Hygiene Led Growth vs Hygiene Led Profit - Ask George

Show Notes

In this episode of the Shared Practices Podcast, George discusses the difference between hygiene-led growth and hygiene-led profit. He explores how to leverage hygiene as a growth tool rather than for immediate profitability and the impact each strategy has on a dental practice’s success.

Key Highlights:

1. Hygiene-Led Growth: George explains how focusing on growth through hygiene means expanding patient volume and creating opportunities for long-term production. This approach sets the stage for future profits but requires patience.
2. Hygiene-Led Profit: The alternative strategy is maximizing profitability through hygiene in the short term. This approach focuses on immediate returns by optimizing hygiene production and collections.
3. Which Strategy is Right for Your Practice? George offers insights on choosing between growth and profit depending on your practice’s goals, financial stability, and long-term vision.

 

 

Curious about which approach will work best for your practice? Tune in now to discover how to leverage hygiene for either growth or profit!

 

 

Have a question or topic you want us to cover? Reach out to us on social media or our website at www.sharedpractices.com. Don’t forget to subscribe and leave a review if you enjoyed this episode!

 

What is Shared Practices | Your Dental Roadmap through Practice Ownership?

Shared Practices is the go-to podcast for dental business owners who want to grow and elevate their practices. Whether you're an experienced practice owner or an aspiring entrepreneur, Shared Practices offers a wealth of resources tailored specifically to the dental industry.

Hosted by Dr. George Hariri, the podcast delivers fresh, relevant content every Monday. From practical advice and expert interviews to deep-dive discussions, Shared Practices gives dentists the insights they need to become better business owners. Whether you're scaling your practice or just getting started, you'll find valuable guidance here.

We're changing the way dentists approach practice ownership. Join us on this journey at sharedpractices.com/podcast.

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Welcome to Shared Practices 2.0 with another Update Ask George episode.

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The collision of frameworks that we talked about last week, the mess,

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the goodness, the learning, the joy.

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We're going to talk about that a little bit more today. So, George, welcome back.

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Thanks, Richard, for having me back. And, you know, this will be a shorter episode

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because a lot of people who have kind of heard our, you know,

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original framework, this will sound more or less familiar.

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And I think that on the last episode, we talked about Scott coming on to the

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Shared Practices podcast.

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And we talked about shared practices, sharing best practices.

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And we talked about where Scott changed our framework.

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And he changed our framework in the minds of income, right?

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Like we've always proposed dentists take a fast path to growth that has a period

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of income turbulence that we just

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call something that they need to set expectations for and move through.

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And Scott suggests taking a slower, more patient path that doesn't necessarily

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have that drop in income.

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And that was a lot of what we talked about on the last episode of Ask George.

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And this episode, we're going to talk about the y-axis of that chart,

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which is just the movement through avatars of our philosophy through a patient

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flow hygiene-led growth.

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Because when we were in the process of recruiting Scott to join Shared Practices,

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that was one thing that we kind of said, no, this is our flag in the ground

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where we're different and we're unique.

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And it's what makes us, in our minds, so good at what we do is that we have

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this totally different way of taking practice management and topping it upside down.

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And that's through our hygiene-led growth. And so I feel like this episode,

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it's just a really good place to kind of bring that back into the conversation.

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Because, you know, we've removed the whole, you know, 700 episodes of the podcast.

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And, you know, that was, you know, like early, we hadn't yet discovered that way.

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And then later, it kind of came to fruition.

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And then we did start discussing this new way of doing things,

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what we call hygiene-led growth.

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And so I think that that, for me, is really where I would like to go in today's episode.

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This was an instant light bulb, even as we hit record, because we just talked

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about this in our previous episode a little bit in terms of there are two different

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tracks or what are we maximizing for?

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Are we maximizing for income all along the way or are we maximizing for growth speed?

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And I think as you have been talking, the light bulb turned on for me of the

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hygiene department is really where the rubber meets the road here.

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We are either maximizing the hygiene

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schedule for the most productive hygiene schedule and therefore a ton amount

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of profitability in a dental office comes from that hygiene schedule or we're

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maximizing it for openings and new patient growth and expanding of hygiene days

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as a constant in our practice,

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which is a little inefficient in terms of cost and in terms of maximizing profit.

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You are sacrificing a jam-packed schedule for a schedule that can grow faster.

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And you still can be profitable all along the way with a hygiene schedule like this.

