Dental Practice Heroes

Secrets to Keep Your Practice Running On Time

• Dr. Paul Etchison, Dr. Henry Ernst, Dr. Steven Markowitz • Episode 591

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Running behind every day isn’t normal — it’s a systems problem. From scheduling to delayed exams, this episode explores what causes chaos in dental practices and simple fixes that can get the whole office running smoothly again.

Our tips and tricks will help you time hygiene exams, handle emergencies, and create a culture that keeps everyone on time. If your days feel like a game of catch-up, this episode is for you!

Topics discussed in this episode:

  • How running behind impacts patients and your team
  • Why so many offices fall off schedule
  • Systems that keep hygiene appointments on time
  • Smart scheduling and team communication
  • Creating a culture that values timeliness
  • How to plan for patient emergencies
  • What to do when you’re running behind

 

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Paul Etchison:

Patients hate waiting. Your team hates feeling overwhelmed. You hate spending the day trying to catch up. Every office runs behind, but if it's happening every single day, it's time to take a closer look at your systems. Today, the DPH coaches are here with me to break down what causes so many practices to fall behind and how you can make your office more efficient. You're gonna get some tips on how to manage your schedule, get better case acceptance and stay on time even when the unexpected happens. Plus, we're going to share how to keep things calm on those days when things get a little crazy and we do run behind.

Paul Etchison:

You are listening to the Dental Practice Heroes podcast, where we teach dentists how to step back from the chair, empower their team and build a practice that gives them their life back. I'm your host, dr Paul Etcheson, dental coach, author of two books on dental practice management and owner of a large four-doctor practice that runs with ease, while I work just one clinical day a week. If you're ready for a practice that supports your life instead of consuming it, you're in the right place. My team of legendary dental coaches and I are here to guide you on your path from overwhelmed owner to dental practice hero. Let's get started.

Paul Etchison:

Welcome back to the Dental Practice Heroes podcast. We are so thankful to have you joining with us. We are here with my two DPH coaches Dr Henry Ernst, owner of an 18-op large practice in the Carolinas, and Dr Steve Markowitz, owner of six practices, a group and a whole mess of employees. Steve, how many employees? You got 152, I think today. Wow, today, oh, did you just hire one today or fire one? We hired two assistants, so he just pushed past 150. He's at 152 now, and that's a lot of responsibility for one man. It's not just on me. That's what we talk about. What a humble answer. This is why you belong here, steve.

Paul Etchison:

This is why the listeners come back for you.

Steve Markowitz:

They love this. I'm sure it is, I'm sure it is Humble, steve. Yep and then for the. Now, for the next 11 minutes, I will stay quiet and you will learn from Henry.

Paul Etchison:

So so today we are talking about you know, I'm going to tell you, every single I just said this before we, we hit record every single coaching client I've ever ran with, you know, ever I ever worked with, I talked to their team and they don't run on time. And every doctor thinks they run on time and every team thinks their doctor does not run on time. So I mean there is a discrepancy here. There's there's. There is some difference in perspective. But today we're going to talk about secrets to running on time because I think you know, if you look at the reviews in my office, it's one of the things that consistently comes up in reviews always sad on time. Like always on time. I never have to wait, they get me back right away, they get me in fast. So let's talk about running on time. Steve, what does that look like for you in your group?

Steve Markowitz:

It is part of who we are, and I think that is where to start with. This is why is it important that we run on time For us. We know that patients do not like going to the dentist. They don't want to be there. They're already afraid, and when they are sitting in the waiting room and their appointment was supposed to be at one and it's 105, the fear starts to get even greater. So sitting on time is important, what I also share with our team a patient's appointment in their mind starts when they break through the threshold into the back. So sitting them on time is more important than finishing their appointment on time. There are multiple perspectives.

Steve Markowitz:

Let's go from the doctor's perspective. The first thing you need to know is you need to know how fast you do procedures or how slow you do procedures. You need to know your time and you need to know where there is opportunity for you to speed things up if you need to. A crown prep is not a crown prep is not a crown prep. An extraction is not an extraction is not an extraction.

Steve Markowitz:

Things happen, complications happen, patients have things they need to, they start coughing or whatever. Things just happen in every day, in every dental office and we have to know that. So if it's, if it takes you 20 minutes to prep a crown, you need to know that, because now you have 30 minutes to do everything else. If you have an hour for that appointment and then 10 minutes to turn that room over and do it again, or there needs to be some time within that hour where you pick it up and find opportunities to be more efficient throughout that appointment, I would start with timing and then just create a culture of staying on time and then for me personally, when that rare occurrence happens where I'm running behind, I am walking out to that waiting room and saying I'm so sorry, I'm going to be with you in a second and we're just turning the room over, or I want to make sure that it's not. We're not just, they're not just sitting there without any acknowledgement of us running behind.

