What You Really Should Be Doing with Your Hygienist

Welcome to Million Dollar Dentistry with your host, Gary Katie, brought to you by Next Level Practice. Next Level Practice is the leader in dental practice management. In fact, they are the best in the world at creating happy teams that implement sustainable results. Your host, Gary Katie welcomes you to this podcast as he discusses the common concerns, challenges, and shares his decades of experience in empowering dentists and dental teams to go from good to world class. Gary Katie is the visionary voice of Next Level Practice and has for the past 20 years interrupted the status quo of the dental world. He continues to bring national attention to the oral systemic connection and believes in the complete health dentistry model. He is a powerful educator and advocate for dentistry, dentist and dental teams. He is inspired every day by the courage and personal successes of the doctors and team members he has the privilege of working with. Welcome, Gary.

Oh, Amber, we're back.

We are.

Amber, you ready to rock it out? One of my favorite chapters here, chapter four. Uh, oh.

So what you really should be doing with your hygienist. Hmm? What did you mean by that?

Oh, my gosh, you know, look, here's the deal, All right? Now, my wife said, as I mentioned last time, my wife said, you better not name that. People are going to be offended. And I don't know, I just had many of my doctors who, who ended up with their dental hygienist. So I, look, I can't make this stuff up. I just pay attention. So anyway, we'll leave all that other stuff out, but it's really honoring. I'll tell you, Hygienist really saved, really changed my life, really. You know, all kidding aside, you know, the work that we have here, I really learned that hygiene is really the catalyst and the center of a great general practice. And most, most of them are not running at full efficiency. And, you know, there's a lot of amazing hygienists, and there's a lot of hygienists who just like, you know, they're good with polishing teeth. So it's like this big range of components to a great hygiene department, a great hygienist. And, you know, and there's different philosophies, and none are bad or wrong. It's just that are they working or are they not working? And, you know, what's the philosophy of the practice? And how does the dentist relate to the hygienist? You know, so often the dentists go like, you know, soft tissue. They don't even think, what the heck is that? They just like, what? You know, you know, the kicking it Old school dentist is like, hey, I just want to do restorative care or implants or, you know, cosmetics or whatever and, you know, care less about soft tissue. But, you know, there's like a big deal with all the science. You know, in my, in my documentary that I filmed much after this, this first edition of Million Dollar Dentistry, here's where hygienists changed my life. I went into a hygiene meeting and I was doing typical systems processes. You know, we do the four four Ps purpose people process and platforms. And I'm in there and I'm doing that work. And, you know, my dad had a heart attack the night before. He survived quintella bypass. He now has eight stints. When he always said, go to the dentist, Amber, over and over, he said, make sure you go to the dentist. He always took me every six months. But the dentist didn't have a hygienist and polished his teeth. They did not clean below the gum line. My dad, you know, had the heart attack. And these hygienists go, well, how was your dad's perio? And they go, what are you asking that for? My dad had a heart attack. He goes, don't you know the connection? And those hygienists changed my life because I got obsessed about learning about the oral systemic connection and its impact on whole body health and really extending lives. And now we have, you know, now, you know, my dad's hanging on by a stint, but it's 20 years. You know, he's, you know, out of, you know, he's in dentures. But, you know, ultimately it was lesson learned. And now I just want to help people save and extend lives. Like we say now in the hygiene department, on a good day, we save a smile, and on a great day, we save a life. And when you start moving into, you know, the next generation of hygiene, I mean, we have hygienists doing more than associates, and we have hygienists doing two brand now, all legitimate, all kinds of customer service. They're using things like periprotect, which puts the power of, you know, managing inflammation in the hands of a hygienist. I mean, that's unheard of. That is unheard of. And I was able to put all these pieces and parts together after we got started. So it's a big deal. And it's the machine that runs the whole practice. So ask me questions. Okay, I can go on forever, but I know you have an agenda here to make sure I really dig, take a deeper dive. At what's in the book.

Okay? So the hygienist should be empowered to recognize problems, educate patients about the nature of those problems, point out those problems to the dentist when he or she comes into the hygiene room to visit with the patient. So what are we saying here? That the hygiene is not supposed to just be polishing. They're supposed to be really, truly educating. It sounds to me like here.

