Ep 159: The Untapped Goldmine in Hygiene Production

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Wendy Briggs (00:01.134)
Hey everybody, I'm Wendy Briggs. Welcome to this episode of The Double Your Production Podcast. We have got an amazing podcast planned for you today. I am joined by Dr. Marcel Lambrechts and his amazing hygiene guru. I don't know what should we call you? Kathy Muse. She's a hygienist, but she's also evolved into a hygienist leadership role in your organization. I'm really excited to have you both here today. So thank you so much for joining us today. It's going to be an

Marcel Lambrechts (00:19.744)
She's a hy-genius.

Awesome, awesome conversation.

Thank you, Wendy. Yeah, It's pleasure for us for sure. It's awesome.

Yeah, so real quick, let's just tell our listeners a little bit about your journey, kind of how we met, how you got started working with us. And then we'll kind of dig into some of the changes that you saw, because I can tell you this right now. Hygiene is a hot topic in dentistry right now. There's a lot of challenging circumstances that are causing really a higher level of frustration. And I see in some circumstances, in some situations, a growing divide between doctors and hygienists that really doesn't have to be. So let's dig into your story and then we'll solve, we'll talk through some of those really tough challenges that people are struggling with right now.

Yeah, so we met in the summer of 2017, Wendy, it was a Hygiene Diamonds lecture. At that time, we were maybe 2 % perio rate in my practice, which is obviously pretty low. We were having 40 and 50 minute appointments, so our hygienists were working extra hard and fast. And I had maybe 30 seconds to say hello to the patient. We would walk in, walk out, and basically did one tooth dentistry the whole time from 1995 until 2017. And when we saw what you could offer, what you said we should be offering patients, the best way to put it, Kathy actually said, we gotta do this. And so she was a big impetus on how we got started. And I'd like Kathy to talk a little bit about that.

Kathy Muse: Yeah, was exciting to me that, I mean, our perio numbers were low. Were we doing perio? Yes, but we just were not doing it in the correct way. And I think it was the first break in that meeting that I looked at Dr. Lambrechts and said, we need to do this not only for our patients, but for the office, the practice for all the way around. prevention was could be so much more for our patients. Yeah, it was key.

I mean, you guys already had a thriving practice.

We did.

You were busy. You were doing, I can't even remember the exact numbers at that time, but do you have an idea off the top of your head, like on an annual basis, what the practice was producing?

So when we joined you guys, we had just hit $2 million as a practice. just to kind of give you a quick synopsis, the following year, just the half year, we did 2.3. The following year, we did 2.8. The following year, we did 3.5. And it just kept on going up from there. Today, we're at 12. So it's been a crazy ride since 2017 to 2026.

So 2017 to 2026, in about a nine year span, you've six times the size of your organization, which is remarkable. And what's interesting is we always look back and say, it began with that key shift in hygiene. I love how you guys said, Kathy turned to you, Dr. Lambrechts, and said, we've got to do this, right? And when I hear stories like that, as I watch your journey from the outside looking in, the first thing that shifted was your mindset.

That's right.

Right? You recognize there was an opportunity to serve your patients at a higher level. And Cathy, because you're such an amazing hygienist, you're like, I want to learn how to do this, how to shift these things. So mindset is a key element in recognizing the potential and I guess being open and willing to make some changes. Right?

Absolutely. So I really didn't believe that taking a patient, your schedule from a 50 or 40 minute schedule to an hour per patient, I thought that was going to be a waste. I really didn't think it was going to work. I didn't think it was going to be a very good idea. As it turns out, it allowed me to have more time with our patients talking about the prevention, actually using cameras that we didn't have that Wendy did say put a camera in every room. And so we have one camera that stayed on a shelf.

