August 7, 2025 • 25 mins
Running behind every day isn’t normal — it’s a systems problem. From scheduling to delayed exams, this episode explores what causes chaos in dental practices and simple fixes that can get the whole office running smoothly again.
Our tips and tricks will help you time hygiene exams, handle emergencies, and create a culture that keeps everyone on time. If your days feel like a game of catch-up, this episode is for you!
Topics discussed in this episode:
- How running behind impacts patients and your team
- Why so many offices fall off schedule
- Systems that keep hygiene appointments on time
- Smart scheduling and team communication
- Creating a culture that values timeliness
- How to plan for patient emergencies
- What to do when you’re running behind
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Paul Etchison (00:02):
Patients hate waiting.
Your team hates feelingoverwhelmed.
You hate spending the daytrying to catch up.
Every office runs behind, butif it's happening every single
day, it's time to take a closerlook at your systems.
Today, the DPH coaches are herewith me to break down what
causes so many practices to fallbehind and how you can make
your office more efficient.
(00:23):
You're gonna get some tips onhow to manage your schedule, get
better case acceptance and stayon time even when the
unexpected happens.
Plus, we're going to share howto keep things calm on those
days when things get a littlecrazy and we do run behind.
You are listening to the DentalPractice Heroes podcast, where
we teach dentists how to stepback from the chair, empower
their team and build a practicethat gives them their life back.
(00:46):
I'm your host, dr Paul Etcheson, dental coach, author of two
books on dental practicemanagement and owner of a large
four-doctor practice that runswith ease, while I work just one
clinical day a week.
If you're ready for a practicethat supports your life instead
of consuming it, you're in theright place.
My team of legendary dentalcoaches and I are here to guide
you on your path fromoverwhelmed owner to dental
(01:08):
practice hero.
Let's get started.
Welcome back to the DentalPractice Heroes podcast.
We are so thankful to have youjoining with us.
We are here with my two DPHcoaches Dr Henry Ernst, owner of
an 18-op large practice in theCarolinas, and Dr Steve
Markowitz, owner of sixpractices, a group and a whole
(01:32):
mess of employees.
Steve, how many employees?
You got 152, I think today.
Wow, today, oh, did you justhire one today or fire one?
We hired two assistants, so hejust pushed past 150.
He's at 152 now, and that's alot of responsibility for one
man.
It's not just on me.
That's what we talk about.
What a humble answer.
This is why you belong here,steve.
(01:53):
This is why the listeners comeback for you.
Steve Markowitz (01:54):
They love this.
I'm sure it is, I'm sure it isHumble, steve.
Yep and then for the.
Now, for the next 11 minutes, Iwill stay quiet and you will
learn from Henry.
Paul Etchison (02:04):
So so today we are talking about you know, I'm
going to tell you, every singleI just said this before we, we
hit record every single coachingclient I've ever ran with, you
know, ever I ever worked with, Italked to their team and they
don't run on time.
And every doctor thinks theyrun on time and every team
thinks their doctor does not runon time.
So I mean there is adiscrepancy here.
(02:25):
There's there's.
There is some difference inperspective.
But today we're going to talkabout secrets to running on time
because I think you know, ifyou look at the reviews in my
office, it's one of the thingsthat consistently comes up in
reviews always sad on time.
Like always on time.
I never have to wait, they getme back right away, they get me
in fast.
So let's talk about running ontime.
(02:47):
Steve, what does that look likefor you in your group?
Steve Markowitz (02:51):
It is part of who we are, and I think that is
where to start with.
This is why is it importantthat we run on time For us.
We know that patients do notlike going to the dentist.
They don't want to be there.
They're already afraid, andwhen they are sitting in the
waiting room and theirappointment was supposed to be
at one and it's 105, the fearstarts to get even greater.
(03:11):
So sitting on time is important, what I also share with our
team a patient's appointment intheir mind starts when they
break through the threshold intothe back.
So sitting them on time is moreimportant than finishing their
appointment on time.
There are multiple perspectives.
Let's go from the doctor'sperspective.
The first thing you need toknow is you need to know how
(03:33):
fast you do procedures or howslow you do procedures.
You need to know your time andyou need to know where there is
opportunity for you to speedthings up if you need to.
A crown prep is not a crownprep is not a crown prep.
An extraction is not anextraction is not an extraction.
Things happen, complicationshappen, patients have things
they need to, they startcoughing or whatever.
(03:54):
Things just happen in every day, in every dental office and we
have to know that.
So if it's, if it takes you 20minutes to prep a crown, you
need to know that, because nowyou have 30 minutes to do
everything else.
If you have an hour for thatappointment and then 10 minutes
to turn that room over and do itagain, or there needs to be
some time within that hour whereyou pick it up and find
(04:18):
opportunities to be moreefficient throughout that
appointment, I would start withtiming and then just create a
culture of staying on time andthen for me personally, when
that rare occurrence happenswhere I'm running behind, I am
walking out to that waiting roomand saying I'm so sorry, I'm
going to be with you in a secondand we're just turning the room
over, or I want to make surethat it's not.
We're not just, they're notjust sitting there without any
(04:39):
acknowledgement of us runningbehind.
Paul Etchison (04:40):
You personally go out to the waiting room.
Every time I do, I mean, oh myGod, dude, I feel like that's
like the floor is lava out there.
If there's patients in thewaiting room, I don't want to
even like step foot out there.
I didn't want to go out thereand get like a bottle of water.
I'm like, oh patients, see mebackstage, what?
Steve Markowitz (04:55):
the heck.
I totally understand that andI'm seeing patients.
I try to like turn on all ofthe charm that I have left in my
body, but but I think that thatthey're paying for me.
They're there to see me.
(05:15):
Part of that is when things aregoing perfect.
I need to go towards it and sayhow do I fix this?
And it's I've shared this manytimes.
I am scared shitless of flying.
I will if I could have itanyway.
I would love the pilot to comeon the entire time and talk to
me and say we're going to beturning right in the next couple
minutes, so just look out yourright window.
And then, every single timethey talk, I'm like thank God,
(05:36):
that guy's the best.
So I know that patients areafraid when they come in the
dentist.
So anytime that I can createsome kind of interaction, let me
run towards that and give anopportunity for them to be like.
I know I'm running behind.
That's on me.
I'll see you in a coupleminutes, don't worry.
