Thriving in a Tough Economy

Dentistry Today


Many dental offices around the country are experiencing slowdowns. In some cases patients are changing appointments, new patient flow is decreased, patients are changing their minds about previous treatment plans, or they’re choosing to do only what their insurance will pay. These stories are not region specific. They run from the East to West coasts, and from North to South. The general feeling is that schedule openings have increased since the September 11 tragedy and the slowdown of the economy.

Simultaneously, there are many dental offices that seem to buck this trend. They continue to bring in new patients, existing patients are saying “yes” to treatment plans, and their schedules are full with little room to accommodate emergencies. So what are these offices doing differently? Why are they continuing to be successful? My observations after interviewing our national network of Hygiene Mastery coaches comes down to this—they are paying close attention to their systems.
Many strategies lead to success in a dental practice. Here are seven steps that can get your practice back on track.

Yes, communication is a system, one that you must master in order to create a robust business. The place to begin building this system is within yourself. Ask, “How do I feel about our circumstances at the moment?” Chances are your patients are reflecting your attitude rather than you reflecting theirs. Remember, some offices are thriving, right next door to those that are failing. The difference is their outlook on life and the vision they hold for their practice and their patients. 
Find successful practices and model their core beliefs about their present situation. Some say we are in a recession. Others say this is the greatest “sale” of the decade and seek the opportunities. 
Begin immediately to change your vocabulary. Linguists tell us that you literally become what you think about most often. By changing your vocabulary, you literally change the way you represent yourself to the world. This will have a tremendous effect on you, your team, and your patients. By changing one or two key phrases within your office, you can transform the environment and attract more patients to your practice. Try transforming the words:
  • cancellation into opportunity
  • drill into prepare
  • hole in the schedule into time available
  • bleaching into whitening
  • quadrant scaling into periodontal therapy
  • a bad day into an uncomfortable moment
  • “What insurance will pay” into “Happily apply benefits to your account”
  • Just, but, however—eliminate these.

Are you aware of your service mix? Simply put, this is a listing of all services and products provided in the practice. One of the most powerful monitors within your office is the production by procedure report generated by most dental software programs. This report will tell you the quantity, dollar amount, and percentage of mix each procedure represents. Use this report to discover your primary income centers, and set targets for new income centers. Set production goals by day, week, and month, and use this report to analyze each revenue stream. If you are not focusing on the services that reward both you and your patients, then you need to change your focus and start recommending specifics to your patients. 

Discuss these issues with your staff. Have them dust off the intraoral camera and use it to educate your patients. I can guarantee that if you start using the camera on every patient, your enrollment level would increase dramatically. Remember—a picture is worth a thousand words. 
Another key area to monitor is the hygiene department. Hygienists can be good producers or outstanding producers. It all depends on their periodontal focus. If your hygienists are not enrolling a high percentage of your patients into periodontal therapy, then the production numbers will be quite a bit lower than other offices that provide more therapy. The ADA estimates that 70% to 80% of all people nationwide have some form of periodontal disease. How does your practice compare to this average? When you recognize, educate, treat disease, and charge for it, then everyone wins. 
To check hygiene procedures, determine the number of patients receiving codes 1110 and 1120 in comparison to codes 4341 and 4910 (remember that 4341 is by quadrant not patient, so you must divide that number by four). If your percentage is below 40%, you could be missing out on a huge income center. Monitor this regularly. It is your roadmap to improvement.

Determine your active patient base by physically counting the charts. As a general rule, you include patients who have been seen within the previous 24 months. Computer data is typically inaccurate; you must do a manual chart count. Next, calculate the number of adult prophies, child prophies, and periodontal maintenance procedures performed in the last 6 months. Divide this number by the number of active patients in your practice, and you will get a percentage of how many of your patients you are seeing on a regular basis. Example: 2,000 active charts divided by 1,000 adult/child/perio recare patients previous 6 months = 50% active in continuous care.
In a typical office experiencing slow downs, this average is between 30% to 40%. That would mean that six out of ten of your patients are not being cared for on a regular basis. Practices experiencing double-digit growth in spite of the “recession” have a much higher rate. Many patients are waiting for you to call them and reactivate their status into your office. It only takes a phone call. 
The entire staff can be involved in this process. Have the best influencers make the phone calls. The rest of the staff supports this process by reviewing 10 charts per day and writing down on a clipboard the names of the patients who are overdue either for operative treatment or for continuing care. Ten or more calls are made each day from the list to reactivate these patients. When phoning, a good script to use is, “Hi, this is Patti from Dr.’s office. I am calling because we are concerned about you. We realized that we have not seen you for an oral cancer screening and dental exam since ________(month/year). Which appointment time would work best for you—mornings or afternoons?” Then pause and allow the patient to make the next statement. When done consistently, this can be a great way to fill openings in your schedule. The staff must be committed to making this happen.


If you’re having difficulty with cancellations and no- shows, then you may need to address the confirmation protocol in your office. It’s important to have a step-by-step process for preappointed continuing care patients and for recently appointed patients. Utilize a three-step process for your preappointed patients to help reduce no-shows and last-minute cancellations.

