Rejuvenate your Practice

The Changing Role of the Practice Administrator, Part II

Today's dentist practices in a highly complex environment, dealing on a daily basis with HR issues, governmental regulations, changing technology, staff concerns, new marketing approaches, clinical options, 2014, debt -- just to name a few! Not to mention trying to take time for family, exercise, personal interests, spirituality, fun - all of which compete for time and attention. It can often feel like "something's got to give".

As dental consultants, our clients are telling us they need help now more often than they ever have before. But the help they are looking for is a different kind of help - they aren't looking for the "traditional" administrative staff member, but someone who has the ability to "do more". Someone in a key position helping coordinate practice operations (sample job description follows) that will take the proverbial "monkey off the back" of the dentist.

Here are some of the situations we have encountered with dentists who are ready for a PA:

• The senior dentist is adding an associate and coordinating the transition. The impact of this requires additional support, which he sees continuing as the practice grows.
• A doctor has endured a serious illness, and her priorities have shifted. She wants to spend less time managing the practice.
• A doctor's busyness in his professional and personal life do not allow for adequate time to spend on practice management. He's highly stressed because he feels he's never able to catch up.
• A dentist is having her second baby and wants more family time. She is not ready for another dentist to join her practice, but does want someone to play a much larger role in business operations.

Without question, cultural shifts are taking place. These four situations are hardly new but, in years past, doctors would "tough it out", spend more hours at the office, bring charts home, and come in on weekends. The end result: resentment at the time taken to be the business owner. The 21st century dentist still works hard-let's face it, it comes with the territory-but today's dentists also have a desire and a willingness to work and collaborate with a skilled person who is able to share workload and management responsibilities.

As consultants we take emerging trends, our client's issues, and conversations we have with dentists and staff members during our speaking engagements seriously. Our job is to provide solutions. We are confident that a PA is the right decision for many dentists. In this issue, we'll address two key questions you may be asking yourself:>

• What will the PA do?
• Can I afford a PA?

What will the PA do?

A PA's job responsibilities are primarily determined by four things: 1) ability and skill, 2) what the doctor wants to delegate or add to practice operations, 3) whether the position is full- or part-time, and 4) what the doctor can afford.

Before looking at job responsibilities, let's look at the core abilities/personality traits the PA must possess, including:

• Emotional maturity.
• Intelligence.
• Philosophical congruence with doctor's leadership.
• Strong communication skills.
• A professional and respectful demeanor.
• Empathy.
• Ability to represent the doctor well.
• Ability and willingness to get along well with others.
• Motivation.
• Initiative.

There are undoubtedly other competencies you could add to this list. Before interviewing for this position -- or you may have someone on your staff with potential -- consider the experience level, personality style and complementary values the PA must possess. (For more information on this process, and the forms you need to support you along the way, read about our book "How To Assemble a Winning Team").

All hiring decisions are important, but hiring a PA ups the ante. This person is a key player, entrusted with important responsibilities and someone who works closely with the doctor and team. Performing a background check and checking references is vital. Bent Ericksen & Associates can help you with this process.

Training is also critical and requires commitment on the part of the doctor. Investment in time and resources is necessary. I recently spoke with a doctor who is starting the interview process for this position. In discussing the potential training plan she said, "I want a self-starter, someone who will come to me with ideas." I agreed with her but reminded her that "self-starters" require training too. This person is will be a vital component in your business and skimping on training and/or making assumptions could spell disaster.

Before going further, let's look at some of the PA's responsibilities. As you read through this list, keep in mind that any job description must be customized for your unique practice situation.

Responsibilities are divided into three key categories:

• Team management
• Operations
• Financial management

Team management:

• Ensures the practice is HR-compliant.
• Manages the hiring system.
• Conducts performance appraisals and salary reviews.
• Deals with conflict resolution.
• Celebrates and acknowledges achievement.
• Coordinates and schedules team meetings.

Operations:

• Systems management
• Patient management
• Facility management (e.g., leasehold improvement coordination)
• Project management (e.g., working with consultant)
• Marketing coordination

Financial Health

• Annual planning.*
• Production/collection analysis.
• A/R analysis.
• Expense monitoring (QuickBooks, etc).
• Liaison between doctor and accountant, banker, insurance broker, pension administrator, dental sales reps, etc.

