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The Slump

It never fails.  Just about this time every year, I begin getting calls from many of the doctors I know.  It begins the same way each time.  What about this new laser system or this CE course?  It takes a while, but it finally gets around to the  real reason for the call.  After two or three busy months, they can’t figure out what happened.  The new patients have dropped off, collections are fair, but production is way down.

I always begin the same way.  When was your best month?  What did you do to make it happen?  After they tell me they’re not sure, I ask them what they did 6 to 8 weeks before that great month.  It usually takes a few minutes, but they realize they’ve heard this before.  Each of us has slow times during the year.  Mine always seemed to fall in January-February, in June, and again in OctoberNovember.  To minimize these dips, I would plan a specific marketing campaign 6 to 8 weeks prior to the customary slump.  In this way I can increase new patients, production, and collections. I know we’ve discussed this before, yet I continue to get these calls.

Sometimes I feel I’m missing the cause.  A time of infidelity which leads to divorce isn’t really the cause of the split, it’s only a symptom of a deeper problem.  Failure to market isn’t the problem.  Since marketing has been with us for many years, I assume everyone will be comfortable with it by now.   I’m wrong.  If these doctors knew how important marketing is to their success, why would they fail to follow through with it?  I’m sure we still find ourselves feeling less of a doctor for advertising.

Why is it that a doctor can sleep in advertised pajamas on an advertised mattress, awake to an advertised alarm clock, drink advertised orange juice and eat advertised toast, drive to the office in his advertised car, and work with advertised equipment, and then say “I don’t believe in advertising!”?  Then, when he dies, his widow advertises his practice for sale.

Dentists advertise  — in Rotary and Lions clubs, on school boards, everywhere.  They promote themselves as Dr. Nice Guy in hopes of garnering more business and attracting patients. Countless stock portfolios and mink coats have been gained by such carefully planned activities as seeking the presidency of Jaycees, chairing Children’s Dental Health programs, or stumping for popular causes.

And yet, mention advertising and dentistry in the same breath to many of these dentists, and they recoil in horror.

“Advertise in dentistry?” they gasp.  “It will ruin professionalism.  The dignity of the profession will go down the drain.  People will choose their dentist for all the wrong reasons.  Dentistry will cost more and you can kiss quality good-bye.  Advertise in dentistry?  Never!”

Dental advertising’s never-never land has been with us for a while now.  The Supreme Court says we can.  The Federal Trade Commission says we should.  Will dour predictions for the future of our profession now come true?  Probably not.

Half the citizenry of the United States did not see a dentist last year.  It’s a national disgrace.  Of the half who sought dental care, half of them doctor-shopped during the year.    If people are so content with what we deliver now, why do they shop around so much?  Sixty-four  percent of our population of 300 million persons have unmet dental needs.  That’s enough to book our entire dental care system solid, forever!

Yet “busyness” seminars continue as we meet to figure out why the only time most people open their mouths to us is to yawn.  Marketing conferences pack dentists in to teach them about the dawning of retail dentistry.  Collectively, we use cutesy ad campaigns that “Sparkle, Glow, Beam, and Dazzle” us , but not our patients.  If this is good, how bad can bad be?

Today, there is no intelligent way to choose a dentist.  To say that advertising may mislead people into choosing their dentist unwisely is to imply that people choose wisely now.  Nothing could be further from the truth.  People choose their dentist emotionally, not intellectually.  Currently, people choose their dentist for all the wrong reasons.  They have no other choice.

Your new patient may come to you because you are conveniently located, have a smart office, keep long hours, accept Mastercard and Visa, have a sweetheart staff, employ happy gas, offer free parking, have a name beginning with an A at the top of the Yellow Pages listings, or pay thousands of dollars for a glitzy website (plus more for  “Optimizing” – whatever  that means).    None of those reasons are logical.  They are all emotional.

The same is true if your patients chose you because of your long years in practice.  Some dentists have twenty years of experience, while others have one year of experience repeated twenty times.  If you were chosen because you do quality work, how was that quality evaluated?  Probably by a person who wouldn’t know a margin from margarine.  Again, it was an emotional bias, not an intellectual choice.

