I Don't Have Enough New Patients

You've been in practice 18 years and you're pretty clear that most patients are very impressed with both your dentistry and the TLC factor of your team's patient interaction.  You're a solo practitioner so there's no other doctor in the office to undo the great experience you're delivering to your patients.  Your staff are simply the finest you've ever worked with.  So where are the new patients?

You know that the national average for monthly new patients in the dental office is 22 but that's for the average clinic delivering the average service.  You know you're better than that, so why aren't new patients breaking down the door?

That's a great question and one I probably hear about once per week. What is it in this picture that many doctors are missing?  We should look a little closer at the monthly referrals before we jump to any conclusions.

How many patient-to-patient referrals should a dentist be getting each month and how many are possible?  At this moment Whitehall is coaching doctors who average upwards to 200 referral patients each month.  The current all time world referral record is held by a doctor in the Northwestern United States with just over 300 referrals per month.

Granted, these offices have numerous associates so that has to be taken into consideration. Personally I think an office that can generate these amazing monthly referrals numbers is accomplishing the near-impossible.  When you have just one owner doctor ready to impress and schmooze it's not so hard to hit these great monthly referral numbers.  When you have a chaotic tangle of staff and associates bouncing around a monster office and still achieve referral numbers north of 200 per month, you're in a class by yourself.

So how many referrals should you be averaging?  From decades of personal experience coaching I have to say that my number is 40 per month, and that's per practitioner.  If you have 3 doctors under the roof, you should be shooting for 120 direct patient-to-patient referrals per month.

So many doctors mistakenly think that a shortage of new patients indicates a marketing deficiency.  In other words, too few new patient simply means that not enough money was spent on marketing.  To answer this best think in terms of two stages of new patient shortages and responses (like marketing).

First, for the solo practitioner, his or her schedule can and usually should be filled with patients referred by other patients, in other words, marketing is often optional for these doctors.  The second stage involves filling an associate doctor.  This is where the marketing budget comes into question.  When a doctor calls to ask how much he or she should be ready to spend to flood their associate doctor with new patients, they, like me, wince at my answer.

The right number is 7% of your gross monthly revenue to be spent on hard hitting, high impact marketing pieces.  At Whitehall we don't have a doctor grossing in the $500,000 per month range who is spending less than that number.

Let's start with the referral side and then discuss paid advertising.  First referrals, they come from several sources:

1.  Insurance companies send them to you because you've signed up for their plan.  The discount they insist on often makes marketing look cheap by comparison.

2.  Staff working for incentives, watch for patients with family members or professed friends that aren't a patient of the practice.  Once identified, they make a direct request for the patient to send in the friend or relative.  Often there's a small incentive tied to this action in an effort to keep the staff person in the hunt.

3.  Inspiring patients with full-on knock your socks off approach to wow the patient into telling and selling their friends on you.  This one is of course, the most difficult because you have to give the practice a complete overhaul to see that the patient never encounters an unpleasant staff member or is left waiting 30 minutes for the doctor to check them so they can leave.

No doubt, number three is the gold standard, it's the one that tests your control of the practice (staff).  This subject was introduced in an earlier blog entitled "The Biggest Problem In Dentistry".  If you can only make suggestions to your staff as opposed to giving commands, it's very unlikely they're going to put their full focus on impressing your patients to the point they'd naturally tell everyone they meet about you.

If you are really impressing patients and they're not referring others to your office, you're just kidding yourself, you're NOT impressing them.  Oh, maybe in some ways but not in the ways that count.  Maybe you do have someone running up to new patients as the enter the practice for the first time, putting a water bottle in their hands and fussing over them in other small personal ways. All's well until they meet the hygienist on commission who hammers them for 4 quads, a sonic spinning toothbrush and a ticket to her own multilevel sales meeting.

Sure, you're doing most things right but unfortunately, it only takes one predictably unpleasant encounter in the office to insure that all your schmoozing and fussing over the patient goes up in smoke.  Like I say, inspiring patients to refer indicates highest evolution of customer services.  All patient encounters with the office need to be better than expected.  By the way, if you do achieve this, you don't even have to ask the patient to refer, they'll do it naturally.  If you don't impress or inspire them with your service, there's nothing you can say to make them go tell everyone they know to come to your office.

