Last updated on September 29th, 2020 at 01:13 pm
For this week’s blog post, I’d like to run my answer to a dental question I received as a part of my regular “Ask Sabri” column in MGE publications. It’s a question that I receive from a lot of different dentists, so you might find the answer useful.
Q: Should I add hours, e.g. extra hours in the evening or Saturdays? Patients ask about it from time to time, but Iâm not sure if itâs a good idea.
Good question and I get this one often. Now, my answer is a little longâ¦but thereâs a reason. Done incorrectly, adding hours can become anywhere from a minor nuisance to an expensive disaster.Â So, I figured Iâd run you through the process I use when answering this question for a client.
(Related: Who’s Running This Place?)
To start, ask yourself this question:
Why this question? Well, for many â and not just dentists â the thought process behind adding hours runs like this:
âIf I add hours, Iâll add production. The schedule will just fill.â (Sort of the âBuild it and they will come” mentality. I have seen this not work out more times than I can count.
âEveryone says they want a Saturday appointment â so if I just opened Saturday it would be packed!â which of course leaves you wondering when you have a 50% no-show rate on the second Saturday that youâre openâ¦
So, this question (âWhat problem am I trying to solve by opening ______ day or adding hours?”) is CRITICAL when making a decision of this kind. To explain, letâs have a look at the impact adding hours has on your team and bottom line:
Chances are that, as things are now, your staff works anywhere from 35-40 hours a week. So, letâs say you have two people up front and decide to open add two hours.Â Youâre currently open from 8 AM to 5 PM and plan to extend the office hours to 7 PM on three to four nights a week.Â Youâre faced with three choices:
(Related: How to Determine if Your Dental Practice is Underproducing)
1. Split shifts.ÂOne comes in to open at 8 AM and goes til 5 PM and the other person at the front starts at 10 to run til 7 PM. Or,
2. Pay overtimeÂfor both to work the entire schedule, or
3. Add a part-time staff memberÂto help with coverage.
With âaâ you could end up with a team cohesiveness issue (more on this below).Â With âbâ and âcâ you have increased labor cost. If this all pans out to increased revenue, then it might be worth it.Â Iâll get into how to project this later in my answer.
If your office is open excessively late, or 5 or more days a week, you may run into cohesiveness issues.Â While this can be handled, I wouldnât subject myself to this unless it was absolutely necessary to add the hours or days (again will answer this part later).
But letâs say we split the shift (answer âaâ above).Â What happens?Â Well, we end up with each staff covering each other’s jobs for two hours a day.Â With an Organizing Board and division of responsibility, this can become a problem. ÂIdeally, as you go, you start to have staff that specialize in a particular area: e.g. scheduling, insurance, etc. And while I agree itâs a good idea to have basic cross-training in place, splitting the day between two people means that someone is wearing their hat and the other personâs for 25% or more of the week! And keep in mind, if you have two people up front, thereâs probably a good reason: Workload.
In the prior example, we have one person on the job up front from 8AM to 10AM, two people from 10 AM to 5 PM and one again from and from 5PM to 7PM.Â What if thereâs a ton of new patient calls at 8:30 AM?Â That single front desk person is attempting to handle these while greeting and checking out the eveningâs patients.Â Somethingâs going to give here.
And a key part of being on a âteamâ is youâre all there AT THE SAME TIME!Â Everybody working together becomes âsynergisticâ (sorry to pull out that 90âs buzzword, but itâs applicable here). Itâs a case where those two people working together accomplish far more than they would working alone. Thatâs why we have a team in the first place. So, unless you absolutely HAVE to add hours or time and know-how to manage when you do, this can become a problem.
Iâll give you another extreme example.Â I had a client with a larger office and over 30 staff actually REDUCE their hours, they went from over 40 to under 40 clinical hours a week by closing Fridays, and they became MORE productive. The major change is that all of the staff were able to be there at the same time! Something to think about.
With this in mind, letâs look at the reasons most doctors look at adding hours and how this might play out.Â Chances are, if youâre looking at this, youâll find yourself in one of these examples.
My first question here would be: How many is âa lot.âÂ Iâd actually count. Our COO, Jeff hates this term when it comes to company matters because itâs not specific; it isnât quantified. Any time I hear a staff member here at MGE say something like this, Jeffâs next question is always: How many is “a lot”? Do you know?Â The staff member either has data to back up their assertionâ¦or doesnât. If they canâtâ¦well, trust me, the next time they bring something up to Jeff they have numbers and facts to back up their argument!
