Dr Phillip Palmer, October 2002 - Many people think that dentistry is not the profession it once was.

It isn't – it’s potentially a better profession than ever. I believe we are in the early stages of a golden era for dentistry - full of opportunity, abundance and with wonderful prospects (for those who want it), to have a full, and enjoyable and lucrative career. There will also be those of course who find it a very ordinary "job", and those who will at best, struggle.

There is a considerable shortage, I believe, developing in the profession, of dentists who want to go into private practice on a fulltime basis. This is to a large degree because of the relatively new phenomenon of many dentists becoming public health dentists or health fund employees and also because of the change in the demographics of who is going through the dental schools.

A large percentage of the graduates are female, and many of them have less desire for a long, or fulltime career than graduates of 10-40 years ago who were predominantly male. They want to combine it with starting and raising a family (I know this may sound sexist, but it is still primarily the females who take time of from their careers for family reason).

Alongside the decreasing number of full-time dentists, more of the population is keeping more of their teeth into old-age, and requiring more dentistry as a result. Finally, there appears to be a groundswell of greater and greater demand for cosmetics in dentistry, and this demand again is being met by fewer and fewer in the profession.

If all this is true, as I believe it is, then how do we get dentists to satisfy that demand and at the same time manage for themselves a satisfying career and business.
In the last issue we discussed all the various expenses of running a practice, and what percentage these should make up of total production.

Obviously the higher the production, the lower the percentage the same expenses make up. For example, a practice with employee expenses of $100,000 would have a 25% employee expenses if production was 400,000 and 16.6 percent of production was 600 000 yet no decrease in pay was involved.

It is impossible to absolutely benchmark practices incomes, because of the huge variation in hours worked, types of dentistry performed etc. What we can do is talk about what areas of income should be tracked to compare with "best practice".

The areas that Prime Practice recommends to be tracked include the following statistics:
 

• Total Doctor production
• Doctor production per hour
• Hygienist production per day (and total hygienist production)
• Amount of unused time for dentist/ hygienist (and whether its because of cancelled appointments, no-shows or no bookings)
• Accounts Receivable, Accounts Receivable ratio, and Accounts Receivable percentage over 90 days
• Collection Percentage
• Number of New Patients
• New Patient Potentia
• New Patient Value
• Case Acceptance-New Patients
• Case acceptance -Patients of Record
• Case Acceptance and New Patient Potential for Walk-ins Or Yellow Pages Patients vs Referred Patients
• Percentage of Patients involved in Six-monthly recall system
• Percentage of patients paying on the day
• Credit Adjustments
• Emergency Patients converting to Patients of Record
• For Specialists----Number and Value of referred patients by each Referring Dentist

I have not tried to list here what each one of the above statistics should be, partly because it would vary so much with different situations but mainly because if I did that it would end up as a book. What I am trying to show is that if you wanted to, you could track how you're going in a huge number of areas of your practice, depending on what you want to achieve.

When you boil it down, the one statistic that is a true measure of how much you're improving your efficiency is the Dentist production per hour. This will prevent dentists working harder and harder to produce more and thinking they're getting better and better results.

Dentist production per hour can be improved through:

• Greater teamwork/efficiency
• Different diagnosis or case type
• Improved case acceptance/ treatment presentation
• New equipment &
• Increasing fees

Hygienists

What should a hygienist produce and how much should I pay her/him?

I should note before going any further that I include in Hygienist production any work done in her/his room. That is, any check-ups done and x-rays done in her/his room and any bite splints, bleaching etc that is commenced in her/his room.

If that is included, then a hygienist production should be up to and over $1400 -1500 per day (an 8 hour day) when averaged over a year (that way it will include cancellations, no-shows etc.). For a hygienist working a 4 day week, 45 weeks per year this would amount to $250 000-$270 000. Equally we should all realise that most hygienists are more likely to produce (at least before their dentist takes on a management programme) $500-900 per day.

Payment for hygienist's wages is a very controversial subject. Firstly it is a matter of supply and demand and everywhere I go around Australia I get told of the enormous shortage of hygienists that exist everywhere.

Ideally hygienists should take home approximately 1/3 of their production. The previously accepted guidelines were 1/3 for the hygienist, 1/3 expenses and 1/3 for profit for the dentist. However the shortage has lead to the amount for the hygienist going to 40-50% and above of their production, just so that the dentist can pay market wages.

And what are market wages for hygienists?

We've seen anything from $25 per hour going up to $70/ hour depending on which city and state the practice is in and demand for hygienists in that state. Other factors that influence the hygienists wage rate include: his/her experience level, the equipment being supplied by the dentist, and the desirability of the "job"-including the dentists knowledge and experience level in using a hygienist, the type of practice, what staffing the practice has, and the leadership style of the dentist.

Hygienists can be very valuable members of the dental team and contribute enormously to the profitability of a practice-if it's the right practice, and if everyone on the team is committed to the concept.

However the biggest contribution to the profitability of the practice comes not from the figures generated by the hygienist (considerable tho' these might be), but by the amount of dentist's time that is freed up by the presence of the hygienist. This results in the dentist being available to do procedures that are generally regarded as being more sophisticated and more remunerative (and for many dentists more satisfying) than scaling and polishing and oral hygiene instruction work that can then be passed on to a staff member that is trained superbly well to do that work.

Simultaneously the hygienist can add a very valuable role by being a 'second opinion' for patients to use as a sounding board for considered dentistry, thus contributing to a higher case acceptance for the practice. Lastly, but by no means least importantly, it is such a pleasure for the dentist to work on clean and healthy mouths.

Most dentists who have used hygienists would never be able to work without them again. Maybe they know the true value of working with these truly wonderful additions to the dental team.

[Published Australasian Dental Practice, October 2002]