actually went up with higher profitability, it would still freak me out a little bit, because, where are all the people? I don’t feel busy. And I like people. I'd much rather have a full seminar room. I think what happens is they start dropping these plans and they see patients migrate out of the practice, albeit a small percentage, and we tend to focus on the negative anyway as human beings. Then people freak out that they're not as, quote unquote, busy anymore, but they're not comparing that to the actual revenue and profitability. It's not a small thing, and there are contracts involved, so it's an overwhelming move for a lot of people. That's why I recommend they do something like this. I think we call it the Fees and Plans Analysis. It is free. We're getting close to the end of the year, and I don't know whether this episode airs before or after the new year, but take advantage of it. Launch yourself into 2025 actually getting out of insurances.
Jeff Santone: I think that would be great. Just have the numbers ready, is really all I tell anybody. If you have the numbers, you're armed with a lot more information, especially your risk exposure.
Jeff Blumberg: Let's assume they don't have the numbers. You can help them get the numbers.
Jeff Santone: It's super easy. Really all you need is your fee schedule.
Jeff Blumberg: Mainly you're looking for how many patients are in the plan, how much revenue they made from the plan, and the fee schedule for the plan, which their software should be able to kick out.
Jeff Santone: It's pretty easy to get. Even if they don't have any of that, if you just know your fees versus your UCR, which they can get from their front desk, that's super simple, and I can walk them through it.
Jeff Blumberg: That's problem number one, insurance. We're hearing that a lot more. This is our problem: we're always too early. We were yelling about the recession and inflation in 2021, and people said, what's wrong with you? Then we were talking about insurances, saying they're squeezing here, and we had a few people talking about it, but now all of a sudden it's a huge thing.
Jeff Santone: I think it's a huge thing now because of inflation. You could get away with continuing to play the game when there was 1 to 2% inflation and fees moved 1 to 2%, and it was okay. But now, when you're paying a hygienist the same as an associate doctor, you can't play the game like that anymore.
Jeff Blumberg: So that's number one. What's number two?
Jeff Santone: Number two is probably a result of number one, in my opinion. We hear a lot about hiring.
Jeff Blumberg: Specifically hiring or staffing? What aspect?
Jeff Santone: "I can't find people. I can't find staff. I can't find quality staff."
Jeff Blumberg: Is it a particular position, like hygienist or assistant, or is it anybody?
Jeff Santone: It's anybody. Any general dentist right now, or perio, is always saying, "I can't find a hygienist." That's true. You're in competition for every hygienist out there. But it's also the other positions in the practice. They just can't seem to find people, and they're getting no responses from their ads. If you ask them what they're doing, they say, "I'm going through the standard way of hiring," and you say, well, one, that's not going to work, and two, you're out of touch. You have no idea who you're competing with these days.
Jeff Blumberg: Do you see any commonality in what people consider best practices for hiring that aren't workable?
Jeff Santone: The idea that people need to have dental office experience. I hear that a lot. Definitely for a hygienist, or anybody who requires a license, that makes sense. But do you need experience?
Jeff Blumberg: When somebody puts a hygiene ad out, you always get someone saying, "I'd like to apply for the hygiene position." "Are you a hygienist?" "No, but I'd love to be one."
Jeff Santone: “Do you need a license for that, can’t you just teach me on the fly?” No. But every state is different. In Washington, DC, for years, dental assistants and surgical assistants didn't have a requirement for X-ray certification, so we just trained them ourselves. Anything that needs a license, fine. The way to put it is: the fewer requirements necessary, the easier it is to find people. The more requirements you put in the ad, the more you limit your population.
Jeff Blumberg: So they really have to zero in on what's really required. I mentioned this before. I think it was Chris Menkhaus or Sabri who told me this: when they have clients place ads for hygienists, they don't put any filters on. On Indeed, when they take the filters off, they get a ton of responses, because there were people being filtered out who were licensed RDHs but, for some reason, weren't showing up when the filter said they had to have a license. Maybe the person who applied didn't mark that they had a license, even though they did, so they didn't show up.
Jeff Santone: It's a little thing. You hear hygiene a lot, but you also hear the rest of the practice, like admin teams and dental assistants. There's not enough emphasis put on the front end of the office, in my opinion. Almost every office I talk to is significantly or severely understaffed up front, and the office is then super stressed, unbelievably stressed. Once you have an understaffed admin team, the rest of the practice is eventually going to feel it. We've got holes in the schedule but nobody to call. Why is our AR out of control? I can't follow up on that and check people in. "I forgot to collect it. What about the lab?" We see that, but the hiring for those positions is not done in a way that I would recommend, or that the company recommends. It's kind of like, when I need somebody, I start looking, and that's too late. You also compete now with the likes of Starbucks and Whole Foods and Target, and they offer better money, better benefits, and consistency.
