Increasing your Speed and Production with Aaron Nicholas

You don't have a scheduling problem. You have an efficiency problem.

This episode breaks down the efficiency gaps standing between you and $1,200-per-hour production. Dr. Aaron Nicholas shares one exercise that could cut your crown prep time by 50% or more, a simple room setup method to save time (and stress), and his protocol for eliminating the biggest time suck in dentistry.

Topics discussed:

• Why your schedule isn’t the problem (and the real culprit)
• The exercise that cuts crown prep time by 50%
• A room setup method that helps you and your team
• The biggest time suck in dentistry and how to fix it
• How to get in and out of a hygiene exam in under 5 minutes
• Tips for evaluating and improving your efficiency
• Same-day add-on production

Connect with Dr. Aaron Nicholas:

https://www.mondaymorningdentistry.com/
https://www.mondaymorningdentistry.com/endosurvey

Get your free resources to start implementing these strategies: https://www.mondaymorningdentistry.com/resources

This episode was produced by Podcast Boutique https://www.podcastboutique.com

Come Join us at the DPH Live Retreat in Tennessee April 24th-26th.   Click Here for More Info and to Register

Don't be a silly goose....Download the Dental Practice Heroes App today and access all the free resources available to you. (Awesome Android ppl Click Here)

Take Control of Your Practice and Your Life

We help dentists take more time off while making more money through systematization, team empowerment, and creating leadership teams.

Ready to build a practice that works for you? Visit www.DentalPracticeHeroes.com to learn more.

Transcript

Why Schedules Fail Slow Doctors

Paul Etchison 1:55

If you're a slow producer, your schedule, it's never gonna save you. You can put in the time, you can block perfectly, you can diagnose great treatment, you can get the acceptance, you can have decent fees, but none of it matters if it takes you two hours to do a crown and three separate visits to do what should have been handled in one. Now, a lot of dentists they don't necessarily have a scheduling problem. They have an efficiency problem. They're leaking time all day long. They're blaming the schedule, they're blaming the team, they're blaming their patients, maybe they're blaming the insurance. But I assure you, the blame is going in the wrong spot. Today, I am joined by Dr. Aaron Nicholas, and we're gonna get into the real reasons doctors struggle to hit strong dollars per hour and what you can actually do to fix it without sacrificing quality. And we are not, absolutely not talking about run-on roller skates. We're talking about easy things that any doctor can do. Now, you're listening to the Dental Practice Heroes podcast, where we teach you how to create a team-driven practice that allows you to live an amazing life all while taking amazing care of your team, your patients, and your family. I'm your host, Dr. Paul Etchison. I'm the author of two books on dental practice management, a dental coach, and the owner of a large five-doctor practice in the south suburbs of Chicago. If you want to do excellent dentistry faster, smoother, and with a whole lot less stress, you are in the right place. All right, let's dive in. Thanks so much for coming back in the podcast, man. I love having you on. One of my favorite guests to have, and listeners, you are in for a treat today. Aaron is one of those people that he he lectures, he teaches, he makes the dental teaching products, like just, but it's for stuff that I think we need. We god dang it. If you guys are gonna listen to somebody, listen to Aaron, because he he is always talking about stuff that is so valuable. So welcome back to the podcast, dude. How's things?

SPEAKER_00 3:45

Thanks, Paul. It's great being here. I always enjoy being on your podcast. So things are good.

Paul Etchison 3:49

Awesome, man. So like today we wanted to talk about Aaron was we were talking about a an older episode that you know a few months ago, and it was about we were talking about dollars per hour, and we were talking about the$12 for dollar,$1,200 per hour blueprint. If you want to look back on that episode, that came out sometime in January, I believe, at 26. And it's one of those things is it's I was focusing on, you know, making sure that your procedures are the same or that they meet that dollar per hour requirement. But a lot of people say, you know, it's in the scheduling, but a lot of people say it's in the speed. And it's kind of, you know, it's one of those answers. Well, it's it's a little bit of everything. But like, as far as like, if I had to ask you, Aaron, if we want to be a high, high profit, high production, we want to take care of a lot of people, what is usually getting in the way of these doctors that can't seem to reach these like epic dollar per hour that some people talk about?

