Dental Practice Heroes

More Staff, or More Efficiency? How to Tell with Dr. Paul Etchison

• Dr. Paul Etchison • Season 3 • Episode 66

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Are your front desk team members constantly asking for more help? In this revealing episode, I tackle the challenging question every dental practice owner faces: when should you hire more administrative staff versus improving your systems?

I walk through practical solutions I implemented during COVID when my team was drowning in new protocols and administrative burdens. Rather than immediately hiring additional staff, we automated patient check-ins, digitized forms, and streamlined communication processes. The results were transformative - not only did we handle the increased workload without adding headcount, but we created a less stressful environment for our existing team.

Ready to transform your front desk operations? This episode delivers actionable insights to help you build a more efficient, profitable practice without unnecessarily expanding your payroll. Your administrative team - and your bottom line - will thank you.

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Paul Etchison:

Now I guarantee you, at some point in your career people working for you on your admin team they're going to tell you either that you need to pay them more or that you need to hire more people up front, and a lot of times they will tell you both at the same time. So what are you, as an owner, to do? How do you know if you are just inefficient at the front or if you truly need more people? As owners, we want to take care of our teams. We want to pay them more, but realistically, we have to watch costs and payroll is the biggest cost we often have. So today I am going to teach you exactly how to know how many admin people you need on your team and give you some tips and tricks to make your front end more efficient, so that you don't need so many and you can have better control over that cost on your profit and loss. If you've ever wondered how many people you need up front, well, this is the episode for you. Stay tuned, let's get to it. My name is Dr Paul Edgison and you are listening to the Dental Practice Heroes Heroes podcast, where we teach owner dentists how to practice less, make more and take more time off without cutting corners or running a high volume practice. I've authored two books on practice management. I've been coaching dentists for over five years now and I own a large multi-doc practice in the south suburbs of Chicago. My goal is to teach owner dentists how to live better lives by running more efficient practices that allow them to take more time off. Now I want to share a story with you that helps illustrate that the answer to chaos in your office is not always throwing more employees at it. It can be something different.

Paul Etchison:

Now, when we came back from COVID I mean you've heard me talk about COVID before I loved when it happened. I know a lot of bad stuff happened, but I'm saying I loved being off. I loved being home for 11 weeks with my family and, to tell you the truth, I really wasn't all that excited to come back to work. I mean we had all these new rules and regulations and things that we had to do. We had air purifiers all over the place. We were doing a whole bunch of different disinfection. We were wearing an incredible amount of PPE. I mean I remember feeling like a fricking Eskimo. I did that for a week and I'm like I can't do this. I'm sweating my ass off. I'm not wearing a gown, I just didn't do it. So I didn't follow the protocols as they were determined.

Paul Etchison:

But you know, we come back from COVID I guess we're trying all these new things on and my front desk goes from you know, bring the patient in check if they have a balance and tell them to have a seat, and now all of a sudden we want them to stay in their car and we're texting them to tell them to stay in their car, and now they have to fill out an additional form for COVID, acknowledging that COVID is a pandemic and you know we can't guarantee that they won't get COVID from us, that we're following all the protocols and sometimes we have to update forms. We had to do this other stuff. So it's like there was this front end burden. Now I want to say like there was a burden on every part of the practice due to COVID, but there was an additional front end burden and what we noticed was it was the front was getting so burnt out because it was just like so much to do. They were so busy just following the new protocols and it was in a complete pain in the ass. So the solution, doc, with these new protocols we need more help up front. Well, you know that sounds good, but since we have new protocols, we can't see as many people. Revenue is down. Where's this money going to come from? Right, and I think a lot of doctors were in this predicament and it was stressful. It was a pain in the ass. So what was the solution? Did I really need more people or not? Now I'm going to tell you what I ended up doing, but I want to share a more recent story that's going to explain how I found the answer to this, because I didn't have this information back then when I was worried about it at COVID. I have this information now.

Paul Etchison:

So very recently at my practice we have been auditing different departments and looking at payroll and looking at are we overstaffed or not? We were growing, growing, growing, trying to get ourselves to $6 million in collections. We got there and then you know, we've kind of been hovering right under 6 million for now there's no more capacity in my practice to grow past that. So about $6 million is where we will be at collections. So we're auditing different departments, we're looking at how many people we have. I reached out to my regional manager and I said I'm really struggling to see if I'm overstaffed at the front, and you know what I mean. It's like you go up front and you see people not doing stuff. You see them on their phones and you're like man, I got too many people up here. But then it's sometimes they're all on the phone and you can't get anyone to help you with the patient you have in the chair and you're like, huh, maybe we need more people. So I'm talking to my regional manager and she mentions to me that MB2 did this case study with all their practices and essentially what they did is they looked at the best practices, so not like the top echelon of practices, but the majority of the best practices, so like the good practices, and they said how many admin people do these teams have that have a good profitability, they're efficient and they run their practice well?

