Tiff and Dana talk about a large trend happening in dental practices this year: last-minute cancellations, and why it’s such a stressor for the doctors. They share how to notice the signs of no-shows further in advance, plus ways to troubleshoot the problem.

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Transcript

Tiffanie (00:01)

Hello, Dental A Team listeners. We are so excited to be here with you today. I have the one and only Dana here with me. Dana, we're still working on that dynamite. Dana is my favorite nickname, but we'll see what Kara decides sticks. So.

 

Thank you, Dana, for being here with me today. If you guys are watching this podcast, which I think is still a weird concept in my brain, Dana has the most incredible hair today. Dana, I'm always impressed with your lovely loc. So thanks for coming ready to go today. How are you?

 

Dana (00:34)

doing good. Thank you. If you only knew how little time it took me and that's why it's consistent because it takes me no time to get it to do this. I'm excited to be here anytime I get with you on this podcast tip is special time. So

 

Tiffanie (00:42)

I love it.

 

Thank you. Thank you. And I do enjoy our time together. I'm trying to make sure we get that one on one time a couple more times per month than just podcasting. So thanks for being patient with me on that. Dana, I get to pick your brain all the time. We have a really fun one coming up here in a second that I know everyone's going to be really excited for. But right now, I really want to pick your brain a lot on cancellations and the cost of cancellations to a general practice. I know in

 

My client base, what I have seen and tell me Dana what you're seeing as well. I have seen this year just like a wild bag of like, patients coming? Are they not coming? Are they canceling? What are the reasons? Like it just feels like a mixed bag of information. Since realistically, I would say it probably, I think it started trickling around November, but January, February was wild. Weather was wild.

 

And then now that we're getting into, you know, summery months, we're getting out of spring and into summer months here in May, it just still seems to be like trends are just kind of cycling around that same space. are you seeing that with your clients you're working with and friends in the industry that you're chatting with as well?

 

Dana (02:03)

Yeah, I feel like it is a weekly basis where it's like, okay, how are things going? Well, the schedule was full, right? It was looking great and it just seems to be falling apart. So a lot, a lot of last minute cancellations where it is really hard for the team to pivot and pivot quickly in those instances.

 

Tiffanie (02:09)

Yeah.

 

Yeah, I totally agree. I totally agree. And so on one hand, I want you guys out there, doctors, team members, office managers, those of you who are listening today, on one hand, if this is something that you guys are coming up against this year, I want you to know that right now in 2025, this has been a trend that we've noticed within the dental community as a whole. today we really want to talk about the cost of those cancellations. I think it's great for doctors to know that information.

 

A lot of doctors do, lot of owners already have that information, but I think it's great for team members and office managers to really know the cost of that as well so that we can see why are the doctors harping on us, not just because they don't have patients, but why is it so stressful to them? And doctors, why am I feeling this internal stress? And then I've also got some tips in here, Dana and I have gone through that are ways for you to know that there's a problem, start noticing it more in advance.

 

and then ways to troubleshoot those problems as well. So first and foremost, I think, Dana, the most important thing to remember is that we've got to make sure that we've got a solid plan and a solid action, actionable pieces as far as our goals. If we don't know our goals, if we don't know where we're heading, then...

 

Like, what are we even doing? Right? So as long as we, as long as we can keep a good heading on our goals. And I mean, by that, like, what is our monthly goal? What is our daily goal? And then always looking at what have we done? Where are we going? And what's that gap in between? If we're not watching that gap in between, we can fall into a really scary space. And then it's that last week of the month that we've all lived where the office manager is like, okay, guys, we just need $30,000 in addition this week. Who needs ortho?

 

right? And we're like, scraping the bottom of the barrel trying to get that money in. But it's because we haven't watched all month where those numbers are at. making sure that we're always looking at that, and we're always paying attention to those things is going to be massively important. Now, Dana, I know you have a lot of practices that are tracking this, that are they're watching these trends. As far as like dollar per hour kind of cost to the practice and what this actually looks like in conjunction to the goals.

 

What are you seeing with your practices right now and what do you suggest they really start to watch?