Well, yeah, you know, like, a lot of people have accelerated hygiene. And the old school way of looking at a hygiene department, in my opinion, you can still have accelerated hygiene, but you've got to have your education in what is the purpose of a hygienist, and what is the purpose of your hygiene department? You know, a lot of times doctors are just trying to churn. You know, some doctors try to churn cash. So they're going, if I pay this hygienist, you know, I don't know, 30, $40, I need to get as much as revenue as I can through there. So they double them up and put in assist assistant in there. Churn and burn. Not a bad thing. But they missed the other part that hygiene is used for. It's the. Also the patient education engine. And the reason why this is important is because if a doc, you should always have one doctor to two hygiene, it should be that ratio. That means you're retaining your patients. That means that every hour, you got to do a hygiene check, and you got to do two of them. So if you can't get in and out of there and the hygienist doesn't take his or her time to get that set up, what happens is you're now spending 20 minutes at each of those hygiene checks. That's 40 minutes. And you only have 20 minutes back of your chair versus the hygienist does all the education because they're more trusted than you. You know, Dennis, patients think you're trying to buy your next portion your mouth. And what happens is they think that when you make a recommendation, it's for you, not for them, but when it's originated by the hygienist using all the things that we talked about in the earlier chapters, like a healthy mouth, baseline and intraoral cameras. And then you just walk in. It's like a ball teed up, like on a golf tee, and you just come in with the driver and give that guy a flap, and you're just hitting it right down the middle of the fairway. So it's like having a caddy, you know, who. Who actually tees you up, sets you up, lets you know what's going on, with which way the wind's blowing with that patient, which club to use. So giving the power away to the hygienist, letting them manage that room, having them take the time, because you don't have it. You got to get back to that chair. Your job is called balls and strikes. Balls and strikes. Balls and strikes. Yes. Validate your hygienist. Validate your hygienist. That's the way you should come in. Five minutes each, kiss babies, hug babies, kiss babies, get on your way. Next person, boom, boom, boom. Get back to the chair, and you're on your way.

Aha. So how much time should the hygienist have with each patient? Because, I mean, I've seen offices where it's like 30 minutes, 45 tops. But you are suggesting a full hour. I mean, how is that going to be profitable if you're cutting in half the amount of people that someone can see? I mean, if they were doing 30 minutes, I just, you know, I'm like, okay, I'm trying to figure out how that works.

Yeah, it's pretty simple. First of all, you got to know, are you a quality service and price, you know, are you. Are you just churning and burning, polishing, or are you a quality and service position, which most private practitioners need to be a quality and service position because the DSOs, the lower end practices, the drill fill and bill, PPO mills, those people are the ones that. Those are the ones. They're accelerated hygiene or doing half hours. And that's fine. They can do that. But you create experiences. You're offering experience. Now, here's how it's affordable, because you can't outrun restorative care. And if you look at your hygiene department as the machine that makes the practice run, and you look at your patient, annual value of a patient is two profis, two exams, set of bitewings, and the average adult will invest in a crown and a buildup. Now, if you're just looking at your hygiene department solely on hygiene revenue, you're only going to get so far. But if you look at it as hygiene revenue, plus the restorative care that comes out of hygiene Amber. Now all of a sudden, each, each, each. Let's just say the average annual value of an adult, two probies to exam, set a bitewings, crown and build up is 1300 bucks. They come in twice. That's 650 for each hygiene visit. Because. And guess what? You don't have to do any selling manipulation. You don't have to close the case. You don't have to touch it. You're just going, yep, that needs a crown. And yep, great job, Brittany, for finding that, showing me the pictures. Yep, well done. And then you get out of there, and all of a sudden you have the machine built that will allow you to grow your practice and get your patients healthy and taken care of. So it's a win, win, win all the way around. And then we bonus the hygienist on the treatment that comes out of the room, and then we bonus the treatment coordinator on the cases that they get closed. And that's how you change the behaviors, get consistent behaviors, and really run a highly profitable practice, not just a highly profitable hygiene department.

Okay, So I like that because while we're not suggesting that the hygienist diagnosed, we're teaching them to educate. And once you need an hour to do that, because I know if I feel rushed in the hygiene chair, I'm not going to be inclined to. To actually purchase care. So, you know, and if they're actually introducing that healthy mouth baseline to the.