When Wendy suggested putting him in area rooms, I said, okay, I'm going to try this one thing. And it just changed my practice immensely, having the ability to talk to the patient, Lauren, Cathy, doing the preheating and all the things that she can do. It made my discussions a lot easier and in my production almost doubled just in my own hands, just because I had a better discussion with the patients rather than saying, how are doing? See you later. There was a lot better talk about what we could actually do for the patient. So it wasn't a big rush to talk to the patient about treatment.

Yeah, I love that. And thanks for pointing that out. I can tell you, you what you first described is very, very common in a lot of practices. You know, doctors will come in, the exam is quick, we're looking for anything big or anything obvious, but we really haven't time to chat with patients about what they'd like to see happen in their mouth or doing a deeper dive into opportunities, right? Sometimes we're just looking for those emergency, the 911 moments. But what we see is with the right mindset and the right structure and the right systems, great providers like yourselves end up really elevating the care they provide to their patients. And then overall, the practice realizes a higher level of greatness. And so it might seem counterintuitive to some to think, okay, we need a little bit more time in hygiene rather than less because the prevailing thinking right now, very, very common is that because we have PPO limitations and we've seen, you know, this incredible squeeze recently where hygiene salaries have gone up a pretty significant jump in some areas, yours included. And insurance reimbursements are flat or even declining, the thinking is, "How can we survive this?"

There was a post on social media the other day that I want to share with you. It's really quite sad, but it's very, very common. The doctor said RPPO is paying an average of $70 a profy,
hygienists are asking for 55 to 65 an hour appointment. How do we make this work? Something's got to give. And so this thinking of, know, the answer to that is shorten the appointments down or just get rid of all insurance overnight. You know, actually, sadly, we did a call with a doctor just last week that followed terrible advice from the group think on social media, dropped all insurance plans. And now guess what? Sees patients two days a month. That's heartbreaking.

Wow, that is heartbreaking. Well, the other thing about doubling your hygienist, it seems to me like that's a really quick way to burn your hygienist out. Now they're doing twice as much work. They get more likely injuries, workplace injuries, whether it's carpal tunnel or neck issues or back issues. They're just overworked. And so if you can find or have a different mindset, as you say, to think about, if I have more time with this patient, they will actually do what they need to do rather than me just finding the things that are on fire.

Kathy Muse (07:28.364)
To me, it's not fair to the patient. The patient should still get the highest level of care. And it's our job to tell them what they need. It's their job to tell us what they want to do without insurance being the key factor in determining what goes on.

Yeah, that's a good point too, Kathy. That was something else that we kind of identified early on, wasn't it? That you had some team members, not all, but some that were really allowing insurance to dictate the level of care that patients could have.

Yeah. Yeah, I've seen that.

Even to the point, Dr. Marcel, of changing your recommendations on restorative side, right? Now, calling everybody to amalgams and things like that and saying, that patient, they don't want fluoride, insurance doesn't cover it. That mindset was also keeping some team members and really your entire practice, as a result, stuck in that thinking.

We had to difficult conversations with our staff. This is the way it's going to be. If we don't do it this way, we're not helping the patient. We're not giving them what they want. We're actually telling them what they need. And dictating treatment for the patient is never a good idea. You should have an open and honest conversation about what they want and what your goals are and try to meet those goals. And if you do it any other way, I don't think it's right.

Kathy, you mentioned as well, something that we often talk about is, you know, with the mind mindset in hygiene, we often talk about where you're operating in regards to your license, right? Some practices and kind of where you were at the beginning, you were stuck in that bottom-of-the-license thinking that you were providing hygiene. You were doing all of the things that, were typical, you know, exam, bitewings, x-rays, you know, profys, all of those things. Like you said, you were doing perio, you were doing essentially bloody profys.

Bloody profys, yeah.