 

Dana (04:39)

Yeah, I think that it is one just like you said, tracking and making sure that they know how much is open schedule time impacting their production and their ability to get to their goals. How much you know, if their hygiene team isn't getting to their 30 % or hitting their daily goal, is it because they just didn't have a full schedule of patients because that is pretty crucial for them to get to that point. Daily goals are set up with full schedules in mind, especially if we use block scheduling to get to daily goal. If

 

our blocks aren't full, we're not gonna get there. So I think it is tracking to be able to look and say, how much is it impacting our production and what are we losing when we have a hole in our schedule? Because sometimes when we can attach a monetary value to that actual appointment, it becomes a little bit more important. When we see, if we know that every time a restorative appointment is open, that that costs us

 

$1,000 right or $900, right? Well, then we know how much that's going to impact our goal if we know that every time a Recare patient doesn't show up that equals $230 well, then we can sure be strategic about how we make that gap up

 

Tiffanie (05:40)

Yeah.

 

Dana (05:56)

later in the month or later in the week and sometimes too for team members it's like oh we only have one cancellation well one cancellation for every 17 days that you're open when you know what that value of that appointment is it really really

 

You can see how it's impacting. And so I would say take a look at your doll, you know, your production per hour on both sides so that you know, when I've got an hour open, it's costing the practice this much. When I've got an hour and a half open, it's costing the practice that much. And that's just the missed dentistry. That's not the costs of the practice just to be open for that hour, right? Like there's all of those fixed costs that extend into that too. And so getting a real picture of what each hour in our practice leads to

 

Tiffanie (06:25)

Good job.

 

Dana (06:41)

production and expenses can just be so eye-opening on its impact.

 

Tiffanie (06:48)

I totally agree.

 

I think the actual cost, like if you look at it and we're looking at our goals, that actual cost is what is your dollar per hour? So like Dana said, it could be anywhere between $500 to $1,500 an hour on a doctor's schedule. And then again, that $100 to $300 on a hygiene schedule just really depends on what your practice's goals are and what you guys are set out to achieve. So if you've got $1,200 between doctor and hygiene, we've got a goal of $1,200 per hour and you've got those openings on the schedule, that's what the cost is.

 

that data that we've done really really well and we've done differently this year with our current clients is really having them go through and track the number of open hours on each provider's schedule. So the reason that we do that is last year

 

I had a couple of doctors that were really, really close to, one of them was really close, he was about $30,000 away from hitting the goal that he wanted. Another one was like $20,000 away from exceeding where he thought he would be this year. And I was like, gosh, wow, how did we get so close, but we missed it by that much. So what I did was I sat down and I looked through the whole year and I tallied.

 

doctor, open hours, hygiene, open hours. So whether that was cancellations, the schedule fell apart, who knows, but it was just open hours that were on the schedule that could have been scheduled, meaning that was an open block, nothing was there. And both of those doctors would have far exceeded what they anticipated had those been filled. Now,

 

We like to say a variation rate of about 5%. If you're more than 5 to 8 % on the long end, like 8 % is high.

 

If you're more than that in cancellations, you're in hot water. So even if we deducted that five to 8 % from that math that I did, we still would have hit those goals. And so it really brought a lot of reality into the situation. Like you were saying, Dana, to really be able to see what that gap is and why it happened. And I had a practice just the other day, she did fantastic. This office manager, she had the information before we even went into the call. one of the doctors, one of the owner doctors was really, really intrigued on why are we

 

just why are we short in collections and by that he was looking at QuickBooks, right? So why is the bank short? So because when we look at their data, when we look at their collections and their production, just looking at those straight from Dentrix, they were above 100 % on collections. So the team is like, bro, like we're at 102%. Like, what do you mean? And he's like, yeah, but there's no money. Like there's not the overhead, right? So the overhead is hitting well,

 

The office manager knew that we were going into this conversation. She knew that he was going to ask these questions and that I wasn't going to have that immediate information. So prior to the call, she went through the whole first quarter of the year. And what she did was not only she took cancellations on one side, because that was an aspect of it, but another piece that she took was we've had a lot of call outs from hygiene and ⁓ vacation.

 

And surgery, was a surgery that, you know, quote unquote, she's on her vacation. So we had a lot of time that there wasn't a hygienist available to see patients. And when she tallied that it was literally that missing piece and his mind was just blown and he was like, my gosh, thank you. He just needed the satisfaction of knowing what it was, right. But the cost of not only cancellations, but that missed opportunity of hygiene because there had been hygienists ill, there had been hygienists on PTF.

 

as a hygienist that had to have shoulder surgery, these things come up and they happen, but we're not always anticipating them and our goals get missed. So these cancellation spots where patients are calling and they're like, gosh, I just can't come in are even more important.