Jeff Blumberg: It depends on the person. Some people are more entrepreneurial, others are not, but if someone's looking for a stable long-term career with upward mobility, they may want to go to a big corporation, because they can start small and work their way up. I've known lots of people like that.
Jeff Santone: Or it's just better pay. So many doctors I talk to say, "My staff member just left me for a position down the road," and I say, can you blame them? A gallon of milk is what, seven or eight bucks? If you're going to get a dollar or $2 more an hour, and they have kids, they say, "I'm taking it. I'm sorry. My loyalty only goes so far." So in my opinion, doctors are not in tune with their competition. They think they're competing against their fellow doctor. They're competing against major corporations, and because they gave their money away to the insurance companies, they're getting a bit stingy on staffing. They're getting squeezed hard.
Jeff Blumberg: Let's take a look at this for a second. I'm not the only one having a problem finding good staff. So is the guy down the street, and the person around the corner, and the other person in the high rise over there, and there are also big corporations in the area that now pay more than they used to and have better benefits than I do. We're all looking for people. To compete, the first thing I'd want to know is what people are getting paid today. I used to recommend salary.com, and I don't anymore. Not because I have anything against them, but I think they didn't keep up. I haven't looked recently, and I now just check Indeed. I had a client in Southern California, and another client in the same area told me he had just hired a hygienist, this was a few years ago, at $65 an hour. I asked how much they were paying in 2019, and it was something like $42. We had another client near this client who couldn't find a hygienist for the life of him. So I went on salary.com and put in their zip code. Normally it gives you the low, median, and high. The high for that zip code was $55, and the median was in the 40s, so I don't think they updated. Things were changing so fast that salary.com couldn't keep up. So, like you, I went to Indeed and looked at what people were paying in this area for this position. There were lots of people looking for a hygienist, and $60 to $65 was very common. I saw that client's ad for $50 or $55, and I thought, they're just going to get skipped. To top it off, a lot of corporate offices were offering signing bonuses, like these hygienists were LeBron or something.
Jeff Santone: Four or five thousand, with fine print.
Jeff Blumberg: But here's where it got interesting. I started looking at other areas, and Indeed is a great source for that. At the time, I looked at Miami, the Miami-Dade area, and what the hygiene market was like. There were no signing bonuses, and salaries were lower than what people were paying here in the Tampa-St. Pete area. It's supply and demand. Eventually the economy's going to take care of itself. There are a lot of hygienists down there, so for clients in our area having trouble finding a hygienist, I said, advertise in South Florida: do you want to move to the Tampa-St. Pete area? They're all licensed in Florida. If you find yourself getting squeezed, number one, I'd want to know what people are paying a treatment coordinator, a schedule coordinator, or a receptionist, because I at least have to match that. Number two, if there's a particular position, and I know assistants and hygienists have definitely been a problem the last few years, I'm going to train assistants as much as I'm legally capable of doing, and a lot of people can just get X-ray certified. You find somebody who has good aptitude and wants to be an assistant. For a hygienist, and this isn't necessarily the case, let's say I'm in the LA area and there's no hygienist. I might look at other metro areas in California, like San Diego or Northern California, where somebody might fit the bill. You could even make part of the package, instead of a signing bonus, moving costs.
Jeff Santone: There are so many ways to be creative. It's one of the areas of the practice where a lot of owners, rightfully so, and I understand it and I'm not trying to criticize them, just throw their arms up and say, "Hey, man, it's kind of working. I don't have the attention span to also stay every Wednesday night to do interviews to find people."
Jeff Blumberg: That's why you need an office manager.
Jeff Santone: Hiring is a huge issue. Take hygiene out of it and it's also finding admin staff, and there just isn't enough attention put on it. If there's no squeakiness going on, you're not going to put any oil on that wheel. If the staff aren't coming to you and saying, "We're not able to do this," which they won't, by the way. When I talk to a lot of doctors and ask how their staff are, they say, "My staff are stressed, they're frustrated, I can see it in their faces." I say, good, what are you doing about it? And they say, "What do I do?" I say, well, they're going to quit soon. They're looking. The tension is going to become too toxic, and they're going to look for jobs. So I always tell everybody, you should always be hiring. Always be closing, sure, but always be hiring. You can't stop hiring no matter what, even when you're fully staffed.
