Dental Practice Heroes

Stop Getting Behind and Hurrying through Your Days with the DPH Coaches

• Dr. Paul Etchison, Dr. Henry Ernst, Dr. Steven Markowitz • Season 3 • Episode 56

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Busy January? If your office struggled to keep up, you’re not alone. In this episode, we discuss why hurrying may be to blame and how slowing down can actually help you reduce stress, boost productivity, and provide better patient care. Let’s explore how packed schedules, inefficient systems, and understaffing impact both your team and your patients—and what you can do to fix it!

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Paul Etchison:

Have you ever noticed that when you're rushing through your day at the office and the faster you go, the more things seem to go wrong? We all want that busy practice but, let's face it, sometimes the level of care we want to provide is not in line with the amount of patients that we need to see at our office. In this episode, we break down why being in a hurry at the office is hurting your team, your patients and your profits, and what you can do to turn things around. You're going to learn how to take control of your schedule, your time and your stress so that you can leave the office each day feeling accomplished instead of exhausted. You are listening to Dental Practice Heroes, where we help you create and scale your dental practice so that you are no longer tied to the chair.

Paul Etchison:

I'm Dr Paul Etcheson, author of two books on dental practice management, dental coach and owner of a $6 million group practice in the suburbs of Chicago. I want to teach you how to grow and systematize your dental practice so you can spend less time practicing and more time enjoying a life that you love. Let's get started. Life that you love, let's get started. Welcome back to Dental Practice Heroes.

Paul Etchison:

I'm your host, dr Paul Etchison, and I'm joined here today by my DPH coaches, dr Steve Markowitz and Dr Henry Ernst, and we were just having a little conversation talking about how this January it kind of feels like there might be a lack of compassion in the world and at our practices in some points Not saying that we're all horrible people, but just something that we picked up on a notice and we all kind of shared the same feelings on it and you know it led us to talking about you know where does that come from? And we think it kind of comes from being in a hurry. So, steve, I'll pass it to. And man, what are you seeing and what are we even talking about here? Like, what am I saying here?

Steve Markowitz:

I feel like January is always a busy month. I mean, people insurance benefits renew, people took time off, they didn't want to go to the dentist around the holidays, and December is always one of our slowest months of the year and January is always one of our busiest months of the year. And what I'm noticing this January is that there's a lot more patient complaints and billing complaints and our schedules are busier than they've ever been. And I think when you're busy and when there's a lot going on, it's harder to be empathetic, because you just have more stress and that's normal. But when you are losing that ability to lead with empathy and truly listen, you're forgetting that we're in a people business, trying to take care of people, and that empathy is the only thing that we got for them to understand, for us to understand what's truly going on with our patients, and I think that's why we're getting more patient complaints than we typically see.

Paul Etchison:

So what's interesting is something I noticed not that long ago, and I read this in a book, and I can't remember what name of the book was. It was something about hurrying. But essentially what it says is that if you can think about this is anytime you are in a hurry, none of the positive emotions will ever show up, you will never be compassionate, you will never show empathy, you will never be happy, in a good mood. When you are in a hurry, it is like fight or flight, get the hell. You have only one thing focused on is getting to the next thing, and it's really hard to be happy with this. And that was the whole premise of the book was that in order to be happy, we've got to stop hurrying. But when we're talking about hurry at the dental office, I think we've really got to look at some of the systems. Like where is that hurry coming from? What have you noticed in your practice, Henry? Like about just workloads, people's emotions and just what we're talking about.

Steve Markowitz:

Paul, that book was the Ruthless Elimination of Hurry, by the way.

Paul Etchison:

Oh, the Ruthless Elimination of Hurry. Thank you, Steve.

Henry Ernst:

Thank you, google, you're welcome. So actually our practice is like interesting. Steve, you mentioned all that stuff because I don't know if it's our area, but our area is kind of like the opposite, believe it or not. Oh wow, december is our busy, busy, busy month. Everybody's waiting until the end. We do a lot of surgery and we do a lot of surgery. Everybody wants to have surgery right before the break and all this stuff here. So I have time to heal and all this stuff. And January is kind of like I wouldn't say it's like amazingly busy, but it's like it's good.

Henry Ernst:

But I think I'm always that person. I'm trying to find the solution, like what's the problem? And, yes, we incur the same things. You're busy and sometimes you're running around. You're just like why am I running all this routes? Why am I doing this stuff here?

Henry Ernst:

I always tell our associates they look at their schedule, like, oh, look at this, look at that. Dude, you're the one that's in charge of your schedule. Right, look at your schedule. Look at it. Two weeks ahead of time, a week ahead of time, did they give you 30 minutes to do a root canal buildup in Crown? Right, dude, extend it, make it what you want. Did they give you like two hours to do an MO on number four? That's crazy, that's ridiculous, that's not being efficient. Make it what's right.

