Dental Practice Heroes

Dentistry Scheduling 101: The $1,200/Hour Block Schedule Formula

• Dr. Paul Etchison • Episode 630

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Struggling to hit production goals despite a packed schedule? In this episode, we get into the root issue of why your production is falling short and the mistakes you probably don't know you're making. Learn which appointments are practice killers, when block scheduling doesn't work, and how to design a schedule that can hit $1,200 per hour!​

Topics discussed:

  • Why you’re busy but underproducing
  • How to implement block scheduling
  • Who shouldn’t use block scheduling and what to do instead
  • The bottlenecks in your day that keep production low
  • How to train your team to schedule patients
  • Small changes that improve the flow of your day
  • Procedure time benchmarks

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


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Why Busy Days Still Underproduce

Paul Etchison

If your schedule feels full, but you're still looking up at the end of the day wondering, why didn't we produce more? Well, you're not alone. A lot of owners are stuck in this sneaky trap where the day is packed with activity, but not with the right dentistry. Choppy procedures, crazy hygiene schedules, low value visits, eating up prime time slots, and cancellations that blow holes into your perfect day. And then you're left feeling like you worked hard and you have nothing to show for it. Today, we're gonna break down how to fix that. Not by rushing, not by cramming, but by designing a schedule that actually produces what you need it to produce. In this episode, we're breaking down the real mechanics of a productive schedule, how the DPH block scheduling system should be the foundation of all scheduling, why you should never do just one filling, how you can control the flow and hygiene, and how you can tighten up the operatory efficiency without rushing through your patient care. Now you are listening to the Dental Practice Heroes Podcast, the show for practice owners who want to work fewer clinical days, increase profits, and build a team-driven practice that runs without you being the bottleneck. I'm your host, Dr. Paul Etchison, the author of two books on dental practice management, a dental coach, and the owner of a nearly six million dollar practice in the south suburbs of Chicago. And today I'm joined again by my two DPH coaches, Dr. Henry Ernst, who owns an 18-op practice in the Carolinas and has built it to where he only practices two days a week, and Dr. Steve Markowitz, a multipractice owner with six practices in the Boston area, who practices just one day a week. These are the guys who live the DPH style and have helped dozens of dentists do the same. Are you ready? All right, let's jump in. Hey everybody, welcome back to the podcast. We're so happy you're sharing some time of your day with us. We got Henry and Steve, the DPH coaches, here, and we're gonna take apart how do we get our schedule to be more productive? Because it's one of those things, there's a lot of ways to do this. There is no one way. And I can think of maybe like one or two ways that it makes a huge, huge difference that we teach to all of our coaching clients, but there's so many little ones that just add up and make such a big difference. And I'll just start off by saying when we're talking about making our schedule more productive, start with a baseline. Start with what are you producing per hour? Dollar per hour is the great equalizer, adjusted production, dollars per hour. What are you actually bringing in revenue-wise to this office if you collected 100% of it? I think we all need to start with that. And I tell you, if you get to the point where, which I think you should be as an owner doc,$1,200 an hour, I mean, you're getting to a point where I think every minute's$20, it becomes a lot where every minute matters, can cost quite a bit. So pass it into you. I'll go to you first, Henry. We are big on associate-driven practices, all of us here. So we want to make our schedules productive. We want to make our associates productive. How do we make it productive? Give us some advice.

SPEAKER_01

Well, the first thing, number one, the hallmark of making the schedule efficient is block scheduling. And I know we are huge with that over here at DPH. Blocking out your schedule. The worst schedule you could ever see is I call it a choppy schedule, where there's a whole bunch of like 40-minute procedures, filling, filling, one extract. That's the worst, most unproductive day. So it's gonna get more into the weeds here, but we can talk more in depth. But blocking your schedule is really important. That's typically where you have maybe two blocks in your schedule in the morning, and these are for high productive procedures, crown, multiple crowns, a root canal crown, high product. This way they're reserved. It's like first class. We're reserving those first class procedures for there. I'll throw in one or one thing else besides blocking is fillings. And I'm grateful to you, Paul. I learned this from you years ago where I became the pseudo-specialist, and all of a sudden I would see like the one filling on your schedule. It's a practice killer. One filling. If you're in hygiene in our practice, we try to get one or two fillings, we try to do it in the chair while they're there. We treatment planted in the chair. Assist uh hygienists can numb them. Doctors come in there, knocks out a filling. Yes. If they decide that they don't want to do it that day, then we don't treat them, we don't push them. We don't even put them on the follow-up list. We'll get you on the next go-round in hygiene. So we don't really do the one to two filling visits in our schedule.

