September 8, 2025 • 20 mins
What if you could double or even triple your dental practice's profitability without working more hours? The secret lies in understanding and optimizing your dollar-per-hour production.
Most dentists unknowingly operate practices that generate around $300 for every 40 minutes of work when they could be making $1,500 in that same time frame. This profound difference doesn't just impact your income—it transforms every aspect of practice ownership, from stress levels to management decisions to work-life balance.
Take Control of Your Practice and Your Life
We help dentists take more time off while making more money through systematization, team empowerment, and creating leadership teams.
Ready to build a practice that works for you? Visit www.DentalPracticeHeroes.com to learn more.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Paul Etchison (00:02):
Now imagine you own two businesses one in which
you make $1,500 for 40 minutesof work and in the other one you
only make $300 for that sametime, 40 minutes.
Which one do you want to scaleand try to take to new levels?
Now I know what I would choose.
I would choose the first one,and the thing is is I've owned
(00:23):
both of those businesses and Idon't want to go back to the
second one.
I want the one that's $1,500for 40 minutes of work, and the
thing is is we can have either,but most of us, as dental
practice owners, we do have thesecond one.
Now let me ask you this whichone is gonna be more stressful?
Making decisions, making harddecisions about payroll and what
(00:45):
you can spend money on?
Should we run more marketing?
Do you think it's easier tomake those decisions when you're
making $1,500 every 40 minutesversus $300?
Hell yeah, it is.
Which one is going to have moremanagement issues where the
team wants things?
Maybe they want new instruments, maybe they want another person
up front, and you're looking atthe revenue and you're like the
revenue doesn't justify this.
(01:05):
So I told you I've had both.
I've went from one to the other.
I'm going to teach you how todo that today.
So stay tuned, we're going totalk about dollar per hour and
how we can maximize what we aredoing at the office.
Now you are listening to theDental Practice Heroes podcast.
I am your host, dr Paul Edgison.
I'm the owner of a largepractice in the south suburbs of
(01:27):
Chicago.
I'm a dental coach and I'vewritten two books on dental
practice management.
I am here to teach practiceowners how to live amazing lives
through creating highlyprofitable, team-driven
practices that do not requirethem for every little thing and
actually don't require them muchat all.
So if that's the practice youwant to run, you are in the
right place.
(01:48):
All right, today we are going totalk about dollar per hour.
Now, what the hell is dollarper hour?
Sometimes this is somethingthat you can get with those
metric reporting services, andsometimes they have it and it's
not that great of a metric,because it's hard for the
systems to calculate this forsome reason.
But what is dollar per hour?
(02:10):
We are talking about thedollars that you produce.
I'm talking about collectibledollars Now.
I'm talking about, like, afterinsurance write-off, real money
the dollars that you producedivided by the amount of hours
it took you to produce it.
So pretty simple, right.
So every provider in youroffice should have production,
should have adjusted production,and they should have the amount
of time it took to make thatadjusted production and they
(02:30):
should have the amount of timethat it took to make that
adjusted production.
So then you can figure outdollar per hour.
Now what should these numbersbe at?
Now I have some ideas of what Ithink they should be at Now.
I think, as a doctor, nowassociates, I want all of my
associates at $600 per hour.
That's where I want them.
I think it's a reasonablenumber.
I don't think if you're anowner doc and, like you, want to
(02:52):
crush it $600 per hour, I meanyou can do it.
But I think you should do a lotmore.
I have tons of clients above athousand dollars per hour.
I know doctors doing fifteenhundred two thousand dollars per
hour.
When I was practicing myself, Iwas doing around twelve hundred
thirteen hundred dollars perhour.
That was consistently where Ilanded.
That's where my goal was,that's where I felt comfort.
(03:14):
So there is no right or wrong,but you have a lot more options
if you produce more per hour.
Now what about hygienists?
We always hear this thing theyshould be producing 3x what
they're paid.
I find that very hard to get tothese days with hygiene
salaries, that is damn nearimpossible.
But I will tell you, in mypractice I want every single
(03:35):
hygienist to do about $150collectible per hour.
That's where we are at myoffice and those are just some
baseline metrics.
So if you go and calculate yourstuff and see what your
hygienists are doing, at leastyou have an idea of where you
should be All right.
So let's talk about the thingsthat affect dollar per hour.
I remember back in the day whenI opened up my practice, we were
(03:56):
having this one day where, man,we crushed it.
We were turning rooms, we weregoing from room to room on
roller skates, the hygienistswere numbing for me.
I was doing a bunch of fillings.
I don't think I did a singlecrown the whole day, but it was
a bunch of fillings, maybe someextractions in there too mixed
in.
But we saw a ton of patients,we saw new patients, we were
(04:17):
vibing.
We stayed on schedule all daylong.
It was busy as hell, but we didit.
And then when I looked at thenumber at the end of the day and
I was like shit, that can't beright.
There's no freaking way.
And then I looked at some otherdays where we had these huge
days and I'm like what is the Xfactor here and this is what it
was is it was crowns.
(04:38):
Is that if I do a full day offillings, I don't care how fast
I do them, it's never going tobe as profitable of a day when
compared to a day that I docrowns.
