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Removing the Obstacles to On-time Doctor Time Scheduling by Ken Alexander

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Most practices have heard of doctor time scheduling, and most computer systems can easily pre-code each day to allow for the templates to juggle doctor time for maximum efficiency. But the difference between a schedule where the practice survives each day and one that is a top-notch orthodontic scheduling system, is as stark as night and day in results and efficiency.

Over my career I have worked to popularize the concept of doctor time scheduling that is used in a majority of orthodontic offices. The concept is simple: plan out an entire day for all necessary procedures with the doctor time built into them and make sure that the doctor is not needed at more than one place at one time. Certainly this is easier said than done.

Removing the Obstacles

Often creating the template is the easiest part of the equation, but doctors often fail to identify the obstacles that stand in the way of their success and then create solutions around them. The following are some common obstacles that, without resolution, may kill your well-meaning attempts to move to the next level of efficiency and growth with doctor time scheduling.

Do you have enough chairs?

How many should you have? At least one more than you book, and ideally two more. Why? Go ask your assistants how many hours a day they stand around not being productive because they are waiting on the doctor and have no chairs in which to start their next patient.

Do you have enough assistants?

The average assistant can see between 15 and 20 patients per day. Booking one assistant per chair with maybe an extra chair for checks is ideal.

Do your appointment times have too much wait time built into them?

Appointments grow like yeast in dough; 10 minutes will turn into 20 minutes, will turn into 30 minutes, until the practice has created its own inefficiencies by building wait time into each procedure. The job will expand to the time allotted.

If you want to solve your scheduling issues you must trim your appointment times down to the time it actually takes to complete the procedure, on average.

If you cut out the wait time, did you build in any wiggle room?

We sometimes see schedules that are booked with patients back-to-back-to-back with no wiggle room at all. Not even time for a bathroom break, let alone emergency appointments.

Eliminate the wait time, but schedule yourself a short break every 40-90 minutes. This helps everyone know they have a little time to catch up or take a quick breather.

Are you on the right unit of time?

I would be remiss not to mention a very big obstacle in far too many practices, and that is the 15-minute unit of time. Out of 500 orthodontic clients for whom I have drawn templates in my career, I can think of only two that stayed on a 15-minute unit after we explained the significant efficiencies built into the 10-minute unit. With ten minutes there are six places to start and end a procedure instead of four, which is far more effective in juggling doctor time.

Imagine the practice has four A15s that all come in at 3 p.m. What does the doctor do for the first three to five minutes? Nothing! She is waiting for the assistants to untie and call her over. Three assistants call the doctor over at the same time and a fight ensues as to who called the doctor first. So one patient is seen on time, the next seen three minutes late, another six minutes late and the last nine minutes late. The problem is that the assistant who is nine minutes late is now late picking up her next patient, and the wait time begins to accumulate. A 10-minute unit allows you to see the same number of patients every hour, or more, but they can be staggered so they do not all clump at the front desk, or all need a doctor check at the same time.

Did you map out the doctor time effectively in your template?

Doctor time scheduling is all about making sure the doctor is not needed at two or three places at once. The example (Figs. 1a and b) show a doctor’s schedule before and then after the “Millenium Doctor Time Template Designer.” See the doctor time conflicts (red text) that occurred throughout the day by viewing the “Total” column.

The first patients to be seated and seen will always be the ones booked in the doctor’s chair. We still had too many short 10-minute A’s (activations, change chains, and reties) that did not fit, but we had an experienced assistant who was working at the front desk. We asked the financial coordinator to help cover the phones and front desk from 3-5 p.m., and took the experienced receptionist and put her to work on the shortest procedures of all just during the busy times, giving her time to also help out at the front as necessary. Voila! Success that comes from thoughtful planning and overcoming the obstacles.

Where is the doctor?

Nothing eats away at assistant time more than a doctor who cannot, or will not, get to his chair in a timely manner. If a doctor was at the chair the instant he or she was needed, there would be a lot of saved assistant time. In fact, when I ask this question of assistants, the most common answer I hear is 2-3 hours per day. Doctors should aim for getting to the assistant’s chair within two minutes of the request. Commitment to this is important.

Often commitment can overcome a poorly designed template, but when the template is poorly planned and executed every day, frustration turns to apathy and soon the team gives up trying to stay on time. The only way to reach your peak performance and greatest potential is to plan for it with on-time doctor time scheduling.

A doctor time schedule will keep the doctor and team on time, but just as importantly it communicates to patients that you can handle more growth. Why would patients send friends to a practice that cannot meet their needs, and is perceived as being too busy? Those who fail in the timeliness of each appointment make an implicit proclamation to their clients that they are at their maximum capacity. Worse yet, an inefficient scheduling template will prevent you from capturing potential new patients and starts if delays during peak months push clients to other, more efficient practices.

Maintaining an efficient scheduling system is the single-most important factor in growing and sustaining an orthodontic practice. The goal of every team should be to not only reach peak potential, but also to practice each day at a high level of efficiency and enjoyment.

Author's Bio
Ken Alexander has been the director of Millenium Management Services for the past 25 years. He lectures regularly throughout the USA and Europe and has been a consultant to more than 500 orthodontic practices. His areas of specialty include all areas of orthodontic practice management, especially scheduling, new patient enrollment, staff management, customer service and marketing. Ken also has a significant consulting practice in transitions work, helping orthodontic transitions with buy, sell, valuations and partnerships. Contact him at kenalexander2@aol.com or visit the Millenium website at www.millenium-management.com.
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September 2025
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