Practicing Dentists - How do you schedule

[djeffreyt]

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Hey,

I'm a couple years out now and have worked in a couple practices. The current one was largely Medicaid based so they mostly saw kids, probably like 95-99%, and did lots of same day treatment since most cases are fairly simple. However, with changes in the medicaid system here, patients are less mobile and the practices I work at have decided to start pushing harder into the PPO and FFS market. Don't bother telling me how you can't just change your model on a whim without other major changes, I'm well aware of that and have been making that argument with the Owner dentist and partners for months. The problem is the managing corp is so hands off that they haven't really made any changes with staff training to help make this a reality and one of my main hurdles right now is scheduling. For background, the practices (2 of them) that I work at are 5 chair practices. We still have a lot of kids (at least 70% are under 17 and many are recalls). The other 30% are now shifted towards PPO and FFS patients over the last few months. Before, the staff used to just schedule 3-6 patients per hour regardless of whether they are recalls, new patients, or treatment. Sometimes I got backed up. Other times patients didn't show and it was fine. It was a horrible system, but working on fairly easy treatments made it doable.

The problem is the staff has absolutely no idea how to schedule differently and I'm sorry, I can't do 3 kid recalls, a new patient exam on a 48 year old with several concerns, and same day treatment on an older woman who needed two crowns at the same time, especially since we don't have a hygienist. Adult patients require more time for examination, prophies, and to explain treatment plans - not to mention that since they aren't getting their work paid for, there's talk of money and insurance coverage. And we can't do same day treatment on everyone, so we need to learn how to reschedule appropriately. I have some ideas about how to better schedule, but I was curious how some of you do it.

The way that I've done it before and thought I'd try it again was:
Op-1: Exams and Recalls (30 min for kids, 60 min for adults)
Op-2: Exams and Recalls (30 min for kids, 60 min for adults)
Op-3: Minor Treatments / Lab (fillings, crown cementations, simple extractions, partial and denture steps, blocked out for 30 - 60 min increments depending on treatment)
Op-4: Major Treatments (RCT, crown and bridge, blocked for 1-2 hours depending on the case)
Op-5: Emergencies and Overflow (Figure we can also use this room for additional recalls)

Anyone have any other suggestions? Does this seem like too much since I don't have a hygienist to do my cleanings and ScRP?

 

[dent_girl]

if you are the only one working ( no hygienist), you can't work out of 5 chairs at once. I've been out for a year and half and working out of 3 chairs with one assistant was challenging. if they really want to flip the office into PPO, FFS practice, they need to hire a hygienist so you can focus on treatments. the thing is that PPO, esp FFS patients won't stay in your practice if they know you are in and out of the rooms. takes a little longer to explain treatment to the patients than working on medicaid kids. I've worked in both settings, unless your staff is super good about explaining procedures to the patients (which doesn't sound like they are at this pt), you have to serve as a treatment coordinator that way you can stay busy while hygienist is doing recalls. it seems ridiculous to lose a pt who needs two crowns because you have to do kid's prophy. maybe convince your boss to hire hygienist part-time to start out with, and make that your high production day and see how it works.

 

[beannaithe]

The trick to PPO/FFS is to slow your schedule down and have hygiene. You can't run five chairs, do same day dentistry, do all your own recalls and provide adequate care. If you run behind in a Medicaid office, patients don't really care because there aren't many places for them to go. For a PPO patient, and moreso FFS, they have options and will go somewhere else if they're constantly waiting or feel like you're not spending the amount of time they want with you.

Most ideal set-up for you is hygiene doing recalls/SRPs, two rooms for you with one for minor and one for major treatment and delegating things the assistants can do, like making temps or completing restorations.

I did a year in a big PPO office 4 hygiene, ran 2 chairs and it was pretty nuts. Recently switched to a higher class mixed FFS/better PPO office and I run one chair, 2 hygiene. The most common complaint I get from new patients that switch from another PPO office is "the dentist only spent 5 minutes with me!"

Any reason the owners of your office don't want to hire a hygiene? With the higher reimbursements from PPO/FFS patients, there should be more then enough cashflow to hire at least a part-time hygienst.

 

[djeffreyt]

Yeah, I read it and thought it looked like too much already, just figured I'd ask.

Beannaithe, if you run off two chairs with two for hygiene, do you schedule new patients to have their exams in the hygiene chairs? Do you schedule them in the minor treatment chairs?

There is no good reason why the owners don't have hygienists except that they simply never have had hygienists at this group. Like I said, the owners decided to make these changes but I'm not sure the owners have ever run PPO or FFS offices. While they don't want to completely change the model and only do PPO, cause they still make good money from Medicaid, I think they just haven't really considered what the change would entail to entice the clientele to change. I get the sense that they think if they just offer more services (veneers, implants, etc.) that the patients will come, but being a FFS patient myself, I know that what I value is respect of my time more than most other things, so that's why I think the scheduling issue needs to be addressed.

I'll talk to my owners about adding hygienists.

 

[beannaithe]

In my old office where I did the 2 chairs, all NPs came through the minor treatment chair with xrays by the floater assistant and I'd pop in for the exam. It gave the patient some time to get to know me and have a few minutes talking with me. I'd usually coordinate with my assistant to make a temp or finish a procedure to do the exam. The one on one time definitely helped my case acceptance.

In my new office, the higher PPO/FFS office all NPs go through hygiene and I usually coordinate to do an exam when I get a break.

If you offer more services, patients will come but if they end up waiting a long time, they won't come back. They'll find an office that offers the extended services with more individual attention.

I think if your office does it correctly, they'd be able to break into the PPO market. But it'll probably take some tweaking from the five chair situation you have going on now. Also, remember that PPO patients are generally more reliable then Medicaid, so you'll probably get less no shows.