Patients, you know, it's 67, 33, 67% you're diagnosing, you're doing your hygiene treatment, 33% of the time, you're doing your patient education. So if that's an hour, 20% of the time is spent doing education. There's no other place to find that, because if it's not done in the hygiene chair, it's going to have to be done in the doctor's chair, or you're not going to grow your practice because it's not done anywhere and it's not done efficiently. But when you do it while they're there, patients have no time to come back. You know, back in the day, when I first started, even 2008, they would like, if there's a big treatment plan, you can have them come back. You know, that's even. We find that that even throws people off. So it's better if you have a big treatment plan to get them started. Not every time. Sometimes, you know, and depends on your philosophy and if they're used to it. But it's really good to just get something started and then do a whole treatment plan when they come back. This way, you know, you get them in the hopper and you get them moving. So, you know, there's again, this is advanced conversation that we're having right now. But in general, you need a space to be able to present and get cases closed. And the best place to do that and the fastest way and the leverage, most leveraged ways in that hygiene department.

Okay, so this, you mentioned a little bit about the triple win. So how do you bonus the hygienist with the triple win? And how do you make sure that the hygienist and the doctor are out of the sales business? So they're not selling dentistry.

Well, it all goes back to what is the purpose of the business? And, you know, one of the things that we set up a practice to buy into is, you know, we're here, Like, I'll give you an example, like, the meaningful purpose of the business. If you treat your business like a breathing entity, what is the purpose behind it? And, you know, one could be, on a good day, we save a smile. On a great day, we save a life. Another could be San Diego is going to be the healthiest city in all of America. Right now. It is number 10. We are playing for number one. So they have a mission behind. So the context that holds that patient education together has a bigger purpose, a more meaningful purpose that everybody buys into. Another one could be, we are the go to practice in, let's just say Boston, Massachusetts, to look better, feel better, and be healthier. So when you have the context that drives the education that fits inside the education. I want to distinguish context here for our listeners. If I gave you a glass with water in it, the context would be the glass and then the water would be the content. You. The context gives meaning and action to what to do with the water. So then you drink the water because it's in a cup meant for drinking. Boom. But if I gave you a bathtub with water in it, you're not drinking that. The context says, and you better not. Exactly.

I'm like, no, especially after I get.

A workout and I take a bath and then you show up and you're like, I'm not drinking that water.

Definitely not.

Especially in today's world, you know, with all the things going on with germs and stuff, you don't want to be doing that. So. But it gives you action. And so most doctors, the reason why they don't have sustainable outcome is because they don't have their practice set up as mission based practice. This is the other reason why they don't attract good team members. This is the other reason why millennials don't want to work there, because they don't like selling widgets without a purpose. These are all the things that are going on behind the scenes that need to be addressed. And it's all in the concept of Context versus content. Right? So you want to bonus them. So that takes the sales away. So it's sort of like what you said about hope and despair. Like, I can look at one thing as despair or I can look at it as hope. It depends on where I'm looking from. That's the context. Same is true here. You could look at this as, oh, you're selling or I'm help. Truly authentically, if my heart is coming from help. And then I share with you a healthy mouth baseline intro, pictures, good verbal skills and communication. The person responds differently, very, very differently. And they feel that you're authentically there because you care. It's the difference between caring and taking from somebody. Like, if my context is I'm here to help people, then you're gonna feel that, like, and I am, you know that that's why I do write books and do podcasts and because I want to help more people. And when they get what I'm saying and they want an implement, they're gonna come find me. I don't have to sit, sell hard sell this thing. It's you. Do you have a problem? Do you align with the philosophy? Do you want to handle the way I'm suggesting it? And if it makes sense to you, then you're going to be all over it. So, you know, how do you get the triple win? Well, the patient has to win. And if they don't understand, so we never sell dentistry that's not needed or wanted. They get in there, Amber, and they. We find out what's, you know, here's the healthy mouth baseline. We are here to let you know what's going to happen. It's the least expensive, the least intrusive. We're looking to, you know, be conservative with you like the tread on the tire so it doesn't become, you know, a root canal or it doesn't become whatever the truth is, if they keep. If we keep watching it, like having a Timex factory, you're watching the debt that the health get worse. Right? What are we watching? I'll watch it. Let's take care of it. When you know, when it looks like it's needed and you get to say that so the patient wins number one, the team wins, and the hygienist, in this case, the way we incentivize everybody is we give them the incentive on what we need them to do. There's two things that we need a hygienist to do. Increase their dollar production per day. So equal to or greater than and the way you do that is you get them to do treatment that's correlate with the purpose behind the work. So I ask a hygienist, never selling, so what is your purpose? To get people healthy. And well, great. Then we say use the internal camera, use the healthy mouth baseline. Here are some solutions like perio protect. You know, that's an investment of $750. But I can't live without my perio protect. It was part of my inflammatory markers going dramatically down. I'm alleviating my heart attack and stroke potential and my dementia potential like my parents have. And $750 is cheap for me. And I feel like a bazillionaire. And it gets rid of halitosis and it whitens my teeth. Look how white my teeth are. It's like bling, you know. Right. So the thing about this is that where are you coming from? And then who are you helping? And is it genuine or not? I mean, that's really the bottom line. And then, you know, we bonus hygienists in two ways, like I mentioned. One is increasing their dollar per day, which we figured out. And the way they do that is they do, you know, advanced perio. By the way, we have 8 million treatment plans in our database because we track all the treatment plans and only, only 4% accept treatment for perio and 8% are diagnosed.

