For years I’ve struggled to understand why dentists care so little about the day to day and monthly performance of their practice. Believe me, I’ve tried to make monthly management data interesting and relevant.
We even came up with six Breathe Key Performance Indicators, tailor made for dentists together with an online infographic with their important numbers graphed to demonstrate trends.
This created some interest for a while which is now gently dying like a wood-burner around midnight. Dentists are like those entrepreneurs on Dragons’ Den where the pitch is going fabulously well until Deborah or Peter asks about their business turnover, direct costs, overhead and profit and the poor victims struggle and stammer their way back into the lift without getting the Dragon’s investment… Very few of the dentists I’ve ever met would survive that part of the Den!
I’ve long wondered why dentists approach their practice like this. I used to think it was because they didn’t have sufficient resource within their practice to collect and package the data. (So we created a service that processed their numbers off site and fed them back to the principals every month — and guess what, they still didn’t look at them!)
So, why do dental practice owners ignore most of their daily and monthly numbers compared to, for example, the monthly management of a law practice or an architects office? (I’ve worked with both.) I believe it’s because dentists intuitively know that their practices are driven by the gross that they and their clinicians generate on a daily basis and they know most of their costs are predictable (lab, materials and clinician costs) and their overheads are pretty constant and therefore predictable too. The really unpredictable number is the monthly practice gross which will vary from great to poor depending on the performance of the clinicians, and when they take their holidays!
So how much do dentists know about their practice gross and their personal gross? Well, they tend to keep an eye on the cash (or cards) coming over the counter (daily) and they already know the size of any monthly plan provider cheque or NHS contract cheque. A few keep a day book (or look for a way for their software to keep a day book). Most simply seem to have a feel for their turnover and they know as long as the monthly practice gross is high enough they will get their £10k a month!
So, is that OK?
Yes, if you just want a quiet life and an average of £10k a month (which will be £8k on some months because of a one-off unexpected cost. Sound familiar?).
But hang on, if these dentists are right and the only number in the practice worth taking notice of is the practice gross, then why not measure the gross all of the time? The most effective way to do this is to use an old fashioned, hand written day book completed by the clinician after every patient leaves the surgery with a fee that represents the value of what the clinician has achieved, not what the patient pays.
The day book records the value of the dentistry produced, not what money is collected. In most dental practices bad debts are so low that it’s OK to assume you will get paid for the work. In fact measuring the money you collect will give you a skewed measure of how hard or effectively your clinicians are working because patients pay in advance or at the end of treatment, not always when the work is produced.
For example, most of the work in providing a crown is in the prep appointment. However, many practices collect all of the fee when the crown is fitted despite this appointment representing just a third of the whole procedure. And capitation patients pay something every month rather than when they have their dentistry done, so for them it’s important to record the value of what is done rather than money collected so that when you compare the two numbers you can see whether their capitation payment is in credit or loss!
So, let’s agree to measure the production of all of your fee earners. Measure the value of the dentistry done every day by all of your clinicians and then average it out over, say, a month in order to give you the average daily gross for each of your clinicians.
Average daily gross (production). The only number that matters!
Here’s what you should be shooting for:
- NHS dentists. £800-£1,100/day
- Mixed dentists. £1,000-£1,300/day
- Private dentists. £1,100-£2,200/day
- Private dentists who do some implants or adult ortho. £1,600-£3,000/day
- Private endodontists. £1,500-£2,000/day
- £3,500-£6,000/day
- £550-£950/day
Of course, if you start getting interested in your clinicians’ average daily gross, you will quickly become interested in how to improve it! There are many, many ways of doing this but essentially all of the tactics are about keeping your clinicians effective and focused every day. To illustrate this, let me describe the behaviours of three dentist stereotypes that I meet regularly.
- The busy fool.Their diary is randomly booked and is liable to short notice cancellations. Emergency appointments are sprinkled throughout the day together with double bookings, lengthy reviews and children’s appointments. There are few high value appointments, most of the work being single unit treatments. These dentists often start late, finish early and run late. They usually insist on working as a hygienist and spend time cleaning teeth. They are slow at restorative dentistry, slow to write their notes, slow to create treatment plans and slow to send referrals. They see 35+ patients/day.
- The busy high grosser. These dentists are grafters. They come in early and go home late, work long clinical days, long weeks and work quickly.Their diary is randomly booked and is liable to short notice cancellations. However, if this happens, they find something to do on the patients that are attending. Emergency appointments have their own zoned times. They avoid lengthy reviews and group children’s appointments alongside their parents. They have some high value appointments during their day, however they still do a lot of single unit treatments, sometimes in the check-up appointment. They start on time but are always running late by the end of the session. They see 25+ patients/day.
- The relaxed high grosser. These dentists work smart. They come in early and go home early! They have trained in some high value skills and have a rigorously zoned and organised diary with a minimum of three hours a day of high value (above hourly rate) work. Cancellations are rare and emergency appointments are seen in the times zoned in their book. They won’t tolerate double bookings and avoid lengthy reviews and children’s appointments. These dentists run on time (if not slightly early!). They understand the value of having a hygienist in terms of freeing their patients from the blight of perio disease and so they can restore teeth in a mouth without active perio disease. They have an efficient and compliant system for writing notes, making referrals and writing treatment plans. They see 10+ patients/day.
So, in summary, a profitable dental practice depends on high daily and monthly gross fees. This is best measured by each clinician using a hand written day book and attributing their gross throughout the day to the dentistry they produce (not the fees the practice collects). Averaging your clinicians’ daily gross will give you a figure which measures their production and allows you to compare your clinicians’ performance and manage changes and improvements in their effectiveness. High grossing dentists do more work on fewer patients and have a structured, organised day which enables them to achieve a high average daily gross.
If you would like some help with measuring and increasing the only number that matters in your practice, contact me for a chat!
e. simon.hocken@breathebusiness.co.uk
m. 07770 430576