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But I love this episode because it is a major difference in these two frameworks

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or these two paths is the ability to make a decision with what you're going

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to do in your hygiene department.

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Yeah. And I'm going to kind of bring back Dental Money Ball,

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right? Dental Money Ball is the book that we wrote.

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And the purpose of that book is saying, I've never heard of shared practices.

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I have no idea what, you know, hygiene-led growth is.

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And, you know, we essentially kind of explain it all in 180 pages.

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And in that book, we talk about the dental two-point shot versus the dental three-point shot.

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And so I want to kind of talk through, you know, these two different hygiene

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gene approaches and what they each optimize for.

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And so let's start with the dental two-point shot because that's what...

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So the dental two-point shot, and a two-point shot is a known,

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predictable, responsible outcome. Robert Leonard.

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So if you kind of look at like our, you know, high income earning,

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slower growth path, that's where this slides in, you know, very effectively.

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And the question that you asked between the two point shot and the three point

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shot is what are we optimizing for?

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What is our strategic approach aimed at accomplishing?

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And in the case of the two point shot, the strategic approach is aimed at optimizing

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for hygiene department profitability, right?

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So if you're taking that slower path and you are interested in income being

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something that is highly prioritized, then your hygiene department needs to

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be an income-generating engine for you and the practice.

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And so when you're making decisions around hygiene, you need to be thinking

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about it with income in mind.

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And so that's really the perspective that Scott is bringing into our podcast

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is the, Scott is a proponent of the assisted hygiene schedule,

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and he's a proponent of the profitability being like a staple of a well-run hygiene department.

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And that is optimizing for that hygiene department contributions to the practice level profits.

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And that ultimately means that you have a tight schedule, you focus on adjunctive

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services, You focus on kind of pulling value out of the hygiene department,

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but you're not laser focused on growing the hygiene department.

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And that is kind of the key difference. So, Richard, like,

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what do we need to say about kind of the responsible profit-focused philosophy

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on hygiene that, you know, has really been a staple in our industry for a long time?

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I mean, this is where you can just build that stable profitability of,

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you know, the beauty of a GP practice is your recurrent hygiene base.

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And if you can really push towards maximizing, okay, we've got the assisted hygiene.

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Here are the patients that maybe have less dental needs.

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They're less likely to need SRP. They're less likely to need ongoing restorative care.

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And so they're the straightforward patients. We kind of move those onto these

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schedules and we've got the patients with higher needs.

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But I also think there's the ability to evaluate all these parts and pieces,

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and we're providing some paths, but there is the ability to take the best of

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these and your unique situation.

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So it's like maybe you really just can't find another frigging hygienist.

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And so you're trying to grow, you're trying to accelerate your hygiene schedule,

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and you need to do assisted hygiene to have more hygiene openings.

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So while we're describing these as kind of dogmatic paths of here's one way

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to go, here's another way to go, as an entrepreneur and as,

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you know, this is why we provide coaching, this is why we help people on an

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individual level, there might be times where your path is a blend of these or

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you have to use one tool for a little while before you can use the other tool.

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But the profitable hygiene department and a periodiagnosing fluoride using case

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acceptance driving hygiene department is the pinnacle of a systems-based practice.

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We love all of this stuff.

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But what are you doing with all of that?

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Are you really doubling down on profitability and controlling the costs?

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Or are you doubling down on growth? And so it's the same tools just applied

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in different directions.

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And I think, you know, one thing that was really interesting in our process

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of bringing Scott on board is...

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We both agreed that assisted or unassisted hygiene is not a one-size-fits-all

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answer to all situations, right?

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And so I think that we've always approached it from an unassisted hygiene perspective.

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But I say that saying that we have a client who I personally worked with very, very long ago,

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who started with five operatories, is now in 11 operatories,

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and grew using the the dental three-pointer in assisted hygiene the whole time.

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And so I think that whether you do assisted hygiene or unassisted hygiene is

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more a function of your local environment, the wage of a hygienist,

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the ability to attract new hygienists.

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I think that's where you make the decision if you're assisted or unassisted.

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I think that is almost independent of optimizing optimizing for profitability

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versus optimizing for growth. Those are two separate things.

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You can optimize for profitability, assisted or unassisted.

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You can optimize for growth, assisted or unassisted.

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I actually don't think assisted or unassisted hygiene is really a differentiator

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between the two schools of thought. I think they're just tools in the toolbox.

