Five ways to improve endodontic practice efficiency

Editor’s intro: Dr. Roger Levin offers five tips to raise efficiency to a higher level in the endodontic office.

Dr. Roger P. Levin offers some tips to reduce stress and increase profitability

Question: How can endodontic practices increase efficiency to compensate for the lower level of delegation potential in the endo-dontic practice model?

Answer: Endodontic practices are faced with a myriad of challenges. It’s true that they typically experience a high volume of cases (including many emergencies) that create high practice production and profitability; however, they also create chaotic scheduling, unpredictable appointment times, and high levels of stress. And while other specialties such as orthodontics can count on a well-trained assistant to help perform orthodontic treatment, endodontic staff members cannot assume endodontic treatment responsibilities. This lack of delegation opportunity contributes to endodontic practice revenue flattening out at a much earlier rate than other specialty practices.

Today’s endodontic practices are also challenged by competitive factors that did not exist even 10 years ago. General dentists are providing more endodontic services; more DSOs that perform root canal services are emerging; and dental implants are becoming a more trusted solution for certain issues that had required endodontic treatment previously.

All of these factors necessitate a new look at endodontic practice efficiency. Although delegation will still be limited, maximizing practice efficiency is a smart strategy in helping to maintain and increase patient volume. The following five ways to improve efficiency will be beneficial to many endodontic practices.

1. Design a schedule that meets daily goals.

Every endodontic practice should establish a daily goal that adds up to an annual production goal. For example, an endodontic practice could schedule four patients in advance at an average of $1,500 per patient. You could then expect to have four other patients at an average of $1,200 per patient. This simple hypothetical formula will allow the practice to hit a daily goal of $10,800 per day.

Another practice may want to schedule six patients per day at an average of $1,300 per patient, leaving additional time for multi-chair scheduling to also accommodate emergencies at an average of $900 a day with at least 50% of the emergency root canals being completed in one appointment.

Choose what’s best for your practice based on the number of patients that can be pre-scheduled for services, average number of emergencies per day, average production for all of these cases, and any other contingent factors. Then plan to ensure that the practice hits the daily goal (plus or minus 10%) approximately 9 days out of 10.

2. Endodontists should use two or three chairs at a time.

This works particularly well when there is one assistant per chair managing each patient and performing all legally acceptable clinical parameters within the practice. Use procedural time study analysis to determine how long the average patient will be in a chair if the practice uses two or three chairs.

Every few years an endodontic practice should update the procedural time study. Simply saving 10 minutes per hour in an endodontic practice that is open 4 days per week will result in the equivalent of almost 2 extra months per year of doctor production time. This means that every 6 years, the practice picks up the equivalent of 1 extra year of production time. Think about what this would mean over a 35- or 40-year career.

3. Endodontic assistants should be fully trained with scripting to explain endodontic procedures.

A well-trained endodontic assistant communicates effectively and efficiently with patients, saving the doctor a great deal of time by already providing a thorough explanation and answering preliminary questions before the doctor comes in to see them. This in no way diminishes customer service. There are many practices where the staff handles a large portion of communication, and patient reviews are excellent.

4. Endodontic practices should measure the current rate of one-appointment versus multiple-appointment root canals.

There are endodontic practices that have 20% to 30% of their root canals completed in two appointments. The goal should be for 90% of root canals to be completed in one appointment. Multiple-appointment root canals require more time and overhead. Many endodontic practices end up

providing a larger percentage of multiple-appointment root canals simply to manage scheduling inefficiencies resulting from the unpredictability of emergency referrals.

5. One assistant per chair will increase endodontic practice efficiency.

There are practices that have added the policy of one assistant per chair with tremendous results. Data clearly indicates that by using this model practices can experience 50% to 100% growth. Although it may appear at times that the assistant is merely baby-sitting a patient, this approach works because the assistant runs the doctor. The endodontic assistant should have complete command of the clinical area and advise the doctor on where to be at all times based on communication with other assistants and overall management of the patient schedule and clinical procedures. Endodontists will find that having the assistants make the majority of administrative decisions in the clinical area results in very low stress levels, high levels of efficiency, and highly productive endodontic practices.


High demand and unpredictable emergency referrals contribute to inefficiencies in the endodontic practice. There are excellent opportunities today to create much higher levels of efficiency and lower levels of stress when the concepts outlined above are applied.

Dr. Albert (Ace) Goerig offers his insights into how to raise efficiency to a higher level. Read his article about three main areas to work on in the practice here.

Roger P. Levin, DDS, is the CEO of Levin Group, a leading endodontic management consulting firm. Founded in 1985, Levin Group has worked with over 30,000 dental practices. Dr. Levin is one of the most sought-after speakers in dentistry and is a leading authority on endo practice success and sustainable growth. Through extensive research and cutting-edge innovation, Dr. Levin is a recognized expert on propelling practices into the top 10%. He has authored 65 books and over 4,000 articles on dental practice management and marketing. To contact Dr. Levin, visit or email

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