Dental Practice Heroes
Where dentists learn how to cut clinical days while increasing profits - without sacrificing patient care, cutting corners, or cranking volume. We teach you how to grow a scalable practice through communication, leadership, and effective management.
Hosted by Dr. Paul Etchison, author of two books on dental practice management, dental coach, and owner of a $6M collections group practice in the south suburbs of Chicago, we provide actionable advice for practice owners who want to intentionally create more time to enjoy their families, wealth, and deep personal fulfillment.
If you want to build a scalable practice framework that no longer stresses, drains, or relies on you for every little thing, we will teach you how and share stories of other dentists who have done it!
Dental Practice Heroes
Growing with Less Hygienists: New Models for the Age of Hygiene Scarcity
Dental practice owners across the country are facing a critical challenge: how to continue growing when hygienists seem impossible to find. This shortage creates a frustrating bottleneck - you've got the new patients flowing in, your clinical skills are sharp, your systems are solid, but without adequate hygiene capacity, your practice hits a growth ceiling that feels impenetrable.
The mathematics behind this problem are straightforward but concerning. A full-time hygienist seeing seven patients daily for four days weekly can accommodate 672 patients on a six-month recall schedule. For practices bringing in 80-100 new patients monthly with strong reappointment rates, a single hygienist reaches capacity within just eight months. This reality forces practice owners to make difficult decisions about resource allocation.
Beyond simply raising compensation to attract scarce hygiene talent (though that may be necessary), savvy practice owners are deploying creative solutions: becoming more selective about recalls and building robust ASAP lists; extending recall intervals beyond the traditional six months for appropriate patients; restructuring patient flow to route new patients directly through doctor exams with same-day dentistry opportunities; and implementing assisted hygiene models to increase capacity. Each approach has merits and challenges, but combining these strategies can help practices continue growing despite staffing limitations.
Remember that transparency with patients about industry-wide staffing challenges helps manage expectations, and consider that new patients often represent a population with greater immediate treatment needs than established patients who already receive regular care. By implementing these five practical solutions, you can continue growing your practice, serving your community effectively, and maintaining the profitability that supports your ideal lifestyle.
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unfortunately, practicing without adequate amounts of hygienists is becoming the reality for more and more practice owners. So what are we to do if we can't find hygienists? I can tell you that, personally, I have a number of coaching clients right now that are seeing an incredible amount of new patients. They had the right number of assistants, they got the right amount of the front end, and every single thing in their practice is primed to make their practice explode, but they don't have the hygienist to continue growing their patient numbers and they really struggled to get to the next level because of it. So, other than the simple solution of find more hygienists, what can you do? In this episode, I'm going to share five different solutions for operating with less than ideal hygienist numbers so that you can continue to grow and create a practice that gives you the freedom to take loads of time off, all while making an incredible income. You are listening to the Dental Practice Heroes podcast, where we teach practice owners how to make more money and work less days, all while taking great care of their patients. I am Dr Paul Edgison, author of two books on dental practice management, a dental coach and owner of a large group practice in the South suburbs of Chicago, I want to show you how easy it can be to create a systems driven practice that is run by your team. So today we are talking about hygiene. Where did all the hygienists go? And you've heard me joke about it before. They're all on Hygiene Island. They're all sipping on mojitos and posting things that annoy dentists on dental Facebook groups. That's what they're doing. They're just up there posting sarcastic comments about how much they hate dentists and just driving us crazy. Obviously, I'm just kidding, but it does seem like there's a lot of anger if you go on Facebook, and I think it's not a good representation of the real hygienists in America. I have a great hygiene team. I have 11 hygienists. I love them all. They are fantastic and I think anytime you go on Facebook you get the most vocal of the vocal and it can make the whole group look bad. But where are all the hygienists? And what are we supposed to do if we can't find any? And how do we continue to grow our practices? So let's think about this. It's really just math. Okay, everything we're doing with hygiene and new patient numbers, it's all math. So if we've got a full-time hygienist, they're gonna see seven patients a day. They're gonna work four days a week, going to see seven patients a day. They're going to work four days a week and they're going to work 48 weeks per year. They can see 672 patients two times a year. So that is the max capacity of a single hygienist. This is often why you'll see that a full-time dentist can service about 1300 active patients, because that's the math with having two full-time hygienists each seeing 672 patients each twice a year. And if you're running a high growth practice, like I hope you are, that you might be seeing like 80 to 100 new patients a month. And let's say that you are seeing, let's say you're seeing 100 new patients a month. If you're seeing 100 new patients a month and you can reappoint 85% of those people so you're going to reappoint 85 patients a month You'll get a full-time hygienist at full capacity within eight months.
