Dental Practice Heroes

How to 2-3X your Production Without Working Harder

• Dr. Paul Etchison • Episode 600

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What if you could double or even triple your dental practice's profitability without working more hours? The secret lies in understanding and optimizing your dollar-per-hour production.

Most dentists unknowingly operate practices that generate around $300 for every 40 minutes of work when they could be making $1,500 in that same time frame. This profound difference doesn't just impact your income—it transforms every aspect of practice ownership, from stress levels to management decisions to work-life balance.

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Paul Etchison:

Now imagine you own two businesses one in which you make $1,500 for 40 minutes of work and in the other one you only make $300 for that same time, 40 minutes. Which one do you want to scale and try to take to new levels? Now I know what I would choose. I would choose the first one, and the thing is is I've owned both of those businesses and I don't want to go back to the second one. I want the one that's $1,500 for 40 minutes of work, and the thing is is we can have either, but most of us, as dental practice owners, we do have the second one. Now let me ask you this which one is gonna be more stressful? Making decisions, making hard decisions about payroll and what you can spend money on? Should we run more marketing? Do you think it's easier to make those decisions when you're making $1,500 every 40 minutes versus $300? Hell yeah, it is. Which one is going to have more management issues where the team wants things? Maybe they want new instruments, maybe they want another person up front, and you're looking at the revenue and you're like the revenue doesn't justify this. So I told you I've had both. I've went from one to the other. I'm going to teach you how to do that today. So stay tuned, we're going to talk about dollar per hour and how we can maximize what we are doing at the office.

Paul Etchison:

Now you are listening to the Dental Practice Heroes podcast. I am your host, dr Paul Edgison. I'm the owner of a large practice in the south suburbs of Chicago. I'm a dental coach and I've written two books on dental practice management. I am here to teach practice owners how to live amazing lives through creating highly profitable, team-driven practices that do not require them for every little thing and actually don't require them much at all. So if that's the practice you want to run, you are in the right place.

Paul Etchison:

All right, today we are going to talk about dollar per hour. Now, what the hell is dollar per hour? Sometimes this is something that you can get with those metric reporting services, and sometimes they have it and it's not that great of a metric, because it's hard for the systems to calculate this for some reason. But what is dollar per hour? We are talking about the dollars that you produce. I'm talking about collectible dollars Now. I'm talking about, like, after insurance write-off, real money the dollars that you produce divided by the amount of hours it took you to produce it. So pretty simple, right. So every provider in your office should have production, should have adjusted production, and they should have the amount of time it took to make that adjusted production and they should have the amount of time that it took to make that adjusted production. So then you can figure out dollar per hour. Now what should these numbers be at? Now I have some ideas of what I think they should be at Now.

Paul Etchison:

I think, as a doctor, now associates, I want all of my associates at $600 per hour. That's where I want them. I think it's a reasonable number. I don't think if you're an owner doc and, like you, want to crush it $600 per hour, I mean you can do it. But I think you should do a lot more. I have tons of clients above a thousand dollars per hour. I know doctors doing fifteen hundred two thousand dollars per hour. When I was practicing myself, I was doing around twelve hundred thirteen hundred dollars per hour. That was consistently where I landed. That's where my goal was, that's where I felt comfort. So there is no right or wrong, but you have a lot more options if you produce more per hour.

Paul Etchison:

Now what about hygienists? We always hear this thing they should be producing 3x what they're paid. I find that very hard to get to these days with hygiene salaries, that is damn near impossible. But I will tell you, in my practice I want every single hygienist to do about $150 collectible per hour. That's where we are at my office and those are just some baseline metrics. So if you go and calculate your stuff and see what your hygienists are doing, at least you have an idea of where you should be All right. So let's talk about the things that affect dollar per hour.

Paul Etchison:

I remember back in the day when I opened up my practice, we were having this one day where, man, we crushed it. We were turning rooms, we were going from room to room on roller skates, the hygienists were numbing for me. I was doing a bunch of fillings. I don't think I did a single crown the whole day, but it was a bunch of fillings, maybe some extractions in there too mixed in. But we saw a ton of patients, we saw new patients, we were vibing. We stayed on schedule all day long. It was busy as hell, but we did it.

Paul Etchison:

And then when I looked at the number at the end of the day and I was like shit, that can't be right. There's no freaking way. And then I looked at some other days where we had these huge days and I'm like what is the X factor here and this is what it was is it was crowns. Is that if I do a full day of fillings, I don't care how fast I do them, it's never going to be as profitable of a day when compared to a day that I do crowns. So we got to recognize, as practice owners, I'm not saying don't do fillings anymore, but I'm saying we got to recognize that we need both. And here's the thing I want you to think about is let's take a typical crown and we're just going to make some round, easy numbers here.