Just getting paid for that, right? And so once we kind of pulled the reins back or pulled the curtain back and said, okay, let's really take a look at what's happening day to day and what patients really deserve. What happens is you shift. We see providers shift from that bottom-of-the-license mindset. You know, essentially profy mill, "We're just gonna do what insurance covers". And we realized we can step up that ladder into the top-of-the-hygiene mindset where we're really partnering with our doctors or becoming advocates for our patients. We're embracing and providing on a consistent basis, a higher level of preventive therapy, a higher level of periodontal therapy. And as you mentioned, everything changed there.

Another compelling thing that we often talk about with mindset is we shift the comp plan a little bit, right? Instead of an hourly wage, we open a doorway of opportunity for providers to earn a bit of what they produce once they're profitable. Talk about your personal production, like before you learned some of these things and then what happened, what you saw come after that.

It was life changing, quite honestly, as far as from a workplace one and a personal satisfaction level. I mean, it was, Dr. Lambrechts has always been supportive of his team members and his hygiene team. And this was just another example of that. You know, when I said, I think we need to do this. So we started coaching, which you learn everybody needs a coach. We're all professionals, but we still need to continue to learn and grow. And then the more you added these services and you saw the results, you believe in it.

And to me, it just takes, you know, we have so many things that we need to relate to our patients as far as periodontal disease and their whole health that to me it's just, it opens a whole new wealth of information for our patients to be healthier. And if you believe in all of that, it just makes it so much more satisfying to take your level of work to the highest, you know, and offer these patients the best.

And then... Again, Dr. Lambrechts supported you. If you're working hard, he's gonna reward you for working hard. So the compensation, and I didn't do it for the money, but that was a nice little reward at the end of the day. You walked out of the office and you had accomplished a whole lot of good things for your patients and you got rewarded for it in other ways, compensation.

And from the doctor's side, she saw less patients and she produced more, which was pretty amazing for me, the Doubting Thomas. I was very skeptical, I can say.

It just was a really good feeling as a hygienist to be offering, to be using everything in my tool belt, which I wasn't doing before. It was good for me and it was great for the patient.

Yeah, and let's highlight, you when you had more volume, more patient flow, so shorter appointments, you are still producing very well in regards to the national average for hygiene. You're 30,000 a month, right?

Actually, it was, it went up. It actually went up.

She went from doing anywhere between 25 to 30,000 before TTI and then she was doing 30 on average. Above that, she made it to 38 and $40,000 in a couple of months. It was crazy what she was doing. And I really had no idea what kind of production could happen from a hygiene department if they were doing the right things for the patients, at the right time, every time, and it makes a big difference.

Yeah. And even another really important thing to note, you said your production increased, right? So we talk about mindset, talk about skillset, and toolset too. So Kathy, you just mentioned your skillset improved, right? As you learn some of these things. And then Dr. Marcel, you mentioned earlier, the toolset, they didn't necessarily have everything that they needed to really maximize those skills and to operate at the top of the license because you had one camera, for example, you were sharing, right? Yeah. And so once we actually identified, "Hey, there's opportunity here. Here's what we do. Here's how you use that appointment time, you know. Like you said, you were the Doubting Thomas, 60 minutes is gonna be way too much time. Well, not though, if we use all of these strategies and tools and we partner together. So the result of that was your own production jumped.

My production jumped, almost doubled. It was crazy how much more we did. So it was definitely an eye-opening.. In case you wondered how we.. we ended up going from 2 million to 12 million and how many, it was productivity that I couldn't do anymore. So I had to hire more doctors. I ended up having to get more doctors. We're now up to 12 doctors here in a practice where in 2017 we had one and a half doctors. And so it just grew like crazy and it's a... the dust doesn't even seem to settle ever. So it's kind of, it's been a lot of fun.

Right. And you know, it's been really amazing and gratifying to watch your growth both, both personally and professionally. Cause I remember Dr. Marcel, when we had lunch the first time, first time we had a meeting about opportunity. I remember you just saying, "I just want to be able to help pay for my daughter to go to hygiene school." Right. And that was your ask. And I'm like, you know, I loved that humility about you. And, and you know, I also say, it's really difficult when we meet people for the first time because I'm like, we have this wide open door opportunity. I can see it, but you almost can't quite believe that it's possible. So if you look back at that 2017 conversation, the 2017 practice, and you look at how far you've come, I think it's important for our listeners to know as well, you practice in Richmond, Virginia, in that area. So it's not a high.

