Dental Practice Case Study: More Production, Less Stress

The client in this case study, whom I will call Dr. Smith — not his real name — hired me in the early 2000s. I am not going to disclose anything which could identify him, so that I can give you the details of why he hired me, what we did, some of the challenges we faced, and his exact production numbers before and after.

The Practice

Dr. Smith was a solo practicing general dentist who had graduated from dental school a few years before our consulting work. He practiced in a town of between 50,000 and 80,000 people.

He heard about me through two classmates and a friend who had all used my dental consulting services in the past.

At the time, he had a staff of six: two front desk, two dental assistants, and two hygienists.

The Problem: A Productive Practice Under Unsustainable Stress

Dr. Smith was actually quite desperate.

He told me he didn’t care about any production increases. He only wanted me to reduce his stress.

He was experiencing a level of stress which was unsustainable. It was leading to burnout, disliking his career, and a fear that he would die young due to the immense stress he was under.

He said he dreaded work. His schedule was too tight. He was booked out three months and was constantly running behind. He worked into his lunch hour and after his 5 p.m. closing time every day.

He told me he went non-stop all day with no time to manage the business or his staff. He also said that he didn’t know how to manage the staff, even if he did have time.

That is a painful place for a dentist to be. The practice was busy. It was producing. It was booked out. But the doctor was exhausted, the days were too stressful, and the systems inside the practice were not giving him control.

The Initial Conversation

I assured Dr. Smith that I could help him get his stress level to a healthy, manageable level.

I also told him that I believed we could increase his practice by more than $20,000 per month.

Dr. Smith was highly skeptical, but he trusted his friends and classmates and ended up hiring me.

Dr. Smith's Goals From the Consulting Agreement

The following are his actual goals and results to be produced, straight from our Consulting Agreement:

Drastically decrease the doctor’s stress level.
Train staff to consistently schedule efficient, productive, low-stress days with smooth patient flow which stay within office hours.
Increase monthly production by a minimum of $20,000 per month or more, while increasing profit margin.
Dramatically decrease doctor’s overhead percentage.
Increase hygiene productivity substantially.
Put systems in place for an efficient, well-run front office.
Make staff feel like they are part of the office, not just employees.
Position the doctor to take off 4 weeks per year and also some extended 4-or-more-day weekends.
Have the doctor be able to be more selective of the patients he sees.

These goals are important because this was not simply a production project. The goal was to create a practice that was more productive, more profitable, better organized, and much less stressful for the doctor.

Starting Numbers: Production & Variation

When we started our consulting work, my client was averaging $9,139 per day.

$9,139 Per day
$146,224 Per 16-day month
$1,754,688 Per year

In the 12 months prior to working with us, looking at production month by month, his highest average daily production was $11,289. That was also his best month at $180,624, working 16 days.

In those same 12 months, looking month by month, his lowest average daily production was $7,842. That was his worst month at $125,472, working 16 days.

That is a whopping 44% variance. See my blog on how to determine the productive capacity of your dental practice for an explanation of why this number is important.

The numbers told us something important. This practice already had significant productive capacity. The problem was not that Dr. Smith needed to work harder. The problem was that the practice needed better structure, better scheduling, better systems, and better control.

What We Did NOT Change During Our Consulting

There were no changes made to the office work schedule.

There were no changes made to the fee schedule, diagnosis standards, office hours, or staffing during the consulting period.

Staffing and base pay remained unchanged. No additional staff were needed.

That matters because the improvement did not come from working more days, adding hours, raising fees, changing diagnosis standards, or adding staff. The improvement came from making the existing practice work better.

The Goals Were Connected

Although the consulting agreement listed separate goals, the problems in the practice were not separate.

Dr. Smith’s stress was connected to the schedule. The schedule was connected to front office control. Front office control affected production. Hygiene affected both daily production and future restorative production. Leadership affected whether the team would protect the systems after they were put in place.

That is why we did not treat each goal as a separate project. We focused on the systems that could solve several problems at the same time.

The purpose was not to make Dr. Smith busier. The purpose was to make the practice more productive, more organized, and less stressful.

