EP 93: How to Stop Worrying About Profitability and Staffing [Free Book!]


Can better patient care really lead to more profitability (even during Omicron, with staff shortages, cancels, and fails)? Yes, it can.

How? That’s the subject of today’s episode of the Double Your Production Podcast.

Listen and you’ll find the surprising keys to profitability as we take a deep dive into Dr. John’s new book, Cracking The Code. (Plus, there’s a free copy waiting for you at the end of the episode.)

Listen to discover:

  • The critical difference between production and profitability
  • How to tell if your hygiene is hopelessly outdated
  • The 3 keys to profitability
  • Why most practices spend too much on marketing (and where to reinvest those dollars)
  • How to get your free copy of my new book

Intro: Welcome to the Double Your Production podcast with the Team Training Institute, the one place designed for dentists and their staff who want to grow their practices by following in the footsteps of those that have done it, who in the trenches, who know exactly what you are going through, and now your leaders, the stars of the podcast, Dr. John Meis and Wendy Briggs.

Dr. John Meis: Hey everybody. Welcome to this edition of the Double Your Dental Production podcast. I'm Dr. John Meis here with Wendy Briggs. Hey Wendy. How you doing?

Wendy Briggs: I'm great. How are you?

Dr. John Meis: I'm doing fantastic. We're both fresh back from separate trips to Hawaii and feeling refreshed and ready to go.

Wendy Briggs: That's right. Something to celebrate too. You had a big accomplishment happen over the last few weeks.

Dr. John Meis: I sure did. I'm very, very, pleased and very gratified. My newest book Cracking The Code, made it to number one bestseller status on Amazon after being available on Amazon just nine days. So, super excited about that. It was fast to the top, and I know that it's going to have a lot of impact on our profession and everybody who reads the book. So there is a lot of real world solutions in the book to the problems that dentists are facing right now. So it's pretty good. I encourage everybody to go out and buy it of course.

Wendy Briggs: Yes, of course. We absolutely love learning from you, Dr. John, and the reason there's a lot of real world solutions in that book is because you've lived a lot of those challenges yourself. And then of course, with our clients we face a lot of obstacles in the path, it's not always smooth sailing. And once you deal with a certain situation, you learn a lot from that challenge, right? And that's some of the insights that you've put into the book for others to learn from our experiences and your experience. And again, I've heard nothing but positive things. In fact, we already got our first raving comment from one of our members who read the book. So even though it's only been out a short time, it's already having impacts, you should be very proud of that.

Dr. John Meis: Yep. I am. And later on in this podcast, we'll let you know how you can get a copy of the book for free even. So hang on for that.

Wendy Briggs: Yeah. Super excited about that. So, given the fact that there's real world knowledge in your new Cracking The Code dental book, right? We thought that would be a good topic for today is to just bring on a challenge that someone shared on social media, and you can talk through some of the lessons that are contained within the book that can help others that may be having a similar problem or a similar struggle used to solve that scenario.

Dr. John Meis: Sounds good.

Wendy Briggs: May act actually end up being a series, right? Because there's all sorts of challenges and problems that people have today. And it never ceases to amaze me at how willing they are to share this online, right? It seems to me almost every day when I pull up social media, it can become exhausting because there's so much negativity out there. And then I have to kind of switch my thinking and realize that the reason they're posting on social media is because they want help. And that does take some courage, right?

Dr. John Meis: Yep. It does.

Wendy Briggs: I thought maybe we would just go through a recent post, a recent cry for help. And going to talk through some of the lessons in the book that can help with this particular scenario. How does that sound?

Dr. John Meis: Sounds great.

Wendy Briggs: Okay, good. Well, I'm going to go ahead and read the post. So, and the post says basically, "in more than 20 years in practice, I never thought my business would be run by signs because nobody showed up to work. This is most likely coming to a business near you, as small businesses are the canary in the coal mine. I'm no mathematician, but if you have to pay a hygienist 30% more, and when insurance will pay the office, that won't last very long, anyone else out there having to pay to go to work?" and then there's an image of the sign at this doctor's front desk that says "due to the staffing shortages, someone may not be here when you arrive for your appointment, please have a seat and we'll check you in shortly. Thank you."

So we're hearing a lot of similar struggles, difficulty finding a team, difficulty being profitable because of increasing or decreasing insurance reimbursements, and the increasing prevalence of PPO and, and many more markets across the country having to accept reduced fee insurance plans. So this is a very common struggle.

Dr. John Meis: Well, it sure is. You can hear the frustration in that writer's voice and I really get it. It is a very, very difficult time. I think back to the lovely days of 2020, when we were closed for two months and nearly all of our clients had record years in 2020. And now I look at 2021 and the end of 2021, and now the beginning of 2022, we're seeing a much bigger impact on dental practices now, as the virus runs through the population. So the good news and bad news to that, of course the Omicron virus is easily caught. Thankfully it, for most people, for people who are vaccinated anyway, they don't get very sick. Most of them don't even know they have it, but it's going through the population very, very quickly.