Paul Etchison:

Let's say a crown and a buildup is $1,500. Now if you are going to book an hour of doctor time now I'm saying doctor time, right, I'm saying an hour of doctor time, maybe that's 30 minutes of doctor time for the prep and 30 minutes of doctor time for the delivery. That's an hour total doctor time. You got $1,500 there. That is a $1,500 per hour procedure. Cool, that makes our average go up for the day.

Paul Etchison:

So we want to do some more of those, right? But what if we now take two doctor hours to do that. Now it's $750 per hour. What if we take three hours to do that and I can't tell you how many times I see people doing this They'll book a two hour doctor slot for a crown and then they'll book an hour for the delivery and the doctor is in there the whole time. So, three hours $1,500, and you're doing $500 an hour and you wonder why you're struggling to pay your bills. Well, it's great that you got something to do for three hours, but shit, that's not very profitable. So we want to do something about that.

Paul Etchison:

So we got to realize that when we have crowns on our schedule, it's not just by them being there. We have to do them in a certain manner. And I don't want you to hear me and say I'm telling you to hurry through all your procedures. I'm not saying that. I'm not saying cut corners and I'm not saying you got to run on roller skates. I'm just saying be smart about it. Be smart about the way you use your time and the efficiencies that you build into your practice. And this is what we teach with our coaching. This is what our programs are all about, because if you're a doctor and you wanna cut down your days, you gotta get your dollar per hour up. So this is what Dental Practice Heroes is all about.

Paul Etchison:

Now let's talk about the second thing fillings. Here we need to minimize the drag that fillings have on our schedule, and we do that a few ways, first of which is we limit how many filling appointments we're willing to see each day and we hold spaces for crowns. This is the DPH block scheduling you might've heard me talk about before. We're holding spaces for crowns. So we have that extra note, those big numbers, those high profitability procedures to make up for the lower profitable ones, and we're limiting how many fillings we're going to do. But the thing is too, we need to think about fillings in a special way.

Paul Etchison:

I remember one time I it you know it should have been a crown, I should have crowned it, but I did a big M-O-D-B-L. Sometimes, dude, those are fun as hell because it's just fun to put all that stuff in that tooth. That looks like crap. And then you're carving it, and it's one of those ones I like spent time, I put anatomy into it, I polished it really nice. Oh, baby, it looks so good. And there was like this little mesial buckle cusp that was holding it all together. And the patient came back about three weeks later in that little tiny sliver of a cusp that I left there. Well, it broke off and I looked at that. I said, ok, well, I guess I'll just patch that. And then I looked at that and I said, dude, this should have been a crown. What the heck am I doing? How long did it take me to do that filling? And what did I benefit the patient?

Paul Etchison:

A lot of the times we feel like we're doing the right thing for the patient because we're saving them money by not doing the crown. But over time, what I want you to see is that if we don't properly restore teeth, we don't have a good long-term prognosis and we can, a lot of the times, cause the patient to pay more. I mean, I am putting that patient in a situation where they've got something that looks like a tooth there. They can chew on it, but they ended up breaking that mesial buccal cusp off. Now what if that broke down to the root? They had to take the tooth out. What if it broke into the nerve chamber? Now they need a root canal. What good did I do this person by doing a filling on them. That took me a ton of time. It was no profit at all in the procedure and then they ended up having to spend a ton more money into getting a ton more work down the line, right?

Paul Etchison:

So we're going to use the block scheduling to limit how many fillings we're doing. We're going to use the block scheduling to have a certain baseline level of profitable procedures that we're doing. But we also need to realize, when we're treatment planning things that are just dumb, that don't make sense, because we're scared to tell the patient what they really need, because we're treatment planning things that are just dumb, that don't make sense, because we're scared to tell the patient what they really need, because we're prejudging the patient on what they can afford and what they value, and that is not the best way to treat your patients. So watch how you're treatment planning. Make sure that you're not treatment planning dumb stuff. If it needs to be a crown, make it a crown.

Paul Etchison:

And now the third point we need to make every single procedure as profitable as possible, and here's what I mean by that. We talked about the crown thing. You know, if it's $1,500 an hour, if it takes us an hour, if it takes us two. It's $750 an hour. But we need to look at every single procedure. And what does it look like when we do that? Let's look at every single procedure and what does it look like when we do that.

Paul Etchison:

Let's look at fillings. You know, how can we make fillings more profitable? How can we utilize our assistants better? How can we prep faster? You know, I'll give you just a quick tip on prepping fillings is take that high speed and drill it out until you've got a clean DEJ all the way around your prep. Then you know that you've got this outline form of your filling and now all you do is go within that filling and clean out the decay in the middle. Pick up the slow speed, clean up the decay, you're done. You know you're not switching burrs, you're not taking a bunch of looks at different angles. Don't stop the burr. Same thing with prepping crowns Don't stop the burr, unless you have to Stop looking. When you start touching a surface, prep that whole surface. When you reduce the occlusion, reduce the occlusion so you don't have to come back and do it again. When you're prepping the buccal axial wall, reduce it enough so you don't have to come back and do it again. Do things once. Okay, this is not hurried, this is just effective and efficient.