SPEAKER_00 4:41

It's interesting because a lot of people want to pin it on one thing or another. Oh, it's the block scheduling, oh, it's the speed, oh, it's the this, oh, it's the that. And the truth is, yes, it's all that stuff. And one builds on the other, and one can get in the way of the other. So, you know, you start out and you go, well, I want to have these blocks that I schedule into. Okay, great. But then if you're only presenting single-tooth dentistry, it's really hard to fill those blocks because you're only presenting single-tooth dentistry. If you're starting to present quadrant dentistry or full arch dentistry or side-to-side dentist, you know, however you want to phrase it, then it's a whole lot easier to hit those scheduling targets simply because you put more, you know, the patient sits down and you're gonna do more work. So there's all of the things that burn up time and make multiple appointments take longer, like every time the patient walks in the door and they're five minutes late every time. And you got to set the room and you have to reset the room and you have to get things ready and you have to wait for them to get numb. And, you know, all of those things are above and beyond where we even get to start working. That's just all ancillary stuff, you know, that that ends up making it take more and more time. Um, so you can do that. And then it's like, okay, well, I want to schedule this quadrant of dentistry in this block, but I'm so slow I take an hour and a half to two hours to do a crown appointment. It's like, okay, that's a problem. It's really hard to do a crown, a bunch of fillings, maybe a root canal and extraction, if each of those procedures is gonna take you an hour and a half or you know, two to three times the length of time that it really is appropriate to be taking. So everything kind of builds on each other. I don't think like you can point at one thing, but certainly speed, efficiency. And as soon as you say speed, everybody goes, oh, it's gonna be crappy work. It's like, no, you can do good work efficiently. You can also do crappy work efficiently. You can also do good work slow, and you can do crappy work slow. So, you know, that's a the quality is an internal, an internal game.

Paul Etchison 6:35

Yeah, you know, it reminds me of this story I was just telling in our mastermind group. We've got this 15-person cohort mastermind where we're all working on each other's practices and trying to cut days and and and and increase production is a big part of it. And there was this story I read about in a book, and it was about this guy who got his, he had a called a locksmith, and he had the locksmith unlocking his apartment door. And it took the guy about two minutes, and he said, that'd be$200. And he said, Damn, that's that's a lot of money for something that took you two minutes. And he goes, Well, you know, it's actually funny. When I started doing this five years ago, to do this would take me about an hour, and I didn't really know what I was doing. I typically would break the lock. So I would have to charge$200 for the hour, and I'd charge another$80 for the lock. And people would be so thankful. They'd even tip me on top of that. But now I can, since I'm experienced, I can do it in two minutes. The whole point of the article was like, gosh, we really tend to sometimes attribute the value of something that is provided based on the effort and time that goes into it, but it's completely unrelated to the quality. I mean, you can do high quality things quickly, especially when you become proficient.

Quality Is Not About Time

SPEAKER_00 7:37

I think people are worried that people are that other doctors are gonna be unethical or something. Or the other thing, too, is like maybe they're not that fast. And the way they make that okay for themselves is to say, well, I do really high quality work and that's why it takes. That's what I think. Yeah, it takes me an hour and a half, two hours to do a crown. You know, I've I've literally sat a patient up from prepping a tooth for a crown. And and I said, Okay, so I'm gonna leave you in good hand. She's gonna make a temporary, we're gonna take an impression, and we'll have you done about another 10, 15 minutes, and have her go, wow, that was that was really, really fast. And I'm like, Well, if you want me to piddle around a little bit, I can do that. Like, you I'll lean you, but they're like, no, no, no, no, no, don't do that. We're fine. This is fine. Yeah, you know, and sometimes doctors are afraid. I'm not taking enough time for the amount of dollars that I'm charging. And, you know, my comment is always, well, what you got was the premium service, because anybody can take two hours to get the job done, but someone, only a really skilled person who knows what they're doing is going to be able to do that. So one of the things, so that I have that 90-day accelerator group, and we, you know, it's an online clinical coaching thing, and I have exercises for them to do. And one of the things I make them do is take five teeth to five extracted teeth, sit down in the practice one day, figure out how you like to prep, you know, what's your system for prepping crowns, and I give them my system and which burrs I want them to use. And I'm like, I want you to prep five in a row. Don't prep like one today and one tomorrow. It's like prep five in a row. And so they start, and I keep time on from burr on tooth to I can make a crown on here, how long it takes. So usually we see a 40 to 50% drop in prep time from tooth one to tooth five. We had this one girl in, and um, she had done it, she had sat down, she'd done the whole thing, and I'm like, Well, how'd it go? And she's like, Pretty good. I'm like, so like what was your starting time? She said, Well, I think it hang on, let me pull them up. She pulls it up. My starting time was 16 minutes on tooth one. I'm like, okay, great. And what was your final time on tooth? She actually did six teeth on tooth six. What was your time? She said, on tooth six, it was six minutes. I'm like, really? So you cut off more than 50% of your time. She's like, Yeah. I'm like, how long were you sitting in your practice prepping extracted teeth for zero dollars? And she's like, an hour and 10, maybe hour and 20. I'm like, so you invested an hour and 20 minutes in your, she's very young, in your career that is gonna pay you off for the next 30 years, hour and 20 minutes, cutting your crown prep time in half, less than half. Seems like a pretty good exchange. Yeah. You know, and that's that's the thing people don't think. It's like, well, I don't want to go in there and prep tea, it's like gross and it's it smells, and you know, all those things are 100% true. But that little bit of time, and she just reduced her crown prep time by more than 50%.

Paul Etchison 10:16

And just by like, I mean, what do you make of that? Just is it doing them in sequence or is it doing them as focusing for speed? Like, what is what's the X factor that makes you go quicker when you keep doing it and repetitively?

