Full Schedule, Low Profit: The Real Problem With Your Dental Schedule

Exhausted, underproducing... but busy. Sound familiar? Instead of grinding away, you could be building a $1.5 million practice with just two procedures a day.

In this episode, the DPH coaches break down block scheduling, guardrails that keep low-dollar procedures from stacking up, treatment planning benchmarks, and how to coach your team into building a profitable schedule — not just a full one.

Topics discussed:

• Why a packed schedule doesn't always equal a profitable one
• The real reason your days feel chaotic
• Block scheduling: how to protect your time
• Where low-value procedures belong in your schedule
• What a $1.5M production schedule looks like day-to-day
• How to diagnose what’s wrong with your schedule
• Four reasons you have a bad schedule
• How to audit and coach your team without drama
• The leadership mindset shift that ties it all together

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

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Transcript

Why Busy Days Still Feel Bad

Paul Etchison 0:01

If you're running around all day doing dentistry and feel like you're behind in your schedule more than 10% of the time, well, your schedule is doing something that is working against you. A packed schedule, it doesn't always mean a productive schedule. A busy day does not mean a profitable day. And most dentists, they're not struggling with effort. They are trying, they are grinding, but they're struggling with the proper structure. And the real problem is not always that you need more patients. As much as that would help, and that seems like a logical solution. A lot of the times the real problem is the way that you have your schedule built and the way that your team is booking, and also how your treatment's being planned in the first place. So today we're going to be breaking down exactly why your schedule feels chaotic, why you can be busy without being productive, and how to fix it so that you can work less, produce more, and actually enjoy your clinical days again. Now you're listening to the Dental Practice Heroes podcast, where we teach you how to create a team-driven practice that runs without you being the bottleneck so that you can have the freedom to live an awesome life, make an insane level of profit, and have an insane level of time to spend with your family. Now, I'm your host, Dr. Paul Edgeson. 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. Today I am joined by my two DPH coaches, Dr. Henry Ernst, who is the owner of an 18-out practice in North Carolina, and Dr. Steven Markowitz, the owner of six practices in the Boston area. Now, these two guys, they are not practicing a lot. They are managing and running large offices. And that is what unlocks the freedom for you to live the exact type of lifestyle that you dreamed of when you jumped into practice ownership in the first place. All right, let's dive into this episode. Hey guys, welcome back to the podcast. We are here with the coaches, the best coaches in the world. Unbelievable. They do things that you could never dream of and they make your practice better. So today we're going to talk about something that's important to every single practice owner. Whenever we take over a practice, maybe we open a practice, maybe we're acquiring. It doesn't matter. But at some point, we've got to take a really hard look at our schedule and say, hey, like, I need patience. I'm here. My team is here. The overhead's getting paid. I need to start doing some work. Like, as we the old hotel analogy, what's the most expensive room in the hotel? Everyone's like the executive suite. No, it's the empty room. So with the empty chair, how do we fill our chairs? So I'm going to go to you first, Henry. Like, I know that you deal with this a lot with your clients and stuff. What do you recommend to somebody who's looking at their schedule and saying, I don't know. I just don't have it. It's not as busy as I want it to be.

Empty Chair Problem Meets Choppy Days

Henry Ernst 2:36

Yeah. So the most common thing that we get is what we call a choppy schedule, right? Like clients will show us their screenshots of their schedule and it looks very choppy. There's so many patients that they're seeing, and they're all small procedures, right? So first we have to go back and see how are we treatment planning? Are we treatment planning people correctly? All right, especially when we're looking at associates. Are they treating plan fillings when they should be crowns and all that stuff? But we need to put guardrails, and this is probably the biggest challenge is somebody who buys a practice and the staff is all used to a certain way of doing things. And, you know, now the doctor's trying to change things, not have a choppy schedule. So I think you're the king of this, Paul, is just trying to do block scheduling. I know we talk about a lot. It is so paramount, right? Block scheduling just it's kind of like first class, right? In first class on an airplane, the airline is guaranteed to have a certain amount of seats that are going to have good paying passengers, right? And they're happy to sit in those seats. We need to make sure that we have our first class patients, at least like two a day, maybe to start with, that are high-paying procedures, that are booked a certain amount of time and that are guaranteed that you're going to have that good schedule. Some people are so against that, and it's such a big change that I'll say, you know what? Okay, if we're not willing to commit to that, let's at least put guardrails on our schedule. Don't allow them to put all these non-productive things next to each other and make rules, right? I call them smart scheduling rules where I can't put this next to this. You just can't do it. And as the doctor in this circumstance, it really stinks in the beginning because you're gonna have to talk about why we're doing this and you're gonna have to audit it. And it's gonna be so many times where they mess it up and you can't go off the rails and lose your temper. You gotta coach, you gotta teach them why this is not right to do this, and let's not do it again. Eventually, maybe six or seven times of doing that, they get it.

