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Beyond a Donor Practice

Occasionally you have an epiphany (I call it a brain fart) when answering a common question.  In the process of just visiting over the phone with a young doctor, he said something that gave me pause.  In a month that was his personal best, I asked why he had such a large increase in new patients.  In thinking back,he said that a doctor down the street closed his doors for 4-6 weeks to completely remodel his office before reopening.  During the furlough, that same doctor referred all of his patients to this young doctor.  The young doctor added that not only did this other doctor do that, but many of the other doctors refer their patients to him when they are out of town.  In this particular case, the referrals almost doubled the number of new patients seen in the practice, with a corresponding increase in production.  The young doctor added that he felt “the reason the other dentists did this was because he always sent the patient back to the referring office”.  This wasn’t the case of a general practice referring a patient to a periodontist and that specialist keeping the patient in their hygiene department forever, just a general practice to general practice referral.   I could hear the pride in the voice of the young dentist as he tried to convince me that not having any of the patients wanting to stay with his office was a noble and good thing.  My thought was that if some doctor had done this for me, the patient would never want to leave.  I have always felt that no one could compete with our systems, facility, fees, convenience, or level of service.  Why would anyone want to return to a “lesser” office after being served by us?  Walt Disney said:  “Do what you do so well that people can’t help but tell everyone they know about you.”  Bottom line:  Even though I would try to direct this type of patient back to the referring doctor, most would find the difference too great to ever be comfortable in their old office again.  I found that in the future these patients made their way back to our office seeking their next round of treatment.

So here is the dilemma:  If the referred patient did decide to stay with your office, in spite of your best efforts to get them back to the referral source, are you:

  1. Stealing the patient?  (Young doctor’s attitude)
  2. Or, is the other dentist running them off, or not inspiring them enough to have them stay?  (My attitude)


I would have to say that I favor #2.  Your practice is a small, consumer driven business in which your patients vote with their feet.  Fail to be there when they need you, charge too much, or have an attitude, and you can count on diminishing new patient numbers.  Lack of new patients indicates that you are not giving patients what they want.  Far too often our assumptions about what our patients “want” are based on what we have to “sell”.  DON’T GET CAUGHT TRYING TO SELL WHAT PEOPLE DON’T WANT, ESPECIALLY IN A MATURE BUSINESS.  Start listening and stop selling.  Get comfortable with happily giving them what they want and telling them what they need.  Allow your patients, the consumers, to tell you what they want and then figure out how to give it to them.  Maybe it’s just me, or it might be the 10 days in a row of 100 degree plus heat we’re experiencing here in Texas right now, but I’m finding less and less patience with lame excuses from doctors not achieving their goals.  It is as if a majority of dentists have adapted the “Brown Pasture Syndrome”:  Where they think theirpatients are worse off than anyone else.  They add to that a posture of “recession think” where they incorrectly assume that patients are suffering from a lost spending capacity.  Neither one of these have any basis in fact.  Regardless of the economy, location of the practice, or any other external input, patients willalways find the money and buy what they “want”.   The problem is that your lack of growth is tied to your inability to inspire your patients through convenience, caring attitude, consumerism, cost containment, and excellent systems.  Add to this the ever present increase of overhead cost and competition from other dentist’s, and you are destined for mediocre results.

Every month I receive calls from clients of ours who by their own admission are just average dentists from Any Town, USA, yet are having their best month ever.  Not the best month this year, or a better August this year over last year, but the best month in their entire careers.  When I hear that, I have to take my hat off to a unique office that has finally decided to incorporate our Summit materialsand become a “thermostat” rather than a “thermometer”.  They decided to control their environment rather than being controlled by that same environment.  They leave excuses behind and forge ahead to a greater month and better career.

Let’s go back to our young doctor, and his attempt at rationalizing why few if any patients stayed in his practice.  I posed a couple of questions to our young doctor.  First I asked if he had read the article I did on “Donor and Recipient Practices” and did he understand its implications.  He assured me that he had, and yes he understood the implication.   Secondly, I asked him why, if he was doing everything he could to inspire every patient that he saw, none of the referred patients stayed in his practice, and why his office routinely had only about 15% of their total new patients come from direct referrals (you should have at least 50% before even considering marketing:  Never look for an external solution to an internal problem).  There was a long pause as he considered hisanswer.  For the first time he was seeing that even though he felt that he was doing everything right, he was not getting the results he should.  Like it or not, each of us as owners and doctors are the main reason our practices flounder.  By omission or commission, we are responsible for our results.  Bottom line:  If the practice is not getting great results it is always the doctor’s fault.  To help the young doctor understand why the other doctors might allow their patients to come to him with no fear of having them stay, I told him the story about our former pastor at our church.  Dr. Puckett, pastor of this church, would take a couple of weeks off for vacation and maybe a few more weeks for mission trips:  Great guy, terrible speaker.  In any event, he would have to have someone take his place in the pulpit.  From my perspective, it always seemed he was very deliberate in bringing in someone that was less inspiring or gifted in delivering a message than he was (A remarkable task in itself).  Not that these referring doctors were doing the same, but you have to give some consideration if you look at it objectively.

If you are “doing everything” you have heard me say, write about, or coach you to do, and are not getting the results that we consider to be benchmarks, something is wrong.  Looking back over some thirty years of working with doctors, there is a common thread for doctors who find themselves under-achieving.  Many go through the motions or steps to implement a system.  This will bring some improvement.  They are efficient in their application of knowledge.  Where they miss out is being effective.  You must have both for this trend to perpetuate itself.  This disconnect is brought about by a lack of understanding or ownership of the process. Doing the right thing for the wrong reason will not wring out success, even from the best systems.  We need to get back to a “whatever it takes” attitude.  A feeling that there is no system, staff position, or procedure that is sacred.  Everything except our “purpose” or “mission” will need to evolve and change.  The good and bad of a recession just makes this decision more pressing.  From now on we need to run our practices based on results.  Not what we wish would happen, not postponing taking action hoping things will change by themselves, but proactively relooking at everything until we get the results we desire.  The following page is a form we use to evaluate and analyze practices and it allows me to diagnose any blockage that you might have.  If you will complete this form and fax it back to me along with a P&L statement and a copy of your schedule for a week, I will spend a couple of hours speaking with you revealing strategies and areas that need attention.  No cost, no hidden agenda.  We just believe that there is no other consulting group that can even come close to unraveling your practice blockages.  When there is no cost, waiting is over rated.  Don’t put off emailing or giving me a call.  You too, can have your best month ever.

Michael Abernathy DDS

P.S.   The young doctor could handle the truth.  He is having the best year of his career, and no, I did not scare him off by being honest with him.