Therapist model doubles volume & lowers stress

Rhu McKelvey owns Beam Orthodontics, a mixed practice which he established in Dundee almost eight years ago. He runs a therapist model that’s seen him delegate routine work, double volume and reduce his personal stress. We asked him about how it works…

What’s your staff?

We’ve had another full time orthodontist join us recently and on a normal day we’ll have four therapists and five nurses on duty.

Why did you hire therapists?

After the first thousand bond ups as an orthodontist you’ve probably got it sussed and you’re maybe not going to miss doing them all from that point on. My clinical life’s definitely been extended dramatically by the fact that I’m not trying to churn through all the patients that come into the waiting room on a day to day basis. I’ve been there and done it and didn’t particularly enjoy it because when you start to run late it’s only you to dig yourself out, whereas on a clinic with four therapists and four nurses there’s much more capacity, firstly to get through a higher volume but also to manage the ups and downs of a normal clinical day.

Before we were heavily consumed by our NHS work and under-utilising and underserving the private side of it. Once we appointed a treatment coordinator we began to redress that and therapists were a way of maximising my unique ability by devolving routine work. Even with our nurses we’ve devolved all the record taking – they’ve all done dental radiology training, and they’ve been trained in house at clinical photography. What I’m doing is making the decisions and treatment planning.

How is the business performing as a result?

The number of patients seen and treated has doubled. My role now involves a lot of oversight and ensuring the continued development of the therapists. We don’t need to spend any more money on kit so it only gets more profitable from here. Ortho is a growth area at the moment and the demand for quality care is there, that’s why we’re focusing on growing the private side.

How are the costs spread?

The NHS work covers the costs and therefore I look at the private side as the profit. Having another orthodontist on board allows me to devote more of my week now to the private side and private turnover continues to improve dramatically.

What do patients think?

The patient experience is far better. The patients get a bit more love from a nice therapist and a nice nurse rather than one stressed out orthodontist running late who’s worried about the thing he should have done this morning. They also get more love from me because I’m able to swan about and chat in a carefree liberated way that I couldn’t before. The rest of the world has been doing this for decades. Now it’s become normal here. It’s just good service delivery.

How do you separate NHS and private?

We try and delineate the clinics and have a private clinic at a separate time. That’s not possible all the time and so we are flexible with patients. As a general rule I’ll have four therapists working on an NHS clinic and two on a private clinic, which gives me closer oversight and more scope to step in.

Is it hard to delegate?

It was a very difficult thing to get used to, but now I love it. It’s the classic dentist problem – you’re just busy being busy until you recognise the obvious and evolve. Breathe has helped with that all the way – I think we started working with them after our first six months.

How do you recruit therapists?

I’ve done the training in house with people I’ve already worked with. They have usually already done orthodontic nursing exams and perhaps dental radiography. They’ve got to be clinically astute and capable, morally and ethically upstanding in that they’re going to be holding responsibility for the patient’s treatment and the day to day interaction, and academically capable of getting through a tough training course and a lot of study. It’s a challenging year for them.

How long does therapist training take?

Usually I’d need to see either an orthodontic nursing or radiography qualification to see they’re up to the challenge. That might take them a year and then the orthodontic therapist course is a year.

Are you happier?

I’m from the west of Scotland, I’ve got cardiovascular disease running through my veins, and if I kept churning through patients myself, running two chairs and trying to bounce between them, I wouldn’t live to retirement, no way! Now I can actually smile…

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