Dr Michael Sernik, April 2004 - “My staff are reluctant to call ‘old’ patients who have dropped out of our recall system. They hate calling these patients and I think they will quit if I insist they call. This is very important to me because I want to hire a new Assistant dentist but I’m not growing quickly enough. How do I get them to do it?”

Dr Harry called me 12 months ago. He’s a Brisbane dentist who had been told by a management company that the quickest way to boost his income was to get his staff to call the patients on his ‘dead’ file. (No, I don’t mean hold a séance).

I told him NOT to call these patients.

Here is why.

When his staff started to call those patients, they were so uncomfortable getting rejected and having patients hang up on them, he was facing a mass staff resignation. Well, I needed more information before I could offer any advice. Sometime calling the ‘dead’ file makes sense. Sometimes it doesn’t.

To solve any issue you need to understand 4 things.

1. How big is the problem and what is it costing you?
2. The cause of the problem.
3. Your ability to rectify the problem.
4. Is the ‘cure’ the best use of your resources?

This is what I needed to know.

1. What is Dr Harry’s hourly rate?
2. How many Active Patients (unique patients seen in the last 18 months) are there?
3. What is the Retention Rate? (number of patients of record who came for Active Maintenance this month x 6 as a percentage of Active Patients) This tells us what percentage of patients are returning for regular maintenance (you might call them checkups/cleans/recalls/recare /preventive care, etc.)
4. What is the Dentist to Staff Ratio?

After 5 minutes on their computer, this is what we discovered about Dr Harry.

1. His hourly rate is $290/hr. (This is lower than our benchmark number.)
2. There are 1540 unique patients. (This is higher than our benchmark number.)
3. His Retention Rate is 28%. (This is lower than our benchmark number. When I ask any dentist how many patients return regularly, they usually guess its anything from 70-90%. Most Dentists seriously overestimate the effectiveness of their Active Maintenance System.
4. The Dentist-Staff ratio is 1:2.5. (1 DA, 1 Front Office Manager, 1 part time Practice Manager.) (This is lower than our benchmark number.)

So what have we learned?
Item 1: Dr Harry has a relatively low hourly rate (while it’s not our goal to boost a dentists hourly rate, unless that is what they want, a low hourly rate usually indicates a lack of comprehensive dentistry)

Item 2: Dr Harry sees lots of patients every day
Paradoxically, our most successful* dentists (lots of income, lots of free time) see the fewest patients. It’s difficult to do high quality comprehensive dentistry when you have a waiting room full of people.

Item 3: Low retention rate
If your patients are not returning regularly in an Active Maintenance programme, you need to implement proven systems involving practice protocols and verbal skills for the whole team. This is a lengthy process, but we often see a 400% increase within 2 years. This makes a very large difference to your ability to add clinicians, and develop the practice into a leveraged* business (*create a recurring flow of income).

Item 4: Dr Harry does not have enough staff
Being cheap with staff usually costs you dearly. A dentist cannot provide high touch ‘customer’ service if he/she is understaffed. There are lots of powerful protocols that need to be done if you want your practice to grow efficiently. If you want patients to accept your treatment plans and refer lots of other fans, you need to spend a lot of time with each person. Typically a fast growing, high earning, efficient large practice needs around 4 staff per dentist. (Don’t just hire more people. You need to know what to do with them)

Dr Harry has been in practice for 19 years and though the practice had many years of rapid growth, it has reached a ceiling. Short examination times, too much drill and fill dentistry, lack of schedule control with many inefficient emergency appointments squeezed into the day created stress for everyone. He spent the day trying to catch up.

After one year of Practice ‘Makeover Therapy’, his hourly rate is over $500/hour; he has just hired a full time assistant dentist with a ‘view’ to doing a buy-in transition; they run on time because they know how to get control of their schedule; they have 4 more staff members; have a lower overhead percent (was 68%, now 58%, not because they cut costs, but because they boosted income). Everyone has more time off.

Every practice will have some patients who drop out of the Active Maintenance Programme, but when you run an efficient system you should have no more than 5% attrition. When it’s more than 5% you should regard it as a symptom of a breakdown in protocols and verbal skills.

Simply dragging reluctant patients back into this flawed system is an inefficient, unpleasant, short-term example of symptomatic treatment. It’s far more productive to learn how to prevent the leaks in the first place.

[Published Australasian Dental Practice, April 2004]