How to Make Every Procedure Hit Your Dollar Per Hour Goal

You end a whirlwind clinical day feeling like a champ, until the production report steals the win. We’re tackling the real metric that decides your freedom: dollar per hour. When you stop chasing raw revenue and start engineering each hour for high yield, your schedule calms down, profits rise, and time off stops feeling expensive.

We lay out concrete targets you can actually hit: $650 per hour as the floor for associates and general clinicians, and $1,000–$1,200 per hour for owners who tighten systems and add selective high-value work. Then we make it practical. You’ll hear fast, repeatable benchmarks for core procedures—class II composites in 15-minute bites, crown plus buildup and delivery inside an hour, night guards with five minutes of doctor time—that show how small changes stack into big hourly gains. Extractions become strong earners when paired with ridge preservation, and we unpack the timing traps that keep molar endo at $500 per hour instead of $1,400, including access, patency, and a crisp obturation “dance” with your assistant.

Walk away with a simple audit: total collected production divided by doctor clinical hours over the last two weeks. If you’re under target, pick one procedure to improve this week by trimming time, delegating steps, or adjusting your mix. Subscribe for more systems that trade chaos for clarity, share this with a colleague who needs a calmer schedule, and leave a quick review so we can help more practice owners design the life they want.

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

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

The Real Problem: Dollar Per Hour

Paul Etchison 1:55

You just finished a long clinical day and you're exhausted. And you ran the two columns. You did it on roller skates. You didn't stop moving. You feel accomplished. You feel like a winner. You pat yourself on the back and you say, Doc, you did it. You did it today, Doc. But then you look at your production and all of a sudden it just doesn't feel worth it. Mmm, why? That feeling right there, what is it? It is a dollar per hour problem. Today, I'm going to teach you how to fix it. How do you make sure that every procedure you do is high profit, high production without rushing through your day, without cutting corners? We're going to show you exactly how to do that this episode. Now, you are listening to the Dental Practice Heroes Podcast. This is the podcast for practice owners who want to work fewer clinical days, increase their profits, and build a team-driven practice that insulates them from all the garbage of day-to-day practice ownership that drives them just absolutely bananas. I am your host, Dr. Paul Etchison. I am a dentist. I'm an author of two books on dental practice management. I've been coaching dentists on business and communication skills for the past seven years. And I'm also the owner of a large group practice with five doctors in the south suburbs of Chicago. My goal is to teach you how to create an amazing practice that allows you to live an amazing life and all the while changing the perception of what dentistry feels like for all of your patients in your community. Not to mention, take great care of your teams in the process. So if you want to be the owner of a practice that is low stress, runs without you being the bottleneck, and allows you to have an insane amount of time off, you've come to the right place. And today we're going to talk about something that dentists, most almost all dentists, completely ignore. Dollar per hour because the production, I mean, let's face it, it is kind of a vanity metric. But dollar per hour is truly the most important metric in your practice. Now, you can be one of those docs, you can be a solo doc. You can produce, you can be the owner of an office that collects$1.5 million a year. But if you're open Monday through Friday and every other Saturday, and it takes you five and a half days a week to do it, that's going to be a completely different life than someone who produces and collects$1.5 million just in three days a week, which is what nearly all DPH clients do. That's like the floor we're shooting for. So revenue without context is more or less meaningless. That's why the dollar per hour comes into it. Because I mean, face it, I mean, I could crush it seven days a week, but that's not a very good life. I need to figure out a way to do that in an amount of days that works for my life and that allows me to have a life outside the practice. So let's define some targets for dollar per hour. Now I'm talking about collectible dollars, all right? Not talking about before write-offs. I'm talking about dollars that you actually can collect real money. So my clinical target for doctors is$650 per hour. That is for any doctor. And I have never had an associate not be able to do it. So I know anybody can do it. I don't care how slow you are, you can do$650 an hour because I've never had an associate not be able to do it. Now, there's things that go into that, there's training that's involved with that. It is the DPH block scheduling plays a huge part in that. But nonetheless, that is the floor. If you're a doctor, you got to do$650 per hour. If you got associates, if you can get them at$650 per