Paul Etchison:

So it's not like the unicorn practices. These are reasonable things that you can do. They found that for every $720,000 in collections, you should have one full-time employee. Now here's the special disclaimers. This does not include your office manager. So for every $720,000 in collections, you should have one full-time front desk person. $120,000 in collections, you should have one full-time front desk person, not including your office manager. So if you're collecting about $1.5 million, you should have two front desk people and an office manager. Now this is them doing everything, from insurance verification to revenue cycle management, posting the EOB, sending statements, everything, start to finish, admin scheduling, answering the phone. They're doing it all.

Paul Etchison:

I know you're saying what about when you outsource stuff? And we're seeing a transformation on the admin side of dentistry because of artificial intelligence. So there are going to be a lot more things that you outsource. So I want to give you three different areas where you can really focus on the efficiency of front desk to make sure that you're finding that optimal balance between employees and efficiencies.

Paul Etchison:

First of all, what can you outsource? Can you outsource the insurance verification? Is that something that is predictably going to be correct? Now, a lot of people say we tried it before. It didn't work. We had like a certain percentage of these were entered wrong and then we didn't trust any of them, so we never wanted to do it again. So what I would ask you is when you do this on your own, do you get a certain percentage of them wrong? Yeah, you probably do so. There's always going to be some level of error. But now with artificial intelligence, you can get the insurance breakdowns. They can enter it into the computer for you. It can save you a ton of time and, depending on how big your practice is, I mean for me to outsource insurance verification. That's probably one and a half full-time front desk people for me. You know the $6 million practice. Now the other thing is we're seeing AI with claim follow-up and the revenue cycle stuff.

Paul Etchison:

So our goal of outsourcing is not so much that we don't want to hire personnel, but it's more so that our personnel can focus on the patients and again, it's a very difficult hiring environment right now, so we might be short staffed. So it might help us. We might have to outsource. Another thing you really have to manage with your front desk is managing the phones. If we don't answer our phones, we are losing opportunities for new patients. So we need to be able to answer the phone and when we answer the phone we've got to have the mental energy to be polite and be friendly and make a good impression. So if we're like chaos and running all over the place and we pick up the phone and we're just like crazy busy, that's not going to give the best patient experience. So here's some ways you can help. Your front desk with. The phone is one.

Paul Etchison:

I love this idea. It's called auto attendant. Now, if you're using VoIP services, this is really easy to set up. You set up auto attendant and what this means is when somebody calls your practice, it picks up automatically and it plays a message Our says you know well, thank you for calling Nelson Ridge Family Dental, we're giving you the greatest experiences, our utmost priority, something like that. But then it says if you're looking to schedule a cleaning or a new patient visit, you can schedule online at nelsonridgecom. So we tell them that first thing. The reason we do is because maybe that will save a phone call. A lot of people would prefer to schedule online. So if my team doesn't have to answer that, that's one less phone call they had to take and now they can schedule online. They can enter in their own information and it goes straight into our system and it saves us some time.

Paul Etchison:

Now the other benefit of doing this auto-attendant is you can also set it up so that you know if you've got. If you're a new patient, press one. If you're this, press two. Or you can say I like if you have questions about your bill or your insurance, press three and if you want, you can send that to a voicemail so that you can tell them to leave a message with your name what your question is. And then that way, when it's not a busy time, you can get all the information you need and you can call that person back, because most people are going to try to call you during their lunch break it's a very popular time, say from like maybe 1045 to like 2 pm.

Paul Etchison:

A lot of people calling. So you need to be there to answer the phone. And if somebody calls with a billing question and you don't have the answer, I mean you're looking through it they're sitting there waiting on hold. It's a phone call that doesn't need to happen at that point, so you can just send them to a voicemail. And the other benefit of doing auto-attendant is that now you didn't miss a call, they're just on hold. And you can set up with VoIP providers we do this with ours is that if somebody hangs up while they're on hold, it automatically texts them and says we are so sorry, we didn't get to you. Please tell us what we can help you with and we will text you back as soon as possible and often people say, hey, I just was looking to make a new appointment and we'll text them back, okay, great, and we just start communicating with them that way. Or we follow up with them because we missed it, but most of the time, because they're already on hold and they're not like going to a voicemail, we will get to them before they hang up. So those are some ways that you can really help the phones as you grow, because the fact of the matter is is you don't want to miss phone calls and a lot of people will have those busy lunch hours and will miss some phone calls and that immediately means that we don't have enough people.

