Ep. 152: Patient Retention – Why Your Practice Isn’t Growing
Dentistry is one of those professions where if you aren’t growing, you’re shrinking. So, if you aren’t making an effort to regularly reactivate your patients and get them back into the office, you are going to be fighting an uphill battle. This week, Jeff gives you some immediate action items to help you make sure you are retaining patients and are set up for growth going forward.
Links:
The MGE Reactivation Program - https://www.mgeonline.com/mge-reactivation-program
Download the Hygiene Formula Spreadsheet - https://www.mgeonline.com/hygieneformula/
MGE New Patient Workshop - https://www.newpatients.net/
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Questions From This Episode
What does the "John" example illustrate about the real cost of losing a patient to inactivity?
Acquiring John as a new patient cost about $400, while the attempted follow-up calls to retain him after a missed appointment cost only $60 to $75 in labor. Jeff uses this to show how little effort is typically spent protecting an already-expensive new patient relationship, especially since John, at 58 with completed restorative work, will likely need more dental care in the future that he's no longer receiving.
What's the simple experiment Jeff recommends to check how healthy a practice's patient base actually is?
Pull a report showing how many total patients currently have a future appointment scheduled. He says doctors typically guess that figure is around 80 percent of their patient base, while staff tend to guess closer to 10 percent, and the real number for the average practice usually lands around 20 to 30 percent.
Why does a practice's hygiene schedule often look "fine" even when a large share of patients have gone inactive?
If hygiene is already running at full capacity, four or five days a week, new patients added on top of that should theoretically push demand even higher, but since the existing schedule stays full regardless, nobody notices the gap. Jeff says the most reliable 20 percent of the patient base keeps the schedule looking busy on its own, while the remaining 60-plus percent, who need active follow-up to come back, goes largely untouched.
What are the only legitimate reasons Jeff says a patient chart should be deactivated?
The patient has passed away, the patient has explicitly and firmly stated they're never coming back, the practice has decided it doesn't want the patient back and formally dismisses them following the state Dental Practice Act, or the practice has dropped an insurance plan the patient needed. In that last case, Jeff recommends removing them from active recall calling but keeping them on general newsletters and mailings, since patients who leave over a dropped plan sometimes try the in-network alternative, dislike it, and come back later.
What two free tools does Jeff recommend for a practice that wants to start fixing this problem?
The Hygiene Formula, a simple spreadsheet that estimates a practice's real hygiene compliance rate from a few basic numbers, and the MGE Reactivation Program, a step-by-step framework covering phone, email, and mail outreach for bringing inactive patients back. He stresses that whatever tools are used, someone in the practice needs to be actively, specifically responsible for the effort.
Episode Transcript
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Did you know that if you're a general dentist, just based on how your business model is structured, your practice should be growing every single year, regardless of economic conditions? I say this because we work with a lot of general dentists here at MGE, and especially with newer clients, I see a lot of practices that simply haven't been growing year over year. This might be the case for you too, and if it is, you might be wondering why. That's what I want to talk about this week. My name is Jeff Blumberg, and I'm your host.
I think the best way to explain this is to start with a quick story. If you're like most offices, you spend a lot of effort chasing new patients, Google ads, Facebook ads, postcards, maybe an implant funnel, all kinds of marketing. New patients matter, they're genuinely important to growing a practice. That's only partially true, but let's set that aside for a moment.
Say you get a new patient, we'll call him John. John is 58 and has some dental issues. He found you through Google, and acquiring him cost your practice about $400. He comes in, gets an exam and x-rays, and you diagnose mild periodontitis along with a need for three crowns and an implant. He accepts the treatment plan, you complete the perio therapy, place the implant, and do the three crowns. Afterward, you set him up on a three-month recall.
He keeps his first recall appointment. Three months later, he misses the second one, he calls the day before to say he'll be out of town and needs to reschedule, but doesn't have time to sort out a new date right then. You agree to connect when he's back. He returns, you call his office, he's busy, nobody manages to actually connect. Over the following months, maybe you try calling once or twice to fill a last-minute hygiene opening. Six months pass. A year passes. John never comes back. Eventually, around the two-year mark, you classify him as inactive.
