Speaker 1:
Fantastic. Well, welcome to our webinar tonight. We're so happy to have you. I can tell you that this is one of the most commonly requested topics that we get currently in today's climate is how are we dealing with all of these changes that are creating some difficulties in our practices on the hygiene side? Okay, so let's dig in to this. A couple things that I wanted to share with you. Look at the first one just interviewed a hygienist who graduated. She started her first job, another private practice in May. She's asking for more money than my veteran hygienist is making. I offered her a starting rate due to her lack of experience. I told her to think about it and get back to me. I don't think she'll take the job, but what is she thinking at the rate she wants? She'd better do two pro fees per hour.
Speaker 1:
That's the harsh reality that we're running into in some of these practices. It's almost impossible to maintain profitability with a reduced insurance reimbursement. Now, I get it. Insurance is the bad guy, and do I believe hygienists should be earning six figure salary? Absolutely I do. I believe hygienists who understand what we teach and maximize their roles are worth that. Here's another one. A hygienist deep in the application process for an office looking to expand. A second hygienist gets to the point of receiving an offer. Same offer that the other hygienist currently employed already makes more than she currently makes. This is the only applicant we have to choose from. Hygienist. Has I received a much higher offer from another dentist? What is your highest offer? So the challenge to me with that is that takes something that really should be a very important decision from a relationship standpoint and turns it into a transactional standpoint. We don't want our hygienists and the hygienists that we hire to feel like hiring them is a transaction. We want to hire someone who we think is the best possible fit to take care of our patients in the best possible way. And I think it's somewhat off-putting when we approach it that way.
Speaker 1:
I've seen evidence that the market will adjust when things are unsustainable. We see some doctors advocating for a hygienist free model. Here's one of those doctors. I've had a few people message me about my practice transition to a hygienist free model. So far it's all been positive. On the other side, his comments continue. I think we all get in our way. We say hygiene is beneath us. We're better than that and our patient can see someone more suited to treat them. That may be true, but in this day and age where insurance will often pay less than your hygienist salary, the hygienist becomes a luxury. And we didn't do this. They did. They demand a six figure salary and do very little to ensure they make it back. Some do, but the vast majority don't. And if we ask them to, they just cut and run to the next sucker willing to open their wallet.
Speaker 1:
Now, do I agree with those? Absolutely not. But as I said, we're going to have some uncomfortable conversations tonight because this is reality. There are some states that are moving to allow assistance to deliver local anesthesia assistance are being licensed to scale. We've got to be careful hygienists that we don't make ourselves irrelevant. Okay? So we've got to have a deeper understanding of what's happening. Can you see why I say there's a growing divide? Now, granted, we absolutely don't advocate for a hygienist free model. We believe that doctors are the most productive and most capable when their hands are on handpiece, doing things that only a doctor can do. Hygienists, same thing. We want your hands on the scalers. We want you taking great care of your patients, but we've got to find a way to make it workable. So what to do? What do we do here?
Speaker 1:
Right? Same thing. High wages made it really, really difficult to hire people just came on the page to see hiring advice, and I see all these posts about not finding hygienists that I guess we're all currently competing to get a hygienist. Someone says, I'm in Michigan too. There's a shortage of hygienists. It's very hard to find good people. We tried to hire and have horrible luck. Many hygienists don't show up to work or quit after a short period of time because they found someplace else. So these are very real challenges that we're having. High hygiene wages, difficulty with hiring. How do we solve it? The good news is we actually can help you solve it. The focus should be if we've got to have high hygiene wages, we've got to find ways to increase our production. Again, the good news is we can do this the right way by elevating care for patients.
Speaker 1:
There's no need to ever talk about finding or doing unnecessary services. There's so many things that our patients desperately need, right? So let's dig into that. When we talk about increasing production, we talk about a couple key systems. We want to provide a higher level of care for patients. That's how we increase production. We also focus on minimizing the no-shows cancellations in open time by embracing our eight Rs. I'm going to talk more about that in a moment. Then also, another key way to increase production and compensate hygienists at the highest possible level is to have them earn a bigger future by providing a production-based compensation model. We don't want to have hygienists demanding a bigger future. We want to give them the opportunity to earn it. And in my opinion, that's a big difference. There's a big difference between those things. So when we look at these things providing a higher level of care, we often talk about maximizing the role of a preventive therapist.
