Ep. 164: How Many New Patients Does Your Practice Really Need?
We all know new patients are crucial, but how many new patients do you really need in order for your practice to be healthy? Well, that depends on a few different factors, and that’s what Jeff is going over in this week’s episode!
The MGE New Patient Workshop - https://www.newpatients.net
ABCs Seminar- https://www.mgeonline.com/mge-communication-and-sales-seminars/
Free Fees & Plans Analysis – https://www.mgeonline.com/fees-and-plans
Law of Diminishing Returns Tip - The Law of Diminishing Returns & Practice Growth | Dental Practice Management Tip
Law of Diminishing Returns Podcast Episode - https://www.youtube.com/watch?v=cMpLS36qffw&list=PLadh6PLCMCduuZDq3D3ITLS-Zz-1tQwoW&index=68
Download the Hygiene Formula Spreadsheet - https://www.mgeonline.com/hygieneformula/
Listen to full episode :
Have a question for Jeff?
Fill out the form and he will get back to you.
Questions From This Episode
How many new patients does Jeff say a healthy, established GP practice needs per doctor?
Around 30 new patients a month per full-time doctor, with 20 as an acceptable low end. A part-time associate working two days a week would need roughly 15 more, and two full-time doctors would need about 60 total. A newer practice still building its patient base should aim higher, 40 to 50 or more.
Why does Jeff say a struggling hygiene department artificially inflates how many new patients a practice thinks it needs?
A practice that doesn't retain patients well effectively turns itself into a specialty-style, new-patient-dependent business, since patients aren't coming back for recall. He walks through the math showing that even at a 20 percent attrition rate, 30 new patients a month should generate almost 14 and a half days of hygiene a week by year ten, growth that quietly gets absorbed by new patient and soft-tissue slots and never gets noticed.
Why does Jeff say outgrowing your physical space is inevitable if you're managing new patients and retention correctly?
If a practice keeps adding new patients while genuinely retaining them, hygiene demand compounds year over year until it consumes more operatories than a solo doctor can keep pace with, eventually requiring a second doctor and running the practice out of chairs. He calls this outcome essentially inevitable for a practice doing both things right long enough.
What two steps does Jeff recommend before spending money on a new office when a practice starts running out of space?
First, drop insurance plans, since the worst-case attrition from dropping a plan is usually around 30 percent, and the profitability gain from full fees typically outweighs the lost volume. Second, consider running a second shift, splitting the day into two staffed shifts in the same physical space, to get more use out of a facility that's already being paid for around the clock.
Why doesn't doubling new patient volume typically double revenue?
Jeff explains that generating leads is actually the easiest part of the equation, revenue also depends on front-desk capacity to handle calls, schedule space to see patients, and enough doctor and treatment coordinator time to properly present and close treatment. When those don't scale alongside marketing spend, a practice that expected to double revenue by doubling new patients might only see a fraction of that increase, since presentations get rushed and follow-up gets squeezed out.
Episode Transcript
-
We all know new patients matter. It makes me think of the ad copy I've written over the years for the MGE New Patient Workshop, lines like "new patients are the lifeblood of your practice." That's not really up for debate, we all know it. They're important, that's a given. But how many new patients does your practice actually need to stay healthy on a monthly or yearly basis? I could just throw out a number and give you some general guidelines, and to a large degree it does depend on conditions specific to your practice, which is what I want to dig into this week.
We'll cover general guidelines you can use to maintain or fix your practice's health based on new patient volume, along with a few things worth checking in your own practice that could push that number up or down. My name is Jeff Blumberg, and I'm your host.
Let's start simple. And to be clear, I'm talking about general dental practices here, not specialty practices, that's a completely different conversation, and not even a GP practice doing heavy full-mouth reconstruction or All-on-4 case volume. I mean your regular, run-of-the-mill general dental office, maybe restoring implants without placing them, that kind of practice.
Assuming the practice is well established, has been around a while, and has an adequate chart base, you need roughly 30 new patients a month per full-time doctor to be healthy, 20 at the low end, but I'd feel comfortable saying 30. If you have a part-time associate working two days a week on a four-day schedule, you'd need 45 total, 30 for you plus 15 for that associate. Two full-time doctors, you'd want 60. Could you get away with less? Sure, plenty of practices do, but I wouldn't advise it, 30 is a solid target. Working an average 17-day month, that works out to roughly 1.75 new patients a day, some days two, some days one.
If it's a newer practice, freshly opened or only around a year, that number needs to go up, since you're still building your patient base from scratch. If I opened a new practice, I'd want to see at least 40 new patients a month at the low end, ideally 50-plus, and I'd run a genuinely heavy marketing push right out of the gate. I'd also be careful, especially given the current economic environment, inflation, and insurance companies lowering reimbursement, about joining a bunch of plans purely to generate that volume. This is just my own take, but if it were me opening from scratch, I'd rather stick closer to my normal fees than join every plan available just to inflate volume. Sure, my year-one volume might be a bit lower than a doctor who joins every plan under the sun, but I'm actually getting paid what my work is worth, and I'm building the practice in a sustainable way from day one. It's a bit like starting to lift weights with bad form, you end up hurt and having to retrain yourself to do it right. Better to start correctly, even if it builds a little slower, it pays off in the long run.
