Packed patient schedule and growing-pain solutions: You’re not alone

July 20, 2021
Dr. Stacey Gividen talks about some of the ways practice scheduling has changed since COVID-19 and offers talking points on how to handle supply and demand for dental treatment.

In a previous video, I shared that for the first time in my private practice career I’ve had to turn patients away (or modify how they are accepted into the practice), because I just don’t have the time or hands on deck to keep up with the demands. I’ve had an ad out for another hygienist for the last eight-plus months, but alas, no takers. I’m not alone as several of you shared your stories and given insight into a conundrum resulting in some of the most creative provider/small-business owner/employer tactics being used in the dental profession.

First, the question that begs an answer to this perplexity is: Why is there a huge influx of patients bogging down our phone lines and filling up our waiting rooms all of a sudden? It can be surmised that the underlying common denominator is COVID-19. Are we surprised? No, not really, but let’s flesh that out a bit…

During the beginning of the pandemic, anything we did was considered dangerous, including and especially dentistry. The fact of the matter is that numerous articles were put forth on this front—from dental workplace aerosols to infection control procedures. But as we all know, dentistry has always been safe. The profession practices some of the most stringent infection control protocols in the health-care industry.

Interestingly—but not surprisingly—the real risk wasn’t the actual dentistry we performed; it was the lack of patient care and neglect of oral health that has now manifested itself in an increased demand for our services. I would submit that oral soft-tissue lesions, broken teeth, and caries that have resulted in abscesses are at the core of the care we provide. My writing has portrayed this on many occasions. To play devil’s advocate, we also must recognize that as a result of the pandemic, many have started down a self-wellness path that comprehensively includes oral health. There is more patient need yet the same number of providers’ hands and hours, hence our reason for coming full circle with this discussion.

I have listed some of the highlights I’ve found helpful below. Take a read, and discuss with your office managers/scheduling coordinators and staff in general. There isn’t a right or wrong way to approach the dental scheduling quandary, but this will help you generate ideas that you can piggyback off to customize to your specific situation.

  • Demand for services and space is a recurring problem in dentistry. The danger in turning patients away is if you need to open your schedule again, will those patients come back or will existing patients refer to you again? Referring is a habit and a learned activity needing validation and feedback from the patient referred to the referring patient.
  • Dialogue can make or break the potential for a patient to return to your practice down the road, so keep it positive, be reassuring, and don’t shut the door completely (see above bullet).
  • Implement block scheduling (taken directly from a reader response).
    • Though the problem of "booking out" appointments in the schedule has been around for a long time for successful practices, the pent-up demand for services after a shutdown of routine care and other COVID-related challenges—along with the paucity of auxiliaries—has exacerbated the issue.
    • Execution of block booking requires discipline and will from the practice owner. It is scary to see blanks in the schedule, but if you keep your nerve, this concept eases the schedule and reduces the strain and stress. Before long, your staff won't let you change back.
    • For doctors: One or two emergency slots per day will only increase your “booked out” schedule; one to two days per month is negligible in the current busy environment.
    • For hygiene: Utilize one one-hour slot per day for either a new patient or an SRP appointment. This slot is “released” for the short cancel list or reschedules 24 hours in advance.
  • Increase the hours per day and/or days per week you provide services. If you’re a more-than-one-doctor practice, be flexible with the bookend hours of the day (i.e., 6:00–7:00 a.m. and 6:00–8:00 p.m. time slots).
  • Consider hiring an associate. This is a big step and not as easy as it sounds, but it is something to consider if you have the space or are willing to stagger your schedule.
  • Double hygiene—hire an assistant especially for the heavier patient flow. Some patients do well with this, and some don’t. Double hygiene isn’t for every hygienist.
  • Extend your “best of the best” hygiene patients by putting them out to a nine-to-12-month recall, alleviating the six-month bog down. This may create a challenge with the three-to-four-month periodontal maintenance patients, but it can help.
  • Consider hiring incentives (pay, benefits, sign-on bonuses, etc.) for any staff members you need—i.e., hygiene (new graduate), dental assistant/rovers in the clinical areas, clerical staff, etc.
  • Choose not to care about the overflow more than letting people know that you appreciate their call and are happy to set up a time. Just let them know that it’s going to be awhile. You could reserve a day not currently on the books to see nothing but new patients for exams only, and you could add cleanings as well if you can solve the staff shortage issue.

So, what solution am I applying in my practice? We have found that dialogue is huge. When a potential new patient calls, we let them know there isn’t currently an availability in the schedule for that type of appointment, but we’ll place them on a call list as long as they know it may be a bit of a wait. Family members who are already established patients are taken as a priority (i.e., we saw the kids and now the mom wants to get established). By doing this, it keeps the door open for change and adaptation. While we’re slowly going through that call list, it’s still growing.

Win-win? Not sure. We’re also being very strict on our block scheduling. This has helped with production, ease of room turnover, managing hygiene exams, and subsequently allowing us to maximize our restorative time. We send appointment reminders via text/email; if there isn’t a response, we call. With each of these attempts, we let patients know that we require a confirmation call within 24 hours, and if they don’t confirm, their reserved time will be given to someone else. We’ve been very firm with this policy. Surprisingly enough, once patients have been booted, they won’t do it again! Additionally, we hired another front desk team member so we can streamline the work, such as with insurance claims, treatment planning, AR, check-in/checkout, etc. When things run efficiently in the front, it translates to smoother clinical time in the back, and subsequently more patients can be seen.

And lastly, I’m still looking for that hygienist…

All in all, we’re managing and still making it happen. This is a growing-pain phase that will iron itself out, hopefully! As one reader put it, “These people are choosing you, but you are limited by your own humanness. Yours is a good problem to have and there is no excellent way to deal with it.” Amen to that!

Keeping it real, raw, and day-to-day...

Dr. Stacey

Editor’s note: This article first appeared in Through the Loupes newsletter, a publication of the Endeavor Business Media Dental Group. Read more articles and subscribe to Through the Loupes.

Stacey L. Gividen, DDS, a graduate of Marquette University School of Dentistry, is in private practice in Hamilton, Montana. She is a guest lecturer at the University of Montana in the anatomy and physiology department. Dr. Gividen is the editorial codirector of Through the Loupes and a contributing author for DentistryIQPerio-Implant Advisory, and Dental Economics. She serves on the Dental Economics editorial advisory board. You may contact her at [email protected].