Ask a dentist when they write their notes and you rarely hear "during the visit." You hear "at lunch," "between patients if the schedule slips," and most often, "after we close." The chart work that does not fit inside the appointment does not disappear. It moves to the evening.
That pattern has a price, and it is larger than most practices guess. The best evidence comes from medicine, where researchers have followed clinicians with stopwatches and pulled the event logs from their record systems. The numbers are worth sitting with, because the mechanics they describe are the same ones running in your operatory.
What the time studies found
In 2016, Christine Sinsky and colleagues published a time and motion study in the Annals of Internal Medicine. Trained observers followed 57 physicians in four specialties for 430 hours of clinic time. The result: physicians spent 27 percent of their office day in direct clinical face time with patients, and 49.2 percent on EHR and desk work. The authors put it plainly. For every hour of direct patient care, physicians spent nearly two additional hours on the record and the desk. And the day did not end at the office. The 21 physicians who kept after-hours diaries reported another one to two hours of work each night, most of it in the EHR.
A year later, Brian Arndt's team measured the same problem a different way in the Annals of Family Medicine. Instead of observers, they pulled EHR event logs from 142 family physicians in Wisconsin. Same story, sharper edges. Physicians spent 5.9 hours of an 11.4 hour workday in the EHR, including 1.4 hours after clinic. Clerical work, meaning documentation, order entry, billing, and system tasks, accounted for 44.2 percent of that screen time. The paper's title says the rest: "Tethered to the EHR."
A third study connects the hours to what they do to the people working them. Tait Shanafelt and colleagues surveyed 6,375 physicians for Mayo Clinic Proceedings. Physicians who used electronic records were significantly less satisfied with the amount of time they spent on clerical tasks, and use of computerized order entry was associated with a higher risk of burnout even after adjusting for factors like age, specialty, practice setting, and hours worked. Documentation load is not just an efficiency problem. It is a burnout problem, and burnout is a staffing problem.
Dentistry is not exempt
Those are medical studies. Dentistry has no time and motion study of that scale yet, so we will not invent one. But every mechanism that produced those numbers exists in a dental office running Open Dental.
Every visit needs a note that can survive an audit, an insurance request, or a lawyer: chief complaint, medical history review, findings, treatment performed, tooth numbers and surfaces, anesthetic, materials, post-op instructions, prescriptions, next visit plan. A full perio chart is six measured sites per tooth, 168 probing depths on a 28-tooth dentition, plus recession, bleeding, mobility, and furcation, traditionally read aloud to an assistant who keys in every number. Referral letters have to be written and then chased. Medical history updates have to be collected, signed, and filed. None of that is chair time. Dentists commonly report that it lands exactly where the physician studies say it does: the lunch break, the gap after the last patient, and the laptop on the kitchen table.
Put numbers on it
You can estimate your own documentation cost with three inputs:
- Visits per month. Completed appointments, not scheduled ones.
- Minutes of documentation per visit. Time an honest sample: writing the note, entering the chart, drafting the referral. Count the time it takes, not the time you wish it took.
- What an hour is worth. Use the loaded value of provider time. If the dentist writes the note, that hour is dentist-priced whether it happens at 2 p.m. or 9 p.m.
Multiply the three and you have a monthly figure. Multiply by twelve and it stops looking like a rounding error.
A worked example
Take a two-doctor office doing 400 visits a month. Suppose better tooling saves a conservative 7 minutes of documentation per visit, and provider time is valued at $125 an hour.
- 400 visits x 7 minutes = 2,800 minutes a month.
- 2,800 minutes is about 47 hours a month. That is more than a full work week, every month, spent typing up what already happened.
- 47 hours x $125 = roughly $5,800 a month.
- Over a year: about 560 hours, or about $70,000.
Change the inputs and the shape holds. A smaller office at 150 visits and 6 minutes saved is still about 15 hours and $22,000 a year. A busy office at 700 visits clears $120,000. Whether you take that value as cash, as capacity for more visits, or simply as evenings returned to the people who earned them is up to you. The point is that it is real, and right now most offices are paying it without ever seeing an invoice.
What the math leaves out
The formula is deliberately conservative, and it still undercounts.
- It prices only the provider's minutes. A perio exam read aloud ties up two people, the one probing and the one typing. That assistant hour has a cost too.
- It ignores quality. Notes written from memory at 8 p.m. are thinner than notes captured at the chair, and thin notes are what audits and disputes feed on.
- It ignores the burnout tax. Shanafelt's data ties clerical burden to burnout, and replacing a provider or a seasoned assistant costs far more than any software line item.
- It prices the evening at office rates. Most people who have missed a kid's game to finish charts would price those hours higher.
Getting the evenings back
The answer is not typing faster or trusting memory. It is capturing the documentation while the visit is happening. That is what Molaris does for offices on Open Dental: one ambient recording of the visit becomes a structured 11-section clinical note, drafted for the provider to review, edit, and approve. Nothing is finalized without your sign-off. Call out numbers while you probe and the full six-site perio chart fills itself, then files into Open Dental's own Perio Chart module. The referral letter drafts itself from the same visit. Approved notes attach to today's appointment. The work still gets reviewed by you. It just stops eating your night.
If you want to see the math with your own numbers, the calculator at getmolaris.com/roi runs this exact formula with your visit count and rates. Or book a 15-minute demo at cal.com/molvo/molaris and watch one recorded visit become a finished note. Either way, run the numbers. Your evenings are already paying the bill.