Henry Ernst:

And then I think that, no matter what happens, if we have a busy practice, you're going to be busy and as a doctor you have to handle this. And, like I'll give you some rules that we have If I'm in a room working on a patient, I never, ever want an assistant walking in the room saying doctor, we're ready for you in room six. That never happens in my practice. It's a huge no-no, because you know what that makes me feel like I'm in a diner and somebody's like table number four. Right, dude, we're in a dental practice.

Henry Ernst:

Have your assistants walk in the room, give you a rounding slip and we have rear delivery. So our patients don't even know somebody's coming in. They come in very quietly, they just put the slip down and I see the slip, I make eye contact, I mean that's just a couple of examples in my head that can kind of not give the perception of being busy. But also, on the front end, as a doctor, you're in charge of your schedule and we trust our hygienists too, and we don't have hygiene divas, we have the hygienists that are respectful and we trust them to make their schedules like tweak them, tweak your schedule. Don't just be a victim to your schedule.

Paul Etchison:

Yeah, it's true Like we are a victim of our schedule and that's one of the things we have 100% control over, and I think so much of the hurry on the clinical end comes from the schedule. I mean, I think about when hygienists get behind. Why do hygienists get behind? Well, they either don't have enough time scheduled, but most of the time they do, usually it's they're waiting on the doctor. So how can we not make the hygienist wait? And then, when we're looking at our clinical with us and our assistants, it's man, are we just overbooking ourselves? Are we so production hungry that we think the idea is to see more patients?

Paul Etchison:

And I did this for years with my ortho nights. I would do one or two ortho starts and I would do like a million 30-minute ortho checks in three columns. And every single Monday it was Sunday night I was just like ill, I didn't want to go into work. I woke up pissed off, I walked in pissed off, I went seven hours of being pissed off along with three assistants who were all pissed off. And we did it for years and all we had to do was take that 30-minute ortho slide, extend it to 40, and see like four less patients that day or something like that, and it made all the difference in the world. It was like a cloud had lifted.

Paul Etchison:

So if you're running around your office and you're just busy as hell being pissed off and wondering why you're so pissed off at your office, it's because you don't have enough time. And to another extent, I want to talk about what about when we're just the office stuff, like the front desk stuff, like all this administrative stuff? Sometimes we need to schedule some time for that. You know, I found that if we don't schedule time for it, people will just, when they don't have anything else to do, they pull out their phone and they should be working on these other things. But that's just not the way it works in the real world. That's what I think about. I just try anything I can do to keep people out of a hurry.

Steve Markowitz:

Yeah, I love that, paul.

Steve Markowitz:

I think it's important for us to know the best way to save time is to solve the issue.

Steve Markowitz:

So if there is an upset patient or an issue that's happening in the office, putting it off or like no, I don't want to go talk to that patient because they're mean, only makes it bigger, and then we're going to be in more of a hurry. So I tell all of our team, all of our doctors if there's an upset patient and it's your patient, walk towards it, get your ass in there. Don't go in there with facts about a study that you read about in JADA in the early 90s. Talk to the patient, understand where they're coming from, ask them questions and tell them that you're going to try and make it better and just sit there and listen. When we put it off any of those things and that can be administrative or clinical it becomes an office topic, it becomes a bigger thing. The negativity spreads because that negativity is so contagious. And then we are now in a bigger hurry because we spent 45 minutes talking about something that we never even started.

Paul Etchison:

It comes down to completion. Spent 45 minutes talking about something that we never even started. It comes down to completion. We've got to complete things. If we got an upset patient, start it, end it. Make sure everybody's happy. If we're collecting a balance, collect the balance. Collect the whole balance, if you can. I had one client where they weren't inputting fee schedules into their system. So this is what they were doing with every single treatment plan. They were doing a pre-treatment estimate for every single treatment plan and then, when they got it back, they would send the claim out with the UCRs for every single treatment plan and for every ELB they got back, they would adjust every single code and they would fix the balance, either send a refund or call the patient for more stuff, mail a statement. And it was a mess because all those things were incomplete, whereas all they had to do is go back and look at the system that caused that incompleteness.

Henry Ernst:

Yeah. So I would say look and see if your systems are actually stupid, right? Because if I was coaching that person I would say these systems are stupid, right? That makes no sense. This is wasted time. This is being bad busy, right? I want to be good busy. There shouldn't be such a thing as I'm too busy, right? Are you understaffed? Can you add more staff?