Jeff Blumberg: It's also what people forget when they're placing an ad for employees: that's marketing. You have to know how to market a little bit to get good employees.
Jeff Santone: You really do. Once in a while, when a client comes on board and we do their onboarding and their first meet and greets, they'll ask me to look at their ads, and I'll say, the message in your ad is going to attract the wrong person. So you definitely have to do something different. I've been working with another group, a massive office with five hygienists, three doctors, and four people up front. I'm talking to the office manager, and they're a client now. I said, are you stressed? She said, "Oh my God, I'm so stressed. I can't deal with insurance now." I said, okay, you guys need to be hiring now. Today. I think it's a combination of two things. One, I don't think the doctor is always aware how understaffed they actually are, which leads to staff leaving because they're stressed and overworked. Two, they don't put attention on always hiring.
Jeff Blumberg: Let's say I'm listening right now and I wonder, do I not have enough staff, or do I have too many? Is this something I could call you about and you could help me with?
Jeff Santone: Yes. We'll take a look at your staffing metrics versus production and find out dollar values: where you could afford it, why these people aren't doing anything else. You added staff, but they're not adding value. This is stuff we look at.
Jeff Blumberg: We'll put your email on the episode webpage. The other thing to think about is what goes missing when you have an understaffed front desk. They're keeping up with the current traffic and that's about it. They're not building the practice. They're not able to reach out. They're not calling all of the patients who are slowly going inactive. The 3,000 patients who've been in over the last couple of years are just not getting called. The incomplete treatment list is not getting worked at all. We're just handling the incoming. Theoretically, we could be losing half of our income like that.
Jeff Santone: Easily. You and I talk about this sometimes, and you hate when I say some of those things, but I'm going to say it anyway. I issue challenges to a lot of doctors. When we're at the New Patient Workshop, one of these challenges is the attrition rate challenge. I'll bet anybody there $500 right now that if you open up your database and pull the list of patients from today back to the same date last year, 40% of those patients do not have an appointment in the future. They're in your reactivation list, or in your recall program somewhere.
Jeff Blumberg: Say it's November 10th. I pull a list from November 10th of last year to now, and you’re betting me that at least 40% of the patients who have been in the practice in the last year do not have a next visit date after today.
Jeff Santone: Mathematically it's the only explanation for how you're getting 50 new patients a month but haven't added any days of hygiene.
Jeff Blumberg: How often do you win that bet?
Jeff Santone: No one ever takes me up on it. I'm always going to win. I've done it enough with enough doctors, where I've been doing some of the reactivation with them.
Jeff Blumberg: Don’t the staff usually underestimate and the doctor overestimates? If you ask how many people have a next visit date, the doctor says, "Oh, at least 85%," and the staff says, "10%." The doctor's super optimistic about it:
Jeff Santone: "We book everybody, no one leaves without an appointment." The staff say, "What are you talking about?" That's true of most practices. Some doctors don't appreciate how amazing some of their staff are. They're complaining about the hole in the schedule today in hygiene, and the front desk is thinking, "You have no idea what dumpster fire we walked into today. We had one person on this schedule, and we managed to get six more in." That happens on a regular basis. As you said, that's a hiring issue, because if you're just handling day-to-day operations, anything that slips through the cracks, you're not staffed to pick up.
Jeff Blumberg: You need to be staffed to continuously reach out from the business, to follow up with people who are not in the business today or are not going to take the initiative to call you.
Jeff Santone: That's a ton of wasted energy, promotional dollars, and opportunity. A lot of these practices are absolute gold mines. I hate to reference it as money, but there's an opportunity to help a lot more people. We're constantly trying to attract them in the front door, and then we go to the back door and open it up twice as wide and shoo people out.
Jeff Blumberg: And then they end up essentially becoming a specialist as a GP, living off their new patients.
Jeff Santone: Right, or "We need new patients, because all of our existing patients are clean." That's only because the top tier of patients are the ones coming in, the guys who never have any problems.
Jeff Blumberg: If folks are having trouble with this and want to know whether they need staff, they can make a call to you, and I'll put the link on the episode webpage.
Jeff Santone: Come on, let's have a meeting and talk about it. Talking's free.
Jeff Blumberg: Let's get to problem number three. This is based on you collating all the data. Insurance, staffing, and number three kind of took me by surprise. Tell everybody what it was.