And when viruses go through the population quickly, they go out in the population very quickly. So that's the good news. But in the meantime, we have this horrible situation where we're trying to get staffing. We're trying to match staffing with the number of patients that are going to come in. So we have a higher number of last-minute cancels and fails, because our patients are having the same virus issues as our teams are having. And we never know which team members we're going to be able to take care of patients, meaning if there's a sign at the front desk, there's not probably not anybody answering the phone either, right?

So we are really in a tough spot now and that's going to pass and that's going to pass pretty quickly in most of the major cities. Now the Omicron variety is dropping very, very rapidly and I expect that to happen everywhere, which is good news. But in the meantime, we've got a mess to try to struggle with.

Wendy Briggs: With the Omicron variant, Dr. John, we still have a reduction in the workforce that we've been hearing about for several months, prior to that, right? So this is only adding fuel to the fire of the challenges that are already present in an office. I just heard from a practice today that all their hygienists are out with the variant. So what do they do? It's all of their hygiene providers, right? So they're not left with a whole lot of resources. So much like this doctor, other than putting a sign at the front at desk saying, "Hey, someone will be with you as soon as we can". We've seen these signs in other industries, right? Please be patient with those who did show up for work today, right? We're all under pressure. This is something that's not just focused on dentistry to dentistry, but it is a challenge nonetheless. And also the comment and the feeling that obviously with fewer team members and fewer patients, the profitability is taking a big hit. And this is something we're already worried about as a profession.

Dr. John Meis: Yeah, no, this is definitely going to be a tough go for many practices. In my own practices, we are struggling with profitability for this very same reason. Lots of patients aren't coming to appointments, lots of team members aren't there, and we're just trying to juggle the capacity and the demand, which is hard enough without a virus going through. So that's a big challenge, but there's a couple things in this post. I think are a not really related to that at that are more mindset things. And the two that I thought of, Wendy, and I wanted to get your opinion on this. The two that I heard was something about paying hygienists more than you're getting paid was one of them. And the other one was coming to work to lose money or something like that.

Wendy Briggs: Yes.

Dr. John Meis: Right? Was there any... Two other things?

Wendy Briggs: Yeah, no. Those are probably the biggest ones that I think most of our listeners would like to hear some solutions for. Because it is something that I'm hearing a lot on social media, not just this one post, but there's many, many practices that are saying, "hey, the hygienist coming in, I just had a hygienist applied for a job today, been out of school a year and a half, asking for $65 an hour, and also submitted an entire page of literally just demands in their form of work agreement".

So now you have the employees setting the demands on the employer. Who's already struggling and worrying about profitability, already dealing with reduced insurance. And that's why we're seeing, some people are saying, just get rid of hygienists altogether. And so it becomes a little bit of a challenge on, okay, which model of dentistry are we going to run? What's the difference between practices who have high production and practices who have high profitability? There's a big difference. And how do dentists know where they are in that?

Dr. John Meis: Yeah. So when we talk about hygiene reimbursement and their pay, obviously the pay structures are being challenged. We had a big workforce reduction in dentistry, a good portion of that was in hygienists that have left the profession or at least left the profession temporarily. And so most markets are short on hygienists. And the challenge with that is now hygienists, they know they're in short supply and the laws of supply and demand are what they are. And in some markets in the past, there have been too many hygienists and dentists have been happy to have lower wages in some states there's a big supply, so the wages are lower. And so the law of supply and demand works both ways and it certainly is frustrating. And the answer really is to make sure that we have a good patient flow, which is interrupted by the virus, but that'll pass. Have a good patient flow and then have efficient delivery.

So Wendy, you've taught... I learned from you the three roles of hygiene and how those three roles of hygiene can really impact the profitability of a practice and the productivity of a hygienist. And so in our Cracking The Code book... Cracking The Code is all about how do we crack the business code of dentistry so that we can grow a business. Think of our practices as a business. It's also a profession, it's also a caring healing profession. But as the poster mentions, if we're not making any money, it's not going to last very long. So you have to think of it in both ways.

And so Cracking The Code is doing that. And one of the first things that we focus on in Cracking The Code is maximizing what you already have right now. We see an attempt of people wanting to add locations and add, and add, and add, and buy, and buy, and buy, yet their own original thing isn't really performing at the level that it should be. And so now you can be compounding problems when you add additional locations and you haven't figured out how to manage one first. So that is the very first thing, and so in the book, we talked briefly about maximizing the three roles of hygiene and you taught me Wendy. So maybe you ought to talk a little bit about that, how we can raise hygiene productivity so that we are not concerned about reimbursement rates.