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And I really think it's like, if you're paying $60 an hour for a hygienist,

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like you're probably going to want to get an

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assisted hygienist like right and if you're paying 35 40

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an hour for a hygienist you may want to

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skew towards the unassisted hygienist and so i think that you know it really

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depends on the makeup of your local market and the economies that are around

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your local area with insurance reimbursements and that type of thing to really

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dictate and also practice footprint right like you know assisted hygiene is

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more financially efficient,

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but it's like a little less space efficient.

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And so I think that you also kind of have to consider your practice as well

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in making that decision.

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And I actually don't think assisted

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or unassisted, it's something that somebody could easily focus on.

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And I would almost rather say that Scott and I kind of, I was the unassisted

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camp, he was the assisted camp, we kind of both agree that it's not a one size fits all.

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And it really has nothing to do with your hygiene department strategy,

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like in terms of the bigger picture of what you're optimizing for.

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I think this all does come to a head when you are at the moment of having the

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right number of hygienists or hygiene columns for the number of doctors.

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In that moment, what are you doing next? So you've got a full hygiene schedule.

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This is the fork in the road. Do I take that excess pressure of new patients,

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of trying to fit people into the practice, and renegotiate insurances,

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drop insurances, try and increase the profitability per patient right now?

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Or do I want to grow into my footprint?

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Because I think there's more opportunity in quickly growing into my footprint

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and what's possible in this location and getting to another doctor.

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And so do I take that excess demand and add more hygiene days?

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And I think that's the crux of which path are you going to.

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And until you reach that moment, this problem doesn't exist yet.

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It's like you keep adding hygienists and assisted or unassisted until you have

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maximized the amount of hygiene patients that one provider can see.

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And as you're approaching that limit, now the fork exists in the road.

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And to Richard's point, there's kind of a fundamental truth where a dentist,

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if they're checking for too few exams, then they're not as productive as they could be.

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Then there's an optimal amount, and we kind of believe that to be two columns

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of hygiene per dentist, right?

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That's kind of what we've always said, is like two hygienists is sort of that amount.

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But there's that amount where I'm seeing, and that's maybe a little different

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for every dentist, but this is the amount where I'm peak productivity per patient.

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I'm seeing a healthy volume.

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But also, I have enough time with each one to focus on good case acceptance

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and comprehensive treatment planning and diagnosis.

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And so there's this optimal spot where you are in that good 55-mile-an-hour

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pace that Scott was talking about.

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And Richard's kind of fork in the road is, if you're in that place and you have

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more demand, and both philosophies generate more demand, it's just, what do you do with it?

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The kind of the Scott's approach is to increase the fees and value of each of

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those patient interactions to further push profitability.

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And our approach is to open the schedule ad providers and grow towards,

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you know, more hygienists, more patients, more providers, and that may mean more dentists.

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And that's kind of where, you know, Richard's saying the rubber meets the road.

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And so I want to kind of talk about our dental three-pointer,

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which we call retain, open, fill, or like those three things in that order.

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And where this originated was me.

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I bought a solo practice thinking it was a group practice.

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And so I elevated my costs all the way up to my revenue, and I was making no money.

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And I kind of had two options.

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I had a group practice. I had multiple dentists. I had three hygienists. I had four assistants.

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I had this big team. And so it was like, if I wanted to go back to earning a

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sustainable income, my options were to remove a lot of people costs,

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maybe remove a dentist, remove a hygienist.

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Maybe get rid of a front desk and an assistant and really free up some overhead

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so that I can have profit.

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Or on the other side is grow my practice this to have four hygienists so that

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each dentist was seeing enough patients to produce.

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And then the revenue would grow to a point where I could be profitable as a group.

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And that was really kind of the genesis for our philosophy.

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And so I went to practice management courses that I'd been to.

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One of them was the Scott Lewin Education Course.

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And I saw Scott's philosophy about maximizing hygiene profitability.

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But in my unique situation, hygiene profitability is not solving my problem.

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My problem is that I had too many team members for the number of patients I had.

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And that was where I had this lightbulb moment, which we call kind of the epiphany

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behind our philosophy, which is there's a very linear correlation between...

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There's like a very like, you add more patients, there will be more exams,

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there will be more diagnosis, diagnosis there will be more doctor treatment and it's like.

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It's almost accidental practice growth. If you focus on adding more patients

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to your recurring subscription of hygiene, right, then there's more patients

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coming back every six months.

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You will just have more revenue each month because you have more people walking

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through the door that have potential solutions.

