By John C. Cranham, DDS 

 When I’ve looked at and really studied my practice numbers over the years, my favorite has always been productivity per hour. I have aimed to focus on a low volume of patients who need advanced dentistry. As my practice developed, I was able to earn more per hour on fewer patients. I was able to earn as much or more while working fewer hours, and my overhead went down because the office was open fewer hours. 

 Rather than just firing off from the hip and trying to make a treatment plan with the patient who is in the chair, I now invite them back for what I call an “advanced records visit.” Then I focus on making comprehensive records and studying those to create a well-thought-out treatment plan. The time spent planning the treatment may be an hour.  

 When you become good at treatment planning, it may take as little as 20 minutes. But the idea is to do better dentistry for your patients and get to where you are working on about 12 big cases each month. I have found that doing more than that is exhausting and makes it difficult to maintain general patients.  

 As you develop your reputation for being a “go to” dentist who solves problems, the big cases will flow in steadily. When you are planning a big case, you are generally working off a treatment plan where you’ve mounted models, you’ve studied photographs, and you’ve got an architectural plan of where you’re going. It’s very cerebral.  

 When you’re executing the plan, everything must be done in a specific way. So, in my office, we have time scheduled for executing planned dentistry—without interruption. We have another time scheduled for seeing general patients and moving between operatories. In the morning huddle, we review the plan for the day and decide where we can fit in an emergency appointment if one is needed. 

 Over the years, my schedule has changed. I’ve tried various schedules and had to experience them to know what works best for me. Now, I like to arrive at 6:00 AM, do my cerebral case workups in solitude, schedule patients with advanced needs in the morning, and have short afternoons for general dentistry. I don’t bother with lunch because I have determined that I don’t need that break in my day.  

 You’ll find what works for you. Keep in mind that your schedule might change over the years in response to patient needs, staff needs, family needs, and your pursuit of other activities. That’s okay. There is no perfect one schedule that fits all dental practices all the time.  

 Once I had a steady flow of big cases coming in and productivity per hour was high, I no longer felt the need to keep my office open long days or to offer evening appointments. I discovered that evening appointments were the ones patients most often cancelled. And when we cut back on our afternoon appointments a few years ago, patients were accepting once they heard it was because the team and I wanted to spend more time with our families.  

 You may discover that when there are fewer appointment slots available, your patient’s perceived value of them rises, and patient calls to cancel or reschedule diminish. 

 Starting out in practice means delaying the gratification of shorter workdays. It will take some time to get your steam engine rolling but stay the course, balanced with being kind to yourself so you can keep going. Keep your vision alive and educate your patients toward the comprehensive dentistry that will serve them best. Be patient. Your low-volume/high-earning productivity per hour will grow slowly and then faster. 

 At every stage of practice, I think there is one thing all dentists have in common. They relish the quiet hours when they are alone planning treatment. Those are the hours when they feel most at peace, most able to solve complex problems, and actively create plans for efficiently delivering dentistry. As a young dentist, you might experience this once per month, and after a few years, you may experience this nearly every day. Those quiet hours are powerful hours for driving productivity.