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The Dental Management Pyramid: Part II


Dental practices that have outgrown their business systems often consult the Levin Group for assistance in developing management skills and systems as they expand their clinical expertise. These practitioners often approach the Levin Group once they witness a decrease in practice productivity and profitability and an increase in stress. The Levin Group Practice management Pyramid helps practices achieve maximum income, minimum stress, and outstanding quality of life for the clinician and office team.1  

The Practice Management Pyramid has six building blocks that are implemented step-by-step over the course of one year. Each block is a specific management system that must be incorporated one at a time and in specific order. If system changes are not made sequentially, important organizational areas will be missed and the practice will not be successful in creating an effective change to its management system. It is essential that all six aspects of the pyramid (ie, scheduling, case presentation, patient finance, hygiene productivity, customer service, leadership) are addressed. This article will concentrate on scheduling, the foundation of the Practice Management Pyramid.


The Foundation of Management Systems

The foundation of all dental practice management is the scheduling system. A scheduling system is a predesigned approach to scheduling, where the clinician and office team have almost complete control of the daily schedule. Patients are placed according to different policies and principles that allow the practice to function with low stress and optimal productivity. Scheduling is one of the most misunderstood and single most important production factor in all of dentistry.

Many practices view scheduling as merely the act of putting names in the computer or on the books. Generally, schedules are designed early in a doctor’s career and are rarely redesigned. Since many of these systems were never actually properly developed to begin with, increased patient load caused the scheduling system to become a method of shove patients in or put them somewhere. The end result is a highly stressed practitioner who is working faster and seeing more patients without the benefit of increased production or income.

The ideal scheduling system should be reviewed regularly and designed to fit each individual clinician’s needs. That means the following categories all need to be considered when developing a scheduling system:

  • Days
  • Hours
  • Work Speed
  • Fatigue Patterns
  • Types of Services

Most practices currently produce a minimum of 30% below their production and profitability potential—simply due to the way their scheduling is organized and carried out. Levin Group has proven that the ideal schedule for every working day can be established with 90% predictability.


Creating the Ideal Schedule

There is no need to be a victim to your schedule. To create a productive, stress-free scheduling system, try taking the following steps:



Levin Group believes that every unit of the schedule should be outlined in advance to determine exactly how each 10-minute interval will be used, and this applies to every chair. Before the first patient is put on the schedule, the clinician can look at the schedule and estimate how each workday will flow.


Schedule by Production

The way to handle scheduling by production is to evaluate the different services offered and categorize them. The schedule is then created based on the different categories of productivity, being sure to always leave sufficient time for the most productive and profitable procedures.


10-minute Intervals

Many practices still incorporate 15-minute units into their scheduling. This costs the practice approximately 13 days of treatment time each year. These 13 days are simply lost, which means that practitioners are working that much harder to compensate for the lost time. Shift your practice to 10-minute units immediately, if you have not done so already.


Schedule Clinicians and Assistants Separately

One of the larger problems of dental practices is that doctors and assistants often waste a significant portion of their time with the belief that they need to constantly work together. While it takes a few weeks to master this new process, many practices have been able to immediately increase productivity by 20% to 22%, with a significant decline in stress as the patient flow improves.


No-Shows and Cancellations

Eliminate any patients who miss two appointments in one year. These individuals clearly have demonstrated that they do not respect the time of the professional, and this issue must be addressed without fear. Although it is uncomfortable to invite patients (via a well-phrased letter) to leave a practice, and there may be concern about other family members leaving the practice, the number of no-shows impacts approximately 4% to 5% of practice productivity over a clinician’s career. The loss of a patient or even a family is minimal compared to this type of time loss.



Dentistry should be an invigorating profession, where the clinician actually has more energy at the end of the day and is not left stressed, wishing that tomorrow were a day off. Proper scheduling will make a significant difference in a practitioner’s productivity; scheduling is the place to begin when changing your practice. All changes emanate from the schedule, and this aspect of practice management controls almost every aspect of a practice’s activity. By applying some of the aforementioned recommendations, clinicians can revolutionize both their practice income and their overall enjoyment of dentistry. Incorporation of these simple modifications will result in significant profit and growth, as well as a greater degree of daily satisfaction and stress reduction.


*Founder and CEO, Levin Group, Baltimore, Maryland



1. Levin RP. The dental management pyramid. Pract Proced Aesthet Dent 2002;14(5):430-432.

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