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And so our, you know, turning hygiene up on its head is essentially saying we're

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going to optimize for hygiene department growth.

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And that's really going to be where we sell out.

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And we're going to sell out so much so that maybe for a period,

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the hygiene department won't be as profitable because we're going to have openings in the schedule.

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And openings in the schedule are hygiene department profitability hindrances.

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They make it harder for the hygiene department to produce as much profit if

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you have periods of time where your most expensive hourly employee,

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the hygienist, is sitting there without seeing patients.

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And so this was a very innovative philosophy because what it allowed for us

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to do is to grow practices at a faster rate because we took this kind of risk.

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But the downside and the flip side of that is that for a period of time,

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a dentist has a reduced income because they have less profit contributing from hygiene.

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And so, you know, that's really the kind of the hour side of things is,

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you know, first we focus on retention

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because we're trying to grow that hygiene base as much as we can.

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Then we open up the schedule to allow for more people to come in.

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Then we fill that openings and we teach team members how to be really creative in filling openings.

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And then we retain all those people. And we just kind of do that in a cyclical fashion.

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And the number of patients who come into the hygiene department grows.

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And we can go from a solo to a group. And then we can go from a group to a mega

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group, because we're essentially methodically growing the practice by adding

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hygienists and adding a subsequent group of patients with each hygienist.

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And so really kind of the dental three-pointer and the hygiene-led growth kind of.

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Elements of our philosophy are around that predictable practice growth through

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increasing the number of patients who come to your practice every six months

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by aggressively opening and filling the hygiene schedule and optimizing for

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practice growth instead of hygiene department profitability.

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So you're running a hygiene department with growth as the key objective,

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and it does trade for income in the short term, but it does grow your practice faster.

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And so that was kind of where the shared practices hygiene-led growth philosophy

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takes some of the, you know, maybe more profit-focused,

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you know, traditional beliefs in the industry and kind of flips them upside

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down because we say, you know what, the hygiene department does contribute profit,

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but we actually want it to contribute practice growth instead.

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And so we need to operate it differently with that in mind. so that was a very

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long-winded but just kind of like the full very my most succinct way of describing

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kind of what we do that's different as it pertains to hygiene.

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Well and and one of the key parts of

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this too that redeems this you know ache in a dentist's stomach when they're

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like oh hygiene openings and they push back one of the redeeming qualities of

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a new patient is the higher production per new patient and i also think it it

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leans back into this conversation we were having earlier that's not that important

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around assisted hygiene versus a hygienist.

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Hygienists are going to close better on needed treatment when well-trained than

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in an assisted hygiene setting.

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And if you've got more new patients, your ability to close on these higher potential

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dental need patients because not been regularly in your care is going to be

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better, which can redeem some of those openings.

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And I also just had a light bulb moment. I'm sure we've addressed this before

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and talked about it before, but I haven't fully grasped this.

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By having openings in your schedule, your retention is better.

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If your schedule is packed, not only do you decrease your number of new patients,

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you also inherently decrease your retention numbers and percentages.

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So we're accelerating the two halves of practice growth by paying for those

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openings, both the retention and the new patient flow and the overall growth of the practice.

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And the economics of it is helped by the additional revenue per new patient.

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And so, Scott, if he was listening to this, I think he would say that he also

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has sufficient openings in his philosophy for new patients and patients who want to come back in.

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And that's like Like if you're going at 55 miles an hour,

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There's going to be, you know, three openings in the next week or whatever it

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might be to offer a new patient.

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Like that's kind of something that's like kind of believed to be like best practices

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is to offer a set number of opportunities in the next week, but to not have

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like 13 chances for them to come in in the next week, maybe three or four.

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So it's like we're kind of riding that line between profitability with breathing room.

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And where we come in is we say, okay, let's have 13 openings in the next week

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to bring in a new patient. And, you know, to Richard's point,

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if you do that, there's going to be two consequences.

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One, the hygiene department will be less profitable. And two,

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more patients will book and more patients will be retained because there's more availability.

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And so, you know, we have always slanted towards that patient growth is the

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number one objective in operating a hygiene department because we've always

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had a very entrepreneurial dentist who wants to grow their practice aggressively, right?

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But we also have some dentists who have gone to two dentists,

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they've gone to a group practice, they've gone from a solo to a group,

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and they say, all right, I don't want the third dentist.

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I want to have myself, I want to have an associate.

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And then we're going to use that strong retention, but the openings are going to dwindle.

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And we're going to kind of evolve back into hygiene department being profitability driving.