If getting more new patients is something you want real control over, and you should, since being able to reliably influence your own new patient flow is one of the most important levers you have in this business, I'd recommend checking out the MGE New Patient Workshop. It covers everything new patient related, not just external marketing, but internal marketing too, and how to handle new patients once they walk in the door so your conversion rate actually holds up. I'll put a link on the episode webpage. It's one of our original services, and it comes with a money-back guarantee, if you're not happy for any reason within six months of taking the course, we'll refund the tuition, no questions asked.
The most important thing is being able to control this flow effectively. What makes marketing actually effective isn't just generating leads, it has to be cost-effective too. If I'm spending $10,000 a month to generate $11,000, or worse, less than $10,000 in return, that's not a good outcome. Marketing's real job is just getting the phone to ring, or generating a form submission off a landing page. From there, you have to convert that lead, get them scheduled, and once they show up, actually convert them into a long-term patient who ideally accepts the treatment they need. That last part is a sales issue, not a marketing one, I've talked before about the MGE Communication and Sales Seminars, I'll put a link on the episode webpage for that too. This is usually the first thing we address with new clients, marketing and sales, since those are the real keys to both income and, just as importantly, getting patients the treatment they actually need.
So, what are some things that could shift your new patient requirement up or down, meaning you'd need more, or could theoretically sustain the practice with fewer, which I still wouldn't recommend? And here's something interesting: if you do this correctly, you'll eventually hit a point where you simply run out of physical space, I'll explain why in a moment.
The first factor is the condition of your hygiene department. Think about the business cycle of a general dental practice: you bring patients in with the intent of remaining their doctor, ideally for their lifetime, or the practice's lifetime. If you're consistently acquiring patients and genuinely good at retaining them, it's a bit like filling a bucket with water, not the most flattering comparison for patients, but bear with me, eventually the bucket's simply too small. What actually happens in a lot of practices is they're not great at retention, this is one of the biggest problems in dentistry from a business perspective, and I've talked about it before if you've listened for any length of time. The worse your hygiene department is at retaining patients, the more new patients you'll feel like you "need" just to sustain the practice, and you end up unintentionally running your GP practice like a specialty one. An oral surgeon genuinely lives off new patients and referrals, that's the model, they don't have a recall program, patients see them once for an extraction or an implant placement and that's it. Same with an endodontist, root canals, done, no recall relationship. But a GP practice that neglects its hygiene department, often because hygienists are hard to find or expensive, ends up losing that steady internal flow too, the office feels slow, and the instinctive fix becomes "I just need more new patients."
Let me walk through some numbers. Say your practice averages 30 new patients a month, from the day you open, for ten straight years. First question: what percentage of those patients would you expect to lose? Most people land around 20 percent, two out of ten, roughly one in five. So: 30 new patients a month is 360 a year. Lose 20 percent, and you're left with 288 patients who actually stick with the practice. Those 288 will need at minimum two recall visits a year, some will need three or four, but let's stay conservative and use two. 288 times two is 576 recall visits. Spread across 50 working weeks, that's about 11.5 recall visits a week, or, at roughly eight patients a day per hygienist, almost a day and a half of hygiene, generated purely from year one's new patients.
Now extrapolate that forward. Keep bringing in 30 new patients a month every year, at that same 20 percent attrition rate, for ten years, and this doesn't even account for patients who joined in year one and eventually leave in year eight, just to keep the math simple. By year ten, you've accumulated 2,880 net patients (288 a year times ten years). At two recalls a year, that's 5,760 recall visits annually, which works out to 115 recall appointments a week, or 14.4 days of hygiene a week, just for recall, not even counting soft tissue management or new patients seen through hygiene. That's more than three and a half hygienists working solely on recall. Factor in new patient visits and a real soft tissue management program, and you're realistically looking at four to five full-time hygienists on a four-day week.
Think about what that means physically. If you've got five operatories and four, maybe four and a half, are consumed by hygiene alone, there's no way one doctor keeps up with that volume of hygiene plus 30 new patients a month, you'll need a second doctor, possibly even another part-time one, just to keep pace, and that's with a relatively forgiving 20 percent attrition rate.
Now let's run a more realistic scenario, a 40 percent attrition rate, four out of ten patients you never see again. Year one: 30 new patients a month, 360 for the year, lose 40 percent, leaving 216 patients. That's 432 recall visits a year, or 8.64 a week, roughly a day of hygiene a week after just one year. Extrapolate that to year ten at the same 40 percent attrition rate: your total accumulated patient base is 2,160 (216 a year times ten years), which is 4,320 recall visits a year, 86 a week, or 10 days of hygiene recall a week, over two and a half hygienists just handling recall.
