Richard P. Gangwisch, DDS, MAGD, ABGD

	We’ve all seen cartoons of a street dentist pulling teeth on the corner with a pair of pliers. Not only is it comical, it’s a tad enticing. A whopper profit margin with cheap tools and no labor expenses!

	I’ll make a big assumption that this is not the road that you want to take for your practice - but that doesn’t change the fact that today’s drastically-reduced 

 fees have put economic pressures on most dental practices. Labor costs are the largest percentage of a dental office’s overhead; thus, a healthy business needs to take a careful look at labor costs.

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	The salary component of your expenses should stay within 25 percent of your production. You could consider salary reductions, but the groaning would hurt your ears, not to mention the mass exodus. To save everyone’s sanity, here are 10 ways to keep your labor overhead under control while retaining a happy, quality staff:

 based on production. When doing this, it is important to set goals that can be attainable within reasonable limits. It should be a goal that can be reached with quality hard work approximately once per quarter.

	If the goal is reached consistently every month, staff members tend to think of that as being part of their normal salary and can become irritated when they fall short in a given month. You want the goal to be a reward for going the extra mile.

	It is amazing how the staff will bump up their efforts when there is a goal in mind. Once they have ratcheted up their performance and begin to consistently make goal, then it is time to raise the bar, so the bonus continues to be a special thing.

	2. Eliminate across the board annual raises

If revenue has been flat or decreasing, then I recommend no raises. When PPO payments are taking a huge chunk of the profits, let alone funds to cover overhead, one cannot afford increases in the cost of labor.

	3. Consider replacing a full-time employee with a part-timer

	Have the part-timer work during peak hours. You can usually pay a lower wage and won’t have to pay for fringe benefits.

	4. Eliminate overtime by staggering hours

	In my office, we have two staff members, a business and dental assistant, show up a half hour early to prepare for the day. The bulk of the staff starts at the first appointment time. Two remaining staff come in a half an hour after first appointment time and stay behind to close. The cost of overtime can really add up over the course of a year. Staggering the hours can be a huge savings.

	It is best to make sure that they do not clock in any earlier than they are scheduled. Fifteen minutes extra every day for every staff member can add up in a heartbeat. If they do show up early, make sure that they are not doing any off-the-clock work. You don’t want to run afoul of federal employment laws. Let them get caught up with their Facebook or personal emails and texts, then punch in.

	5. Coordinate staff vacations with yours

	It is vitally important for a dentist to take adequate time away from the office to avoid burnout. And while the dentist is working at the office, he/she needs to have a full staff available to keep the machine running smoothly. Dentists can’t afford to have staff members consistently out on vacation. This leaves a burden on the rest of the staff to pick up the slack.j

Related article: How to deal with lazy employees

	In my office, we allow employees to select one week of vacation whenever they want. The remainder 

 be taken when the doctor is out. Keep only enough staff available to answer phones.

	The cost of paying a half dental assistant/half business assistant versus two fulltime employees can be a sizable saving. Plus, it helps immensely when someone is out sick or on vacation to keep the office running without missing a beat.

	7. Consider outsourcing your payroll processing

	This will free up business personnel to do front desk work like answering phones or greeting patients.

	Limit any in-office payment arrangements to automatic bank drafts or credit card charges to minimize billing and collection activities. Financing fees are significantly less than collection fees. And, it saves your staff from having to make collection calls.

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	“One bad apple will spoil the barrel” is well said. If you have a staff member who is underperforming or causing static throughout the office, it’s time to say goodbye. Not only will the other employees thank you, but you’ll also find that productivity increases.

	Finding that magic compromise on what it will take to keep a wonderful staff pleased enough to stay and what you can afford to pay them can be daunting at times, but it is doable with the right amount of effort. Keeping an eye on labor overhead can make a huge difference in your take-home pay.

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	What if there were a way to advertise for free and bring in droves of new patients? Any dentist would jump at the opportunity.

	Unfortunately, offering free dentistry is the only real way to attract lines of new patients wrapped around your building. But, by intelligently using social media platforms such as Facebook, you can exponentially spread your name, reputation and explanation of services all over town - without spending a penny on advertising.