SPEAKER_00 10:28

So two things. Number one is the more you do something, the better you get at, just plain and simple. And the closer those experiences are together, the more that they they play into each other. Number two, you sit down and you prep that first one and you do it the way you always do, and it takes you about as long as it always takes you. Okay, and you pull up the second two and you prep that one, and it's about the same. Then you pull up the third one, and you're like, I've been sitting here for how long? And you start prepping a little bit faster. By the time you get to the fourth, and you're getting a little pissed off because you've been here for a long time. Your times haven't gotten that much better. And by the fifth one, you're just going in there and cutting off what you need to cut off, and then smoothing it over at the end, which is what every experienced doc who is efficient does. And all of a sudden, you just educated yourself from tooth one to tooth five. You know, you don't need me to sit there and tell you the the only parameters are uh burr on tooth, burr off tooth, and you have to do it the same way every single time. You can't change your process in the middle because then we're comparing apples and oranges. But and literally every single doc that goes to the program and does that exercise has a 40 to 50 percent drop at least in the crown prep time.

Paul Etchison 11:35

I'd love for you to just to point out uh I think it's slightly obvious, but maybe not, and it's worth saying, is you notice with this one person you're talking about in your example, this 10 minutes savings over the course of a career. I mean, we're just talking about crown preps, but I mean, that could be expanded to more or less.

SPEAKER_00 11:54

I mean, is there anywhere you can expand that? You just look at that and you go, so now you're confident enough that you could do this crown in way less time. What are the chances you're then gonna add those three fillings in that quadrant? Because, hey, it's numb, mispatient. We should just go ahead and knock this out. And you know you can do it and it's not gonna take three hours, and the patient's not gonna be like exhausted when you're done, and you're not gonna be exhausted. I mean, it pays off not just in that procedure, but in everything that goes on around that procedure.

Paul Etchison 12:19

Yeah, exactly. And this is a big part of like speed dentistry. You know what? I shouldn't even say that. Speed dentistry. What should I call that, Aaron? I don't want to say speed dentistry.

SPEAKER_00 12:30

I I mean I would say efficient dentistry is I mean, as good a good term. Um, yeah, no one likes to hear that you're doing their procedure fast, but you're being very efficient, you're not wasting any time, there's no wasted motion, there's no wasted steps. We we work together. Um, one of the things that they they look at, and it's like if you if you film yourself doing the procedure and you start to look at how much time are you spending looking outside the mouth or waiting for stuff to happen. If something's always happening, if your eyes are always inside the mouth, then stuff's gonna happen a whole lot faster. I mean, for me, even if like I'm waiting for the etch, there's not much you can do at that point. It's like I'm looking over, okay, what kind of debris do I have on the tray? Can I throw that away? Can I get something out? Can I load a burr for the next thing? It's like, yeah, it might only be 20 or 30 seconds, but you can switch all your burrs over from I'm prepping to I'm polishing and finishing, you know, in that 20 to 30 seconds. And that's 20 or 30 seconds you don't have to take then to go ahead and get ready once you've put in the composite.

Paul Etchison 13:29

Yeah. That makes me think about like in my composite routine is when the assistant's doing that final cure of that composite. I'm back and I'm loading my polishing bars. Yeah. You know, for that eight seconds or whatever, how long that cure is. It's not that long, it might be five seconds. But I I hate when we got to go out of the room to go get something and I'm sitting there waiting. And I swear that 15 seconds feels like three minutes. And I'm just like sometimes I'm just picking up instruments and dropping them. So it seems like I'm doing something because I don't feel like having the small conversation while we're just sitting here with the patient. So I'm obviously busy. You can hear my clink, clank, clank, you know, it's but that's that stuff adds up.

SPEAKER_00 15:29

I mean, the other thing too is it's it's the unknown because you don't know she's coming back in 15 seconds. If you knew that, that would be okay. But you don't know when she's coming back. You know, okay, do you sit back, do you clean some stuff up, do you start to tell a joke? Do you know any jokes? Um, you know, is she gonna run into somebody and talk about what happened last night on her way back and then lose track and you know, you know, all of those things, and you just don't know when it's gonna when it's gonna happen again. So that's why I'm also really big about let's get the room set up. Let's get it set up the same way every time. Let's make sure all the pieces are in the room before we start so that we're not having to wait and wait for somebody to run down the hall. And then the other thing that happens on top of that, it's like, okay, so I basically forbid them to leave the room, but now they have to call for it on the radio. So now we've got two assistants assisting one procedure, and that's really inefficient. You know, it's you know, it's a mess. It's a mess. A lot easier just to cut it off right from the get-go. Let's get everything in the room we need and get started right there.

The Five-Tooth Speed Training Drill

Paul Etchison 16:28

So if a doctor's listening, and I think that's a big part, I'd see it with my coaching clients all the time, is the room setups, and it's we just don't ever clarify what we want to do. And then we get all pissed off. And then we say things like, Hey, you know that articulating paper we use every filling? Yeah, we're gonna need it on this one too. Like, get it out. Like, you're we need it, you know. Why is it how do you approach this with your assistant without causing the defensiveness of like, oh, so you don't like how I set up your rooms? You don't, it's not good enough for you, doc. Like, how do you prevent that? How do you make this a very neutral conversation?

