I love mechanical toys. Nothing better than a great bike ride, or racing motorcycles, or hunting. If you accumulate things like I do, you notice they all tend to deteriorate over time. Your air conditioner wears out or your hot water heater springs a leak. You forget to clean your shotgun or wash off your dirt bike and things seem to fall apart. A great example is rust. There is always humidity in the air or moisture in our environment. This same water that you can’t live without over about 3 days, silently corrodes metals. Rust can be a silent killer of anything mechanical.
In our practices, there is also a silent killer, like rust, called “attrition”. I cannot remember a time that I can recall, ever seeing an article or lecture about this pervasive killer of dental practices. The definition of attrition is: The action or process of gradually reducing the strength, effectiveness, or numbers due to external and internal causation. Attrition rate, for our purposes, could be referred to as a “churn rate”, measuring the rate at which people leave or silently never return. This could be applied in our practices as the number of staff or patients who leave. I just spoke with a fee for service practice that averages 80-100 new patients a month and has no hygienists and no one ever comes back. Basically, a large front door where the patients enter, and evidently the entire back of the building is wide open because no one returns. Just saying, that is weird.
In our constant striving to attract more patients, far too many offices forget to cultivate the patients they have. From a statistical point of view, 67% of all the clinical work you will ever do is from recall patients. The logical next thought should be that, wow, I need to spend as much time keeping and cultivating my patients as I do chasing new ones. Think about the lifetime value of a patient that is inspired and impressed with your office and tells everyone they know about you while never missing a recall appointment. We are talking tens of thousands of dollars in your pocket, as well as an ever-increasing pool of patients coming from direct referrals from these raving fans. Patients are the life blood of a practice and your recall/reactivation percentages are the pulse of whether or not you are doing things to inspire your patients and whether or not your systems are designed to keep them coming back.
Every practice management software can give you the number of active patients and the number of active patients that do not currently have an appointment. From my experience, few if any offices look at these numbers. Since your goal in life should be to have 100% of your current patients on a consistent recall, you should be horrified to know that the average practice only has a 42% recall percentage. The goal should be 90% plus. Why not 100%?
At a time when our overhead is continuing to creep ever higher (average is 67%-75% plus), each of us should take a look at what we spend on marketing and at least a third of that expense should be getting patients of record to return every 6 months. The obvious killer in attrition or having patients not to return is the office and doctor. Add to that list the lack of consumer hours, convenience, plus a wide range of services for a wider range of ages and you can see how patients move away and never make a fuss. They just end up at the office down the street. I am happy to say that most offices become aware of things that patients don’t like but some doctors just assume that what they do and how they treat patients is great, even though a large percentage of patients never return. Tip a mirror up and take a look at yourself and your results.
Here’s a little homework. Take the number of new patients you average a month and total it for a year. 30 a month would be 360 patients for the year. A pretty average number. This would be your traditional average office with one hygienist. NOTE: A normal hygienist who sees about 25-30 new patients a month along with an excellent recall, can only accommodate about 600 patients if she sees then twice a year. So do the math. How many new patients do you see a year? In our example of 360, that office should need to hire another hygienist every 24 months just to take care of the new folks coming in, assuming they return. Now look at how many hygienists you have. If you just have one and you are average at 25-30 new patients a month and you’ve been doing this for years but you don’t need to hire another hygienist, you can bet your bottom dollar you are a donor practice and you have as many patients leaving your practice as are coming in. Patients that don’t come back will never be a referral source. Patients that never come back are an indication that you are not doing as well as you can do. Patients that don’t come back rob you of the profit you could have made from recall dentistry that you never had the opportunity to present. Overall, a bad attrition rate, with a solvable solution.
There is another attrition rate with an entirely different cause that everyone should be aware of. Often times, doctors will brag to me about their new patient numbers but seem to never understand that in addition to people not coming back because of internal problems in the practice, there is also an external reason, like rust, that undermines our profitability and recall. Demographics are strange in the way they can affect your success. None is more important than the fact that nationwide the average percentage of patients that leave your practice because they move or relocate is 12 to 15%. In McKinney, Texas, which is a bedroom community for Dallas, the rate is almost 22%. In other words, every year a practice in McKinney will lose 22% of their patients of record due to them moving to another location. While yours may be at 12%, remember that to average 30 new patients a month, part of the problem is that you are replacing those that left. Add to that anyone that was not impressed with your office and we sometimes see offices in a state of stasis where the number leaving is about the number of those coming in. The sad fact is that the average dental practice in the US has a recall rate of 42%. If you are not growing, they are not coming back. If they are not coming back there is always a reason for it. Since 67% of the dentistry you will ever do comes out of hygiene recall, the loss of a patient of record is a huge hit to your bottom line. Factor in the lifetime value of a patient and it can mean millions of dollars over the life of your practice.
If you have gotten this far, I hope you are checking your own offices’ performance and considering making recall, reactivation, and attrition a topic for your next team meeting. Being aware and acting quickly is how you learn to Summit.
Michael Abernathy, DDS