Paul Etchison 4:21

Yeah. You know, the thing is too, is I think whether or not you're gonna block schedule too, is you can create all the blocks, but you can also not have enough demand to fill the blocks. So at some point, like you do need to have more demand. And so, like when I'm looking at this, I'm like, we're looking at, I mean, a lot of people want to fall back on marketing. What is it on marketing? We could just got up our marketing. But I think there's a lot of opportunity in I mean, marketing, but we're not throwing more dollars at it, but looking at what is the product and the projection of the brand that we're putting out into the world. I mean, there's all these websites that are just generic as hell and they don't look good. We took a team picture with like a like a flip phone, and we all wore different color scrubs today. You know, it's like, what are we doing here? Like that stuff matters. No, it doesn't matter to me. It didn't matter for the last 40 years. No, it does. It really does. So I think we got to look at our marketing, what we're putting out there. What pops in your brain now, Steve? I'm thinking so much about patient demand.

Demand, Diagnosis, And Key Metrics

SPEAKER_02 5:17

Like block scheduling is is great when there's enough demand. But if we're taking the the scenario of we just acquired a practice, how many active patients do we have? Like, is there do we buy a practice where there's 600 patients? Are we buying a practice where there's 1500 patients? Because if we bought a practice that has 1,500 active patients and we have, you know, even 20 to 30 new patients a month, our schedule should be full if we're treatment planning appropriately. And appropriately to me means at least two times what we want to produce, but the benchmark should be two and a half times what we want to produce in a given day. So that's that's really where my head goes of just like, if we don't have enough patient demand and we're treatment planning appropriately, there's no way for our schedules to be full. So that's where my head goes.

Paul Etchison 6:03

But what I would ask you is because I know you're so deep in you like Steve likes numbers. Like Steve, like he showed us this picture of his childhood bedroom and all his sheets, everything was just like numbers, different color numbers and stuff. Like if you go to Steve's house and you go to his practice, he's got like those number magnets on the fridge. It's really weird. But he it we we let him we because we love Steve.

SPEAKER_02 6:21

It is amazing because I don't even know how to do basic math. So yeah, it is really impressive that you guys think that I'm of the three of us, I'm the numbers guy. You are the numbers guy. Just to throw this out there. Every single time we talk about numbers, Paul's like, I'm not the numbers guy. And then I'll say like two metrics. He's like, Yeah, of course, those are the basic ones that you of course you do, but you know, there's also these four other ones that you also gonna look at. So you're full of crap, dude. I don't like to rely on the numbers.

Paul Etchison 6:47

Steve's like, if you look at a cell phone bill, it's a bunch of 900 numbers. But like Steve is like deep in no, but here's what I'm thinking. All right, so like when we look at demand, okay, what we're really looking at is new patients. To some extent, it's dependent on the number of new patients, their diagnostic percentage, how many people are diagnosing on, what we're diagnosing. And then it's just our case acceptance. Like it's it is the math. And I wonder, Steve, from you having 24 doctors working your practices, how do you benchmark diagnosis from a case acceptance standpoint or from a treatment planning standpoint? Treatment planning. Like somebody, how do you look at because the thing is is we can get more new patients, we can get more, we can diagnose more, or we can get better case acceptance. People are like, I love getting better case acceptance. I love getting more new patients. But when you talk about diagnosis, they're like, I feel like I'm diagnosing fine. I don't want to change the way I diagnose.

SPEAKER_02 7:32

Perfectly. That's the word mentorship actually wins because we need to be there with them and look at the x-rays and look at the photos and listen to the patient conversations so that we can actually understand where there was opportunity to take better care of that patient. So in my experience, two and a half times what you want to produce in a day and 30 to 40 percent of treatment dollar acceptance will lead to a full predictable schedule where you can use block scheduling and have it make your days easier and productive and not feel like you're just running around on roller skates.

