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The Top Ten Reasons Why Your Marketing Is Not Working

Desperate phone calls from struggling dentists fill my message box.  More and more I am hearing how their marketing is no longer working or that after twenty years of never marketing, they want or need to start.  I am even hearing doom and gloom from other management companies marketing “super stars” with unlimited marketing budgets, that hired the next best greatest marketing company that “Beta” tests every direct response marketing and branding strategy with hundreds of doctors, and did not even get them one new patient.  They literally spent over $30,000 and got only one phone call from the ads from these so called experts that sit in Seattle, Phoenix, Las Vegas, Chicago, Atlanta or New York and pontificate at the dental meetings about how they are the new messiah of new patient acquisition.   The struggling (and now poorer) doctors want to know why the marketing isn’t working and can’t find an answer.  This is the first of a two part article that will give you some insight into what I have been able to glean from countless phone calls and one on one encounters with doctors who are searching for a reason why their marketing is not working.

1. You are looking for an “external solution” to an “internal problem”.  You have heard me say this before while talking about Donor and Recipient practices.  “Good practices” don’t need to market and should, while “Poor practices” need to market and shouldn’t.    If your number of new patients has continued to diminish over the last few years, something is very wrong.  Sure, patients are spending less or postponing elective treatment, but they are still maintaining their hygiene, and they will always complete treatment they want (not treatment you think they need).  If a poorly performing practice (over 60% overhead, less than 20 new patients/month, referrals less than 50%, constant staff turnover, inability to pay bills on time, hygiene production less than 33% of the total office production, etc.) were to market, they would just accelerate the number of patients they alienate.  It would just accelerate their demise.  A lack of patients is not the “problem”. It is the primary symptom of a deeper more complex problem hiding just under the surface of all you do.  You have failed to inspire your patients by trying to give them what they do not want.  Your basic assumption of business and how to deliver your services is flawed.  You need an emergency diagnosis for a terminal disease:  A lack of Consumerism.  In other words you are failing to give potential patients what they want, when they want it, at a price that they can fit into their budget.

2. Too much competition.  Selecting a location to practice is a scientific process.  You need facts to give you every possible advantage.  New doctors have a clean slate and can practice anywhere.  Knowing this allows you to create a list of parameters that, as you consider each location, you can make sure that you line up as many positive characteristics as possible.  If you have half a brain you would cross off any areas that did not meet a minimum number of these positive qualifications.  To not do so would be professional suicide.  The established dentist that opened a practice years ago with the idea that they would work your entire career and retire in that same spot has a different problem — things change.  If you have been practicing in the same location for a decade or two, you are probably in the wrong location.  For many of you the area you currently practice in has changed so dramatically through the years that no one could make a living where you are.  This is a tough discussion with doctors who thought they just needed to market more, change staff, or spend half a million dollars on a remodel.  For many of you it is like trying to prevent the Titanic from sinking by rearranging the deck furniture.

Take a look at  Once you are on the home page, go to the far right and click on “Resources” and   then “Dentistics”.  This will take you to a page that will ask you for your zip code.  Doing this will give you the ratio of general dentists to population.  You need at least a ratio of 1:2000.  Once you dip below that magic barrier, you will have slipped into a “negative competitive spiral”.  If you have a ratio below 1:1000, you are almost guaranteed a struggling, low growth, mediocre practice that will face an uphill battle to be competitive and profitable while maintaining a suitable increase in productivity (before you call and start trying to show me how wrong I am, I understand that you are probably the one in a thousand that is surviving and thriving in this competitive environment: just keep reading).   I compare this to flying a plane and getting into an unrecoverable dive.  You can literally spin your plane or practice into the ground and never even know why.  The bad news is that in either case you will not walk away.  Too much competition means your marketing will lose traction.  It gets diluted in the multitudes of messages that are being sent out by everyone else. Patients now have an option to your care on every corner.   With increased competition you have doctors willing to work consumer hours, at fairer fees, who will take patients that have managed care plans, and they will adopt the attitude of “whatever it takes”.  They are actually willing to listen and care for their patients.  For too many years some established doctors have adopted an attitude of “entitlement”.  If you have ever lived through decreasing market share and a challenging economic time, you know that entitlement means nothing.  Wait, it actually does mean something, it means business failure.  The business world rewards change and adaptation.  Doing the same thing day in and day out and expecting a different result is one definition of insanity.  You truly are crazy if you think what you did a decade or even a year ago will somehow insure profitability and continued growth today and in the future.