SPEAKER_00 17:02

Yeah, it's you know, it's interesting because it also depends on how experienced your assistants are and how long they've been with you. So, new assistants, it's really easy. It's like, hey, this is how we do it. Everything's fine. With your assistants that have been with you for a while, when we did this, we actually set up a template system. But the way we started it was I had three assistants, they'd all been with me for a really long time. And I was like, okay, guys, like we sort of need to standardize this because sometimes you guys, you know, it's like pro wrestling, you guys are tapping out in the middle, and someone else comes in, and then you can't find something because they put it in a different place than you do. So let's do this. Let's all agree on a particular placement of things for each procedure. And so one afternoon, and you know, they're getting paid, you know, we sat there and I said to the first assistant, why don't you set this up? And so they set it up and we set up multiple rooms with multiple procedures. They set it up and said, okay, guys, who sets theirs up exactly the same way and who makes it different? And then we talked about why it was there and you had to make your case, and then we voted on it. And then if there was a tie, I had to break the tie. That wasn't much fun. Um, but we we came to an agreement about what how we were gonna set this up, and then we took a picture of it, and then we we created a uh a check sheet, and then picture and check sheet back to back, laminate them, okay, and then we put one of those in every room where we actually were gonna do that procedure. So if we have three rooms where we do Crown and Bridge, there's three copies of that thing, and there's one in each room. It didn't, you know, at first you put it you, and I did the same thing, you put it in the manual. It's like, yeah, nobody ever looks at the manual. That's that's not gonna work. So we we put it in each room, and then I heard about this concept of creating a template, and so you print it out life size, and it says right on there what's supposed to be there. So you put the template down for the procedure, and all you have to do is fill in the template. If you can read the thing, then the thing's not there. Go get it, you know.

Paul Etchison 18:52

Are you saying the instruments are set directly onto your laminated template?

SPEAKER_00 18:56

Yes. Okay, okay, and it covers the entire delivery. And so that that's the way we did that. And then for all the procedures where there's lots of little parts like uh endo and like implants, we have carts that are stocked and keep that stuff, and then we just push those into the room. Uh, and so that that reduces setup time. So, like our setup time for root canal buildup and crown is 11 minutes, you know, and the whole thing's good to go, which means that if an emergency comes in and we need to set it for a root canal buildup and crown, it's gonna take us 11 minutes to do that. And then we can even cut that shorter by starting by putting having them place the topical, and then they'll call me. I come in, I'm the patient up, I finish doing whatever I'm doing, they finish the setup, and now we're ready to go. And now, so getting back to your$1,200 an hour, all of a sudden that day that wasn't looking so good, you just added a root canal build-up and crown. And that's gonna make your day look a whole lot better.

Paul Etchison 19:44

Yeah, my assistants would tell you that I'm a notorious for just throwing a mole at a root canal in the middle of the day. And I can think of so many times that I have said, Hey, I will get you out of pain, we'll get the nerve out, and then we'll get you back to finish this root canal. Right. And I think I do that all the time. And I would say in my 15-year dental career, man, 17 years now, geez. Um I think I have not finished that endo maybe once or twice. I always end up finishing the endo because you look at the patient, you say, Hey, you know what? Like, I got another patient over here. I'll probably be out of there 25 minutes. You want me? Are you cool? Just you want to finish this up today? And they're like, Yeah, they could they they don't expect you to not take care of your day. They're just happy they're getting out of pain, and they're super happy that they don't have to come back for a root canal. That is like mental, emotional weight that is on their brain. I gotta go get that root canal finished in two weeks. I gotta go get that too. Root canals suck. Everyone says they suck. I don't want to get numb. I don't want to be sore. Just to get it done, and you can squeeze it in your day. There's a lot of, but you've got to be efficient, you've got to be with your assistants. What are some other things that you notice that are are helping a lot of people, you know, get their production up and get their speed and efficiency going?