Paul Etchison:

I want you to think about the analogy of a restaurant. A restaurant is fairly maybe not that busy Monday through Thursday, but on Friday, saturday, man, there's a wait list. So you might have to wait 30 minutes, you might have to wait an hour before getting to your table. If you just walk in there, nobody working in that restaurant is gonna say, dude, look at this wait list, we need more tables, we need more tables, we need more staff, we need more of this, because you would say, hey, well, throughout the week we're not really packed at all. This is an efficient way to run this, because on the weekends we got a little bit of a waitlist, but we're still seating as many people as we want to. So the same thing goes for your front desk. You may not have enough people to answer a million phone calls at some parts of the day, but for the most part of your week you do have enough people. So just because you have a few parts where it gets a little bit busy, know that that's expected. Use that restaurant analogy with your team so that they can understand that, because often they will think we need more people.

Paul Etchison:

Obviously, look at how we weren't able to answer all those phone calls and take care of all those patients so often. We don't need more people, we just need better processes. Look at the efficiencies of your front desk. I can tell you one big spot that we often drop the ball is we don't do phone training, and when we don't do phone training we can often spend way too much time on the phone. Now I know with a new patient call it's going to take more time. You want to give a good experience, you want to warm them up to coming to the office, but you don't need to be on the phone for 15 minutes for that phone call. I need to be like a four or five minute phone call tops. So you want to train your team on the proper way to answer the phones. If you're looking for some training, we have my online training at the heroective. You can get all my training videos. There's about three hours of actual phone calls and critiques. That helps your team see what not to do and what they should do. But you can check that out at dentalpracticeheroescom. That will help your front end team immensely. Stay off the phone so long and land and convert more new patients for your practice.

Paul Etchison:

Now let's look at the form entry. We used to, a long time ago, have them do their new patient forms. We print them out, they would fill them in and then we would take them back and we would enter in all the information into our practice management system from those sheets. We don't do that anymore. So that's one of the ones that we automate at our office. We automate a number of other things that we used to sign and scan. We don't do that anymore. So do you need to look for a technological upgrade so that you can take care of some of these tasks that you were doing manually and do them automatically. So just look at your processes and see what's out there, and the best part about automating any kind of new patient forms or stuff like that is that the patient enters it in and it goes straight into your system. So there's no errors because you're copying it over from a piece of paper.

Paul Etchison:

What about payments? You know we used to send statements like crazy we did. It was like twice a month we had to print out all these statements, stuff the envelope and send them. Now it's just texting a link. You know we don't send those statements anymore. We text them a link. They can click on the link. It shows an invoice. They can pay it right there.

Paul Etchison:

So before you hire more people, really look and say am I maxing out the efficiency of my team? Because chances are you're not. You can automate more things. Let's go back to the COVID time, when my front desk team was struggling because of all the new protocols, like checking in the patient, texting them. Stay in your car texting them. Okay, come in, we'll let you in, like cause we couldn't have anybody in the waiting room together. Oh my gosh, we're going to contaminate everybody. So what we ended up doing is we did not hire any more people.

Paul Etchison:

We did exactly what I explained in this episode is we looked at our systems and we looked at all the different steps along the way and said what can we automate? So we automated the check-in process, which saved us a ton of time. It would automatically text the patient about 30 minutes before their appointment Say hey, when you get to the office, click this link. They'd click the link, it would check them in, they would do any new patient forms that they needed to do, and then we can automatically text them from our system when we were ready for them. So it was all automated. And when we automated that, that was the same time that we switched to automating patient forms as well, which also saved us a ton of time. And then we switched to informed consents being on an iPad instead of being on paper where we had to scan it. So there was a number of processes where we were able to cut down the time and become more efficient and be able to work in this new workflow that was created by the new guidelines and protocols that were intended to keep all of our patients and our workers safe from COVID.

Paul Etchison:

So once we optimized everything, everything was great and we didn't need any more people and everybody's job was a lot easier, which is better, because now I could pay my team more.

Paul Etchison:

I don't have to hire more people. So if you're looking to optimize more areas of your office, and check out the Hero Collective at dentalpracticeheroescom and here's your final takeaways the $720,000 rule one full-time employee at the front for every $720,000 in collections Use it as a benchmark. I don't want you to take a front desk team that's chaotic, seems like they're burning out and say the solution is more people, because I promise you more times than not, it is not more people. You got to look at what can be outsourced. You got to look at how the phones are managed, all the processes that you can automate and optimize all those things, and if you still then need more people, well then you can hire more people. So thank you so much for listening. I hope you're having a great spring and getting geared up for summer. By the time this episode comes out, I will be coming back from a 10 day vacation to Vegas and Turks and Caicos, so I'm super pumped for that. Thank you so much everybody for listening. We will talk to you next time.

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