3. Not taking into consideration the demographics of your practice area.  Go to and put in your zip code.  Maybe I’m just a deluded simpleton but I never hear these overpriced marketing gurus ever explain to the doctor that what works in Atlanta may not work in Nowhere, Arkansas.  You be the judge.  Stop reading, hit the link (or print and take the printed copy of this article) and go to and put in your zip code an let’s look at the people where you live.  Demographics make a difference and ignoring your specific location and its unique circumstances seems a little crazy.  So are you there yet?  Look at the column just below and to the left of your zip code.  It is titled “Social Indicators”.  It will describe educational levels, marital status, and stability factors of the residents in your zip code.  The higher the educational levels the more utilization of dental services there will be.  A 94% or higher high school graduation rate, and a 40% bachelors or higher would be ideal.  Lower than that doesn’t mean the residents are not great people, it just indicates that there will be a diminished demand for certain dental procedures (C&B vs. bread and butter general dentistry).  Marital status and stability numbers indicate whether your particular part of the country is more nomadic or very consistent about people moving in and staying.  A 25% stability number means that a quarter of your population moves every year.  That means that to just stay even we need to attract at least 25% of our new patients just to replace the ones that moved last year.  A number higher than this will require a larger budget in order to reach each potential customer.  They move in and then move out.  It will take more dollars to reach the reachable in a shorter period of time.  Now slide to your right and let’s look at Economic Indicators.  Median household incomes are particularly important.  The average income in the US by household would be about $35,000-$40,000.  Keep in mind the cost of living in your area.  Forty thousand wouldn’t go far in California, but in parts of Arkansas you could be “The Richest Man in Babylon”.  It makes a difference.  This income is for the household, not the individual.  You need to consider that the income level likely represents what could be spent by two adults and a couple of children.  How much and what type of dentistry will a household with an income of $40,000 be able to do?  It will not be full mouth rehabs and a lot of elective cosmetic procedures.  It will be basic bread and butter general dentistry consisting of extractions, fillings, single crowns, and possibly orthodontics.  Keep this in mind when marketing.  Your marketing needs to reflect your demographics.  Pushing things through marketing that do not appeal to your audience limits the percentage of patients this information will be valuable to.  Doing this is like trying to get better at giving patients what they do not want: Impossible.  One last thing in this area: In green you will see the percentage of population at or below the poverty line.  When you exceed the national average of 4% you are faced with a challenge.  Drop down to the next level in the web site on the far left called Demographics: Race.   In Texas, where I am from, it is not unusual to have a Hispanic population of 25-30%.  The higher the white population, the higher the statistical utilization of dentistry.  In most parts of the country economic diversity is the norm.  You need to keep in mind that your practice and your marketing need to reflect the race demographics of the population surrounding your office.  If you had a significant Asian or Hispanic population you would want your staff and marketing photos to reflect that population demographic.  If Spanish is spoken, you would want staff who could converse fluently with your patients.

Slide to the right and look at median ages of the population.  Boutique practices or practices that do primarily C&B need patients in the 45-65 age bracket.  If your demographics indicate a median age of 32, you can be sure that they will not need loads of scaling and root planing, implants, or C&B.  They will need bread and butter dentistry that is delivered Monday through Saturday.  Just a note:  Sedation dentistry, implants, full mouth “make-over’s”, etc., are not growth markets.  Yes, 15 years ago a “cosmetic dentist” was a unique situation.  10 years ago sedation dentistry was a selling point.  Today, we have insurance companies, and marketing from every dentist in town, telling the public that a crown is a crown.  Every doctor is touting sedation procedures and cosmetic competence.  I know this (equal competence) is not true, but the public is being told that every dentist can do every procedure.  The bad news is that the public is buying it.  If insurance companies can finally convince the public that a crown is a crown, all dentists are the same, that dentistry is a “commodity”, the public will logically choose a provider based on cost.  In other words, if a crown is a crown, I should just find a dentist close to me and have him/her do it.   This does not bode well for practices that continue to try and buck the demographics and go on their merry way of pushing procedures that patients do not want at times they will not come in for, at a price that will not fit their budget.  Start making decisions about practice strategies and marketing based on fact, not fiction.  If you have started down a path of practice that is not growing, you are not inspiring your patients, and you need to reassess your direction before it is too late.  Change or move.  There are only two choices.  Staying the course is a slippery slide to failure.    Let me make this perfectly clear:  You should do sedation, implants, orthodontics and any other procedure you feel qualified to do, but you must also take into consideration that most of the folks around your office will want other simpler services also.  Before we finish on age demographics, look at the percentage of the population below the age of 30.  For most of you, it will meet or exceed 50% of your total population.  Are you willing to turn your back on such a large percentage of your population?  If you have been in practice 5-10 years, consider bringing in another doctor to service that segment of your population.  Widen your demographic appeal and watch your new patients and profitability skyrocket.