Right. We're by the airport, not necessarily in the middle of a luxury town kind of home place. It's an airport area. We know what those look like. But the people there are all just like any other people. They want the best possible treatment. They want the best care. And if you don't offer it, they're not going to have the opportunity to accept it. So with the techniques and the training that we received through you all's team training, of course, we learned how to maybe slow down and actually take care to look at everything that's going on with the patient, ask them about their concerns, listen to their concerns, and then deliver those patients the best care. And that's really what made the biggest difference.

Yeah, and I share that because I think sometimes people make assumptions, right? That little voice that our brains says, "Well, they must be doing unnecessary dentistry, or they must just be, you know, putting Arestin on 40 sites for every patient." And, that's just not our approach. It's not your approach, certainly.

Certainly not. Nothing.

This is still bread-and-butter dentistry, right, and you know, serving the people in your community that are often blue collar workers and have budgets and limitations just like anybody else. But, it's the way in which you just, like Kathy said, my job is to let them know of the opportunity and they can decide. And giving them the opportunity to decide, we're often surprised at how excited patients get about even sometimes simple things, you know, Curadont or sealants. Yeah.

Yeah, turns out patients don't like to have fillings done. Isn't that funny? So if you prevent them, that's actually something they want.

Yeah, I love that. One other thing I want to run past you is, know, I mentioned that social media post and there was a comment made by a doctor on that post that really made me sad. You know, they said, "You know, we know there are good hygienists out there, but not all hygienists really do a good job. And everybody knows that. Honestly, our hygienist right now sucks. Horrible at notes. Won't lift a finger to help anybody else. Spends 20 minutes on the profy and then just the patient sits in silence until we're ready to do the exam. Never goes over the need for treatment and spends the majority of the day on their phone."

So Dr. Marcel and Kathy both, now you've kind of evolved into, you mentioned you own a larger organization now, you've got a bunch of doctors and hygienists that answer..

The three locations, yep.

You're leading your team to a bigger future. And I think that's wonderful. So when you hear posts like that, to me, it's so sad and it's demoralizing. And frankly, I mentioned the other day, sometimes I feel like the person on the beach that's trying to save all the starfish, know, throw it back into the water. And it gets to be frustrating because I don't feel like I have the energy to keep up and answer all of these really sad situations. But if you had a hygienist like that, you know, where do you start? Where do you start with somebody like that? Like we mentioned, you know, the things that you learned, Kathy, you moved from the bottom of the license to the top of license, but you know, Dr. Marcel, even your insights on, okay, what do you do if that's your reality? Like, where do you begin?

It's challenging. The hygienist, of course, everybody that can accept coaching and willing to be coached, that's an important thing. So if there's not any willingness there, I don't know what to say other than maybe that's not a proper fit for that particular practice. However, you may remember the story.. I nearly fired her. It was my second, maybe third month into my practice ownership in 1995. She's sitting there cleaning teeth. I'm sitting on my rear end. And I thought, I could do that. I don't need her to do that for me. So that was my mindset. Luckily, the doctor at the time said, "Don't ever fire her." And so I haven't and so this is what's happened since. many years.

Well if you fired her, I would have probably hired her, but that's beyond the point.

But that's the mindset I had. So sometimes it's the doctor's mindset needs to change and sometimes it's the hygienist mindset needs to change, maybe both. But I think that's where coaching comes in, Wendy. think with your always coaching talent, the pool that you have in your talent pool. I think it really changed a lot of the people.

We have a lot of hygienists and not everybody is in the same direction at first, but if they all start swimming at least in the same direction, it makes a huge difference. It makes the morale, the culture changes. It becomes fun for everybody. It becomes an issue of just watching it grow. just organically at that point. So then it's fun.