Save Big Procedures, Limit Low Value

Paul Etchison

Yeah, we do the same thing. We get them on the next hygiene go-round. Or if you get that one filling in your schedule, just walk in the room and look the patient in the eye and say, Hey, you feel like doing this today? And when they say no, be like, get out of here. Let's go. I don't want to do it either.

SPEAKER_01

The joke that we always tell our patients is, you know how when you go to the get some automotive um maintenance and you need an oil change and they're like, Oh, you need the filter change. And you just say, okay, just do it. And they give you that magical little sticker in the corner of your core that says, You're good until this many miles, right? I want the patients to leave and be good. I don't want you to have anything outstanding. So let's just get her done. So blocking out the schedule, that's the hallmark. That's number one. Get rid of the one-two fillings on your schedule. The with the blocking out, it'll also get rid of all these choppy, non-productive things, denture adjustments and stuff like that. And on the back end here, policies. What are your policies? What makes a patient no-show on you and stuff like that? Because that's a practice killer, too. I know that's a whole nother discussion, but those are the first things that came into my mind.

Readiness To Block And Data Thresholds

Paul Etchison

Yeah, I think we look at these no-show policies and then we say, what is the policy that's gonna make people show up? How do we get people to show up? And I asked the coaching client this recently. I said, what is a reasonable amount for somebody calling to cancel their today appointment that you think your front desk should be able to save? And they said, Man, reasonable? About 25%. I said, Well, that's probably the wrong place to look at fixing this policy. It's got to be more upstream. But you're right. I think the saving the major blocks, having the blocks for the big procedures, we've got to save big procedures. And another way of saying what you said about those little procedures is a productive schedule needs to limit. And you're like, don't do dental dent adjustments. A bunch of people listening are like, well, what am I supposed to do? It's not about not doing it, it's limiting the amount of low production procedures that you allow to get on your schedule each day. So I think those are huge as well. Steve, what pops in your mind when we're talking about tactical ways we can make our schedules more productive?

SPEAKER_02

I would love for everyone to block schedule, but not everyone is there yet.

Paul Etchison

But why not? Can't everybody be there? This is non-negotiable for me and my clients.

When Blocks Cancel: Recovery Tactics

Efficiency Without Rushing: The Dance

SPEAKER_02

Everyone with a dental license should be able to get there. But if you're not booked out for a week or two, and if you're not able to produce over$600 net an hour, you're just pushing out dentistry. That doesn't help anyone. So there's you're gonna have holes in your schedule, or you're gonna be doing three-hour crowns or whatever. So I think everyone should be doing log scheduling. But before that, for me, Paul, what you were saying, you need to know your data, your hourly production. And if you're able to get over$600 an hour net, that tells me that you can create value in explaining dentistry. You create urgency, and patients want to do it. And now we need a strategy to maximize our ability to help as many people as possible. And that's what block scheduling does. But we need to make sure that we have enough of a runway of patience to allow us to block schedule predictably moving forward. And for me, that that threshold is$600 net an hour. Before that, it may not be productive, but what I tell patients to do is take their patience, put it on in your hand, and throw a heaping pile of poo against the wall and see what happens and learn how to be efficient because you're not you're not there yet. What so once we get there, now we can block schedule and we need to stay consistent for it. And where I see the next challenge is now I had someone who knows who cancels two days before. So I have this production block, and what do I do with it? And this came up actually this morning. I was interviewing for a manager position in one of our offices, and I was just asking, I wanted to know where she is now, they don't do block scheduling. So it was more you have an opening, and you're the doctor's is sharing with you that they've been they're unhappy with how full their schedule is. What do you do? And I I actually loved I loved her answer. The answer was the first thing I'm gonna do is I'm gonna look at today's schedule and I'm gonna see if there's anyone who needs dentistry who can benefit from already being in the office. The second is I'm gonna look at patients who need follow-ups, who may be on the schedule a couple days out, have deliveries that are already back, and get them in to open up the next couple days. And then after that, I'm gonna make sure we have our follow-up list, whatever you want to call it, 222 is what we use in our office. I'm gonna have our follow-up list and we're gonna get a hot list from the doctors of patients that we know want to be seen sooner. And she went through all that, and I'm like, that's gold. And then what we need to make sure is we're following up with that as part of our huddle in the morning, as part of our meeting with the doctors, so that we're all communicating where we want things to go when maybe things don't go exactly how we planned. Did you hire this person? I don't make that decision, and uh, I think she did a great job.