So we got to recognize, aspractice owners, I'm not saying
don't do fillings anymore, butI'm saying we got to recognize
that we need both.
And here's the thing I want youto think about is let's take a
typical crown and we're justgoing to make some round, easy
(04:59):
numbers here.
Let's say a crown and a buildupis $1,500.
Now if you are going to book anhour of doctor time now I'm
saying doctor time, right, I'msaying an hour of doctor time,
maybe that's 30 minutes ofdoctor time for the prep and 30
minutes of doctor time for thedelivery.
That's an hour total doctortime.
You got $1,500 there.
That is a $1,500 per hourprocedure.
(05:21):
Cool, that makes our average goup for the day.
So we want to do some more ofthose, right?
But what if we now take twodoctor hours to do that.
Now it's $750 per hour.
What if we take three hours todo that and I can't tell you how
many times I see people doingthis They'll book a two hour
doctor slot for a crown and thenthey'll book an hour for the
(05:41):
delivery and the doctor is inthere the whole time.
So, three hours $1,500, andyou're doing $500 an hour and
you wonder why you're strugglingto pay your bills.
Well, it's great that you gotsomething to do for three hours,
but shit, that's not veryprofitable.
So we want to do somethingabout that.
So we got to realize that whenwe have crowns on our schedule,
(06:02):
it's not just by them beingthere.
We have to do them in a certainmanner.
And I don't want you to hear meand say I'm telling you to
hurry through all yourprocedures.
I'm not saying that.
I'm not saying cut corners andI'm not saying you got to run on
roller skates.
I'm just saying be smart aboutit.
Be smart about the way you useyour time and the efficiencies
that you build into yourpractice.
And this is what we teach withour coaching.
(06:23):
This is what our programs areall about, because if you're a
doctor and you wanna cut downyour days, you gotta get your
dollar per hour up.
So this is what Dental PracticeHeroes is all about.
Now let's talk about the secondthing fillings.
Here we need to minimize thedrag that fillings have on our
schedule, and we do that a fewways, first of which is we limit
how many filling appointmentswe're willing to see each day
(06:45):
and we hold spaces for crowns.
This is the DPH blockscheduling you might've heard me
talk about before.
We're holding spaces for crowns.
So we have that extra note,those big numbers, those high
profitability procedures to makeup for the lower profitable
ones, and we're limiting howmany fillings we're going to do.
But the thing is too, we needto think about fillings in a
special way.
(07:05):
I remember one time I it youknow it should have been a crown
, I should have crowned it, butI did a big M-O-D-B-L.
Sometimes, dude, those are funas hell because it's just fun to
put all that stuff in thattooth.
That looks like crap.
And then you're carving it, andit's one of those ones I like
spent time, I put anatomy intoit, I polished it really nice.
(07:25):
Oh, baby, it looks so good.
And there was like this littlemesial buckle cusp that was
holding it all together.
And the patient came back aboutthree weeks later in that
little tiny sliver of a cuspthat I left there.
Well, it broke off and I lookedat that.
I said, ok, well, I guess I'lljust patch that.
And then I looked at that and Isaid, dude, this should have
(07:46):
been a crown.
What the heck am I doing?
How long did it take me to dothat filling?
And what did I benefit thepatient?
A lot of the times we feel likewe're doing the right thing for
the patient because we're savingthem money by not doing the
crown.
But over time, what I want youto see is that if we don't
properly restore teeth, we don'thave a good long-term prognosis
(08:06):
and we can, a lot of the times,cause the patient to pay more.
I mean, I am putting thatpatient in a situation where
they've got something that lookslike a tooth there.
They can chew on it, but theyended up breaking that mesial
buccal cusp off.
Now what if that broke down tothe root?
They had to take the tooth out.
What if it broke into the nervechamber?
Now they need a root canal.
What good did I do this personby doing a filling on them.
(08:27):
That took me a ton of time.
It was no profit at all in theprocedure and then they ended up
having to spend a ton moremoney into getting a ton more
work down the line, right?
So we're going to use the blockscheduling to limit how many
fillings we're doing.
We're going to use the blockscheduling to have a certain
baseline level of profitableprocedures that we're doing.
But we also need to realize,when we're treatment planning
(08:49):
things that are just dumb, thatdon't make sense, because we're
scared to tell the patient whatthey really need, because we're
treatment planning things thatare just dumb, that don't make
sense, because we're scared totell the patient what they
really need, because we'reprejudging the patient on what
they can afford and what theyvalue, and that is not the best
way to treat your patients.
So watch how you're treatmentplanning.
Make sure that you're nottreatment planning dumb stuff.
If it needs to be a crown, makeit a crown.
(09:11):
And now the third point we needto make every single procedure
as profitable as possible, andhere's what I mean by that.
We talked about the crown thing.
You know, if it's $1,500 anhour, if it takes us an hour, if
it takes us two.
It's $750 an hour.
But we need to look at everysingle procedure.
And what does it look like whenwe do that?
(09:33):
Let's look at every singleprocedure and what does it look
like when we do that.
Let's look at fillings.
You know, how can we makefillings more profitable?
How can we utilize ourassistants better?
How can we prep faster?
You know, I'll give you just aquick tip on prepping fillings
is take that high speed anddrill it out until you've got a
clean DEJ all the way aroundyour prep.