Speaker 1:
And some of the keys to that are listed here before you. In many practices, we don't see patients accepting or understanding the value behind fluoride. The research behind sealants has changed dramatically. Bonded protective agents are a great solution for patients that have exposed root surfaces that are also high risk for decay. We're seeing an amazing new opportunity for a new product, a new service that even has an A code attached to it, guided enamel remineralization in many practices. These are for the watch areas, the incipient lesions. Isn't it an amazing thing that in today's world we actually have technology that can help patients heal those cavities? Now, if you would've filled it before, chances are you're still going to fill it now. But on those incipient and approximal lesions that we would've watched, we can now offer a solution. We're seeing more opportunities brought to us by artificial intelligence and by higher level, better quality digital radiographs.
Speaker 1:
So all of these provide opportunities for us to serve patients at a higher level. And again, I want us to talk about what's really working. Here's another. This is from a group, a small group. These are all their amazing hygienists. And look at the impact they've had month one by offering a higher level of care to patients. It's amazing the impact. They're already up close to a hundred thousand dollars one month into the program. And you can see it's a variety of services that we track and measure. Many of them are preventive services that patients desperately need, and I can tell you as well that this practice's influence and effectiveness will continue to improve. Now, let's talk about maximizing the schedule, minimizing all of that open time that we talked about. The eight Rs are how we do that. These are key systems at the front desk can help us with, but hygienists should be involved in.
Speaker 1:
All of these systems are recall, reactivation, recovery, referrals, reviews, retention, reappointment. All of these are critical systems that help keep our hygiene schedules full. They help keep our practice growing. They help us retain our patients. They help us retain our providers because our providers have a deeper connection with the patients that they serve. We have so many patients in our bucket that leak out because we don't have clarity on these vital systems that help support and fuel practice growth. So the next part of it is production-based compensation. Now, in my experience, when we ask a lot of our providers and practicing world-class hygiene is so much more than just cleaning teeth as some patients would say. We all take offense to that because we know we do so much more than that, right? But what I've seen is return on effort absolutely is required for long-term sustainable results.
Speaker 1:
Okay, now I'm going to move to the last frustration that we're going to talk about here today, and that is insurance fees being low, taking a hit on profitability. Here's some real world comments. I've yet to understand how we're okay accepting lower insurance fees than ever before. And frankly, everything else is inflated. Why can't we fix this problem? Dropping insurance is valid, but we often understand in our model, you shouldn't have to drop insurance to be more profitable. Here's another example. I live in an area where a hygienist with one year experience is getting started on a pay of 65 to 70 an hour.
Speaker 1:
On the other hand, insurance fees have stayed the same and would make a prophy or exam in Florida, almost non-profitable. How you deal with this as salaries are getting higher by the year, a very real problem. Okay, so here's our solution for this challenge. Again, insurance fees are low, profitability takes a hit. We've got to increase our profitability, and we have some clearly designed systems that can help us do that. We focus on the anatomy of an appointment. How can we maximize services to patients in the most efficient way possible without having our hygienists feel like their hair's on fire without causing burnout and frustration? Another way that we focus on increasing profitability is same-day dentistry, both on the preventive and the restorative side. So where are you right now with same day dentistry? Do you do a lot of it? Are you seeing much of that happening in your practices?
Speaker 1:
Again, real quick, red, yellow, green. I want to see what's happening. And I'm not talking here about cadcam. We're talking about all things of same day. If you identify opportunity for fluoride or sealants, is it happening today? If we have a small one surface filling, are we doing it today? I kind of want to see what's happening with that. And for some reason, I am not seeing the chat bar currently. Really strange, but that's okay. I'm just going to carry on because I want to make sure that we cover everything. So this is us, right? This is how we often feel at the end of the day when we don't have systems in place for maximizing our appointment time, me trying to raise kids, exercise, excel in my work, be that world-class hygienist, not be broke, stay hydrated, get enough sleep, maintain the house and not lose my mind.
Speaker 1:
We feel like we're beat up most of the time. The good news is we don't have to feel that way. We can focus on a higher level of systems. So we do this by focusing in on appointment anatomy, both for recare visits and new patient visits. And to give you a little bit more clarity, if you have a 60 minute hygiene appointment, what does that actually look like? We break it into three phases. The first 20 minutes is the assessment phase. The next 20 minutes is the hygiene treatment phase, and the last 20 minutes is reserved for the examination and same day services.
Speaker 1:
Very good. So what are we seeing in hygiene every day? What does our opportunity really look like for same day, just another day in hygiene, 19 lesions on a 13-year-old female, we have so many opportunities that we can elevate care to our patients, and we love to see our providers celebrating that. These are two amazing hygienists from Canada sharing how they protect the 10 teeth, 14 teeth in one day. The day that those opportunities are diagnosed, they're actually doing them. Dr. Cam Zuli, some of our favorite people from Louisiana, Michelle and the brand new hygienist, Abby, sharing how many teeth they're protecting, right? The impact that they had together, they protected 325 teeth in the month of February alone. We love that. So there's so many opportunities for us to increase our productivity by elevating patient care.