Wow.

And 50% have it in the US of adults. So I. So you don't have to be searching for patients to care for if you set the benchmark of zero bleeding in your practice. Right. Because if there's some bleeding, there's some infection and some bacteria present that is affecting that. Right. So when you come from that place, you know, increasing your daily production through doing the treatment. That's really Right. I can't tell you how many times I see people charging for profis and they're doing debridements or they're doing perioscaling. It's. It's just crazy. And because they, it goes back to deserve level. So can you see how deserved level, like cascades all the way down here. Right. And then the other one is the treatment presented and accepted out of the hygiene room. So we give them a percentage for that. So we give them 10% above what their benchmark per day is. So if they did, if their benchmark was 1000, they did 2, the difference is 1000, they get 10%, they get 100 bucks for that. And then, you know, if they presented $5,000 of treatment that came out and 3,500 was accepted. Well, you know, that becomes 35 bucks in their, in their pocket for diagnosing and helping the patient understand what the treatment is. So it's a win win all the way around. And doctors can't wait to spend this bonus money now. They only pay it out if the collections that covers the bonus that we estimate will cover the bonus is paid out. So that's how the triple win gets affected. The patient gets all the care they need. The team member grows personally, professionally and financially on the specific area that they're accountable for. Then the doctor, practice owner wins because they get the only have to pay it out if they can afford to pay it out when the collections come in for that month.

Perfect. Okay, so you talk about a recare coordinator comes in 10 hours a week and makes calls. So are you. So what you're saying is that there should be a designated person doing recare as opposed to the hygienist running around trying to be up in the front making phone calls?

Yeah, like look, I don't think I take out the trash in my own company. I don't think anybody's below that. But I would rather take responsibility for filling in the schedule for what the people were hired to do. And hygienists were not telemarketers or they don't run our system which is a platform that communicates with patients the way they want to be communicated to, like texting and through patient education. So, you know, yes, they can help out, but it should be spot help, not regular help. And it's because the number one reason is because you don't have a whole body health or a complete health hygiene patient education system. They don't understand the value that's the source of this problem. Once we get the source of the problem, you get your patient education in. Then the symptom of filling in comes from Marie, Care coordinator. Here's the problem. Most doctors go get on the phone with people. You can't outbound call. And especially if you only have one person at the front desk, you got to have a treatment coordinator and appointment coordinator if your practice is rolling. This person doesn't have the time to outbound call because they're reacting to new patient call ins. They're checking people in and checking people out. It's impossible to concentrate and do that job well. So here's what we've decided to do is get a third party person part time, somebody who's really passionate about helping people get back into the practice. And it's not just phone calls. It's phone calls, texting, and it's also how you leave messages. How you leave a message is this is gary calling from Dr. Rosenfinger's practice. We are.

Did you just say Dr. Rosenfinger?