Henry Ernst:

Dentists are so hesitant to add more staff. For example, we've been doing 100 ortho starts Invisalign starts for the last three years. So what happens? You develop so many patients that are in the middle of treatment in the middle of treatment. So we said you know what? We're going to create a whole column or two some days where we have one assistant that's per column that is just treating those orthodontic in the middle of treatment patients. Because essentially with Invisalign, you know, we have to remove the buttons. We got to do IPR. But most of the stuff our assistants can do.

Henry Ernst:

So that's an example of if we never did that my schedule would be so full of all these intermittent ortho things that are just somebody else can do it. We could be so much more efficient. So look at your schedule too and see is there stuff? Can I have an assistant, have an emergency column every day. Do we have the volume for that Great and don't feel pressure, right, we do this on Saturdays. This is a hallmark of our practice.

Henry Ernst:

On Saturdays, we're in the practice from eight till two, and I'm not joking on a Saturday from eight till two. We will see, like with a normal schedule too, 10 emergencies, eight emergencies, and I don't tax the schedule. Right, if I know that I can squeeze in a crown or two, I'll do it because I've got enough staff that I can do it. But if that's going to tax my schedule and make everybody crazy, I'm going to say hey, you know, I want something to be productive.

Henry Ernst:

So they got a broken tooth, I'm going to smooth it. Hey, jane, let's get you on the schedule when I have time. This way the patient is understanding and say, hey, he wants more time to do it. Right, if it's somebody that's got an infected tooth, hey, I'm going to give you an antibiotic. Let's get you on the schedule next week. You know that kind of thing. So you have to. You're in charge of the schedule. But also, don't be that person that can't look ahead and say maybe I should hire somebody else to make this, so I'm not feeling that busy and strained and stressed.

Paul Etchison:

Well, you know what's a good punt as well as I'm going to throw this tip out to the listeners is that we see a patient with a lot of very just decay everywhere Big case, okay. And we look at it and we got two patients in the other room, we got two people in the other hygiene chairs, and we look at it and we say, man, this is a big treatment plan. Okay, look at, we say, man, this is a big treatment plan. Okay, we got to do this, this, this, this, this, this, this. Okay, okay, do you have any questions? Blah, blah, blah.

Paul Etchison:

Look at that patient and be like you know what I mean. Your case is pretty complex, as you might know, and maybe they don't know, but you could show them. There's a lot going on. You know, I really would love to look at your records's. Okay, if we get you back and I can present all these different options to you on a different day, they would be happy to do that and then you can sit down with those records, come up with a larger treatment plan, but instead of just firing something off or staying in that room forever for a patient that really needs a lot of doctor time.

Henry Ernst:

And I'll tell you this besides the time factor you're in a practice that has younger associates, maybe associates that aren't comfortable with big things like that that also gives them a punt we'll call it a knowledge punt to say, hey, you know what I want to sit with my senior doctor and what do you think about this? And it's another topic, but associates should be comfortable doing that and that also gives you that comfortable thing where you can give them good aspects to go through this complex case.

Steve Markowitz:

I was going to add to that. Sometimes I'll even if it's decay and there's just quadras of decay everywhere and the patient's going to need some time. I'll just pick a tooth and say, like tooth number 29, there's a cavity there. I need some more time with you. Let's extend that appointment by 10, 15 minutes and I just want to make sure I have enough time to sit with you, but we get the process started for them and we show them that dentistry isn't that scary, that's not all the time.

Steve Markowitz:

That's not ideal, but it's more ideal than me feeling like I'm in a hurry or feel like I'm not giving this person everything that they need to make the best decisions for themselves. So there are and I think that comes with experience, there are compromises that we need to make to eliminate that hurry, which I think we should just publish that book, paul, because it really is. We can't make the best decisions, we can't be the best doctors, if we feel like we're in nine places at once. And if there are little tips or tricks that we can do or systems that we need to put in place, like Henry said, or people we need to hire, then we can definitely reduce the hurry and then be able to be more present, and maybe that's what it is Just be more present for our patients and for our team to really deal with the issues or the most pressing things in front of us.

Paul Etchison:

Totally so. Yeah, if you've sent some hurry at your practice, sit down, write down what happened. Just get really granular on what is the situation here and try to come up with why it happened and look upstream what caused these situations. We want to avoid hurry at all costs because it takes us away from being present. It takes us away from being happy, being in a good mood. There's nothing good that comes from hurry and it's all fixable things that can be fixed upstream with some different protocols or different systems or perhaps a different way of looking at it. So if you're interested in working with a coach with Dental Practice Heroes, you can work with Steve Henry or myself. Please check out our website at dentalpracticeheroescom. Thank you so much for listening and we'll talk to you next time.

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