Paul Etchison 8:12

But I mean, okay, so let's say that I love the idea that I think that's a very like in theory. Yeah, I just want to hear like, but if I only see 10 new patients a month versus I see 40 new patients a month, yeah, how can I say the right amount is two and a half times? Because that means if I'm seeing 10 patients, I gotta diagnose way more. Like at some certain point, you're making things up that don't need to be done. Like if you're trying to make that your benchmark, I said this is my thought. I'm prove me wrong.

SPEAKER_02 8:36

Totally. That's part of the diagnosis of what the issue is. Is the issue patient demand? Because if it is, then we need to go down. Like, do we have the ability to see more patients? Are we an important metric to us is reappointment percentage? Are we reappointing these patients to have them come back so that we can get other opportunities to share with them what we see and have them invest in their care? So part of our understanding, and if a doctor comes to me and says, My schedule sucks, I'm not busy enough, I can't treatment plan things I don't see, well, then we need to understand: is it truly a patient demand issue? Is it a treatment planning issue? Is it a diagnosis issue, or is it a case acceptance issue? And it's gotta be one of those four things. And if we can understand which lever to push, dentistry's pretty easy. If we understand which lever to push of those four, then we'll we can invest in that and then change our outcome.

Paul Etchison 9:31

I just wonder if there's like some number for diagnosis, or you have to just open the charts and see. I mean, that's what I do with my associates. I look and see is it there, is there a big difference? I'm I'm it's a relative number thing, you know?

SPEAKER_02 9:42

Okay, I I kind of understand what you're saying. So when you can go even further is dollar treatment plan per exam. Yeah. That is a metric that you can look at. What I have found is that once that number crosses the$2,000 per exam threshold, that is also a good metric. So if I see a doctor where their dollar treatment per exam is in the hundreds, well, they're probably not discussing crowds. They may that on teeth that could benefit crowds. So that is something that we discuss in our discovery of why our why this schedule may not be what we want it to be.

Paul Etchison 10:18

Yeah, that makes sense. Henry, what's this look like for you in your practice?

Henry Ernst 10:22

Well, actually, I was gonna tweak the roles here a little bit. Instead of being the traffic cop here, I was gonna put you on the spot, Paul, because I feel like you're really good at this. So let's talk about because I see this a lot. Dentist, schedule sucks. They're scheduling all these crappy small things for me, right? What is your advice? And it's not a volume problem, plenty of new patients, but obviously there's gonna, no matter what you do, there's gonna be crappy things that you treatment plan. There's somebody who's got two fillings, there's somebody who comes back for a denture adjustment. What is your advice to those people? How do you actually do it? So in a schedule? Like tell me, like what how do you physically just do this?

Block Scheduling With Real Guardrails

Paul Etchison 10:56

Yeah, I would say like when I'm looking at creating a block schedule, we're doing a few goals here, one of which is to hold time for big procedures, big dollar per hour procedures such as crowns, root canals, things like that, that are going to offset the lower dollar per hour procedures. But at the same time, we need to limit the amount of those lower dollar per hour procedures we're going to see. I don't care if you got a point where you've got these patients and you've got the demand for it. That might be something that was self-inflicted because you have lack of true diagnosis or bad case acceptance. But you have to limit the amount of those that you're seeing. Now, for us, and I just talked about this in my three-day virtual, is I went through like what I thought was a reasonable time for every procedure. You know, the the thing that's gonna slow us down dollar per hour is always gonna be MO, they're class twos. In OB, is you could do it super fast. Like, so as long as if you've got like four, five, six fillings you can do in an hour visit, you're gonna going to be profitable with it. But where you're gonna get screwed is when you're just doing MODO, MODOM DO. So I think that is the appointment that needs to be constantly watched and limited. And you got to be careful about diagnosing so many of those. I mean, some some patients need that, but I don't know if this is truly answering the question. I'd love to hear if you had a different take on it, Henry. But I I think you've got to, the schedule needs a force to limit those. And then we got to make sure the other things, like at a single extraction, we've got to get the ridge preservation in there. And another thing that pops in my mind when I'm talking about an empty schedule, if we're scared to do an extraction, if we're scared to do an endo, you know, if we won't place an implant, at some point we've got to ask ourselves, gosh, like if we're gonna cherry pick all these perfect cases and we're just gonna do fillings and crowns, how can we ever expect to be busy? There's a lot of work that needs to be done that your patients are getting done, but they're getting done at some other office. That's right. Which way do you take that, Henry?