Yeah, I just make this stuff up. Actually a friend of mine, Ron, tell me about Dr. Rosenfinger, which cracks me up so I still use it without royalties. He gave me permission to do that without royalties. But yeah. Dr. Rosenfaker's office. And we're calling regarding your health. Please give us a call. Call regarding your health. Is going to get a call back. What do you mean about my health? What's wrong with my health? Like what do you mean? And like you put mystery in. And so for those of you that are not getting calls back, oh, Joe Blow called because of her health. And then you have the script that says yeah, we haven't seen you in a while. And do you know that your mouth is connected to your body and if you don't take care of your hygiene, if your gums bleed, it can affect your overall body. And so that is why we are in the healthcare business, preventive healthcare business. And that's why we care. And we wanted to invite you in for your appointment. What works for you today? I happen to have an opening, an opportunity. Show up at 4 o' clock or would tomorrow at 6 o' clock clock be good for you?

Perfect. Okay, so, so the appointment coordinator makes sure that the hygienist time is always used to the maximum then.

Right. So the appointment coordinator is filling it and then if something opens up, they're looking to fill one or two. But if a whole height, you know, so often doctors aren't looking, you know, if you had, let's say I see this happen all the time, somebody's out sick first, then a period, or, or you have a temp hygienist who's not doing pre appoints or reappoints. What happens is, you know, we like to get 90% pre appoints before the patient leaves. If you have a lull on that like it goes down to 50 and 60. We're tracking these upstream indicators because here's what happens, Amber, six months downstream. If you don't, if you're not getting your data pushed to you that the person that was dealing with your recare during that period of time, let's say your front office was out and they weren't double checking that you were getting everybody scheduled, six months from now you're gonna have a huge dip in your hygiene. And that's what the Recare coordinators to do. The appointment coordinator gets that, like one or two that can't get filled. And maybe the recare coordinator fills same day stuff if they can, but they're making sure that every hygiene day is filled out weeks and weeks in advance. And not only phone calls and texting, but we have a whole platform that. It's called my patient care system that actually does it via a platform and through patient education. So we're sending automated newsletters out. We're sending out, you know, stuff for bad breath and pregnancy and whole body health. So the patient's getting educated as to why they need to come in. And it's not about polishing teeth.

See, I like that idea because I feel like so much of the time when you go to the dental office that, you know, sometimes they'll even forget to make your appointment before you leave. So, you know, or they're. They're busy and they'll, you know, or you're trying to rush out of there. And I'll say, I'll call back, but you don't call back. And then you get off the schedule and you forget what you're doing.

We're tracking, we're tracking two key things here. How many people leave with an appointment and then how many people break and cancel appointments, and that becomes the front desk. And by the way, they can click on our dashboard and. And they can know what patients to call immediately because that's. Most appointment coordinators don't know who to call. And we automate that system. Very powerful.

Definitely. So kind of like recapping here. So one of the things you want, you want your hygienist to have a full hour to do their work and to do the patient education.

Yep.

Okay. Then you get to come in for five minutes and confirm the case.

Yep.

Then your hygienist turns over the patient to the treatment coordinator. And what happens with the treatment coordinator at that point?

The treatment coordinator then sits down and they go over the patient. They say, do you understand your treatment and do you understand you need your treatment? Now, if they say yes and yes, great, then you can say, what's next is I'd like to go over the financial arrangements so that we can fit this treatment into your lifestyle. So if they don't say yes and yes, then they have. Then they don't know they need that treatment and you got to start all over. And that's why we use intraoral pictures in the treatment room, so that it's a private room. There's the intraoral pictures and we highlight.

Re.

Highlight the problem. So we go back over why they recommended what they recommended, because so often, you know, doctors and hygienists in the back, they'll say something because the person heard it for the first time. They didn't really understand it. They said, yes, they didn't understand. And they were going to do that, what I call the walk down the hallway of amnesia. So they walk from the back to the front, they get amnesia, and they don't know what you talked about. So it eliminates that and it eliminates what I call the six month boogie. So they say, what they do is they go, hey, man, I'm going to come in, say yes, mean no, and walk out. And then, no, I got out of this mess without having to do any treatment because I didn't have to commit to anything because, you know, I just went to amnesia.

And then six months later, you have to start over again. And that problem is probably worse by that point.

