THE READERS' CORNER

This month's topics are bracket recycling and patient scheduling.

1. Do you recycle brackets, bands, or archwires through outside companies? If so, how regularly? Do you recycle any of these in-house?

Although one-third of the respondents reported using an outside company to recycle brackets, only 3% recycled bands and 11% recycled archwires commercially. None of the orthodontists recycled brackets or bands in-house, and only 11% recycled their own archwires. A little more than half of the practices that used commercial recyclers did so routinely; the rest used them occasionally. In addition, 10% of the respondents reported selling their brackets to recycling companies for cash without reusing the brackets themselves.

Do you recycle ceramic brackets?

The vast majority of the readers (94%) said they did not recycle ceramic brackets.

Does your debonding technique minimize bracket damage ? If so, please describe your technique.

Only 29% of the respondents used a debonding technique designed to reduce bracket damage. The technique usually involved leaving a full-size archwire in the bracket slot while debonding.

If you do any recycling, how much per year do you save?

The mean annual saving was $2,030, with a range of $100 to $6,000. The most commonly reported figures were around $500.

Have you experienced a higher bracket or bonding failure with recycled brackets than with new brackets? Do you find that recycled brackets maintain their built-in features?

More than 90% of the orthodontists felt their failure rate was no higher with recycled brackets than with new ones. A similar percentage believed the recycled brackets retained their built-in features.

Do you find that recycling removes bracket identification? Do you have a system for recording how often each bracket has been recycled?

Sixty percent of the respondents were concerned that recycling removed bracket identification. Only 13% said they had a system for keeping track of the number of times a bracket had been recycled.

How do you insure the integrity of the screen mesh with recycled brackets?

This did not seem to be a concern of most offices that were recycling. Comments included, "We don't worry about it", "The company does it", "We visually check".

Have patients ever asked whether you use recycled brackets?

About three-quarters of the orthodontists reported that no patient had ever asked about recycled brackets. If the question had been asked, it was often on only one or two isolated occasions.

If you once recycled and have stopped, what were your reasons?

There were only a few respondents who had stopped recycling, but their reasons included potential legal problems and public relations.

Other specific comments:

"I sell my used brackets to a recycling company, and they resell them."

"We only recycle brackets on the same patient."

"We mark on the chart brackets that were recycled and only use them once (in other words, we don't recycle a recycled bracket)."

2. Do you schedule patients by chair? by operator? by assistant? by procedure? Do you schedule like procedures at like times?

The most popular scheduling technique was "by procedure" (86%), with the other methods used by less than 10% each. Forty-six percent of the respondents scheduled like procedures at like times.

Do you have time periods reserved for initial examinations? consultations/case presentations? diagnostic records? initial bonding? final debonding? emergencies?

Initial bonding was the most common procedure for which specific time periods were reserved (85%), followed by final debonding (79%), initial examinations (77%), consultations (69%), and records appointments (67%). Emergencies were given reserved times in only 17% of the offices.

Do you schedule part-time employees based on your patient scheduling? Is your employment of part-time employees related to your scheduling pattern?

Scheduling of part-time employees was based on patient scheduling in 73% of the practices, while 58% reported that their employment of part-time staff members was related to their schedules. This was particularly true of the after-school rush, when many offices reported using part-time employees to supplement their full-time staffs.

Is your scheduling computerized? If so, what system do you use?

Computer scheduling was used in 56% of the respondents' offices. The most frequently used system was Orthotrac/OMS (45%), but seven other commercial systems were also mentioned.

Do you reserve certain days for scheduled patients and other days for non-patient procedures such as administration, training, and attending courses?

Fifty-three percent of the orthodontists reserved certain days on which patients were not appointed. Friday was the most commonly mentioned day, and it was used most often for the doctor's administrative needs and for staff training.

Please list what you feel are the best features of your scheduling system.

"The best feature of our computerized scheduling system is the ability to see if a patient is behind in payments when scheduling. It gives you the opportunity to ask them for payment."

"The best features of our non-computerized system include:

"1. Scheduling diagnostic records, bandings, debandings, and recements only in the mornings.

"2. Limiting afternoon new-patient exams and consults to the first and last appointments of the afternoon.

