How Many Patients are Enough?

Clients often ask me about which key numbers they should monitor in their practices every month in order to effectively manage and monitor the success of their practice. One such critical number, and one which is rarely mentioned, is the size of their patient list (and that of their associates).

I believe that large patient list sizes are counter-productive and restrict practice profits. They can create one or all of the following situations:

  • Patients are unable to make an appointment for treatment
  • New patients have to wait weeks to get a new patient consultation
  • The practice profits fall consistently year on year
  • The Dentist gets bored of having to carry out relentless check ups
  • A decision is made that means some of the patients should only receive check ups every 12 months or, worse still, every 18 months.

Strangely, the full appointment book scenarios above are likely to make the dentists feel more secure, which is ironic, as they should really be sounding the alarms! All of these situations will reduce the effectiveness of the practice and potentially reduce the profits.

So, let me explain how it can all go wrong…

I was working with a client recently who is a very capable and ambitious restorative dentist. We were looking at the average daily production (gross) that he earns for every day that he works. Despite having a (private) practice that is focused on restorative work, he was shown to be grossing around £1000/day. This is not enough gross to allow his practice to create the ‘right’ profit for him so, together, we analysed his situation. We looked at factors such as:

  • Were his fees high enough?
  • Was he charging for items of treatment or for his time?
  • How much discount was given?
  • Was he experiencing high ‘no-show’ rates?

All of these variables looked fine, so we then considered his patient list size and what follows is the source of his low profitability:

This dentist works a 4 day/week. He likes to take around 8 weeks holiday every year, and he needs at least a couple of weeks to fulfill his desire to learn new clinical and business skills (including his time with Breathe Business!). So, this leaves him 42 weeks to actually practice dentistry and run his business, (this is made up of 168 days doing clinical dentistry and 42 days running his practice).

He looks after 1250 adult patients who he sees twice a year for a ‘check-up’, which takes 20 minutes. His fee for this appointment is £39. He therefore spends 833 hours a year doing these ‘check ups’ on his patient list which for a 7.5 hour clinical day adds up to 111 days/year. He is therefore spending the equivalent of 111 days, or 66% of his clinical time doing check ups, grossing the equivalent of £877/day. In his remaining 57 clinical days per year, he has to do all the restorative dentistry and push his gross high enough every day to compensate for 111 days grossing too little! Unsurprisingly, he is finding this a thankless and exhausting task.

Before we look at the solutions, let’s model this situation some more as it’s very common and I’d like you to consider your own situation.

If you work a little more often than my client, say: 4 days a week, taking 6 weeks holiday a year and a week to do your CPD (and a week to have Flu) you will be working 44 weeks/year, that is 176 days/year clinical. If your ‘check ups’ take 15 minutes and you see patients twice a year then:

  1. If you look after 1000 adult patients, you will spend 67 days/year doing check ups (Leaving 109 days to do clinical dentistry/year or 9 days/month.)
  2. If you look after 1200 adult patients, you will spend 80 days/year doing check ups (Leaving 96 days to do clinical dentistry/year or 8 days/month.)
  3. If you look after 1500 adult patients, you will spend 100 days/year doing check ups (Leaving 76 days to do clinical dentistry/year or 6 days/month.)
  4. If you look after 2000 adult patients, you will spend 133 days/year doing check ups (Leaving 43 days to do clinical dentistry/year or 3.5 days/month.)
  5. If you are doing 10-minute check-ups, then you can re-work the figures. BUT…how do you find enough time to sell any significant treatment plans in a 10-minute check up?

Let’s look in more detail at the dentist who is, for example, looking after 1200 adult patients. If his fee for a ‘check up’ is £30, he will spend 80 days a year earning £900/day. In our client’s practices, we find that the average surgery has a fixed cost (outside of London) of around £450/day. This therefore creates £450/day profit, the equivalent of an annual taxable income of £79,200. However, if this dentist is an associate on a 50% contract, then when they are performing ‘check ups’, the associate and the owner will receive £450 each. A good day’s pay for the associate, but a day with no profit for the principal…

I apologise for all the ‘sums’, but I think you can see now that attempting to look after too many patients is bad for your profit! I believe that private practitioners should consider the following:

  1. Maximize their patient list size at 1000 Adult Patients
  2. Monitor this monthly, patients will be leaving the list all the time and list size will demonstrate how many new patients they need in order to replace the leavers
  3. Zone their diaries so that they do a maximum of 1.5 hours ‘check-ups’ per day.
  4. Zone their diaries so that every clinical day has a ‘New Patient Consultation’ included
  5. Consider instigating ‘check-ups’ lead by their Hygienists for their patients who are dentally fit and stable.

Decide that once their list grows in excess of 1000 patients either:

A. Employ an associate to see the new patients

Or, my preferred option,

B. Allocate a substantial number of their list of patients to an associate for them to maintain and for the principal to see the new patients!

Creating the right patient list size per dentist in your practice and monitoring this on a monthly basis, is essential to creating an effective practice that makes a satisfying profit. Remember: Too many patients per dentist can actually become just as big a problem as too few!

If you would like some help analysing your practice profits, then please contact Ernie on 0845 299 7209 or to discuss and find out more about how we can help you.

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