The ADA top 6 concerns that impact dental offices bring up the need for more cash flow. Dr. John Meis and Wendy Briggs discuss strategies to increase cash flow as well as increasing new patients. You do not want to miss this episode!
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EP14: ‘Have More Cash Flow AND More Patients’ Transcript:
S1 00:00:02.284 [music] 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 are in the trenches, who know exactly what you’re going through. And now your leaders, the stars of the podcast, Dr. John Meis and Wendy Briggs. [music]
S2 00:00:27.522 Hey, podcast listeners. Welcome to another awesome episode of the Team Training Institute podcast. So today Dr. John and Wendy have a lot of good information for you. I’ve heard a little bit of what they’re going to talk about. So they are starting a new six-part series and Dr. John is going to kind of explain that. But I just wanted to remind you to go back and check www.theteamtraininginstitute.com/podcast. If you like what you hear, the transcript will be there as well as any references used today in this episode by Dr. John and Wendy. So without further ado, I’m going to turn the time over to Dr. John. Dr. John, do you want to go ahead and introduce the topic of this podcast today?
S3 00:01:12.922 Hey, thanks, Katie. This is Dr. John Meis and I am here with Wendy Briggs. And we are starting a new six-part series. And I’m excited about it. I was recently at the American Academy of Group Dental Practice meeting. And it was shared there a list of concerns that dentists have. So the ADA surveyed a large number of dentists, asking what their biggest concerns are. And so Wendy and I are going to go through the top six concerns one by one on this Double Your Production podcast. So it’s going to be a six-part series. And so over the next 12 to 18 weeks, you’ll see these coming out interspersed with our regular podcasts where we have guests, and experts, and things like that. So Wendy, how you doing?
S4 00:02:04.603 I’m doing amazing. I’m super excited about these topics. It’s going to be some good stuff.
S3 00:02:08.587 It really is. And so shall we start with the number one concern?
S4 00:02:14.395 Yes, let’s hit it hard.
S3 00:02:16.099 The number one concern, according to the ADA, is cash flow and not being busy enough. And this is something that we hear all the time. No big surprise on this one, is it, Wendy?
S4 00:02:27.007 No, not at all. We hear this struggle from dentists all the time, and not just about cash flow but the not being busy enough. I think that’s probably the number one thing that people reach out to us about, especially on the hygiene side. And so it’s all over social media, and we get emails and questions about this all the time. So it’s something that is very concerning to a lot of people.
S3 00:02:49.800 For sure it is. And it’s kind of interesting when I hear this because at the same time, we have so many of our members, particularly ones that we’ve been working with for even a short time– this turns around so quickly when you get the formula right. When you have the right pieces in place, it’s amazing how quickly it turns around. At one of our member retreats recently, we were talking with a practice. They had one thing that once they solved that one thing, they were so busy they couldn’t handle all the patients. So there’s nothing really super secret about this. It’s just a very methodical process. So first of all, one of the things that we help our members execute on is to give patients what they want. And I know this sounds silly. It sounds so simple. But it’s really not that common, and it’s difficult for people to get there. But once they do, their practice fills up quickly. So, Wendy, what are some of the things that you know that patients want that sometimes dental practices are not that interested in giving them?
S4 00:03:59.533 Well, this is a really interesting one, and a lot of team members hate when we teach this principle, but patients want to be seen in more convenient hours. So it’s interesting, Dentistry Today did a survey and they surveyed patients about when they want to be seen. And the results of the survey were stunning, that 57% [inaudible] surveyed wanted to be seen on evenings or weekends. And we talked to the dental teams, that’s not when they want to be at the office, right? And so it can be a challenge. Sometimes we find that what patients want and what the team members of the dentists themselves want don’t quite line up. And when practices work hard to close the gap, it’s amazing what happens to the growth of the practice. All of a sudden, like you said before, we have more patients than we know what to do with. So finding the balance is challenging, and certainly, we don’t expect every dental practice to be open every weekend and every evening, but having some of those hours to offer, 57% of your patients want it. And so it’s an example of something we need to get better at if we really want to close that gap.