Wendy Briggs: Yeah. You know, it's such a powerful point because I think too many of people are stuck in an outdated way of doing hygiene. You know, when they look at their schedule, it says, "exam, bite wings, prophy, exam, bite wings, prophy, exam, bite wings, prophy". If that's all you're doing all day long, you're not going to be successful.

And you know, too often, years ago, when I first started this in this profession, we were told experts were saying, it doesn't matter what hygiene produces. Hygiene's the loss leader. Hygiene gets the patients in the door and then we treatment plan restorative dentistry. And that's where the real profitability happens in a practice.

And certainly we're making some... We have an understanding on a few things. First of all we're talking about only necessary dentistry, right? We never recommend a treatment plan, unnecessary dentistry, even if we're trying to grow the restorative side.

That's one thing that that should be understood. And the other thing is, hygiene is... We are providers. And so we always say, production's never the goal. Instead, what we hope to do is take excellent care of the patient. And when we do the right thing for the patient, the production will naturally follow that.

However, hygienists only have a certain model to work from. I've heard from hygienists that say, "yeah, I love providing fluoride to my patients, but the current office I'm at now, we do none of that." And they feel like they can't rock the boat. And what I try to help hygienists understand is, you are the patient's provider. And you're the one that can maximize those three roles, right? Preventive therapist, periodontal therapist, and patient treatment advocate.

So if the practice you're in right now doesn't allow for a flexibility within those models, or if you get shut down by an office manager, or even the doctor on that's not how we do things here, really, it requires a deeper conversation, right? Probably they don't know what they don't know. And so we help hygienists know not only what to do to help elevate patient care, but why they should do it. What does the science say? And then we help them know how to do it in a timely manner, on a consistent basis.

So day in and day out, they're maximizing their role as a preventive therapist, as a periodontal therapist. And then, as that patient treatment advocate, because that is an important component of hygiene is driving patients to the restorative side, but you don't have to sacrifice one at the expense of the other. In fact, I would suggest that if your production and hygiene is low, chances are your patients aren't being served at the level they deserve, right?

We're not doing risk assessment and evaluating what risks the patients have and we're not really providing preventive solutions for the patient. Many dentists that I talk to want to actually be physicians of the mouth. And too often, if we're not maximizing these roles on the hygiene side, what they end up being are carpenters, right? They're just fixing the broken things all day long and we're really not preventing the problems.

And so what we try to help hygienists know and see is how they can directly affect the level of care that patients receive on a daily basis. And once they understand not only what to do, but why they should and how to do it consistently that's when we see radical transformation occur in the lives of patients, but also in the practice from the profitability standpoint as well.

You know, if you are seeing your insurance rates and reimbursements dropping, we've got to do more than a prophy exam of bitings on our patients. They deserve more anyway. And what's interesting is when we talk about reduced numbers of patients in our world, that's not always a bad thing, because if you have a hygienist that knows what to do and how to really maximize patient care, we've seen hygienists have record production days on only six patients, right? Because it opens the doorway for an opportunity to do more on the patients that come in when you know your next patient's not coming. So there's a mindset that's required for the hygiene team too, not just the doctor and the right systems make all the difference in the world.

Dr. John Meis: Yep. Prophy exam, x-rays, prophy exam, x-rays, fails both on the business end, and on the profession end because you're not giving the patient all the options that they have to accept a higher level of care. So that's a failure on both ends.

Wendy Briggs: Right.

Dr. John Meis: Fantastic. Thanks Wendy. The other piece was on the profitability. And so I have a little diagram that I'm going to describe and draw. And so for those of you who are listening, I'll describe it. For those of you who are watching, you'll see it happen in real-time. And it really is how we teach practices to become more effective in treating patients and become more profitable as well.

So imagine a triangle, three sides, and on one of the sides, there's three things that we need to have profitability. So the first one is patient flow. And so we help our clients by looking at their patient flow and deciding whether they have a capacity or demand problem.

So it's really hard to tell when you're in the practice, whether you need more new patients, or whether you need more capacity to treat the patients you already have. Our entire profession's knee jerk response to this is, "if I just had more new patients, I'd be doing better". But the fact of the matter is that is not true for most practices. More practices would be better off if they were just more effective with the patients that they have.

So the next thing that we do to increase patient flow is we have a whole system, a whole process, called the patient flow generator. And it is an algorithm. And the idea behind the algorithm is you do step one, maximize the effect there, do step two, do step three. If this happens, do this, if this happens, do that. And it's just a way for practices to build patient flow and do it in a highly effective, cost effective manner.

There are so many companies that are trying to sell marketing to dentists right now. And marketing may be a function of this, or a part of this, but it's just a small part of it. Most people are overspending on marketing and underspending on experience, underspending on delivering, underspending on operational excellence.