Jeff Santone: Scheduling. Just problems with scheduling productively. A lot of people are complaining that their schedule is falling apart.
Jeff Blumberg: Do these people have a system, or is it "open slot equals put person in slot"?
Jeff Santone: That's what it is. They have no system. Well, they might have a system, but it comes back to how everything is connected. In my opinion, it's all connected to the amount of energy or income or profit you can put back into the practice to train the staff properly and find the time to do that. You cannot do that when you have a $2 million practice in production and you're going to take home $150,000 this year, because you're running around on roller skates. Scheduling comes up a lot, the inefficiency of it, and the fact that there are days where they say, "Man, I didn't get to eat today and we didn't produce more than $1,000," and then there are days where they say, "I feel like I'm sitting around and we did $8,000." There's this inefficiency in scheduling.
Jeff Blumberg: Sabri and I were visiting a client recently, looking at their schedule, and one of us pointed out that the schedule is supposed to be a schedule. It's not a suggestion. It's just become a suggestion. If a procedure takes an hour and a half, you schedule it for an hour and a half. You don't schedule it for an hour hoping everything's going to go perfectly, even though it's never gone that fast before, because then you end up in a situation where you don't really have a schedule.
Jeff Santone: You're just upsetting people.
Jeff Blumberg: And it makes it tough on you, the doctor. You feel stressed, and everything feels like an emergency, not in a dental sense, but you're constantly operating in panic mode.
Jeff Santone: When you talk to doctors about the scheduling problem, it's like they found an open slot and just shoved a patient in. I ask, where's your policy on what to do? Do you have a manual? No. Well, then they're doing the best they can.
Jeff Blumberg: How many people are saying they have zero scheduling system? Obviously they have some type of system for hygiene, because hygiene appointments take a certain amount of time. By "no system," do you mean we do these types of procedures at these times?
Jeff Santone: I would say 80% of the people we talk to have zero policy in writing on how their practice schedule should operate.
Jeff Blumberg: What's shocking about that is that if you talked to a doctor in the 1990s or early 2000s, I would say at least 50% had a system, or were used to some system, like primary, secondary, and tertiary procedures. We're doing primary procedures in the morning. That's where that all came from. They'd tell the patient that the doctor does these procedures in the morning because that's when he's freshest, which I'm like, please don't ever say that, because I'm going to end up getting four crowns done at 3 PM and wonder if the doctor is upset and tired now. That drill looks scary. But most people at least had been exposed to a system like that. The problem was they couldn't implement it, or the staff couldn't get patients to show up in the morning. But you're saying these guys don't even have a system.
Jeff Santone: They've been exposed to systems. They know of the system. They have this idea that they should do primary procedures, but if I ask where it is, it's kind of like Bigfoot or Sasquatch: it exists, but I've never seen it. Since there are no policies in writing on how to operate the schedule, it's kind of an exercise in theory. "Theoretically, how should we operate the schedule?" "Well, Dr. Smith says we should do X, Y, and Z." "Do you do that?" "Well, we do that until we get a hole, and then we throw somebody in."
Jeff Santone: Again, there are parts of the practice that lead to these issues. We've probably spent multiple episodes talking about the fact that if a patient isn't sold, they don't come in. And we've done episodes on the scheduling system. We have that stuff everywhere. When I talk to doctors, I'm not trying to rag on them. I totally understand that they want to be a dentist. But the minute they sign their loan docs and the practice documents, they're owners, and the responsibility of ownership is to ensure the success of the practice, the efficiencies, and stable growth.
Jeff Santone: One of the questions is, how do people get into a schedule, and how do you correct it? If we're going to do $8,000 a day, how do you foresee yourself doing that? What's the plan, and is it real? There are a lot of guys I talk to, and I ask, what's your goal? "Our goal is $15,000 a day." How many chairs do you have? "Three." That's the maximum. What are you doing on average? "$2,000." So it's an unrealistic goal. How did you come to that goal, and is it possible to achieve it with your current setup and staffing requirements? It's not. But there's no policy, so the schedules fall apart and the doctors are frustrated and sitting around. One thing I'll ask them is how many hours they work a week. They say, "I'm here Monday through Thursday, and I do four hours of admin on Friday." I ask, how many hours of your four days do you think are wasted? "Anywhere from four to eight hours." That's a whole day, spread out in 10-minute increments, 20-minute increments, another 30-minute increment. When you look at it, could you lose four hours in four days? Easily, without a doubt.