How the Core Systems Worked Together

Core Systems

Scheduling Structure

Front office training

Leadership and team building

Hygiene systems

Bonus system

Problems It Helped Address

Stress, production, patient flow, staying on time

Schedule control, cancellations, daily disruption, handling pressure from patients

Staff accountability, doctor stress, system follow-through

Recall, broken appointments, average production per patient

Motivation, shared goals, team buy-in

What We Changed

We Built a Better Scheduling Structure

We advocate first for customer service, and we don’t recommend rescheduling patients unless it is absolutely necessary.

So, since this office was booked out three months, we built a scheduling template so that when three months passed, the schedule would match our goals to achieve less stress and higher production. That allowed us to improve the future schedule without unnecessarily disrupting patients who were already scheduled.

An effective dental schedule cannot be built by simply filling openings. It has to be built around patient flow, doctor time, hygiene flow, procedure mix, emergency control, production goals, and the ability to stay on time.

That is where we focused.

The goal was to create efficient, productive, low-stress days with smooth patient flow that stayed within office hours.

We Trained the Front Desk to Improve the Existing Schedule and Protect the New One

Improve the Existing Schedule

We trained his front staff on how to rearrange the current schedule when patients cancelled or needed to reschedule.

That mattered because the office was already booked out three months. We could build the ideal template into the future schedule, but we also wanted the existing schedule to improve as quickly as possible without unnecessarily inconveniencing patients.

When patients cancelled or rescheduled during that transition period, the front desk was trained to place patients back into the schedule according to the new template guidelines. Over time, that helped the existing schedule begin to look more like the schedule we were trying to create.

That was the first part of the front desk training: using normal schedule changes to move the practice toward the new structure.

Protect the New Schedule

The second part was protecting the schedule once the new structure was in place.

A scheduling template only works if the team knows how to maintain it when the day changes. The front desk has to know how to handle cancellations, fill openings correctly, confirm appointments, guide patients toward appropriate appointment times, and rebuild the schedule when parts of the day fall apart.

Often, the front desk is trying to serve the patient in front of them, answer the phone, fill openings, respond to cancellations, and keep everyone happy. Without clear systems, that pressure can result in a schedule that serves no one well — not the patients, not the staff, and not the dentist.

The Unforeseen Scheduling Snag

We did have a breakdown and hit a snag.

One of the front desk staff could not maintain the scheduling standards we had chosen.

If a patient was upset about having to wait to get an appointment, this team member would cave and offer the next available opening, wrecking our tailored, structured schedule.

That may sound like a small issue, but it is not. In a dental practice, one team member who does not protect the schedule can undo the structure of the day.

We cleared that up, eventually having to move that team member to another position and placing a different team member in charge of the schedule.

Duties were changed, but no team members were added or removed.

We Strengthened Team Building and Leadership

We completed a team building and communication seminar with the entire team, including the doctor. Teamwork and alignment are essential for effective change. Every team member must pull in the same direction to create forward momentum.

Leadership and management skills were the focus of weekly calls between Russ and Dr. Smith. These calls covered staff management, strategic planning and analysis, and a wide range of other ownership challenges.

This was important because a better schedule will not hold unless the team understands how the schedule helps the practice achieve its goals. Dr. Smith also had to learn how to lead the team without feeling like he had to manage every detail himself.

Before our work, Dr. Smith felt like he had no time to manage the practice or the staff. Part of reducing his stress was helping the team take more responsibility for the systems of the office, instead of leaving the doctor to carry the entire burden.

Through that work, he cut staff management time down to almost nothing. He also learned how to motivate and lead people with less time and effort.

Dr. Smith did not just need a better schedule. He needed a team that understood the goals, bought into the systems, and helped protect the structure that made the practice more productive and less stressful.

We Improved Hygiene Productivity

Only two things increase hygiene productivity.

Increase the number of patients a hygienist sees.
Increase the average amount of production per patient.

We did both.

Increase the Number of Patients Seen by the Hygienist

By reducing broken appointments, the hygienists averaged more patients per day. We have several blog posts covering tactics for managing no-shows.

This did not happen by simply requesting a confirmation. It required training the team to set clearer expectations, respond more consistently to cancellations, and protect the value of reserved appointment time.

Increase the Production Per Patient

By maximizing insurance eligibilities and making sure patients received certain x-rays and other eligible procedures in a timely and consistent manner, we increased the average production per patient.

