Dr Phillip Palmer, November 2006 - Every year coming up to the Christmas break, I hear the same stories from many dental practices with the same problems.
There are two commonly recurring problem areas for dental practices at Christmas time. The first problem area is the Christmas rush and the second is the office closure. Both problem areas need to be addressed by dentists with structure and protocols so that their impacts are controlled.
The Christmas rush
I do not think that the general population at large would believe there is Christmas for the dentist but almost all dentists would agree that there is a Christmas rush that exists for their services.
From about early to mid November onwards, patients start coming out of the woodwork and saying that all year they’ve been thinking of that crown, that implant, that bridge, or even that gum work, and that they have finally decided they want it done, finished and over with before the Christmas holidays.
Even though you have had occasional quiet spots, and for some, been able to drive a truck through the gaps in your appointment book in some months, suddenly by early December, you are just about booked-out until the day you go on holidays. And if by any chance, you yourself are not booked out by then, your favourite ceramist or plastics technician rings you around then and tells you that he cannot accept any more work from you because he’s booked out.
No one really knows why it happens. It isn’t like people buy teeth for Christmas presents and/or dentistry doesn’t go up in price after Christmas every year.
I have heard many slightly different explanations for the phenomenon. One explanation is that it is health insurance induced. Some company’s cut-off for entitlements is 31 December – this creates a ‘panic’ effect, as patients want to use their dental insurance entitlements before they disappear.
Another explanation is that it that there is just an artificial deadline produced by the fact that many of us are going to be on holidays for at least some time around Christmas. Patients who would ordinarily have their appointments set in the holiday weeks ask to be seen a little earlier because they fear that they will be unable to access treatment throughout the extended holiday season. Many patients who would ordinarily be unable to make an appointment during office hours because of work commitments have some hours available during the day when their office closes and make appointments for then.
Whatever the reason for it, the consensus is that the phenomenon exists and almost all dentists would like a way of minimising its impact on the practice. So let’s look at what can we do to either prevent it or at least minimise its effect this year. We all know that preventive dentistry is preferable to the cure of dental disease. So surely, the same applies to the Christmas rush. There are two protocols that need to be put in place in order to minimize the impact the Christmas rush has on your practice.
Protocol 1: Communication
We need to prevent the rush as much as possible by talking to patients right through the year about scheduling their more comprehensive dental needs. Tell the patients that the practice always gets frantic from November onwards and that last year there were a number of patients that just couldn’t get in for their work to be done in time. So why don’t we do it now?
Protocol 2: Pre- Blocking
We also need to prevent the impact that the rush makes on the practice. This can be done by pre-blocking extra appointments for production in November and December, so that you can get those indirect procedures both prepared and seated. This would also include early contact with your lab technicians so that you know what their cut-off dates are. If their plans and yours can’t be aligned, don’t despair. You may just have to use another lab technician over the Christmas rush as well. There are plenty of quality technicians-both ceramic and otherwise who would love the opportunity to dazzle you with their expertise and competitive pricing.
Protocol 3: Christmas office closure and annual leave
Office closures over the Christmas and New Year’s period are a great idea. They allow serious relaxation time for everyone in the practice at the time of year when the weather in Australia is the best and the kids are on holiday from school. Many businesses are closed over that period, so it’s not considered an unusual event, and your patients are unlikely to be upset. There are however, two main problems that always arise from these office closures.
The first problem is with the staff annual leave. Every year when its time to close up, there will be team members who tell you that either they don’t want any more holidays at this time, or that they’re not owed any as they’ve used up their entitlement.
A good solution for this issue is to set up in your practice the protocol for an office closure time (in our practice this was two weeks) over the Christmas, New Year period.
It should be written into employment contracts and job offers that employees have to take this office closure time as annual leave. Teachers have a similar set up where they are only allowed to take their annual leave during school holidays when the school is closed.
What this does is effectively gives the principal more control over staff absences throughout the year. It lessens the impact on the practice of each employee being able to schedule four weeks of annual leave.
Protocol 4: Schedule your availability for emergencies
The second problem is that no matter how good a dentist you are, the chances are that you won’t be able to shut your offices for a couple of weeks without one or more of your patients needing emergency treatment.
If you simply shut your doors and aren’t available for your patient’s emergencies, they will have to go to another practice. Do you think the other practice will do you the courtesy of not diagnosing comprehensive treatment while they have your patient in the chair?
A group practice should set up a schedule for when each dentist of the practice (associate, principal or employee) would be on call for emergencies during the office closure. The rest of the dentists can relax knowing that any of their patient’s emergencies will be taken care of by someone in the practice.
If you are a single practitioner, consider coming to an arrangement with the nearby practice(s) whereby you each agree to do palliative care only for each other’s emergency patients and organise a roster for holiday times so that you can all have a break.
The dental practice problems of Christmas exist only because they are not prepared for. Like all management issues, when it is properly considered and proper protocols put in place, it’s amazing how easily they can disappear.
[Published in Australasian Dental Practice magazine November/ December 2006]