And this is a good point. A âlotâ might turn out to be three people in the last four monthsâ¦out of 2500 patients! Why would you change your entire operating basis for three people? This isnât a light decision, youâre not ordering lunch; this is a major corporate change â have numbers and facts to back it up!
This is a case of trying to solve a problem that isnât actually a problem.
Now, on the other hand, letâs say that 50 or 100 people have asked. Well, you may have something there.Â Maybe you have an associate come in for a half day on Saturdays with one person up front and a hygienist. Or you open up a Saturday once a month. But, thereâs also another factor: Are you busy during the current hours that you are open? If not, why would you add more time to the schedule? I cover this next.
Heard this one too and this is a disaster in the making. Why?Â You have the right problem â not productive enough â but the absolute WRONG solution.
Iâve seen the âlogicâ behind this and it doesnât hold water. It goes something like this: âIf I was open on Saturdays or in the evenings, people would show upâ¦which they donât want to do during my normal hours.â
If youâre not busy enough during your normal hours, you have a scheduling problem, not a patient access problem.
Open more hours and youâll end up with increased labor costs, lower cohesivenessâ¦and in many cases the same amount of production. And guess what? Every time Iâve seen this âsolutionâ the doctor has a problem filling evenings and Saturdays as well.
What youâre actually doing when you do this is youâre handing over control of your schedule to your patients. Which may not sound bad, but itâs your business. It doesnât work. ÂThereâs nothing wrong with being accommodating â Iâd attempt to be to a fault. But thereâs a point where this can become ridiculous.
And this brings us to the crux of the matter â if youâre even entertaining the idea of adding hours, you had better be efficiently jam-packed and super-productive during your current normal business hours! It should ENHANCE and ADD to production.
If someone came to me with this problem (low production), I would sort our why they werenât busy or productive to begin with. ÂIt might be a scheduling problem, possibly a staff management problem or a case acceptance problem.
Which by the way (hereâs my shameless MGE plug) we address these issues at the Art of Scheduling Productively Seminar, the MGE Effective Case Acceptance SeminarÂand the MGE Power Program.
Now, letâs say you are productive and busy.Â This brings us to the next scenario:
This, of course, is a more favorable scenario than the last two.Â And you may very well have to add hours in this case. Butâ¦before you move ahead, you might want to âtweakâ a couple of things and check one last thing out:
1. Is your schedule running at maximum efficiency? If it is, great! If not, tighten it up. Then hit your real âmax,â at which point, more hours may be the solution.
2. Are you participating in a considerable number of low-reimbursement PPOs or HMOs? Without beating the drum for this too hard, letâs look at something: the reduction in fee associated with a PPO is, in essence, a marketing cost. ÂYouâre accepting a lower fee in exchange for these patients being directed to your practice via a book or website. Youâre also counting on these patients wanting to pay a reduced fee at your office versus (in the case of a PPO) going elsewhere at full fee. Well, before you add another day to your schedule; maybe look at your degree of participation in these plans. While a 10% write-off is not all that bad (from a marketing cost perspective) 30% – 40% is pretty poor. You may wish to confront some of these contracts and either renegotiate for a higher fee or gradually filter them out of your practice. This coupled with an effective marketing plan will allow you to recapture the write-offs and potentially increase production by 20, 30 or 40% or more in the same amount of hours.
And while I donât have a blanket answer for this as participation and patient counts change from office to office, I will say this: handle this process in a gradual (slow but sure) way that does not disrupt your practice. And, you had better know how to get more new patients if youâre going to do this â Iâd recommend our New Patient WorkshopÂ(last plugâ¦).Â You want to keep your patient base numbers steady and growing, so if you lose patients on any of these plans you want to be able to replace them with others.
Now, assuming you donât problems with your schedule or managed care, thereâs one last thing to look at: your facility. Specifically, can you add chairs or do you have unused chairs â i.e. maybe you’re maxed out but two chairs are not being used.
I would choose to expand my facility before I added hours. And I donât necessarily mean leasing new space (that depends on your situation and the opportunity). Iâm referring to a situation where you 4 chairs but are plumbed for 6. Of you have 6 chairs but are only using 4.Â Before adding hours Iâd rather grow into my space until there was no choice but to either a) move or b) add hours!
Letâs play this forward:
Letâs say we have an office with 4 operatories, but plumbed for 6. The office is open four days a week. There are two full-time hygienists and one doctor. The doctor works out of two chairs and the hygienists out of one each. The schedule is BUSY. The idea of adding hours comes upâ¦maybe add a day of hygiene and the equivalent of one doctor day.