The American Dental Association booklet,   How to Be a Wise Dental Consumer, is an example.  It suggests several ways to choose a dentist, the first of which is “Ask your friends, neighbors and co-workers.”  What, pray tell, do friends and neighbors know about choosing a dentist wisely?  A dart board would be faster and just as logical.

“Ask a faculty member of a dental school.”  The odds are he doesn’t know the market any better than the local third grade teacher.  He may know a few officers of dental societies, but being a dental officer guarantees nothing but a lot of thankless work.  Also, he will not know dentists who have entered his market area from other schools.  Some of those imported dentists actually do quality work.

“Check with a hospital having an accredited dental service.”  How a hospital dentist is blessed with powers to evaluate community dentistry escapes me.

“Check the ADA directory.”  Now we’re getting down to the meat.  In the directory you learn the year a dentist graduated, his school, and his zip code.  These should help the layman, if he is into Chinese astrology (a person born in the year of the Goat might not want to be attended by a dentist who graduated in the year of the Rooster).  If the eager patient is into numerology, he can attach a meaning to the ADA number listed for dentists in his area.  Otherwise, the ADA directory is as useful a tool in choosing a dentist as the license plate on a doctor’s car.

“Check with your family physician (ask who provides his care).”  Most physicians don’t know an inlay from an onlay.  Why should they?  Physicians, too, rate their dentist on emotional factors.  “Check with your pharmacist” has the same effect.  Our choices of physicians and pharmacists are made the same way — emotionally.

Various public interest groups have kicked up a flurry of amalgam dust by publishing directories of dentists.  Those directories reveal hard data on topics such as education, equipment, payment plans, office hours, and disciplines of special interest.  In the absence of a better method, perhaps it would be wise for dentists to take the initiative and publish a meaningful body of data that would beat the ask-your-buddy system.

We want to think our patients choose us for all the right reasons.  They do not.  There is little likelihood they ever will because buying decisions are emotional decisions, borne apart from logic.  Our patients choose us, not on the basis of the superb quality of service we render — since none of them is qualified to judge the quality — but on the basis of every emotional factor under the operatory light.

There is just as much opportunity to mislead your friends in the church choir, to mislead the community because you are the newly announced president of your dental society, or to mislead everyone who has heard you took a dozen Boy Scouts to a Jamboree, as there is to mislead the public in a full-page newspaper advertisement.  Really, what is the difference?

The stated difference is in the deterioration of professional dignity, which some dentists feel occurs through advertisement.  Personally, I do not feel I’ve lost any professional dignity because national TV exposed a dentist Superman dressed like a clown (or was it the other way around?).  Neither does my dignity suffer when dentists shoot themselves, get drunk, or fill hyenas’ teeth.

The point is there is no such thing as the dignity of the profession.  There is only the professional dignity of individual dentists.  Each of us builds or wrecks our own.  The public fully understands that. People do not ask the profession to protect their dental health.  They ask one specific dentist.  We should understand it, too, even if Dr. Big Ads hypes the whole community on how great he is.

If Dr. Slippery cannot deliver quality dental care, the public will find him out faster when he advertises.  My guarantee to you is this: Please a patient and he may tell his friends; displease him and he will tell the world.

If you want to fret over professional deterioration, here’s a handful to keep your fretter working overtime.  What about dentists who judge another’s work with a raised eyebrow or a tongue cluck, followed by a grunt and a shake of the head?  It’s probably over dramatization to throw your head in your hands and cry out: “Dr. Abernathy actually did this work for you?  Oh my gosh!  I thought he was through with that sort of thing!”

How often do colleagues chop each other up like liver pate?  Plenty!  You know this is true because it always comes back.  But mud throwers lose ground when they sling.  In such cases the dentist is saying that the patient was stupid enough to buy bad dentistry.  He doesn’t just put down the former dentist; he puts down the patient as well.

