Breaking Down The Math: Why AOX Efficiency Is More Important Than You Think

I think we can all agree that being more efficient is better than being less efficient.

And to clarify, I am never trying to be “fast”.

My goal, first and foremost, is to deliver the highest level of surgical quality – and then be the most efficient at that level of surgery. 

For those that know me, they know I am a stickler about efficiency. I am constantly trying to cut out steps that don’t provide value and even minimize movements and motions that are not necessary. 

At times this can be overwhelming for assistants who are new to my team. It can also make sense, but seem a little overboard to new doctors who train with me. 

Everyone understands that finishing an arch in 1 hour is better than 2 hours. But as my team has asked before, 

“C’mon Doc – why does it really matter that you got done in 60 minutes instead of 67 minutes!? It’s not that big of a deal!”

There is truth in this statement. There is, however, also an error in this way of thinking.

While it may not truly make a difference on that particular day, it will make a difference throughout my career. 

Over the past few years, I have changed the way I analyze efficiency from a career longevity and financial standpoint. And, while I did say the “F” word, I want to reiterate that the quality of the surgery my patients receive is always my priority. However, I do not see the rationale in performing that same level of surgical quality inefficiently in 90 minutes, when it can be done efficiently in 50-60 minutes. 

So, let’s take a look back at the 67 minute arch time versus the 60 minute arch time that my team poked fun at me about.

We will assume the same level of surgical quality and assume a 15 year All-On-X career.

The basic math listed below will highlight the vast differences small inefficiencies of a few minutes can have over a career. 

In order to understand the rationale behind Why AOX Efficiency is More Important than You Think, let’s take a look at the math first.

Breaking Down the Math…

Let’s quantify inefficiency from a mathematic standpoint. 

• In my practice, I cut around 45 arches a month. Let’s assume that due to small inefficiencies  here and there, I am cutting those arches in 67 minutes as opposed to “efficiently” at 60 minutes an arch. 

• 7 extra minutes per arch x 45 arches per month = 315 minutes of extra surgery per month

• 315 minutes per month x 12 months of surgery = 3,780 minutes of extra surgery per year

• 3,780 minutes of extra surgery per year x 15 years = 56,700 minutes of extra surgery over a 15 year career. 

• 56,700 minutes ÷ 60 min/hour = 945 hours of extra AOX surgery over your career!

• In my case, at an average arch time of ~50-60 min/arch, that’s theoretically an extra ~1000 arches I am cutting for free over my career! 

• This is simply because I am adding 7 min to each case that are not necessary. 7 minutes does not seem like a lot for any given case. But over your career, you are spending a lot of extra time and doing a lot of surgery you are not getting paid for!

5 Reasons Why AOX Efficiency is More Important than You Think

So now that we now the math, let’s look at some specific examples that highlight the importance of AOX surgical efficiency. 

1. Decreased strain on your neck and back. 

AOX surgery is not easy on your body. This surgery can be anywhere from 45 minutes to a few hours depending on your experience level. This is a long time to be in a less than ideal posture position. Whether you sit or stand, your neck or back will take some wear and tear if you do this procedure long enough. 

So what does efficiency have to do with posture? Well as we can see above, adding only 7 min to each arch in my scenario, means that I would be bent over, straining my neck and back for an extra 945 hours to accomplish the same surgical outcome over my career. 

That is a lot – a heck of a lot – of extra surgery time and strain on my neck and back with no increased value for me or my patients. 

Shaving off that seemingly inconsequential 7 minutes per arch, saves my neck and back nearly 1000 hours of surgery and increases the life of my career. 

2. Reduced time surgical patients are under anesthesia. 

The majority of AOX patients present with multiple medical comorbidities and can be difficult anesthetic patients. An obvious way to limit anesthetic risk, is to limit the time these patients are under anesthesia. 

In the math scenario above, small inefficiencies at only 7 extra minutes per arch would lead to an extra 945 hours of patient anesthesia over a 15 year career. 

Even looking at this scenario month to month, my patients would receive an extra 5 hours and 15 minutes of anesthesia per month. That’s a lot of extra anesthesia time, often with high risk patients.

3. Significantly decreased practice overhead. 

If you run your own AOX practice, you understand the importance of not letting overhead get out of control. But, what you may not realize is how much slight arch inefficiencies can impact that number. 

In this example, 945 hours of extra surgery over my career might look something like this in terms of extra overhead (not accounting for inflation): 

• Surgical Assistant A at $35/hour x 945 hours = $33,075

• Surgical Assistant B at $30/hour x 945 hours = $28, 350

• CRNA (Anesthesia) at $400/hour x 945 hours = $378,000

• Extra overhead, over a 15 year career, due to an added 7 min/arch = $439,425

If you own multiple locations you can let your mind run wild with the math. And remember… this is just 7 minutes of inefficiency per arch.  

Taking back that 7 minutes of inefficiency per arch can reduce your monthly overhead by ~$2,500 per month! That’s ~ $30,000 per year you gain in income. 

4. You are more in control of your time – your most valuable resource. 

It may be obvious that being less efficient means your surgery will take longer. 

What may not be obvious is that being less efficient over the long run, also means losing more of your time. Time you cannot get back and time that has both financial and emotional value. 

I want to be clear that I love what I do. I love being in surgery. And I love helping my patients. But that does not mean that I want to do an extra 5 hours and 15 minutes of surgery a month, or an extra 945 hours of surgery in my career simply because I’m inefficient. 

That’s 945 hours away from my family.

That’s 945 hours of working for free. 

At ~50-60 min an arch… that’s ~1000 arches I would be doing without getting paid. That is A LOT of surgery to do without any reimbursement. 

That’s 945 hours I will never get back.  

While this may be an extreme way of thinking, my point is that in order to fully understand why efficiency matters, you need to shift your thought process. Little inefficiencies do add up and they will steal your most valuable resource – your time. 

5. Being intentional, and therefore efficient with your surgery shows expertise, pride, and a passion in what you do. 

In my mind, becoming a great AOX surgeon means being able to consistently reproduce a fluid, almost choreographed surgery. No unwanted movement. No wasted motion. Every action with a thought and purpose. 

And no, I have not yet perfected this dance. But this is my goal, and it is a challenge and a learning process each and every surgery.

Does aiming for this level of efficiency mean that my surgery will be better than someone else’s? Maybe not. 

But I feel it shows a pride and a passion in what I do. And I believe that this attention to detail, this intentional level of surgery, will be directly passed on to my patients and influence the level of All-On-X surgical care that they receive.

I believe efficiency is a by-product of being a great surgeon. And I believe being a great surgeon is a by-product of efficiency. They truly co-exist in a symbiotic relationship. 

That is why I will always continue trying to improve my efficiency. I will never try to be faster. But I will pursue efficiency each and every surgery. 

Here’s to the seconds that become minutes, and the minutes the become hours… 

Matthew Krieger DMD