4. Not looking at the number of direct referrals to your practice from existing patients.  Every time we look at the numbers from a practice, I want to see what percentage of new patients come from existing patients.   The number of referred patients has a direct correlation to whether you have your act together.  It indicates that you are either inspiring patients to refer or you are primarily marketing driven.  A referral is what makes marketing work.  If you spend money on a marketing strategy and get a 3:1 return on investment (in other words you are making $3 for every $1 spent) you are doing OK.  But take that initial investment and have it pay dividends by encouraging referrals makes your ROI soar.  It is not what you pay to get someone to come in, but rather what you do with the marketed patient once they arrive.

5. Failure to have the right person answering the phone.  You have 3 seconds to inspire a potential patient.  The first contact is always the phone.  The average dentist has 25 new patients per month.  That means you have 75 seconds to pay all the bills and make a profit each month.  Fail in that first 3 seconds and the patient will walk.  If you continually see the backs of people’s heads leaving your practice, you are doing something wrong.  Tick, tick, tick:  When does the three second clock start?  It begins the minute you pick up the phone.  If you have the wrong person in the wrong seat on your bus, you will never be successful at motivating potential clients to show up, follow thru, and refer everyone they know.  A doctor the other day told me that he tried marketing and it doesn’t work   He said he sent out thousands of pieces of direct mail and didn’t get any new patients.  I responded with:  “So you sent out all this mail and no one called?”  He said:  “Yea, I got lots of calls, but no one made an appointment”.  If you have the wrong person handling the most important piece of technology in the office (the phone), and they fail to come across as competent, caring, compassionate, and convenient, no one will make an appointment.  You need to measure the response by the phone calls, not the appointments made.  If you get phone calls responding to the marketing, it has done well.  It is not the fault of the marketer that you have an inept staff person unable to connect with the patient or make the appointment.  You cannot keep marginal staff in any position, let alone the most important position in the office.

6. Not being convenient. Convenience is not what you might think.  It embodies many different aspects.

a. Hurdles: How many hurdles does a patient have to crawl over to get into your office?  It’s called the threshold test.  You’d better start thinking that whatever the patient asks for, the answer is “yes, we can do that”.  What do I mean by “hurdles”?  Listen for statements like these from the person in your office who answers the phone.  “No we don’t take that insurance.” “We don’t ever clean teeth on the first appointment.”  It’s our office’s policy to never _________.”  “No, we’re only open from 8 to 5 on Monday to Thursday.”  Basically if you are constantly telling your patients no, it is time for an attitude adjustment.  Remove the hurdles and open the front door wide.

b. No peak demand times available: Peak demand times are times that patients want to come in.  Every day Monday through Friday patients want to come in early (7-10), and late (3-6), and any time Saturday.  The average dentist is open Monday to Thursday from 8 to 5.  Consumer hours demand we be there when the client wants to come in.  Your existing patients all want to come in at those times, and new patients want to come in at those times.  We have a dilemma. If existing patients are already occupying all the peak demand times, where do we put our new patients?  In other words, if you do not have peak demand times available every day, you should not be marketing.  New patients will not make an appointment unless it is during a time that is convenient for them.  If you do somehow convince them to come in three weeks from now at a non-peak demand time, you are likely to have an increase in Cancellations and No-Shows.  Are any of you experiencing an increase in CA and NS?  Look at how you schedule new patients.  No peak demand times, no new patients.

c. Location: In large cities you should not expect a patient to travel more than 3-5 miles to your office.  Marketing further than where you currently get 80% of your patients is a mistake.  It is not an exact circle around your office.  Marketing companies do not take into account your actual location versus where your patients come from.   We all know there are artificial barriers beyond which a patient will not cross:  A highway, or particular part of town, a river, or city boundary.  It doesn’t make sense from a distance for time factor, but many of you are held captive by being in exactly the wrong place by just one block or street.