Speaker 1:
Amazing group in Texas, north Texas Dental Care, and these amazing hygienists and doctor together protected 3,200 teeth in the first nine months in the program. So there's opportunities for same day everywhere. So we focus on these systems, it's really amazing what can happen. And when we dig into efficient delivery, same day dentistry, all of those things have a tremendous impact. So growth first year, year one, by focusing in on overcoming these hygiene challenges and implementing the systems that I've talked to about look at the difference year to date, this is a group in Alabama, prior year to date was 2,000,700. This year they've seen growth of over a million dollars. Okay, almost a hundred percent growth it looks like. If I'm reading that right, maybe I'm not. No 39% growth from the prior year to date. Okay, amazing things. What about California? We always hear our practice is different, our market's more challenging.
Speaker 1:
Here's another example from California, very heavily PPO areas collections. Year to date was 1.4 before working with us and dialing in on overcoming some of these systems. And year to date this year is over 2 million. So a $600,000 bump by following some of these systems that we talked about. Okay, so right now what I'm going to do is I'm going to go ahead and stop my share. I'm not quite done. I'll bring back my slides here a momentarily and we're going to start off and have some time for some q and a. And I really want to dig into your challenges. So Stacy, do you want to give them some insights? I don't know if you have any questions that were submitted via the chat.
Speaker 2:
Yes, so I did have a few questions come in the chat, so I'll ask a couple of those. But if you guys have any questions, feel free to unmute and ask your questions. I would love to hear from you guys live or you can type 'em in the chat too and I can read 'em out, whatever makes sense. But I thought we could start out, there were a few questions kind of about the same thing, and it was about the standard of care and integrity in hygiene, sort of maintaining the standard of care, even if insurance won't cover certain things. They were saying our patients won't accept perio, they won't accept. Do you have any guidance on that?
Speaker 1:
Yeah, I love that question. So standards of care are really critical. We teach a few things for each one of those three roles that we call non-negotiable standards of care. And I can tell you in my experience, when patients understand the why behind the services that we recommend, they often are very willing to move forward. I also find that we talk a good talk in dentistry. We say things like we refuse to allow insurance to dictate the level of care we provide, but every day in our treatment rooms we say, ah, they're not going to accept that insurance doesn't cover it. They won't do it, insurance doesn't cover it. Or we'll tell the patient, we should probably do a fluoride today, insurance doesn't cover it. What do you want me to do? And in that instance, we're not building value for these services, which is probably why patients aren't accepting the care.
Speaker 1:
I think also I mentioned my own personal ethics and integrity at the very beginning, and we all agreed that patients deserve the very best care we could give them. So we have a responsibility as their providers to stay on top of the latest research to understand the latest science and to see the impact that it has in our practice. Stacy, real quick to answer this, I'm going to ask Bert to unmute for a second because I know that Bert Trish has lived some of this with us and when she first heard some of this stuff, she was able to double her production and triple her production. So give them just maybe a couple short sentences, Bert, on how you were able to maybe disabuse your belief that patients wouldn't accept this care.
Speaker 3:
So the biggest thing I learned was when I would present this to patients, usually without building the value, without using a risk assessment to really give them a compelling why. A lot of them would look at me and go, does my insurance pay for that Bert? And I would say no. And they'd go, well, I don't want it. What Wendy did for me in the practice when I was still a hygienist was I had the what I knew what they needed. I had the why they needed it, I knew it. I wasn't communicating it very well with patients. She gave me the how. Once I had that piece of the puzzle and I had a system, and now I teach that system to other hygienists. It's amazing what happens the day after we leave, right? With the patients. The patients now all of a sudden own the problem because we've explained it in a way that they understand using what I call the medical model of risk assessment.
