We orthodontists are orderly creatures. “A time for everything and everything in its due time”, could easily be our profession’s motto. That is well and good for most things but not for a doctor running multiple chairs in a growing practice that is getting busier – more patients and more patient days are a blessing and a curse!

I also hear your concerns about the difficulties of doing more with less and being more efficient while still rendering great treatment and getting awesome results. One of the things that will help you do more, do well AND run on time is to throw out the idea of going to chairs in the order in which you were called by the assistants. The assistants may not like the change at first but it’s dumb to determine the order in which you visit chairs that way and the assistants and patients will love the change when they see how much more efficient you can be! You will love it because you will increase efficiency and efficacy with zero additional cost!

What am I talking about? Well, think about the procedures we do in terms of 1) doctor time 2) patient time and 3) assistant/chair time. Then think about how best to utilize all three types of time to do what needs to be done most efficiently. Let’s think about a hypothetical 6 chair orthodontic office and the respective procedures as an example to illustrate what we are after. Imagine that all these chairs/patients/assistants are seated and/or ready for you NOW.

What are you going to do?

Which chair will you visit first?

Generally the goal in our office is to go from shortest appointment to longest (in terms of doctor time because there is usually only one doctor) and to clear the clinic before going into new patient exams. In addition to being smart about the order, it certainly helps if you learn to do what you do faster, doctor and the value of 5 minutes.

Hypothetical Office and Procedures:

Chair 1 – Full Debond

Chair 2 – Retainer Check

Chair 3 – Full bond

Chair 4 – Repair Broken Bracket

Chair 5 – Active Adjustment (check elastics)

Chair 6 – Active Adjustment (increase wire from initial to next in your sequence)

Of course there is not just one way of doing things and you may do it differently (and that’s fine) – I’ll just tell you how we do things and what I would do faced with this scenario. In our office the assistants place retractors, etch, prime, put glue on the brackets and then set them on the teeth so that the doctor can do final placement of bracket position and remove any flash. In our office, when someone lets the doctor know that it is time to place brackets, the doctor stops what he or she is doing and goes to that chair. Period. We have very low bond failure and I’m convinced it has to do with how quickly we can get braces on the teeth and cure them. The longer it takes the worse the bond failure. So there is the first rule in our office – a call to place brackets trumps all else!

Next, as stated, we generally try to address the appointments that take the least doctor time first and then work to the ones that take the most. This is a general rule but it holds more than 90% of the time and it is key to avoiding situations where assistants are spending time waiting on the doctor to look at the patient. In that vein I would go to the retainer check in chair 2 as those tend to be less time intensive relatively speaking (assuming the retainer fits and/or needs minor adjustment). Next I would go to chair 5 to evaluate elastic wear and make a plan for elastic wear and any other changes from this point forward. The assistant at chair 5 is not able to evaluate treatment progress or prescribe treatment so she is at a standstill until I arrive. Fourth I would go to chair 4 to fix one or two broken brackets. In our office the assistant doesn’t call the doctor over until she has the wire out, the new bracket, primer and glue ready and a handpiece hooked up (in Arkansas and many states only the doctor can run a handpiece – and I think this is a very reasonable policy for something that turns 400,000 rpms). For the repair of a bracket or two, the doctor sits down, removes the glue and holds the lip back with his or her finger to do the bond right there and then. We find this much more efficient than the doctor making multiple trips to the chair. Next I would go to chair 6 to look at the wire the assistant placed and prescribe elastics and appointment interval as appropriate. In our offices the wire sequence is standardized and in the early stages the assistant has the ability to remove the wire and place the next one in sequence before the doctor sees the patient as long as things are proceeding normally. The assistant also knows what to do because the doctor prescribes what we will do next visit at every appointment and we document that in the electronic chart. The doctor always looks at and DX/RX every patient at every visit but the order in this instance can be reversed to normal with the doctor coming for a final check. This gives us flexibility in the chair sequence and the doctor will wait to see this appointment later in this example scenario because the assistant can proceed before the doctor arrives. So, even though this wire change visit takes less doctor time than the bracket repair, it may be seen after the repair in this example scenario to enhance efficiency. The final chair the doctor would visit in this scenario would be the debond because debonds are the most time intensive for our doctors since only the doctor can run a handpiece.

Remember that this is just an example scenario and that your office may run differently than mine and your rules may be different yet equally effective. The point of this article is to suggest that you should go in a well thought out order when called to multiple chairs at once instead of just going in the order that the assistants call you. Sometimes when I am confronted with a full clinic I’ll go down the line and ask every assistant what they have before deciding what order to visit the chairs. This may seem like a waste of time that I could spend working on teeth, but it actually makes my progression much more efficient.

Think I’m crazy or stupid or that this is nonsense? Well, maybe you’re right and I would love to hear a better way so please share! If you’re satisfied with what you are doing then continue with that. If you’re looking for something better and a more efficient way of running your clinic, I can promise you that being thoughtful about how you proceed will make a huge difference.