hour, magically, all of the other expenses and all of your profitability, it just tends to work out. That's the magic number. Now, as an owner doctor, I think you truly can get up into that$1,1100,$1,200 per hour collectible range, but you have to be willing to be uber efficient and you've got to have to have some level of specialty procedures in there too. Now, can you do it with bread and butter dentistry? Of course you can, but it's a little bit more difficult. I have one coaching client on the East Coast that produces like$2,400 collectible per hour. He's a maniac, but he's doing it, you know? So just to know it's out there, people can do it. Now, what about hygiene? Yeah, hygiene, everyone says three times their salary. How can you even say that? I mean, we're on so many different fee schedules. It's hard to say. I say, you know,$140,$150 an hour. I think it's reasonable. I think it's good. I think it's still profitable at that level. And I don't think I'm asking three times our salary. You know, we got these people on the West Coast, like, you know, Washington and California, hygienists making like$85 an hour, I think. I don't even know if that's true. I'm pretty sure that's true. If I'm way off, forgive me. But it's gonna be hard to find a hygienist that can produce and collect$250 an hour. Whoa. You know, that's a lot. So, nonetheless, we decided our targets. Now let's get intentional about it, right? All right, here's my first point. Like I said, production, it's kind of a vanity metric. You know, we love to brag about it. We love to brag about our collections, we love to brag about our yearly revenue and stuff. And I, you know, I'm cool with that. I don't have a problem with that because sometimes I think on the internet and the Facebook groups, there's just way too much doom and gloom. I want to see some people bragging. Bragg. Show us what's possible. I wish more people knew that they had the potential to do that stuff instead of just poo-pooing it. But you know what? When we compare the dentists that are producing and collecting the same amount, but one is doing it in half the time. Like I said, those are two different lives. Same production, very different quality of life. So it's that dollar per hour is what's going to determine your amount of freedom as a dental practice owner. It's gonna determine the amount of stress in your life as a dental practice owner. Because let's face it, if you're producing more and less time, you have more time to deal with all the other aspects of the practice that might stress you out. But since you have time to deal with them, you can be more proactive about getting in front of those things instead of always chasing your tail and reacting to things that happen at the practice. That's what happens when we get intentional. It affects your lifestyle, how much time you're going to have off from the practice, how many weeks you can take off from your practice and not feel like crap about shutting your practice down because you see the opportunity cost of going on vacation. You know, if you can get intentional about your dollar per hour goal and you can hit it, you hit year-end goal and you're like, well, I can hit my year-end goal and still take off 10 weeks. You're not gonna feel bad about taking off that 10 weeks because you hit your goal. So, to some extent, it is a vanity metric. People brag about it, but nonetheless, it is very important because it loops back and relates to your lifestyle and your quality of life. So we're gonna focus on it. I don't care if it sounds braggy, it's important. Let's do it. Now, every procedure that you do at your practice, it has to earn its spot in your schedule. You can't just throw things in, well, it's dentistry. We put it on the schedule. We put all dentistry on the schedule with no intentionality and there's no rules involved with it. I had this one doctor in Missouri, great doctor, great dude, like one of my favorite coaching clients I ever worked with. But when I started with them, he was running this sort of, you know, like the panky FMR kind of practice where, you know, big cases, full comprehensive evaluation with like all the AACD picture sets and JVA of the joints and like all this stuff, which is cool. That's the type of dentistry that he wanted to do. But my problem with it was that he was booking two hours of his schedule to do these exams. Okay. Two hours of the doctor schedule. Now he was, well, I'm charging$400 for the exam. Awesome. You're charging a lot for the exam. He's out of network, so I guess it works. But$400 for two hours of doctor time, that's$200 an hour. As far as I'm concerned, if you want to do$200 an hour, just go be a kick-ass hygienist. You know, like$200 an hour as a doctor is not a good use of our time. So at any level of production that's above$200 an hour, that procedure they're hogging two hours of your day, it's gonna lower your result. So if your goal is$600 an hour, that's gonna hurt you. And this happens in practices everywhere, not just with exams. It happens with every single procedure. And we're gonna go through some procedures and some procedure times, and I'm gonna talk to you about each individual procedure, how to make it meet that dollar per hour goal in just a moment. But everybody does this. People book an hour for a