Paul Etchison:

You personally go out to the waiting room. Every time I do, I mean, oh my God, dude, I feel like that's like the floor is lava out there. If there's patients in the waiting room, I don't want to even like step foot out there. I didn't want to go out there and get like a bottle of water. I'm like, oh patients, see me backstage, what?

Steve Markowitz:

the heck. I totally understand that and I'm seeing patients. I try to like turn on all of the charm that I have left in my body, but but I think that that they're paying for me. They're there to see me. Part of that is when things are going perfect. I need to go towards it and say how do I fix this? And it's I've shared this many times. I am scared shitless of flying. I will if I could have it anyway. I would love the pilot to come on the entire time and talk to me and say we're going to be turning right in the next couple minutes, so just look out your right window. And then, every single time they talk, I'm like thank God, that guy's the best. So I know that patients are afraid when they come in the dentist. So anytime that I can create some kind of interaction, let me run towards that and give an opportunity for them to be like. I know I'm running behind. That's on me. I'll see you in a couple minutes, don't worry. We're setting up, all is great.

Paul Etchison:

I think that's great advice and this is, you know, you mentioned start with making it part of your culture to stay on time. Part of our culture and something this is part of our onboarding videos is I go through this study called the psychology of waiting and one of the things is it says anxious waits are longer than non-anxious waits. And this is just some study about waiting. And you know, is an anxious wait sitting in the waiting room at the dentist? Yeah, so it's going to seem a lot longer if you're waiting. But one thing that we say that came from this, it was that finite weights are shorter than infinite weights.

Paul Etchison:

So if you are behind my team knows this if we're running behind somebody not me, not me the doctor I'm not doing it. But somebody is going out there and saying, hey, mr Jones, we know you're here, we're running about 10 minutes behind, we're so sorry, and immediately that takes the pressure off of Mr Jones. Now, now Mr Jones doesn't have to sit there and think, oh, did they forget about me? Do I have to go? So I know that doesn't necessarily mean we're supposed to be talking about how to stay on time, but that is. I love that you brought that up that makes such a big difference. What's this look like?

Henry Ernst:

in your office, henry. Well, let's talk about one of the things that I find that is the most common aspect of running behind is doctor slash hygiene. You know most offices and I'll take this from different points of view points of view where we've got multiple hygienists or we've just got one, it doesn't matter. Or we're assisted or not. Assisted hygiene Typical hygiene patient comes into the room assisted or not assisted. You're getting all the initial work done, the x-rays, the evaluation. Is it prophy, is it gum infection? And once you get to that point where work is going to get done, prophy is about to happen. Let's say right then. And there the hygienist should write down the time stamp. It's 2 16 pm. That indicates that's the time I'm starting the prophy. That should doc should find the doctor. And this could be a one doctor office. This could be a one doctor office. This could be a multiple doctor office. It goes into the doctor's chair.

Henry Ernst:

Nonverbal communication I hate it when a patient's in a room and somebody says, okay, we're starting the prophy in room six. That's freaking like a lunchroom. We don't want that Nonverbal communication. You come into the room nice and quietly. You've put that little slip right in front where the doctor can see it. I'll look at it. I'll say, okay, 216. I've got a half hour to get in. There is how we've always tell our doctors For an adult prophy patient, you've got 30 minutes to get in there. We want our doctors to get in there before 30 minutes, while the hygienist is there, not after. Mistake mistake that people make in offices is hygienist does the prophy. There's no communication and the hygienist or assistant is now trying to find the doctor after the prophy is done and the patient's just sitting there. Right Now the doctor's in the middle of a root canal on number 14 and they don't come for like 30 minutes.

Paul Etchison:

The patient is pissed and how does that patient feel when the doctor eventually comes and takes a 30-second look and then sends them on their way?

Henry Ernst:

Even more pissed, right, yeah, so system. So let's go back with this system here. Doctor gets a slip. It says 2-16. The doctor in their head says I got to get in there with a half hour and just for systems points of view, if it's a child it's 20 minutes. So we all know in our office we got to get in there sooner. If they made their evaluation and it's gum infection therapy in our office we don't do anything. That first day We've got a highlight that says gum infection patient and I know I need to get in there within 10 minutes because the hygienist is educating the patient. I just need to come in there to put the cherry on top of that. So systems are very important. Let's take it from the doctor point of view. So in that same scenario, the doctor has to understand that they have to be cool about it. They have to learn how to juggle right.

