I hear doctors talking all the time about how long their new patients must wait for an appointment. A wait of three to six weeks is not uncommon at all and many doctors talk about even longer waits as a point of pride. It seems most doctors feel that the wait a new patient must endure is an affirmation of how in demand they are and confirmation that they are running their practice and business properly. I also suspect that doctors view their wait list like a bank account – as a reserve of new patients. I know it sounds silly when you say it out loud but secretly almost all dentists and orthodontists fear that they will run out of patients whether they admit it openly or not. That being said, making people wait more than just a few days for a new patient appointment is no way to assure yourself a steady stream of new patients. It can actually have the opposite effect as many will go elsewhere rather than wait to see you.

Despite what we think, despite how cool we know we are, despite our self-assurance that patients will wait for “the best” (aka our practice), we live in an increasingly on-demand society. It’s human nature to want what we want when we want it and the more this desire is satisfied the more it is expected. Even in healthcare. Even in your office. I guarantee you are losing patients if you are making them wait more than a few days to come see you. Well, you are losing patients unless you are Anil Idiculla or Cole Johnson… They are actually as cool as the rest of us think we are! Even the “industry standard” of seeing patients in two weeks or less needs to be reassessed in the light of modern expectations. This should strike you all as reasonable seeing how much the world has changed!

“But I’m doing all I can and seeing all the patients I can and I don’t want to work any more days because I want to spend quality time with my family” I can hear you saying. And that’s a valid positon to take for lots of reasons! The trick is to choose both. Whenever you’re confronted with an either/or choice, be creative and innovative and ALWAYS CHOOSE BOTH**. Yes, you can. You can choose to shorten your new patient wait, increase your capacity, increase your production, increase your efficiency and maintain or even increase your home time. YES. YOU. CAN. Stop thinking and saying otherwise. If someone else has already done it then it’s probably possible and I’m here to help you. Let’s look at some options:

