I am not a dental hygiene guru. There are plenty out there, and they all do a great job of coaching dental offices on maximizing their hygiene departments, but I am someone who got lucky with being handed this solution and system. Then, as CEO, my job was to implement accelerated hygiene across our locations.
Dr. Kartik Antani.
You see, I inherited a well-run hygiene department in the second practice we bought, and it changed the game for our entire organization. Let me explain.
Our first acquisition came with a hygiene department that had the following:
- Too many gaps in its schedule (There was no confirmation system)
- No protocol dictating when x-rays should be taken
- No optional yet beneficial services like fluoride, toothpastes, etc.
- A slow, inefficient schedule
- Two full-time hygienists, each working at half of their potential
Our second acquisition, though, came with a hygiene department that had the following:
- A full schedule with hardly any gaps, and if there were gaps, the overall schedule was still very productive
- Protocols on when imaging is needed
- Numerous services and products that patients could benefit from and added to practice collections
- A smooth, efficient schedule that allowed for seeing almost double the hygiene patients as the first practice in a day
- A hygienist-assistant team that allowed people to work at the top of their license and efficiency
Some say that hygiene is a loss leader. It can be, but it can also be profitable.
Let's talk about what hygiene is for a practice. In a general dental practice, hygiene is the blood flow of the practice. It doesn't matter if you're working in a high-volume public insurance office and doing your own hygiene or in a high-end office with numerous highly advanced treatment modalities, most people come to the dental office for their "free cleanings."
A hygiene appointment is a great way to welcome new patients to your practice, identify any issues or help them with their confidence, and bring new revenue to the practice. A great hygiene department is also crucial for reducing patient attrition and keeping your practice full of great patients.
In your practice, you have two major types of costs: fixed and variable. Fixed costs are expenses that do not change if the hours you're open or the number of patients you see changes. Rent, insurance policies, and debt service are examples of fixed costs. Variable costs are those which change as your practice changes. Higher material costs for providing more dentistry, higher wages for being open more hours, higher utility bills for using more electricity are examples of variable costs.
It's just math that if you produce more revenue per hour of costs used, your bottom line increases. Seeing more patients per day is Step 1. How can your hygiene department see more patients within the same amount of time? If your local laws allow it, then assisted (or accelerated) hygiene is the best way to accomplish this.
Why assisted hygiene works
Using this model, you're allowing your team to work at their highest capacity. A hygienist does not need to floss, polish, take radiographs, apply fluoride, or do the exam with the dentist if there is an assistant who is trained and certified in those. Just like a dentist would rather be placing an implant than cleaning teeth, hygienists can spend their time wisely at the top of their skill set and have a competent assistant help with the rest.
With assisted hygiene, we saw 50% to 80% more patients per day. We inherited a flow that kept things moving like a well-oiled machine, and the hygienist and her assistant were able to dance a meticulous dance all day with their schedule.
There are some common issues that plague our profession (from a hygiene standpoint), which include:
- A shortage of hygienists: It's no secret that hiring hygienists is very challenging right now, and most industry experts believe it will only get worse.
- Low fees: You should definitely negotiate insurance reimbursement (but let's talk about that another time), but generally speaking, fees have not kept up with rising costs. If a hygienist can see 1.5 patients every hour rather than 1, the fees can make more sense.
- Increased costs: Both fixed and variable costs have increased. If you're lucky enough to have enough hygienists, you know that their wages have increased recently. Depending on your office and vendors, supplies and utilities may have increased too.
When we implemented accelerated hygiene, we were immediately able to attract and retain only those hygienists who shared our vision and workflow. One hygienist-assistant team could see almost the same number of patients as a two-hygienist team, with the same level of service and without compromising quality.
This allowed us to free up the future of those hygienists who did not want to work with our vision and allowed us to then bring on talented assistants to help those hygienists who stayed. This also reduced the financial burden of hiring a second full-time hygienist and that person's increased salary.
We had three scenarios happening concurrently.
In Office A, we were ramping up marketing but had two hygienists who were working inefficiently. This carried the burden of two hygienist salaries and an inability to treat new patients in a timely manner. Accelerated hygiene allowed us to change the teams to include those members who were efficient, timely, and were able to see new patients sooner rather than later. Our wage costs also decreased a bit with not having to have two hygienists. Someone acquiring an office may relate to what we did.
In Office B, accelerated hygiene had been in practice for many years before I bought the office, so we maintained the status quo and enjoyed the systems already in place.
In Office C, initially, we barely had patients, and the staff was not reliable initially. Once we implemented accelerated hygiene, we were able to ramp up marketing to get new patients in ASAP without adding further strain to the team. As the team developed and the right people fit into the right roles, the well-oiled machine began to run on its own. A startup might relate to what we did.
How assisted hygiene changed the game ... and thoughts about it
So you see, by using assisted hygiene, we added top-line revenue, we reduced costs, and yet we maintained the same level of quality a patient deserves. It's not a perfect system, and like all systems, it relies on people to understand it and to use it as designed. As a note, you will find it to be a barrier during hiring. Some hygienists believe that this is not what they want, and they have the right to that decision, but most of the hygienists who have tried it, love it.
You will run into the barrier of training staff, and initially, mistakes will be made. As time goes on, these mistakes will reduce, but they will still happen.
If you go into this with the knowledge of how accelerated hygiene works, how to implement it, how to monitor it, and that nothing is perfect, but it can still be great, you'll be fine. Trust me, I was very reluctant to make any changes but, ultimately, assisted hygiene catapulted our group's growth, and it was well worth the risk.
There are numerous hygiene gurus, coaches, and consultants. Do your own research and find someone who aligns with what you want, but I believe it's worth the time and monetary investment to do this.
Dr. Kartik Antani graduated from the Rutgers School of Dental Medicine and completed a one-year hospital-based general practice residency. He also holds a master's degree in biomedical sciences. He owns and operates Napa Family Dentistry. He is a winner of the New York Academy of Dentistry Ethics Award.
The comments and observations expressed herein do not necessarily reflect the opinions of DrBicuspid.com, nor should they be construed as an endorsement or admonishment of any particular idea, vendor, or organization.