S3 00:05:10.956 It used to be that banks didn’t have branches. Banks didn’t have convenient hours. We were recently in New York City. Multiple 24-hour banks there now. Do those bank employees want to work the night shift or whatever? Probably not. Some of them, maybe, but probably not. That was probably an uncomfortable and difficult transition, for sure. Look at pharmacies. Look at Walgreens open 24 hours. How about urgent cares? Urgent cares, that’s on the medical side. They’ve got it figured out. They are definitely hitting those convenient hours. So that’s a biggy. What’s another one–
S4 00:05:51.764 It certainly is.
S3 00:05:52.861 –that you know that we have trouble with in dentistry?
S4 00:05:57.988 Yeah. Well, I think we often– there’s a couple things. Handling the phones is another one. I called a practice just yesterday again and got the voicemail during their lunch hour. And here we are saying, “We’re just not busy enough,” but we have these barriers that we unknowingly place between the patients and them being able to schedule or receive care from our office. So handling the phones, we’ve been preaching that one for years, but we’ve gotten some recent statistics that really surprised me about how often we don’t do a good job in this area.
S3 00:06:37.317 So you and I have said for a long time that we thought the number was around a third. Because when we call offices, it’s only about 60% of the time that we actually get somebody. I’m not talking about weird hours. I’m talking about at times when a customer or patient would think that the office is going to be open and would be answering their phone. For us, we thought it was about 60%. At our last retreat, we actually had our team call the offices and the range was– there was one practice there that had call center support so I’m not going to count that one. But for practices that didn’t have a call center support, it ranged from 30% missed calls to 100% missed calls. So can you imagine– so these were test calls. I think there was 20 calls done over 14 days. And so in 20 calls, one office, they never got through to that office. Obviously, a significant problem. So phones are such an important thing because patients, they’re calling. They want to talk to somebody. And if they don’t talk to somebody, particularly when they’re trying to make an appointment, they’re just going to go on to the next person. So fixing phones is [crosstalk].
S4 00:07:52.769 Exactly, and not only– a huge one. And not only do we want to answer the phone, but we need to answer it well. And sometimes we do what feels natural, but there really isn’t– the outcome hasn’t been clearly communicated to the team. And the outcome of every call is to be a scheduled appointment at the end of the call. And so sometimes when we have shopper callers, or when we have people calling and saying, “Do you take my insurance?” our team, when they’re operating in a state of overwhelm, despite their best intentions, they want to rush the person off of the phone. And when we listen to recorded phone calls – we listen to hundreds of these recorded calls – it’s really stunning at how inept we are. We don’t mean to be that way, but we lose opportunities. And I think the statistics are stunning on the– a national average is 26 appointments for every 100 calls. So there’s a tremendous amount of improvement we could do here. We want to convert the caller into a scheduled appointment. And we need to have a path for that. We need to work on that. And it’s amazing to me how few offices really communicate the desired result. We call it the commander’s intent. And even if we are clear, schedule the appointment, we may not have equipped our team with the verbal skills, or the knowledge, or the tools in which to do that. And really the second– that brings us to the second thing, Dr. John, and that is we’ve placed barriers between the patients that want to have our services– we have all these barriers that we erect. And again, a lot of time, it’s not on purpose, but when patients ask us questions, the answer to those questions is often no. So do you have–? Can I schedule an appointment on a weekend? No.
S3 00:09:37.034 No.
S4 00:09:37.763 Do you take my insurance?
S3 00:09:38.963 No.
S4 00:09:39.152 No [laughter]. Can I make payments to the office?
S3 00:09:42.911 No.
S4 00:09:44.438 No, so these are–
S3 00:09:44.698 We prefer you to pay cash up front before any treatment’s done. Prepay, prepay for your first visit. We’ve seen that. So a lot of those– these are great ones. So these are what patients want. They want you to take their insurance, right. They want you to have financial clarity and easy-pay options. There’s no doubt about that. And I think the financial clarity is probably even bigger than easy-pay options because– not in the ADA survey but other surveys I’ve seen, it’s confusion about what they’re ultimately going to have to pay that causes people to not accept care. So financial clarity is really, really important.