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And so we view it as like a gas pedal, where it's like, yeah,

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I'm going 55 miles an hour. I can keep doing that forever.

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But I really want to get to this place. So I'm going to go 110 miles an hour

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for a short period of time.

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And it's going to hurt my income. I'm going to get there. And then I'm going

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to kind of turn the screws back to 55.

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And that's kind of where we really include that. It's like we want to have those

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intermediate periods be as fast as possible.

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And so we're going to use practice growth through hygiene opening as a way to

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get there maybe a little faster.

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But, you know, in the meantime, maybe hygiene won't be contributing as much

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profit to the overall picture, but we're going to be growing.

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And so that's sort of the trade-off that a dentist needs to make.

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And you can see how this kind of builds on the last episode,

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because we were talking about it from the perspective of choosing what you want and avatar selection.

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And now we're talking about it in the framework of how are we going to operate

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the hygiene department with different objectives for different people.

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And, you know, hopefully that kind of starts to come together for people,

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and I'm sure we're going to touch on it again in future episodes.

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But that's kind of more or less on a high level, how the differences in how

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we think impact how we operate, you know, the same thing, which is a hygiene department.

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One school of thought optimized for profitability, the other school of thought,

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optimize for practice growth.

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The instant like place my brain goes here is I really want to have a conversation

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next about the alternative of the dropping insurances because I think people talk about that as like,

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you know, it's easier than it sounds or it sounds easier than I think it really

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is either renegotiating insurances for higher rates, dropping insurances, raising your fees.

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And that is a different version of painful. There is different things that will

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occur in your practice. And so exploring that other fork in the road of,

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do we optimize for hygiene growth and practice growth?

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Do we optimize for revenue per new patient? What is the good,

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bad, and ugly of that? What is painful about that? What's good? What's hard?

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Where are the challenges? How long does this realistically take to go through this process?

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And whether that's you, me, and Scott, or Suzanne and Scott and I,

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I would love to have one of those conversations here in the next month or two,

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because I think it's the natural place my brain goes when thinking about these options.

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Yeah. And I think that we've always taken the philosophy of saying,

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we want to get a client to their ideal patient flow before we start making it

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more difficult for patients to stay in the practice.

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And so, you know, like if we're going to start cutting insurances,

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we want to cut insurances when we've met the long-term configuration of the practice.

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So if a dentist comes to us as a solo, and they say, I want to have one associate

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in a group practice, we've got seven operatories, and so a two-dentist configuration

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is the long-term configuration I'd like for the practice.

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We're going to keep the insurances, grow to that size, then we're going to use

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all the growth that that our philosophy creates.

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To cut insurances, the same way Scott has been discussing, right?

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Scott's philosophy, retention-focused, also efficient systems,

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he's also going to generate in practices this excess demand.

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And so we're both using that tool, it's just we may be using it at different

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times, or we may be more strong in saying we're comfortable with the insurances

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to get us to our desired volume.

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And then once we're at our desired volume, then we will bring them back down,

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maintaining our long-term desired volume.

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And so, you know, I think we, it's so, you know, when you can hear these things,

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you could think that we're super different from one another,

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but it's like, we all have the same tools in the tool belt.

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There's only these set ways to kind of operate dental practices.

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And I think it's more of an order of operations differences than it is like

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we have different beliefs on what to do.

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It's just, we have different beliefs on when to do certain things.

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And I think, again, that goes back to personal preference for the client, right?

Guest Track::
We use these different tools to help our client know the best way for them using

Guest Track::
all the analytics and knowledge and everything that we bring to the table is like,

Guest Track::
we're going to help you based on your situation and using all these tools assess

Guest Track::
what's the best path for you and your practice.

Host Track: :
Well, I couldn't summarize it better. George, this has been an awesome discussion

Host Track: :
of, once again, kind of the merging

Host Track: :
and the exploring of these similar but slightly different frameworks.

Host Track: :
Works, but it's really just a set of tools to get the dentist to wherever they

Host Track: :
want to go in whatever route they want to get there.

Host Track: :
So thank you, George, for coming on. This has been awesome.

Host Track: :
I love these conversations. And I'm looking forward to the next one.

Guest Track::
Absolutely. Thanks, Richard. And I look forward to coming back on to another episode of Ask George.

Guest Track::
And keep chugging along and creating great content for our audience on the Shared Practices podcast.

Host Track: :
Love it. We'll talk to you next time on Shared Practices 2.0.