Paul Etchison

I feel like you have a very political answer. Like you make a great politician. Like you never I bait you, and sometimes you don't go there.

SPEAKER_02

I am very independent. Look at me, straight down the middle. There's some I'm Chris Rock. There's some stuff I'm on the left about, and there's some stuff I'm on the right about.

SPEAKER_01

Markowitz 2028. I can see it now.

SPEAKER_02

Yeah, Henry, you'll you'll run with me, dude?

Paul Etchison

Markowitz earns.

unknown

Yeah.

Get Out Of Hygiene And Lead

Paul Etchison

There we go. That's what I need. He'll help you with the red states. All right. So uh so you know, one thing that pops in my mind is that we're talking a lot about block scheduling, and and you're right, Steve. Like there needs to be some level of demand that comes with that. But you know, how do you get through procedures faster? And people say, I don't want to rush through my procedures. I don't want to hurry. And I think if you watched me practice, you would see I'm not in a hurry. You would just see it's very efficient. Like my assistant and I are always doing something. And I think take your assistant dancing. You and your assistant, you're gonna go dancing. And what I mean by that is you're gonna sit down in the chair and you're gonna pretend you're going through procedure and you're just gonna say, what do we do here? Well, why don't we try I pass this under my other arm? Or why don't you hand this mirror to me this way? Well, about when I reach back for this, you're doing this. Find something to do at every moment. Now, we're talking about shaving off seconds to a minute from every procedure, but I think really when you get this down and you get in the flow, you really do shave off a lot of time and you make it a lot more enjoyable to do dentistry. I mean, it's I would hate like my endo procedure with my assistant is so spot on that we don't have to communicate anything. When I've got to dry and operate canals with a new assistant that doesn't know our order and I have to tell them every next step, I think it adds 20, 30 minutes to the procedure. And it just sucks. So that's one thing that I think we got to sit down, we've got to do this with our assistants. It's fun, it shouldn't be something that they take offensively, and I think it's an easy thing to do. The other thing I think about is you've got to get out of hygiene. Get out of hygiene. I get it. I love talking with my patients. Okay, well, then you can't complain about the results when you're spending 40 minutes every hour in hygiene. You're going to get the results that come with spending 40 minutes an hour in hygiene. You've got to get out of hygiene. And I'm not saying don't provide a great experience. You should, but be reasonable. And one thing I always give my my assistants have a Dr. Kennedy. Dr. Kennedy gives us a call. Doc, Dr. Kennedy's on the phone. That means get your ass up. Dr. Kennedy's not really on the phone. We just we got this tip from a Dr. Kennedy before. And it's also for those patients that just keep you in there talking. My assistants know, hey, doc, Dr. Kennedy's on the phone.

