One of my favorite sayings is, “If someone else has already done it, then it’s probably possible.” I know this is heresy in orthodontics where anyone who is doing more than you are must be “running a mill and rendering subpar work”… but none the less, I’ve learned how to do what I can mostly from visiting other offices and meeting smart people who know more, have seen more and can do more than I. So, in order to share what is not only possible but very doable, I took photos of my clinic schedule for a normal day (this past Thursday) and also for a catchup day (today, Saturday). Have a look, ask questions, and let’s expand what you think is possible to the benefit of you patients, your team, yourself and your practice. That’s the point of interaction with peers – to learn and expand our abilities! Maybe while looking at this you’ll notice a way I can improve. If you do please share!
The schedule below is for an 8 chair office (both Jonesboro and Paragould are set up that way and the photo above is Paragould) and we have an assistant for each column. On a normal day we have a records person but on the catchup day we don’t. At the time of writing this we have started every new patient who was ready for treatment today – which has been all of them (it’s 10:23 am now). I am required by law to remove glue for all repairs and debonds and am the only person allowed to run a handpiece. I position all the brackets on all repairs and bonds. If your state allows you to do otherwise then you can likely do even more than we can.
Here is the schedule for the first half of the catchup day in Paragould (today) – 8 am to 11 am. I’ve included the template and the flow from orthotrac.
Here is the other half of the catchup day (today) in Jonesboro – 1pm to 4pm. The Jonesboro and Paragould offices are about 25 minutes apart. I only have the template for Jonesboro because the flow won’t show up until we go to that office and start working.
Here is a template for a normal Paragould day (this past Thursday). It’s pretty typical for here and for Jonesboro. I am including two photos because the AM got cut off where we work from noon to 1 pm.
I hope you find this useful and I’m happy to answer questions. Have a great weekend!
I had an assistant take a video of the activity here in Jonesboro this afternoon to give you an idea of how the clinic runs.
Thanks for sharing Ben!
Can you clarify if there is one assistant per column including NP or just for bonds/actives and does that mean there are 8 chairs plus records chairs?
Impressive that you can go 4 exams at the same time in 30 minutes, keep the day running, and have a high conversion rate!
We do the new patient visits chairside now so the assistants handle them and we have a roving TC/admin person who helps them get the job done and start the case as needed.
How do you schedule emergency appts?
First we try to minimize them 🙂 but knowing that we will have them we have space every day between 10:00 and 11:30 that we set aside for repairs. When patients call we tell them we can see them today in that time frame. If they want to be seen after school we tell them it will be several weeks. Most of the time this works fine because either you have an emergency or not. (Actually if somone is in pain we see them immediately but that happens almost never – there are very few emergencies in orthodontics so I assume you’re asking about repair appointments here). Every once I a while you’ll get somone who will demand an after school appoint the today even if they are not in pain. We let them have that. We tell them to come see us at 3:00 and they can wait for an opening. The opening will probably happen at 5 or so. You can’t please all the people all the time. We take care of exceptions as they come up but most people are reasonable. In our new office MySmileyFace.com we solved the problem of people wanting after school appointments and it causing big problems by no longer having after school appointments.
Whats your take on “Like things at like times” concerning scheduling?
Nearly every practice- management- course i took recommends to schedule blockwise, for instance:
monday morning only NP, tuesday morning only bonds and debonds etc… and then rotate those templates every week.
I´m currently scheduling like you, lets call it more “freestyle”…bonds / debonds / NP / Obs / Retainers etc…all at the same time and it works but i guess its a lot more stressful for the team and me than maybe blockwise scheduling.
On the other side if i schedule with templates we will lose flexibility and new patients will have to wait longer for appointments. So i´m a bit torn…
Well as a contrarian this makes me happy. If you do what everyone else is doing then you’ll get what everyone else gets!
Of course you can schedule any way you want to do it but I’d recommend that, at minimum, new patients can come any time during the days and hours you’re open. Your instincts about making them wait are correct!