Standardised Room Setup That Works

SPEAKER_00 20:54

Following that molar root canal theme, the other thing that that we tend to do is I'm teaching that my course is root canal and crown all at the same time because it actually makes the whole process faster. But the flip side of that is if you're, and and I see this with younger docs, like, well, I'll get the root canal thing down 100%, then I'll start prepping the crown at the same time. And really, you you should do it the other way. It sounds weird, but you should. Prep the crown first, start the root canal, keep an eye on the clock, okay? If you can't finish the root canal, that's fine. Stick some Teflon tape in there, put the buildup in, finish out the crown, okay? Do your impressions, make the temp, et cetera, et cetera. You sit the patient up and you say, you know, if it's a matter of I couldn't get the canals to stop weeping because there's so much pus coming up through there, I just yeah, I just can't finish it today, or whether it's just you couldn't quite get the job done, it's like, hey, you know, you had a real complicated case. You had this and this going. We've prepped the tooth for the crown. I want you to go on the antibiotic, or I want to wait for about a month and the month is over, the case will come back. The next time you come in, what we're gonna do is we're gonna finish up your root canal and give you your crown, you'll be all done. So that even if they do have to do a two-step root canal, the thing that also is making them come back is you got that crown that they're gonna put in. So they can concentrate on the crown that's coming in rather than the other. So that can really up your productivity. And, you know, worst case scenario, you get into it and you realize I can't do this and I need to, I need to refer it. Well, you've still prepped the crown. They're still gonna come back to the crown and say, hey, your case is really complicated. I'm gonna refer you to our specialists. We love them, they do a great job for us. And every so often, when ones really, really difficult like this, we refer. That's why we have the specialists. But when you come back to my office, I'm gonna put your crown on and you'll be all done. And so that way, yeah, you lost the root canal, but you still did the production for the crown, you know, and so that's gonna keep your productivity moving. Another one, probably more with extractions, is that we mess around with different things and it's not working and we keep messing around with it. And so the biggest problem is I don't know what to do next. And so I don't go back to the thing I think is gonna work. When that doesn't work, I go back to the first thing. And we're just we're just spinning our wheels, basically. So if you have a much clearer idea in your head about, okay, if this doesn't work, I'm gonna go here. If this doesn't work, then we go here. Knowing that you get far enough down the decision tree and that tooth's coming out one way or another, you know, then that makes it work a lot better rather than I've only got two tricks. And if trick one doesn't work, I'm doing trick two, and if trick two doesn't work, I'm gonna do it. Push and wiggle. Yeah.

Paul Etchison 23:15

I go from push to wiggle, and if wiggle don't work, I'm back to push. Yeah, yeah. Yeah.

SPEAKER_00 23:20

You forget there's a handpiece over there still. Um that might be helpful.

Paul Etchison 23:24

So I think it's great that we're talking about these things because I think a lot of docs don't ever think about this is an opportunity. This is such the speed in which we can deliver care, it's matters a lot for patient experience, but it matters a lot for just our numbers. And if we think about, I'm gonna try to do the math here. I mean, if we're doing$1,200 an hour, I mean, that's every minute is$20 worth of production. You know, so like if you think about what are the things that take a minute while getting an instrument from the other room or the, you know, just stalling or getting the articulating paper out, those things add up. Now, what would you say? There's a certain number of things where I think like maybe we look into scheduling or just things that really screw up our day. And what are those things that come to mind where it will screw up a productive day and how can we avoid them?

SPEAKER_00 24:11

Like we've already said, stuff's not ready in the room, keep having to go back, keep having to go back, keep having to go back, and then that just ends up taking a bunch of extra time. I always say that waiting for anesthesia is the largest time suck in dentistry, period, bar none, because you give an injection and you go, okay, we're gonna let that soak in. Now, A, have you ever timed it? Okay, I have, you know, so I know that when I give a uh a Galgates or an IN, back when I gave it IN five minutes. If they weren't numb, it wasn't likely they were gonna get numb. Okay. I know that my infiltrations on the upper were uh 60 seconds, sometimes less than that. I know infiltrations on the lower, which was gonna be anything premolars forward, um, was about three minutes. These are all was septicane. And then since then we've buffered, it happens even faster. Um, and then we also realized that our assistants weren't sitting our patients up when we gave them blocks, so they'd leave them sitting back. And then the anesthetic doesn't go where it's supposed to go. The the gravity pulls it behind it rather than down the ramus and getting numb. So, okay, you need to sit them all the way up. And so, like once we did all that, it's like, Like we actually write down what time we gave the injection so I can come by and go, okay, it's time to jump in. If they're not numb, it's time to go to option two. Option two is for me, is given a PDL, and then I should be able to start right away. Or I can give it an intraosseous injection, so like an X tip, something like that. And again, I can start right away. And rather than given a second block, and now I'm waiting another five minutes, if indeed I've ever even checked and was on time, you know. So you can get 20, 30 minutes into appointment and you're not gotten anywhere, and you only had an hour to go to start with, and now they're finally numb. Okay, well, you can't not treat them, you know, even though you don't technically have enough time, but you can't not treat them. You've stuck them three or four times, you know, so you got to kind of do this thing. And now that pushes the rest of your day back, you know. Or hygienist comes by and says, Hey, I need to check. And you're like, okay, you find a time and you can jump over and check her patient. And now you're in the hygiene room for 15 minutes. So all of those, those different things can just start to train wreck your day, and you know how it goes. Once a couple of dominoes fall, you know, pretty much the rest of it is, you know, cyanar. It's just gonna be the tough day.

Paul Etchison 26:22

Well, so talking about the anesthetic thing, I mean, it you obviously explained what your protocol is to move to the next thing. As far as like the hygiene thing goes, what would your suggestions be for that to make that work a little bit more efficiently?

