Ask Linda Miles questoins

Oct. 13, 2011
Readers ask Linda about scheduling woes and no raises despite working harder.


We are constantly running behind schedule and patients are irate...some even get up and leave our hygiene treatment rooms before the doctor comes in for the examination. How can we stay on schedule, keep our patients happy, meet production goals, still have lunch and go home soon after 5 p.m.?


Before a practice can fix a bad situation such as running behind schedule all day, the people in the practice must first identify that everyone is part of the problem and therefore must be part of the solution. The blame game does not work well in time management. Second, the doctor and team members must identify time spenders (necessary duties) and time wasters (unnecessary things) that are creating the problem. Here's a list of the five most often discovered time management problems:

  • Interruptions are the biggest source of time management issues in a busy practice. How many times per day does someone else on the team interrupt you to ask a question when they could have easily handled it themselves with proper training and initiative? Some team members are fearful of making an error so they double check every detail before taking action. Other team members may not have adequate training to complete tasks on their own, so they constantly ask questions. And a few non busy staffers decide that if they are not busy, it is chat time to others who may be busy.
  • Use of cell phones or internet during office hours. Patients should be the primary focus throughout the work day. Making and taking personal calls, texting family, friends or personal business during the work day is totally unacceptable yet has become the number one time management problem in the past few years. A strict phone policy of cell phones being OFF during patient hours is the only way to control the problem. The same holds true to using the internet for personal business. If the doctor and middle management use their phones and internet, the team members follow suit. Good leadership is of utmost importance on this issue.
  • Redundant patient education. Oftentimes the clinical team explains the clinical treatment with short and long term benefits to the patient ... then the doctor repeats the process during pre and post treatment discussions. It must be decided who will do this part of important patient education before patients are seen. This can save 5 to 6 minutes per patient. With 30 patients per day (doctor and hygiene) this is a total of 165 minutes (2.7 hours per day).
  • Poor scheduling. It is important to know your dental assistants' state dental practice acts and know what they are legally allowed to do. This determines what type procedures can be scheduled side by side in the doctor's two treatment rooms. Patients are kept waiting when the doctor is double booked with operative opposite operative. The key to effective scheduling is to have two very well trained dental assistants with "filler appointments" (those procedures that can be done by the assistant), scheduled in chair two opposite the doctor's busy time in chair one. When the dental assistant in chair one is working independently, the doctor has operative scheduled with assistant #2 in chair two. The dentist is typically in treatment room #1 60% of the day, at chair #2 30% of the day and checking hygiene 10% of the day. This however varies based on state laws governing dental assistant duties, the number of hygiene patient exams etc.
  • Speed of those working in the practice. Some workers move very quickly and others move very slowly and deliberately in the workplace. The key to staying on schedule is to know how much time it takes to perform each procedure (timing each is a good idea). Then each person on the team must be aware of time allotted and try to be prompt with each patient. Some dentists encourage their assistants and hygienists to anonymously show them a 5, 10 or 15 minute cue card. Others tell me that would not go over well with them.

Each practice should make a list of time spenders (those duties that must be done at each patient visit). Then make a list of time wasters. Asking each member of the team is important as there are some time wasters the doctor may not be unaware of. Make it a point to eliminate the time wasters in your daily routine. Watch your stress level go in half and your productivity and patient satisfaction soar.


We haven't had a raise for almost three years yet we are working harder than ever. We lost one staff member who was not replaced and are now expected to do her job of sterilization and lab work without any additional compensation.


Your statement is one we hear often as the economic downturn is being felt in most areas of the country. The message I'm giving in today's lectures is that we who are still working and have a roof over our heads are STILL fortunate! Yes, while it does not solve your frustration; we are all working harder for the same, if not less income. But, many people are not working and have lost not only jobs but their homes and their dignity. "Tough times don't last but tough people do!"

My advice is for each team member and doctor to make a list of all that you are grateful for. Focus on what's good about the practice, your job, your coworkers, doctor(s), team and most of all your patients. Believe it or not, some practices (in spite of the recession), are having their best year ever. They are aware of the situation around them...but they have decided to use their slower, down time to work on reactivating past due patients for hygiene, working on past due (incomplete) treatment plans, explaining to patients what can happen if they postpone needed treatment. And they are using this time to focus more on making each patient feel special at a time in their lives when they too have struggles and not feeling good about themselves. Remember: "It's not what happens to us that gives us stress...but simply how each of us decide to handle that stress. Your doctor(s) feels worse than you do about no raises and no increased benefits...but if he or she is smart, they know that "this too shall pass". And it will pass very quickly when the entire team forms a bond of "no whining and more winning!" Homework assignment:

Make a list of what's good about your job/ your practice and focus on this at a team meeting. When attitudes change so does one's outcome. "What comes out of our mouths comes back to our lives." So make it a great month/quarter and year!

Linda Miles, Founder
Linda Miles & Associates (Now Miles Global), 1978
The Speaking Consulting Network , 1997, 2011
[email protected]