John Meis (00:02.7)
Hey everybody, welcome to this episode of The Double Your Production Podcast. I'm Dr. John Meis here with my partner, Wendy Briggs. How you doing, Wendy?
Wendy Briggs (00:09.939)
Doing great. Thanks for asking.
John Meis (00:11.832)
Fantastic. So one of the things that I love about having a partner like Wendy is that she is fantastic at keeping up on all the current trends in dentistry in general, but particularly in hygiene. And as we all know, hygiene has been a real mixed bag here since COVID when we saw a reduction in the labor force and now practices are short. We've seen hygiene salaries go up very, very significantly. And so we thought it would be a good idea to let Wendy really bring us up to date and up to speed with what the trends are in hygiene right now, because it's evolving rapidly. And I think it's been a while since we did an update like this. So Wendy, I'm really excited to hear what you have to say.
Wendy Briggs (00:52.713)
Yeah, you bet. I think this will be a good conversation. So really the theme of today's podcast is going to be the hot topics, right? What are the topics that people are talking about? And we have three that we'll focus on a little bit on each one. And I think it's important for us to clarify that sometimes in Facebook, in some of these dental groups, you get kind of the collective knowledge of the group. And sometimes that's not actually very good advice, right?
I think it's important that we are mindful of that. And that's why we wanted to do this podcast, right? Because some of the hot topics and some of the trends that we see are actually, in our opinion, taking practices the opposite direction in many cases of where they want to be going. We've seen the long-term consequences of some of these decisions, and often it's not good. So let's dig in. We can talk about some of the hot topics. I would say because of the challenges that you mentioned, Dr. John,
One of the topics that's getting a lot of oxygen on some of these dental groups is the concept of going hygiene free. Just get rid of the hygienists. Doctors, you can do the hygiene yourselves. And it's less stressful. These are the claims of the collective knowledge. And we have a couple of voices that are fairly loud.
John Meis (02:18.573)
Yes.
Wendy Briggs (02:24.061)
in this conversation, those voices are like, I've done this, I did it this way for so many years and I had a very successful practice. But when we define very successful, it was a million dollar a year practice. And for some people, that's great. That's what they're trying to attain. But for many of our members, a million dollars a year in their practice is far below what they hope to create, right? And we found that this concept of a hygiene-free model, while maybe attractive in the moment, isn't always the best long -term strategy for patients or for the practice.
John Meis (02:58.848)
Yeah, for sure. you know, focusing on shrinking down, you know, so the idea of a hygiene-free practice, let's shrink everything down so we don't write checks to people, but we have less checks coming in as well. Right. So a single doctor with no hygienist producing a million dollars a year. Well, what's that practice going to be worth someday? Well, you know, not a whole lot because there's not a whole lot of revenue driving through. There's not all that much profitability, compare that to a practice that has a full complement of providers and the value of that practice and therefore the net worth of the owner dentist will be multiples of what this shrunk down idea is.
Wendy Briggs (03:46.463)
Right, and some of the claims, some of the reasons for going this direction are that the doctors are able to spend more time with the patients and therefore case acceptance grows. And in our experience, you know, the doctor's really not spending the full hour with the patient, right? They're having the assistant do a lot of the work and they may be 20, 30 minutes with each patient. And certainly during that time, in our experience, they're scaling teeth. So there's really not a lot of time for conversation about dentistry.
In our model, we take a team-driven approach when it comes to case acceptance. And so there is time for those conversations. And certainly we have found it to be very effective with the team members driving those conversations initially and the doctor coming in to confirm the findings. We see a much higher acceptance for restorative dentistry in that model than we do with a solo doctor doing all the hygiene and all the conversations.
John Meis (04:40.45)
Yep. So the argument is that shrink it down and you'll have a higher profitability percentage, but less revenue, so less income and certainly less value of your practice. So therefore less net worth. So this one is one that we're not in favor of. Now, some people practice this way. They love it. And if it's if you practice this way and you love it and it's working for you, great. Don't stop. But the idea to move to this maybe a step backwards.
Wendy Briggs (05:13.191)
Yeah. And we always say, careful what you wish for. And we understand, we know there's doctors that have had to do this out of necessity because they couldn't attract or they couldn't hire a hygienist. That's different. That's a different story. For a short-term fix, it certainly can happen. We have other short-term fixes that might be more effective if we really are in a crisis. And that really, we should move on to the next topic. That's the one that we're going to be talking about that doesn't get a lot of conversation on these social media groups. And it really should because an assisted hygiene model can really help us in times like this when we are short providers and unable to hire additional providers.
John Meis (05:48.322)
Yeah, so this one is one of my favorites to talk about because assisted means one thing to one person and one thing to another person. go ahead and describe what you mean by assisted so that people understand exactly what you're talking about.
Wendy Briggs (06:07.423)
Yes, so assisted hygiene in our definition is radically different than accelerated hygiene. Accelerated hygiene often means shortening appointments down and cramming more patients through. Whereas assisted hygiene in our world, the patient still is scheduled for a 60 minute appointment if that's what you're scheduling now. But instead of one provider seeing to the needs of those patients, we have two dedicated providers. So this often means that we're scheduling patients in two columns with a dedicated assistant.