We're setting up, all is great.
Paul Etchison (05:53):
I think that's great advice and this is, you
know, you mentioned start withmaking it part of your culture
to stay on time.
Part of our culture andsomething this is part of our
onboarding videos is I gothrough this study called the
psychology of waiting and one ofthe things is it says anxious
waits are longer thannon-anxious waits.
And this is just some studyabout waiting.
And you know, is an anxiouswait sitting in the waiting room
(06:15):
at the dentist?
Yeah, so it's going to seem alot longer if you're waiting.
But one thing that we say thatcame from this, it was that
finite weights are shorter thaninfinite weights.
So if you are behind my teamknows this if we're running
behind somebody not me, not methe doctor I'm not doing it.
But somebody is going out thereand saying, hey, mr Jones, we
(06:41):
know you're here, we're runningabout 10 minutes behind, we're
so sorry, and immediately thattakes the pressure off of Mr
Jones.
Now, now Mr Jones doesn't haveto sit there and think, oh, did
they forget about me?
Do I have to go?
So I know that doesn'tnecessarily mean we're supposed
to be talking about how to stayon time, but that is.
I love that you brought that upthat makes such a big
difference.
What's this look like?
Henry Ernst (06:56):
in your office, henry.
Well, let's talk about one ofthe things that I find that is
the most common aspect ofrunning behind is doctor slash
hygiene.
You know most offices and I'lltake this from different points
of view points of view wherewe've got multiple hygienists or
we've just got one, it doesn'tmatter.
Or we're assisted or not.
Assisted hygiene Typicalhygiene patient comes into the
(07:18):
room assisted or not assisted.
You're getting all the initialwork done, the x-rays, the
evaluation.
Is it prophy, is it guminfection?
And once you get to that pointwhere work is going to get done,
prophy is about to happen.
Let's say right then.
And there the hygienist shouldwrite down the time stamp.
It's 2 16 pm.
That indicates that's the timeI'm starting the prophy.
(07:40):
That should doc should find thedoctor.
And this could be a one doctoroffice.
This could be a one doctoroffice.
This could be a multiple doctoroffice.
It goes into the doctor's chair.
Nonverbal communication I hateit when a patient's in a room
and somebody says, okay, we'restarting the prophy in room six.
That's freaking like alunchroom.
We don't want that Nonverbalcommunication.
You come into the room nice andquietly.
You've put that little slipright in front where the doctor
(08:02):
can see it.
I'll look at it.
I'll say, okay, 216.
I've got a half hour to get in.
There is how we've always tellour doctors For an adult prophy
patient, you've got 30 minutesto get in there.
We want our doctors to get inthere before 30 minutes, while
the hygienist is there, notafter.
Mistake mistake that peoplemake in offices is hygienist
(08:23):
does the prophy.
There's no communication andthe hygienist or assistant is
now trying to find the doctorafter the prophy is done and the
patient's just sitting there.
Right Now the doctor's in themiddle of a root canal on number
14 and they don't come for like30 minutes.
Paul Etchison (08:36):
The patient is pissed and how does that patient
feel when the doctor eventuallycomes and takes a 30-second
look and then sends them ontheir way?
Henry Ernst (08:43):
Even more pissed, right, yeah, so system.
So let's go back with thissystem here.
Doctor gets a slip.
It says 2-16.
The doctor in their head says Igot to get in there with a half
hour and just for systemspoints of view, if it's a child
it's 20 minutes.
So we all know in our office wegot to get in there sooner.
If they made their evaluationand it's gum infection therapy
in our office we don't doanything.
(09:04):
That first day We've got ahighlight that says gum
infection patient and I know Ineed to get in there within 10
minutes because the hygienist iseducating the patient.
I just need to come in there toput the cherry on top of that.
So systems are very important.
Let's take it from the doctorpoint of view.
So in that same scenario, thedoctor has to understand that
they have to be cool about it.
(09:25):
They have to learn how tojuggle right.
So many doctors are so focusedon what you're doing right here
right now, which is fine.
But if you're doing a crownsurgery, you can always stop and
tell the patient tap them onthe shoulder.
Hey, listen, we've been workingfor a while.
Let's give you a little break.
Gives you a chance to slip out.
Let's say you're doing a rootcanal.
Hey, I'm going to put somemedicine in this tooth here and
(09:46):
I'm going to leave you for a fewmoments.
My assistant's going to keep aneye on you.
Let's let that medicine sit inthe out right.
This way you can slip out, doyour hygiene visits and stay on
time.
So now let's take the twodifferent patients.
(10:06):
The first patient I saw, 216.
I came in there within fiveminutes, I gave my exam and
treatment plan was given to theassistant.
So now the hygienist isfinishing their cleaning.
In the meantime, the admin teamis putting together the
treatment plan and as soon asthe hygienist is done, it's a
seamless transition Boomtreatment plan.
Patient never waited once, asopposed to doctors screwing
(10:28):
around with a tooth is sofocused on what they're doing
comes in a half hour later andthen the patient's pissed.
It's a 30-second exam, like yousaid.
Now they're waiting 15 minutesfor a treatment plan.
On top of that, which of thosetwo scenarios do you think
you're going to get a patientthat's going to say yes?
Paul Etchison (10:48):
Yeah, totally.
And the thing I was justthinking about is that when you
don't get up gracefully fromyour patient, it's like when you
have the hygienist sittingthere.
Doctor, I really need the examDoctor.
I'm still waiting for the examDoctor, still waiting.
I'm so sorry, mr Jones, I'll beright back.
That's not a nice way to get up.
You know one thing that forappointments I always tell my
coaching clients forappointments that they don't
have a good get up point, likeput medicine in the tooth.
I mean, you just mentioned hey,we're just going to give you a
(11:14):
job break.
I say to my assistant can youget the V3 system?
Henry Ernst (11:16):
We're going to use it like a laundry list of them.
Hey, your gums are bleeding alittle bit where there was decay
.
Let's have you bite on somegauze.
There's so many, a lot of thatthey're valid in some sort, you
know.
But it gives the patient a nicelittle break and it just makes
you stay on time.
That doctors just have troubledoing that for some reason.
Steve Markowitz (11:32):
Create the workflow that will allow that to
happen.
So, like I was just talkingabout that with a couple of my
doctors this morning, they'relike all right, I want to make
the temporary.