Speaker 3:
Medicine has been doing this for years. Dentistry never did it. And now we use that model as part of our teaching, and when patients get it and they own it, they're willing to pay for it to fix the problem. So we tripled hygiene in a year and all we did, guys, we didn't add any more hygienists, we didn't work anymore time. All we did was change the conversation about what was happening with them and how we could help them mitigate damage from all of the habits that Wendy mentioned, right? The scale was out of balance and you simply put 'em back into balance and they start saying yes to these services and then you start seeing the numbers that you saw in some of those charts. It was amazing to me. I never thought that it would happen. I had been with these patients for 28 years and never had success, and all of a sudden, because I had a right way to do it in a system, they changed and they saw the value that we were trying to bring to them. So it's not hard. It takes effort and you have to learn it, but the tools are there. We provide the tools to be able to make you effective. I
Speaker 1:
Love that. Thanks Bert. I absolutely put her on the spot and did not give her advanced notice that I would be calling on her at all. But she is one of our amazing hygiene coaches within TTI. I'm so blessed and fortunate. All of our hygiene coaches are world-class hygienists themselves. So you're able to work with people who understand the challenges that you're going through day in and day out in your hygiene department. So I love that. Next question, Stacy.
Speaker 2: The only other thing I have was a few people are asking about coaches. So what do the coaches do? What does Coach Bert do? How much does it cost? What does training look like? Some questions like that. So if you have any guidance on some of those types of things.
Speaker 1:
Yeah, that's a great question. We love our hygiene coaches. So our program, depending on which program you choose, we have programs that start for as little as 199 a month, and of course go all the way up to full service consulting packages that probably reflect more of what you would expect to see as the price tag. But I can tell you one thing that's really unique about our programs is that they pay for themselves very, very quickly in the increase in hygiene production. Okay? I shared a few examples with you on that. The practice that was up 95,000, they paid for more than double their annual investment in month one, right? So it really does depend on what you're trying to accomplish, and that's why I'll share my slides again here, Stacy, because I actually have some things built in for you that can help answer some of these questions.
Speaker 1:
I love this quote, integrity is choosing courage over comfort, choosing what's right over what's fun, fast or easy, and choosing to practice our values rather than simply professing them. So I wanted to leave you with that positive thought. Choosing what's right for patients is really, in my opinion, fun. It's not fast or easy. It's integrity though, and it really takes courage to choose to do something differently than you've always done. So what I wanted to show you is your question about how much do things cost? How does it work? It really depends on where you want to go as a practice. So what I would encourage you to do, if those were your questions or if you'd like to know more about how we work with practices, is help us put together a plan for you. Scan that QR code. You can go to www.schedulewithtti.com and request a call there as well.
Speaker 1:
There's a wealth of information on how we work with practices, therefore, you as well. And I can tell you that our hygiene coaches, our most common programs usually are a combination of in-office coaching and in-person live events. So our coaches are the ones that go and help do the in-person onsite trainings. They do a fabulous job and they also help you establish your production based compensation model. They'll help you figure out that formula and get that started day one. And then they help hold your hand and guide you all the way through. They become a really valuable partner and mentor for your hygiene team and our most valuable programs, our most common program that the most effective, we assign a hygiene coach and a business coach for each of our practices. So really, the program that you choose depends on where you want to go and what your current scenario is.
Speaker 1:
And like I said, we have a wide range of offerings for practices because not everybody wants the same thing. Not everybody needs the same thing. So the best thing to do is to schedule with TTI get on the phone with us, we can put together a plan that helps you accomplish your goals and your vision. And that's probably the best place to start right there. So with that, I'll leave that up so that you can go ahead and continue to scan that. Hopefully that answered your question. Again, we have a online member library with a lot of resources and training materials for the do it yourselfers that starts at 1 99 a month. That's the best deal around. But often people want more help with implementation. They want some more guidance, they want a faster return on investment. And that's why we have the amazing hygiene coaches that we have that can come and get you jump started. We call that hygiene explosion, and they spend an entire day with you walking through all of those services to really help you maximize preventive therapy in your practice. And it's an amazing experience and we just are so proud to have worked with so many amazing practices over the years, and so proud to be invited in to the amazing practices that you've built to help in your journey. We'd love to be involved in your journey.
Speaker 1:
So with that said, thank you for joining us tonight. I went a few minutes over, so I appreciate all of you who stuck around. For the end, we would love for you to drop us any comments or questions in the chat if you want to stay on. We'll keep it open for a little bit. And again, reach out Schedule A TTI, we'd be glad to get on a call and talk through where you are and where you might like to go. And again, if you're anywhere near Miami or would like to join us for some summer heat, I shared that code earlier and that's also in the chat. You can have a quick call. We just do a quick call to make sure you're a good candidate to join us at the retreat, and we'd love to have you join us. So thanks again for joining us. Again, we love the fact that you chose to be here. It does take courage to make a decision to make a change, but what got you here won't get you there. And overcoming these challenges sometimes requires a different approach and a different way of thinking. So we wish you all the best and we hope to see you all soon. Thanks so much for joining us tonight.
