Episode #395: How Many Patients do I need? With Angela Heathman

To be a profitable practice, you need to have the right number of patients. But how do you know how many are too much, and how many are too few? In today’s episode, Kirk Behrendt brings on Angela Heathman, Lead Practice Coach at ACT, to discuss how many patients a practice should have. Kirk and Heather talk about when to add a new doctor, the dangers of exhaustion, tips on how to get the most out of the patients you have, and much more. To answer the question “How many patients do I need?” listen to Episode 395 of the Best Practices Show!

Main Takeaways:

• More patients doesn’t mean better.
• Determine what you want out of your practice—how much do you want to be working?
• For one doctor working four days a week, 1200-1500 patients is the capacity. 
• Capacity for hygienists is around 750 patients.
• A doctor’s schedule should be full 95% of the time, and a hygienist’s 92% of the time.
• You can expect to lose 15% of clients due to natural causes—figure out how many you need to add to offset that.

Quotes:

• “If you are a single practice and had 3100 patients, I would expect that you would be exhausted. I would expect that you would be exhausted or that your patients weren’t really getting probably the standard of care that you really wanted them to, because you probably just don’t have the capacity in your office to take care of that many folks. The simple answer is usually about 1200-1500 for one doctor working four days a week.” (05:03—05:33)
• “Typically, that office that has 1200-1500 patients has two full-time hygienists then, working four days a week. So, the number that we think about for hygienists is usually around 750. Again, longer story is that it could be anywhere between 750-1000, but typically the offices that we’re coaching are spending 60 minutes with their patients, they’re doing perio, which means they’re needing time for scaling and root planning, and also three and four-month re-care appointment, so that’s why that number is more around 750 instead of 1000.” (06:36—07:13)
• “You can be anything that you want to be, but figuring out how to make that work for your own life is what’s most important, and a lot of times you don’t have to do that, and sometimes we get kind of caught up, like you said, in the ‘more, more, more,’ but you can have a very good life and not have to do that if you don’t want to, so figuring that out first is important.” (08:15—08:37)
• “If you’re feeling like ‘Oh, we need to add more hygiene hours, we need to add another hygiene day,’ one of the things you’ll want to look at is your capacity; like how full is your schedule already? Because if you’re measuring that and every day you have two hours of open time, then I would argue that you don’t need another hygienist—at least not right now—first you need to fix that problem of having all the open time.” (09:31—10:01)
• “I always want to look at [capacity] in terms of percentages. So, for a hygienist we want their schedule to be full about 92% of the time, and for a doctor, 95% of the time. And so, what that shakes out to in the matter of a week is only about two cancellations—so only having about two hours open to really hit that benchmark.” (11:34—12:03)
• “One of the things we coach our teams to do is something called an RFR. I would like to give credit to whoever started that, but I don’t even know who it was, but RFR stands for Reason For Return. So, making sure it’s clearly documented in your clinical notes the importance of why that patient needs to come next time. So, if next time you’re going to be taking a PA to check a tooth, or a pano, or looking at an implant, or something like that, putting a little something additional in that clinical note so that whoever is fielding that cancellation call can have something very tangible to refer back to. Like, ‘Oh, you need to change this appointment? Well, it looks like here, last time they mentioned it was time to look at your whatever, or follow up on this,’ and so it just gives them a little bit more of an ‘Oh yeah, I do need to make that appointment.’” (14:30—15:27)
• “We just want our doctors to be very realistic and thoughtful about adding new team members, new ops, and things like that.” (19:15—19:23)
• “We use Dental Intel for a lot of our team’s metrics, and as a coach, when I get a brand new client, the first metric that I look at in their Dental Intel is their annual patient value, because it can tell me—as a coach—how comprehensive care the office is, it tells me how stressed out the office is; and so, yes, I got a new client this week, it was the first thing I looked at—their annual patient value was very good, so it gave me hope that ‘Okay cool, this office is already doing great dentistry, their team’s probably not too stressed out.’ Usually the number that we want to shoot for is around the 800 mark for your annual patient value, so if I see a team that’s $250 annual patient value, I know they’re exhausted.” (21:06—22:01)
• “We do run analysis for our clients, and we’ll find often that [fees] are actually really low, and I hate to say this, because sometimes they’re just aligning them with insurance reimbursement, which is—don’t do that—we want you to be reimbursed for what you’re doing, not just because of what insurance tells you that you’re valued at.” (24:15—24:41)
• “We’re always going to face attrition, and attrition we expect to be around 15% in a normal office…From moving, patients getting relocated or passing away, there are just natural reasons why people will move out of your office, so just keep that in mind when you’re thinking about your active patient count too. If you have around 1500 patients…and you have 15% attrition just naturally in your practice, then you’re probably going to want about 20 new patients a month just to kind of keep that number stable.” (26:29—27:13)
• “There’s usually a lot of patients that we’re not pre-scheduling, and they’re active, but they maybe don’t have another appointment, so that’s a great report to look at.” (28:23—28:32)

Snippets:

• 0:00 Introduction.
• 03:42 Angela’s background.
• 04:19 How many patients should you have?
• 06:03 Number of patients per hygienist.
• 08:37 Should you add a hygienist?
• 10:53 Capacity.
• 12:12 What do the numbers mean?
• 13:34 Partnering with ACT.
• 13:03 Cancellations and the RFR.
• 17:36 Keeping the practice stable.
• 20:23 Look at the Annual Patient Value.
• 23:53 Value yourself.
• 26:17 Loss due to attrition.
• 27:32 Unscheduled active patients.
• 28:39 Wrap up.

Reach out to Angela:

Angela’s Facebook: https://www.facebook.com/angeheathman

Angela’s Instagram: @angeheathman

Angela Heathman Bio:

Angela Heathman is a Lead Practice Coach who works with dentists and their teams to help them accomplish their goals. She believes the hard work you do on your practice is just as important as the work you do in your practice!

Angela has over 20 years of clinical dental hygiene, dental sales, and practice coaching experience. When she transitioned from her role as a clinician to her role as a sales account manager, she realized both her passion for education and practice development. Angela holds a master's degree in dental hygiene education from the University of Missouri – Kansas City.