Henry Ernst 12:38

And I would say this too is people don't realize this, how much patients hate that. Oh, yeah. They don't understand that. I can't tell you, we've kind of developed that niche of we're like the practice that does pretty much everything. And I can't tell you how many times I have a patient walk in with an endo referral slip that says number 30, please, you know, perform rook and all on number 30. And they come to our office and the what's the first thing they ask? Can you guys do all of this here? They sent me somewhere else. I don't want to go to multiple places. I'm telling you we get that at least three times a month. But I think I wanted your take on it because I just provide the guardrails, right? And sometimes it's an uncomfortable conversation because you're literally telling people, like, hey, you can't tell this patient, like you can only put this many of these things. Like with the block scheduling, we talk about a lot about the first class situations where we've got higher dollar procedures that are blocked out, maybe like two or three hours in the morning, two or three hours in the afternoon, but we also have to put guardrails on the smaller procedures. And I, in the beginning, when I coach other offices, and we did this in the beginning, I tell people, like, hey, you can't put fillings next to each other, you can't put non-productive procedures like denture adjustments next to each other, put it somewhere else. I don't have this time available. Take control of the conversation, offer them this day or this day. I don't want to see the choppy schedule. The choppy schedule is a killer. And it's a stressful as hell day. You're going from patient, your your assistants are swapping cleaning rooms out back and forth. How much do we love to see when we walk in in the morning and we're looking at a schedule? And there's only like three big procedures on the schedule and hardly anything else. Those are the best days, right?

Paul Etchison 14:59

Yeah. Well, that's the thing is if you think about the dollar per hour, anything low dollar per hour is stressful. Yeah. There's a reason it's low dollar per hour because it takes a long time to do because it's tedious. So have a full day of that. I mean, you can do an equivalent day of three buildups, three crowns, or probably 20 composites.

Henry Ernst 15:16

You choose. I want three crowns. Years ago, I had an associate who was an older doc, really nice guy, and he only did fillings in crowns. That's fine, right? He was a successful dentist. But I remember one day we were walking into two separate rooms, same exact time. I think he had like seven or eight fillings he were doing. A lot of them were like MOs and DOs. And I remember I was doing it, I think maybe two implants. And I looked at him, I said, I guarantee you, I'll bet you any amount of money, I'll be done way before you. And I was done so much faster than him. And I literally was like, challenge. Like kind of waving at him through the window. Because it's just an example of, and he was a nice guy, could we kind of would rile each other up like that? But it's a perfect example of if you can feel confident in doing these high, it's gonna make your life so much easier and less stressful.

Paul Etchison 16:01

Yeah, it really does. And you can relate it with your team. They're like, wow, this scheduling's all about money. It's all about money. No, it's about taking better care of patients. You do not take your best care of patients when you're behind. You do not take your best care of patients when you just got uh done doing 10 class two fillings. You are spent. So if we want to take good care of our patients, we got to make sure we get a little bit more intentional about our schedule. And we're doing when we take care of the doctor, when we take care of the practice, we take care of all the patients and everybody works there. That's how I love to relay it back to the team. Steve, thoughts. No, I do love that, Paul. I see you pressing buttons.

SPEAKER_02 16:35

I just took up my because I'm the numbers nerd who uh I just took up my calculator and I was like, what does it take to do$1.5 million? And I think that's like a good benchmark for a successful practice. And that's$4,100 of doctor production a day net.

Paul Etchison 16:51

Okay, that's with the doctor doing how much production?