Henry Ernst:

So many doctors are so focused on what you're doing right here right now, which is fine. But if you're doing a crown surgery, you can always stop and tell the patient tap them on the shoulder. Hey, listen, we've been working for a while. Let's give you a little break. Gives you a chance to slip out. Let's say you're doing a root canal. Hey, I'm going to put some medicine in this tooth here and I'm going to leave you for a few moments. My assistant's going to keep an eye on you. Let's let that medicine sit in the out right. This way you can slip out, do your hygiene visits and stay on time.

Henry Ernst:

So now let's take the two different patients. The first patient I saw, 216. I came in there within five minutes, I gave my exam and treatment plan was given to the assistant. So now the hygienist is finishing their cleaning. In the meantime, the admin team is putting together the treatment plan and as soon as the hygienist is done, it's a seamless transition Boom treatment plan. Patient never waited once, as opposed to doctors screwing around with a tooth is so focused on what they're doing comes in a half hour later and then the patient's pissed. It's a 30-second exam, like you said. Now they're waiting 15 minutes for a treatment plan. On top of that, which of those two scenarios do you think you're going to get a patient that's going to say yes?

Paul Etchison:

Yeah, totally. And the thing I was just thinking about is that when you don't get up gracefully from your patient, it's like when you have the hygienist sitting there. Doctor, I really need the exam Doctor. I'm still waiting for the exam Doctor, still waiting. I'm so sorry, mr Jones, I'll be right back. That's not a nice way to get up. You know one thing that for appointments I always tell my coaching clients for appointments that they don't have a good get up point, like put medicine in the tooth. I mean, you just mentioned hey, we're just going to give you a job break. I say to my assistant can you get the V3 system?

Henry Ernst:

We're going to use it like a laundry list of them. Hey, your gums are bleeding a little bit where there was decay. Let's have you bite on some gauze. There's so many, a lot of that they're valid in some sort, you know. But it gives the patient a nice little break and it just makes you stay on time. That doctors just have trouble doing that for some reason.

Steve Markowitz:

Create the workflow that will allow that to happen. So, like I was just talking about that with a couple of my doctors this morning, they're like all right, I want to make the temporary. I want to make temporary first, then impression and then adjust the temporary, and I'm like they're sitting in the chair the entire time when, if they were to prep the tooth, take the impression and then leave the room so the assistant could make the temporary. There's built in gaps within that appointment where they can go and check hygiene. So understand your workflow, not just for the workflow of the appointment that's in your chair, but also for the other rooms that are the other patients that are in your office that need to be seen. I would look at fillings are the hardest one, but I would look at almost every single procedure and create gaps in your workflow and this is when I'm going to go check on hygiene.

Paul Etchison:

Yeah, absolutely. And I think a lot of us look at this and we say, hey, we got to do our procedures faster. How do we get more efficient? How do we do this? And there's so much time lost with the hygiene waiting when you have the hygienist come get you when they're completely done, and it's a total BS way of doing it that nobody likes, you know. And well, the other thing is that I want to bring up is that when you interrupt the cleaning for hygiene, you can usually do that exam pretty quick, because you're just trying to get in and out and you don't you're interrupting. And when the patient's already sitting up, I've got to go through. How are the kids? How are the let's? Let's sit there and talk and then I go hey, is it okay if I lean you back, like they're not even laying back right there, and then it's like if they're telling you a story, you got to like press the button and interrupt them.

Henry Ernst:

It's it doesn't feel good either. For some reason, in dentistry, when I first started and I first started implementing this 2014 in my practice, like there was some hygienists were like what, you're going to come in the middle of my cleaning, my cleaning, you know? Or doctors would say I don't want to interrupt the hygienist. There was some like I don't know what it was that it was like forbidden.

Paul Etchison:

They're having this moment. You don't want to interrupt that moment.

Henry Ernst:

Yeah, and now I think it's gotten better. But you could get those hygienists or doctors from other offices that are used to bad habits I call them. But what I was about to stick in there too is when you go in there, your exam can be also quicker because you know, you put your gloves on and you give the hygienist the floor. You basically, if your hygienist named it hey, jane, how did everything look? How was oral hygiene? And now your hygienist, who's already spent time with them, can point out some things. Oh yeah, we noticed that broken tooth on the top and it gives you just so much better, so much better of an experience where the you know you just so much better visit. So much better of an experience where the you know the patient just really sees this as a team and you can make your exam a little bit more efficient and, like I said, you get out of there. Hygienist does it. Treatment plan is in motion.

