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Resetting the Clock by Ken Alexander and Ryan Alexander

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Resetting the Clock 

10 tips for on-time doctor time scheduling

by Ken Alexander and Ryan Alexander

If you were to ask us what has created the most success for our orthodontic clients throughout our years of consulting, we’d say it’s been the effort to improve “on-time doctor time scheduling.” Honing the role and work of the treatment coordinator would be a close second, and if a practice has these two vital systems in place, it can often grow significantly beyond average— perhaps even three to five times average with a solo orthodontist.

It should be recognized that staying on time is a vital component to marketing the practice, but doctor time scheduling is also about creating the intake ability of a practice to allow it to continue to grow. As the Peter Principle envisions, most practices will grow to their level of incompetence, then stop growing. Once growth exceeds the scheduling template, the systems begin to fail: Patients are squeezed into a fifth or sixth column with no assistant to work the chair and no doctor time to see the patient, yet they must be seen! Then a battle begins to brew between the front and the back, where receptionists are pressed to get patients into a schedule that’s too small to handle what the practice is already seeing, yet the marketing department is bonused to sell beyond capacity.

The team will come up with potential solutions to try to alleviate the stress on the schedule. Certainly, going from six to eight to even 10 weeks for regular adjustments opens up room in the schedule, particularly after school. Changingto self-ligating brackets, indirect bonding and other efficiencies can also open room to continue to grow. Some orthodontists have delegated so much of the hands-on treatment that they rarely put their fingers into a patient’s mouth! But most orthodontic practices still experience the constant knocking of their heads against the ceiling of growth because their scheduling system is maxed out.


How to identify a problematic schedule
The symptoms of an overloaded schedule aren’t hard to miss. That once-good template that worked so well is now all discombobulated, with patients thrown into any open spaces, including extra columns. Assistants regularly complain about things not being scheduled correctly and take their complaints directly to the front desk—sometimes within earshot of the patients. The assistants are frazzled, while the doctor can’t keep up with the multiple chair lights that need her all at once. When we’re observing such offices, we often see assistants sitting idly by their patients, longingly inviting the doctor with their gaze to “please come see me first” or looking at the exam room door, hoping the doctor will get out of the exam soon.

What’s not so easy to see is the actual cost that comes when patients are unhappy with wait time or when they can’t find convenient appointment availability, particularly with a new-patient exam. To best capture growth, we like to ensure new-patient appointments are available one to two weeks out in the mornings, and no more than two to three weeks out in the afternoons. It’s not unusual to visit a practice in June and be told all of the exam spots for the summer are already taken, yet then have the orthodontist tell us over dinner that she has wanted to grow for many years and can’t figure out why the practice is locked at its current level.


Improvement takes effort (and often outside help)
Practice growth can only come if there are more entrylevel codes available in the template than you presently need. In other words, a fish only grows to the size of its aquarium, and by this we’re referring not just to the scheduling template but also the facility itself—its waiting room, number of clinical chairs and treatment coordinator rooms.

To grow, you need space to grow. The right facility is the third-most important factor that limits or accelerates growth. To stay on time and grow, you need at least one more chair in the operatory—ideally two— than you currently schedule. We often creatively find a spot for one more chair even when the client is certain it can’t be found.

So, what does this “on-time doctor time scheduling” template look like? We’ll get into some of the most vital keys in a moment—but please also remember that often, doctors who insist on doing things all by themselves often run into the problem of being limited to what they think they know and can see. A consultant, meanwhile, will be more aware of what it takes to unlock a practice’s schedule and growth and can quickly see the current pitfalls, some of which the team can’t yet see.


10 steps toward a smarter schedule
1Determine the doctor and assistant time for each major procedure. We discuss the types of appointments being scheduled and coach the doctor and team as to how much time other successful practices allot to complete each of them. Taking time studies in advance can be helpful in this process, but practice guesses usually have inflated times, so the consultant’s knowledge often becomes the final determinant of how much doctor and assistant time it should take to complete each procedure.

By way of illustration, a typical 30-minute bonding appointment, or “B30,” often looks like this:
  • Assistant time: 10 minutes.
  • Doctor time: 4 minutes.
  • Assistant time: 16 minutes.
  • Total: 30 minutes.
2Place each procedure into a code or class. Once you have the majority of your regular appointments mapped out, try to combine as many procedures into as few codes as possible. Some scheduling codes, such as an “IB” (initial bonding) or “DB” (debonding), may be limited to just one procedure, but a B30 code often has six to 10 different procedures that fit into it. The same applies to the “A20” and “A30” codes, which will catch most of your archwire and activation procedures.