And we call that an assisted model. And much like the doctor works with an assistant so that the doctors are then focusing on doing licensed tasks, we have hygienists that are able to utilize their assistants in a similar manner. So the hygienists are spending most of their time doing licensed tasks as well. And the assistant really helps have the conversations with the patients. They're taking the radiographs, they're helping to flip the rooms and do sterilization. They're often assisting with the doctor for the exam while the hygienist is taking care of another patient in the other operatory.
So when done well, this model actually elevates the experience for patients. Patients feel like they're served at a higher level because they have two dedicated people seeing to their needs. And when done well, we don't see any reduction in case acceptance from our patients because we've got carefully scripted trust transfers that are happening between the assistant and the hygienist, between the hygienist back to the assistant, and then from the assistant to the doctor. So when done well with the right caliber of an assistant, this model is my preferred model. Like this is the model I prefer to work. And I worked at for many, many years as a hygienist.
And hygienists often are a little bit worried about this and think, well, gosh, am I going to be too hard on my body? Or this isn't sustainable long-term. And in my opinion, it's actually easier on you long-term because you're not doing a lot of the tasks that become taxing and exhausting. So, in my opinion, my experience with this model, when it was done well, it was the best of both worlds for both the patient and the provider.
John Meis (08:14.242)
Yeah. And this, as you said, this can work really well when done well, but it's kind of hard to do well, isn't it? It takes, it takes first of all, a hygienist that is willing to do it. And the second of all, it needs a really good assistant. This isn't an entry level assistant job in an office. This person has to be able to talk restorative dentistry, have to understand the flow of a hygiene appointment, they have to be able to stand on their own two feet with patients.
And so it requires a level of skill and training that most practices aren't used to doing. And what we see very often is if the doctor loses an assistant, they want to pull that hygiene assistant out of hygiene onto the restorative side. then now we've got a new trainee, so we can't do that. There are some rules that you need to follow in order to make this work well. But when it works well, we see that a hygiene assistant team, the visits per hour goes up by about half, half to a little more than half. So it is clinically efficient and it is, so it reduces some expense, increases some revenue, and if done well, can be an amazing experience for patients.
Wendy Briggs (09:39.485)
Yeah. And I think practices don't look at this option enough, right? Without the proper training, they may not have the confidence to do it. But in my opinion, instead of hiring a temp, we should have a systematic process by which if someone's out or on maternity leave or something like that, we shift to an assisted model. I also like to see us shift to an assisted model in high demand appointment times. So let's say we have, you know, the hours between three and six PM, we can shift to an assisted model.
Especially if we're out of capacity on hygiene side and don't have hygiene appointments available for months, we should really be looking at how we can creatively shift to an assisted model to help us overcome those challenges. Now we have an assisted hygiene training course on our member website. So if you're a subscriber to our member website, you most likely have access to that course. But if you aren't, you can actually purchase that course. And it's a great way, it's a great thing to invest in if you're struggling with some of these challenges in your practice right now.
John Meis (10:41.326)
So the most sophisticated practices that we work have the capability to shift out of assisted based on demand, based on how far we're getting out scheduled, based on availability of hygienists. So the most sophisticated practices, this is on their tool belt. They're able to shift back and forth. They may not be doing it as a permanent strategy, but they're able to turn it on when it's gonna be helpful to the patient and helpful to the practice.
Wendy Briggs (11:12.499)
Yeah, I love that. And that's one of the reasons why we really focused in on doing it, updating our assisted hygiene course, because it is such a need right now. And there are so many practices that think, you know, they don't have very many options, but they do. You know, if they really understood how to do assisted hygiene well, it gives them a whole world, a whole new world of options when they're down a provider. And, you know, frankly, the hygienists who are given the opportunity to work in assisted model when done well, really love it too.
They love the opportunity to earn more by providing a higher level of care to patients. And it's kind of, in my opinion, much easier than working with someone who's unfamiliar with the practice, unfamiliar with our values and our strategies. It's easier to deal with the people that already know the team and know the patients and know the practice.
John Meis (12:01.134)
When you see it working well, I always want to say these are professionals. Don't try this at home. But it really is a difficult thing to implement on your own if you don't know how. So the course is really valuable in helping drive it in a positive direction. Get the team on board so the team's excited about it, so I highly recommend.
Wendy Briggs (12:26.004)
Yeah, for our last topic, this is another hot topic and I just saw a post on this yesterday. So I had to take a picture of it. And this is posted on a Facebook group and it said, question for dentists, mainly in-network dentists. How is everyone managing the rising cost of hygiene salaries as a practice that's in-network with many insurances? The rising per hour salary is quite honestly becoming an unsustainable model. We spoke about this already. "Curious how others are navigating this dilemma while I value and appreciate my hygienists and the important role to my team, I can't support a salary that's more than they're producing per hour based on insurance reimbursement."