Paul Etchison:

I love when the hygienist talk about. You know, we talked to Mr Jones about his flossing. He's really got to get that going, because when they don't say that, sometimes it's like hey, everything looks great and they're just like I just talked to him about. He has a flaw since the last time he was here and well, thanks for letting me know. I didn't notice, you didn't write it down and you had no way to tell me.

Henry Ernst:

And I wanted to hit on something that Steve mentioned, which was a really good point Scheduling. Hit it. We have to scheduling, you don't just stick anybody anywhere. Crowns I love crowns. I can bounce around a crown like a juggler, you know. I can know I'm patient. I can go do an extraction, I can come back. I prep the tooth, I get the heck out of the room after the impression I'm done. I'm not going to go back there. I can jump around really, really good.

Henry Ernst:

There are certain things that we can never double book and I don't allow them to double book fillings. I know other states have EFTAs. We don't have those. So fillings in our office we have to stay there the whole time unless we come up with a reason, you know, to get out. So we never double book fillings. We never double book crown seats because those are just unproductive procedures, anything unproductive. So we can't have a crown seat and then a denture adjustment and then a bike guard adjustment. We just don't do that. And then you mentioned this also, steve is understand your limitations. My crown visit may be different from a new graduate's crown visit, you know, and it's okay to give yourself more time, it's okay to extend it, shorten it if I don't need that much time. And also, we're treating people here sometimes. Oh, you know what this patient? She requires a shitload more time because she's a pain in my ass and she never gets numb. Okay, great, let's make that longer. Let's not stress out our day before it even starts.

Steve Markowitz:

I wrote down like three things I want to share, because we are supposed to do tips and tricks for staying on time. It's the unpredictability stuff that always causes some us to get behind. So what I recommend in my offices and doctors that I work with today and tomorrow I need you to communicate with either your manager or the front or your assistant. If someone calls, where are we putting that person? So there's an emergency. This person needs to be seen today, instead of having them come back, stand outside the room, this person on the phone like I need them to know exactly where to put this person. Or either they're going to try and squeeze in and the place is like the worst thing ever, or they're going to interrupt me and slow me down. So I start by today and tomorrow knowing where to put those last second emergencies.

Steve Markowitz:

The other thing I wrote down is your hygiene exam cards. For us, the hygienists do their data collection, which is x-rays or period charts, depending on the exams. Then they'll have an exam card and on that exam card is a picture of their face and it says I need an exam. And then they drop that in the room and on the back it will say have I met this patient before the patient's name? Have I met this patient before the patient's name? Chief complaints, anything else and just those four bullet points and they'll just write that right in on the card, that information. And then I know I have at least 20 minutes from the time that that's dropped off, because it's after the data collection, to go in and interrupt or do the exam. And then the third thing I wrote down was train your assistants. If you're spending time doing things that your assistant can, you are not being as efficient and there will be times where you will be behind. So invest in the people that you can delegate to and it will allow you to multiply time.

Paul Etchison:

Yeah, it's so true, that's what I was going to bring up. Is that bite guard adjustments? Can your assistant do these like crown seats? I mean, take a 30-minute crown seat for doctor beginning to finish and turn it into where your assistant does everything Adjust the bite, adjust the contacts, gets the tooth prepped, gets the temp off, gets it all ready to go. Maybe your hygienist had to come in and numb and you walk in there and just squirt, squirt, squirt, smush and you can be out of there. I mean you can literally be out of there while they clean up the cement. I mean, look and check out what your practice laws are, because I just took a 30 minute crown seat and turned it into like a 30 second. I mean it was I don't even know what you call it when it Steve's honeymoon or something I don't know.

Steve Markowitz:

Yes, that was a great day. I don't know why this, I don't know what you I'm ignoring that, paul, but I don't know why what you just said made me think of it. But quality dentistry shut up. Quality dentistry, like great impressions lead to great results crowns that seat easily. So I think, as a new doctor, we're talking about efficiencies and all these things, but the most efficient way to do dentistry is for things to be done well, cleanly and not have all these complications and bloody I'm using crowns here but bloody margins and things all over the place. So focus on the quality of your work and then focus on your efficiency and you'll have those follow-up, those next visits, be much easier and able to find more time throughout the day.