Play that scenario back for a second. You spent $400 to get John in the door in the first place, on top of whatever else you're spending on marketing generally. How much did you spend trying to keep him? A few phone calls, maybe $60 to $75 in labor cost if you add it up. You spent $400 to acquire John, and somewhere around $60 to $75 trying to retain him. And what's genuinely wasteful about this isn't just that we're no longer maintaining John's dental health, we're not keeping an eye on him at all, even though he's 58, he's already had real dental work done, and he's going to need more in the future. He's just not showing up anymore.
Now take John and multiply him by the thousands of patients sitting in your own patient base who aren't showing up regularly, and you've got the average dental office, and ultimately, that's why your practice isn't growing.
If I had to pick the two biggest problems in dentistry, one is case acceptance, the other is patient retention, inactive patients. Every business tries to keep its customers active, but this is a genuinely significant, and genuinely poorly handled, problem specific to dentistry.
Here's a simple experiment to check how bad this is in your own practice. Sit down at your practice management software, or grab your office manager if you're not sure how to pull this yourself, and ask it how many of your total patients have a next appointment scheduled after today. Say you've got 4,000 charts, if you're the average practice, that number comes back around 20 to 30 percent, maybe 1,000 to 1,200 patients. I've seen offices with four or five thousand charts come back with a number as low as 700.
Funny enough, Jeff Santone, who's been on the podcast before, runs this exact survey with doctors at the MGE New Patient Workshop, I'll put a link on the episode webpage if you'd like to know more about it. He'll ask doctors to guess what percentage of their patient base has a future appointment scheduled, and doctors typically guess around 80 percent. Staff, on the other hand, tend to guess closer to 10 percent. The real answer is usually somewhere in between, but nowhere close to 80.
This is exactly why we'll see a new client come to MGE with 4,000 or 5,000 charts, still only running three or four days of hygiene, and struggling to keep even that full, when a practice with that many charts should realistically be running 12 or 13 days of hygiene a week.
And here's the irony in a story like John's: some practices will actually purge John's chart if he hasn't been in for two years, deactivating him, dropping him from the call list entirely. And everybody has a ready explanation for why John hasn't come back. "He probably found another dentist." "He doesn't care about his teeth," even though he cared enough two years ago to complete real restorative treatment and get an implant. We all come up with a reason. But if you asked John himself who his dentist was, he'd probably still say your name, you just don't know that, because nobody's actually spoken to him, because nobody's actually making the effort to reach him.
If you've listened to the podcast for a while, you've heard me talk about this before in various forms, and you might wonder why I'm bringing it up again. Two reasons. First, as I mentioned, it's one of the two biggest problems in dentistry, sales being the other. Second, I still see clients, some of whom became MGE clients after listening to this very podcast, show up and hygiene is still a genuine mess. This is something so easy to fix, it just takes real, sustained time and effort, and it's genuinely the key to long-term practice growth.
Let's run some basic numbers. Say you're the average practice adding 30 new patients a month, 360 a year. What would you expect to lose out of those 360? Let's say a 20 percent churn rate, that's 72 patients lost, leaving you with 288 retained. Multiply those 288 by two recall visits a year, and you get 576 new recall appointments generated annually, just from that one year's worth of new patients. Divide 576 by 50 working weeks, and that's about 11 and a half additional recall visits per week. If a hygienist sees roughly eight recall patients a day, that's an extra day and a half of hygiene your practice should be adding every week, just from 30 new patients a month, and this is recall specifically, not scalings or anything else your hygienist might be doing, and it's likely an undercount, since not every one of these patients will be on a strict six-month recall, some will need three or four-month intervals.