Before we get too far, what about just having your staff scrutinizing the patient flow for referral opportunities?  Sure, that works so long as the patients weren't traumatized by emotionally unstable assistant or left waiting for the doctor for 45 minutes.  Usually, the incentive runs around $25 for a referral you can trace directly to the efforts of a single staff person.  The scripting and technique for this process is a topic for another blog.

So, what about marketing and the 7% of gross.  What do I need to know about marketing other than spending a lot of money on it?  I suggest we take up our next blog right here.  We'll lay out what works and what doesn't.  Who's really ready to market and who needs to fix a few things in the practice first.

A Starting Point For Growing Your Practice

In most cases doctors seek out a practice consultant because they want a better or larger practice but they don't know where to begin.  I'd like to share a few thoughts on simply finding a starting point for growing your practice.  Take a moment and see which of these conditions most closely describes your current situation.

1.  I don't have enough new patients.  I'm standing around with nothing to do while the overhead clock is running at warp speed.  I can tell that several of the staff really don't mind having some slow time during the day so they can catch up on other work, but I, on the other hand am experiencing high anxiety when things are slow.

I'm convinced that if I could get more new patients through the door I could reach my goals, one of which is a sense of the fulfillment that comes from being fully utilized.  Sure there are some busy times here and there but for the most part, my schedule isn't really challenged.  I've tried marketing, asking for referrals and I've even joined some local civic groups.  Is this ever going to change?

2.  I have plenty of patients but I'm pretty sure that the cases are not being fully developed.  In other words, there's lots of new patients but they're not accepting the treatment they really need.  I feel very busy but not terribly productive, does that make any sense?  If it's not disruptive composite cases, it's full-on new patient exams that end up as NTs (No Treatment).  Oh I'm busy all right.

I'm also hounded by the thought that we're not being very efficient.  I've often thought that if my monthly new patient count were to go up by 20% that I'd probably make even less money than I do now.  The practice is starting to feel like an unprofitable hamster wheel and it's wearing me out.  I always thought that if I could just get more new patients that all would be well, I was wrong.

3.  I'm reaching all my production goals but the profit just isn't there.  I hear and read about national averages for the typical dental practice but it just doesn't seem to apply to my office.  I've repeatedly gone over all the numbers with my accountant and I'm pretty sure we're not being embezzled or wasteful, the net just isn't there.  I've checked to see that I'm not overpaying my staff, my rent is within the 8% (of gross) guideline and my Patterson Rep is careful not to let my office become a supply warehouse.

My patients get high quality dentistry and first class service from a dedicated team of seasoned veterans.  My staff are well compensated, my patients are fussed over but it feels like all of this value is coming at my expense. I'm starting to wonder if I should have become an associate doctor or a manager at Wal-Mart.  At least I wouldn't have to worry about making payroll.  I hate to sound so selfish but there it is. I'm doing the work and delivering a great experience for both patients and staff but I'm not getting the paycheck I hear other dentists are getting.

All I'm asking you to do at this point in the process is to identify yourself.  I realize there really could be other perspectives on practice blockages but most of the ones I run into in the consulting trade fall under these three headings.  In the upcoming blogs we'll look into each of these frustrating conditions.  Stay tuned, we'll take them one at a time and in order.  You're comments are welcomed.

The Biggest Problem In Dentistry

With few exceptions, I'm in a practice somewhere in the U.S. almost every week of the year. When on sight, I interview all staff, study the practice KPIs (key performance indicators) and of course, talk to the doctor. The goal of the visit is to find and remove practice blockages to allow the office to express the doctor's personal vision for the practice.

Over time, this blog will detail a long list of the blockages and solutions for removing them. However, there's a great axiom that should be considered when the search for profitable practice growth is undertaken and it's this: all system upgrades are useless until the practice is under the control of the owner doctor.

In other words, it does you no good to identify growth blockages unless you have control of the team. With few exceptions, I hear a horror story daily from a doctor who unsuccessfully attempted to implement some improvement to his or her office, only to be quietly or openly ignored by the staff.