Speaker 1:You can see how not having a hygienist can really hold you back, and I'm seeing this so much with so many different offices. So I sat down and I started to think about man, what are some different solutions that we can do as we move into this next era where there is a hygienist shortage? So I've got five things for you. Let's go through them. Number one the easiest solution is going to be hire more hygienists. That's what everybody tells you. So you've got to decide. You know there is a high demand for hygienists. Do you want to pay more to acquire another hygienist? And I see this so often is that people say I'm willing to pay more for that hygienist, but I don't want to give my whole entire hygiene team a raise because that's going to cost me so much money. Now you've got to decide what is right for you, what is the right amount for you that you're willing to pay your hygiene team, and how valuable is this service to you? Things to think about is that if your doctors are doing hygiene and they have enough demand to be doing other work that's more productive than hygiene, it's costing you money to not have a hygienist. So at a certain point, if doing hygiene as a doctor is preventing you from doing more valuable work, it's going to be worth a lot to you to pay for a high demand hygienist. That might cost you a lot more than you're used to paying hygienists. And this is the first solution of five, and this is obviously the one that everyone's told. But everyone's like dude, I want to. I just can't find them. So what else are we to do? Let's go through the next four. The second one is see less people for recalls. I want you to think about this.
Speaker 1:When I opened up my practice, my startup I was just like. My attitude was like I'm not going to care about your teeth any more than you're going to care about them. So if my patients didn't want to get their teeth cleaned every six months, I was cool with that. So what we used to do is, after the cleaning, we would say did you want to make an appointment for your six month recall or are you the type of person that just wants to call us when you're ready to come back? And I would say it was about 50, 50. We would get 50% of the people that would want to make their appointment and the other 50 percent were like yeah, I'll just reach out to you. And I was cool with either. Now, what happened downstream for this is that we ended up growing a lot slower than we could have because we were just attritioning so many patients because we weren't keeping people in our system.
Speaker 1:But now that we're in this situation where we don't have enough hygiene to see our existing patients. This is actually becoming something that a lot of offices might need to move back into. We need to see new patients at our practice. That's a big part of my block scheduling program that I teach in my training. That sets your practice up to create capacity so that you can continue to grow. You've got to block time for new patients, but the fact of the matter is is if we don't have enough hygiene capacity, we don't have anywhere to put our recalls. So a lot of people are saying well, we've got to take care of our existing patients. What am I supposed to do? But you've got to see a certain amount of new patients, otherwise you're just not going to have the production numbers that you need. We never want to let our recall patients take over our entire schedule where we can't see new patients.
Speaker 1:So the possible solution is to see less people for recalls. Give them the option of say, hey, did you want to make your appointment now? And if they say no, and then they can call in six months and they might be a little upset because they can't get in, what do you mean? You can't get me in for four months. This is how you slowly build an ASAP list that goes along with this. You find out who your patients are that want to be seen. You put them on an ASAP list and anytime you've got an opening in hygiene you've got this list you can boom, call somebody and get somebody to fill in right there. When you don't have a lot of hygiene capacity, you've got to be super efficient on making sure that every hour of those hygienist days are full, and you do that by building an ASAP list and not scheduling the people that aren't going to value your time. So that's one way of doing it.
Speaker 1:See less people for recalls. Don't reappoint everybody, all right. Number three see people less often for recalls. So what I mean by this is who said we've got to see everybody every six months? I mean, is that just sounds good twice a year? Right, but why? Is there any research justifying that? And if there is, I'm sorry, but you can see people on eight-month recalls. You can see people once a year. It's all in the way that your hygiene team and you as the doctor are presenting this. You can let people know hey, you've got really good oral health. Every time I see you, everything looks great. If you're comfortable with it, I think we only need to see you back once a year from now on. We're happy to clean your teeth every six months if that's what you like, but I think it would be okay to see you once a year.
Speaker 1:I think there's a lot of patients in our practice that want to do what's right for their oral health. When we tell them six months, six months, they're going to be here every six months. And if we say, hey, you know what, I think we can see you every year, they're going to be like, thank God, I don't like coming here every six months. The doctor said they can see me every year and that's what I'm doing from now on. So you've got this option with so many of your patients that you can schedule them out for longer recalls. Now remember I said a full-time hygienist can see 672 patients a year, twice a year. Well, how many patients can they see a year if they're only seeing everybody once a year? Well, it's 672 times two. Two times as many 1,344 patients. So you can open up your hygiene capacity immensely by just seeing people less often. So that's number three.
