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Delegate, Delegate, Delegate

Delegate Delegate Delegate

Delegation of tasks in an orthodontic office is one of the most important management tools. There is no question that practices that delegate more treat more patients and earn a higher income. Assuming compliance with the state dental practice acts, if it can be agreed that properly selected and properly trained auxiliaries can perform most of the tasks in an orthodontic office in a satisfactory manner, the amount of delegation becomes a question of the doctor's managerial style--his ability to hire and train effective employees, and to have the trust and confidence that they can perform tasks he may have considered to be uniquely his own. The uniqueness stemmed largely from the requirements of earlier dental practice acts that orthodontists perform virtually all the clinical tasks.

No dental practice act required that orthodontists perform the administrative tasks, yet the majority of orthodontists still delegate very few of these tasks. It would appear that fee presentation, progress reports, post-treatment conferences, patient education, patient satisfaction surveys--all can be delegated to auxiliary personnel without hurting, and in many instances enhancing, the doctor/patient relationship.

I believe that one administrative task he cannot afford to delegate is the case presentation. Nowhere is the doctor's communication with patients more important than at the beginning of the doctor/patient relationship. If you start out with an auxiliary/patient relationship, the chances are that there never will be a strong and useful doctor/patient relationship. If you eliminate or diminish the doctor/patient relationship, you are throwing out one of the strongest components of professional practice, indeed one that delineates professional practice from a business. Unless the orthodontist is a dismal communicator--and that is rare--he owes it to his patients and to his practice to perform the case presentation. Patients have a rightful expectation to hear from the doctor what his findings are with regard to their health care problem. The practice will benefit from this appropriate beginning of the doctor/patient relationship. Much has been made in marketing circles of a phenomenon called post-purchase dissidence, in which people have second thoughts or doubts about a purchasing decision. I believe this is less apt to occur if there is a good, thorough case presentation by the doctor.

It is an anachronism that a majority of orthodontists delegate record-taking tasks--impressions for study models, x-rays, and ceph tracings--but very few of the treatment tasks. Record-taking is the first clinical procedure, done at a time when the patient is most apprehensive, and requires great sensitivity and skill.

In the clinical area, the doctor should retain diagnosis and treatment planning, progress evaluation, instructions to personnel regarding treatment, needed supervision, and quality control. Beyond that, he can delegate effectively, within the provisions of the state dental practice act.

However, many orthodontists prefer to perform the treatment procedures themselves, and delegate the administration and management to employees. The trouble with this approach is that it is usually management by default. It seems rare that this arrangement works well. It usually limits the number of patients who can be treated effectively, and it generally shortchanges patients on communication and the practice on organization. This type of practice usually drifts along on its own momentum, until something slows it down. It is then in big trouble, because the nominal head of the practice--the orthodontist--has neither the time nor the ability to make the decisions necessary to turn the situation around.

Many orthodontists who perform the treatment procedures themselves believe that they can perform the procedures better than any employee and that patients expect the doctor to perform the work. While both of these may occasionally be true, properly selected and properly trained employees can be brought to a most satisfactory level of competence; and the harmony and trust within a competent orthodontist/competent staff team is transferred easily to the staff/patient relationship.

Apart from the specific duties in administrative and clinical tasks that the doctor should retain, his job is essentially one of diagnosis, planning, implementing, and evaluating in all areas of the practice--business administration, practice promotion, communication, patient relations, staff relations, dentist relations, and patient care. Beyond that is his own continuing education to broaden his professional horizons in the most recent developments in orthodontics and allied fields.

A significant implication of extensive delegation is a new relationship between doctor and staff. Auxiliaries are no longer just hands and legs. The higher quality people they are, the more highly trained they are, the more competent they become, the more responsibility and authority the doctor can delegate to them, the more important they become to the success of the practice, and the more dependent the doctor becomes on them. Doctor and staff become fellow workers--a working team--with mutual respect, trust, and confidence. Such a staff needs and deserves suitable recognition by sharing in the spiritual and financial rewards of the practice, in whose success they play an increasingly significant role.



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