Related article: How do your dental marketing habits compare to other practices?

	We all know by now that nothing is truly free. While you don’t need to spend money on social media sites, your staff will have to put forth the effort and commitment. The key is to make social media postings part of the daily office routine so it doesn’t interfere with patient care. It’s helpful to assign the task to a staff member who is responsible for maintaining your social media.

	The internet is bursting with social media sites, and it would be a full-time job to keep up with them all. They include the big ones like Facebook, Twitter, Google+ and Instagram, but there are many more. Surveys of dentists show that Facebook is the biggest and that’s where you should concentrate your posts. An occasional post on Google+ may boost you higher in its search engine rankings.

It’s quick and easy to set up a Facebook business page. Include a picture of yourself and your staff as your profile and cover photos. People will identify more with pictures of people versus buildings or operatories. Add as much information as possible concerning your experience and the services that you provide and, of course, your location. Treat your Facebook business page like a second website for your office. You want prospective patients to find out more about you and your practice and, hopefully, they will pick up the phone and make an appointment.

	Once you have your page set up, you need people to “Like” your page so you can keep them updated on your office and hopefully share your posts and spread the word. Place signs in your office encouraging patients to Like your page. Send letters or, better yet, emails asking people to join your many followers and be able to keep in touch with your office.

	You can run contests that will encourage people to like your page. Facebook has specific rules for running contests, so check them before running one. You cannot require users to like your page to enter a contest, but you can make them like a post to enter. Wording such as “We would love for you to Like our page, however, that is not required to enter our contest” would hopefully be enough to entice someone to click the Like button.

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	Special offers spike your fan base. Tell patients to Like your page so that they don’t miss out on specials that you run frequently. Specials can be a call-to-action for patients, either existing or prospective, to pick up the phone and make an appointment. Promotions such as 50 percent off bleaching or $100 off crowns can attract procrastinating patients.

	Encourage comments by asking patients what type of dental offer they would most enjoy. This will boost your interaction rate. You may get a smart aleck who suggests a free full mouth rehab, but for the most part, you will get honest, realistic proposals. It’s a great tool when deciding what type of offers to present.

	Now it’s time to start posting. Try to limit your posts to once per day - You don’t want to annoy your followers and make them click the dreaded unlike button!

	People engage more with photos and videos. Images get more likes and comments than a post with just text. Users tend to interact more when emojis are displayed. Interaction with your page tends to be higher towards the end of the workweek. Try posting at different times of the day to see if there is a general time that your patient population tends to interact more. And keep in mind that shorter posts get more frequent responses.

	Any time you attend a continuing education course, snap a picture and post. Patients love to see that their dentist is staying at the forefront of dentistry. If you do any community service, post a photo. It shows that you are giving back.

Related article: Getting real about social media marketing for the dental practice

	Now for the exponential potential of your Facebook page. When a patient has a good checkup or a good appointment, ask them to post a photo on their Facebook page (and, of course, Tag your office page). It’s so easy to take their picture with their smartphone. It’s nice to include a staff member, such as the hygienist who cleaned their teeth. Have placards like “No Cavities Club” or “Look Ma, No Cavities” to attract attention.

	Encourage patients to check in on their Facebook page when they come in for an appointment. When they do, have them find your page in the dropdown that is presented and Recommend your business. As an incentive to check in, you could add their name to a periodic drawing for something like an electric toothbrush or free bleaching.

	The goal is to have people share your posts. These Shares will show up in their Facebook friends’ timelines. If the post is interesting enough, friends might share it with their friends breeding exponential circulation of your office brand - and all of that is for free!

Facebook can be a powerful tool for attracting more patients to your practice. Learn how to take advantage of it.

How to use social media as free advertising

	When you walk into a well-managed restaurant, there is a good chance that you will be greeted with a warm, friendly smile that will make you feel so welcome that you’ll think that you were at home.