  1. Get Faster. Do what you already do, just do it faster. I’ve posted multiple videos of bonds and debonds and repairs showing you how to do these things very quickly and easily and well. Anything I can do, you can do better.
  2. Realize that broken brackets are part of life, no big deal and act accordingly. Learn to do repairs quickly and during a regular active appointment.
  3. Delegate more. What we do isn’t that hard. Plus if you’re a dude then your hands are likely larger and heavier than those of your assistants so patients prefer they do the work.
  4. Stop using steel ties. Patients hate them. Assistants hate them. You don’t need them. They take forever. Blah, blah, rotate, blah… If I can practice without them and others can then so can you…
  5. Do more Invisalign. There is less wear and tear on the schedule, the team and your time with patients in plastic and emergencies are a non-issue. Yes the lab bill is more but patients want Invisalign so you need to choose if you want all of nothing or part of something…
  6. Increase your appointment interval. Like seriously do it, don’t just talk about it. Elastic and super elastic wires work great over time, it’s more comfortable and convenient for the patient and it massively increases your capacity. 10 weeks is very reasonable for most appointments.
  7. Use fewer wires. The tendency of every orthodontist and experienced assistant is to use more wires and shorten the appointment interval. This is ego driven. We want to do more, more often to prove to ourselves that we are needed and necessary. Stop it. Don’t do an arch wire sequence that even resembles this – .012, .014., .016, .018, 16×22, 17×25, 19×25! A very reasonable wire sequence is 014/012 NiTi (014 80 percent of the time) for 10 weeks, 20×20 CuNiTi for ten weeks, 19×25 TMA. Another, less expensive sequence is 014/012 NiTi, 018 NiTi, 20×20 NiTi, 19×25 TMA. Yes, you will need an 018 steel, a big reverse curve NiTi wire and a 19×25 SS occasionally but that is not what we are discussing here. Still don’t believe me? Well, have you ever seen a patient with decent bracket positioning and an 014 or 018 wire disappear for 6 months or so and then show back up at your office? What do they look like? Darn near perfect! Think about what that means.
  8. Do same day starts. Make them the norm. I’ve talked about this until I’m blue in the face. There is NO REASON not to do same day starts.
  9. Do same day debonds.
  10. Bond upper and lower arches on the bond appointment whenever possible. Bonding one arch doesn’t save you time, it costs you time. BIG TIME. You are creating two bond appointments to save, what, 10 minutes tops by bonding upper only?
  11. Learn to bend wire to finish cases.
  12. Don’t go in order.
  13. Bond molars instead of banding them. It saves several appointments and bands are terrible. Almost as terrible as separators.
  14. Don’t do indirect bonding – IDB is stupid for lots of reasons. I know many will disagree but it is. Sorry, I wish it wasn’t as I’d like to utilize it.
  15. Stop talking so much at every active appointment. Patients don’t like you as much as you think they do. Be nice and friendly and shut up.
  16. Stop talking so much in the new patient visit. No one cares about you or me or anyone… Except for Anil Idiculla and Cole Johnson of course.
  17. Start on time, run on time, finish on time. Every day. All day. Accept nothing else and lead by example.
  18. Take the braces off. Seriously. Overtime is killing you. If the case isn’t perfect at 30 months it won’t be perfect at 36. Take them off. The patient will be happy. It looks better than it did when you started. You did your best (didn’t you?). Move on.
  19. Schedule for what happens 98 percent of the time and just deal with the 2% when an IF it actually happens. Not the other way around. Scheduling for the freak occurrences really slows us down. We suck at this.
  20. Make hay when the sun shines. In the summer (especially at the end, just before school), during holidays, and any other time you are in high demand, open more days and more hours and crush it. Work a Saturday to catch up if your new patients are piling up. Conversely, when you are not busy – like the first week of school or during standardized testing – close the office and go do something fun. Your vacation schedule and that of your kids shouldn’t align with everyone else if you want to maximize BOTH of the most important aspects of your life. It’s just how it is.
  21. Simplify your template and drastically reduce the number and types of appointments you have. Most offices have 30-50 appointment types. That’s dumb and hard to teach to new assistants.
  22. Schedule chairside without the parent. The kids know their schedule, don’t need their parent’s help and this makes things go much faster. Of course if a parent is in the back or wants to get involved we let them.
  23. Stop doing class II correctors. Nothing takes time like class II correctors. I’ll admit that when they work, they work great but in my experience they work great about 25 percent of the time, work ok 50 percent of the time and are a nightmare about 25% of the time.
  24. Simplify your mechanics. Simple is always better. Always. See Occam’s Razor.
  25. Go to each chair/patient one time per visit whenever possible. #17 and #18 make this possible
  26. Control your schedule. If you schedule patients evenly during the entire work day, not only will you be happier but you’ll be more efficient and massively increase your capacity. What’s that? You can’t do that? Patients demand after school? Well, my friend, then you have big issues because you cannot render good treatment if your afternoons are blown up and you cannot be efficient if you have doldrums before and after lunch. If you are unwilling to control your hours then you’ll likely be better off shifting your hours to work the desired ones only. Of course, that leads to an entirely new set of issues and is contrary to our attempt to attain greatness in both business and family time. You’ll have to decide.
  27. Stay out of non-dental conversations and issues. Let your office manager or the assistant handle issues for which there is policy. Things like replacing lost/broken retainers, patients wanting after school appointments or upset moms are much better handled by non-doctors. Despite what we believe. Shut up, stay out of it and back the employees you have empowered and support their decisions. Don’t undercut them when they enforce the POLICY YOU SET or they will never enforce it again. They can help you if you’ll listen to them! 
  28. Change the amount of time you schedule for appointments and base it on how quickly you can actually do them rather than “the way it’s always been done”. You can do most things faster than you think. Especially new patient visits. People have stuff to do and don’t want to hang out all day. If you think you’re going as fast as you can then try this: Start a procedure at 4:50 pm on a Friday (oh wait, you don’t work Fridays) on a Thursday then and see how long it takes. You’ll be surprised how fast it’s done when the team wants to head home. Use that time as the standard.
  29. Do staggered lunches with TCs and front desk people and a clinicians and have your lunch brought in so that you see patients straight through and grab a bite in between. Lunch is a waste of time for most of us! Trade that wasted time for family time.
  31. Join Orthodontic Exchange, ProOrtho FE, The Pragmatic Orthodontist Clinical Discussions, Ortho101 and the like to find others who have done what you think is impossible. Nothing will help you more than these groups. Read The Progressive Orthodontist Magazine as well!
  32. Don’t put off the family trips you’ve been meaning to take. 

As you can see there are lots of ways you can have both a great practice and plenty of quality time with the family AND see those new patients sooner so they don’t go elsewhere. Most of us are not, but it is possible that you are as awesome as Cole and Anil. Patients may be willing to wait to see you… but what happens when a new, cooler kid comes to town and opens an office with immediate availability? No matter how awesome you are, you’re better off to figure out how to do more in the same time or less and harness your new patient flow NOW. At minimum, it’s something to think about. We should never stop striving to learn, grow and improve. To do otherwise is to go backwards.

**I learned to choose both this from the book, Secrets of the Millionaire Mind