Why Ignoring Patient Volume Can Affect Retirement Savings

Learn how to manage patient volume in your practice to increase efficiency, productivity, and income for a more secure retirement.

By Roger P. Levin, DDS

This is not an article on how to increase the number of new patients which, of course, would increase practice volume. This is an article on managing patient volume so that your practice can be as efficient, effective, and productive as possible. We all know that practice production is the number one metric that should be evaluated to understand the performance of an orthodontic practice. More specifically, production as a ratio of many other numbers. We are finding that many practices are below their volume potential, and this is showing up in lower production and production ratio numbers. This means that the orthodontist has lower income. At a time when student loan debt is higher than ever before and it is more difficult to retire in America, managing volume as early as possible in the career cycle of an orthodontic practice is now essential.

Improving orthodontic volume

Many practices think they do not need to improve their volume. They may be right in the short term, but, in most cases, not improving volume is a long-term mistake. The reason many orthodontists don’t think they need to address practice volume is that they are satisfied with their basic income to fund their lifestyle. The problem is that orthodontists are now retiring later, and this trend will continue. The key to successfully funding for retirement at a reasonable age is to start as early as possible, increase income, which happens through higher volume, and allow compound interest over many years to contribute toward the retirement fund.

Being satisfied with your current lifestyle and income and thinking that you will add more towards retirement savings later is a classic mistake. It is well acknowledged that for most people, the best way to accumulate wealth is by maximizing income as early as possible, living within your means, not touching principal investments, and allowing compound interest to increase the next day.

Another reason that orthodontists don’t address improving patient volume is that the practices are already stressed. Most doctors reason that if they have higher volume, they will have to work harder and have even more stress. However, after 39 years of studying orthodontic practice management, I understand that when an orthodontist doesn’t know specific ways to improve volume and efficiency, which actually lowers stress, they will simply assume that any higher volume means harder work and that has a negative effect on the orthodontist and the team. We have even heard orthodontists state that higher volume would mean a drop in customer service, which is patently untrue. These belief systems are difficult to overcome, and it may be many years before a practice recognizes that they could have done things differently and had much better performance and a bigger retirement fund.

Finally, many orthodontists don’t know specifically what to do to improve practice volume and therefore ignore it. There is a sense of hope that things might get better through technology or materials, but there is no great momentum to improve the volume of patients each day. When we don’t know what to do, we often either ignore the situation or simply become paralyzed. I recently spoke to an orthodontist who told me, “I knew I should have addressed this 10 years ago, but I never got to it. Now I wish I had.”

Improving patient volume

Here are several recommendations on how to improve patient volume through higher efficiency, which means lower stress. You may want to think about this question that has been the basis of my approach to practice management for some 39 years: 

How do you increase production in an orthodontic practice while reducing stress? 

1. Every 3 years or at the time of any major change in the practice, you should perform procedural time studies. Procedural time studies are a technique where you track exactly how long it takes you to complete a procedure. In orthodontic practices this should be done for both the orthodontist and the orthodontic assistant. You typically find that you end up saving time and not losing time. It is quite common to save up to 10 minutes an hour, which in a 4-day week practice represents two extra months and a year of production. In a 36-year career, this represents 6 extra years of production. Conducting routine procedural time studies will keep you aware of pockets of waste and opportunities.
2. Improving the speed of the orthodontic assistant will allow for increased volume. We often find practices that have trained the orthodontic assistant at a higher level, which allows them to increase speed; however, they haven’t changed the schedule. So, while the orthodontic associate is completing procedures faster, the rest of the appointment time is simply wasted. Once again, we can often pick up 10 minutes per hour by improving the speed of orthodontics systems through training, technology, or advancements. This is another opportunity to add 2 months a year of production time.
3. Understanding power cells or methods of production blocks being placed into the practice. Most orthodontic practices have at one time or another had an intense focus on building a new schedule. That in itself is really good. What is not good is letting that schedule continue year after year in perpetuity as if nothing else ever changes. There are always changes with patients, technology, materials, and staff. All these changes require that orthodontic practices regularly review their schedules to determine if they are still efficient and effective. Levin Group recommends a concept called power cells. This involves analyzing the performance of each day, based on production while maintaining a lower level of fatigue for the doctors and team. These schedules can be built using mathematical analysis.
4. Managing the patients. No-shows create unfilled chair time that will never ever be recovered. This non-recoverable chair time not only wastes that appointment, but the patient must return for an additional appointment. If your no-show rate (which includes last-minute cancellations) is higher than 2%, then there is a big opportunity for improving inpatient volume. Remember, you were taking two or more appointments for every no-show or last-minute cancellation, which reduces the number of available appointments for patients as part of the daily practice volume.
5. Reducing unnecessary appointments. I will never debate with an orthodontist what they should do clinically as that is an individual decision. I can only report that more and more orthodontists are limiting retainer checks or moving them into a virtual environment. The fewer appointments that you need for specific aspects of orthodontics, the more appointments you open for a higher volume of other patients, which will lead to increased practice production. Many orthodontic practices have up to 50% volume represented by retainer checks, no-shows, or last-minute cancellations. Once again, this means chair time is wasted and unavailable.

Improving patient volume is one of the smartest and most effective strategic methods to increase practice production, doctor income, and retirement funds. This is even more important now that the average retirement age of an orthodontist is reaching 72 years of age and with the pressure of paying back student loan and practice debt amidst higher interest rates. Increasing patient volume will help offset this. This can all be done while lowering stress and fatigue and improving overall practice performance. OP