Literally every comment on this post was the only option is to shorten the appointments down and schedule hygiene for 30 minutes only. That's the only option there is. And so that's really the third hot topic is this concept that the only way to be profitable is to have 30 minute hygiene appointments. Danger, danger, right? We see that this takes practices backwards. And it creates a real problem with case acceptance and restorative dentistry. And when we consider the fact that 70 % of all restorative is referred from hygiene, this is a really, really dangerous strategy.
John Meis (13:37.164)
Yeah, you know, I love the way that you have championed the idea of the world class hygienist having three roles. And one of those roles is treatment advocate, talking about treatment, talking about restorative treatment. And so if you shorten the appointments, that's the role that gets dropped, right? They'll still do the preventive role. They'll still do the parirole to some degree. But the treatment advocate role gets dropped. And so that's costing restorative, right? So now, yeah, your high team may be a little more productive, although that's not what we've seen because we've measured this in practices with 30, 45, 50 and 60 minute appointments and the 60 minute appointments beat them on productivity per minute every time, right? If they're well trained every time, 60 minutes wins. But also that's not even looking at the effect on restorative.
And so we teach a team case acceptance process that the hygienists have a very, very significant role in. And if you shorten the appointments, that team case acceptance process goes out the window. And now we see restorative treatment going down. So now dentists are doing more short appointments, more single tooth dentistry. They're getting on that hamster wheel where they're just going faster and faster and faster and really not making any progress. And so we think going to 30 minutes is really a bad idea.
Wendy Briggs (15:01.279)
Absolutely, and I know it might seem like that's the only way to be profitable, but honestly invest in some training, understanding those three roles, understanding the comprehensive approach to hygiene. We see practices wildly profitable.
I want to share a story of small practice in Texas, single doctor, single hygienist. The hygienist was doing about $169 production per visit before we got there. The doctor recognized something needed to change, invested in some coaching. And now that same provider, same town, same patients, the very next month did more than $300 production visit. Month two, more than 330. Month three, more than 350. Month four, more than 370. So it's continuing to go up. And the reality is nothing changed. They didn't shorten the appointments down. What they did was they understood how to use risk assessment as a part of that process, how to provide more comprehensive care.
I agree if all we're doing is exam, bite wings, profy, exam, bite wings, profy all day long with the high cost of salaries in a 60 minute appointment, that math doesn't work, right? They are losing money in hygiene, but we've just got to use a different formula, right? We've got to have different procedures in the mix. We've got to understand that patients will accept more care when they understand what's in it for them. And as you mentioned before, really maximizing that role of a patient treatment advocate.
Like that's the entire purpose of the hygiene visit in many instances. You we could say, gosh, you know, we've got to have tissues healthy. We've got to do all those things. And that's true. However, that's a lifeblood for many of our practices. And we know the impact that that can have. Now you mentioned our team case acceptance process. We actually have a course on that as well. That's coming up in November. Usually every November we have that course. And in the context of that two-day workshop, practices learn how to leverage their team in a much more powerful way to radically improve their case acceptance. So again, some of these decisions, some of this collective knowledge of the group, wisdom of the group is really horrible advice. And when I see this propagated, I'm going to be honest, I don't have the time and energy to answer or post on every one of those posts. I just can't do it. But that's why we do these podcasts, so that people can...
John Meis (17:12.75)
Yeah. You know, if you want to be average, go on Facebook and see what everybody else is doing. And if you do it well, the way they say you'll be average. Yep. You know, we like to help people go beyond average to exceptional. And so what we teach improves the quality of care, improves the patient basis dental health. And we want to work on it in that direction, not doing less care, not giving patient options, not educating patients on what's available. We think that's the wrong direction. And all of this chatter that we're hearing in dentistry right now on this, I think is really misguided. And it's just because they don't know.
Wendy Briggs (18:03.433)
Right. And again, you know, like I said, when you look at the math, they're right. The math doesn't work out. It doesn't compute. It's not sustainable. But there's a different approach, right? There's another way. And we prefer the approach, like you said, that really is excellence, you know, is about doing common things in an uncommon way. And when we put the patient first and do its best with the patient every time, it opens up a whole new world of profitability and opportunity. And we just really wish that more people knew what was possible even with the constraints and the challenges that we have in hygiene. There is another way and we'd love to help show more people.
John Meis (18:40.824)
Yep. Well, we're out spreading the message. We're on stage all across stages, all across North America sending this message. And we're going to do our part to make sure that we try to make dentistry be simpler, be more productive, be less stressful, less hurried, less rushed and much more enjoyable. And so that's what that's the way that we think. And, Wendy, I appreciate you giving us the update on these three messages that are going through social media and that we've heard at conferences. And so I appreciate you giving us good update.
Wendy Briggs (19:19.583)
Yeah, it's my pleasure. You again, sometimes, like I said, I don't always have the energy, but I think it's an important message. So we want to make sure people understand.
John Meis (19:27.338)
It is. Yep, it sure is. All right. That's it for this episode of the W Production Podcast. Thank you, Wendy Briggs, hygiene queen. And we'll see you all next time.
Wendy Briggs (19:31.902)
Make
Wendy Briggs (19:40.553)
Thanks, everybody. Thanks, Dr. John. Bye -bye.
John Meis (19:42.222)
Bye bye.
