Front desk problems

April 1, 2010
In the past several months, there has been an upheaval in the business office where I work.

by Dianne Glasscoe Watterson, RDH, BS, MBA
[email protected]

Dear Dianne,

In the past several months, there has been an upheaval in the business office where I work. First, one of our wonderful front desk assistants died tragically. She was so efficient and thorough that she could handle the front desk by herself if necessary. We miss her terribly! Then another business assistant had to be out of work for an extended time due to surgery. Our third business assistant was recently out for vacation on a one-week trip to Europe. Out of urgency, two more business assistants were quickly hired. Unfortunately, neither of the new hires have much experience. It seems like nobody in the business office knows what’s going on!

One of the most stressful things for those of us in the clinical area is not knowing whether patients have arrived or not. We have a light system that business assistants are supposed to use to notify us when our patients arrive. It seems to me that someone up there could let us know, but it’s not happening. It’s so frustrating to find out a patient has been waiting, while we’re thinking the patient has not arrived since the light was not turned on. Notification of clinical staff has been discussed at staff meetings, but the problem persists.

When we talked to the office manager, she told us to be patient with them, that they are still learning. But in the meantime, we continue to suffer. We are a very busy practice with three dentists and three hygienists. Our schedules are usually full, and some days are quite hectic. It just seems like somebody at the front could let us know when our patients arrive. Is that too much to ask? What should we do to solve this problem?

Frustrated Hygienist

Dear Frustrated,

The problem you have described is happening because your front desk lacks organization and the new hires are inadequately trained. People have been “baptized by fire” into the business assistant positions and are expected to learn on the fly. The resulting chaos brings many negative outcomes, including unhappy clinicians, dissatisfied patients, and falling profits.

The scenario you describe brings to memory a consulting client of mine from several years back. The doctor described how he worked very hard but barely had enough profit to pay his bills, much less pay himself. Over the previous two years, several different people had worked at his front desk with little or no training. His practice became very financially unhealthy as a result of business assistants not filing insurance properly and not collecting fees from patients as they should. The accounts receivable was around four times a typical month’s production when it should have been about a month’s production. Situations like this can result in bankruptcy if not corrected.

Can you imagine how bewildered and inadequate you would feel if you were expected to do your job with little or no formal training? That is often the reality for business assistants. What I see in many offices is that there are two or three people at the front who do a little of everything, and no one is really held accountable for any particular body of work. Most of the problems I find in dental offices as a consultant originate at the front desk. It is the nerve center of the practice.

What needs to happen is the implementation of systems at your front desk. There are distinct jobs there. Instead of everybody doing a little of everything, positions should be well defined with written job descriptions. One person should be designated as the scheduling coordinator. Everything about the schedule should be this individual’s responsibility. Check-in of patients and notifying clinicians that their next patient has arrived would be one of this person’s responsibilities. (Some large practices need two scheduling coordinators, one for doctors and one for hygienists.) A second person should be the financial coordinator and should be held responsible for making sure the money comes in. Every person that is seen in the clinical area is handed off to the financial coordinator before exiting the practice. If the office has extensive insurance participation, the practice may need an insurance coordinator. Offices with multiple providers (such as your practice) will need an office administrator with a complete job description of duties too numerous to list here. The point is, everyone at the front desk needs a written job description and cross training to help at other front desk positions if a coworker is absent.

The number of business assistants depends on the volume of patients being seen. Offices that have a preponderance of short appointments and heavy patient volume will need more clerical help than practices that perform longer procedures. The most important consideration is that business assistants should not be so overwhelmed with non-patient duties that they cannot take care of people face-to-face. Good customer service involves creating a warm and welcoming atmosphere, especially from business assistants. One rule of thumb is that frontline business assistants should not need to spend more than 50% of their time on non-patient duties. This usually ensures they have adequate time to take care of patients face-to-face in an unhurried manner.

In addition, please consider that untrained business assistants are very unaware of what is happening in the clinical area. They are often required to keep several plates spinning at the same time with these tasks:

  • Multiple telephone lines ringing practically nonstop
  • Clinicians asking questions
  • People waiting to check in
  • People lined up to check out
  • Making appointments
  • Dealing with irate customers
  • Searching for lost charts
  • Filling schedule openings
  • Processing mail
  • Interfacing with salespeople
  • Sending patient correspondence

The front desk area is often the noisiest place in the practice, especially when clinicians walk their patients to the front and carry on extended conversations, seemingly oblivious to the fact that the business assistant is on the telephone or assisting another patient. Some clinicians insist on writing up their patient narratives at the front desk, causing bottlenecks and congestion around the business area.

My opinion is that your business assistants are not purposefully trying to make your workday stressful by not notifying you of your patient’s arrival. Rather, they are caught up in the frenzy that happens naturally when the proper systems are lacking. The disorganization you describe doesn’t fix itself, and as other people leave and new hires are brought in, the situation usually gets progressively worse.

Zig Ziglar made this astute observation, “The only thing worse than training your employees and losing them is not training your employees and keeping them.” The business owner has the responsibility to see that people are properly trained for their jobs. The good news is that one-on-one training is available. Consultants can help by bringing structure, training, and organization to the business area. It’s amazing how smoothly things run in the office when the front desk functions as it should in an organized, efficient way.

Best wishes,

About the Author

Dianne Glasscoe Watterson, RDH, BS, MBA, is a professional speaker, writer, and consultant to dental practices across the United States. She is CEO of Professional Dental Management, based in Frederick, Md. To contact Glasscoe Watterson for speaking or consulting, call (301) 874-5240 or e-mail [email protected]. Visit her Web site at

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