Paul Etchison:

Let's talk about another procedure. That could be super profitable, but sometimes not so much. What about a night guard? Okay, we usually will have our assistants. They'll take the impression for a night guard and then the patient comes in on the doctor's side and we spend 40 minutes to an hour. We're delivering this thing, we're adjusting it.

Paul Etchison:

Now, what is this? A $500 procedure. We took like 40 minutes to an hour. What's the dollar per hour on that? I don't know. $350 to $500. That's not a lot, you know. It's not worth an hour of doctor time.

Paul Etchison:

What if we could teach our assistants how to make the adjustments, get it all ready and then you pop in as the doctor and you say let's take a look. Chomp, chomp, chomp. How does it feel? It feels great, oh my gosh. You look at your assistant and you're like you are so good at this. You give him a compliment in front of the patient. The patient's like hell, yeah, you know what.

Paul Etchison:

So now, how long did that take you? Five minutes, you didn't spend any time. But if you've got a $500 night guard, that takes you five minutes. What is the dollar per hour production. On that five minute procedure. That becomes like a $6,000 per hour procedure. Now, it's only for five minutes, you know, but that becomes a very highly profitable procedure. So you start looking at everything you do and you start saying, how can I make this a profitable procedure that meets my goals for what I want to produce every year and every week and every day? You can take these goals all the way back to the daily and move them all the way back to an hourly goal and then you can plan your whole year from it.

Paul Etchison:

We also got to make sure that we're adding the right procedures. You know, are we offering fluoride? Are we offering sealants? Are we even offering those nightguards? Are we offering whitening? You know these are things that you can add on that can increase your dollar per hour, because these don't require you. A lot of these procedures can be done by the assistants. So what's the dollar per hour on that? Well, it's kind of infinite to some extent because you don't have to do it.

Paul Etchison:

What about extractions? I mean, I see clients they'll book one single extraction. They'll book an hour to an hour and a half of it. The procedure is about $200. I'm sorry, you're not going to have a profitable practice if you're spending an hour to an hour and a half to do a $200 procedure? If you wanted to spend an hour to an hour and a half doing a $200 procedure, you should have went to hygiene school. You could do it all day long, but you're a doctor so you should not be doing that.

Paul Etchison:

So what do we do with extractions? I mean, I'm telling you you got to offer the bone graft. If you think there is value in preserving bone around extracted teeth and in the extraction socket and preserving that ridge, offer that to the patients. That makes that little extraction become a much more profitable procedure. How long does it take to do a bone graft? To throw some bone chips in there and to cover it with a little membrane and sew some little sutures on top of it. It doesn't take very long but it makes it a really profitable procedure. But I'll tell you what else is really killing a lot of people's extractions, because I have associates.

Paul Etchison:

I see it is we pray, we just pray that tooth comes out. We take that little elevator and we push, push, push from over here, we push, push, push from over there and then we push, push, push back in the first spot, back to the second spot, back to the first spot. We keep push, push and we say please, please, come out. And we pick up those forceps and we grab it and we say this doesn't feel like it's going to come out, but maybe I'll get lucky, because sometimes you get lucky. Right, it's like the slot machine If it pays off every now and then you keep doing it. So you do that and then you snap it off and then you sit there and you push, push, push with your little elevator, push, push, and nothing happens.

Paul Etchison:

And then you pick up your drill. Finally you remove some bone, but don't remove a lot, because we're trying to be conservative and we don't want to remove too much bone. And then you push, push, push, and where you lost that little bone, guess what happens? You snapped off your root at the tip. You drill a little bit more away, you snap it again and before you know it, this patient's never going to see you again, because they're like what the hell is wrong with this person? You literally spend an hour and a half stressing yourself out over a $200 procedure and then you put the bone graft in for free because you felt so bad that you pretty much cut a giant hole in this person's face. Have you ever done that? And the only reason I know is because I've been there and I see it happening.

Paul Etchison:

Here's what you do you try something for 20 seconds. If it doesn't work, you pick up your handpiece and you drill away a ton of bone. And then you try something else for 20 seconds and if it doesn't work, you pick up your handpiece and you drill, you section the tooth, you remove bone, you get aggressive and this is how you get teeth out fast. You quit messing around. You say you know what? I'm gonna get this tooth out of this person's head, so I'm gonna drill away bone. I mean that furcal bone in those upper molars and those lower molars. I mean this crest is typically going to heal from facial to lingual crest, right. So get rid of the fercal bone. It's not doing anything for you.