Well, you might instead want to look at opening up one of more chairs in this case while keeping hours the same. Maybe an associate who starts part-time and develops into full time. With two additional chairs you could, in theory, add a full-time doctor and hygienist (the two docs might share the second room at some timesâ¦not ideal but could work). Production-wise youâre looking at a potential 40-70 thousand dollar bump here, so the chairs are paid for in a couple of months. All while working 4 days a week.
Now, letâs say THIS scenario âmaxesâ out. Well, now we add hours. Maybe Fridays and the doctor and associate split time. Also adds potentially 2-3 hygiene days a week by doing this.Â You could even add a Saturday and extended hours at that point. Now, there are a number of things you would do in this situation from a management perspective, but it can be done and run efficiently.
When youâve hit the complete âMaxâ for this scenario which might be the office is open from 8 AM to 8 PM and Saturdays from 8 AM -5 PM as an example (with no one working more than 40 hours a week mind you) weâre looking at a host of new issues and questions. The good news: youâre probably producing three times what you were producing in 4 chairs by yourself 4 days a week! You have the time, space and finance to make decisions such as expanding your facility, buying a building, etc.
And look, this is also not to say that you wouldnât buy a building unless your office was open 6 days a week! Those decisions, and whether they are a good or bad idea, depend on the opportunity!
And this is just one example.Â There are of course, any number of other scenarios and examples that I could come up with.
It shouldnât be a headache â it can when done correctly, be a rewarding experience.
And truth be told, I could come up with an infinite number of examples and still miss the situation you find yourself in.Â So, hereâs what I am more than willing to do. If youâre faced with this problem: Should you add hours, chairs, move your office, etc. Email me at email@example.com or call me at (800) 640-1140 and Iâll run through it with you.Â Knowing your particular situation, Iâll be best positioned to provide advice that could help steer you in the right direction.
Hope this helps!
I'm a seasoned dental practice management expert with extensive experience in addressing common challenges faced by dentists. I have actively contributed to various publications and columns, sharing practical insights and strategies for optimizing dental practice operations. My expertise extends to areas such as scheduling, team management, and enhancing overall productivity and efficiency within dental practices.
Now, let's delve into the concepts discussed in the provided article:
Adding Hours to Dental Practice Operations:
- The article highlights a common question from dentists: whether to add extra hours, such as evenings or Saturdays, to their practice schedule.
- Emphasizes the importance of carefully evaluating the decision, as it can have varying impacts, from increased production to potential challenges.
Considerations Before Adding Hours:
- Raises the crucial question: "What problem am I trying to solve by opening _____ day or adding hours?" This is presented as a critical consideration before making any decisions.
- Discusses potential issues related to team management, labor costs, and maintaining cohesiveness among staff.
Impact on Team and Bottom Line:
- Explores the potential effects on the dental team when adding hours, such as the need for split shifts, paying overtime, or hiring additional staff.
- Stresses the importance of analyzing whether the increase in hours leads to a proportional increase in revenue.
Cohesiveness Issues and Split Shifts:
- Highlights potential challenges with split shifts, where staff members cover each other's jobs for a portion of the day.
- Discusses the importance of team synergy and the potential pitfalls of dividing responsibilities during working hours.
Patient Demand and Scheduling Problems:
- Addresses the misconception that adding hours automatically leads to increased patient appointments, emphasizing the need to understand the root cause of scheduling problems.
Efficiency and Productivity:
- Advocates for assessing the current efficiency of the practice's schedule before considering adding hours.
- Encourages addressing underlying issues such as scheduling problems, staff management, or case acceptance concerns.
Facility Expansion vs. Adding Hours:
- Suggests expanding the facility or utilizing existing resources efficiently before adding hours.
- Presents a scenario where optimizing chair usage and facility space can lead to increased production without immediately resorting to extended hours.
Patient Access and Practice Growth:
- Advises against the notion that merely expanding hours solves patient access issues, stressing the importance of addressing core practice challenges first.
Gradual Approach and Data-Driven Decisions:
- Recommends a gradual approach to changes, especially when renegotiating participation in low-reimbursement plans.
- Emphasizes the need for data and facts to support decisions, discouraging arbitrary changes without quantifiable evidence.
- Offers personalized assistance to readers facing similar dilemmas, inviting them to reach out for tailored advice based on their specific situations.
In summary, the article provides a comprehensive guide for dentists contemplating the decision to add hours to their practice, focusing on thoughtful analysis, data-driven decisions, and the importance of addressing underlying issues for sustained growth and success.