I want to make temporary first,then impression and then adjust
the temporary, and I'm likethey're sitting in the chair the
entire time when, if they wereto prep the tooth, take the
impression and then leave theroom so the assistant could make
(11:54):
the temporary.
There's built in gaps withinthat appointment where they can
go and check hygiene.
So understand your workflow,not just for the workflow of the
appointment that's in yourchair, but also for the other
rooms that are the otherpatients that are in your office
that need to be seen.
I would look at fillings arethe hardest one, but I would
look at almost every singleprocedure and create gaps in
(12:17):
your workflow and this is whenI'm going to go check on hygiene
.
Paul Etchison (12:22):
Yeah, absolutely.
And I think a lot of us look atthis and we say, hey, we got to
do our procedures faster.
How do we get more efficient?
How do we do this?
And there's so much time lostwith the hygiene waiting when
you have the hygienist come getyou when they're completely done
, and it's a total BS way ofdoing it that nobody likes, you
know.
And well, the other thing isthat I want to bring up is that
when you interrupt the cleaningfor hygiene, you can usually do
(12:45):
that exam pretty quick, becauseyou're just trying to get in and
out and you don't you'reinterrupting.
And when the patient's alreadysitting up, I've got to go
through.
How are the kids?
How are the let's?
Let's sit there and talk andthen I go hey, is it okay if I
lean you back, like they're noteven laying back right there,
and then it's like if they'retelling you a story, you got to
like press the button andinterrupt them.
Henry Ernst (13:02):
It's it doesn't feel good either.
For some reason, in dentistry,when I first started and I first
started implementing this 2014in my practice, like there was
some hygienists were like what,you're going to come in the
middle of my cleaning, mycleaning, you know?
Or doctors would say I don'twant to interrupt the hygienist.
There was some like I don'tknow what it was that it was
(13:23):
like forbidden.
Paul Etchison (13:23):
They're having this moment.
You don't want to interruptthat moment.
Henry Ernst (13:26):
Yeah, and now I think it's gotten better.
But you could get thosehygienists or doctors from other
offices that are used to badhabits I call them.
But what I was about to stickin there too is when you go in
there, your exam can be alsoquicker because you know, you
put your gloves on and you givethe hygienist the floor.
You basically, if yourhygienist named it hey, jane,
how did everything look?
How was oral hygiene?
(13:46):
And now your hygienist, who'salready spent time with them,
can point out some things.
Oh yeah, we noticed that brokentooth on the top and it gives
you just so much better, so muchbetter of an experience where
the you know you just so muchbetter visit.
So much better of an experiencewhere the you know the patient
just really sees this as a teamand you can make your exam a
little bit more efficient and,like I said, you get out of
(14:07):
there.
Hygienist does it.
Treatment plan is in motion.
Paul Etchison (14:10):
I love when the hygienist talk about.
You know, we talked to Mr Jonesabout his flossing.
He's really got to get thatgoing, because when they don't
say that, sometimes it's likehey, everything looks great and
they're just like I just talkedto him about.
He has a flaw since the lasttime he was here and well,
thanks for letting me know.
I didn't notice, you didn'twrite it down and you had no way
to tell me.
Henry Ernst (14:26):
And I wanted to hit on something that Steve
mentioned, which was a reallygood point Scheduling.
Hit it.
We have to scheduling, youdon't just stick anybody
anywhere.
Crowns I love crowns.
I can bounce around a crownlike a juggler, you know.
I can know I'm patient.
I can go do an extraction, Ican come back.
I prep the tooth, I get theheck out of the room after the
(14:48):
impression I'm done.
I'm not going to go back there.
I can jump around really,really good.
There are certain things that wecan never double book and I
don't allow them to double bookfillings.
I know other states have EFTAs.
We don't have those.
So fillings in our office wehave to stay there the whole
time unless we come up with areason, you know, to get out.
So we never double bookfillings.
We never double book crownseats because those are just
(15:10):
unproductive procedures,anything unproductive.
So we can't have a crown seatand then a denture adjustment
and then a bike guard adjustment.
We just don't do that.
And then you mentioned thisalso, steve is understand your
limitations.
My crown visit may be differentfrom a new graduate's crown
visit, you know, and it's okayto give yourself more time, it's
okay to extend it, shorten itif I don't need that much time.
(15:34):
And also, we're treating peoplehere sometimes.
Oh, you know what this patient?
She requires a shitload moretime because she's a pain in my
ass and she never gets numb.
Okay, great, let's make thatlonger.
Let's not stress out our daybefore it even starts.
Steve Markowitz (15:46):
I wrote down like three things I want to
share, because we are supposedto do tips and tricks for
staying on time.
It's the unpredictability stuffthat always causes some us to
get behind.
So what I recommend in myoffices and doctors that I work
with today and tomorrow I needyou to communicate with either
your manager or the front oryour assistant.
If someone calls, where are weputting that person?
(16:09):
So there's an emergency.
This person needs to be seentoday, instead of having them
come back, stand outside theroom, this person on the phone
like I need them to know exactlywhere to put this person.
Or either they're going to tryand squeeze in and the place is
like the worst thing ever, orthey're going to interrupt me
and slow me down.
So I start by today andtomorrow knowing where to put
(16:31):
those last second emergencies.
The other thing I wrote down isyour hygiene exam cards.
For us, the hygienists do theirdata collection, which is
x-rays or period charts,depending on the exams.
Then they'll have an exam cardand on that exam card is a
picture of their face and itsays I need an exam.
And then they drop that in theroom and on the back it will say
(16:54):
have I met this patient beforethe patient's name?
Have I met this patient beforethe patient's name?
Chief complaints, anything elseand just those four bullet
points and they'll just writethat right in on the card, that
information.
And then I know I have at least20 minutes from the time that
that's dropped off, because it'safter the data collection, to
(17:16):
go in and interrupt or do theexam.
And then the third thing Iwrote down was train your
assistants.
If you're spending time doingthings that your assistant can,
you are not being as efficientand there will be times where
you will be behind.
So invest in the people thatyou can delegate to and it will
allow you to multiply time.
Paul Etchison (17:37):
Yeah, it's so true, that's what I was going to
bring up.
Is that bite guard adjustments?
Can your assistant do theselike crown seats?