What about half the dentists in America who refuse to treat 55 million Medicaid recipients?  Could you imagine, in your wildest imaginings, a circumstance that reflects more poorly on the state of the art in dental America?  Hardly.

Or how about profiteering?  There is no reason in the world for a denture to cost a patient’s life savings, plus a loan from Junior.  But it often does.  And this very profiteering has paved asphalt streets with gold for denturists.

Another advertising windmill that is getting a lot of tilting action is cost.  This really is grasping at straws.  Dentistry is not higher quality because or when it costs more.

What about dentists who aren’t dealing from a full deck?  With all the professional chatter about stress in dentistry, there must be a host of over stressed fingers plying the dental business out there in Stressville, USA.  What is their effect on the dignity of the profession?

How about dentists who wish they had not entered the drill mill, who refuse to nudge their sons and daughters into dentistry, and who are bored to tears with the means of their livelihood?  How well do these doctors represent the dignity of dentistry?

What about dentists who attempt to practice without hugging continuing education to their bosom?  Even in states requiring annual CE quotas, how many quotas are filled by a half-hour spin through the aisles of shiny gadgets at dental conventions?

There are, indeed, ways to deteriorate our group dignity.  But we do them one by one, one on one, not collectively.

Dentistry  often costs what it does in America because of inefficient practices that multiply patient costs.  We are today  at the same threshold we were 50 years ago when we passed from solo, standup operators with single assistants to multiple, sit-down operatories with four and now six-handed dentistry.

Abundant evidence in the business world demonstrates that costs decrease when advertising introduces a product or a service.  For example, think of ball-point pens, calculators, and razor blades.  The Supreme Court  noted this in its Bates decision brief.  They called attention to evidence that advertising has contributed to lowering the cost of eyeglasses, prescription drugs, and legal services.

If it is true that half of our patients doctor-shopped last year, at least one reason they did so was cost.  Other reasons were convenience and failure on the part of their current dentist to communicate with them.  Talking to our patients does not supplant talking with our patients.

In the U.S., it’s reported that more dental supplies are purchased from discount, mail-order suppliers than from local suppliers by doctors who, themselves, decry discounting.  Is there a message here?

Doctors who drive all over town to save a buck on hunting boots, case beer, and megavitamins find it difficult to understand that the public does the same thing.

The Supreme Court, noting the objection about advertising in dentistry raising its costs, pointed out that such an idea presumes the public is unaware that dentists earn a living from dentistry.  Few people, the Court added, climb in a dental chair expecting free service.

What we  can do in advertising is to do exactly what the word means: to announce.  This must be honest and stripped of hyperbole.

Advertising without hype informs.  It tells of availability of service, kinds of services offered, who the doctors are behind an office name, payment plans available, and the like.  In short, these announcements help people make decisions based more on data than on the emotionalism of word of mouth.

Decisions based on data may still be wrong decisions.  But decisions based on hearsay have far greater chance to be in error.  How any dental organization can recommend hearsay referrals as a “wise” course of action escapes me.

Where is advertising in dentistry leading us?  Well, it doesn’t necessarily contribute to the deterioration of our dignity.  We do enough things, individually, to so do without any help from the FTC.  It does not contribute to choosing a dentist more emotionally because that’s the way patients choose us now.

Advertising will not lead to a poorer quality of service any more than does greed.  And dental services will not cost more than they do now because of advertising.  Dr. Slick will never steal our patients whom we are satisfying with convenience, quality service, good communication, and fair fees.

If we don’t let our high-speed handpieces blow away our cool, and if we keep our paranoia in check, perhaps advertising in dentistry may let a little of the dark leak out of our operatories.  Maybe we can entice a few of those hundreds of millions of non-believers into taking better care of themselves, as can only happen in a dental office.

Nice dentists can advertise — with dignity.  And when it is done skillfully, no one will know that you advertise.  But we must do so with dignity, finesse, and a rifle aimed toward our markets — not a shotgun aimed at the community.

The bottom line is this: the 21stcentury demands we run our practices as a business with consumers in mind.  Consumerism, with all its implications, dictates marketing.