SPEAKER_02 16:53

70%. 70% of the production comes from the doctor, 30 comes from hygiene. So it's that's a million fifty, I think. The typical dental practice, 70-30 split. 4,166 bucks. Even on a PPO, you can do that with two big procedures with that may take you an hour and a half. We'll call it three hours of your day on two big procedures, and the rest of your day, you get to do whatever denture adjustment or small procedure you want to do. And you have, if it's an eight-hour day, which I would think is a normal working day, you have another five hours to do as many buckle composites or whatever it is that's gonna fill your day in the exams. You can get there if you have enough patient demand. In my experience, I don't think every doctor needs to be able to place a molar implant or uh uh uh do a molar endo. I don't think that you need to do that to be successful. It may make the path a little bit easier, but if our goal is to just create a practice that we're proud of and have it be financially healthy, this is the structure. You need two big procedures a day, fill the rest in with smaller stuff to make your that the patients need, take good care of your patients, have them come back, and you should be on your way to creating a one and a half billion dollar practice.

Paul Etchison 18:18

That's amazing. I mean, that's literally like$510, maybe$515 an hour. Exactly. Yeah. I mean, you work hard for a few hours.

Henry Ernst 18:26

That's entry-level associate, basically, level.

SPEAKER_02 18:29

Is the average dental practice Henry, is the average dental practice doing a million and a half bucks? It's not. No, not even close.

Paul Etchison 18:34

I'd say like$750.

SPEAKER_02 18:36

It's such an awesome opportunity here. It's like the problems that we're trying to solve. It's not like we need to go back and like get our MBA and how to create a more than a billion dollar dental practice. We just need to do two things a day and then fill it in with some other stuff that we learned in dental school. And if we do enough of it, we'll be fine.

Paul Etchison 18:52

But you know what's interesting? Every office I've seen that does less than a million dollars is open five days a week.

Coach The Team And Raise Acceptance

Henry Ernst 18:59

Like they always are. I don't know. But our goal is success. We can understand these things. And even as a doctor, we can understand. But the problem is the team. So I'll give you a perfect real life example. Uh conversation with a client, and hey, why is your schedule so choppy? Yeah, my office manager, she always just tries to please people, right? People like need to come in here and she just puts them in. Well, stop telling them to put them in, right? Put guardrails. It's the team, right? So, yes, everything you said makes a lot of sense, Steve. But if we have people that are messing us up, we have to be leaders as doctors and we have to coach and we have to audit, and we have to make sure that other people don't mess up our schedules. Because does the doctor make their schedule? No. The treatment planning people make the schedule, the people that upfront answering the phones make the schedule. You have to make sure those people don't mess up your schedule. So you can't just get that simple$1.5 million practice that you just talked about, Steve.

SPEAKER_02 19:55

Just a hudge, Henry, but my guess is that the doctor that told you that their office manager was a people pleaser. I just have a just a guess, but I bet that doctor's also a people pleaser.

Henry Ernst 20:05

Yeah. Exactly. It's like double-edged sword, right? We have to teach the doctors how to audit, how to coach, how to talk to people, right? They don't want to have the uncomfortable conversation, right? It's not even an uncomfortable conversation. It's just you're educating and you're leading and teaching. Well, this is like coaching in a nutshell.

SPEAKER_02 20:23

And they're mad at the office manager for creating that schedule. Yeah. But they haven't created the guardrails, like you said, to do it.

Henry Ernst 20:29

They get huffy and puffy and they're like, damn it, who did this? Why does this keep happening? Right? It's your fault. As the doctor, look in the mirror. It's your fault.

Paul Etchison 20:37

Doctor, do you have a problem with the schedule I made for you? No, no, it's great. It's great. I think this is coaching. I mean, this is what it is. When I started coaching with offices, a lot of it was like, let me tell you how I did my office. And then as I did it for more and more years, it was like, how can I more effectively change this person's mindset and the way that they approach these issues in their practice? And I think that's what the magic of hiring a coach is. It's not just the what do we do? What's the best way to write a schedule? I can tell you the best way to write a schedule. You can read it in my book. But like, how do you get over these team issues? And that's where I think all three of us excel is that we've got big teams, we've dealt with people, and we've worked over through these other situations and we've worked through them to get to the other side. But yeah, I don't want to ever give anyone the impression listening that we you're dumb if you got a bad schedule, if you're dumb if you got doing less than a million dollars. That is not at all. Where's no, we went to no training of how to do this. But I think what I want to convey to anyone listening is that the answer is not grind harder, work longer, all this stuff. It's get smarter and do it, create the proper leverage in your practice. And that's what we provide with coaching. All right, Steve, what were you gonna say?