SPEAKER_02

I also think the doctors themselves sometimes overexplain things because they think that if they talk more, then the patient in the hygiene room will finally understand it. So one thing that I'm working on currently with my doctors is if the patient isn't ready to ask questions and they need a ton of work, I can't force them. If someone needs all their teeth out and they're not ready to do it, maybe this is controversial, but this is how I practice and screw you if you disagree. Um but so someone comes in and they need all their teeth out, and they know they need all their teeth out, but that's a big decision for them and they're just not ready to hear it. I'll start to pick up signs, and I will not spend the next 20 minutes trying to convince them that they want their teeth out. What I'll do is I'll stop and I'll say, I know I'm throwing a lot at you. I just want to make sure I'm taking the best care of you the way you want to be treated. If you're not ready to move forward, I totally get it. I'm gonna put everything in the treatment plan. I'm gonna have the girls up front present that so you know what to move forward, what the next steps will look like. If you're not gonna do anything right now, what I want you to know is I would look for any swelling, any pain on biting, anything like that you're experiencing. Please let me know and we'll we want to make sure we're here to help you. And I don't go on more than that. I need them to be ready to be part of the solution because it ain't my problem, it's theirs. And I think sometimes as doctors, we see this disease and we're so focused in on wanting to show them that this is a disease and I need to help you with it, that they don't, their patients aren't ready to hear it, that we lose sight and we just spent 20 minutes trying to convince someone that doesn't want to hear what we have to say. So sometimes understand where the patient is and then stop there. It's okay.

Language, Boundaries, And Associate Targets

SPEAKER_01

I had a few points. So, number one is getting out of hygiene. There's nothing wrong with just telling the patient, listen, you have a complicated situation. Why don't you come back, schedule some time with me when we have time, and we'll talk about it, right? I think that's always a good one. I'm gonna disagree with you here, Paul. One thing that I always say is I never want verbal communication with a patient. What I mean by that is if I'm drilling on a tooth and I'm clean, I don't want somebody walking into the room and saying, Doctor, I'm ready for you in room four. I think that's the worst shit you can do. Because if I'm a patient get getting my tooth drilled on, right?

Paul Etchison

This is during the conversation, is what I'm mentioning, but Dr. Kennedy.

Smart Scheduling Rules For Admin

SPEAKER_01

Even still, even still, like yeah, I know I'm poking holes in it. We have our assistants stand outside and stare me down. That's the sign to say, get the hell out of the room, stop chit-chatting. A couple of other things that I was writing down as you guys were talking. I had a conversation with one of the mastermind people in our meeting, and they hated every time somebody said faster. I never say faster, more efficient. We want our procedures more efficient. When your associate doctors, again, we we grow associate-driven practices here. When your associate knows what the goal is, our associates are tiered, right? So some of our associates are at the 850 an hour mark, some at the starting level are at the 550 mark. When the associate knows what their strike zone is, it leads them to better decisions. So if I'm gonna treatment plant extraction, it's gonna be 350 and it's gonna take me an hour. Hey, doc, maybe that's not in your strike zone, right? So it's good for that. Other interesting exercises, we had a doctor that was having trouble with production, and a couple of us over a couple of beers were going. This is the nerdy things that we do over a couple of beers, where we're going over what's your overhead? What's your overhead per hour? What's your overhead per share? Dorks! Yeah, that's us. That's where I've gotten to in this life. Jeez. So this doctor was talking about how her associate does a three-hour crown appointment, and this is non-ceric kind of visit. This is impression, making attempt, and then they come back for another hour. And we did the math, and every time this doctor did one of those, she's losing like a couple hundred bucks every time. So it's always good to look about, and I was discussing, I said, listen, we gotta be more efficient, not fast. The last point that I wanted to make is with we were talking about limiting the non-productive procedures or the very low productive procedures. You gotta train your admin team to take control of the conversations. So, for example, we're open on Saturdays and we have a policy, we don't do any dental adjustments on Saturdays. So when somebody calls, the admin team doesn't say we don't do dental adjustments on Saturdays. No, we say, we don't have that stay. We have Monday, we have Tuesday, we have this time. Take control of the conversation, right? And that goes with a lot of different things. You also have to train your staff to do what we refer to as smart scheduling because you got the block scheduling. And as Steve mentioned, sometimes you're not ready for that. And I agree with that, because if you have block scheduling, you're not busy enough, you'll just have holes in your schedule. So, in lieu of that, you have to do smart scheduling. And we teach this to the people that are in their younger infancy of their practice. You should never schedule fillings next to each other. Doctor can't be in two places at once. I know some people have FTAs, so you maybe could do a little bit of commingling there a little bit, but we never do. If you have people come back from the lab for crowns, no crown seats next to each other, no non-productive procedures next to each other, like no denture adjustments next to each other. You just have to train your staff. But make sure this is part of phone scheduling and phone training, but always take control of the conversation. Always tell them we don't have that time. How about this time? Give them two options.