Fixing Numbing Delays And Derails

SPEAKER_00 26:34

I mean, the thing with hygiene is you need to go in, you need to make a connection with the patient, and you have to do the exam, and then you're gonna need to uh to get whatever it is you diagnose onto some sort of record keeping, whether it's paper and the computer or whatever. So I come in, I mean, I I literally have a game plan. I know exactly where I'm going. So I will typically walk into the operatory and the gloves are over on the right hand side. I say hello, I get within the patient's um view, and I'm pulling the gloves out of the box, or maybe my assistant or my hygienist handed them to me as I'm saying hello to the patient, as I'm making small talk, as I'm bringing the chair back. Okay, so this is all the the nice connection time. And then I can say to her or the hygienist, however you'd like to do this, and well, at first, how was your cleaning today? Any problems? You know, and then they can kind of talk to you about that a little bit. I'm gonna do my exam. I start at the same spot every single time, so everything the same. And then we have an interval camera in every single room with the sleeve on before I walk in the door. Okay, so if I'm gonna see something, if I'm gonna diagnose something and present it to the patient, I don't do it without a picture. So, and the hygienist knows this, and she's cranking up the camera, and then I'm taking the picture, we put it back up, I sit the patient up, and then I show them the thing. And then I have to make a recommendation. So I'm like, hey, this is what we're looking at. This is what's going on. If we let this go, it's gonna turn into this, this, this, and this. However, fortunately, we've caught this early enough. And if the hygienist told me about it, you know, I can I can build the hygienist up and go, hey, you know, Susie, like she is on it. She caught this right away. This is great. This is the thing that's going on. And so what we really need to do is to go ahead and uh and do this procedure to take care of this. And then I'm watching the patient the whole time. So if you say root canal and they cringe, it's like, oh, I see you like what's your feeling about that? I said root canal and like you did not look happy, you know, so that you're not don't let that stuff go by because that's running, that's that's the framework that's running in the back that you're not privy to, and you don't get the option, they don't get the opportunity to step into that question, you know? And so that way if you're watching them, you can you can ask those sorts of questions. You can go through the whole process, you and you can ask them if they have any more questions, um, and then you answer all of those, of course. And unless they start getting into insurance and scheduling, you're like, you know, you're above my pay grade, let's go ahead and get that squared away. I would get this done in and I give them a specific time frame. So not soon, but like I'd get this done the next couple, three weeks. And then I'm out the door to go to do my thing, and then the assistant could kind of talk to them. But I've walked in, I've made nice, I've done diagnosis, I've answered questions, I'm out the door. If I'm not presenting anything, if everything's just great, that's probably three to four minutes. Yeah. If I'm presenting something, we're probably more like seven minutes, 10 minutes, you know, at the most, at the very most. And then obviously, if you're about to walk into a big procedure, it's like, go check everybody already. Now you should have 40 minutes free before they're they're gonna want you again. So if every time you get up, you just check everybody, you have a lot less jumping up and down, a lot less interruptions in your day.

Paul Etchison 29:41

See, I I feel like the naysayers to this would say, this feels rushed, this feels hurried. I don't appreciate to work that way. But I mean, I and I think you disagree as well. I I disagree. I feel like this feels good. I mean, I with my I mean, there are people on your team that you could go and hygienist, you could do an exam, and every time you do it in the same order, and every time you do the oral cancer screening, maybe you look this way and then you say, Can I get a piece of gauze? And there are hygienists that will have to, you have to ask them for that damn piece of gauze every single time until the day that you say, Hey, we're gonna do this this way every single time. How about you just have the gauze ready to go? And they go, Oh, I've never thought of it. And then you've got those all-stars that they just they kind of pick up on and they're thinking ahead. But the thing is, it's like rehearsing the dance steps. This is not hurried. Like what drives me bananas is not this so-called what we think we're saying as being in a hurry, but what drives me bananas is having to ask for the damn gauze. Oh, let me look. Oh, you know what? There's no gauze in here, I gotta go down the hallway. Oh, yeah. Just want to strangle you. So, but it's this thing is um talking about your process and these things, these little micro things that happen, they're everywhere. I mean, they're they're all over your office.

SPEAKER_00 30:55

Yeah.

Paul Etchison 30:55

And it's it's for me, it's just a better way of practicing. I mean, do you uh feel like it it makes your day feel easier?

SPEAKER_00 31:02

Yeah, I I agree. And the other thing is most doctors have not actually looked at the way they do things. So, like in our in our 90-day accelerator, I have them take their iPhone because everybody or their cell phone, everybody's got one, everybody knows how to take a picture and a video with it. Everybody knows how to take a selfie, because I've seen a bunch of them. Okay. So flip it around, put it on video. When you walk into the operatory, put it behind the patient, record yourself doing an exam. Pull it back out on your way out. Now watch yourself. You don't need anybody to tell you what's going on or where the problem is. I've done this, I've done this with our 90 day accelerator. I don't like how I sound. Yeah, no kidding. No kidding. Absolutely. So fix it. Fix it. I had a doc say, I'm I'm looking at me and I remember this patient. I remember what I was thinking, and I'm looking at me. I don't believe me. Like, I'm looking at myself and I don't believe myself. I'm like, yeah, that's that's a valuable comment. Like, what do you need to do differently? Let's fix that. You know, I was gonna tell you earlier, like, you know, you want to be more efficient, like doing procedures. It's like, start timing yourself. Like, how long does it take you to do a buildup and crown, to prep like burr on tooth, to you get up so your assistant can make the temp? Like, how long does that take? It takes me between eight and 13 minutes. I've timed it a thousand times. It's eight to 13 minutes every single time. So now, if somebody in hygiene needs a crown and you've got a 30-minute block of free time for you, you can say to them, if you have time and I have time, would you like to get your crown done today? All of a sudden, boom, you just bump your production, you know, and that makes for a whole lot better day. And I always go, if you have time and I have time, because I'm like, I'm not making promises because I don't want to get in trouble with the staff, you know? And so that gives my assistant the opportunity to say, I know we had time, but now this has gone in there, or this other thing's gonna happen, or we've added this work. So we can always bail, you know, and then we can just reschedule them. But all of those things help you get through your day more smoothly and more quickly and actually add production. I mean, I've told my front desk before, it's like, because they would like just if I had a hole, they would just jam it full of like deliveries and stuff like that. I'm like, I'd rather have the hole because I have the opportunity at that point to actually produce in that spot. Whereas if you just jam me full of seat crown seats, you know, it's just lost time.