You almost never see this actually happen. Think about what it means compounded over time: if you add that day and a half of hygiene this year, and keep bringing in 30 new patients a month, you should add another day and a half next year, three days total after two years, four and a half after three years. Within roughly three years, at just 30 new patients a month, you should need a full-time hygienist and then some.
So why doesn't this happen in most practices? The most common reason, and if I had to pick the single biggest one, this is it, is simply that hygiene already looks busy. If a doctor's already running four or five days of hygiene, fully booked out three or four months in advance, and they add 360 new patients over the year, which should translate into an extra day and a half of hygiene, but hygiene is already staying full with the existing schedule, nobody notices anything's wrong. The schedule just stays at four or five days, year after year, and as long as it stays full, nobody's raising an alarm, especially with how much hygienists cost these days, nobody's actively tracking whether new patient growth should be translating into more hygiene capacity.
The second reason ties into something like a gradient scale in how patients respond to dental needs. Your top 20 percent of patients are always going to be the easiest, oral health is simply a high priority for them. If John, from our story, had been one of these patients, he would have chased your office down after missing that second appointment. These are the patients who just do what you tell them, no real follow-up needed. But that's only 20 percent of your patient base. The much larger remaining group isn't quite as self-driven, they genuinely need follow-up, someone actually calling them and helping them get back on the schedule. Since that top 20 percent is reliably filling your existing hygiene capacity, and that capacity is already full, nobody's paying attention to the other 60-plus percent sitting out there untouched, because there's no immediate pressure to. To add insult to injury, when you do see one of these top-tier patients for a recall visit, there's often nothing left to treat, since they've already accepted and completed everything you've recommended.
The third reason is simply that nobody makes this a genuine priority. In my view, number of recall patients, specifically recall, not just hygiene patients generally, is one of the most important growth statistics in your practice. It can include three, four, or six-month recalls, and you want to track it weekly, monthly, and yearly, since that number should be climbing steadily, and you should be able to check whether it's climbing enough relative to your actual new patient volume. Say an established practice saw 1,000 recall patients last year, and this year they added 360 new patients while retaining 288 of them, generating 576 additional recalls, next year that number should be pushing past 1,500. If you're not actually tracking this metric, how would you ever know whether that's actually happening? Most practices only pay attention to whether the hygienist has an opening that day, since nobody wants to pay someone $65 an hour to sit at the front desk or sharpen instruments instead of seeing a patient. As long as the hygienist is busy, nobody questions it further, but without tracking number of recall patients specifically, you genuinely have no idea whether your practice is growing or quietly shrinking in the bigger picture.
So, say you've run that experiment I mentioned earlier and found only 20 percent of your patient base has a scheduled next visit, and you want to actually fix it. Here are a few concrete, actionable steps.
First, let's talk about deactivating, or "purging," charts. I've touched on this before, but it's worth repeating until I stop meeting new clients who tell me their hygiene compliance is at 80 percent and think that means they've done their job. There are really only a few legitimate reasons to deactivate a patient chart. First, the patient has passed away, that's a clear one. Second, the patient explicitly tells you they're never coming back to your practice, not because of a plan change, but a genuine, firm decision to leave. You'd want to understand why, since that's never a good sign, but if they're genuinely set on it, fine. Third, you don't want the patient back, there's always that possibility with someone genuinely disruptive to your business, and you'd follow your state's Dental Practice Act to formally dismiss them. Fourth, you've dropped a plan they were on, and they tell you they can't continue seeing you because you no longer participate in their coverage.
On that fourth one, I'd add a caveat: if a patient tells me they can't come back because I've dropped their HMO, I'd take them off the active recall calling list, since it would be a bit pointless to keep calling someone who's told you outright they can't return. But I'd absolutely keep them on my practice newsletter and other general mailings. Why? Because there's a real chance they'll try that in-network office, dislike it, and eventually come back, something I've personally seen happen repeatedly with clients who've dropped HMOs before. So why not keep your name in front of them in the meantime, so when they've finally had enough, you're the one they come back to?