The doctor returns from a seminar or consultation with a practice guru only to find that his staff have a compelling rationale as to why this new idea won't work in this office or town. The put downs that the doctor endures fall into several predictable categories:

1. I've worked in dentistry for 21 years, and in offices bigger than this one, and we never had to... (Pulling rank).

2. Do you want me to implement your new internal marketing program or collect money from the patients? I'll do what ever you ask. (The fatal choice).

3. I don't think our patients will want to us to do... (Using patients or your image as a deal-killer).

4. I've talked to the other staff and I speak for everyone when I say that what you're asking us isn't going to help the office. (The majority rule)

5. When am I supposed to find time to organize and apply this program for our practice? (Probably when you're texting your boyfriend during office hours)

You, the doctor, are just one voice among many when it comes to implementing an improvement to the practice that requires staff to use their creativity and resourcefulness. In short, you are, at best, an influence on the practice when what you really need is "Control".

In offices where the doctor is in control, the staff are highly motivated to come up with permanent solutions to problems that limit practice growth. How is this control achieved? We'll get there but first you have to know control when you see it.

Are you now in control of your practice? Take this simple test: can you get your staff to learn and deliver a simple scripted patient encounter? What would happen if you asked your team to memorize a couple of paragraphs of scripted text and deliver it in a believable way to patients? If you'd like to know how this will end, just look at the 5 numbered excuses I just listed.

Having a lot of great practice building ideas with no control over how your team will behave is the equivalent of revving up the engine of a high performance race car that has no transmission, you're not going anywhere. And by the way it's impossible to gather enough great practice building information to overcome the fact that you're not in control of your practice.

Yes, I know that good staff are hard to find and training new ones is one of your least popular activities. Still, at the end of the day you have to ask yourself, is it better to have unmotivated, highly trained and experienced staff or to have highly motivated staff that don't know what they're doing? No, there's no easy answer to this problem but then that's why everyone's not rich.

You're daily enamel grind can be hard work, but, overcoming unwillingness and half-heartedness on the part of your uninspired staff can be down right exhausting if not overwhelming. You know the old saying, there's no such thing as the right answer to the wrong question. If your question is how do grow my practice, any answer that doesn't start with getting staff on fire for excellence is complete waste of your time.

I've watched hundreds of doctors spend over $5,000 a month for advertising, and this in hopes of generating a few phone calls from the weak, under committed prospects that usually respond to your best marketing efforts. And when these tentative callers finally do reach your mildly motivated receptionist, they are not reached out to and carefully connected to the practice. They are usually seen by staff as a lower grade of prospective patient, whose degrading questions about price or immediate schedule availability are answered with barely disguised contempt. Until you can change this situation should you be spending this kind of money on marketing?

For today, it's enough to simply acknowledge that you are NOT in control of your practice, your staff is. No, they don't have a sinister plan to guide your practice down to utter failure. They do however, have the simple goal of getting through the day and seeing that practice continues to earn just enough to insure their job, and unfortunately there's more of them than there are of you.

The title of this blog is "The Biggest Problem In Dentistry". Well, not being in control of the practice is indeed the biggest problem if profitable growth is the goal. At the root of this problem, that of not being in control of the office, are to following:

1. The doctor is outnumbered and out voted by "hard-to-replace-staff".

2. The doctor has become so close to some or all of the staff that they are seen as family. I don't have to tell you where you end up with a bunch of family members working in your office.

3. The doctor is so beaten down by having to offset the staff's lack of motivation with his super-motivation that exhaustion finally overtakes him and the practice settles into a dreary fight for survival.

If I had to sum up the biggest problem in dentistry I would say it's the relationship the doctor has with his or her existing staff and its resulting lack of practice control. I've found that from the time you acknowledge that you are not in control of your practice it will take between 6 - 12 months to correct that situation, and that's if you know what to do and have the courage to risk a full-on staff walkout. No wonder so few practices reach the great heights. Just decide now, is the vision of your ideal practice worth alienating some or all of your staff over?

While this is my first blog post, the good news is that it really is down hill from here. If you do get in control of your practice the possibilities for profitable growth and personal fulfillment are endless. Most of the doctors reading this blog are painfully attempting to offset their team's mediocrity with their own grim determination. If you've had enough and want a change, read the next installment on getting control of your office.