Then you know that you've gotthis outline form of your
(09:55):
filling and now all you do is gowithin that filling and clean
out the decay in the middle.
Pick up the slow speed, cleanup the decay, you're done.
You know you're not switchingburrs, you're not taking a bunch
of looks at different angles.
Don't stop the burr.
Same thing with prepping crownsDon't stop the burr, unless you
have to Stop looking.
When you start touching asurface, prep that whole surface
(10:16):
.
When you reduce the occlusion,reduce the occlusion so you
don't have to come back and doit again.
When you're prepping the buccalaxial wall, reduce it enough so
you don't have to come back anddo it again.
Do things once.
Okay, this is not hurried, thisis just effective and efficient
.
Let's talk about anotherprocedure.
That could be super profitable,but sometimes not so much.
(10:37):
What about a night guard?
Okay, we usually will have ourassistants.
They'll take the impression fora night guard and then the
patient comes in on the doctor'sside and we spend 40 minutes to
an hour.
We're delivering this thing,we're adjusting it.
Now, what is this?
A $500 procedure.
We took like 40 minutes to anhour.
What's the dollar per hour onthat?
I don't know.
(10:58):
$350 to $500.
That's not a lot, you know.
It's not worth an hour ofdoctor time.
What if we could teach ourassistants how to make the
adjustments, get it all readyand then you pop in as the
doctor and you say let's take alook.
Chomp, chomp, chomp.
How does it feel?
It feels great, oh my gosh.
You look at your assistant andyou're like you are so good at
(11:19):
this.
You give him a compliment infront of the patient.
The patient's like hell, yeah,you know what.
So now, how long did that takeyou?
Five minutes, you didn't spendany time.
But if you've got a $500 nightguard, that takes you five
minutes.
What is the dollar per hourproduction.
On that five minute procedure.
That becomes like a $6,000 perhour procedure.
(11:39):
Now, it's only for five minutes, you know, but that becomes a
very highly profitable procedure.
So you start looking ateverything you do and you start
saying, how can I make this aprofitable procedure that meets
my goals for what I want toproduce every year and every
week and every day?
You can take these goals allthe way back to the daily and
move them all the way back to anhourly goal and then you can
(12:01):
plan your whole year from it.
We also got to make sure thatwe're adding the right
procedures.
You know, are we offeringfluoride?
Are we offering sealants?
Are we even offering thosenightguards?
Are we offering whitening?
You know these are things thatyou can add on that can increase
your dollar per hour, becausethese don't require you.
A lot of these procedures canbe done by the assistants.
So what's the dollar per houron that?
Well, it's kind of infinite tosome extent because you don't
(12:24):
have to do it.
What about extractions?
I mean, I see clients they'llbook one single extraction.
They'll book an hour to an hourand a half of it.
The procedure is about $200.
I'm sorry, you're not going tohave a profitable practice if
you're spending an hour to anhour and a half to do a $200
procedure?
If you wanted to spend an hourto an hour and a half doing a
(12:44):
$200 procedure, you should havewent to hygiene school.
You could do it all day long,but you're a doctor so you
should not be doing that.
So what do we do withextractions?
I mean, I'm telling you you gotto offer the bone graft.
If you think there is value inpreserving bone around extracted
teeth and in the extractionsocket and preserving that ridge
, offer that to the patients.
(13:05):
That makes that littleextraction become a much more
profitable procedure.
How long does it take to do abone graft?
To throw some bone chips inthere and to cover it with a
little membrane and sew somelittle sutures on top of it.
It doesn't take very long butit makes it a really profitable
procedure.
But I'll tell you what else isreally killing a lot of people's
extractions, because I haveassociates.
I see it is we pray, we justpray that tooth comes out.
(13:28):
We take that little elevatorand we push, push, push from
over here, we push, push, pushfrom over there and then we push
, push, push back in the firstspot, back to the second spot,
back to the first spot.
We keep push, push and we sayplease, please, come out.
And we pick up those forcepsand we grab it and we say this
doesn't feel like it's going tocome out, but maybe I'll get
lucky, because sometimes you getlucky.
Right, it's like the slotmachine If it pays off every now
(13:48):
and then you keep doing it.
So you do that and then yousnap it off and then you sit
there and you push, push, pushwith your little elevator, push,
push, and nothing happens.
And then you pick up your drill.
Finally you remove some bone,but don't remove a lot, because
we're trying to be conservativeand we don't want to remove too
much bone.
And then you push, push, push,and where you lost that little
(14:09):
bone, guess what happens?
You snapped off your root atthe tip.
You drill a little bit moreaway, you snap it again and
before you know it, thispatient's never going to see you
again, because they're likewhat the hell is wrong with this
person?
You literally spend an hour anda half stressing yourself out
over a $200 procedure and thenyou put the bone graft in for
(14:29):
free because you felt so badthat you pretty much cut a giant
hole in this person's face.
Have you ever done that?
And the only reason I know isbecause I've been there and I
see it happening.
Here's what you do you trysomething for 20 seconds.
If it doesn't work, you pick upyour handpiece and you drill
away a ton of bone.
And then you try something elsefor 20 seconds and if it
doesn't work, you pick up yourhandpiece and you drill, you
(14:49):
section the tooth, you removebone, you get aggressive and
this is how you get teeth outfast.
