The Orthodontic CYBERjournal: It All Begins WIth Time by Dr. Roger Levin

It All Begins With Time
By Roger P. Levin, DDS, MBA

Introduction

All practice change must begin with the scheduling system. That is the clear indication of data collected by Levin Group from 8,000 general and specialty practices since 1985. During that time, we have conducted extensive data assessment to create statistically valid models that increase practice efficiency and production when implemented by doctors and staffs.

Start with Scheduling

Through scheduling, a quantitative system can be designed to be the ideal, adaptable model for any orthodontist or team. This model will determine whether the practice can reach a certain production on an annual basis.

Levin Group studies clearly indicate that most orthodontic practices have the ability to increase their scheduling capacity by 30 percent without working one more minute.

How is this possible? As an example, Levin Group has created orthodontic case studies comparing two practices that are extremely similar in nature (same numbers of chairs, staff, insurance participation percentage, similar services, similar locations, and similar socio-economics of the populations of the area). In each case study, when one practice adopts an appropriate schedule, its production increases significantly when compared to the other practice. While this is often a surprise to orthodontists when I discuss these case studies in seminars, the reality is that there are many, many practices functioning significantly below their potential and yet still working very hard.

All Change Begins with the Schedule

Many orthodontists work on improving their clinical skills, but never address the scheduling system. Failure to train the team extensively in the new schedule and failure to implement scripting to have patients accept treatment in the new timeframes discourages permanent change. A great deal of continuing education time and money invested by doctors is wasted.

In terms of management, all change must begin with the schedule. To accommodate new patients, time must be available in the schedule to start these cases within seven to 10 days. Our research shows that all new patients should be started within this period in order to tie into motivational and psychological factors.

Too many practices leave the schedule the same and hope that they will be able to fit in new patients at a later time. Patients and their parents arrive at the front desk and are told that they cannot be seen for five to seven weeks. Since there is no sense of urgency, patients will simply think about it, lose their motivation and never schedule. Or, if patients are eager to start treatment, they may go elsewhere - to a practice that can accommodate them sooner. The alternative scenario is that the patient (or the parents) accept the future appointment, but enough time goes by that they lose their motivation and cancel the appointment. It is clear that non-scheduling and dropout rates are significant for some practices.

Scheduling Parameters

In order to create an ideal schedule, certain determinations must be made using mathematical formulas:

Analyze the ratio between the production goal for the year and the number of days worked to establish a daily goal of starts and new patients.
Begin to reanalyze the schedule and create specific templates based on the type of appointments needed throughout the year. It is also important to leave enough space for the average number of new patient visits per month in order to get new patients scheduled within seven to 10 days.
Procedural time studies are essential. Most doctors use more time then they need to complete procedures and can reduce the time without rushing. Procedural time studies allow doctors to create a composite average time needed for each procedure and to use that average within the schedule. We often find that our clients are able to increase production by the equivalent of 15 days of doctor time using this methodology.
Organizing the schedule for flow is critical. Levin Group recommends bunching in order to create efficiencies and improve patient flow. Bunching is doing similar procedures at the same time, which is faster and less fatiguing than performing them separately.
When creating a template, most adjustment appointments should be scheduled at the end of the day. Switching to 10-minute time units can increase doctor and staff efficiency. Levin Group research has found that 15-minute units result in too much "down time" for the orthodontists and staff members. Use an overflow chair for emergencies, retainer checks, observation appointments and other procedures that can be quickly taken care of by an assistant.

Summary

Scheduling is the most critical system in any orthodontic practice. It's the command control center that directs the efficiency and effectiveness of all other practice systems. Scheduling can be built around a series of valid and proven formulas, giving any doctor or team an ideal schedule. In addition to increasing production and profitability (often by 30 to 50 percent), a proper scheduling system can dramatically reduce stress.

It is not a stretch to say that the scheduling system will control when the orthodontist becomes financially independent. Just imagine spending year after year 30 percent below potential. Most doctors could be financially independent much sooner by addressing scheduling concerns. Unfortunately, many orthodontists establish a scheduling system early in their career, seldom tweak it over time, outgrow it, but never fully address the fact that it needs to improve. This is unfortunate because most orthodontists work far too hard for the income and production that they realize when they could work far less and enjoy their practice more than ever before.

Roger P. Levin, DDS, MBA, is founder and Chief Executive Officer of Levin Group, the leading practice management consulting firm in dentistry and the only consulting firm with eight separate divisions for general and specialty practices. Dr. Levin has published more than 2,700 articles and 49 books. He received the 2004 Ernst & Young Entrepreneur of the Year Award in the Consulting Services category.