Dianne Glasscoe Watterson, MBA, RDH

Scheduling issues

Aug. 1, 2019
Dianne Glasscoe Watterson, MBA, RDH, shares ideas about how to accommodate more new and existing patients in the dental hygiene schedule.

Dear Dianne,

My name is Julie, and I’m a hygienist in Nebraska. We have two hygienists and one doctor in our office, and we are currently experiencing scheduling issues. I saw your topic on the RDH website. We are finding that we have no slots available for new patients since our recall appointments are scheduled six months out. When we have cancellations, we call patients on our short call list, but we find that they can’t come in the day we have openings. They ask for appointments on the following week, but we’re already fully scheduled. What are some ideas we can put in place to handle this issue? Your input would be greatly appreciated.

Julie K., RDH in Nebraska

Hi, Julie,

New patients are the lifeblood of a dental practice, and if we really believe that, we will make scheduling them as quickly as possible a priority. Think about it: If I call your office as a new patient, and I’m told the first appointment is several weeks (or maybe months) away, the chances are strong that I’ll keep looking elsewhere. So, if your schedule is already busy, the only way to ensure time for new patients is to reserve time in the schedule for new patients only.

The way to determine how many new patient time slots to block is to run a report showing how many you have had over the past six months. Then, divide that number by six to find the monthly number of slots you need. You can easily determine how many to block per week or per day.

In an ideal world, the doctor would see any new adult patients first and perform a comprehensive exam on each. Periodontal issues (if present) could be diagnosed, and the level of hygiene care needed could be explained to the patient. Wouldn’t it be great if you knew exactly what level of care you would be delivering when the patient is scheduled in hygiene? However, the reality is that many doctors prefer to place new patients in hygiene first. The main reason is that hygienists are excellent at gathering and recording data, and we need lots of data on new patients. I’ll never understand why many doctors do not see the value in establishing a relationship with the patient first while performing a comprehensive exam.

I also understand the reality that many patients call in and ask for a “cleaning and checkup” appointment. Since the patient has never been seen in your office before, the business assistant has no idea what level of hygiene care will be needed. Some offices solve this dilemma by preblocking time in both the doctor and hygiene schedules. For example, the doctor’s schedule could be blocked at 9:00 a.m. for a 30-minute new patient exam, and 9:30 could be blocked in hygiene for a one-hour slot. With this arrangement, a large chunk of the doctor’s time will not be compromised, and the hygienist can also see the patient. The doctor can perform the exam and inform the patient of any existing periodontal problems, the assistant can be there to record chartings and take the full-mouth x-rays, and then the patient can be moved to hygiene. If the patient has extensive restorative needs, the doctor will need a separate visit for a consultation. (It’s never a good idea to throw a large treatment plan at a patient on the first visit.) At least by now, you will know if the patient has any level of periodontal problems and how best to proceed. Your hour may be used to do a comprehensive periodontal charting and decide on severity and class type, thus being able to inform the patient about how many additional appointments will be needed. Then you can proceed with the correct level of care.

When doctors start giving new patients the time and priority they deserve, what they find is that case presentation is much easier. The ultimate results are higher production and better patient relationships. After all, it is no secret that when people like us, they are much more amenable to our treatment recommendations.

Now, let’s move to prescheduling existing patients. We should not automatically preschedule every patient. Here are some guidelines:

  1. Prescheduling is a privilege that we allow some of our patients. Patients who have proven to be unreliable by their history of disappointment should not be allowed to preschedule their six-month appointments. Rather, such patients should receive reminder cards that instruct them to call for an appointment.
  2. Do not completely fill days six months out with appointments. Leave some scattered openings and block off one day toward the end of the month as a safety net in case patients have to be reappointed because of hygienist absence. If no absence occurs, the day can be appointed with patients who telephone for appointments.
  3. Patients should be informed that a reminder card with the appointment information will be mailed about three or four weeks before their appointment.
  4. Do not allow prime-time appointments (first morning appointment or late afternoon appointments) to be scheduled beyond seven months out. If a patient requests a prime-time appointment and none is available, offer the patient a close alternative. “Mr. Jones, the schedule indicates there are no appointments available at the time you have requested. However, I do have _____ or _____ available.” Since there is more demand for late afternoon and early morning appointment times than midday appointments, some offices award prime-time appointments on alternating visits to allow more people to enjoy those time slots. Other offices offer an incentive or discount to patients who accept a time that is typically hard to fill.
  5. When attempting to fill an opening, the verbiage and vocal tone are important. Here is a sample script: “Hi, Mrs. Jones. This is Brenda at Progressive Dental Care. It’s time for your preventive care appointment and examination, and I’d like to work out a time for you.For voicemail, say, “If you could return this call, I’ll be happy to work out a good time for you to come and see us. Our number is (XXX) XXX-XXXX (and repeat the number). I’ll look forward to hearing from you.” Then, document in the patient chart stating that a voicemail message was left.

Now, I’d like to address the full-schedule issue. Believe me, this is a good problem. Just ask any office that has large blocks of open time and not enough patients to fill it. It is a demand versus capacity issue. Your practice has more demand for services than capacity (time slots in the schedule) to meet the demand.

The answer to this dilemma is to create more capacity in the schedule. There are several ways to do this. One way is to open up an additional hygiene day or add some nontraditional hours, if possible (if hygienists are allowed to see patients under general supervision). Another way is to simply add another hygienist if there is operatory space available. The caveat is that the doctor’s schedule will have to build in some time to perform hygiene exams. Many doctors struggle to keep up with examining two hygienists’ patients. One way to address this is to omit the doctor exam for select patients, primarily patients who have no dental concerns and who had an exam six months ago. Check your state rules. Many regulations state that patients should be examined once per year unless there are dental concerns. Another way to increase capacity is to implement assisted hygiene. Please feel free to email me if you’d like a complimentary copy of a typical assisted hygiene schedule.

In conclusion, the doctor should start to prioritize new patients and arrange to get them in quickly by reserving time for them. The hygiene department needs to use discretion with prescheduling patients of record. Finally, find a way to increase capacity in the hygiene schedule to accommodate more patients.

All the best,

DIANNE GLASSCOE WATTERSON, MBA, RDH, is an award-winning author, speaker, and consultant. She has published hundreds of articles, numerous textbook chapters, and three books. Her new DVD on instrument sharpening is now available on her website at wattersonspeaks.com under the products tab. Visit her website for information about upcoming speaking engagements. She may be contacted at (336) 472-3515 or by email at [email protected].