You quit messing around.
You say you know what?
I'm gonna get this tooth out ofthis person's head, so I'm
gonna drill away bone.
I mean that furcal bone inthose upper molars and those
lower molars.
I mean this crest is typicallygoing to heal from facial to
lingual crest, right.
(15:10):
So get rid of the fercal bone.
It's not doing anything for you.
Section teeth.
If you don't know how to dothis, learn how to do this.
You could take out teeth sofast and you can be such a
profitable procedure.
So that's just a little Idigress.
I don't know why I went on that, but I hope you learned
something there.
You know, stop, push, push,push in and pray, push and pray,
hope I get lucky.
Push and pray no, that doesn'twork.
(15:31):
That's not how teeth come outof people's heads, all right.
So I want to give you sometakeaways here.
Do the math on your procedures.
Calculate the dollar per hoursfor your common procedures,
figure out what you are doingthem at and figure out where you
can improve.
And figure out what is yourgoal.
You should have a goal, but youshould also have a floor,
(15:54):
because I'm telling you fillingsare never going to be as
profitable as crowns dollar perhour.
Typically, they just can't be.
But the thing is is you shouldhave a floor and if it's taking
you four hours to do a molarroot canal, either you got to do
that faster or you got to referit out.
It's not worth your time.
If it doesn't meet the floor ofjust minimum production per
hour, send it out.
Don't be doing those proceduresNow.
(16:14):
I really think you can learn it.
You can get better at it.
But if I'm saying, if you can'tsend it out, don't be dumb about
your schedule and look at yourschedule.
Try to identify the low profitstuff that is killing you.
I had a coaching client onceand they were doing these
elaborate exams.
They were charging like $350for it, but it was taking an
hour of doctor time.
I'm sorry you can't have thedoctor for an hour for $350.
(16:37):
You just can't do that.
Okay, maybe you can do that incertain boutique practices where
you're doing full mouth rehabsand stuff like that.
That's not going to work inyour everyday practice.
It just doesn't make sense.
The math doesn't work.
And protect your high profitprocedures.
This is what I love about blockscheduling is we are holding
time in our schedule for thehigh profit procedures.
(16:57):
We're making sure we're goingto see at least two or three
crowns per day and we're not.
And it's not negotiable.
It's not like I know I want tosee two or three crowns per day,
but this person's got fillingsand they want to come in next
Tuesday.
No, this spot's for a crown.
You don't got to tell a patientit's for a crown.
But I mean, you know we aresetting up our days in a way
that we can be profitable.
We can hit our goal.
We could take great care of ourpatients.
(17:19):
We can have a nice chill day sowe can take great care because,
let's face it, when we'rerunning around like crazy, we're
not doing a good job.
We're not doing good dentistry,we're not providing a good
experience.
So everything is for thepatient's benefit, but it is
also very profitable and itworks for the owner as well.
Look at all your appointmentsand elevate every single one of
them.
See what you can do.
Can you utilize the assistantto deliver night guards?
(17:42):
Can they get the crowns readyfor you so that maybe a crown
delivery, instead of being 40minutes of doctor time, it's
just a five minute thing you doas you walk down the hall?
And we didn't talk much abouthygiene today.
I mean, we don't think wetalked about hygiene much at all
.
But same thing.
What's their profitableprocedure?
Scaling and root planing.
Let's make sure they do acertain amount of that every day
.
What else do they do?
Well, they can add adjunctslike fluoride sealants.
(18:03):
They can do lasers.
Let's equip them to do that.
Let's give them the verbiage todo it.
Let's teach them how to sellthat stuff.
Teach them how to teach theirpatients what the benefits are.
How can we get hygiene's dollarper hour up?
I would say for a lot ofoffices with hygiene low dollar
per hour, they're giving thehygienist way too much time to
do some procedures and alsothere's just a lot of
(18:25):
cancellations and a lot ofinefficiency in the schedule.
That's what I see.
These are all things that wetalk about in the Dental
Practice Hero programs.
So just summing up these highprofit procedures, that is what
really makes you profitable.
Profitability comes from how youmanage these high profit
procedures and how you takethese lower profit procedures
(18:45):
and make them more profitable.
So I could tell you I couldpick some of your schedules,
your four-day schedule, and meand my two assistants could
pound it out in eight hours.
I know it because I've seen it.
This is what happens when youwork with your team and you
start getting intentional abouthow you're doing things, and you
could sit over my shoulder andwatch me do it.
I'm not doing crappy dentistry,I'm not cutting corners.
(19:07):
I am doing solid stuff and Iguarantee my patients are just
as happy as yours and if maybemore happy because they don't
have to spend more.
They don't have to spend asmuch time as at the dentist
right, I mean, they don't wantto be there.
So reflect on your schedule.
If you ran the math, whatprocedures are you doing that is
secretly dragging you down,dragging down that average, and
(19:29):
what are some small changes thatyou can make to flip that, and
if you're looking for some help,this is the kind of stuff we
teach with our coaching.
We teach all our clients how tobe more efficient, how to be
better with their procedures andhow to lead a team, so that we
create those natural systemicefficiencies that make things
move along really fast andcreate the proper schedule that
(19:51):
hits you to your goals.