Step 1. Patients must receive a reminder card by mail 2 to 3 weeks prior to their scheduled appointment. These cards are sorted and mailed out each week. They should also have appropriate verbiage referring to their appointment as a reservation rather than an appointment. Remind the patient that he reserved this appointment for his professional cleaning either 3, 4, or 6 months ago. This helps to reiterate the importance of keeping it. Never say on the card that it’s okay to reschedule.

Step 2. Patients should be called 1 week prior to their scheduled appointment to see if they have received their card. If you don’t get them on the first day, keep trying. Consider a patient “unconfirmed” until you speak to him personally. Answering machines do not count. This is the time to ask if that appointment will still work for them. Here’s an example of a script that works well in many offices: “Hi, Mrs. Jones. I’m calling to see if you received your reminder postcard for your appointment next week. Is there any reason you can foresee that would prevent you from keeping this appointment? I’ll call you again the day before as a courtesy reminder and to see if there is anything special we can do for you during your appointment.” If the patient can’t make the appointment, then you have several days to work on filling that space, rather than dealing with it the day before.
Step 3. The courtesy call is provided 1 day prior to the scheduled appointment. This is a reminder call only, and specifics about treatment can be reviewed at this time. For example, “Hi, Mrs. Jones. I’m calling to see if you have any special concerns about your treatment tomorrow at 10:00. We look forward to seeing you.” This is also a good time to remind them of premedication needs.
When patients appoint for treatment with the doctor, often a call 1 to 2 days before their appointment is adequate. Most of these patients have made this appointment recently, so they don’t need a call 1 week before. However, if the appointment has been on the schedule for a longer period of time, then it is wise to go ahead and confirm 1 week ahead and give a courtesy call 1 day before the appointment. 

It’s important to make sure that your staff’s skills are being utilized in the most efficient way possible. Mark your calendar and update your copy of the state practice act each year, as rules and regulations change often. Knowing what can be legally delegated to your staff increases the amount of service you can provide and decreases the stress on you as the sole provider. Properly train your team and delegate everything you can to them. It only makes sense to have the doctor focusing on high-production procedures that only she can do. The assistants and hygienists can then take care of whitening, impressions, occlusal guards, athletic guards, sealants, anesthesia, and so much more in states with expanded functions. Efficiency is the key. Don’t be afraid to delegate.

Many offices complain about new patients calling and scheduling appointments and then not showing up. Here’s a powerful and unique way to create value for these patients before they come into your office and to decrease broken appointments at the same time. The scheduling coordinator creates a list each Thursday afternoon of the new patients to be seen the following week. The list includes name, phone number, referral source, and date of appointment, and is given to the doctor. The doctor calls each patient to introduce himself, ask if there are any concerns, and let the patient know how much the office is looking forward to his visit. This simple phone call takes less than 2 minutes and works wonders in eliminating new-patient broken appointments. 

Another great way to establish patient relationships is to call patients after invasive treatment to see how they are doing. Your patients will appreciate the compassion and concern you have for them. It makes them feel that you really care and understand. As an added bonus, they may even tell their friends about you.
Another way to show patients that you really care is to ask questions when they’re in for an exam or treatment. Two great questions to ask a patient concerning oral health values are, “What are your long-term goals for your teeth?” and “How long do you plan to keep your teeth?” Let the patient look at her teeth in a mirror and ask her, “If there were anything you could change about your smile, what would it be?” Remember that, as a dentist, you are there for your patients to help facilitate their wants and needs. You can’t do that until you ask the questions.

Increasing case acceptance ultimately comes down to supporting patients in making the care affordable. Financial policies are designed with two purposes in mind. First, they should be liberal enough to provide access to care for as many patients as possible. Second, they should relieve the practice of cumbersome follow-up and collection procedures. 
Review your systems. Do you have options for cash courtesies? Accept major credit cards? Work with outside finance companies to provide affordable monthly payments? If you don’t have each of these elements, you may be missing great opportunities for growth. 
Set the stage so that patients are comfortable speaking to you about financial concerns. Always begin the conversation by re-establishing the problem that you are committed to correcting. Assure them they are in good hands, and address issues of time and scheduling. Once these fears are alleviated, it will be easier to handle the issue of affordability. 
Start the financial conversation by saying something like, “Mrs. Smith, I’m so happy that you are taking care of this treatment now. Let me share with you several options for handling your account with us. We can begin treatment with no money down and payments as low as $ ____.” Utilizing outside finance companies such as Dental Fee Plan or Enhance Patient Financing (and many others) will allow you to be paid up front, and your patients to make comfortable monthly payments. Should your patients have the means to pay in full, they will let you know. They might say “I’d rather not incur interest charges. Can I simply write you a check?” That question is music to any financial coordinator’s ears! 

As a nation we may be slowing economically, however, in dentistry we can still make treatment affordable and keep our patients healthy. You must monitor your departments, pay close attention to your systems, and continue to let your patients know how much you care about them. In turn, they will do whatever they can to be great patients for you. Not only will you survive a downturn in the economy, you will come out of it smelling like a rose.

Ms. Sooy is a coach with Hygiene Mastery and has over 21 years’ experience as a hygienist and business leader within her practice in Cheney, Wash. For a complimentary assessment of your hygiene department service mix, contact Hygiene Mastery at (888) 347-4785 or