* Interested in Annual Planning. If so, please consider joining us in Chicago in August for our two-day training course, "Know Numbers, No Fear". Find out more...

No wonder you're tired! It seems obvious that if you are treating patients for 32-36 hours per week, it can be tremendously challenging to find time to accomplish these necessary business tasks as well!

"Can I afford a PA?"

Depending on your profitability your answer might be a simple "yes" or "no". If your answer is "no", ask yourself -- are you maximizing your potential? Do you know how to "diagnose" potential? If you do and your diagnosis is accurate, do you know how to improve the situation, thus increasing your profitability?

Make the right decision for your practice by starting with an annual plan. This plan consists of four components-an analysis of practice history, expense projections for the upcoming year, an evaluation of potential and an action plan to maximize potential.

Here is an example of how maximizing potential can improve profitability:

Upon analysis, a practice discovers that only 45% of its "active" patient base is coming in regularly for recare. (The industry goal is 85%.) The practice currently has four days of hygiene per week (185 days per year) and produces an average of $1200/day. Patients are inconsistently pre-appointed for their next Recare visit, and the only time spent reactivating past due patients is when there is a cancellation. The Production Analysis report reveals that there were 37 quadrants of scaling and root planning performed in the last year, and 71 periodontal maintenance visits. The remaining production mix primarily consists of prophylaxis and bitewings.

Diagnosis

• Potential to add hygiene days.
• Less than 30 minutes per week is spent on reactivating past due patients.
• Practice is not pre-appointing 95% of their recare patients, instead waiting for patients to call after receiving their postcard.
• There is little periodontal diagnosis and treatment planning.
• The hygienists often scale but do not charge for it.
• Periodontal and recare protocols have not been established and there are inconsistencies amongst the two hygienists.

With a specific plan of action, driven by the accurate diagnosis, the practice will:

• Add one day of hygiene per week for the next six months.
• Add an additional day in the last six months of the year for a total of 70 additional days of hygiene for the upcoming year. (Total goal days is 255.)
• Implement a fee increase in five months.
• Restructure administrative job responsibilities so that 6-8 hours per week are spent reactivating past due patients.
• Establish periodontal protocols, thus increasing potential for more scaling and root planings and periodontal maintenance.
• Set hygiene daily production goal for first six months at $1250 per day and $1325 per day for last six months.

With an accurate diagnosis and the execution of this action plan, this example can result in the following:

Prior year production: $1200 x 185 days = $222,000

Next year:
$1250 x 127 days = $158,750
$1325 x 128 days = $169,600

Total goal production:

$328,350-or an additional $106,350 in production.

Keep in mind this illustrates just one area of the practice. Other potential may also be revealed from a thorough analysis of expenditures, an improved new patient experience, additional clinical offerings, improved efficiency at chairside, improved staff utilization, payment protocols and receivables management-the list goes on and on.

Clarity about where potential lies and watching it translate into dollars is very exciting. Having a skilled PA who can help with diagnosis and has the ability to move an action plan forward for you is even better!

We want to bring more clarity to the role of the PA for you. We also want you to know we can help -- by asking you the right questions about why a PA may be a good fit for you, by helping with the analysis of your practice to diagnose potential, by leading you through the process of annual planning, and then by putting an action plan in motion to help train and lead your PA to be the person you have always hoped for.

Watch for more on this topic in upcoming newsletters. If you would like to discuss this further, feel free to call Virginia at 530-527-9457 or Debbie at 415-924-5213.

Here we are entering the last month of the first quarter. What kind of a start is your year off to? What did you learn over the past year? Are you finding that doing the same things are not necessarily getting you the same, or better, results?

As we worked with clients on their Annual Plans for 2010, part of the process was looking back at 2009 and analyzing how they did, Goal versus Actual. The findings? Overall, our clients enjoyed an average increase in productivity of 4.3% (adjusted for changes in number of workdays). Many did even better, with increases as high as 16.4%.

What accounted for increases like these in a year that was troublesome for many dentists?

When we took a closer look, several common elements emerged.

Our clients:

• Had a plan.
• Paid attention to monthly monitors.
• Responded to their numbers proactively, not reactively.
• Knew how to tap into the potential within their practices.

