By Russell Lieblick, DMD
I’ve had discussions with many surgeons planning to expand their practice. These surgeons are often deliberating about adding associates or partners to increase production. When I’ve had these conversations, I often find that although they may be at better production for an OMS, they almost always abandon the idea of adding more providers and look to systems and staff leverage to be more productive.
Discussing office systems in the practice to be more productive is always helpful, but staff leverage is the fastest way to increasing production. But what is staff leverage? Simply put, if you only do what you must do under the law while avoiding tasks that someone else can do, you can use that time to produce more.
My favorite analogy is about a law firm. Senior partners only do what junior partners cannot do. Junior partners can only do what associates cannot do, and associates can only do what paralegals cannot do. The closest example to us is the orthodontic practice. Orthodontists must place brackets and other cemented or bonded appliances. After that, they rarely do any hands-on work for the patient. They determine treatment, assign it to their assistant, and move on to the next patient. They have the best staff leverage of any dental practice. It allows them to be more productive. Most surgeons immediately understand these analogies, but are unable to accomplish this. They need better training for their staff!
In our practice, we have become highly productive due to staff training. Our goal is that I only do consultations, surgery, and communicate with referring doctors when a direct conversation is necessary. Everything else is accomplished for me. Assistants manage each case, charge assistants manage each day, office managers take care of each office, and the practice manager takes care of the practice as a whole. The only way to do this is to make sure that everyone knows how to handle their job effectively and autonomously. That requires effective training.
When I’ve described our system for training, I generally get wide eyes from surgeons. How will I create this system? When will I have time to do all of this training? My response to these objections is that you can be limited to what you are accomplishing now, hire expensive surgeons to increase production that you will never be able to take advantage of, or you can put a little work in now to have a practice that can scale almost without limits. After that, new staff are trained by existing staff for almost everything except medical knowledge. If you treat your assistants like surgery residents, they’ll train and then perform like residents.
Effective training is a system unto itself. The way most surgery practices train staff is by bringing them in and having them watch what assistants do until they are ready to try it themselves… but are they learning efficiently? Are they learning enough? The answers to both of these questions, in my experience, is a resounding NO. In fact, we recently hired a surgery assistant that has 20 years of experience who will still require over a year to complete training in our office. Properly training someone requires a step-by-step system to bring them through each facet of training and make sure they know what to do, when to do it, how to do it correctly, and WHY we do it. Everything from sterilization, surgery hand skills, scripting for consultations or postoperative instructions, communication with referring offices, and charting must be detailed and exact.
The first step is to figure out each phase of training as a group of items that must be trained. I break down the training into phases that correlate to positions that they’ll be assuming each day: sterilization, assisting, instrument passing, anesthesia assistant, simple consultations, complex consultations and, finally, implant training. Existing staff who are fully trained can detail each phase with specific items that pertain to the phase. Make a checklist for trainees! For each item, trained staff must sign off the trainee when they can accomplish the task with “Minimal Supervision,” “Independent,” and “Able to Train” competency. Staff who sign off on the trainee are held accountable for their signature.
Along with the phases, I find it’s very important for assistants to be trained in medicine. For an efficient consultation portion of your practice, you cannot spend the time detailing your patients’ chart with their History and Examination. You should be able to get a full report from your staff and focus on the items that affect your treatment. Your staff should be able to be conversant with medical offices for conditions that need follow-up as well as be independent in dealing with regular obstacles, like anticoagulants and premedication. This takes a fair amount of medical training, but it isn’t difficult for you to do.
When a trainee is ready, they are given a list of medical conditions to define and detail why they are important in your office. Each item is reviewed with you until they know them to the detail that is necessary for independent function in your office. This is also a key ingredient to make sure they are able to effectively chart your consultations!
A properly developed staff training system takes coordination and work to organize. However, the dividends will be paid in efficiency and reduced stress. Your newly acquired staff leverage will empower staff to accomplish tasks with autonomy, which leads to job satisfaction. Most importantly, you will be able to scale your practice production immensely.
Russell Lieblick, DMD
Beacon Oral & Maxillofacial Surgeons
Dr. Lieblick has been proudly serving the Portland metro area for over two decades. A board-certified oral and maxillofacial surgeon, Dr. Lieblick and his partner, Dr. Brandon Rehrer, practice the full scope of surgery.