I mean, take a 30-minute crownseat for doctor beginning to
finish and turn it into whereyour assistant does everything
Adjust the bite, adjust thecontacts, gets the tooth prepped
, gets the temp off, gets it allready to go.
Maybe your hygienist had tocome in and numb and you walk in
(17:58):
there and just squirt, squirt,squirt, smush and you can be out
of there.
I mean you can literally be outof there while they clean up
the cement.
I mean, look and check out whatyour practice laws are, because
I just took a 30 minute crownseat and turned it into like a
30 second.
I mean it was I don't even knowwhat you call it when it
Steve's honeymoon or something Idon't know.
Steve Markowitz (18:15):
Yes, that was a great day.
I don't know why this, I don'tknow what you I'm ignoring that,
paul, but I don't know why whatyou just said made me think of
it.
But quality dentistry shut up.
Quality dentistry, like greatimpressions lead to great
(18:37):
results crowns that seat easily.
So I think, as a new doctor,we're talking about efficiencies
and all these things, but themost efficient way to do
dentistry is for things to bedone well, cleanly and not have
all these complications andbloody I'm using crowns here but
bloody margins and things allover the place.
(18:59):
So focus on the quality of yourwork and then focus on your
efficiency and you'll have thosefollow-up, those next visits,
be much easier and able to findmore time throughout the day.
Henry Ernst (19:10):
Yeah, and I was gonna say a couple of things
that also little tidbits here Inthe system that I was talking
about, where doctor gets therouting slip from the hygienist
and they know they need 20 or 30minutes, we have trained our
hygiene assistants.
So if it's 10 minutes, if the10 minute warning is starting to
come, so 215, the prophy wasstarted, it's 235.
(19:30):
There's 10 minutes before thedoctor is supposed to come in
there, we will have that hygieneassistant stand outside the
doctor you know treatment roomand stand there and just stare
them down.
And I tell the doctors I saiddon't get mad at the assistants,
because I'm telling, we'retelling them to do this.
This is for the greater good ofthe office, so you don't run on
time.
And they've even establishedlike these little pictures it's
(19:52):
like a picture, you know to makeit fun of a sad person and when
it gets really close to beingtime or it's like time, they'll
have that sad picture up thereand that's like telling the
doctor in a nice nonverbal wayget your ass in there, right?
We don't.
We're not the office where thepatient's done with the prophy
and they're sitting there for along time.
We're just not that office andso any means you need to do it,
(20:13):
you do it and no matter what wetalk about here, the three of us
can talk about, we've got thishumongous nice practice with 152
people.
No matter what we do, there'sgoing to be instances where we
ran behind and we screwed up.
Right, it's going to happen.
There are some patients that,no matter what you do, they're
going to hold you to such atight window and I tell those
(20:35):
patients ahead of time listen, Iunderstand, that's how you are.
Let's always schedule you firstthing in the morning or first
thing after lunch and Iguarantee we'll get you back
right on time and I'll even puta pop up in there, get this
person's behind in there on timealways.
And then let's say you reallyscrew up.
And you know, I love the waythat you said, steve, hey, I go
out there and I takeaccountability.
I'll do the same thing.
I kind of do it in a differentway.
(20:56):
We have a little gift area inour practice where we keep stuff
Car wash.
So we have a car wash likeacross the street.
We keep like a stack of giftcards for car washes.
We have like Pleasant Plainsbeer mug, pleasant Plains lots
of stuff.
I'll kind of like oh, you knowwhat this guy seems like he'd be
a car wash guy.
I'll go there, grab a car wash,say listen, I'm sorry we messed
up, here's a car wash for you.
It doesn the owner doctor oryou know you.
(21:17):
You said we messed up, it's nothow we do it and you gave them
you know something for it.
Paul Etchison (21:27):
That's cool, you know, and I'll I'll share.
We have a deal with a pizzaplace by us and I'm sure you
could do this.
I don't know what you did.
It's a car wash place but a lotof businesses are willing to
give you like a discounted ratejust to hand their stuff out,
like it's a promotion for them,and like we had this pizza place
that's in our strip mall, wewould give out these coupons for
a free large pizza and thenthey would just keep the coupons
(21:49):
and they would give them to usand we would buy all the pizzas.
But we're only buying them forlike maybe like seven dollars a
piece or something like that.
You know, but here's, thispizza place is getting a full
order, like it's not justthey're going to order other
things too.
So it's like it was a win-winfor everybody.
And now we have somethingreally cool that didn't cost us
a lot of money to give away.
Henry Ernst (22:06):
We did like a hundred car washes that we
purchased, and we purchased at athird of the price all at once,
you know, and stuff like that.
So I think that's how we didthat.
Steve Markowitz (22:14):
Dunkin' Donuts and Starbucks.
You can actually brand the card, so, like it's our brand on the
gift card, we say that if we'remore than 10 minutes late, I'm
sorry.
We owe you a cup of coffee.
Coffee's on us and we justbought you.
But you can buy them online.
You can put your logo on it,and I don't know how many we
have in the office.
They're all over the place.
Not that we try not to bebehind, but when we are, we want
(22:35):
to make sure we acknowledge it.
Paul Etchison (22:37):
That reminds me of like back in the day, like
growing up.
I'd go to the mall and getSbarro pizza and there'll be the
sign that says if our cashierdoes not give you a receipt,
your meal is free, and every.
I have no idea what that wasabout.
I was in bezel man or something, but every time I was sitting
there I kid like dude, don'thand me that, don't hand me that
, I'm going to call you out.
(23:00):
Yeah, oh man.
Yeah, I still appreciate thepizza, you know.
I want to come back to what yousaid, henry, before we close out
.
Is you mentioned the thing withthe hygienist sitting and just
standing outside the room?
I think this is a good exampleof owners.
What the owner should do thisis leadership is you are
creating a boundary of what isacceptable for people to let
other people know I need you andsome doctors.
(23:24):
If you didn't tell them that,you know they might say I hate
when she does that, I hate whenshe's standing out there.
It's so rude but it's like.
No, this is how we do it whenyou are late, because you are
not to be late.
Henry Ernst (23:33):
Yeah, they do that to me and I'm appreciative of it
.
I'm like okay, I realize it.
Let me come up with my littlethings here and get the hell out
of here.
Paul Etchison (23:40):
Come up with my little things here and get the
hell out of here.
Love it, man.