7. Not understanding that the number one reason practices are successful is the people skills of the doctor and staff.  I wish that the most profitable practices were the ones with the best clinical dentistry, but that is so far from reality that it is almost almost laughable.  It is almost a certainty that the guy from your dental class with the worst hands, who in school could not pick his nose and walk at the same time, will have the largest most productive practice around.  It always has and always will come down to the doctor and staff people skills when it comes to growing vibrant practices.  The bad news is that it is almost impossible to train this.  Your staff has got to have it coming in.  You can train anyone to operate a computer or suck spit, but there is no way to train for an enthusiastic people person.  You have it or you don’t.  It is a fundamental part of your personality.  OK, so you just hire the right staff, but what about the doctor, what about me?  You either fake it or hire staff to compensate for your inadequacies.  Identifying the short fall is the hard part.  Once you know that you are lacking in people skills and the ability to inspire patients, you create systems and hire the right staff to make up for the one area.  You “stage” every personal encounter to engender a feeling of serving, caring, compassion, and friendly confidence with the patient.  You become the pair of hands that delivers the service after the patient is under nitrous.  You depend on those you hire with people skills to cover up your lack of people skills.  If you think about it, your spouse has been doing this for your entire marriage.  You try and minimize your one on one interaction with patients and delegate to get the result you need to grow your practice.   This is a difficult task, and even more difficult for anyone to tell you the truth.  Handle the truth and take your practice to the next level.

8. Not spending marketing budgets on reactivating existing patients.  Every practice has huge cracks and fissures that patients fall into and never get out.  If external marketing is the “front door” of your practice, you want it wide open.  The other side of the coin is that most practices fail to keep current patients inspired and therefore have the “back door” wide open also.  You lose as many patients as you attract.  Think about it.  If you are Dr. Average, you attract about 25 new patients a month.  A hygienist can see about 400 patients a year if seen twice.  The math says that every couple of years you should be hiring another hygienist just to service your 25 new patients a month.  Something is wrong.  You’ve been practicing decades with only one hygienist.  You are running off as many as you attract.  This is not a practice building strategy I would recommend.  Take the time and money to reactivate patients with a great offer redeemable during consumer hours.  Don’t let patients remain forgotten.  Get them coming back in.

9. Using sad un-motivating offers that lack urgency and real appeal to your demographics.  I see practices that budget and spend 5% or more of their collection dollars on marketing but fail to ever examine what motivates a patient to call.  Offers of implants, sedation, and treatment options are pretty lame.  In fact, anything you put in print ads that the patient might think:  “Of course they do”, needs to be dropped.  An example would be small pictures of credit cards that you accept.  They know you take credit cards.  A list of clinical treatments you can perform.  They assume you already do everything.  Everybody else does.  We cater to cowards.  How silly is this.  Lose the platitudes and make them an offer.  Any radio, print, TV, bill boards, newsletters, etc., must be appealing to the female eye and within 2 seconds translate the fact that you are a dentist and the offer is worth considering.  People open their mail over a trash can, and women make over 90% of the appointments.  Keep in mind that new patients are looking for “Solutions to problems” and “Good feelings” (Cosmetics).  They are looking for an offer for a low stress, low cost way to meet you and find out what is wrong.  Get this right and you will have unlimited new patients.  Use offers like:  Free Bleaching, $1 emergency visit, consultation and necessary x-rays, free second option.

10. Not acting NOW. Too many doctors call me for advice and do not follow through.   Some just ruminate on the information and are frozen by procrastination.  Others are just too scared to do anything.  There is no learning without application.  Waiting for things to change is just silly.  You need to learn that even a failure moves you closer to your goal.

Go down the list.  If you have checked two or more items, you have entered the failure zone.  Do not stay there.  Give me a call on my cell at 972-523-4660 and let me help you diagnose exactly what is wrong and get you back on track to a great future.