SPEAKER_02 21:44

Where I was going with it is what is the actual step for a doctor if they're listening to this? The first step is you got to diagnose why your schedule is the way it is. Is it a patient demand thing, or is it a treatment planning thing, or is it I need more new patients? You have to first identify that. Once you figure out exactly which lever to push on, now you can go in and create this the schedule and the structure and share with your team why it's so important, not just to the level of patient care, but also to how you're gonna improve their lives too. Because guess what? A busier practice also will allow for a healthier practice which can take better care of its team. So true.

Paul Etchison 22:23

Yeah, if I want to drop a pearl for anybody, there's nothing wrong with talking to your treatment coordinator, have your treatment coordinator present the treatment plan. And if the patient says they don't want to schedule, or before that, just ask the patient this question Hey, I know I went through a lot with you. Tell me how you're feeling about all this. Tell me how you're feeling about everything I just showed you. And they will give the indication of whether. Or not they are bought into the fact that they need this treatment. And if they're saying, I don't know why my last dentist didn't say anything about this, I don't know why they didn't say anything six months ago, I don't know why it doesn't hurt. That is an indication to you that you are not selling the need for treatment better in the back. And nothing will improve case acceptance-wise. I don't care who you put in the front, you need to just do that in the back. And there's nothing wrong with having every single person that doesn't schedule, write it down why they didn't schedule. Ask them what's keeping it from schedule. Write it down. We all want to look in like dental intel and practice by numbers to figure out well how we should drive our practice. Get curious. Ask questions.

SPEAKER_02 23:19

I do love that. I would encourage every doctor to go up and ask the retrieval coordinator, ask the hygienist, would they leave the room? If a patient didn't schedule, they're more likely to share with the the non-threatening non-doctor than they will with you. So ask them.

Paul Etchison 23:34

He introduced himself as Dr. Markowitz. I don't operate like that.

SPEAKER_02 23:38

Yeah, I get it. Steve, we're gonna do it just just Steve. It's funny. I like Dr.

Paul Etchison 23:43

Markowitz.

SPEAKER_02 23:43

I mean, you got a very pronounceable name. Thank you. Yeah. I like the number of syllables. It's sophisticated.

Paul Etchison 23:48

Yeah. I mean, mine's weird and everyone thinks it's Hutchinson. And Henry, yours is kind of just like it just rolls off the tongue like you're like it's this what you would yell out when you're putting up that like last rep at the bench, like there you go. Exactly. It's a grunt. Yeah, yeah. All right. So what this really comes down to is this a chaotic schedule is usually not a scheduling problem. It is a leadership problem, it's a systems problem. Sometimes it's a diagnosis and case acceptance problem. But once you understand what is actually causing the chaos in the way that your days unfold, fixing your schedule is not really that complicated. So here are three takeaways I want you to remember from this episode. First of all, a full schedule, not the same thing as a productive schedule. A lot of people have full schedules. I had a full schedule in dental school. And man, that was one of the least productive schedules in the world. Secondly, block scheduling, smart scheduling, those rules, that's what's going to protect your time and your profitability. Get intentional. What are the rules? Create them, discuss them, roll them out, discuss on how they're working, pivot from there. And lastly, if your team is creating the wrong schedule, that is not the reason to start firing and getting rid of everybody. It is a coaching opportunity. So don't be frustrated about that and think that's a normal feeling to continue month after month. If you are frustrated, do something about it. And if you want help with all these systems in your practice, I mean today we're talking about scheduling and production, but man, that's just a tiny little piece of everything in the practice. We have our seven phase omnipractice program that's full systemization that takes your practice from exactly wherever it starts to exactly where you need it to be. If you want to hear more about that, go to dentalpracticeheroes.com/slash strategy, set up a call with me. Like I always say, it's a conversation. There is no pressure, it's just about clarity. And before you go, if you think this podcast has been helpful, if you have been learning things here that you're applying to your practice, I would just be so damn happy if you could support it by leaving a five star review. It takes about 30 seconds, it helps other dentists find the show. And I am always grateful for it. I read everyone personally. I really do appreciate it. Thank you all for listening. Have a great day at the clinic today, and we will talk to you next time.