 

because there are times where we can't, we can do something about that. We can fill an open spot on the schedule. I can't do hygiene if I don't have a hygienist, a licensed hygienist there to take that spot. So those different spaces really took a toll. the cost on the practice, right? The cost of the cancellations is the dollar per hour, but then on a grander scale, it's like, what did we miss out that month and that quarter? And how did it impact our overhead? Because this example, all three examples,

 

the doctors were like, why is my overhead so high? Where's my profitability? Why is this sucking? Especially when you feel like we're rolling along pretty well. It's like, where's the profitability? Where is it missing? That's the big toll. And then also I think, Dana, the stress, like, gosh, being a team member and then like inefficiencies that it creates, the stress of having to save a patient or

 

Dana (11:22)

Mm-hmm. Yeah.

 

Tiffanie (11:40)

having to talk somebody into coming last minutes, the stress of knowing that there's a cancellation there and Doc's gonna, know, Doc and manager or owner or whomever is gonna come ask me questions. Like Dana, you've been in that position too. And even maybe even from a hygienist standpoint, the stress of having openings, like that's a cost as well. What was that for you and your perception as a provider and a team member, but then also as a consultant, what are you seeing there as far as the cost on a practice with those cancellations from an emotional standpoint?

 

Dana (12:09)

Yeah, I I think is I do this definitely something that weighs heavily on you because I mean, I'm very goal oriented. And so if you put a goal in front of me, I'm going to want to tackle it. And so it is a little bit defeating in that way. And then it's like, okay, well, I would have to book patients out, right. And sometimes even further than when they were due, right, just to have my schedule fall apart. And it's like, man, like I could have seen those people that I had to look out a little bit farther. So it is a stressful on a patient care level is stressful on a

 

goals level it's stressful on like hey I'm here and like I want to do things that are of value to the practice so yeah it plays a burden on everyone and so it's just something that's so important to look at and to set a game plan for and to tackle as a team.

 

Tiffanie (12:58)

Yeah, I totally agree. totally agree. Now areas that we'll tackle some areas where you can tell there's an issue, like not only you see like, my gosh, I feel like there's a lot of cancellations happening, but really just being able to see what that what that entails. So I think one space is open schedule, obviously, right? Open schedule. I think frustrated team members, Dana, do you agree? Yeah.

 

Dana (13:23)

Yeah, yeah,

 

because it's so much more work on the back end to save something that's fallen off or to fill something than it is to just be really good at reappointing from the beginning and being really good at creating value from the beginning. Those things are much easier than this stress and the crunch time of after the fact.

 

Tiffanie (13:45)

Yeah, totally agree. So upset team members, like stressed out front office team members, upset doctors, empty schedule, seeing repeat offenders. So patients that are repeatedly coming off of the schedule seem to cancellations. And you guys, I want to tackle a little bit too on why.

 

why this happens. There's a few things and I mean, you guys are going to tell me and your team is going to tell me patients are sick and patients can't come in because of work. Like I totally hear you. I get that. I understand. But what it boils down to the root cause in my opinion is a lack of a lack of systems or a lack of systems follow through. So lack of consistency. So ⁓ handoffs and patient buy-in might not be there. Team buy-in might not be there. Scheduling rules. So how do we form

 

and build the right schedule. If we're consistently behind on patients appointments, or they're taking longer than we said they would, they're not getting sat on time, like if we're showing that we don't value our schedule because our scheduling template isn't working for us and it's running us behind, I don't like we're telling the patients our schedules don't matter. I'm not sure why we expect a different result. On the other side, we expect our patients to, you know,

 

really, really take into consideration the schedule and to make that a top priority, but we're not even doing that. So hard truth, I think there. ⁓ If you're having these issues, if you're running behind, you're seeing high cancellations and you feel frantic, it's typically a reflection of the schedule that you're running. Right, Dana, do you agree? Am I just in mean?

 

Dana (15:23)

100 %

 

I hands down took the words that I say all the time and I'm like honestly it comes down to a lack of value and that's really hard for offices to hear but it is a lack of value on the appointment itself right we've not created enough value for the patient to feel like this is something I cannot miss and we also haven't valued it enough to ensure that we've done that.

 

Tiffanie (15:42)

Yeah.

 

Dana (15:47)

to ensure that we followed our systems that we've worked really hard to put into place. And so maybe we don't value those systems or we don't see their value. And so it truly comes down to just a lack of value on both ends.