Henry Ernst:

Yeah, and I was gonna say a couple of things that also little tidbits here In the system that I was talking about, where doctor gets the routing slip from the hygienist and they know they need 20 or 30 minutes, we have trained our hygiene assistants. So if it's 10 minutes, if the 10 minute warning is starting to come, so 215, the prophy was started, it's 235. There's 10 minutes before the doctor is supposed to come in there, we will have that hygiene assistant stand outside the doctor you know treatment room and stand there and just stare them down. And I tell the doctors I said don't get mad at the assistants, because I'm telling, we're telling them to do this. This is for the greater good of the office, so you don't run on time. And they've even established like these little pictures it's like a picture, you know to make it fun of a sad person and when it gets really close to being time or it's like time, they'll have that sad picture up there and that's like telling the doctor in a nice nonverbal way get your ass in there, right? We don't. We're not the office where the patient's done with the prophy and they're sitting there for a long time. We're just not that office and so any means you need to do it, you do it and no matter what we talk about here, the three of us can talk about, we've got this humongous nice practice with 152 people.

Henry Ernst:

No matter what we do, there's going to be instances where we ran behind and we screwed up. Right, it's going to happen. There are some patients that, no matter what you do, they're going to hold you to such a tight window and I tell those patients ahead of time listen, I understand, that's how you are. Let's always schedule you first thing in the morning or first thing after lunch and I guarantee we'll get you back right on time and I'll even put a pop up in there, get this person's behind in there on time always. And then let's say you really screw up.

Henry Ernst:

And you know, I love the way that you said, steve, hey, I go out there and I take accountability. I'll do the same thing. I kind of do it in a different way. We have a little gift area in our practice where we keep stuff Car wash. So we have a car wash like across the street. We keep like a stack of gift cards for car washes. We have like Pleasant Plains beer mug, pleasant Plains lots of stuff. I'll kind of like oh, you know what this guy seems like he'd be a car wash guy. I'll go there, grab a car wash, say listen, I'm sorry we messed up, here's a car wash for you. It doesn the owner doctor or you know you. You said we messed up, it's not how we do it and you gave them you know something for it.

Paul Etchison:

That's cool, you know, and I'll I'll share. We have a deal with a pizza place by us and I'm sure you could do this. I don't know what you did. It's a car wash place but a lot of businesses are willing to give you like a discounted rate just to hand their stuff out, like it's a promotion for them, and like we had this pizza place that's in our strip mall, we would give out these coupons for a free large pizza and then they would just keep the coupons and they would give them to us and we would buy all the pizzas. But we're only buying them for like maybe like seven dollars a piece or something like that. You know, but here's, this pizza place is getting a full order, like it's not just they're going to order other things too. So it's like it was a win-win for everybody. And now we have something really cool that didn't cost us a lot of money to give away.

Henry Ernst:

We did like a hundred car washes that we purchased, and we purchased at a third of the price all at once, you know, and stuff like that. So I think that's how we did that.

Steve Markowitz:

Dunkin' Donuts and Starbucks. You can actually brand the card, so, like it's our brand on the gift card, we say that if we're more than 10 minutes late, I'm sorry. We owe you a cup of coffee. Coffee's on us and we just bought you. But you can buy them online. You can put your logo on it, and I don't know how many we have in the office. They're all over the place. Not that we try not to be behind, but when we are, we want to make sure we acknowledge it.

Paul Etchison:

That reminds me of like back in the day, like growing up. I'd go to the mall and get Sbarro pizza and there'll be the sign that says if our cashier does not give you a receipt, your meal is free, and every. I have no idea what that was about. I was in bezel man or something, but every time I was sitting there I kid like dude, don't hand me that, don't hand me that, I'm going to call you out. Yeah, oh man. Yeah, I still appreciate the pizza, you know.

Paul Etchison:

I want to come back to what you said, henry, before we close out. Is you mentioned the thing with the hygienist sitting and just standing outside the room? I think this is a good example of owners. What the owner should do this is leadership is you are creating a boundary of what is acceptable for people to let other people know I need you and some doctors. If you didn't tell them that, you know they might say I hate when she does that, I hate when she's standing out there. It's so rude but it's like. No, this is how we do it when you are late, because you are not to be late.

Henry Ernst:

Yeah, they do that to me and I'm appreciative of it. I'm like okay, I realize it. Let me come up with my little things here and get the hell out of here.

Paul Etchison:

Come up with my little things here and get the hell out of here. Love it, man. Well, hey, if you're listening and you're thinking about man, it would be really nice to work with a coach like one of these guys and have them pick apart my practice, give it the mental focus it deserves and grow. You're ready? Go check out dentalpracticeheroescom and I assure you you will get results that you will be wondering why you didn't do it sooner. Thank you so much for listening.

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