Paul Etchison 33:15

Yeah, exactly. Yeah, it all this is. I mean, I love this this focus and this angle we're taking on things. You know, I remember we when we used to do, you know, the VPS impressions, our material was like two minutes and 10 seconds or something. And me and my assistant Lauren, we would always try to do an acclusal. We'd get everything set up and we said we're gonna do it. And that we had the timer, it was a two minutes. We're gonna have this thing polished and done in two minutes and 10 seconds. And we did it a few times, but we always get really freaking close. Like full prep, like high speed, low speed, etch bond, all the whole shebang. So I'd love if you could talk about this 90-day accelerator program you have. And since we're like looping it into all these similar things we're talking about, I mean, what kind of results as well have you seen in in your clients, in your students that you've worked with?

Faster Hygiene Exams Without Feeling Rushed

SPEAKER_00 34:04

So the idea came about because I was doing coaching for um uh dental success institute, and I would talk to doctors and I would talk uh owners and then associates, and you know, they would bring an associate in, and I I did this too, so this isn't on anybody else's the same experience. You know, you bring the associate in and say, hey, we're gonna meet every Thursday, we'll talk about cases, we'll talk about how to do things clinically, you know, et cetera, et cetera. And so for the first month, you probably hit those meetings. And the second month, somebody has to take the dog to the vet or pick up the kids or do whatever. And so those meetings become further and further apart, and you get a year down the pike, and the owner doc is like, yeah, they're not producing any better than they were the day they came in. And the associate's like, well, they promised me mentorship, and like we had a few meetings, but nothing, you know, and and and pretty everybody's upset and everybody's unhappy, you know, et cetera, et cetera. So eventually I went, I can do this. Like, I have time, we can set something aside, nothing's gonna get in the way, it'll be a thing. And so we meet twice a week, um, Mondays and Thursdays, and Mondays is like some sort of a concept, like that whole thing with the um the prepping the crowns and with um timing yourself and and going through all those sorts of things, and then just looking at where the places where we we lose time. That might be a Monday. And then Thursday is like I tried to implement, uh it's like office hours. I tried to implement, I'm having this problem. Okay, cool, let's talk about that, whether it's this week's thing or another week's thing. Um, and then we record all the sessions and everybody, it's like um four to eight docs. It's highly curated. Everybody has their mics on so that we can have a discussion. Um, you know, and we go through, we talk about each person's thing. Okay, now how's it working for you? How's it working for you? What problems are you seeing, et cetera, et cetera. And so we go through that and things we start with just basic efficiency stuff. We talk about working with assistants because most docs don't really know how to work well than assistants. And if they don't have an assistant that's well trained, how do you train that assistant? Let's talk about getting in and out of hygiene and getting case acceptance, case presentation. That was the that whole thing with recording. We go through all the disciplines of dentistry and talk, you know, when do you decide it's time for filling? When do you decide it's time for crown? When, you know, because a lot of younger docs haven't gotten that sort of experience. And we just go, we go through the whole, the whole bit, and then little by little, we start to see these improvements. And then on Thursdays, the other thing we do is case presentations. So each doc will bring a panoramic and some films, and maybe if you take pictures, you know, this is my patient. I couldn't figure out what to do, this is what's going on, or this is my patient, this is what we decided to do. And so we would talk, everybody would talk about that. And then usually my next thing is like, okay, this patient doesn't want to have a root canal because Uncle Bucky died two weeks after a root canal. Or um, this patient only wants to do the work that is at least partially covered by insurance. How are you going to sequence this now? You know, because those are the things the patients do to us like day in, day out, year after year. And if you don't know what to do, oops, you know, let's figure that out. So that's the deal. We've had a lot of docs come through. It's kind of hard to figure out what's going on with them as far as growth, because a lot of times the office staff change. We we had a doc, Paul Goodman, Dr. Nacho, okay, and he sent two of his associates. And they both went through the program. One was a newer doc, and one had been around for a little, a little while longer. And at the end of the program, over the following year, the newer doc had a 30% increase in productivity. And the doc that had been out for a while had like a 27% increase in productivity, all from starting with this 90-day process and getting in better habits, which is basically what it was. And obviously, the doc that had been out a while had more habits than the other one did. But the newer doc actually was getting a lot more confidence, being a newer doc and not really knowing about certain things. And so all of a sudden, she was walking through her day a lot more confidently. And the assistants, she had said early on that the assistants were sort of, you know, they would kind of try not to work with her. And by the end, they were all like, yes, uh, let's go work together. So she was really excited about that. So both of those are really great outcomes, you know, both increased productivity and increased uh confidence for the doc. It's just really cool.