 

Tiffanie (15:58)

I absolutely agree. Yeah, yeah. And the patient's buy in comes from value, you guys, and it takes multiple times. So some of the systems I think, Dana, that we can we can pop through a couple of systems that really, I think, stand out and helping that. And I think one space to remember is that we want to attract and we want to keep the patients that we want. Not every practice is built for every

 

patient, every person. So some patients are not going to respond well, they're not going to care, they're always going to cancel or they're going to hop. You know, I used to work in a dental practice that it was a heavy retirement community and we had a lot of, them in Arizona snowbirds. And so we had a lot of winter visitors and they were just special hoppers. We would see somebody on, you know, one new patient special that we were running at the time and we'd never see them again or we'd see them three years later trying to use another special.

 

always going to happen. So work really hard and aim to create systems that work for the patients that you want to keep. Who's your patient avatar that you're trying to attract to your practice? What will they appreciate about your communication about your systems? And don't be afraid to lose some patience to make room for the patients that will appreciate the systems you're putting into place. So that's my caveat. And to create that value. really Dana, that word that you use

 

there is spot on because that's really what it's all about. We're creating value, which creates retention and we're, we're selling not only a product, a dental product, we're selling a filling, right, but we're also selling an emotional product of how are they feeling when they're in our practice and our systems boil down to create to

 

being there to create feelings, to evoke emotions in patients so that they do see the value in that product that you're selling. So handoffs, you guys might hear this constantly. If you've ever listened to any podcast, NDTR, if you ever want to hear Dana and I talk about it, there's probably about 50. So go type in NDTR, Next Visit Date, Time, Recare. It's literally the perfect handoff situation. It's something we've used for years. It was something that and I trialed many years ago.

 

And it's worked so well in so many practices to turn around case acceptance, to turn around scheduling, and to really just turn around communication between front and back office that we continue to harp on it. So go type in NDTR on our website, TheDentalATeam.com. When you go to podcasts, you can search NDTR.

 

⁓ And I think treatment planning in general. So making sure those handoffs are right, treatment planning. And I think Dana too, like I stress to practices to treat re-care appointments very similarly. Like it's so easy to get into that routine of like, okay, let's just, let's schedule your next six months real quick. We'll pop it on the schedule. You can let me know as it gets in or, don't worry, they're scheduled. And it's like, we haven't built any value.

 

In my, we built the value of the appointment hygienist, like the value that you have built during that appointment 100%, but that patient has to remember to evoke that feeling in six months from now to keep that appointment on the schedule. So how are we building and creating that value for those appointments even thereafter? So Dana, like NDTR.

 

treatment planning, and then how do you suggest and how did you maybe even as a hygienist build that value for those re-care appointments when they're coming three, four, six months later?

 

Dana (19:25)

Yeah, I see it all the time. And I do think NDTR builds in some value in that and I've been getting a lot of doctors question like, hey, why do I have to ask about their re care? Right? Well, that is that is your chance to build value as the doctor that not only do I need to see you for that treatment, but it's super important to me as the doctor to see you in six months or whatever your regimented cleaning time is. So there is that but then I would use this as a hygienist myself every single patient before I scheduled.

 

Tiffanie (19:47)

Yep.

 

Dana (19:55)

They were given a reason why I needed to see them back. Right? So even my regular six months, and I learned this from an amazing coach, right? So I'm not even going to take credit for it, but it's something that like I did routinely that I instill in all of my hygiene teams that I work with. And that is every patient has to leave with a reason to return. Even if that is, my gosh, Mr. Smith, seeing you every six months has kept you looking so good. We need to make sure we keep that up.

 

Tiffanie (20:01)

⁓ I that.

 

Thank

 

Dana (20:25)

Let's get your next six month appointment scheduled. Even if Mr. Smith has zero issues, concerns, anything, right? Then my people with concerns, that's even more so. All right, so I need you to work on that flossing technique. We did have a fair amount of bleeding this time. My goal for you the next time you come in six months is you've been able to really target that in and we've got that bleeding reduced. I can't wait to see you in six months to check on it.

 

Tiffanie (20:27)

Beautiful.