"3. A late evening per month for new-patient exams and consults.

"4. Not doing debands during school breaks--saves time for banding appointments."

"Winding down the last hour with shorter procedures and/or recalls to allow a consistent on-time finish to the work day."

"Any procedure over 30 minutes in length is in the morning. New-patient exams are available at all times of the day."

"Having all our staff be part-time allows each staff member to work three to four days a week and offers tremendous flexibility if one is sick or on vacation. We book chairs based on the number of assistants available on a given day."

What is the biggest problem you have experienced in scheduling ? If you have solved the problem, how did you do so?

The single biggest problem, reported almost universally, was the difficulty in fitting patients into the after-school period. Parents who were unable or unwilling to make appointments at times when their children would miss school were a particular source of frustration. Other concerns included last-minute cancellations of lengthy appointments and patients running late and thus disrupting the office schedule.

Specific solutions included:

"We schedule exams during school and include the phrase, 'Many appointments must be scheduled during school/work hours to be fair to all concerned', during the consultation. This has helped address the problem, but some people still think they are the exception."

"We do initial examinations at 'off-prime-time' hours to 'train' parents from the first visit that they will sometimes have to come during school hours."

"The biggest problem is that no matter what hours you work, the patients and parents still demand after-school and after-work appointments. Sometimes we get booked too far ahead for certain types of appointments (e.g., banding). We have attempted to solve the problem by keeping a list of patients who are booked too far ahead, and when someone reschedules a long appointment, we call people on the list. Even if they can't make the appointment, they know that we tried to accommodate them."

"My computer shows me which patients arrived on time and which were late. I work on the on-time people first and then the late arrivals. I allow 'phone time' in my schedule for talking on the phone or starting late. I've also stopped doing more procedures than scheduled for--I've stopped being a hero to one patient and a jerk to the other patients who had to wait while I did the 'hero' procedure (e.g., recementing eight loose bands in a 10-minute appointment) . I now reschedule the 'hero' procedures."

"I've had a problem with patients coming in late. I try to be within five minutes of on-time, and after a while they learn to respect that and then start being on time or even early!"

"We don't schedule like procedures at the same time. We schedule complementary procedures, such as initial records and bandings requiring mostly assistant time with exams and consults that require doctor time."

JCO would like to thank the following contributors to this month's column:

Dr. David M. Albert, Littleton, CO

Dr. Michael R. Bailey, Lihue, HI

Dr. Michael Baron, Branford, CT

Dr. Michael G. Behnan, Clinton Township, MI

Dr. Michael A. Beim, Lake Mary, FL

Dr. Richard F. Callahan, Downers Grove, IL

Dr. James R. Dee, Jr., Munhall, PA

Dr. Robert J. Dennington, Frisco, TX

Dr. James W. Fanning, Albuquerque, NM

Dr. Lavonne K. Fore, Rome, GA

Dr. Robert W. Fry, Olathe, KS

Drs. Edward R. and Jeffrey S. Genecov, Dallas, TX

Dr. Gerald Ginsberg, Phoenixville, PA

Dr. Robert I. Goldstein, Bridgewater, NJ

Dr. Brian R. Jesperson, Bismarck, ND

Dr. James D. Kaley, Greensboro, NC

Dr. Robert J. Kuhn, Santa Barbara, CA

Dr. John W. Merchant, Berkeley, CA

Dr. S. Murray Miller, Newton, MA

Dr. Dennis L. Nappen, San Diego, CA

Dr. Edward S. Orenstein, Chester, NJ

Dr. Charles E. Parsons, Richmond, KY

Dr. Peter E. Paulos, West Valley City, UT

Dr. Gary T. Puccio, Castleton, NY

Dr. Frederick L. Randall, Brockton, MA

Dr. John H. Rogers, Wichita, KS

Dr. Neil D. Ross, Los Altos, CA

Dr. M. Joseph Scheingross, Sandusky, OH

Dr. Edward V. Shagam, Mount Holly, NJ

Dr. Keith E. Shell, Morganton, NC

Dr. Robert A. Stoner, Indianapolis, IN

Dr. Donald L. Storm, Rice Lake, WI

Dr. Jack L. Wilson, Watertown, SD