So if that's something you'relooking for,
dentalpracticeheroescom, we willhelp you get there, I promise.
So go back, look at yourschedule and stop being so
inefficient, stop being so lowprofit.
You can do this, I promise you.
All right, thank you so muchfor listening today.
We will talk to you next time.
Now imagine you own two businesses one in which
you make $1,500 for 40 minutesof work and in the other one you
only make $300 for that sametime, 40 minutes.
Which one do you want to scaleand try to take to new levels?
Now I know what I would choose.
I would choose the first one,and the thing is is I've owned
(00:23):
both of those businesses and Idon't want to go back to the
second one.
I want the one that's $1,500for 40 minutes of work, and the
thing is is we can have either,but most of us, as dental
practice owners, we do have thesecond one.
Now let me ask you this whichone is gonna be more stressful?
Making decisions, making harddecisions about payroll and what
(00:45):
you can spend money on?
Should we run more marketing?
Do you think it's easier tomake those decisions when you're
making $1,500 every 40 minutesversus $300?
Hell yeah, it is.
Which one is going to have moremanagement issues where the
team wants things?
Maybe they want new instruments, maybe they want another person
up front, and you're looking atthe revenue and you're like the
revenue doesn't justify this.
(01:05):
So I told you I've had both.
I've went from one to the other.
I'm going to teach you how todo that today.
So stay tuned, we're going totalk about dollar per hour and
how we can maximize what we aredoing at the office.
Now you are listening to theDental Practice Heroes podcast.
I am your host, dr Paul Edgison.
I'm the owner of a largepractice in the south suburbs of
(01:27):
Chicago.
I'm a dental coach and I'vewritten two books on dental
practice management.
I am here to teach practiceowners how to live amazing lives
through creating highlyprofitable, team-driven
practices that do not requirethem for every little thing and
actually don't require them muchat all.
So if that's the practice youwant to run, you are in the
right place.
(01:48):
All right, today we are going totalk about dollar per hour.
Now, what the hell is dollarper hour?
Sometimes this is somethingthat you can get with those
metric reporting services, andsometimes they have it and it's
not that great of a metric,because it's hard for the
systems to calculate this forsome reason.
But what is dollar per hour?
(02:10):
We are talking about thedollars that you produce.
I'm talking about collectibledollars Now.
I'm talking about, like, afterinsurance write-off, real money
the dollars that you producedivided by the amount of hours
it took you to produce it.
So pretty simple, right.
So every provider in youroffice should have production,
should have adjusted production,and they should have the amount
of time it took to make thatadjusted production and they
(02:30):
should have the amount of timethat it took to make that
adjusted production.
So then you can figure outdollar per hour.
Now what should these numbersbe at?
Now I have some ideas of what Ithink they should be at Now.
I think, as a doctor, nowassociates, I want all of my
associates at $600 per hour.
That's where I want them.
I think it's a reasonablenumber.
I don't think if you're anowner doc and, like you, want to
(02:52):
crush it $600 per hour, I meanyou can do it.
But I think you should do a lotmore.
I have tons of clients above athousand dollars per hour.
I know doctors doing fifteenhundred two thousand dollars per
hour.
When I was practicing myself, Iwas doing around twelve hundred
thirteen hundred dollars perhour.
That was consistently where Ilanded.
That's where my goal was,that's where I felt comfort.
(03:14):
So there is no right or wrong,but you have a lot more options
if you produce more per hour.
Now what about hygienists?
We always hear this thing theyshould be producing 3x what
they're paid.
I find that very hard to get tothese days with hygiene
salaries, that is damn nearimpossible.
But I will tell you, in mypractice I want every single
(03:35):
hygienist to do about $150collectible per hour.
That's where we are at myoffice and those are just some
baseline metrics.
So if you go and calculate yourstuff and see what your
hygienists are doing, at leastyou have an idea of where you
should be All right.
So let's talk about the thingsthat affect dollar per hour.
I remember back in the day whenI opened up my practice, we were
(03:56):
having this one day where, man,we crushed it.
We were turning rooms, we weregoing from room to room on
roller skates, the hygienistswere numbing for me.
I was doing a bunch of fillings.
I don't think I did a singlecrown the whole day, but it was
a bunch of fillings, maybe someextractions in there too mixed
in.
But we saw a ton of patients,we saw new patients, we were
(04:17):
vibing.
We stayed on schedule all daylong.
It was busy as hell, but we didit.
And then when I looked at thenumber at the end of the day and
I was like shit, that can't beright.
There's no freaking way.
And then I looked at some otherdays where we had these huge
days and I'm like what is the Xfactor here and this is what it
was is it was crowns.
(04:38):
Is that if I do a full day offillings, I don't care how fast
I do them, it's never going tobe as profitable of a day when
compared to a day that I docrowns.
So we got to recognize, aspractice owners, I'm not saying
don't do fillings anymore, butI'm saying we got to recognize
that we need both.
And here's the thing I want youto think about is let's take a
typical crown and we're justgoing to make some round, easy
(04:59):
numbers here.
Let's say a crown and a buildupis $1,500.