Paul Etchison

Yeah, I always tell my team, I'm like, I'm not an octopus. Like, what the hell is this? Like, I can't do this. All great points. Do you guys know how many tickles it takes to make an octopus laugh? Ten. Seven. It is it is ten. You're supposed to say eight. It's tentacles. Ten tackles.

SPEAKER_01

Ten tickles.

unknown

Yeah.

SPEAKER_02

This is the kind of stuff you get with balls coaching. You just get learn, you learn how to do high-quality jokes. How many patients have did you give that one to?

Paul Etchison

Oh, I give it to people all the time. One of my favorite ones is do you know why uh Ariel the Mermaid wears seashells? She outgrew her B shells.

SPEAKER_01

I love that one. Anyway, this is why you want to come and hang out with us in a mastermind meeting and have a couple of beers and you listen to this kind of conversation.

Standardize Ops And Eliminate Friction

Paul Etchison

That's true. So I'm I'm thinking of the mastermind weekend, and we were outside, me and another member, and we were talking about this exact same thing as like how he over talks in the operatory. And I said, Well, what are you talking about? He's like, I know I'm over talking it. And he said, Sometimes I'm just waiting for a reaction from the patient. And the thing is, is you talked about this, Henry. He's like, we got to take control of the conversation. If you're waiting for a reaction for the patient, don't keep talking. Ask for a reaction. Stop and say, Hey, Mr. Jones, I know I just went through a lot of stuff. How are you feeling about all this? And see where they're at, because the solution is to see where they're at, address their objections. It's not to keep talking over and just get deeper and deeper and they're just watching them space out. You've got to ask. There's nothing wrong with asking. And this is like a thing with phone skills. Man, you want to you want to hear a phone conversation get bad. Let the patient lead the whole entire conversation and you watch all the different directions that will go in. But it's all leading. People want to be led. People don't want to, they don't want to take control. They're in a very weird environment where they're vulnerable. They don't know what's what's going on, they don't know half about dentistry. They want to be led by somebody who knows what they're doing and has their best interests in mind. Amen.

SPEAKER_02

I think part of what these doctors need to do is just if at any point they feel like they're talking too much, it's time for a question. Question times with Paul.

Reasonable Procedure Time Benchmarks

Paul Etchison

So all great stuff. I want to rewind a little bit because we're talking about efficiency. Mahenry mentioned not faster efficient. There's a lot of situations where we could be more efficient in our operatory setup. And I see this a lot. Every operator is set up in a different way. Why do we do that? Why can't we standardize where things are so you can go in any operator? Why can't we buy an excess of inventory, not to the point that it's wasteful, but that so things we use all the time are in the rooms? Why can't we buy, you know, an issue that comes up with me is bite blocks. We did this with bite blocks. We just never had a bite block. That sounds super corporate, Paul.

unknown

Right.

Proactive Huddles To Protect Tomorrow

Paul Etchison

I mean, we did this with bite blocks. We never had a bite block. And I'm like, why are there no bite blocks in the room? So we bought so many that there could never be a room without a bite block in the door. And then we still had the issue. So then we had to take the handpiece out and we had to drill the numbers into them. This is op one, this is op two. It better go back to the right place. And because the thing is. Is you think it doesn't mean anything. I mean, you know, when your assistant leaves the room and you're sitting there in silence with your patient, it might be 30 seconds, but it feels like five minutes and you're just like looking down the hallway like, damn it, what oh God. Like I have to speak to this person. I don't want to. All these minutes add up. There's so many opportunities. So when you're going through your day, look for the opportunities of inefficiency. Look for the points in your day where you lose time, where you could have been doing something. I'm not saying burn all day long, but to some extent, stop wasting time.