Well, hey, if you're listeningand you're thinking about man,
it would be really nice to workwith a coach like one of these
guys and have them pick apart mypractice, give it the mental
focus it deserves and grow.
You're ready?
Go check outdentalpracticeheroescom and I
assure you you will get resultsthat you will be wondering why
you didn't do it sooner.
Thank you so much for listening.
Patients hate waiting.
Your team hates feelingoverwhelmed.
You hate spending the daytrying to catch up.
Every office runs behind, butif it's happening every single
day, it's time to take a closerlook at your systems.
Today, the DPH coaches are herewith me to break down what
causes so many practices to fallbehind and how you can make
your office more efficient.
(00:23):
You're gonna get some tips onhow to manage your schedule, get
better case acceptance and stayon time even when the
unexpected happens.
Plus, we're going to share howto keep things calm on those
days when things get a littlecrazy and we do run behind.
You are listening to the DentalPractice Heroes podcast, where
we teach dentists how to stepback from the chair, empower
their team and build a practicethat gives them their life back.
(00:46):
I'm your host, dr Paul Etcheson, dental coach, author of two
books on dental practicemanagement and owner of a large
four-doctor practice that runswith ease, while I work just one
clinical day a week.
If you're ready for a practicethat supports your life instead
of consuming it, you're in theright place.
My team of legendary dentalcoaches and I are here to guide
you on your path fromoverwhelmed owner to dental
(01:08):
practice hero.
Let's get started.
Welcome back to the DentalPractice Heroes podcast.
We are so thankful to have youjoining with us.
We are here with my two DPHcoaches Dr Henry Ernst, owner of
an 18-op large practice in theCarolinas, and Dr Steve
Markowitz, owner of sixpractices, a group and a whole
(01:32):
mess of employees.
Steve, how many employees?
You got 152, I think today.
Wow, today, oh, did you justhire one today or fire one?
We hired two assistants, so hejust pushed past 150.
He's at 152 now, and that's alot of responsibility for one
man.
It's not just on me.
That's what we talk about.
What a humble answer.
This is why you belong here,steve.
(01:53):
This is why the listeners comeback for you.
Steve Markowitz (01:54):
They love this.
I'm sure it is, I'm sure it isHumble, steve.
Yep and then for the.
Now, for the next 11 minutes, Iwill stay quiet and you will
learn from Henry.
Paul Etchison (02:04):
So so today we are talking about you know, I'm
going to tell you, every singleI just said this before we, we
hit record every single coachingclient I've ever ran with, you
know, ever I ever worked with, Italked to their team and they
don't run on time.
And every doctor thinks theyrun on time and every team
thinks their doctor does not runon time.
So I mean there is adiscrepancy here.
(02:25):
There's there's.
There is some difference inperspective.
But today we're going to talkabout secrets to running on time
because I think you know, ifyou look at the reviews in my
office, it's one of the thingsthat consistently comes up in
reviews always sad on time.
Like always on time.
I never have to wait, they getme back right away, they get me
in fast.
So let's talk about running ontime.
(02:47):
Steve, what does that look likefor you in your group?
Steve Markowitz (02:51):
It is part of who we are, and I think that is
where to start with.
This is why is it importantthat we run on time For us.
We know that patients do notlike going to the dentist.
They don't want to be there.
They're already afraid, andwhen they are sitting in the
waiting room and theirappointment was supposed to be
at one and it's 105, the fearstarts to get even greater.
(03:11):
So sitting on time is important, what I also share with our
team a patient's appointment intheir mind starts when they
break through the threshold intothe back.
So sitting them on time is moreimportant than finishing their
appointment on time.
There are multiple perspectives.
Let's go from the doctor'sperspective.
The first thing you need toknow is you need to know how
(03:33):
fast you do procedures or howslow you do procedures.
You need to know your time andyou need to know where there is
opportunity for you to speedthings up if you need to.
A crown prep is not a crownprep is not a crown prep.
An extraction is not anextraction is not an extraction.
Things happen, complicationshappen, patients have things
they need to, they startcoughing or whatever.
(03:54):
Things just happen in every day, in every dental office and we
have to know that.
So if it's, if it takes you 20minutes to prep a crown, you
need to know that, because nowyou have 30 minutes to do
everything else.
If you have an hour for thatappointment and then 10 minutes
to turn that room over and do itagain, or there needs to be
some time within that hour whereyou pick it up and find
(04:18):
opportunities to be moreefficient throughout that
appointment, I would start withtiming and then just create a
culture of staying on time andthen for me personally, when
that rare occurrence happenswhere I'm running behind, I am
walking out to that waiting roomand saying I'm so sorry, I'm
going to be with you in a secondand we're just turning the room
over, or I want to make surethat it's not.
We're not just, they're notjust sitting there without any
(04:39):
acknowledgement of us runningbehind.
Paul Etchison (04:40):
You personally go out to the waiting room.
Every time I do, I mean, oh myGod, dude, I feel like that's
like the floor is lava out there.
If there's patients in thewaiting room, I don't want to
even like step foot out there.
I didn't want to go out thereand get like a bottle of water.
I'm like, oh patients, see mebackstage, what?
Steve Markowitz (04:55):
the heck.
I totally understand that andI'm seeing patients.
I try to like turn on all ofthe charm that I have left in my
body, but but I think that thatthey're paying for me.
They're there to see me.
(05:15):
Part of that is when things aregoing perfect.
I need to go towards it and sayhow do I fix this?
And it's I've shared this manytimes.
I am scared shitless of flying.
I will if I could have itanyway.
I would love the pilot to comeon the entire time and talk to
me and say we're going to beturning right in the next couple
minutes, so just look out yourright window.
And then, every single timethey talk, I'm like thank God,
(05:36):
that guy's the best.
So I know that patients areafraid when they come in the
dentist.
So anytime that I can createsome kind of interaction, let me
run towards that and give anopportunity for them to be like.
I know I'm running behind.
That's on me.
I'll see you in a coupleminutes, don't worry.
We're setting up, all is great.
Paul Etchison (05:53):
I think that's great advice and this is, you
know, you mentioned start withmaking it part of your culture
to stay on time.
Part of our culture andsomething this is part of our
onboarding videos is I gothrough this study called the
psychology of waiting and one ofthe things is it says anxious
waits are longer thannon-anxious waits.
