Orthodontist or Circus Master?

I’ve bought and worked in dozens of orthodontic offices. I’ve visited hundreds of them. The two almost universally present issues I see are:
1) The office running significantly behind schedule
2) The “After School Rush”

The two issues can be but aren’t always related. Since we have talked in detail about running on time, I’d like to focus on what happens during the 3:15-5:30 pm window in the median orthodontic office. I’m sure I don’t have to explain what I mean but for the sake of completeness indulge me.

Due to a total lack of schedule control, most offices experience chronic bouts of madness at or about 3:15 every. single. day. The 2:00, 2:15, 2:30, 2:45, 3:00 and 3:15 patients all show up at, or soon after, 3:15 in something resembling what would happen if a full school bus pulled up to the front door and emptied its passengers. Chaos ensues. The team gets further and further behind as every single one of the patients appointed in prime time show up plus many, many more (including every “emergency”). In desperation, cries of “change the ties and see them in 4 weeks” or “religate and appoint” are heard as the doctor scrambles between waiting chair side assistants who sit boredly at their chairs waiting their turn. Treatment is not advanced, broken brackets are not repaired, panos are not taken and hygiene/compliance issues are not addressed because there is no time. Treatment times stretch out beyond the estimated completion dates and that, combined with the chronic lateness, upsets patients and parents to near boiling. In addition to the Road Warrior atmosphere developing in the clinic, this is also prime time for new patient visits so the doctor is regularly pulled away from the chair to Dx and Tx plan. The stressful office environment will cause the doctor to be less at ease in the new patient visit, exacerbate the chair side assistants’ wait time and put the team further behind. Amazingly though, it doesn’t generally result in the doctor reducing the amount of nerd talk he spews on the new patient and parents! 5:00 comes and goes even though that is the official end of the day and the team must stay late to finish up again today. This makes them late for picking up kids and other big responsibilities that working parents have. Not a morale builder. The good news is that tomorrow the pattern will be repeated yet again. The early am rush, the mid am and early afternoon lull and then the dreaded chaos of after school time. It reminds me of a description of playing third base I heard long ago: “Hours of boredom interrupted by moments of sheer terror”.

Why do you continue to repeat this pattern? Because moms and patients demand after school appointments…duh!

I know you and your team are non-confrontational, doctor, and I also know that you’ll give in when pressed for fear of offending parents, but you owe it to your patients, their parents, your team and yourself to control your schedule, educate patients about why you can’t see everyone after school and, in doing so, create an environment where good treatment can be effectively rendered. It will take time and effort but you can do it. Bridget and I have done this many times in practices we have acquired. Everything you need is here on OrthoPundit and all you have to do is make a plan and implement. You can even start with an incredibly simple change to ease into the process – simply increase the length of your average appointment interval to take advantage of super elastic wires. But, knowing orthodontists, I realized that you probably won’t change anything… And that’s your prerogative. But if you won’t control your schedule by evenly distributing patients over the course of the day then why not change the hours you work to match the times that people want to visit your office so that you can accommodate them, run on time AND render good treatment? Honestly, the way you’re doing it now makes me laugh – especially when so many “traditional orthodontists” are so fond of pointing to well organized practices that see more patients than they do and call them mills while “they can’t be doing good work!” The irony is that I and others who see volume would NEVER try to render treatment in the madness you consider normal every afternoon!

Life is so interesting.