Jeff Blumberg: What's funny about this too is that most people have switched to a 10-minute book instead of a 15-minute interval. If you're going to run on 10-minute intervals, the amount of control and expertise required to properly schedule the office and make it efficient is higher. The person up front needs to know what they're doing to make that work. If you schedule it correctly, you can take, like you said, four days of work and turn it into two and a half, which opens up all that time.
Jeff Santone: It's interesting that this one has come up, because everything cycles.
Jeff Blumberg: For me, at least, it hasn't been a top three. It's usually new patients, revenue or profitability, and staff. Insurances come up off and on, in the sense that people hate them, but it was never the number one problem. It's always been new patients, staff, and profitability, the big three usually
Jeff Santone: Maybe one of these will fall out in the next six months or a year, but it was shocking how many guys were talking about the inefficiency of the schedule, and how many were interested in hearing about a solution for it.
Jeff Blumberg: . So let's talk solutions for a second. We have a few. Number one, we have a seminar we do for free, about once every few months, called The Art of Scheduling Productively. We also have a similar version of that on our online platform, DDS Success. I'll put a link to that as well. So you can do the free one with Jeff, or the one on the online platform. We also have the big definitive seminar we do here at MGE, called Scheduling for Production, which is two days long and we do it twice a year. I'll put a link to that as well. When people really implement this, the change is marked. It's big.
Jeff Santone: It gives them the idea of time studies, which are huge, and how much the primary block should contain, and at what point, and the policies. We hand out so much free stuff.
Jeff Blumberg: The thing I like about ours is that I could sit here and say, this is what an ideal schedule looks like, but it's sort of like somebody who's completely out of shape looking at a fitness model. This is how an ideal body looks, and I'm never going to get there. We don't do that. Instead we tell them, here's what we're going to do Monday to start moving. There's a point A where you are, and you want to get to point B. How do we get from point A to point B? We do it in doable steps, as opposed to "here you go, figure it out, good luck." That's funny, though, scheduling. When you told me that, I was shocked.
Jeff Santone: Even I was shocked because, as you said, we still hear new patients, don't get me wrong. It’s always new patients. Scheduling is the same as it was when Dr. Winteregg was talking about it. It is the same as it was back in the day when Greg did the scheduling DVD. We'll still go through the system. But the thing we're going to teach them at The Art of Scheduling Productively is that it doesn't matter what system you get. You could have our system, or the rock, pebble, sand system. They all have primary blocks and these differences. If you put people into a schedule the same way in any system, and that's the definition of insanity.
Jeff Blumberg: You also have to get the people to do it.
Jeff Santone: You have to have the policies. It all comes back to the same thing. We don't have money. We don't hire the right staff. We don't take the time to write the training manuals. We don't then create the system. We don't put the people in. We don't write the things someone can come and look at. A lot of times I'll ask these guys at the workshop, what happens if this is done wrong? What are you pointing them to, to show them how to do it? They say, "Just talking to them." I say, that's not going to work very well. How are you going to ever correct anybody, or train anybody, if it's not a written policy? They're all interconnected. But The Art of Scheduling Productively is fantastic, and there is something you can do about it to commit people to the schedule you're laying out. It does have to make sense. You should be able to take lunch. If you want to work 7:30 to 4:00 every day with an hour lunch.
Jeff Blumberg: You have to have time to sell. We have all of that. I'll put the links to it on the page.
Jeff Santone: It was an interesting one that just came up this quarter that I just started hearing more and more about.
Jeff Blumberg: I think it's timely, because we're rolling into the new year. This is the time period when we've elected to make changes: we're towards the end of the year, so we're going to hold off and make a change in January. As you consider these, there's a good chance that one or two or all three are affecting you in some way. I put the links on the episode webpage, and I would definitely advise you to contact Jeff, or someone on his team here in his department.
Jeff Santone: Someone on my team, yes.
Jeff Blumberg: I think those are three great things.
Jeff Santone: If they can start to address them next year, they could have their best year.
Jeff Blumberg: They could even start this year. I don't know the exact air date, so if it's still this year, you can do it this year. Otherwise it's next year. Just do it. Jeff, thank you for being on.
Jeff Santone: Thanks for having me. I really appreciate it.
Jeff Blumberg: So, folks, that's what we have for you this week. Thank you so much. If you have any questions or want to know more about MGE, you can find us online at mgeonline.com or call us at (800) 640-1140. Don't forget, we have the links that were mentioned in the episode on the episode webpage. Other than that, please have a great week, and we'll see you the next episode.