SPEAKER_02

And I think to add to that, we also need to make sure we're we're all being proactive and actually meeting with our treatment coordinator or meeting with our manager to know who to fill in the schedule with if things don't go the way we want them to. I think the biggest take home is we can build this perfect schedule, but it never really works out that way. And if there are changes in today, tomorrow, or the next day's schedule, I would love for our the person responsible to be as proactive as possible and get my input. So if I have people that I think I need to call, or if I have there's someone that needs a that needs an adjustment or whatever, like let's make sure we have a couple minutes a day before the day starts or at the end of the day to look forward to the schedule of the next day so I we can be proactive and not have any surprises.

Paul Etchison

I think what would be useful is let's close out this episode, but I would love just to, I'm just gonna shoot out a few procedures and I'd like to hear from both of you. Just what is the time you should be done with this? And if so a listener says, I'm not, I need to change something. Not like Mario Andretti, but I'm saying, like, you know, what's reasonable. Sitting down to prep a crown to get to the impression part. So the complete crown is prepped buildups in everything. Steve, how long should that take a doctor?

SPEAKER_02

You better be done prepping that tooth if it starts at 8 o'clock by 8 30, 30 minutes.

Front-Loading Profitable Blocks And CTA

SPEAKER_01

Henry? I would say 15 to 25 minutes. I'll bury a hair.

Paul Etchison

I was gonna say 30 minutes. I think it should be faster, but 30 is like, dude. Like I think you could do faster but 30. I'm like, dude, what are you doing?

SPEAKER_01

Look at it from the patient's point of view. I removed the wisdom tooth last week and it took me two minutes, and the patient's like, I paid you$450 for that. And I said, Yes, because I know how to do it that quickly. If you want me to screw around with it, I can charge you more, but I don't think you'd like that.

Paul Etchison

Yeah. Well, it's the thing, yeah, totally. It's like the Pablo Picasso thing. Like, that only took you two minutes. It took me my whole career to learn how to do that. My whole career. All right, class two filling. One single class two, prep it. Not fill, just prep. Henry? I'll say five to ten. I say five. I think five. Yes. Okay. Surgical extraction. Routine, maybe bust it off. More of a challenge. Surgical extraction, if you can't do it in this time, you need to get better at your extractions.

SPEAKER_02

With suture and back up, ten minutes.

Paul Etchison

Ten minutes? Steven? Twenty minutes. I'd say ten minutes. I've worked with people, they're like, I want to produce twelve hundred dollars an hour. Here's a hundred and twenty dollar simple extraction. I'm gonna put it on my schedule for an hour. That math doesn't work. Hell. Okay. Any other procedures you can think of? Go ahead, Steve. I can see your lips are moving.

SPEAKER_02

You know, it does work if you have two crowns before it for an hour and a half. True. There are still things that we need to do to help our patients. We need to do the simple extraction work. I need to do the occlusal belt. We just have to do it if there's no one else in our office to do it. It's just making sure that there's enough of the other things to offset and we're scheduling in a way that allows us to still hit our goals, whatever that might be.

Paul Etchison

True. And that's the whole idea behind, you know, coming full circle here: block scheduling. We're front-loading high profit procedures to take away the sting of the low profit procedures. So I think that's a good place to put a period on this conversation. If you need help working your block schedule, figuring out how to do all this stuff, reach out to us at Dental Practice Heroes. We'll have a free strategy call with you. And I assure you, like when I'm working with coaching clients, this is one of the first things we're working on is developing a schedule. Because when you get an ideal block schedule that hits your dollar per hour goal, that is the foundation of a well-run practice. Is you see visually what you need to do. Now you just got to fill all those little targets you put on the schedule. Now there's a lot of things to do to fill the targets. You need more new patients, you might need to diagnose more, you might need better case acceptance. A lot goes into that. But ultimately, if you can fill a well designed block schedule, everything else will work out. So thank you so much for listening today. Please reach out to us, dentalpracticeherous.com, set up a free strategy call, and we'll talk to you next time.

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Dr. Paul Etchison

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