We have talked a lot about schedule on OrthoPundit and the main things are to 1) make sure the doctor is not needed in more than one place at a time very often (but scheduling by doctor time is not a good idea) 2) make a schedule that you can handle so you can run on time 3) make a schedule that represents your ideal day and then follow it 4) simplicity. Scheduling like with like violates the simplicity demand at least and probably more than that. You say that scheduling otherwise is stressful? Can you elaborate on that? What is stressful about what we do? If we can dig into that I think we can find some solutions. Long story short do your template however you want that works well for you and makes patients want to come see you. There are a lot of variables and you have lots of options. For example, I only schedule patients 9-3, 3 days a week and we have almost no issues even though we don’t have after school appoimebts. Why? Because our pricing is so attractive! The higher your price the more you must cater to the customer’s comfort and convenience and the less you can satisfy your own wants… if you want to have a solid patient flow. Good topic. Let’s discuss more.
Thanks for your thought out reply!
I will try to be more specific what causes stress for me (acknowledging everybody has different stress- levels).
I have 5 chairs.
Yesterday morning we started the day off with a NP- consults, 3 starts, 1 debond and a broken retainer in the upper (i do mostly essix but this was a diastema case).
First i took off the brackets so the assistant could remove the glue (they are allowed to do that where i practice) then i went into the NP- consult while the 3 starts got prepared for bonding.
The consult took longer than we scheduled for because the mother had a lot of questions so when i went out of the consult- room all 3 starts were already waiting for me to do the finetuning of the bracket- placement.
After that i had to redo the upper retainer (taking the old one off, polish, placing new one) while the next NP already was waiting for me in the consult- room. But before that i checked back with the debonding patient if everything was ok, did my retainer talk, asked for a review etc…then i walked into the consult room while 3 controls where already placed in their seats.
It goes on like this the whole day. Like i said it works, we usually don´t have long waiting times (we get praised for that in our reviews) and NP get fast appointments. But at the end of the day i´m just finished…whereas on the days when by coincidence there are only bonds/debonds in the morning the day feels a lot smoother for me.
I guess i feel a bit under the gun when i go into a NP- Consult and patients on the other chairs are already ready or starting to get rdy.
Maybe i will try the like/like- system but still allowing a couple NP- consults to be scheduled the same time (but not back to back).
So from the sounds of it you’re tired at the end of the day because you’re seeing a bunch of new patients and doing a good job and thus starting a bunch of cases. I suspect that you get good reviews and people come to you because, at least in part, you get them in the office and take care of them and start them reasonably quickly. Of course you could stagger your starts so you don’t have three at once but honestly no matter what you do they all tend be ready and need you at the same time… So you have a dilemma. Either you can keep doing what you’re doing and understand that it’s called work for a reason – and thus keep doing what is working and making you successful. Or you can work on your schedule template to stagger bonds to get some relief. Or you can get faster in the new patient visit – 3-5 minutes is usually plenty though there are exceptions. Or you can stop in the middle of a long consult and explain that “glue waits for no man” and leave the inquisitive mom and come back to finish up – this is almost never a problem and if it is then it may be an indicator of someone you may not want to start anyway. Or you can reduce your hours or reduce your days and get more efficient. Or you can increase the number of days you see patients and slow down the pace. Lots of options. You are the one who makes the schedule after all. Make it work for you! But remember that being tired from starting a bunch of cases is an enviable place to be! Boredom is often the enemy of the successful orthodontist! I’m happy to discuss more if you’d like.
“Either you can keep doing what you’re doing and understand that it’s called work for a reason”
True, thats the department i need to work on.
Because of drastic changes in how ortho is funded by the health system in my country the clinic quickly (within a couple of months) grew from 1 chair 1 assistant and seeing maybe 25-30 patients to 5 chairs and 6 assistants and seeing around +/- 100 patients a day four days a week.
Without the help from your blog and some FB- groups the transition would have been much harder, it seems im still struggling a little bit with the new workload but i just turned 34 and have no children yet so working less isn´t a option for me right now (once i have children i will definitely will change that) working on getting more efficient is the way to go.
I will try the “glue waits for no one”- approach in the next overlong consults.
Well then you’re ahead of the game. The fact that you can openly discuss these issues makes you unsuaul and the fact that you’re willing to work on yourself, your perception and your mindset makes you damn near unique. I’m sure you’ll figure it out and do great.
Thank you! I try to keep an open mind as i have the feeling that our profession will change more drastically in the next couple of years than most of my colleagues are aware of.
I would love to visit your office one day!