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Dentists work on reducing costs

Dentists are finding new strategies to combat the current economic downturn, according to the 4th ADA Survey of Economic Confidence.

They say patient needs are different now and they're modifying their practices accordingly.

Sixteen percent of dentists responding reported increasing hours of operation and adding other services during the second quarter of 2009, up from 9.9 percent during the first quarter. More than one-fifth (20.6 percent) reported making cuts in areas including overhead during the second quarter, up from 18.7 percent during the first quarter of 2009.

Many are changing practice hours (sometimes decreasing the number of days but increasing the number of hours per day), hiring associates to expand services or extend hours, doing more bread and butter dentistry, cutting staff hours and fully utilizing assistants and hygienists.

These dentists are on the right track, according to JoAnne Tanner, a practice management consultant with more than 25 years of experience in dentistry. "Once dentists realize their excess capacity they can accomplish two things at the same time—reduce overhead and provide additional convenience to their patients. The practices that are growing are the practices offering more hours and more services."

Ms. Tanner says a dentist who works from Monday to Thursday, 8-5 p.m., is catering to the unemployed.

"People aren't interested in taking a reduction in their paychecks to get their teeth cleaned," says Ms. Tanner. "That's just the way it is today."

Dr. Mark Ritz, a general practitioner in Homerville, Ga., says dentists in his area are typically off on Friday. As a convenience to patients, he now keeps his practice open more Fridays each month and opens as early as 7 a.m. one day per week.

"There are always patients who are interested in the early appointments," says Dr. Ritz, who is a member of the Council on Dental Practice, as well as the Subcommittee on Economic Issues. Created through CDP, the group is charged with identifying ways to help ADA members survive and thrive in tough economic times.

Dr. Michael Halasz, a general practitioner in Centerville, Ohio, and the SEI chair, says it's time to think outside the box about practice hours.

"Working four full days may be a lot more productive than working three full days and two half days, which a lot of dentists do in my area," says Dr. Halasz. "There are costs associated with starting up and shutting down—even a commute can factor into it."

Dr. Halasz says another option for dentists is to reschedule patients when they find holes in their schedules. "Try to fit patients into half of the day and send the staff home for the other half," he says.

Ms. Tanner believes better utilization of the operatory is essential, and that practitioners should consider bringing on an associate for better utilization.

"Two doctors can better utilize an operatory than one can," says Ms. Tanner. "More doctors means more chair time and more chair time equals less overhead."

Dr. Halasz says that dentists who aren't ready to hire a full-time associate may consider hiring one part time. He describes the schedule of a friend in Dayton, Ohio: "He splits his workday. He practices from 7 a.m.-2 p.m. and his part-time associate practices from 2-7 p.m."

Conversely, Dr. Ritz found that adding operatories has allowed him to treat more emergencies on a "how-soon-can-you-come" basis, which is serving his practice well.

"We've definitely seen an uptick in demand for emergency services, such as relief of pain or repair of a broken tooth," says Dr. Ritz. "When you can get those patients in as soon as they can get to the office, you can provide faster relief for them. That kind of service helps attract new patients to the practice."

Dr. Ritz employs one hygienist and three assistants. The assistants work closely with the hygienist, applying sealants and fluoride treatments and exposing radiographs.

Dr. Timothy Herman, a Roseville, Calif., general practitioner, began noticing open hours and no-shows in his hygienists' schedule. Now, the practice schedules two hygiene appointments each hour for a total of eight hygiene patients per day versus the five-to-six hygiene appointments held when he scheduled one hygiene patient per hour.

By using assisted hygiene (the assistants provide polishing and oral hygiene instruction), he says the practice is finally maximizing the use of the hygienist. (Assistants provide polishing and oral hygiene instruction within the scope of their state's dental practice act or as allowed by their state.)

Dr. Halasz says another option for some dentists practicing in states where hygienists can work alone in the office may be to schedule hygiene patients throughout the day on Saturday. "Why keep the entire staff in the office if they don't have to be there?"

Ms. Tanner recommends dentists consider additional training to increase their scope of services or consider hiring an associate.

Dr. Bill D'Aiuto, a Winter Springs, Fla., general practitioner, is trained to provide intravenous sedation dentistry. He says that education allows him to offer a valuable service to his patients and can increase a practice's patient base by 5 to 15 percent in the course of a year.

"I.V. sedation dentistry—meeting stringent ADA guidelines—is another way to provide more services to patients and increase referrals," says Dr. D'Aiuto. "Beyond that, providing such a service fills a need based on a great deal of fear and anxiety that our patients or our patients' family members may have." (The ADA has guidelines and policy on the use of sedation and anesthesia by dentists posted on

Since completing training to provide oral conscious sedation, Dr. Ritz is treating patients who were untreatable in his office before.

"Just today I was able to treat a patient who previously wouldn't allow me to, even when she was in extreme pain," says Dr. Ritz. "Now she's much more comfortable. This ability is a practice booster and is also providing a valuable service to my patients."

Part of a privately owned dental group consisting of six general practitioners and two specialists in four offices, Dr. Herman says patients can easily be referred within the group.

"We all provide all basic dentistry, three dentists provide endodontic therapy and we all have specific niches in the group (two perform conscious sedation, two prepare dentures)," says Dr. Herman. "We're always considering additional services we can provide."

While remaining judicious about how he spends his money, Dr. Ritz just completed a significant expansion and renovation of his office—a "worthwhile investment," he says.

"You always want to present an environment that conveys professionalism and value," said Dr. Ritz. "When it's time to make changes, it's time, recession or no recession."

Whereas lots of dentists are tightening their belts, it may be a good time for others to purchase new technology, according to Dr. D'Aiuto.

"For dentists who are in a position to purchase, there are deep discounts in technology available from dentists who are selling," says Dr. D'Aiuto. "It may be time to purchase the technology you always wanted much less expensively."

Dr. D'Aiuto says now is the time for dentists to remind patients how inclusive their practices are.

"So many dentists who used to be referred to as general dentists are now regarded as only cosmetic dentists by patients," said Dr. D'Aiuto. "It's a good time to remind patients about all the treatments you provide.

"Don't be like the football team that loses because it focuses on the big play instead of the blocking and tackling," he says. "Sometimes it's all about getting back to basics."