S4 00:10:27.527 So important. Again, referencing that Dentistry Today survey. They surveyed patients about what was important to them, right? And the number one thing that patients wanted was an open and honest conversation about cost. And we really look at that response. It’s interesting because we think, “Oh gosh. They want perfect crown margins, or they want quality dentistry, and they want a caring relationship.” And I’m not saying that those things aren’t important, but the number one thing that patients are looking for was an open and honest conversation about cost. And interestingly enough, the number two thing they wanted was convenience. They want to visit a dentist that’s convenient. So it’s really interesting when we look at what patients are looking for and what we as a dental profession choose to offer. And there often is that disconnect.
S3 00:11:15.066 Another thing patients want is a location that’s easy to find that has easy parking. And in the past, so many practices were located in professional complexes which was, at one time, kind of a position of prestige, but boy, that has sure changed. Hasn’t it?
S4 00:11:37.387 Oh, absolutely. Those professional buildings where you’re on the third floor and there’s five other dentists on your floor, that used to be where everybody wanted to be because it was considered more professional. And now we’re seeing a huge shift, a big-time shift for convenient locations in strip malls, even. That was considered completely taboo not very long ago, really, just a few short years ago. But now we have dentists that go into these areas, and we just got an email this morning from a dentist who only has three chairs. He uses 750 square feet, but he’s growing so fast because he’s in a very convenient location with excellent signage and he doesn’t know what to do about being so capacity blocked. And that’s something we’ll probably talk about on one of these– in this series, but it’s fascinating what the right location and signage can do.
S3 00:12:29.106 I would say that the right location and signage could account for 40 or 50 new patients a month. The difference between a good location and one that’s hidden, not visible, has physical barriers, it can be as much as 30 to 40 new patients a month. Amazing difference.
S4 00:12:49.802 Amazing [inaudible]. We have a really incredible case study about this, too, because our friends here in Utah, a larger practice that now has multiple locations that we were working with, they moved into a fast-growing location. It was an excellent location but they had very poor signage. So they had been averaging about 70 patients a month. They added the largest LED sign they could, massive sign, huge sign, and it just opened the floodgates for them. All of a sudden they had to expand even initial capacity in that location. It was a multi-doctor practice but I think they got upwards of 400 new patients a month at one time, because the signage and location had everything to do with that. But it was interesting because they’d been in that location for about a year and had averaged about 70 new patients a month until they added that sign. And then it was just explosion, literally, an explosion of new patients.
S3 00:13:46.248 The community also about tripled in population so that certainly was a factor, too, but it was– if they had been hidden away somewhere it wouldn’t have mattered that the community tripled. The fact that they had such a high-profile location with an amazing sign– and that sign was done back before LED signs got cheap. That was a six-figure sign, and it made a huge difference on their new patient flow. So easy location with lots of of parking, really, really important. So–
S4 00:14:20.997 Absolutely. So all of these things, really, even just fixing one of these things could solve the number one concern of dentists not being busy enough. But once you actually put them all together– you handle the phones appropriately. You convert the patients into appointments. You give patients what they want when they’re there at the appointment. And don’t have the barriers. Make it easy for patients to do business with us. When you put all those together, that’s when we have people reaching out saying, “Oh my gosh, we had record production months. We’re growing so fast. We’re expanding capacity as fast as we can. We’ve had to add additional doctors or additional hygienists.” This is when we see things really, really take off.
S3 00:15:01.365 So another thing that patients want is they want treatment options and the ability to scale care. So they want to do not necessarily every bit of care that the dentists wants them to do. They may have a sub-portion of that, that they’re really interested in moving forward with. But often, offices really try to go for the grand slam and try to sell an entire case when that’s really not what the patient is desiring.