And this is just some studyabout waiting.
And you know, is an anxiouswait sitting in the waiting room
(06:15):
at the dentist?
Yeah, so it's going to seem alot longer if you're waiting.
But one thing that we say thatcame from this, it was that
finite weights are shorter thaninfinite weights.
So if you are behind my teamknows this if we're running
behind somebody not me, not methe doctor I'm not doing it.
But somebody is going out thereand saying, hey, mr Jones, we
(06:41):
know you're here, we're runningabout 10 minutes behind, we're
so sorry, and immediately thattakes the pressure off of Mr
Jones.
Now, now Mr Jones doesn't haveto sit there and think, oh, did
they forget about me?
Do I have to go?
So I know that doesn'tnecessarily mean we're supposed
to be talking about how to stayon time, but that is.
I love that you brought that upthat makes such a big
difference.
What's this look like?
Henry Ernst (06:56):
in your office, henry.
Well, let's talk about one ofthe things that I find that is
the most common aspect ofrunning behind is doctor slash
hygiene.
You know most offices and I'lltake this from different points
of view points of view wherewe've got multiple hygienists or
we've just got one, it doesn'tmatter.
Or we're assisted or not.
Assisted hygiene Typicalhygiene patient comes into the
(07:18):
room assisted or not assisted.
You're getting all the initialwork done, the x-rays, the
evaluation.
Is it prophy, is it guminfection?
And once you get to that pointwhere work is going to get done,
prophy is about to happen.
Let's say right then.
And there the hygienist shouldwrite down the time stamp.
It's 2 16 pm.
That indicates that's the timeI'm starting the prophy.
(07:40):
That should doc should find thedoctor.
And this could be a one doctoroffice.
This could be a one doctoroffice.
This could be a multiple doctoroffice.
It goes into the doctor's chair.
Nonverbal communication I hateit when a patient's in a room
and somebody says, okay, we'restarting the prophy in room six.
That's freaking like alunchroom.
We don't want that Nonverbalcommunication.
You come into the room nice andquietly.
You've put that little slipright in front where the doctor
(08:02):
can see it.
I'll look at it.
I'll say, okay, 216.
I've got a half hour to get in.
There is how we've always tellour doctors For an adult prophy
patient, you've got 30 minutesto get in there.
We want our doctors to get inthere before 30 minutes, while
the hygienist is there, notafter.
Mistake mistake that peoplemake in offices is hygienist
(08:23):
does the prophy.
There's no communication andthe hygienist or assistant is
now trying to find the doctorafter the prophy is done and the
patient's just sitting there.
Right Now the doctor's in themiddle of a root canal on number
14 and they don't come for like30 minutes.
Paul Etchison (08:36):
The patient is pissed and how does that patient
feel when the doctor eventuallycomes and takes a 30-second
look and then sends them ontheir way?
Henry Ernst (08:43):
Even more pissed, right, yeah, so system.
So let's go back with thissystem here.
Doctor gets a slip.
It says 2-16.
The doctor in their head says Igot to get in there with a half
hour and just for systemspoints of view, if it's a child
it's 20 minutes.
So we all know in our office wegot to get in there sooner.
If they made their evaluationand it's gum infection therapy
in our office we don't doanything.
(09:04):
That first day We've got ahighlight that says gum
infection patient and I know Ineed to get in there within 10
minutes because the hygienist iseducating the patient.
I just need to come in there toput the cherry on top of that.
So systems are very important.
Let's take it from the doctorpoint of view.
So in that same scenario, thedoctor has to understand that
they have to be cool about it.
(09:25):
They have to learn how tojuggle right.
So many doctors are so focusedon what you're doing right here
right now, which is fine.
But if you're doing a crownsurgery, you can always stop and
tell the patient tap them onthe shoulder.
Hey, listen, we've been workingfor a while.
Let's give you a little break.
Gives you a chance to slip out.
Let's say you're doing a rootcanal.
Hey, I'm going to put somemedicine in this tooth here and
(09:46):
I'm going to leave you for a fewmoments.
My assistant's going to keep aneye on you.
Let's let that medicine sit inthe out right.
This way you can slip out, doyour hygiene visits and stay on
time.
So now let's take the twodifferent patients.
(10:06):
The first patient I saw, 216.
I came in there within fiveminutes, I gave my exam and
treatment plan was given to theassistant.
So now the hygienist isfinishing their cleaning.
In the meantime, the admin teamis putting together the
treatment plan and as soon asthe hygienist is done, it's a
seamless transition Boomtreatment plan.
Patient never waited once, asopposed to doctors screwing
(10:28):
around with a tooth is sofocused on what they're doing
comes in a half hour later andthen the patient's pissed.
It's a 30-second exam, like yousaid.
Now they're waiting 15 minutesfor a treatment plan.
On top of that, which of thosetwo scenarios do you think
you're going to get a patientthat's going to say yes?
Paul Etchison (10:48):
Yeah, totally.
And the thing I was justthinking about is that when you
don't get up gracefully fromyour patient, it's like when you
have the hygienist sittingthere.
Doctor, I really need the examDoctor.
I'm still waiting for the examDoctor, still waiting.
I'm so sorry, mr Jones, I'll beright back.
That's not a nice way to get up.
You know one thing that forappointments I always tell my
coaching clients forappointments that they don't
have a good get up point, likeput medicine in the tooth.
I mean, you just mentioned hey,we're just going to give you a
(11:14):
job break.
I say to my assistant can youget the V3 system?
Henry Ernst (11:16):
We're going to use it like a laundry list of them.
Hey, your gums are bleeding alittle bit where there was decay
.
Let's have you bite on somegauze.
There's so many, a lot of thatthey're valid in some sort, you
know.
But it gives the patient a nicelittle break and it just makes
you stay on time.
That doctors just have troubledoing that for some reason.
Steve Markowitz (11:32):
Create the workflow that will allow that to
happen.
So, like I was just talkingabout that with a couple of my
doctors this morning, they'relike all right, I want to make
the temporary.
I want to make temporary first,then impression and then adjust
the temporary, and I'm likethey're sitting in the chair the
entire time when, if they wereto prep the tooth, take the
impression and then leave theroom so the assistant could make
(11:54):
the temporary.
There's built in gaps withinthat appointment where they can
go and check hygiene.