It's the final point we look at in more detail in our Case Study, below.

In recent years we've seen a definite trend toward doctors looking at ways to juggle their multitude of responsibilities. Their answer is no longer to stay late or come in on weekends. Quality of life and a healthy balance with other responsibilities and interests is more important to them, which demands new and better solutions for ways to "get it all done". The following Case Study illustrates one solution, which we recommend. Is it right for you? Please read on to find out.

(And remember, it's never too late to develop your annual plan!)

The Case of the "Do It All" Young Dentist

The demands on your time and energy sometimes seem endless: your family, practice, friends, staff, personal and professional obligations, exercise, faith, finances -- the list goes on and on. It may be a rich, full life, yet it's not uncommon for many of us to feel as though some one or something on the list is getting the short end of the stick.

Without question, it's a common concern for many of the dentists we work with.

I recently met with a young dentist. He had cancelled several meetings over the previous 18 months, explaining that he was having problems with the staff he inherited from the previous practice owner. During our meeting he told me he felt his staff exhibited a lack of respect, a low willingness to make changes that suited him, and that, frankly, some of them intimidated him!

He asked for my help in putting a human resource policies in place (he had invested in Bent Ericksen & Associates HR system but had not yet implemented it), and in looking at his systems and his communication skills.

He wanted, and needs, an ally.

Yet, as I write this, he has still not committed to getting help. What is he waiting for? My opinion is that he's a busy guy, and the devil he knows is safer than the one he doesn't. His wife is a professional, they have three young children, as well as other personal obligations and commitments. Intellectually he realizes that getting help will improve his practice, but he also views the time commitment it will take to make improvements -- and the possibility of rocking an already unsteady boat -- as a pain in the neck.

Between us, we have been consulting over 40 years. We've seen a lot. For the most part, when we worked with a dentist on a challenging situation 20 years ago they weren't necessarily jumping for joy about their problem, but leaving to go snowboarding, to a yoga class, or simply getting home to be with the family was not the reason we heard for keeping the issue on the back burner.

Is there a problem with these responses?

Of course not. Exercising, relaxing and being with the family are healthy, important elements in all of our lives. We applaud the fact that today's dentists will not compromise when it comes to making time for what is important to them.

But, there is a problem lying on the back burner and it's those things that keep nagging at you. Things like getting the payroll done, scheduling the appointment with the accountant, having a performance appraisal with your assistant, hiring a hygienist for the extra day, marketing, coordinating the office remodel -- another list that goes on and on. So what happens when things outside the practice are more "seductive", or if your plate is just so darn full that you don't have much energy for doing more than dentistry and basic management?

For some doctors and some practices (not all, of course) managing the demands of a practice today is simply too much to do on your own, for whatever your reason.

As consultants in the trenches, we understand your struggle. We pay close attention to client behaviors and cultural shifts, and we have a solution that mean your business can operate as elegantly as your iPhone. A solution that means even when you are the one who must drive your child to the tutor or get to your Book Club, you will leave the office knowing things are being well taken care of.

So ... what's the solution?

The solution is a Practice Administrator. No, this isn't your father's Office Manager. This is the right person in a position that makes sense for today's practice.

The Practice Administrator may be a current staff member who, when given proper training and time away from current duties, can assume higher level responsibilities once held by the doctor. Examples of these responsibilities could be maintaining HR compliance, coordination and training of new employees, or implementation of marketing efforts. They key phrase here which cannot be overlooked is "proper training".

I had a conversation recently with a doctor who is interested in hiring a full time Practice Administrator for her group practice. We spoke about the characteristics, qualifications, job duties and training necessary for someone in this position. She said, "If I hire someone to do those things I would expect them to come to me with their ideas about how to do the job". I agreed that confidence and a "go for it" work ethic is important, however even if a doctor hires an employee with experience or skills in administration, that doesn't mean training should be limited.

Our advice will always be to hire the best person possible, and then provide solid, consistent training. This is an investment not only in the success of the Practice Administrator, but in your practice -- your asset -- as well.

Job duties, what background and experience is right for your practice, compensation and training are some of the areas we will focus on in upcoming issues of Exactly!

If you would like to chat with us about whether or not a Practice Administrator is right for you, feel free to contact us. We look forward to hearing from you.