To be successful in any endeavor – whether it’s business in general, the delivery of top-flight dental care, or whatever, you must be willing to do three things: Seek out, acknowledge, and most importantly, act to address the hard truths or realities you discover – if you are to ever experience sustainable, long-term, healthy growth of any kind, personal or professional.
In my work with over 1,000 dentists in the last 23+ years, and from 15-years of owning and operating a dental office here in Oregon (from-scratch to multiple providers and successfully exiting in 2018), I’ve observed several “hard truths” or lessons dentists who are not experiencing a growing practice, a higher income every year, and lower levels of stress struggle with. Yet, once they identify for themselves those truths, their growth explodes in nearly every category – to include what I consider the ultimate measure: overall happiness.
Make no mistake – this seeking of truth is not easy. And, unfortunately, most of us either don’t care about, can’t or won’t face these lessons even when they are presented with undeniable support and evidence. Frankly, it’s why most practices are not growing faster, adding more hygienists and outgrowing their buildings!
Let’s start with an easy truth: Nearly every single dental practice in America is losing at least 10% to 15% of their patient base EVERY YEAR. That includes your practice. In over two decades, I’ve talked to a single practice owner who actually had a system in place to track, address and attempt to regain lost patients.
Is it coincidence he owns 14 practices? Is it coincidence that his retention of patients is the highest I have ever heard of (yet even he loses 5% of his patients annually)? Is it coincidence that he has to do very little external marketing for his practices once they reach about 1,500 active patients? Is it coincidence he made a fortune selling just a piece of his multi-location empire? Or, coincidence that patient referrals make up more than 50% of his new patients every month, in every location?
This dentist realized early on in his career, the importance of patient retention and that in fact, retention is the HOLY GRAIL of practice growth. He also realized that he was the only barrier in discovering the truth of why patients leave. He was willing to face what is NOT a comfortable experience. He learned the hard reality that if you want to uncover why patients leave, you must be willing to expose the ugly underbelly of your practice and be willing to accept exactly why. And, then, most important, be willing to do something about it.
When you do undertake this brutal exercise – asking patients why they left (not delegated to an employee, but you actually participating), you’ll discover why patients don’t want to come back. You’ll find out which one of your “amazing team members” is actually a troll in sheep’s clothing and runs off more patients than you can imagine and once you find out, you’re sick to your stomach for days. You’ll discover that your patients don’t like your hours or days of the week you’re open and they are simply inconvenient. You’ll learn your hygienist is actually hurting people. You’ll learn your phones are not answered for days at a time (Friday-Sunday evening, for example) which communicates, albeit not so subtly, that your patients feel like you’re more concerned about your precious three-day weekends than their well-being. You might even learn that patients can’t stand your horrible breath or body odor (I had a dentist in early in my career who discovered he was losing patients because of his off-putting halitosis after he fired his chairside for theft – strange and sad that not a single employee would even mention to him!). You might even hear that your location is hard to find, is not easily accessible or is just in the wrong part of town.
These are but a few ugly truths. And, fortunately, the symptoms are visible, right in front of us and if we are smart about it, they will lead us directly to the solutions.
In nearly every example above, by the way, I found these facts out about my own practice. I was not immune; but like the dentist above, we faced facts and excelled by fixing the problems we discovered. We did the tough stuff like changing job duties, hiring better people, and terminated employees, including dentists and hygienists, that didn’t want to be part of the solution (ergo, they were part of the problem).
That’s just business.
So, if you’re experiencing:
– An empty hygiene schedule and you have more than 1,500 “active” patients
– Cancellations and no-shows at an ever-increasing rate
– A case acceptance rate below 80% for new patients
– Lack of response to your marketing
– Declining production (which leads to declining collections)
– An exodus of patients with insurance who’ve “switched” providers
– Turnover in employees that’s unusually high
– Declining referrals from patients
– No reviews or few if any positive, 5-star online reviews
– Difficulty making payroll or using your vendors to finance your business (which means you’re paying bills more than 30 days late)
…these are all symptoms of deeper issues in your practice that require YOU to dig in, seek the truth and address them head on.
If you don’t, your practice’s decline will continue at an ever-increasing rate. And, your most precious, valuable asset, your practice, will decline in value every year you’re not growing it.
The old business axiom, “If you’re not growing, you’re dying,” is especially true when it comes to establishing a value for your practice. Stagnant growth is NOT what a buyer wants to see, unless they’re an “opportunity” buyer looking for a failing practice they can poach for a bargain basement price, work it for a few years and then, “flip it” for a premium.
Now, when it comes to losing patients, that 10% to 15% annual attrition your practice experiences is due to the following reasons:
Some die, some move, some change insurance plans, and some leave due to the indifference they feel – in other words, they don’t know you care about them, so they have a hard time caring about you.
What’s more, I’ve discovered few dentists underestimate their number of active patients. Instead, most dentists believe their patient base is far bigger than it actually is. Why? They include in their count those who are actually inactive patients – those without a next appointment or those who’ve left but didn’t tell you they were leaving.
TRUTH: If you’ve a desire to reverse the decline in your practice, I won’t sugar coat it: it’ll take an investment in time, energy, and money, and you’ll face tough decisions – in many cases, decisions that required your attention long ago which you ignored or put off.
This is the work entrepreneurs must do – and you are one. You must seek out truth, face facts and make the tough decisions required that are in the best interest of your business.
If you are unwilling to do that, while this may sound mean spirited, it’s just how it must be: sell your practice, get out now, and find a place where you can be an employee and just focus on delivering great clinical care and leave the business side to someone else.
Many dentists hire a consultant to achieve what I’ve laid out. The issue with that is the fix is almost always temporary and unless you learn what it is they are doing so you can repeat it later, you’ll be writing yet another check in no time to have them come back and repeat the process.
In my view, your advisors ought to be viewed as truth tellers and teachers and someone who’s willing to challenge you and your thinking. There are also consultants who can be trainers and systems creators for your unique practice. Neither fills the role of doing the “dirty work.”
Sure, you can hire them for that, but what message does that send to your employees? Is it the message you want to send? Would you rather they viewed you differently and respected you?