Now if you are going to book anhour of doctor time now I'm
saying doctor time, right, I'msaying an hour of doctor time,
maybe that's 30 minutes ofdoctor time for the prep and 30
minutes of doctor time for thedelivery.
That's an hour total doctortime.
You got $1,500 there.
That is a $1,500 per hourprocedure.
(05:21):
Cool, that makes our average goup for the day.
So we want to do some more ofthose, right?
But what if we now take twodoctor hours to do that.
Now it's $750 per hour.
What if we take three hours todo that and I can't tell you how
many times I see people doingthis They'll book a two hour
doctor slot for a crown and thenthey'll book an hour for the
(05:41):
delivery and the doctor is inthere the whole time.
So, three hours $1,500, andyou're doing $500 an hour and
you wonder why you're strugglingto pay your bills.
Well, it's great that you gotsomething to do for three hours,
but shit, that's not veryprofitable.
So we want to do somethingabout that.
So we got to realize that whenwe have crowns on our schedule,
(06:02):
it's not just by them beingthere.
We have to do them in a certainmanner.
And I don't want you to hear meand say I'm telling you to
hurry through all yourprocedures.
I'm not saying that.
I'm not saying cut corners andI'm not saying you got to run on
roller skates.
I'm just saying be smart aboutit.
Be smart about the way you useyour time and the efficiencies
that you build into yourpractice.
And this is what we teach withour coaching.
(06:23):
This is what our programs areall about, because if you're a
doctor and you wanna cut downyour days, you gotta get your
dollar per hour up.
So this is what Dental PracticeHeroes is all about.
Now let's talk about the secondthing fillings.
Here we need to minimize thedrag that fillings have on our
schedule, and we do that a fewways, first of which is we limit
how many filling appointmentswe're willing to see each day
(06:45):
and we hold spaces for crowns.
This is the DPH blockscheduling you might've heard me
talk about before.
We're holding spaces for crowns.
So we have that extra note,those big numbers, those high
profitability procedures to makeup for the lower profitable
ones, and we're limiting howmany fillings we're going to do.
But the thing is too, we needto think about fillings in a
special way.
(07:05):
I remember one time I it youknow it should have been a crown
, I should have crowned it, butI did a big M-O-D-B-L.
Sometimes, dude, those are funas hell because it's just fun to
put all that stuff in thattooth.
That looks like crap.
And then you're carving it, andit's one of those ones I like
spent time, I put anatomy intoit, I polished it really nice.
(07:25):
Oh, baby, it looks so good.
And there was like this littlemesial buckle cusp that was
holding it all together.
And the patient came back aboutthree weeks later in that
little tiny sliver of a cuspthat I left there.
Well, it broke off and I lookedat that.
I said, ok, well, I guess I'lljust patch that.
And then I looked at that and Isaid, dude, this should have
(07:46):
been a crown.
What the heck am I doing?
How long did it take me to dothat filling?
And what did I benefit thepatient?
A lot of the times we feel likewe're doing the right thing for
the patient because we're savingthem money by not doing the
crown.
But over time, what I want youto see is that if we don't
properly restore teeth, we don'thave a good long-term prognosis
(08:06):
and we can, a lot of the times,cause the patient to pay more.
I mean, I am putting thatpatient in a situation where
they've got something that lookslike a tooth there.
They can chew on it, but theyended up breaking that mesial
buccal cusp off.
Now what if that broke down tothe root?
They had to take the tooth out.
What if it broke into the nervechamber?
Now they need a root canal.
What good did I do this personby doing a filling on them.
(08:27):
That took me a ton of time.
It was no profit at all in theprocedure and then they ended up
having to spend a ton moremoney into getting a ton more
work down the line, right?
So we're going to use the blockscheduling to limit how many
fillings we're doing.
We're going to use the blockscheduling to have a certain
baseline level of profitableprocedures that we're doing.
But we also need to realize,when we're treatment planning
(08:49):
things that are just dumb, thatdon't make sense, because we're
scared to tell the patient whatthey really need, because we're
treatment planning things thatare just dumb, that don't make
sense, because we're scared totell the patient what they
really need, because we'reprejudging the patient on what
they can afford and what theyvalue, and that is not the best
way to treat your patients.
So watch how you're treatmentplanning.
Make sure that you're nottreatment planning dumb stuff.
If it needs to be a crown, makeit a crown.
(09:11):
And now the third point we needto make every single procedure
as profitable as possible, andhere's what I mean by that.
We talked about the crown thing.
You know, if it's $1,500 anhour, if it takes us an hour, if
it takes us two.
It's $750 an hour.
But we need to look at everysingle procedure.
And what does it look like whenwe do that?
(09:33):
Let's look at every singleprocedure and what does it look
like when we do that.
Let's look at fillings.
You know, how can we makefillings more profitable?
How can we utilize ourassistants better?
How can we prep faster?
You know, I'll give you just aquick tip on prepping fillings
is take that high speed anddrill it out until you've got a
clean DEJ all the way aroundyour prep.
Then you know that you've gotthis outline form of your
(09:55):
filling and now all you do is gowithin that filling and clean
out the decay in the middle.
Pick up the slow speed, cleanup the decay, you're done.
You know you're not switchingburrs, you're not taking a bunch
of looks at different angles.
Don't stop the burr.