S4 00:15:34.991 Right. And I think there’s a little bit of confusion here because one of the things that we often talk about is the importance of converting a limited exam into a comprehensive exam, right? So people hear us talk about that and they think we mean you’ve got to present all of the potential care the first day you meet the patient. And I don’t think that that’s necessarily true. I think it’s important to convert them from a limited to a comprehensive because of the psychological impact it has on the patient. In the patient’s mind, they go from being an emergent-care patient to a long-term patient. But we still don’t have to present everything all at once, right? We can handle the chief complaint today. But we can gather all the information. Have the doctor take a few days to review that information. Come up with a comprehensive plan. And then present it when the time is right. Present it after maybe we’ve finished the chief complaint and we’ve already established some trust with that patient. Then we can start working through the rest of the plan that we’ve created. So I think there’s some confusion here. And in some ways, if people don’t really listen to what we’re saying, we may be part of that, right? Because we’re really talking about the importance of converting a patient from a limited to a comprehensive whenever possible.
S3 00:16:47.118 For sure. All right. So there’s a difference between a comprehensive exam and trying to make financial arrangements and appointments for every bit of care. So doing the comprehensive exam is awesome, but also being able to back that down to a level of care that the patient is interested in following through with is super, super important.
S4 00:17:12.870 Absolutely. And I would say that the key way to do that is all in the patient interview and asking the right questions. Making sure that we’re really paying attention to what the patient wants, and going in the direction that they want to go. You showed a really great video at a recent retreat of the guy– the car is covered with snow, right? Every bit of the car is covered with snow. And he’s scraping the windshields and scraping the mirrors and going to all of this trouble clearing off the car, only to find that it wasn’t his car, right? It was a car that looked like his but wasn’t his. And so then he realizes after all of this hard work is done that it wasn’t the right car. And we see this a lot of times in this exact instance where we put in all this time and effort. We’re scheduling out 16 separate appointments after we do the comprehensive exam and the patient hasn’t even said yes to the beginning, the first appointment. And so we find that we’ve done all of this work and we really haven’t been going in the right direction. We haven’t been focusing on what the patient wants. And so it can be a real stress for the team and a huge waste of time if we don’t listen to what the patient wants and if we’re not asking the right questions.
S3 00:18:25.450 Here’s another one. Some patients, when they have their first visit, they want their teeth cleaned [laughter]. Some don’t. Some don’t care. But some do. And so many offices have some type of policy or process that doesn’t allow them to do that. Or if they have periodontal concerns, that interferes with them getting what they want. Huge mistake, isn’t it?
S4 00:18:53.141 Absolutely. And we have these complicated scripts that we all work on to try and convince the patient to go down the path we want them to go down. And ultimately, we’re just not starting the relationship off on the right foot. We’re telling them no from that very first phone call. And I get it. I hear from the hygienists and the dentists that say, “Well, what if they have perio? What if it’s not a healthy cleaning? Then that’s what they’re expecting.” Well, we teach that process of what to do in that instance as a part of our five steps to increasing perio case acceptance. And so it’s a big part of it, but you have to have systems in place for that. And having those systems in place is what really can help determine success in that area.
S3 00:19:34.834 I think what you said about having this script that is really trying to manipulate the patient to get– for them to do what we want them to do, it’s really a fallacy. It doesn’t work. But yet you hear so many people trying to train people on just the right words to say to get someone to not do what they want and do what we want. And it just doesn’t work. It’s really a fallacy.
S4 00:20:00.402 It is, absolutely. So you know what’s interesting, Dr. John, is a lot of these things that we’ve talked about, we referenced in our first three Double Your Production podcast episodes. So in those episodes, we talk about the five things that we teach to double production in the dental practice. And in that very first thing– one of the very first things is optimized production. We briefly talk about how important it is to be patient-friendly and give patients what they want. But ultimately, once we get the patient in the chair, then in that first episode we really focus on how to optimize production. So if you’re not busy enough, that’s a key part of it, isn’t it? We can get the patients in the office. But then we also have to make sure that we’re optimizing every opportunity when we serve that patient. We take care of that patient. And that is another way. That’s where all this comes into, like you said, making sure that we’re not giving them too much information right at the first visit. But there are ways to optimize production. So if you haven’t listened to that flagship episode in a while, we recommend that you revisit that one because that episode– those elements that we shared in that first podcast really relate to everything we’ve been talking about here today.
S3 00:21:13.369 So should we go down the list of some– further down the list here, Wendy, of things that patients want?
S4 00:21:19.213 Yeah. Let’s do.