One more scenario people ask about: what if a patient moves out of state? That's genuinely case by case. I've seen patients who move but still return to the area occasionally and keep their original dentist, in which case they stay active. I've also seen cases where they clearly aren't coming back, in which case you'd deactivate the chart and forward their records if requested. But the core point stands: don't deactivate a patient simply because they haven't been in for a while, that's a genuinely bad practice. It gives you a false picture of what's actually happening in your business, and it wastes all the original effort and expense that went into acquiring them as a new patient in the first place.
So how would you actually start reactivating your existing patient base? First, I'd want to assess the real health of my patient base and hygiene department. We have a free tool called the Hygiene Formula, a simple spreadsheet, you plug in a few numbers, your total chart count, how many weeks a month you're open, and one or two others, and it gives you a real sense of your current hygiene compliance rate. I'll put a link on the episode webpage. Worth noting, this spreadsheet builds in a fairly generous 40 percent attrition assumption, which is high, but even using that conservative a number, if you've got 5,000 charts and haven't been actively working reactivation, losing 40 percent still leaves you with 3,000 patients worth going after.
Next, I'd download our MGE Reactivation Program, also free, I'll put a link on the episode webpage, we're currently working on an updated version, so if you download it now, we'll send you the refreshed version once it's released in the coming weeks. It's a step-by-step framework for actually reactivating your patient base, covering email, physical mail, and phone calls, and you can layer in texting or any other outreach channels you're using on top of that. I'm a genuine fan of text-based outreach specifically, there are a number of communication platforms built to integrate with dental software, letting you send something like, "Hey Jeff, you're overdue for your checkup, click here to schedule," with a link that drives straight to online self-scheduling. If a patient can click that link and actually book themselves, that's a real game changer, it won't solve the whole problem, but it should capture 20 to 30 percent of your inactive patients on its own, the ones who just needed a low-friction nudge. I'll probably do a dedicated episode on this specific technology in the coming weeks, since I think it's genuinely significant.
I'd put that scheduling link in every text, email, or other electronic outreach you send. Ideally, someone clicks it, picks their preferred hygienist, sees the next available opening, and books it directly, whether you choose to have staff confirm it before it's official or let it book automatically is up to you. That lets the easier, lower-hanging-fruit patients schedule themselves with minimal effort, freeing up your phone and mail outreach to focus on the harder cases, the ones who might take five or six calls to actually get back in the door.
Whatever specific tools and channels you use, and the Reactivation Program lays out the general framework in detail, what matters most, and this is stressed right at the start of that program, is that someone is actually, actively responsible for this effort. It doesn't need to be their only job, and if your reactivation backlog is large enough, it might genuinely be worth hiring someone specifically for it, but someone has to own it, and it has to be treated as a genuine priority.
Think about it this way: walk into the average dental practice in the US, and you'll see posters for Invisalign, implants, sleep apnea treatment, all kinds of promotional material. How often do you see anything promoting the importance of showing up for your routine cleaning? Pretty much never. But patients can't actually receive any of those other services if they're not in the practice to begin with, whether as new patients or as patients of record who keep coming back. And beyond what this does for your revenue and overall practice growth, it's genuinely good for your patients too. You do restorative work, and you want that work to actually last, you want to maintain your patients' oral health over time, and that's very difficult to do if you're not actually seeing them regularly. That's what your hygiene department exists for, so use it.
If you want to seriously tackle this, download the Hygiene Formula and the Reactivation Program, both free, both linked on the episode webpage. If you run into something you can't quite work through on your own, or want direct assistance, you can always reach out to us here at MGE, find us online at mgeonline.com or call us at (800) 640-1140. You can also email me directly at jeffb@mgeonline.com, happy to answer any questions.
That's about all I have for you this week. I know I've covered reactivation before, but I genuinely can't stress its importance enough, it makes long-term growth so much easier. Start tracking number of recall patients specifically, and you'll finally have a real answer to whether your practice is actually growing. I hope this helps. Have a great week, and we'll see you at the next episode.