We also worked recall, because hygiene productivity is not just about filling the hygiene schedule. It is also about making sure the hygiene department is functioning as a complete recall, prevention, diagnosis-support, and patient-retention system.

When hygiene recall is weak, practices lose production quietly. When recall is organized and consistently worked, the hygiene department supports both daily production and future restorative treatment. See our article on effective hygiene recall.

In Dr. Smith’s practice, stronger hygiene systems contributed to the overall improvement in production, patient flow, and schedule stability.

We Created Front Office Workflows

Systems are so important in the proper, efficient running of a dental office.

For Dr. Smith’s front office, the goal was to create consistent workflows for the situations that happened every day: scheduling, cancellations, rescheduling, recall, patient requests, and changes in the day.

Without a workflow, every situation becomes a judgment call. One team member may handle a cancellation one way, another may handle it differently, and another may simply fill the first opening without thinking about how that decision affects the rest of the day.

That inconsistency creates stress for the doctor and confusion for the team.

We implemented standards for common situations, such as how to work hygiene recall, handle cancellations, manage demanding patients, and rebuild the schedule when it had fallen apart.

That kind of structure allowed the team to move forward without needing the doctor to constantly step in.

It also made the results more intentional. The front office was no longer just reacting to the day. They were helping guide the practice toward the schedule, patient flow, production, and stress-reduction goals we had set.

We Helped the Team Feel Like Part of the Practice

Making staff feel like they are part of the office’s success, and not just employees, is an integral part of what we do.

We get staff to take ownership — not literally — of the practice and care about its success and goals as much as the dentist does.

They were already much happier with the new scheduling results. The changes to the schedule and office systems had made their jobs easier and more enjoyable.

And the doctor’s reduced stress level made the staff happier and more relaxed.

We also added a bonus system tied to production increases. When additional production and collections were created, and after related costs were covered, the team could share a relatively small percentage of the gain.

The doctor retained most of the added profitability, but the staff had a clear reason to support the systems that made the growth possible.

This helped align the team around the practice’s goals and made the improvement a win for both the doctor and the staff.

When the team understands the goals and benefits from helping the practice reach them, accountability becomes much easier.

The Results

The schedule became much more productive. Running on time and within office hours. The stress levels dropped.

Stress Reduction

Stress reduction occurred over time and was very noticeable at about four to six months.

Dr. Smith reported that he no longer dreaded going to work, enjoyed dentistry again, stayed on time, got his whole lunch hour, and left at the end of the day on time.

The timing is fairly obvious. In a practice that is already booked out three months, the full benefit of a better schedule is not immediate. The future schedule has to be built correctly, the team has to be trained, and the doctor has to begin experiencing days that are structured differently.

As the new scheduling systems took hold, Dr. Smith’s days became more manageable and enjoyable.

The Production Increases

With systems, techniques, training, and templates, we increased his numbers to $11,811 per day.

How do we come to that number? Near the end of Dr. Smith’s year-long consulting contract, we evaluated the previous six months’ production. The average daily production over those six months was $11,811.

Ending production

Less beginning production

Production Increase

Daily

$11,811

$9,139

$2,672

Monthly

$188,976

$146,224

$42,752

Annual

$2,267,712

$1,754,688

$513,024

Production Increase

$1,754,688

-Beginning production

$2,267,712

Ending production

Annually

$42,752

Production Increase

$146,224

-Beginning production

$188,976

Ending production

Monthly

$2,672

Production Increase

$9,139

-Beginning production

$11,811

Ending production

Daily

This is a 29.23% increase in production, while at the same time bringing Dr. Smith’s stress down to a manageable level.

That is the key point of this case study: production increased while stress decreased.

The Overhead Impact

Dramatically decreasing overhead percentage was one of the goals.

This one is quite simple.

Dr. Smith’s fixed expenses stayed the same. He still had six team members on staff, so there was zero increase in payroll.

Therefore, the production increases were only subject to variable expenses like supplies and lab bills, which made every dollar of increase much more profitable.

As scheduling and treatments changed, lab fees and supplies likely rose to some degree. Still, with overhead rising very little and production rising substantially, the proportion of overhead to production dropped significantly.