simple extraction. People book an hour for two class two fillings, things that just the math doesn't work on it. So you have procedures that are sitting on your schedule right now that don't hit your number and you allow it because you don't even see the bigger picture that it's causing you harm. And nobody's ever asked you to justify the existence of those procedures on your schedule. So if you have things that are on your schedule that are not meeting your production goal, when you look at what is the collectible dollars that come from this procedure and what is the amount of doctor time I am booking for this procedure, simple math, dollar per hour. You've only got five options to address it and change it. One, you can raise the fee. Many of us are in PPO environment. We cannot raise our fee. Two, you can reduce the time that you spend doing it. So you can work faster, you can get more efficient with your assistance, you can change your mindset, maybe some different workflow things, maybe the room is set up right, everything efficiency-wise, you're not wasting any time so that you can reduce the amount of time it takes you to do the procedures. And trust me, your patients will thank you. They don't want to be there. Three, you can delegate it. So you can delegate it to team members, auxiliaries, they can do more of the procedure. Uh, F does like whatever it takes. Like, as long as it's legal, have somebody else do more of the procedure so that the doctor time is less. Number four, you could just stop doing it. You could say, hey, I can't do this in a reasonable amount of time. So I'm just not gonna do this procedure anymore. Or number five, which is a big part of DPH block scheduling, is you got to make sure you have enough higher production procedures to offset those lower production procedures. You just can't ignore the math. And this is what DPH block scheduling is about. Like we have a few principles, one of which is we make sure we have a certain amount of high production procedures. But the second one is we limit the amount of low production procedures we're willing to see in the day. Because if we just allow unlimited low production procedures that are all below our dollar per hour goal, we're not gonna hit our dollar per hour goal. It's just not gonna happen. So we got to look at our schedule almost like we would look at an investment portfolio. Every procedure is like an asset. And some assets perform really well, and some really just underperform. And then you've got these other ones that you're just super emotionally attached to, like that really stupid investment some friend told you about like five years ago, and you're still hanging on to it. You're like, it's gonna bounce back. It's you're emotionally attached to it. We do this with procedures as well. We've got this procedure. Well, I really like doing it. Well, it's really killing your schedule. Well, I really like doing two-hour exams. Okay, justify it for me. Show me, show me why that works. Because I've always done it this way. I like doing these. What's wrong with a seven-hour endo? That's how we did it in dental school. We split it between two different days and we took the whole time. No, that's just not gonna work. The math doesn't work. It takes you three hours to do an endo. It's not worth it. I mean, I would almost go as far as if it takes you two hours. Eh, you're getting close. It's kind of not worth it. You got to get faster. So if it doesn't hit your number, something else has to always work harder to make up for it. And it's usually you. You know, you're grinding harder, you're working harder, and that's where the burnout comes from. It's not from the dentistry, it's from like the misalignment of what you're trying to go for and what you're actually doing during your days. There's no intentionality around it. So let's go through a few procedures and I'm gonna tell you how this is how you can make sure the dollar per hour is good. So, what is like our slowest, most unproductive procedure for a lot of people? It's those class two fillings, the MOs, DOs, okay? So here's what I think about it. These are my thoughts. I don't care what you say about this, this is my opinion. I understand that everyone doesn't work at the same speed, but this is what I think is reasonable. Okay. And I think like MOs and DOs, every filling that you do should take you roughly about 15 minutes, start to finish. Okay. Now, if you're doing an appointment with three fillings, three MODOs, I'm thinking that should take you about 45 minutes of doctor time. Now, if you can do it so that that always works, we're gonna say$200 each per filling and it takes you 15 minutes. That means every time you're doing MOs and DOs, DO composites, you're typically doing about$800 an hour. Okay. So that's well above our$650 per hour goal. But if we're$1,000 or$1,200 an hour is our goal, it's a little bit below. But that's okay because that's our unproductive procedure. That's the one that's always going to bring us down. Same thing with doing new patient exams on the doctor's side. A lot of us don't have a hygienist or don't have enough hygienists. So we're doing the exams on the doctor's side. We've got to figure out a way that the dollar per hour is not so bad. I mean, the dollar per hour is always going to be