Once again, I have gone and done it. In the space of the 12 words in bold font above, I have probably upset 50% of the doctors that read the title and as a result, walk away without reading and considering the logic of this argument. I will call this group, The Clueless. On the other hand, about 40% of the doctors will actually read this, and then decide that it does not apply to them and quickly walk away with nothing to show for their time reading it. This group is The In-Denial. Finally, we have the 10% that read it, reflect on the subject and content and resolve to do better when they realize that they might be a donor practice. This group is The Enlightened. They are characterized by owning their shortfalls, constantly embracing change and adapting to new circumstances. Keep in mind that not everything that is done incorrectly is actually wrong. Sometimes we do things the right way at the wrong time or do something that on the surface seems fine, but consumers don’t like it. Errors in business strategies are not limited to actions you take, but also can be things you don’t do. You are the number one reason the practice does well, and the number one reason it struggles. By commission (acting) or omission (not acting) you’re accountable for the results you are currently getting. It rarely has anything to do with all of the external reasons we use for excuses. We spend far too much time blaming others and looking for external solutions to internal problems. A place to start would be to lose your excuses and start finding your results.
Some 15 years ago, I wrote an article and coined the terms donor and recipient practices to describe a commonplace occurrence we see in a lot of dental practices. I would like to revisit this topic because denial of your situation, or what causes it, can turn into a death spiral that is irreversible when we look at practice growth.
Early in my career, I realized my best referral or marketing source of new patients wasn’t the direct response mailers, new resident programs, care-to-share programs, signage, pay-per-click or even location. To my surprise, it was the Orthodontist and two other GP Dental practices down the street. In a town of 19,000 people, 35 miles north of Dallas, we were getting 15-20 new patients per month from our competitors. How could that be? Why would so many patients in a town where everyone knew one another, decide to leave their long-time dental practice to come to the new kid on the block? Maybe what I had been taught in dental school wasn’t true: “Patients will bond to your dental practice for life”. In fact, Fortune magazine found that 87% of patients will change their Physician (MD) for a $5 difference in copay. Is it any surprise that they would leave a dentist for money, lack of concern, inconvenient hours, poor location, lack of competence, or a single bad experience? Welcome to the era of “Donor and Recipient” Dental Practices. Fail to inspire your patients, and you will see them seek treatment elsewhere. Even if you make every step of the patient experience perfect except for the last one, they will still leave. Patients today vote with their feet and wallets. If you are seeing the backs of their heads, you are doing it wrong.
Dental Truth #1: There is no way to get better at giving patients what they don’t want.
The worst thing you could ever do is push treatment on patients without happily giving them what they want. Let that small fact elude you (giving patients what they want), and you will find yourself on the fast track to a mediocre, unfulfilling career. Fact: If you are not growing, then you are not meeting your patient’s needs. If you cannot inspire your patients or if you are not growing, then you become the “Donor” practice for your area. Take a moment and see if you can name a practice in your area that is a “Donor” practice. If you can’t think of one, then it’s probably you. The “Donor” practice (the poor practice) has no idea that they are having this effect on their patients. They are usually clueless. It is always the poor economy, terrible location, poor dental IQ, or inability to find and keep quality staff that is blamed for lack of growth. At Summit, we expect our client’s practices to grow regardless of the economy, and they do. The “Recipient” practice (the good practice) quietly grows, inspiring their patients to refer everyone they know.
Here are the symptoms of a “Donor” practice:
Increase in Cancellations and No-Shows (goal should be less than 10%). You are not convenient, and did not sound caring and compassionate over the phone. Poor hours, days and fees (Consumerism) create such a hassle to get into your practice that patients make an appointment never intending to keep it.
Few or no Direct Referrals (Goal = 50% minimally). This is the one black or white symptom. Few referrals spell disaster. Of all the numbers you should follow, this should be number one. A lack of a significant number of direct referrals from your existing patients says that you are not meeting your client’s needs. There is something that patients do not like about your office.
Patients want second opinions. This is often the result of being too assertive, instead of having a balanced case presentation. If you want the treatment more than the patient, you have crossed the line. There should be no selling in dentistry. Give them what they want and tell them what they need.
Marketing Driven: You spend a greater and greater portion of your income on external marketing in order to maintain your numbers. Good practices (Recipient) do not need to market and poor practices (Donor) should not market. Spending money and time on marketing when you have few internal referrals spells disaster. You will just have more patients leaving faster, and telling everyone they know to stay away.
(Don’t look for an external solution to an internal problem. Close your back door first, then open the front.)
Patients say they cannot afford your treatment plans. You must keep comparables comparable when it comes to fees. Stay in the 80-85th percentile for your area. Always give the patient what they want first, then, work at giving them what they need. Never ever assume patients want what you have to sell them. This is a huge mistake.
High staff turnover. Our office was fortunate to average over 14.5 years of tenure for each employee. High turnover is a symptom of lack of leadership and poor business systems. Get it right and the patients and staff will stay. If your patients see a different face every 6 months, they will wonder why. (Actually, they will assume the problem is you).
Assisted Hygiene. Assisted hygiene can work to ramp up the hygiene department, but make sure you have the right assistant in that role. It should be the best assistant in the office. Maybe even the one you can’t work without. If done incorrectly, you will see fewer patients following thru with treatment plans because of a lack of trust that was once created by your hygienist spending the time to adequately explain treatment and discovering what the patient wants. I have seen few offices that do assisted hygiene well. Assisted hygiene can be the number one reason for a poor recall system. It should be greater than 85% to be a recipient practice.
Poor Financial Arrangements. The largest and most used health care patient financing company is not the best just because they pay the ADA hundreds of thousands of dollars a year to receive their endorsement. Add others to your options and watch the acceptance rate soar.
If you are not consistently growing each year in the form of new patients and profitability, you have room for improvement. Growth is a natural result of doing things correctly. Those that are not growing or perhaps struggling to pay their bills are doing something wrong. These are the donor practices. Just to be clear, each and every one of us is a donor practice sometimes. The scary part is that a large majority of struggling practices are clearly donor practices most of the time. The truth is in the results. Hope and clinging to excuses are not strategies that will survive in the form of a successful dental practice. Now is the time to stop chasing myths and begin changing the course of your practice. This is how you Summit.
Michael Abernathy, DDS