Exactly. And then what happens is your revenue is worse because that could have been done in the six months prior. And then you're complaining why you don't have enough money. It's because all these bleeding points in a practice are not tended to. And we just lock all these down. And then, you know, once in a while, they slip through, but not on an ongoing basis.

Okay, so one of the things that the dentist gets to do is perform the dentistry knowing that everybody else in the office is perhaps even more dedicated to keep them working.

Say that again.

So one of the things that if you put this into place, it's going to allow the dentist to perform the dentistry knowing that everybody else in the office is perhaps even more dedicated to keeping them working than themselves.

Well, it basically decentralizes the doctor of having to hold on and make sure everything gets done. It decentralizes. It puts it into the hands of the people that are responsible. But for the control freaks out there, they still maintain control. So how do you maintain control with letting go? You let go with responsibility, measures and metrics, putting a bonus system in and then showing people not just what to do, but how to do it. Amber. So so many consultants, people come to me, they go, yeah, I had a consultant, he told me what to do, but not how to do it. We're giving the how to. That's the key.

Okay, so this can even. Can do even a half a million dollars a year if you get this bottom line fixed.

Are you kidding me? We have. I just. We just broke a record when we have a dentist in one doctor who was working six days a week, she was doing $1 million. She did 1.1 a year later and went down to three days replace herself. That's just a record breaker. That's somebody who just broke a record. Does everybody do that? No. But yes, you can. Absolutely. Because here's why. It's all inside your practice already. It's all because you're just restoring your integrity for what you stand for and then having a process to go behind it and a purpose behind it that is authentic and transparent and here to serve somebody else. When you clean all this stuff up, you know what made this gal successful is because she just did all of it. So our doctors do some of it, they do half of it, a quarter of it. She took it on and she said because she had an eight year old daughter, she had a reason to do it. She was like, I need to be home for my daughter and I want to be able to make money and pay my bills. I'm sick and tired of not being able to pay my bills on time. So she just got to it and she just followed the system to the T and that's what happened. And we see this all, you know, this is, this is not the first time maybe to not that. Not. That's a big degree. To go from six days full time to three and then going up, doubling your practice. It's not unheard of. But to do less than that is happens all the time, every day.

See, that's. What's. To me, it seems really important for the office to get in alignment with their purpose. Having the right people in the right places, getting those processes right in that platform.

Yeah, yeah. It all works in harmony. See, here's what we've done. We DSOs are killing it because they can come into a GP practice that's underperforming and put their systems in and get it to where, you know, get it to pay for itself. We just do that for the private practitioner and we automate everything. We do everything. The four things that they do well, they don't put purpose in it. The DSOs can't retain their team because they don't treat people with care. And that's the downfall of that. So, you know, we put that piece in and that's why we retain team members as well. But, you know, purpose number one, people number two, right people, right places, right things, process. There's only three case acceptance, retention and the experience and acquisition of new patients. And then we put platforms under all this to automate everything. So you're pressing buttons and you have stuff done for you. You don't have to do it all manually, like pulling reports, like training your team, like sending out social media and newsletters and drip campaigns on educating your patients. This is all done while you're sleeping.

I love this. So now I know what you should really be doing with your hygienist.

Thank you. I'm glad we cleaned that up because now I can sleep tonight knowing that named it for the right reason. It's the same thing. Just like hope or despair. Is it selling or is it educating? It is. You know, this is the proper. It's really honoring and respecting and elevating our hygiene team so that they can go out and make the difference for everybody.

I love that. And I can't wait for chapter five when I get to find out why your team hates you.

Oh yeah, I learned that one the hard way. So you know everything in this book, we apply to our own company, so I know it works without a shadow of a doubt. And it's been refined over many, many years. So I'm super excited. Thanks so much. And I can't wait to see all the listeners feedback on this chapter.

Sounds great. Thank you, Gary. Have a great day.

Thank you. Bye Bye.

Bye. Thank you for listening to Million Dollar Dentistry with Gary Katie. This podcast is brought to you by Next Level Practice. Next Level Practice is the leader in dental practice management. In fact, they're the best in the world at creating happy teams that implement sustainable results. If you would like a copy of Million Dollar Dentistry, please contact Amber Keithley at Next Level Practice. You may call us at 212-388-1712, extension 119 or go to nextlevelpractice.com podcast and request a copy in our Ask a Question box. We look forward to brightening your smile.