	And upon departure, you’ll receive the same glowing spirit that beckons you to return soon. This is the KIKO principle - kiss them on the way in and kiss them on the way out. If it works for successful restaurants, then it will certainly work wonders for a dental practice.

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	The wow factor is, by definition, a quality or feature that is extremely impressive. Relating that to your dental practice means that you need to separate yourself from the crowded dental market by providing exquisite customer service. This will not only help increase your word-of-mouth referrals, but also retain your current patients.

	Take your waiting room to the next level

 reception area is a good place to start. Scatter a variety of current magazines and play soft, contemporary background music that would appeal to the majority of age groups. A K-cup coffee maker is an inexpensive addition that takes up little space and is welcoming and appealing to waiting patients. Add a mini, glass-door refrigerator for bottled water, juice and iced tea.

Whether for a new patient or just to update insurance information, have a staff member come out to the patient to deliver forms and to answer any questions. This gives a much more personal touch than someone handing a stack of paperwork over the front desk or through a small window. Massage chairs can relax nervous patients. The air tinted with a hint of aromatic scent helps convey the spa feel. And don’t forget to place your portfolio book with examples of your cases to give them a preview to possible treatment options for their case.

	Once back in the treatment room, provide creature comforts like soft neck and head pillows and warm blankets. Some successful practices even include paraffin wax hand baths and head, neck and foot massages to relax patients. A hot towel provided at the end of a procedure adds a wonderful finishing touch. There are many inexpensive towel warmers available on the market. Offer headphones for music. Many patients appreciate any chance they can get to soften the shrill sound of the high-speed handpiece.

	I highly recommend operatory televisions in the ceiling. This simple luxury has worked for me for decades! Hook it up to cable so your patients can enjoy a wide choice of programming. This can be extremely helpful when there is an extended waiting time - making for less grumpy patients. It also is a huge aid in distracting a patient during treatment making their overall dental experience more pleasant.

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	There are also added bonuses with ceiling TVs. You can play patient educational or informed consent videos. You can hook up an intraoral camera and give your patient a real-time tour of their mouth. And you can focus in on trouble spots like fractured teeth, leaking restorations and perio disease. Another benefit is the ability to display a PowerPoint to show off your cases and to aid in your treatment plan presentation.

	If you have a family practice, don’t forget to wow 

 also. Happy moms and dads mean happy referrals. Get a small toy box and fill it with a bunch of toys that can occupy the kids while mom or dad is undergoing treatment, or waiting their turn while sibling is getting their teeth cleaned. This can cut down last-minute broken appointments due to child care issues. You can also have hand-held video games or DVD players available. These are relatively inexpensive and well worth the price by keeping the kids from running around the office while you are trying to work.

	We have a large toy chest filled to the brim with low-priced trinkets. Every child who enters the office, whether receiving treatment or not, gets a reward for “good behavior” by picking out a toy from the “Treasure Chest.” That produces some very big smiles on their faces. The kids will be excited to return for their next fun visit!

Related article: 10 ways to simplify pediatric dentistry

	Another great idea for the kids and parents that has worked well in our office is the No Cavities Club. It is a wall plastered with photographs of child patients who have no cavities. We take two pictures, one to put up on the wall and the other to take home. We affix a sticker with the practice name to the home pic in hopes that mom or dad will proudly display it on their refrigerator for guests to see (and hopefully the guests will ask who their great dentist is). It’s also a great time to take a pic for your office Facebook page. Make sure that you tag the parent’s page so their friends will see your happy office. When posting on your wall and/or Facebook, make sure that you have the parent sign a release. 

	When treatment is finished, go ahead and give your patient a big hug. That goes a long way to cementing your doctor/patient bond. Give them a hot towel to clean off any stray debris. This gives them a warm and fuzzy feeling. Then, either you or a staff member, should personally escort the patient to the front desk.

	After checkout, give the patient a flower (carnations are relatively inexpensive), to bring home. Even men are happy to give it to their significant other. This gives a wonderful parting shot. And don’t forget that the goodbye is just as important as the hello. With good eye contact, give them a warm, cheerful farewell so that they can carry that WOW experience with them out the door.