This is one of the reasons production growth inside an existing practice can be so powerful. When the practice is already paying for the facility, equipment, staff, utilities, and basic operating costs, additional production can have a much stronger effect on profitability.

More Control Over Time Off and Patient Selection

Two of the goals were to position Dr. Smith to take off four weeks per year, plus some extended weekends, and to help him be more selective about the patients he saw.

We did this in several ways.

More Time Off

First, the dramatic increase in profitability allowed my client Dr. Smith to take more time off and still make a lot more money.

Second, the results set him up to need an associate dentist, making it much easier to take time off while the office did not have to close.

This is another way increased production and reduced stress work together. When the practice is more profitable and better organized, the doctor has more options.

More Selective With Patients

Being more selective with patients was also part of that shift.

He could have done this anytime he wanted. I had to assure him it wouldn’t hurt his practice. He had abundance and had to give up the scarcity mentality.

The production increases gave Dr. Smith the confidence to dismiss a small handful of rude, cancellation-prone, slow-paying patients, plus a few patients whose philosophy of oral care didn’t align with Dr. Smith’s.

This was not about being harsh with patients. It was about helping the doctor understand that a healthy, productive practice does not have to be held hostage by the worst behavior of a small number of patients.

When the schedule is stronger, the systems are stronger, and the doctor has more confidence in the practice, he can make better decisions about which patients are truly a good fit.

The End-of-Year Review

At the end of the year of consulting, I always ask my clients, “Knowing what you know now, would you do the consulting again?”

Dr. Smith’s answer was a resounding YES.

He reported that:

His stress was indeed under control and he enjoyed work again.
He understood the inner workings of his practice much better and felt more in control.
He understood the numbers and statistics of the practice and knew what they meant and what to do about them.
He had confidence that his front desk staff was getting everything done and done well.
He felt that systems were in place that would stick.
He said the practice was far more profitable and was enjoying seeing his growing bank account.
He appreciated how available and reachable I was during the year.
He was excited by the growth and organization of the practice and the motivation of his team.

The Long-Term Outcome

Dr. Smith was very pleased with the results produced.

He referred me to a classmate and a couple of friends whom I ended up working with over the next few years.

And, 15 years later, he and his partner — added after our consulting — brought in a new associate dentist to make now three dentists.

Later, he brought me in again to maximize the productivity and efficiency of the practice, which we did.

Each time his investment paid off handsomely and his practice is booming.

We keep in touch to this day.

The Main Lesson

One thing I must point out is that getting more productive is not about being busier and busier.

Excessive busyness is actually the enemy of productivity in a dental office.

If you’ve practiced long enough, you know there are days that are extremely stressful, overly busy, and draining. The office runs behind, and at the end of the day you look at the production and think, “Is that all we produced?”

Then there are days that proceed nicely with no major difficulties. The schedule stays on time. You get your whole lunch. You finish at 5:15 p.m. and feel like you have worked, but it was rewarding. Then you look at the production and think pleasantly, “Oh my goodness, we produced that much?!”

This is what I mean by busyness does not equal productivity in dentistry.

In Dr. Smith’s case, better scheduling, better systems, better front office control, stronger hygiene productivity, and team training helped the practice produce more while making the doctor’s day less stressful.

The important point is that the practice did not become more productive because Dr. Smith worked harder.

The improvements came from making the practice operate with more structure.

That structure allowed the same doctor, the same number of workdays, and the same size team to produce more, with less stress.

This case study describes one practice’s results. Every practice is different.

Why Dentists Work With The Ledbetter Group

Hands-on consulting for dental practices of many sizes, from solo practices to multi-doctor offices and small DSO groups.

35+ Years of
Dental Consulting
Experience

Scheduling, hygiene, front office, leadership, and accountability systems designed for the realities of a working dental office.

Systems That
Work Inside
Real Practices

The goal is not to make the doctor busier. The goal is to help the practice produce more with better structure and less stress.

Production
Growth With
Less Stress

Could Your Practice Be Producing More With Less Stress?

If your practice is busy, booked out, and still stressful, the problem may not be effort. It may be structure.

The Ledbetter Group helps dentists identify where production is being lost, where stress is being created, and which systems need to change so the practice can grow without simply making the doctor work harder.

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