#AskT-Bone – Ep23 – 45 minute vs 60 minute RDH Appointments


Welcome back to another episode of Ask T-Bone, on the T-bone speaks podcast!

I absolutely love these questions! Today’s question was actually texted to me, I provide my phone number to a close friends and family obviously and then also to Workshop attendees so they can have access to get in touch with me via text and email obviously as well.

So like you I’m a PPO practice. We averaged $850 to a $1000 a day in hygiene with 9 patients a day at 50 minutes appointment. I pay my hygienist $35 an hour, that equals about $300 per day including taxes and vacations and all the cost of having team members. I think one hour would be nice sometimes for marketing education, but I take a hit initially. Have you always done one hour?

Ultimately the question is, do I advocate 1 hour appointment or 50 minute appointments? or even 45 minute appointment or even 30 minute appointments in hygiene?

This is a great great question and a great point. When we are PPO practice, and I am a PPO practice, you feel this pressure because they cut your exam and hygiene and extra prophy and x-ray fees so down, that it kills you. And then, you’re often driven with patients that are very Insurance minded and you perio treatment suffers. And then what happens is you cut down time and you want to see that one extra patient a day, because it brings in that extra $85 or $100 per day, and then what happens is now you cut away time and your perio treatment falls even more. And then what happens you trickle down and your restore of treatment falls or the complexity of your treatment falls, or those things that go beyond fillings and crowns fall.

Listen, whoever invented 45 minute hygiene appointments, 30 min hygiene appointments or 50 minutes hygiene appointment, should be ashamed of themselves. In my opinion a quality hygiene visit is 60 minutes, and I’d love to get, I in fact I will, I’ll get one of my coaches on and we can talk about the anatomy of a hygiene visit.

So briefly what is a 60 minutes hygiene visit does it look like?

We break that down into three 20-minute sections.

20 minutes is information gathering, doing the screening and evaluation of your patient.

20 minutes is about the actual prophy itself

20 minutes is education, treatment planning, case acceptance.

That’s really what I look at it should not take more than 20 minutes to complete a prophy. If your hygienist is taking more than 20 minutes to complete a prophy either that hygienist is slow and lazy, you don’t have enough technology, that hand scaling everything, or the patient is not really a prophy. Member of prophy for healthy patients. Patients that have significant bleeding, significant build-up, need to be charged more, or they need to be seen more than every six months. And we have this fear, and ultimately this is a never-ending spiral. So you get to a way to have a shorter appointments because you need to raise your production, and then you just burn people through, you don’t have time to create a relationship. so I’m a big advocate of the 60 minutes appointment, we ask a lot of our hygienist in our practice. It’s why it’s one of the toughest positions for me to fill in my practice, because I want them to be my eyes and ears. I want them to create a relationship, I want them to have that first conversation about pre diagnosing or what it appears to be looking like that the patient may need. So that way when I walk in I’m just confirming these things. I want them to take photographs, I want them to review at 3D x-ray, I want them to discuss sleep apnea and plant that seed, discuss Orthodontics and plant that seed, of course only when appropriate, discuss occlusal guard.

This cannot be done in 45 minutes, and quite honestly let’s think about this: Your hygienist production of 850 to $1,000 a day, and I know the gurus make you feel bad, like your highness should be doing $2,000 a day, and and look, that may be true, we don’t get there, we’ve got smart people, we’ve got the technology, we have the struggle too, and we can be better. I don’t want to digress, but that $850 to $1000 a day, that’s one Crown. Even a PPO fees, that’s one Crown in build up. So if you give your hygienist, more time, more ability to create a relationship, I promise you in the long run, you will have a much better practice. What your hygienist aren’t giving you in that production will easily be made up in their relationships and the restorative treatment they diagnose, and beyond the restorative treatment they diagnose,  the implants, the sleep apnea the orthodontics, the occlusal guards. And just imagine if your hygienist could do one occlusal guard per day, that’s half their production. And that’s just a matter of a few minutes of having an extra few minutes to have that conversation. Now, if you give your hygienist 60 minutes and they do nothing additional, that’s a problem. So you gotta nip that in the bud, you got to set expectations, and then my suggestion is you have a good talk with them, you set an outline of what you expect, you got to dry out what you want to… The first suggestion is you have to dry, out you have to wire frame what you want that hygine visit to look like. When was the last time you sat down and looked at your hygienist and said this is what a great, the anatomy of a hygiene visit. And the truth is it’s been awhile since I’ve done it, and we’re doing new things in our practice, we got new things going on, but we never sit down and re-look at and re-discuss what would be ideal. And what it is your expectations are, as a practice owner, as a practice leader. What is your expectation of your team?

So, consider going to 60 minutes hygiene appointments, they’re fantastic. You know, we may suffer a little bit on hygiene production, but that’s a different conversation for a different day, Because that is a addiction approval, that is your hygienist being afraid of telling your patients they have perio treatment, they have isolated the perio treatment, they need fluoride, all of these different things.

so I want to thank you very much, hopefully I have an answer that question, and if any of our listeners have additional questions please visit www.tbonespeaks.com, scroll down, leave your question, leave some feedback, listen to some other episodes.

Thank you very much!

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