Speaker 1:All right, let's go to number four. This is kind of cool way of doing. It is that you're saving all of your hygienist time for just SRPs and recalls. Okay, that's all they're doing. They're not seeing new patients. You see all your new patients on the doctor's side, and here's what you do as the doctor. Your assistants will take the x-rays, you'll go in there, you'll do the exam, you'll do some like probing depths and check the perio and stuff like that, and if they have any work that needs to be done that day, you get that done and then you schedule them with hygiene. If they have no work that needs to be done, you should probably clean their teeth, and if there's no one available, you should do it as the doctor. But a certain amount of your patients are going to need dental work done and this just becomes a nice same day dentistry opportunity.
Speaker 1:Now, no matter what you do, at some point you're going to run out of room in hygiene, so you're going to have to do some kind of combination of the previous examples I gave you. That's an option that I see a lot of offices doing nowadays too, because the fact of the matter is is they don't have enough hygienists. They might have two doctors and only two or three hygienists and they're like well, what do we do? We can't choke off the new patient flow and we can't just neglect our existing patients. So they're finding that this is a nice little medium solution in between. All right, number five see more patients per day per hygienist, and that can be an assisted hygiene. That can be by shortening hygiene times. Good luck shortening hygiene times and not having people be all PO'd at you. They're going to be upset. But you can do assisted hygiene and I know a number of hygienists that do assisted hygiene and they love it.
Speaker 1:Everybody wants to put up resistance to it, but once they try it and they don't have to turn their own rooms a lot of times, they like doing it. Talk your team into giving it a shot and seeing if it works. But just remember it's okay to tell our patients that there's a dental hygienist shortage. We don't have enough people to clean our teeth and we are so sorry. This is the best we can do. The best we can do is a nine month recall. The best we can do is cleaning your teeth once a year. That's the reality. And they are welcome to change offices and go somewhere else. That's okay.
Speaker 1:But what I don't want you to do is I don't want you to choke off new patient flow and your team will often put up resistance to this. They'll say we shouldn't be giving priority to new patients instead of our existing patients. But let me ask you this when you look at your existing patients versus your new patients, who needs you more? Who's a sicker population? Most of our existing patients they've already gotten treatment. They have good dental health. A lot of our new patients that need us, they're the sicker people. They need us more. If you're getting resistance from your team, share that with them. Is that you know what? If we want to service the most sick people and the people that need us the most, we need to prioritize new patients over recall. Your recall patients will be just fine and we just don't have a whole lot of options with what we can do.
Speaker 1:So summing up here the five things you can do when you're experiencing a hygiene shortage or inadequate hygiene capacity at your office is the easy one Hire more hygienists, pay more money for them, get out there and try to find them. Number two see less people for recalls, so you're not reappointing everybody and as people call to get in, you start building an ASAP list that you can work really fast for the people that really want to be seen. Number three see people less often for recalls, so we're going to start reappointing people for a longer recall time than six months. We might be putting them on a one year recall, putting them on an eight month recall. Anything that we can push them back from six months will open up hygiene capacity for us so that we don't need more hygienists.
Speaker 1:Number four is only using your hygiene columns for SRPs and recalls and you're bringing all of your new patients through on the doctor side and trying to hope that you can do some same day dentistry instead of doing the prophy. Occasionally. You just got to do the prophy and that's the way it is. You're only seeing new patients on the doctor side and not taking up big hour and a half visits in your hygiene column. This allows your hygienist to see more patients because it's shorter appointments. It allows you to continue to grow your practice with new patients. And the last option is to see more patients per hygienist via assisted hygiene or shortening the treatment times for your prophy.
Speaker 1:So any combination of the above is going to help. You've got to get your team involved. You've got to have this discussion with them. We've got a problem in the dental industry right now and we don't have perfect solutions. There is no perfect solution that everybody wins with. There are going to be pros and cons with all of them, and we have to decide what is the best way for us to take care of the most people and also make sure that our practices stay open and that we're profitable and that we can continue to grow and provide services to our community.
Speaker 1:So if you're looking for more practice management tips or looking for systems and how to run your practice like an efficient operation that allow you to take a lot of time off and still make a lot of money, go to dentalpracticeheroescom and learn the training, learn the systems, learn how to implement these into your practice so that you can start living a life that everyone envies, as your practice gives you the freedom to spend time doing what you love doing, whether that be hobbies, traveling or just spending time with your family. Go to dentalpracticeheroescom for more information on that, and I so appreciate you spending some time with me today. Coming up on Monday, we've got a CPA. Mike Bark is coming on and he's going to tell us all about taxes and what opportunities we have as dentists to be utilizing our taxes, to pay less tax and make more money. So thank you so much for listening and we'll talk to you next time.
