The Schedule Squeeze Play

by Dr. Robert Maguire, DDS

Last week, I had two dentists share with me a similar sentiment, “My team doesn’t support me.” When I asked them for more details, they both indicated that their teams got very upset whenever they decided, spur of the moment, to “squeeze in” more dentistry or more patients than they had originally scheduled. One of the dentists I spoke with indicated that their dental assistant was most likely going to say, “the heck with it.” He expected that she was going to give her notice on Monday morning. Apparently, “squeezing in” more dentistry was something that occurred quite frequently in his practice.

When I asked the dentists why they thought their team members were upset or against them, they were unsure. When I asked them why they often did unplanned dentistry, their responses were similar, “to save the patient an appointment” or “the patient asked me to start their treatment.”

Despite wanting to help their patients or generate more production, I advised the dentists to stop doing this. I told them that these types of unilateral decisions disrupted their pre-planned schedules, created stress, and upset their patients.

High-performing dental teams plan ahead, doing their best to ensure smooth running and productive days. They are organized and responsible. They strive for excellence, preplan, schedule appropriately, set production goals, and work well together to create wonderful experiences for all their patients. In addition, they make financial/payment arrangements ahead of time, and collect that payment at the time of service. Striving for excellence, doing their best for their patients, being timely, working well together as a team, being organized, “informing before performing” are some of the common values these teams share.

Knowing this is important because stress occurs when an individual’s need or value is not met or violated.

For example, squeezing more dentistry into an already busy day undermines your team members’ authority and violates the whole purpose of having a morning huddle. The morning huddle, usually 15 minutes, is the time when the whole team gathers to review the schedule, discuss the flow of the day, talk about any actions they will take, and iron out any potential bottle necks they might see ahead of time. Intentionally and unilaterally injecting more dentistry into an already planned day is a surefire recipe for chaos, tardiness, and added stress.

A dental assistant faithfully organizes the tray and room setups at least one day ahead of time. This helps the day run more smoothly, more productively and more efficiently. On any given day, if more dentistry is required than is planned on a patient, inevitably more work is created for the dental assistant. Not only does this decision disrupt the assistant’s organization and workflow, but it also causes the day to run behind schedule. To illustrate this, imagine that the dentist has allotted 20 minutes to examine a patient with a broken tooth, take a radiograph and a photo, temporize the tooth, discuss the need for a buildup and a crown, and make payment arrangements. Now imagine that in the moment, the dentist starts the crown knowing that the next patient has already arrived on time for their 10:00 appointment.

Doing this added treatment causes appointments to run late; this has a negative effect on the entire team and many of the patients. What happens? (This might sound familiar!)

  • The dental receptionist feels stressed because she is getting the “hairy eyeball” from the upset patient who has already waited fifteen minutes for their appointment.
  • The dental hygienists, who are left waiting for the dentist’s exam, nervously look at their watches. They know that the dentist’s tardiness will create a snowball effect causing them to be behind schedule for the rest of the morning. Inevitably, they know they will have to appease their disgruntled patients. Additionally, they must take a shortened lunch to be on time for their first patient of the afternoon.
  • This hygiene back-up creates even more stress for the receptionist who is faced with greeting each arriving patient with the phrase, “I apologize. The doctor and the hygienists are running just a bit behind schedule this morning.”
  • The dental assistant scurries to quickly set up the room for the unplanned procedure, readying up the additional materials and instruments, resulting in additional room clean up and set-up. All this rushing around increases the chance of mistakes or personal injury.
  • The dental administrator was not given the opportunity to make financial arrangements prior to this procedure. Often, at the conclusion of the appointment, the uninformed patient arrives at the front desk, is shocked at the fee, and is unprepared to pay for the services rendered. This non-payment of the fee messes up the office collection goal for the day.
  • At the end of the day, chances are great that the team will work past the scheduled allotted time (let’s say, 5:00 pm). Most dental assistants understand when this happens occasionally due to a dental emergency, but repeatedly, this can be a legitimate reason to leave a practice.

In this economic climate and workforce shortage, the worst thing that can happen is that a valuable team member leaves a practice, or that a dentist’s perpetual tardiness causes a patient to seek care elsewhere because they feel their time isn’t respected. During the first year in my private practice, often I underestimated the amount of time I needed for a procedure, which caused me to always run late. On top of that, I suffered from “approval addiction” and when a patient asked me, “Oh, Dr. Maguire, can’t you do that today?” inevitably, I would do the procedure and inevitably this caused chaos in the office. My actions caused me to lose valuable team members and patients. Fortunately, with outside guidance, I stopped doing the “squeeze play.”

Speaking as a dentist, even our best planned days can get crazy as we juggle our schedules to take care of our patients who call us with swollen faces, broken teeth or other dental emergencies. Remembering that more joy, more fulfillment, and more financial success will come to you when you and your team work together to provide timely and excellent care for your patients is helpful. One of the keys to having a smooth and successful day is to continuously communicate with your team. Dentists need to resist the urge to inject unnecessary “surprises” and make sure to have clarity with regards to mission, purpose, and values. One needs to preplan and schedule for productive days, “inform before perform,” and most importantly, do have fun with the team as you together care for your patients.

Many dentists have big hearts and their intentions are for the good of the patient and for the good of the practice. In this article, I have illustrated how having a big heart for one patient can sometimes cause big heartaches for an entire team.

About the Author

Dr. Maguire practised dentistry for 34 years. He had a successful solo private practice for 28 years in the little town of Wolfeboro, NH, and retired from his practice in October 2018. He received his DDS from Georgetown University and later earned a master’s degree in strategic communication and leadership from Seton Hall University. He is a past president of the NH Dental Society and currently is a Fellow in both The International College of Dentists and The American College of Dentists. Dr. Maguire is now a speaker, author, coach, and consultant, passionate about helping dentists and their teams find more joy, more fulfillment, and more financial success.

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