Same thing with prepping crownsDon't stop the burr, unless you
have to Stop looking.
When you start touching asurface, prep that whole surface
(10:16):
.
When you reduce the occlusion,reduce the occlusion so you
don't have to come back and doit again.
When you're prepping the buccalaxial wall, reduce it enough so
you don't have to come back anddo it again.
Do things once.
Okay, this is not hurried, thisis just effective and efficient
.
Let's talk about anotherprocedure.
That could be super profitable,but sometimes not so much.
(10:37):
What about a night guard?
Okay, we usually will have ourassistants.
They'll take the impression fora night guard and then the
patient comes in on the doctor'sside and we spend 40 minutes to
an hour.
We're delivering this thing,we're adjusting it.
Now, what is this?
A $500 procedure.
We took like 40 minutes to anhour.
What's the dollar per hour onthat?
I don't know.
(10:58):
$350 to $500.
That's not a lot, you know.
It's not worth an hour ofdoctor time.
What if we could teach ourassistants how to make the
adjustments, get it all readyand then you pop in as the
doctor and you say let's take alook.
Chomp, chomp, chomp.
How does it feel?
It feels great, oh my gosh.
You look at your assistant andyou're like you are so good at
(11:19):
this.
You give him a compliment infront of the patient.
The patient's like hell, yeah,you know what.
So now, how long did that takeyou?
Five minutes, you didn't spendany time.
But if you've got a $500 nightguard, that takes you five
minutes.
What is the dollar per hourproduction.
On that five minute procedure.
That becomes like a $6,000 perhour procedure.
(11:39):
Now, it's only for five minutes, you know, but that becomes a
very highly profitable procedure.
So you start looking ateverything you do and you start
saying, how can I make this aprofitable procedure that meets
my goals for what I want toproduce every year and every
week and every day?
You can take these goals allthe way back to the daily and
move them all the way back to anhourly goal and then you can
(12:01):
plan your whole year from it.
We also got to make sure thatwe're adding the right
procedures.
You know, are we offeringfluoride?
Are we offering sealants?
Are we even offering thosenightguards?
Are we offering whitening?
You know these are things thatyou can add on that can increase
your dollar per hour, becausethese don't require you.
A lot of these procedures canbe done by the assistants.
So what's the dollar per houron that?
Well, it's kind of infinite tosome extent because you don't
(12:24):
have to do it.
What about extractions?
I mean, I see clients they'llbook one single extraction.
They'll book an hour to an hourand a half of it.
The procedure is about $200.
I'm sorry, you're not going tohave a profitable practice if
you're spending an hour to anhour and a half to do a $200
procedure?
If you wanted to spend an hourto an hour and a half doing a
(12:44):
$200 procedure, you should havewent to hygiene school.
You could do it all day long,but you're a doctor so you
should not be doing that.
So what do we do withextractions?
I mean, I'm telling you you gotto offer the bone graft.
If you think there is value inpreserving bone around extracted
teeth and in the extractionsocket and preserving that ridge
, offer that to the patients.
(13:05):
That makes that littleextraction become a much more
profitable procedure.
How long does it take to do abone graft?
To throw some bone chips inthere and to cover it with a
little membrane and sew somelittle sutures on top of it.
It doesn't take very long butit makes it a really profitable
procedure.
But I'll tell you what else isreally killing a lot of people's
extractions, because I haveassociates.
I see it is we pray, we justpray that tooth comes out.
(13:28):
We take that little elevatorand we push, push, push from
over here, we push, push, pushfrom over there and then we push
, push, push back in the firstspot, back to the second spot,
back to the first spot.
We keep push, push and we sayplease, please, come out.
And we pick up those forcepsand we grab it and we say this
doesn't feel like it's going tocome out, but maybe I'll get
lucky, because sometimes you getlucky.
Right, it's like the slotmachine If it pays off every now
(13:48):
and then you keep doing it.
So you do that and then yousnap it off and then you sit
there and you push, push, pushwith your little elevator, push,
push, and nothing happens.
And then you pick up your drill.
Finally you remove some bone,but don't remove a lot, because
we're trying to be conservativeand we don't want to remove too
much bone.
And then you push, push, push,and where you lost that little
(14:09):
bone, guess what happens?
You snapped off your root atthe tip.
You drill a little bit moreaway, you snap it again and
before you know it, thispatient's never going to see you
again, because they're likewhat the hell is wrong with this
person?
You literally spend an hour anda half stressing yourself out
over a $200 procedure and thenyou put the bone graft in for
(14:29):
free because you felt so badthat you pretty much cut a giant
hole in this person's face.
Have you ever done that?
And the only reason I know isbecause I've been there and I
see it happening.
Here's what you do you trysomething for 20 seconds.
If it doesn't work, you pick upyour handpiece and you drill
away a ton of bone.
And then you try something elsefor 20 seconds and if it
doesn't work, you pick up yourhandpiece and you drill, you
(14:49):
section the tooth, you removebone, you get aggressive and
this is how you get teeth outfast.
You quit messing around.
You say you know what?
I'm gonna get this tooth out ofthis person's head, so I'm
gonna drill away bone.
I mean that furcal bone inthose upper molars and those
lower molars.
I mean this crest is typicallygoing to heal from facial to
lingual crest, right.