So understand your workflow,not just for the workflow of the
appointment that's in yourchair, but also for the other
rooms that are the otherpatients that are in your office
that need to be seen.
I would look at fillings arethe hardest one, but I would
look at almost every singleprocedure and create gaps in
(12:17):
your workflow and this is whenI'm going to go check on hygiene
.
Paul Etchison (12:22):
Yeah, absolutely.
And I think a lot of us look atthis and we say, hey, we got to
do our procedures faster.
How do we get more efficient?
How do we do this?
And there's so much time lostwith the hygiene waiting when
you have the hygienist come getyou when they're completely done
, and it's a total BS way ofdoing it that nobody likes, you
know.
And well, the other thing isthat I want to bring up is that
when you interrupt the cleaningfor hygiene, you can usually do
(12:45):
that exam pretty quick, becauseyou're just trying to get in and
out and you don't you'reinterrupting.
And when the patient's alreadysitting up, I've got to go
through.
How are the kids?
How are the let's?
Let's sit there and talk andthen I go hey, is it okay if I
lean you back, like they're noteven laying back right there,
and then it's like if they'retelling you a story, you got to
like press the button andinterrupt them.
Henry Ernst (13:02):
It's it doesn't feel good either.
For some reason, in dentistry,when I first started and I first
started implementing this 2014in my practice, like there was
some hygienists were like what,you're going to come in the
middle of my cleaning, mycleaning, you know?
Or doctors would say I don'twant to interrupt the hygienist.
There was some like I don'tknow what it was that it was
(13:23):
like forbidden.
Paul Etchison (13:23):
They're having this moment.
You don't want to interruptthat moment.
Henry Ernst (13:26):
Yeah, and now I think it's gotten better.
But you could get thosehygienists or doctors from other
offices that are used to badhabits I call them.
But what I was about to stickin there too is when you go in
there, your exam can be alsoquicker because you know, you
put your gloves on and you givethe hygienist the floor.
You basically, if yourhygienist named it hey, jane,
how did everything look?
How was oral hygiene?
(13:46):
And now your hygienist, who'salready spent time with them,
can point out some things.
Oh yeah, we noticed that brokentooth on the top and it gives
you just so much better, so muchbetter of an experience where
the you know you just so muchbetter visit.
So much better of an experiencewhere the you know the patient
just really sees this as a teamand you can make your exam a
little bit more efficient and,like I said, you get out of
(14:07):
there.
Hygienist does it.
Treatment plan is in motion.
Paul Etchison (14:10):
I love when the hygienist talk about.
You know, we talked to Mr Jonesabout his flossing.
He's really got to get thatgoing, because when they don't
say that, sometimes it's likehey, everything looks great and
they're just like I just talkedto him about.
He has a flaw since the lasttime he was here and well,
thanks for letting me know.
I didn't notice, you didn'twrite it down and you had no way
to tell me.
Henry Ernst (14:26):
And I wanted to hit on something that Steve
mentioned, which was a reallygood point Scheduling.
Hit it.
We have to scheduling, youdon't just stick anybody
anywhere.
Crowns I love crowns.
I can bounce around a crownlike a juggler, you know.
I can know I'm patient.
I can go do an extraction, Ican come back.
I prep the tooth, I get theheck out of the room after the
(14:48):
impression I'm done.
I'm not going to go back there.
I can jump around really,really good.
There are certain things that wecan never double book and I
don't allow them to double bookfillings.
I know other states have EFTAs.
We don't have those.
So fillings in our office wehave to stay there the whole
time unless we come up with areason, you know, to get out.
So we never double bookfillings.
We never double book crownseats because those are just
(15:10):
unproductive procedures,anything unproductive.
So we can't have a crown seatand then a denture adjustment
and then a bike guard adjustment.
We just don't do that.
And then you mentioned thisalso, steve is understand your
limitations.
My crown visit may be differentfrom a new graduate's crown
visit, you know, and it's okayto give yourself more time, it's
okay to extend it, shorten itif I don't need that much time.
(15:34):
And also, we're treating peoplehere sometimes.
Oh, you know what this patient?
She requires a shitload moretime because she's a pain in my
ass and she never gets numb.
Okay, great, let's make thatlonger.
Let's not stress out our daybefore it even starts.
Steve Markowitz (15:46):
I wrote down like three things I want to
share, because we are supposedto do tips and tricks for
staying on time.
It's the unpredictability stuffthat always causes some us to
get behind.
So what I recommend in myoffices and doctors that I work
with today and tomorrow I needyou to communicate with either
your manager or the front oryour assistant.
If someone calls, where are weputting that person?
(16:09):
So there's an emergency.
This person needs to be seentoday, instead of having them
come back, stand outside theroom, this person on the phone
like I need them to know exactlywhere to put this person.
Or either they're going to tryand squeeze in and the place is
like the worst thing ever, orthey're going to interrupt me
and slow me down.
So I start by today andtomorrow knowing where to put
(16:31):
those last second emergencies.
The other thing I wrote down isyour hygiene exam cards.
For us, the hygienists do theirdata collection, which is
x-rays or period charts,depending on the exams.
Then they'll have an exam cardand on that exam card is a
picture of their face and itsays I need an exam.
And then they drop that in theroom and on the back it will say
(16:54):
have I met this patient beforethe patient's name?
Have I met this patient beforethe patient's name?
Chief complaints, anything elseand just those four bullet
points and they'll just writethat right in on the card, that
information.
And then I know I have at least20 minutes from the time that
that's dropped off, because it'safter the data collection, to
(17:16):
go in and interrupt or do theexam.
And then the third thing Iwrote down was train your
assistants.
If you're spending time doingthings that your assistant can,
you are not being as efficientand there will be times where
you will be behind.
So invest in the people thatyou can delegate to and it will
allow you to multiply time.
Paul Etchison (17:37):
Yeah, it's so true, that's what I was going to
bring up.
Is that bite guard adjustments?
Can your assistant do theselike crown seats?
I mean, take a 30-minute crownseat for doctor beginning to
finish and turn it into whereyour assistant does everything
Adjust the bite, adjust thecontacts, gets the tooth prepped
, gets the temp off, gets it allready to go.
Maybe your hygienist had tocome in and numb and you walk in
(17:58):
there and just squirt, squirt,squirt, smush and you can be out
of there.
I mean you can literally be outof there while they clean up
the cement.