3Determine how many of each code you need to see in a day. If you’re not analytical or good at math, this part of the exercise is where many practices fail. Divide your yearly kept-appointment stats by the number of days you’ll be working the following year; after accounting for which procedures are grouped to which codes, you arrive at a number of how many of each code you need on the daily schedule.

4Increase the number of each code by 10%–15%. You want to build the template to not just match what your practice saw last year, but ideally increase at least 10% for growth and 5% for missed appointments, breakage and rescheduling. If you’re seeing 55 patients a day now, your new template should have at least 64 codes in it or it won’t be effective for long.

5Create a realistic substitution list. To make the template most effective, establish one or more substitutions for each code. Some of the substitutions are plainly seen in that a smaller code with less doctor time can be substituted into a larger code with more doctor time. Other codes may not align well with doctor time, but even these must have the best substitution possible with the note *rarely* (which means “use rarely if you must”).

6Create the master template. After the first day of consulting, we usually build one master template that represents the ideal day. With our software, we’re able to easily see any doctor time conflicts and quickly move codes around. We start by placing the larger codes with the most doctor time into the template first, to ensure the big chunks of doctor time in the exams don’t conflict with the time the doctor is needed in the long bondings and debondings. Then we start filling in the 30-to- 40-minute codes, leaving most of the early morning and late afternoon for the adjustments and activations.

7Overcome the pitfalls of the current system. At this point, most practices get stuck because they run out of doctor and assistant time doing things the way they currently do them. They need new ideas and out-of-the-box thinking to progress from seeing 60 patients a day to 80, or to 100. Even with our years of consulting experience, we often find it a challenge when the necessary codes won’t fit into chairs that match the number of assistants, or when the doctor shows nine hours of patients to be squeezed into an eight-hour work day.

This is when we try to show the doctor why they haven’t been able to grow and challenge the practice with the necessary solutions. Adding a chair or an assistant, or working more hours, may be one solution, but we often can find far better ones, including reworking the steps taken in the procedures to be more efficient for the practice. Most practices we see on a first consulting visit have plenty of assistants because they thought if they just hired more bodies it would alleviate the doctor time bottleneck, yet all it did was inflate the overhead without solving the main problems.

8Develop different daily templates from the master. Once the main master schedule looks great, customize it for each variation of the practice’s different days and hours. Try to work the same template every day so your team can get good at it. If the master template is built for Tuesday and Wednesday from 8 a.m. to 1 p.m. and from 2 to 5 p.m., you could use the same template for Mondays starting at 9 a.m., with lunch from 2 to 3 p.m. and ending the day at 6 p.m, while Thursday could be from 7 a.m. to noon and from 1 to 4 p.m. It’s easy to add hours, work half-days, and even to create specific growth templates in the summer with eight to 12 indirect bondings in a morning to catch the summer starts. The fewer templates, the better, but each should be designed to match as closely as possible to the others so the team can sense a regular routine.

9Run the new templates and fix what may be broken. Once most clients start on this scheduling system, they still use it—even 20 or 30 years later. They may have to tweak it a few times, particularly when they have a lot of growth, but in many ways, when you run this system systematically, you can easily begin to see if something isn’t working and fix it. If the doctor is always running behind at 2:30 p.m., it may be as easy as moving an observation patient out of 2:30 to another time to cure the problem. If they didn’t plan enough A20s or DBs, the scheduling coordinator will flag that she needs more of them and fewer of other codes. By making incremental changes, you can get closer and closer to perfection.

10Gain true commitment from the doctor and team. Both doctor and team must be committed to staying on time and following the established systems. No system works effectively if it isn’t followed—it needs receptionists placing patients into the right codes, and assistants and doctors committed to hustling to stay on time and working to the doctor and assistant time allotted. Taking patients back a few minutes early for the start of the day and start of the afternoon can help you stay on time. Starting the day late each day proves a lack of commitment to customer service and practice growth.


Conclusion
On-time doctor time scheduling isn’t rocket science, but it does require logic and experience to be brought together to form a system that is highly effective when worked properly.

There is a simple principle in life that regularly holds true: “You get what you plan for.” If you have no plan or a bad plan, you’re reaping its problems daily—but if you have a good plan, even if it’s not perfect, you’ll be far closer to your goals than if you just threw up your hands and gave up trying. Once a good plan is learned and implemented, it often becomes a permanent fixture for practice growth and success.

Author Bio
Ken Alexander

Ken Alexander and Ryan Alexander of Alexander & Sons Consulting are considered two of the top consultants in orthodontic practice management and transitions, having worked with more than 1,500 orthodontists over the past 35 years. Website: alexanderandsons.consulting
Ryan Alexander
Orthotown Magazine
September 2025
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