Well, I think I'm with you, Wendy. I think it's really sad because I even my whole career, I feel like sometimes the hygienist and the dentist are butting heads. And I just have never understood that. And I've been really blessed in my whole career to have great doctors to work with, very supportive doctors. So I think first of all, that's the conversation that needs to take place between that doctor and that hygienist. And let's figure out what's going on. She may not be a good fit. And you know, I think it's crazy to say you would let a hygienist go this day and time, but you need to, it's a fine dance that you live every day. So that would be my first thing.

But to Dr. Lambrechts's point, the continuous support and coaching that we get from you all is key. The calls, we expect our hygiene team to be on these Polished Calls and they are and they learn. So we keep our, they work at a high level and we keep our expectations high of them as well. But they're important to us.

Marcel Lambrechts:
And we love our hygienists. And for any of our hygienists watching, we love you.

So often I think. Yes, right. I love that. Well, and it's okay because what you just described to me is you just have a better, clearly defined system. And too often we look to blame the people, but in reality, it's a systems failure. Right? So as you mentioned, Kathy, the first thing that has to happen is the conversation. Let's be very clear about our expectations. Let's lay out our mindset, right? And let's help see that they have opportunities that they're not maximizing as a provider.

And certainly we love to support dentists and hygienists and helping have those conversations and helping establish those systems. It's one thing we do really, really well at the team. and so we're more than willing to help whenever we can, but, but I would say, you know, the first thing is mindset. Then let's look at the skillset. Do they have the skills necessary? Do they have the equipment necessary? You know, the tool sets, the next piece as well. You know, we want to make sure that they understand, you know, not only what technologies are viable, but how to utilize them, how to implement them. And as you mentioned, the ongoing support.

And frankly, you've also described a measure of accountability.

Right. I have to say that the hygiene schools in this country are amazing. I'm going to say that out loud and I mean it. They come out with some really, really great skills and a lot of dentists let them go to waste. And that's just the honest truth. They just, they really don't let them work at the top of their license. And that's a crying shame. And I think that they think they're just basically going to make a hygiene mill out of them, make them clean teeth every 30 minutes, burn them out like I mentioned. And, it's just not a really healthy environment. I think that the environment that you guys promote is the healthiest, it's best for the patients, it's best for the staff, it's best for the health of the overall practice. But the coaching is so critical because it keeps everybody, again, swimming in the right direction.

Yeah. Well, I love all of that. And I would say, you know, to those, any of the doctors or hygienists listening that are frustrated or have that divide or like, like Kathy said, you, maybe you feel like your butting heads, it doesn't have to be that way. Right. You have the power to change your own circumstance. You have the power to embrace and seek out better systems, a better approach. And what we've proven is that even if you're in a heavily PPO-infiltrated environment, when hygienists operate at the top of their license, they can still be wildly profitable, right? That's what we've seen. And so, I so appreciate you being willing to jump on and share your experience and all of your insights because I still count you amongst my very favorite people on this planet.

Thank you. We do you as well. Same. Thank you.

Yeah, it's our pleasure. And so those of you that are listening here today, if you're interested in reaching out to us and learning a little bit more about how you can elevate hygiene, of course, we stand ready to help. You can go ahead and click the link below. We'll include on our homepage for the podcast a link where you can schedule just a quick 10 minute call to talk about your biggest challenges and we can come up with a plan to help you have a brighter future together.

So, thanks everybody for listening. Thanks again, Kathy and Dr. Marcel for joining us. It was great to chat with you. And that does it for this episode of The Double Your Production podcast. Thanks everybody.

Thank you, Wendy. Thanks. Bye now. Bye, everybody.

Ep 159: The Untapped Goldmine in Hygiene Production

Ep 159: The Untapped Goldmine in Hygiene Production

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