Adding in a few basic creature comforts can make your practice more comfortable for patients (and more profitable for you).

How to keep patients coming back to your dental practice

	Presenting your patient with a treatment plan is one thing - but getting them to accept it is the tricky part. If they don’t say yes, all your careful marketing efforts have failed. Closing the deal is especially difficult with newer patients who have not had time to build a trusting relationship with you. This is where preconditioning can save the day.

	Preconditioning starts before a new patient steps into your office. Referrals are the best source of new patients. They are coming in because someone they trust told them that you are a great dentist. This paves the way for a fast and easy comfort level.

	With external advertising, it’s a lot tougher. You want the new patient to walk through the door already believing that you are an excellent dentist. Start with top-rate ads if you choose to advertise, and a distinctive web site that projects the expert touch. Train your staff to answer the phones with a warm and inviting tone. Upon arrival, it’s imperative the front desk staff greets them with enthusiasm and a big, friendly smile.

While waiting in your reception area, give them something to do. I recommend you place a portfolio album with patient before and after pictures of a variety of services you provide. You want the patient to think: “I want Dr. Smith to do that to my teeth!” It never hurts to have some family pictures in the front of the book to add the personal touch. I have several of those books in my waiting room and every day I see patients flipping through them. It’s always a helpful aid when I am presenting a treatment plan and the patient says, “Yes, I saw that in your book out front.” There are also some excellent educational and promotional programming available to display on a television. You can also display posters with beautiful results of your cosmetic work.

	It is helpful to plant some seeds with your registration and health history form. Asking questions like “Are you happy with your ability to chew your food properly?” can get them thinking about proper function. “Rate your smile on a scale of 1 to 10 (10 being perfect)” and “On a scale from 1 to 10, what would you like your smile to be?” can get the wheels turning towards considering cosmetic treatment. These questions can also give you a good heads-up on the patient’s thought process and helps you steer them in a direction that they value as important.

	Once the patient is back in a treatment room, it’s time for the 

 to spring into action. Staff members need to jump at any opportunity to brag about your wonderful dentistry and the long-lasting, quality treatments you offer. Much easier than having to brag about yourself!

	The hygienist has more time to build rapport with your new patient. They are able to spot periodontal and restorative problems while cleaning the teeth and are able to point these things out to the patient ahead of time. This is the perfect time to talk the doctor up. Gushing (in a controlled and believable manner) about the high quality and gentle work that Dr. Smith performs can go a long way in making the patient much more receptive to the doctor’s recommendations.

	Using the tip-offs from the cosmetic questionnaire, the hygienist can get a handle on the patient’s concerns. From there, they can convey how absolutely beautiful Dr. Smith’s cosmetic care is and how ecstatic the patients have been after receiving a smile makeover at your office. They shouldn’t get squeamish about using superlatives to describe the doctor’s work. New patients need to know you are the best, and that needs to come from your staff, not you.

	When the hygienist is performing a preliminary exam, they can talk about the possible need for scaling and root planing if there is periodontal disease present. If there is a fractured cusp, they can mention that the doctor may recommend a crown. If there are any missing teeth, the hygienist can touch upon the need for implants or other prosthetics. By priming the patient with these tidbits, they will be more receptive to your recommendations.

	The same goes for the assistants when they are preparing an emergency patient. While listening to the patient’s concerns, it’s a great time to throw in that they are in experienced hands with the doctor and will receive the best of care. It never hurts to have them send a subliminal message that the doctor always recommends treatment that is in the patient’s best, long term interest and that it is a good idea for them to follow the doctor’s recommendations.

	Before you walk into the operatory, have the staff member fill you in with the patient’s hot buttons. Is this patient interested in improving their smile? Would they like to function better? What are the primary concerns that the patient has about their oral health? This vital information helps tremendously when it comes time to formulate the treatment plan.

	Proper preconditioning by the staff - before you even meet the patient - can lead to more case acceptance. This will greatly shorten your consultation time and help you build a trusting relationship with your patient because they’ll already know that you are the best.

Patient interactions should involve your whole office, from the decorations to the staff.