Product News in December 2023

For many years I have believed that orthodontists face two challenges throughout their professional lives. The first is to develop a source of patients at a level sufficient to provide some measure of professional and financial success. This is unquestionably the primary task of any success-oriented doctor.

The second challenge, which is much more difficult and too frequently limits professional practice growth, is the challenge to produce a great deal more than fellow professionals. In orthodontics, meeting this challenge is defined as the ability to treat more patients in the course of a day.

Every doctor reaches a limit of productivity. These limits vary from doctor to doctor by tremendous amounts. Some doctors, who cannot treat more than enough patients to earn $100,000 a year, never achieve a level of reward that satisfies them emotionally or financially. The average orthodontist, according to the records we keep, is able to develop a practice more than two and a half times that size. There are a select few, perhaps about 2½%, whose gross incomes reach four times that amount as comfortably as those who may be stuck at about $100,000 or even less.

Why this wide disparity? Is there any fundamental difference in operation that makes this possible? The answer is yes, there really is a specific method by which the superachievers can handle upwards of four times the number of treatment procedures that underachievers can in the same number of days. Of the superachievers, probably less than half are able, together with their staff, to learn this concept of productivity and function without the expertise of an outside consultant.

The Key to Success

The key to the whole system can be expressed in one sentence. The magic dimension is the measure of doctor time per treatment procedure relative to total chair time.The application of that information makes the doctor and staff much more efficient, and makes the limits of productivity expand geometrically. It enables the otherwise restricted and pressured doctor, who can generate more patients than he can treat, to expand his horizons. It enables him to become far more successful in treating as many more patients as he is able to generate, or certainly to treat many more patients than his former limitations allowed. It is the only system that brings a higher level of income and functional achievement.

A Treatment Procedure Analysis (Fig. 1) must be prepared for every treatment procedure, including examination and recall visits, in which the doctor will participate. The schedule clerk is the single most important person in carrying out this basis for scheduling, but the entire staff-- including the schedule clerk-- must agree on both the chair time and the doctor time necessary for each item listed. The Treatment Procedure Analysis should be updated periodically as it becomes

apparent that improvements in time usage are in order.

The second step is to set up a multicolumned schedule book, with one column for the doctor and one for each treatment chair. Most of the commercial schedule books provide for 15-minute scheduling periods, and for anywhere from three chairs and the doctor to eight chairs and the doctor. Many practices that design their own schedule books are more precise about time utilization, and divide the hour into six 10-minute segments rather than four 15-minute segments. This allows greater definition of procedures.

The schedule book should be prepared by a schedule clerk with a thorough understanding of the scheduling system. There must be a constant monitoring of doctor time assignments within each time frame, so that the doctor will not be overscheduled. The entries in the schedule book should include the treatment code for the appropriate treatment procedure alongside each patient's name in each available column as each day is programmed. Corrections can be made by erasures or pasteovers.

Photocopying the schedule and making it available at each treatment chair enables each treatment assistant to know exactly which patients she will be working with and what procedures she will be helping the doctor perform.

Obviously, the doctor time scheduled within any single time period cannot exceed the total time available. In other words, you cannot schedule the doctor for procedures requiring 20 minutes of his time in a 15-minute period. The doctor will fall behind; the level of tension will be raised for all concerned; and the whole system will collapse. The key is to schedule the doctor for an aggregate of something less than the available time within that time slot. If we are talking about a 15-minute schedule period, the doctor should be scheduled for no more than 12 minutes, allowing a 20% margin for the unexpected (Fig. 2).

The program may require several changes in the functional philosophy of the practice. These changes usually involve establishing a rule that treatment procedures not scheduled in advance will not be performed. The recementing of bands discovered loose at appointment time will usually be rescheduled or handled as an emergency, and emergencies will not be placed within time frames that do not provide adequate doctor time.

For emergencies, there should be one treatment chair in the clinical area that does not have an assigned chairside assistant. Patients with loose bands or some other emergency should be sent to that chair and told to expect to be at the office for a long time-- that is, until the staff can fit them into the schedule.

There are two reasons for picking up time: broken appointments and appointments at which contemplated arch changes will not be made. The chairside assistant scheduled for a function not to be performed will then pick up any waiting patient. If time does not become available during the afternoon, the waiting patient will be the last person treated that day.

Patients who are habitually late for their appointments must be trained to fit within the program. Many doctors have met this problem by scheduling habitually late patients 15 minutes earlier on the appointment card than in the office records. This seems to have worked out well in most cases.

Telephone calls can be damaging if they are allowed to undermine a schedule. The doctor who can't terminate a phone call or will accept calls at any time from any person will probably have a difficult time adapting to this system. Telephone calls should be stopped at the front desk, except for those from referring doctors. The referring doctor should be told, "This is our busy time of day. If you are calling about a patient, I will be glad to give the records to the doctor so that he will be able to talk to you as quickly and effectively as possible". This will warn the caller that the telephone call should be brief. Other callers should be told, "The doctor will either return the call after 5 o'clock or tomorrow morning. Otherwise please call again between 9 a.m. and noon tomorrow".

Conclusion

For some doctors, this system is an unacceptable discipline. However, if the system is understood and its installation treated as a game, the chances are very good that the rewards will be great for all concerned.

It is best that doctor and staff approach this sophisticated program together, and that the staff share the benefits-- emotional and perhaps financial. A one-time bonus is recommended for staff members who achieve a new level of functional performance and a higher level of productivity.