Paul Etchison 38:02

And I love the idea, like I'm thinking 30% increase, maybe somebody doing uh$750,000 goes up to$975, almost eclipses a million dollars a year. It's a$275,000 a year, 10 tiers, 20, 25 year, 30-year career. I mean,$8.25 million. You got to charge more, Aaron.

SPEAKER_00 38:25

Well, and and the other thing too was, and I didn't realize this until I was thinking about it a few months after that. In their office, they basically only do restorative, crown and bridge. All of the other stuff goes somewhere else. So they weren't adding a lot of uh a lot of root canals, they weren't adding a lot of extractions. That's just doing restorative and crown and bridge. So it got me thinking, I wonder what it would be like if they had all the other disciplines to be able to pull from. I wonder if their uh their bump would have been even better. But yeah, that's still a solid result.

Paul Etchison 38:54

That's amazing. Well, you know, too, it's it's also it's it's increased production, but it's also depending, if you look at it with a completely different lens, it could be more time off. It could be more time to work on your business. It could be cutting your clinical time to do something more scalable to scale your practice more. I mean, there's there's just no reason not to learn how to be more efficient, I guess is what I'm trying to say. So uh listeners are listening, where can they find more information about all of your programs? I mean, you you have this 90-day accelerator, but you also got your molar endo class, the one hour molar endo class, the extraction class. I mean, you offer so many things that are so powerful for any dentist that wants to become more efficient and better. Where can the listeners find you?

The 90-Day Accelerator And Results

SPEAKER_00 39:34

So they can find me on uh Monday Morning Dentistry, um www.mondaymorning dentistry.com, and all the courses are listed there. Yeah, you were saying we have we have a hands-on live patient extraction and socket grafting course. We have a hands-on, not live patient, but hands-on modal root canal buildup and crown. So the whole the whole bit together, the 90 accelerator, which you already know about, and then we have online courses, including anesthesia and a number of other things. I have giveaways for your audience if they want giveaways. All right. Let's see what's it? It is MondaymorningDentistry.com forward slash resources. And there is a um root canal build up and crown template that we use that's in there. There is a video on giving a Gal Gates injection, which I have found to be much, much more reliable than the uh the IN. And then there is an extraction decision tree template. Basically, you can print it out and laminate it and have it like in the operatory. Um, it'll take you through that whole process. I am in the process of making an endodiagnosis decision tree. So if they want to be a part of answering some questions on a survey and get the beta version and the final version, MondaymorningDentistry.com forward slash endo survey. Awesome. And I'd be happy to get them in there and do that. That would be fun.

Paul Etchison 40:47

Yeah, and these are listeners, this will all be in the show notes, so you don't have to write it down. Just go in the show notes and click a direct link to it. Well, Aaron, dude, thanks so much for your time coming on the podcast. It's always great having you on, dude. And you speak things that I think are just so necessary. I love the teaching that you're doing. I've sent associates to your courses, I endorse you. I don't get anything from Aaron for sending him people. I can just speak from someone who's been experienced and sent my associates. It has been worth it. So check out his stuff. Thank you so much for coming on. Cool.

SPEAKER_00 41:18

Thanks, Paul.

Paul Etchison 41:19

Appreciate being here. All right. So, what this really comes down to is this efficiency, not about rushing. It's about removing waste. It's about having better processes, better setups, better habits, and really more confidence so that you can deliver the great care without burning time that you do not need to be burning. So, here's the big takeaways from this episode of this interview. First of all, speed, it is a skill. It is just like any skill, it can be trained. Train on your speed. Secondly, room setups, assistant calibration, those matter way more than most doctors realize. Take the little bit of time that it takes to put the effort into that until you can reap the rewards. I assure you, these are not difficult things to do. And third, little efficiencies. If they happen all day long, they don't stay little, they add up. So address those, start taking care of them one by one. And if you want help building a great practice that's more profitable, less chaotic, and way, way more intentional, go to dentalpracticeheroes.com/slash strategy, set up a call with me. It is a conversation. There's no pressure. I just want you to leave with a little bit of clarity. And before you go, if this podcast has been helpful to you, leaving a five-star review is the easiest way to support it. Takes about 30 seconds and helps other dentists find the show. And me, you know, I I want to say I'm humble and I don't need it. I'm not fishing for compliments, guys. But you know, it's sometimes it's kind of thankless here. And I really want to be, I want to feel good about myself. So leave me a five star review. It better be five stars. No, four star stuff. Don't even try that. All right. Thank you so much for listening, everybody. Have a fantastic day at work this week, and we'll talk to you next time.