I mean, look and check out whatyour practice laws are, because
I just took a 30 minute crownseat and turned it into like a
30 second.
I mean it was I don't even knowwhat you call it when it
Steve's honeymoon or something Idon't know.
Steve Markowitz (18:15):
Yes, that was a great day.
I don't know why this, I don'tknow what you I'm ignoring that,
paul, but I don't know why whatyou just said made me think of
it.
But quality dentistry shut up.
Quality dentistry, like greatimpressions lead to great
(18:37):
results crowns that seat easily.
So I think, as a new doctor,we're talking about efficiencies
and all these things, but themost efficient way to do
dentistry is for things to bedone well, cleanly and not have
all these complications andbloody I'm using crowns here but
bloody margins and things allover the place.
(18:59):
So focus on the quality of yourwork and then focus on your
efficiency and you'll have thosefollow-up, those next visits,
be much easier and able to findmore time throughout the day.
Henry Ernst (19:10):
Yeah, and I was gonna say a couple of things
that also little tidbits here Inthe system that I was talking
about, where doctor gets therouting slip from the hygienist
and they know they need 20 or 30minutes, we have trained our
hygiene assistants.
So if it's 10 minutes, if the10 minute warning is starting to
come, so 215, the prophy wasstarted, it's 235.
(19:30):
There's 10 minutes before thedoctor is supposed to come in
there, we will have that hygieneassistant stand outside the
doctor you know treatment roomand stand there and just stare
them down.
And I tell the doctors I saiddon't get mad at the assistants,
because I'm telling, we'retelling them to do this.
This is for the greater good ofthe office, so you don't run on
time.
And they've even establishedlike these little pictures it's
(19:52):
like a picture, you know to makeit fun of a sad person and when
it gets really close to beingtime or it's like time, they'll
have that sad picture up thereand that's like telling the
doctor in a nice nonverbal wayget your ass in there, right?
We don't.
We're not the office where thepatient's done with the prophy
and they're sitting there for along time.
We're just not that office andso any means you need to do it,
(20:13):
you do it and no matter what wetalk about here, the three of us
can talk about, we've got thishumongous nice practice with 152
people.
No matter what we do, there'sgoing to be instances where we
ran behind and we screwed up.
Right, it's going to happen.
There are some patients that,no matter what you do, they're
going to hold you to such atight window and I tell those
(20:35):
patients ahead of time listen, Iunderstand, that's how you are.
Let's always schedule you firstthing in the morning or first
thing after lunch and Iguarantee we'll get you back
right on time and I'll even puta pop up in there, get this
person's behind in there on timealways.
And then let's say you reallyscrew up.
And you know, I love the waythat you said, steve, hey, I go
out there and I takeaccountability.
I'll do the same thing.
I kind of do it in a differentway.
(20:56):
We have a little gift area inour practice where we keep stuff
Car wash.
So we have a car wash likeacross the street.
We keep like a stack of giftcards for car washes.
We have like Pleasant Plainsbeer mug, pleasant Plains lots
of stuff.
I'll kind of like oh, you knowwhat this guy seems like he'd be
a car wash guy.
I'll go there, grab a car wash,say listen, I'm sorry we messed
up, here's a car wash for you.
It doesn the owner doctor oryou know you.
(21:17):
You said we messed up, it's nothow we do it and you gave them
you know something for it.
Paul Etchison (21:27):
That's cool, you know, and I'll I'll share.
We have a deal with a pizzaplace by us and I'm sure you
could do this.
I don't know what you did.
It's a car wash place but a lotof businesses are willing to
give you like a discounted ratejust to hand their stuff out,
like it's a promotion for them,and like we had this pizza place
that's in our strip mall, wewould give out these coupons for
a free large pizza and thenthey would just keep the coupons
(21:49):
and they would give them to usand we would buy all the pizzas.
But we're only buying them forlike maybe like seven dollars a
piece or something like that.
You know, but here's, thispizza place is getting a full
order, like it's not justthey're going to order other
things too.
So it's like it was a win-winfor everybody.
And now we have somethingreally cool that didn't cost us
a lot of money to give away.
Henry Ernst (22:06):
We did like a hundred car washes that we
purchased, and we purchased at athird of the price all at once,
you know, and stuff like that.
So I think that's how we didthat.
Steve Markowitz (22:14):
Dunkin' Donuts and Starbucks.
You can actually brand the card, so, like it's our brand on the
gift card, we say that if we'remore than 10 minutes late, I'm
sorry.
We owe you a cup of coffee.
Coffee's on us and we justbought you.
But you can buy them online.
You can put your logo on it,and I don't know how many we
have in the office.
They're all over the place.
Not that we try not to bebehind, but when we are, we want
(22:35):
to make sure we acknowledge it.
Paul Etchison (22:37):
That reminds me of like back in the day, like
growing up.
I'd go to the mall and getSbarro pizza and there'll be the
sign that says if our cashierdoes not give you a receipt,
your meal is free, and every.
I have no idea what that wasabout.
I was in bezel man or something, but every time I was sitting
there I kid like dude, don'thand me that, don't hand me that
, I'm going to call you out.
(23:00):
Yeah, oh man.
Yeah, I still appreciate thepizza, you know.
I want to come back to what yousaid, henry, before we close out
.
Is you mentioned the thing withthe hygienist sitting and just
standing outside the room?
I think this is a good exampleof owners.
What the owner should do thisis leadership is you are
creating a boundary of what isacceptable for people to let
other people know I need you andsome doctors.
(23:24):
If you didn't tell them that,you know they might say I hate
when she does that, I hate whenshe's standing out there.
It's so rude but it's like.
No, this is how we do it whenyou are late, because you are
not to be late.
Henry Ernst (23:33):
Yeah, they do that to me and I'm appreciative of it
.
I'm like okay, I realize it.
Let me come up with my littlethings here and get the hell out
of here.
Paul Etchison (23:40):
Come up with my little things here and get the
hell out of here.
Love it, man.
Well, hey, if you're listeningand you're thinking about man,
it would be really nice to workwith a coach like one of these
guys and have them pick apart mypractice, give it the mental
focus it deserves and grow.
You're ready?
Go check outdentalpracticeheroescom and I
assure you you will get resultsthat you will be wondering why
you didn't do it sooner.
Thank you so much for listening.
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