S3 00:21:20.461 All right. So when patients need care, many, many patients– so this is particularly in an existing patient that’s coming back for a regular hygiene visit. When something’s diagnosed in that hygiene visit, when do they want to get it taken care of?
S4 00:21:37.735 Now [laughter].
S3 00:21:38.610 Yeah, now. They want to take it– they don’t want to have the trouble of another appointment and all that. It’s such a huge change in case acceptance when you can say, “Would you like to do that today?” Because many, many, many, many, many patients would prefer to do it today. In fact I would say all patients prefer it today if their schedule would allow it to happen. So that is a huge one. Having the ability, and having the team trained in a way, and have the capacity that you can take care of at least simple things that are diagnosed in hygiene and do it right then.
S4 00:22:13.566 Right. And it’s interesting because a lot of dentists will actually have systems in place to handle emergencies. And they may not even particularly do that well, right? They may end up running behind or something to try and get an emergency patient out of pain. But in the majority of practices we visit, there are so many opportunities for same-day dentistry. And certainly we have members that are doing this very, very well after focusing on building these systems for awhile. I believe we have one that’s almost past– almost 50% of what they do is same-day dentistry. So it tells you how much of a driver it can be.
S3 00:22:45.446 Yup. And most practices get at least a 30% bump by doing that. So when we talk about these practices– and I was in a practice and watched this happen, and I couldn’t believe I was watching it happen. It was a practice out in the Salt Lake area, Wendy, where you live, and it was a practice that was failing. And we were visiting the practice because we were interested in acquiring it. And we were acquiring it in a short sale from the bank, and the dentist was still there. And he’s got nothing on the book, right? He’s got like two patients the whole day, and one of those patients needed their teeth cleaned. They had some restorative care that they needed, and they automatically scheduled them for another day. I mean, you got the whole dang day open. Why not just do it right now? It was so stunning to me that that was just the model that they had. Just their mental model was, “Okay. We do cleaning today. We do restorative another day,” even though it was so obvious that they had all this time. I mean, it was stunning to me. So getting the capacity and the capability to do same-day dentistry is such a huge service thing for your patients.
S4 00:24:06.724 Yeah. Absolutely. We have another example. It was an undercover video that we were reviewing. And patient accepted the care. They were following the systems as they had been taught. The hygienist offered the opportunity to do these two crowns today. The finances were good, patient was ready to go, and the assistant said, “No. We can’t do that. We don’t have a room.” And when we reviewed the video, there was a room that was empty. But you know why they couldn’t do it? Because that room had already been set up for the next procedure.
S3 00:24:35.587 Drives me crazy.
S4 00:24:38.210 So that’s why they couldn’t do it. I know. It’s such a common thing, and we laugh about it when we hear it. But come on. I mean, you have a patient that’s here, and present, and ready to go, but because the room had already been set up for the next procedure, we sent him out the door.
S3 00:24:51.100 Yup. Yup. All right, last one for this podcast, Wendy. Do patients like to be referred out?
S4 00:25:01.724 Oh, no. They do not. They want to be seen. Even if they desperately need to be referred out, they don’t want to go anywhere else. They want to go with the people they know and stay where they are comfortable.
S3 00:25:11.181 Yup. The people they know and trust. So the building your treatment capability is to be able to do most things. Now, obviously, there are some things that are necessary to refer until we build the skills to be able to do them ourselves, but patients don’t like it. And so that building of a clinical tool belt for doctors is really very, very critical so that you can reduce referrals. And if you do that, you’re going to have better patient retention. Oh man, there we go.
S4 00:25:42.127 Absolutely.
S3 00:25:43.279 Yeah.
S4 00:25:44.199 Lot of really great nuggets there. Lot of really great gems that doctors need to take. And I’m really excited about this series because I know what the other six [inaudible] five top concerns are. And this is going to be really good. I think our listeners are really going to enjoy this a lot.
S3 00:25:56.941 That’s for sure. All right. Very good. With that, Wendy, we’ll call it a day. And thanks for listening to the Double Your Production podcast. And we look forward to seeing you on our next episode.
S4 00:26:10.290 Thanks so much, everybody. [music]
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