Reducing appointment time

Dec. 1, 2011
I work in an office with two other hygienists. Rumor has it that in a few weeks, our scheduled appointment times will be reduced ...

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

Dear Dianne,

I work in an office with two other hygienists. Rumor has it that in a few weeks, our scheduled appointment times will be reduced from 60 minutes to 45 minutes for our three-month recall patients. We do not have the help of an assistant – ever. Evidently the front desk staff approached the doctor with this suggestion, and he approved it.

What I do not understand is how the front desk understands what tasks and treatment we perform and what each three-month recall requires. Sometimes the patient needs full mouth X-rays, oral cancer screening exam, or perio charting. The dental hygienists were never consulted. From what I understand, the proposed change will be discussed at the next staff meeting.

Dianne, we never tell the front desk how to do their jobs, but now the front desk is telling us how to do our jobs. There are many patients who come every three months, and often their oral conditions look as though they have not been seen in a few years! Our three-month patients are on this shortened schedule for a reason.

The situation driving this change is that the schedule is packed, and there are not enough appointment times. The business assistants complain about not being able to find appointments for patients.

I want to discuss this with the doctor, but right now I’m so upset that I’d probably get emotional. Please help me find the right words.

Shannon, RDH

Dear Shannon,

In a time when so many offices are seeing declining demand for all dental services, your office seems to have the problem of more demand than can be handled. What a good problem to have!

Evidently, the practice has a large number of patients on three-month recare, which speaks to the focus on maintaining chronic perio situations in a conservative and evidence-based manner. I’d say the hygiene department has been successful educating patients about the need for frequent care, translating into more frequent visits for those patients. Your patients evidently see value in what they are receiving, as opposed to just coming in because of some third-party benefit. In fact, I’ll bet many of them pay out-of-pocket since most plans do not cover preventive care four times/year.

It’s a matter of supply and demand. When a business has more demand than they can accommodate with their existing capacity, they need to expand capacity. How can a dental office expand capacity?

  • Open more hygiene days.
  • Increase the workday from eight to nine hours.
  • Add hours by offering some non-traditional hours. (Patients love this.)
  • Hire additional hygienists.
  • Move into an assisted model.
  • Cut appointment time to increase number of available appointments.

Of all the options mentioned, the last one should be the least favorable. People are not stupid! If we don’t give them good value for their money, they won’t perceive good value. That is especially true if they are paying out-of-pocket.

Cutting their time will mean you have to cut some of the care they receive. What can you cut? Home care instruction? Chartings? Thorough assessments? Infection control measures? X-rays? Discussions about elective dentistry? Less thorough scaling? Intraoral camera?

Something has to be eliminated in order to stay on time. I would ask the question: “What would you suggest I cut? What if you were the patient? What would you want me to eliminate from your treatment?” If the doctor needs one hour for a procedure but the scheduler only gives him 45 minutes, he either has to “steal” time from the next patient or cut corners. That’s the choice. What would they have you cut?

If you have the operatory space, assisted hygiene would allow you to increase capacity. In fact, it is easy to increase from the traditional eight or nine patients/day to 12 or 13 in an assisted model. Many things that happen during the appointment can be handled by a qualified assistant, such as room tear-down/set-up, scheduling the patient’s next appointment, taking X-rays, sterilization, waiting for the doctor, etc.

Having practiced assisted hygiene for a season, I much preferred it over solo hygiene. I loved having someone at my beck-and-call to help with chartings, suctioning, plus all the aforementioned. I could see 12 or 13 people in a normal workday and be less tired than when I saw eight in a solo model. Plus, my production was stellar, and that made me feel good about being such an important part of the business success.

Can you do a day/week of assisted hygiene? Would there be two rooms and a dedicated assistant you could use? Are you willing to try if all the stars line up and the logistics are worked out?

Your challenge is to help your coworkers and boss understand that your “problem” of high demand exists because people value what you do. They didn’t come to value your treatment because you rush them in and rush them out. Good reputations are built over time but can be destroyed rather quickly.

The business assistants are not seeing the big picture. They only see their dilemma — too much demand for your present capacity. You need to work together to increase capacity without compromising care. Here’s a good question for the doctor: Why do you think we have so much demand, especially three-month patients? Could it be because we deliver such high-quality care that they perceive great value for their money? What happens to that perception when we lessen their care?

One other consideration is the speed at which any clinician works. Every clinician I have ever known develops a speed of delivery at which they are comfortable. I’ve seen dentists who take 1½ hours to do a single tooth crown prep; others who can do it in 45 minutes or less.

Hygienists are no different. I’ve known hygienists to lose their jobs over being told they work too slowly. Just because a dentist or hygienist works slowly does not necessarily translate into better care. Some clinicians have developed great speed and deliver excellent care. Do you need to increase your own efficiency? Are you organized? Do you use a tray system? Are you easily sidetracked? Do you spend too much time socializing?

If the doctor is determined to reduce your appointment time, you have to decide how/if you can be flexible with the new demands. Again, what would they have you cut? In my opinion, you need a personal conference with the doctor. He is ultimately responsible for the decision. If he understands the issues you are having, and if he has high regard for your attention to detail, he may be willing to consider other options for increasing capacity other than reducing appointment time. Approach the situation with a solution and be ready to offer some sort of compromise, because it appears change is imminent.

You may be forced to make some uncomfortable changes. Most of us do not like change, but we all do what we have to do to survive. Remember, the only sure thing in this life is that nothing stays the same.

Best wishes,

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 email [email protected]. Visit her website at

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