 

Dana (20:49)

Right, so when giving them it's not just like let's get your routine appointment scheduled No, there is a reason why every single patient needs to be back in my chair at the recommended interval and

 

Sometimes too we would put little notes and it helped the front office, right? Hey, I know Dana really wanted to keep you on that six months She said you were looking so good last time. Is there any way we can make today work, right? So it was in my auto note I always put it in there and help the front office then they gave them the reason right? Hey, don't forget Dana wanted to check those bleeding points. How's that flossing going? Let's get you in today Let's make sure you're here so she can double check on that so it's something that I have used religiously and that I feel like truly does because

 

we do see that hygiene appointments, right? That's where a lot of the cancellations happen and that's because it's just the routine cleaning, right? Or the routine preventive. And so building that value in hygiene and you can do it with something so simple as just something you need to check on the next time that they're there.

 

Tiffanie (21:48)

Yeah, my gosh, Dana, was stop the podcast. That was all they needed. It's brilliant. Thank you. I love that. So I think that in itself is huge because that that went into the confirmations that went into saving the appointments and the pre scheduling. So I think that was huge, Dana, that little nugget was more than we could have ever asked for. Thank you.

 

Thank you. So, systems, guys, NDTR, go look it up, treatment planning. I love this idea of making sure every patient, whether they're coming in on doctor's schedule, whether they're coming in on hygiene schedule, they have a reason to come back. And remember, I mean, gosh, it makes perfect sense because...

 

your patients are coming back on your your dental schedule and your doctor's schedule because they have a reason because they have decay, broken tooth, missing tooth, whatever the case may be. So find that reason for their re care as well. And I love that you pointed out even the healthy patients you were like, let's keep this up. Let's keep that going. I can say I had my eye exam the other day and he was fantastic. And he was like, gosh, yeah, it hasn't changed a lot from last like he was just bringing up so much information from the last time and like can't wait to see it again next time. I was like, wow, this guy actually in a very short amount of time, I think I spent

 

five minutes with the man, ⁓ massive amounts of trust build and value. I truly will not go to another eye doctor as long as I can go to him. So just building that value, doesn't have to take a long time.

 

It just has to be massive amounts of value. So make sure you're under TR treatment planning, make sure there's a reason for them coming back. They're always scheduled to come back. Confirmations are in place and make sure that you're tracking your cancellation rates, you guys, and really seeing what the impact on the business is and sharing that with your team so that everyone's super aware. This awareness is meant to bring light to trends.

 

It is not meant to be a you guys suck, this is where we're at. It's a hey, this result sucks. Why is this happening? Let's look at our systems. I tell my teams all the time and I think Dana, you do too. I don't want you doing something that's not working. That is such a waste of time and I...

 

would gouge my own eyes out, I could not. There's no way I could live life like that. I did not expect other people to as well. So when we track these metrics, when we're looking at these trends, my goal is to ensure that we're only doing things that are getting the right results. And when we're not getting the results we want, we change the system because it's clearly not working. And when a team knows that that's

 

what we're looking for. I'm not looking at you that you suck unless you literally refuse to use the system. I'm not looking at you. I'm looking at the system. The system and the results are what we're tackling. We're not tackling people. We're never tackling each other. So

 

Dana (24:24)

Thank

 

Tiffanie (24:34)

Go into it that way. Track those cancellations. Look at the real cost to the business and then look at the systems that you have in place. Are you adding enough value to those appointments through your handoffs, through your treatment planning, through your discussions on why they need to come back and then through your confirmations. Are your confirmations working? we lax it easy asking and are we keeping a good schedule? Huge, huge. You will get back.

 

what you give. So make sure that what you're giving is freaking excellent. And Dana, thank you so much. That was a wonderful podcast. That was so many amazing nuggets. You guys go back, listen again, take notes. I'm telling you, Dana's brain, I always get something new out of it. Years and years later, consulting side by side, you still just always drop something on me that I'm like, dang, all my practices need to hear that. So Dana, thank you for being here with me today.

 

Dana (25:29)

Yeah, thanks for having me as always.

 

Tiffanie (25:31)

Of course, you know, I'll steal you anytime I can get you. So awesome, everyone. Go listen, take notes, go do the things, start tracking your cancellations, look at those systems and really start seeing the cost and the value that you're perceiving. Okay. Any questions?

 

Reach out to us, [email protected], if you need checkers, if you need more information on any of the things that we talked about, if you're interested in learning how to have someone like Dana give you amazing tips like that all the time, just off the cuff, please reach out. We are here for you guys. [email protected]. You can reach us.

 

on our website www.TheDentalATeam.com. We make it really, really easy for you guys. So reach out to us and drop us a five star review. We want to hear how amazing you thought Dana's nuggets were today. Thank you all. We'll catch you next time.