And the last thing about patient flow is, doesn't really matter how many patients you get. Where the long term profitability and business value is on the patients that you keep. So what are your systems and processes for keeping patient in the practice? So we teach our five R's, five different systems in order to maintain patient flow from the patients that you already have. So if you have that mastered, you're doing pretty good.

The next thing that you need is case acceptance. So imagine another side of the triangle is case acceptance. So we teach a process called treatment planning for predictability. This is a team discussion between doctors and their teams, helping teams understand what their treatment philosophies are. When they see this, they're going to do this. And so the entire team understands the thought processes and understands what the doctor's likely to diagnose. And it helps them to understand how to talk about it with patients so that your team can talk about treatment just as effectively as the doctor can. That's the goal. And when we get to that point, then we teach our team case acceptance process where the entire team is involved. And there are multiple steps to this. In fact, we do a whole weekend course on this one simple thing, because it's not so simple. It's very hard to dial in. So if you double your case acceptance, you can do with half the number of new patients, right?

So case acceptance is really just operational effectiveness, and if we can bump that up, we need less new patients, we need to spend less on marketing, and our profitability soars. And the last part about case acceptance is having friendly financials, having financials spoken to patients in language that the patient understands. Not using confusing treatment plan forms that your practice management software spits out, having a real discussion about what patients really want to know, avoiding all the stuff that they don't want to know, or don't need to know, which just confuses them.

So once we have a patient flow and we have good case acceptance, now we need efficient delivery. So Wendy was talking about the three roles of hygiene, and the first part of efficient delivery is what we call the hygiene explosion. And that's teaching hygienists how to do the preventive role, particularly how to do it quickly and efficiently.

So the science of what's available, and why we should be doing it, and then how to do it. Specifically, how to do it, because hygienists feel like, "oh gosh, I don't know if we can get that done in this amount of time". Well, how do you get done in this amount of time and how does the whole team support the hygiene team in order for that to happen?

The next is same day dentistry and any practice that is not having this mastered is really struggling right now because our schedules are falling apart every single day. So if we aren't good at maximizing the care that we're giving the patients that do come in, we are really struggling right now. So many practices are doing 50 to 60% of their production on a same day basis, meaning it wasn't on the schedule at the beginning of the day, right?

So when you can dial this up and dial this back based on the patient flow on you have a particular day, your production can maintain relatively steadily if you know the secrets on how to do this. And then the last part of efficient delivery is what we call sane scheduling, right? We don't want to be scheduled so that we're running around with our hair on fire. We don't want to be expected to be in two places at once. We don't expected to be doing four handed things with only two hands. That we're able to have the scheduling laid out effectively and accurately enough so that we're always flowing, we're always moving forward. We're always adding value to our patients the entire day. We're never having periods of time where we sit down for any length of time. We're never having any periods where we're running around with our hair on fire.

So that is what it takes to have profitability in a dental practice, and even though we have challenges right now because of the virus and the topsy-turvy, patient schedules and the topsy-turvy team schedules. If we master this, even though we have those challenges, we can still come out on top.

Wendy Briggs: Absolutely great. Dr. John, and as I mentioned before, we got our first compliment about the book, right? All those resources you just went through, you cover in pretty great detail in that book. And I took a screenshot of the comment because we had a doctor Dr. R call the office today and he bought it. The first date it was available on Amazon. Read it over the weekend. Absolutely loved it. He said, it's one of the best dental books he's ever read about the dental industry. So way to go dr. John, that's just an awesome... For our first reader, giving feedback.

So, love that. Those of you that are listening, Dr. John said that there was going to be an opportunity for you to sign in and get your own copy of this book. So I'm going to go ahead and share the URL now, and we'll also post it in the comment section and on the show notes page, we'll have the link there for you. So if you're listening and you're driving and you can't write it down, don't stress, you can always go back to the homepage and get it there. So I believe we cover the cost of the book. And we just ask for a little bit to cover shipping. Is that right?

Dr. John Meis: Yep. That's it.

Wendy Briggs: OK. Here's how you get it. It's www.crackingthecodefordentists.com. So crackingthecodefordentists.com and we'd be delighted, as a podcast listener, we'd be delighted to share with you a copy of that book. Certainly we've had enough people buy it on Amazon. It's already an Amazon number one bestseller in the dental category, but we would still love to send you a copy. So don't hesitate. You can go ahead and reach out and request your free copy there.

There's so many other good insights in that book, Dr. John, I think we'll probably do another podcast or two, where we talk about a current problem or frustration that we're hearing about on social media. And we'll dive into the solutions that the book has to offer. I think that's a great way for people to understand some of the principles that you share in that book, and also to help with our mission of educating and helping practices grow.

Dr. John Meis: Yeah. Fantastic. Well, thanks Wendy for that. And with that, we'll say goodbye on this episode of the Double Your Production podcast and we'll see you next time.

Wendy Briggs: Thanks so much everybody!

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