Paul Etchison:

Section teeth. If you don't know how to do this, learn how to do this. You could take out teeth so fast and you can be such a profitable procedure. So that's just a little I digress. I don't know why I went on that, but I hope you learned something there. You know, stop, push, push, push in and pray, push and pray, hope I get lucky. Push and pray no, that doesn't work. That's not how teeth come out of people's heads, all right.

Paul Etchison:

So I want to give you some takeaways here. Do the math on your procedures. Calculate the dollar per hours for your common procedures, figure out what you are doing them at and figure out where you can improve. And figure out what is your goal. You should have a goal, but you should also have a floor, because I'm telling you fillings are never going to be as profitable as crowns dollar per hour. Typically, they just can't be. But the thing is is you should have a floor and if it's taking you four hours to do a molar root canal, either you got to do that faster or you got to refer it out. It's not worth your time. If it doesn't meet the floor of just minimum production per hour, send it out. Don't be doing those procedures Now. I really think you can learn it. You can get better at it.

Paul Etchison:

But if I'm saying, if you can't send it out, don't be dumb about your schedule and look at your schedule. Try to identify the low profit stuff that is killing you. I had a coaching client once and they were doing these elaborate exams. They were charging like $350 for it, but it was taking an hour of doctor time. I'm sorry you can't have the doctor for an hour for $350. You just can't do that. Okay, maybe you can do that in certain boutique practices where you're doing full mouth rehabs and stuff like that. That's not going to work in your everyday practice. It just doesn't make sense. The math doesn't work. And protect your high profit procedures.

Paul Etchison:

This is what I love about block scheduling is we are holding time in our schedule for the high profit procedures. We're making sure we're going to see at least two or three crowns per day and we're not. And it's not negotiable. It's not like I know I want to see two or three crowns per day, but this person's got fillings and they want to come in next Tuesday. No, this spot's for a crown. You don't got to tell a patient it's for a crown. But I mean, you know we are setting up our days in a way that we can be profitable. We can hit our goal. We could take great care of our patients. We can have a nice chill day so we can take great care because, let's face it, when we're running around like crazy, we're not doing a good job. We're not doing good dentistry, we're not providing a good experience. So everything is for the patient's benefit, but it is also very profitable and it works for the owner as well. Look at all your appointments and elevate every single one of them. See what you can do. Can you utilize the assistant to deliver night guards? Can they get the crowns ready for you so that maybe a crown delivery, instead of being 40 minutes of doctor time, it's just a five minute thing you do as you walk down the hall?

Paul Etchison:

And we didn't talk much about hygiene today. I mean, we don't think we talked about hygiene much at all. But same thing. What's their profitable procedure? Scaling and root planing. Let's make sure they do a certain amount of that every day. What else do they do? Well, they can add adjuncts like fluoride sealants. They can do lasers. Let's equip them to do that. Let's give them the verbiage to do it. Let's teach them how to sell that stuff. Teach them how to teach their patients what the benefits are.

Paul Etchison:

How can we get hygiene's dollar per hour up? I would say for a lot of offices with hygiene low dollar per hour, they're giving the hygienist way too much time to do some procedures and also there's just a lot of cancellations and a lot of inefficiency in the schedule. That's what I see. These are all things that we talk about in the Dental Practice Hero programs. So just summing up these high profit procedures, that is what really makes you profitable.

Paul Etchison:

Profitability comes from how you manage these high profit procedures and how you take these lower profit procedures and make them more profitable. So I could tell you I could pick some of your schedules, your four-day schedule, and me and my two assistants could pound it out in eight hours. I know it because I've seen it. This is what happens when you work with your team and you start getting intentional about how you're doing things, and you could sit over my shoulder and watch me do it. I'm not doing crappy dentistry, I'm not cutting corners. I am doing solid stuff and I guarantee my patients are just as happy as yours and if maybe more happy because they don't have to spend more. They don't have to spend as much time as at the dentist right, I mean, they don't want to be there.

Paul Etchison:

So reflect on your schedule. If you ran the math, what procedures are you doing that is secretly dragging you down, dragging down that average, and what are some small changes that you can make to flip that, and if you're looking for some help, this is the kind of stuff we teach with our coaching. We teach all our clients how to be more efficient, how to be better with their procedures and how to lead a team, so that we create those natural systemic efficiencies that make things move along really fast and create the proper schedule that hits you to your goals. So if that's something you're looking for, dentalpracticeheroescom, we will help you get there, I promise. So go back, look at your schedule and stop being so inefficient, stop being so low profit. You can do this, I promise you. All right, thank you so much for listening today. We will talk to you next time.

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