bad, but we've got to figure out a way so that it doesn't hog a lot of time on the schedule. We've got to utilize our team. All right, let's talk about like some other composites, like maybe some occlusals or incisal composites, you know, on the lower incisors, you do those four incisals. You don't even have to numb for those. I mean, you could do four incisal composites in like 20 minutes. Easy peasy lemon squeezy at$200 each. I mean, that's$2,400 an hour. That's gonna help your production goal a lot. Same thing with class five composites. Those are super easy. I mean, you should be doing these super fast too. You can do four class fives in about 30 minutes. That's gonna get you about$1,600 per hour. So you're still crushing that goal. Now let's talk about crown. A crown, a buildup plus the delivery of it. How long should that take you? I think it should take you about 45 minutes max, maybe an hour. If you're getting$1,200 for the whole Shabam, that's gonna be a$1,600 per hour procedure. What about a night guard? You know, you don't really think about that as production, but what does that take you doctor time? I mean, you're typically you're probably not the one taking the impression or the scan for it, but you might not even be the one delivering it. Like in my office, my assistants are gonna make all those cluzel adjustments and I'm gonna pop in and check it. So I'm gonna say that's a five-minute procedure for me as a doctor. If I get$400 from that night guard, for that five minutes, I was producing$4,800 per hour. That's pretty profitable. All right, let's talk about extractions. Those are difficult because an extraction sometimes can take a long time and we don't get paid a lot for it. So if you're gonna do an extraction that's gonna take you 20 minutes and it's a$200, maybe$250 extraction, I mean, that's gonna be, you know, about$750 an hour. Still pretty good. But what we want to do with those extractions is we want to get that ridge preservation graft. That is the most ideal thing for the patient. The patient should have the opportunity to say yes or no to our most ideal treatment. We're not gonna judge them and say this person can't afford it. We're gonna offer it. They can still say no. But if we can get that bone graft in there, it only adds maybe like two, three minutes to the procedure, but it's huge. I mean, it's huge as far as dollar per hour. So we take that$750 an hour procedure and we add like a you know,$400,$500 code to it. That's gonna get us up to maybe like$2,000 per hour for that extraction. So that works really, really well. Now let's talk about root canal buildup and crown plus the delivery. I think you can do a root canal buildup and crown and deliver it in 90 minutes. All right. I think people are gonna go, whoa, what are you talking about, Edge? But I'm gonna say that's a$2,200 procedure. Molar root canal, build up and crown, 90 minutes. That's gonna be almost$1,500 an hour. You could take a little bit longer, but I remember working with this one client out in California and he loved molar endo. He was good at it. He did a great job at it. Awesome dude. But I mean, he was still taking two hours to do just the molar endo. And when you look at a two-hour molar endo that maybe you get$1,000 for, I mean, you're sitting there at$500 an hour. So something has to change. It's okay if it's temporary, you're just practicing, you're getting better. But at some point in your career, if that time is not improving, you need to look at that and decide if that's something you want to do. Now I'll tell you, most people, molar endos, they're missing a lot of time in two parts. One, they're taking a really long time to get patency to get to their lengths. Okay. They're not opening up the canals, the orifice is big enough. The second thing is that the obturation process is very long because they haven't worked with it and set up the dance steps with their assistant. So I'll tell you, I would work with a new assistant that didn't have our obturation process. It wasn't my normal assistant. That obturation might take 30 minutes. Where if it was just me and my normal assistant, we could probably get it done in like seven. You get those efficiency savings when you get intentional about how you're doing the procedures. So, pretty much went through most of the procedures there. I'm sure I forgot about some of them, but you get the idea. Look at the times that you're using and what you're doing with them and make sure that it's in line with your dollar per hour goal. So now when you sit there and you say, I don't know how people are doing$1,200 an hour, it's because of this stuff right here. They are setting up their schedule in a way that they only utilize this amount of time, but they're figuring out ways to do it in that amount of time. A lot of this might be mindset stuff. Like stop looking at your prep so much and just drill. Drill. Like when you prep one side of your prep, make sure you prep it to be done. When you do your occlusal reduction, do enough of it so you don't have to come down and do it again. You know, and the other thing is when you prep a crown, prep the whole crown before you remove any decay. Don't sit there removing decay on areas of the tooth that you're just gonna cut away anyway when you prep the crown. You know what