(15:10):
So get rid of the fercal bone.
It's not doing anything for you.
Section teeth.
If you don't know how to dothis, learn how to do this.
You could take out teeth sofast and you can be such a
profitable procedure.
So that's just a little Idigress.
I don't know why I went on that, but I hope you learned
something there.
You know, stop, push, push,push in and pray, push and pray,
hope I get lucky.
Push and pray no, that doesn'twork.
(15:31):
That's not how teeth come outof people's heads, all right.
So I want to give you sometakeaways here.
Do the math on your procedures.
Calculate the dollar per hoursfor your common procedures,
figure out what you are doingthem at and figure out where you
can improve.
And figure out what is yourgoal.
You should have a goal, but youshould also have a floor,
(15:54):
because I'm telling you fillingsare never going to be as
profitable as crowns dollar perhour.
Typically, they just can't be.
But the thing is is you shouldhave a floor and if it's taking
you four hours to do a molarroot canal, either you got to do
that faster or you got to referit out.
It's not worth your time.
If it doesn't meet the floor ofjust minimum production per
hour, send it out.
Don't be doing those proceduresNow.
(16:14):
I really think you can learn it.
You can get better at it.
But if I'm saying, if you can'tsend it out, don't be dumb about
your schedule and look at yourschedule.
Try to identify the low profitstuff that is killing you.
I had a coaching client onceand they were doing these
elaborate exams.
They were charging like $350for it, but it was taking an
hour of doctor time.
I'm sorry you can't have thedoctor for an hour for $350.
(16:37):
You just can't do that.
Okay, maybe you can do that incertain boutique practices where
you're doing full mouth rehabsand stuff like that.
That's not going to work inyour everyday practice.
It just doesn't make sense.
The math doesn't work.
And protect your high profitprocedures.
This is what I love about blockscheduling is we are holding
time in our schedule for thehigh profit procedures.
(16:57):
We're making sure we're goingto see at least two or three
crowns per day and we're not.
And it's not negotiable.
It's not like I know I want tosee two or three crowns per day,
but this person's got fillingsand they want to come in next
Tuesday.
No, this spot's for a crown.
You don't got to tell a patientit's for a crown.
But I mean, you know we aresetting up our days in a way
that we can be profitable.
We can hit our goal.
We could take great care of ourpatients.
(17:19):
We can have a nice chill day sowe can take great care because,
let's face it, when we'rerunning around like crazy, we're
not doing a good job.
We're not doing good dentistry,we're not providing a good
experience.
So everything is for thepatient's benefit, but it is
also very profitable and itworks for the owner as well.
Look at all your appointmentsand elevate every single one of
them.
See what you can do.
Can you utilize the assistantto deliver night guards?
(17:42):
Can they get the crowns readyfor you so that maybe a crown
delivery, instead of being 40minutes of doctor time, it's
just a five minute thing you doas you walk down the hall?
And we didn't talk much abouthygiene today.
I mean, we don't think wetalked about hygiene much at all
.
But same thing.
What's their profitableprocedure?
Scaling and root planing.
Let's make sure they do acertain amount of that every day
.
What else do they do?
Well, they can add adjunctslike fluoride sealants.
(18:03):
They can do lasers.
Let's equip them to do that.
Let's give them the verbiage todo it.
Let's teach them how to sellthat stuff.
Teach them how to teach theirpatients what the benefits are.
How can we get hygiene's dollarper hour up?
I would say for a lot ofoffices with hygiene low dollar
per hour, they're giving thehygienist way too much time to
do some procedures and alsothere's just a lot of
(18:25):
cancellations and a lot ofinefficiency in the schedule.
That's what I see.
These are all things that wetalk about in the Dental
Practice Hero programs.
So just summing up these highprofit procedures, that is what
really makes you profitable.
Profitability comes from how youmanage these high profit
procedures and how you takethese lower profit procedures
(18:45):
and make them more profitable.
So I could tell you I couldpick some of your schedules,
your four-day schedule, and meand my two assistants could
pound it out in eight hours.
I know it because I've seen it.
This is what happens when youwork with your team and you
start getting intentional abouthow you're doing things, and you
could sit over my shoulder andwatch me do it.
I'm not doing crappy dentistry,I'm not cutting corners.
(19:07):
I am doing solid stuff and Iguarantee my patients are just
as happy as yours and if maybemore happy because they don't
have to spend more.
They don't have to spend asmuch time as at the dentist
right, I mean, they don't wantto be there.
So reflect on your schedule.
If you ran the math, whatprocedures are you doing that is
secretly dragging you down,dragging down that average, and
(19:29):
what are some small changes thatyou can make to flip that, and
if you're looking for some help,this is the kind of stuff we
teach with our coaching.
We teach all our clients how tobe more efficient, how to be
better with their procedures andhow to lead a team, so that we
create those natural systemicefficiencies that make things
move along really fast andcreate the proper schedule that
(19:51):
hits you to your goals.
So if that's something you'relooking for,
dentalpracticeheroescom, we willhelp you get there, I promise.
So go back, look at yourschedule and stop being so
inefficient, stop being so lowprofit.
You can do this, I promise you.
All right, thank you so muchfor listening today.
We will talk to you next time.
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