I mean? So little things like that. And I've got a ton of those things in my course that we teach to our doctors to get their dollar per hour up more. But just those things. Think about them. All right, let's talk about hygiene briefly because it is important. Now you're hygienists, they're making money. I hate that we look at it like a loss leader. I don't think it has to be a loss leader, but you do need to have some intentionality around your hygiene. You need to set aside time for the scaling and root planning. That's like the hygienist equivalent of the crown. You got to make sure that you're diagnosing properly so there is enough SRP. You're getting case acceptance on it. And then you got to see like, what are these adjuncts that we could be offering? Are we offering fluoride? Are we offering lasers? Are we making sure we're sealing teeth? Are we using SDF? Perhaps we're using Curiton. There's uh desensitizers, there's a lot of things. Perioprotect. There are so many things, so many tools that we can train to our hygienists that can help our patients that will increase the dollar per hour. So make sure you do spend the time getting your hygienist trained in that, but also training them in the verbiage to present it in a way to patients so that they say yes. Because if we're providing a service to our patients, in some level, we believe in that service, that there's benefits to it. And our patients cannot experience the benefits if they don't say yes. So fundamentally, we've got to present it in a way and teach our hygienists how to present it a way that they say yes. So I want you to look at a mindset shift now. Instead of asking yourself, how can I produce more? I want you to start asking yourself, how can I make every hour of my day count? And that shift will change everything for you. When you start aligning every hour of your day, every single procedure, and you align it to dollar per hour metrics. I mean, you start working less, you'll feel less rushed, you'll stop stacking those tiny appointments. Oh my God, the tiny appointments. You start getting intentional. You roll out DPH block scheduling where you know that if you can just fill these seven appointments during the day, you're gonna hit a big day because you picked what appointments are gonna go where. You just got to find the patience and the work that needs to go there. And you can continue to grow your practice, scale it without adding more chaos. And that's ultimately what we want. We want a bigger practice that makes more money and helps more people in the process and provides an awesome place for our team members to work at. We create all these things, it's win-win-win for everybody. So if you're thinking that that's the type of practice that you want and you want some help, someone to walk you through that process, teach you how to do it, and teach you how to motivate and lead and inspire your team. That's exactly what we do at Dental Practice Heroes. Reach out to me, set up a strategy call. It's free. Go to dentalpracticeheroes.com/slash strategy. I'll get on the phone with you, I'll talk to you about your practice, and I'll let you know if I think Dental Practice Heroes can help you. If we can, I'll talk about what that looks like. If we can't, I'll just give you some advice and you go do your thing. No matter what, you're gonna leave that call with some clarity and it doesn't cost you a thing. So if you're an owner and you are, you know, two years in to your practice and you're still producing less than$650 per hour out of your two columns, your chairs, it's not a patient problem. It's probably some strategic problem. It's your strategy. Because I really want all owner doctors to be migrating towards that$1,000 per hour, doing the higher value procedures, delegating the lower value work, limiting the lower value work, creating that associate leverage at your practice and engineering an intentional schedule that creates some intentional capacity that allows you to expand and grow when you get to that level. I mean, these things, they're not ego. It's design. It's designing our practice so that we can live a better life. So here is your homework. Look at your last two weeks of dentistry. I want you to calculate the total collectible production divided by your total clinical hours. What's your number? If it's below your target, pick a procedure this week that you're gonna improve. And I want you to look at that. I want you to figure out how you can tighten the time, make it how you can do it faster, how maybe you can delegate some of it away. Or if you just really need to say, man, maybe we should start referring these ones out. I don't think I can ever do them in time. But I would rather you don't do that one. Figure out how to do it. I know you can. And if you need help, reach out. We're happy to help you with that. Thank you so much for listening today. I really appreciate you. And if you liked this podcast, please leave a five star review and tell a friend about it. Nothing makes me happier than seeing this podcast grow and get more listeners. It really makes me feel like what I'm doing is making a difference. So if you could do that solid for me, I would very much appreciate it. You have a great day at the office today. Have a great week. We'll talk to you next time.