Here's why I bring this up: the funny thing is, if you run new patients through hygiene too, hygiene openings just quietly get filled by new patients or soft tissue management appointments, and as long as the hygienist stays booked, nobody stops to notice that hygiene should have grown by roughly a day a week, every year, based on the math I just walked through, even at that higher 40 percent attrition rate. By year two you should have about two days of hygiene, year three a bit over three, year four should be a full four days or a bit more, purely from recall, at 30 new patients a month. But because new patient visits and soft tissue management quietly absorb those extra slots, and a fully booked hygienist looks like a healthy hygienist, nobody notices that hygiene stayed flat at three days when it should have hit four. This happens constantly, I'd estimate 80 to 90 percent of the time. Very few practices genuinely max out their hygiene department. And because volume feels low and everyone's hunting for treatment opportunities, the default answer always becomes "get more new patients."
New patients are important, you should absolutely keep pursuing them, but most of your income should really be coming from your existing patients. I'd bet you have hundreds of thousands, possibly millions, of dollars sitting in incomplete treatment, since not everyone accepts treatment the first time it's presented. Keep those patients coming back regularly, and eventually a lot of that treatment does get accepted. From a pure economics standpoint, it costs far more to market for and acquire a brand-new patient than it does to bring back or reactivate someone who already knows you. That doesn't mean you shouldn't market for new patients, just that you need to balance both sides of this. This is genuinely one of the weaker areas in dentistry from a business standpoint, and I've said that before if you're a regular listener.
If you're retaining well, getting more than 30 new patients a month, and you genuinely commit to maximizing your hygiene department, say you plumbed your original office for six chairs but only built out four, and you're already running a full-time and part-time hygienist across six days of hygiene a week, you'll eventually hit a point where hygiene demand outpaces your physical space. You max out at six operatories, needing four or five hygienists just to keep up with a genuinely well-retained, growing patient base, and now there simply aren't enough chairs left for you and an associate. If you do this correctly, outgrowing your space is essentially inevitable. I'm not saying a newer practitioner should plumb a new office for twelve chairs, though you certainly could if you wanted to, just that a practice genuinely committed to both new patient growth and retention will eventually run out of room.
So your new patient requirement gets artificially inflated whenever your hygiene department is neglected. But even with a healthy hygiene department, 30 new patients per doctor remains a solid target.
Last couple of points. Say you do find yourself in that position, hygiene chairs filling up, running out of space, wondering what to do before spending $600,000 building out a new office. There are a couple of steps worth taking first. If you're in network with any plans, I'd start by dropping them, done systematically, in whatever way feels manageable for you, some people prefer a cold-turkey approach, which tends to be rougher, there are gentler ways to sequence it. We offer a free fees and plans analysis to help with this, I'll put a link on the episode webpage. The worst realistic outcome from dropping plans is losing around 30 percent of the patients tied to that plan, so if you're consistently filling up, retaining well, and running out of chairs, dropping plans is a great next step, you may lose some volume, but you'll recover it in profitability, since you're now collecting your full fee instead of a discounted one.
The second thing you can do, once plans are dropped and you're still packed, three hygienists running, you and an associate sharing a second operatory, working, say, eight to four Monday through Thursday and a half day Friday, is remember you're already paying for that space around the clock, even if you're not physically using it that way. You could open a second shift, one team running roughly seven to two, another running two to eight, using the same software and charts, with separate schedulers and separate statistics for each shift. That effectively doubles your usable hours out of the same physical space, and you could add Saturdays the same way.
If you're still maxed out even after dropping plans and adding a second shift, genuinely killing it across six days a week with strong profitability, then relocating or adding a facility becomes a reasonable next step. At that point, since profitability is strong, you can afford to take your time finding the right new space rather than rushing into a costly move.
So that's the first factor, an under-retaining hygiene department artificially inflates how many new patients you feel like you need, when in reality it's a retention problem, not a new patient problem. The second factor that can modify your new patient target is how aggressively you actually want to grow. A brand-new practice starts at zero, so aggressive growth makes sense there, hence the higher new patient targets. Sometimes an established doctor decides they want to blow past 30 and push to 60, 70, 80, or 90 new patients a month, which is a fine ambition, but a couple of things matter when you do this.
First, as I mentioned, make sure your hygiene department is genuinely being maximized alongside that push for more new patients. Second, watch out for the law of diminishing returns, something I covered in more depth back in episode 95, with a companion video on YouTube I'll link on the episode webpage. Say 30 new patients a month currently generates $50,000 in revenue. It's tempting to assume 60 new patients would generate $100,000, simple doubling. But several factors stand between "new patient walks in the door" and that revenue actually materializing, and those factors don't automatically scale alongside your marketing spend.
First, do you have enough front-desk capacity to properly handle the incoming call volume? Second, assuming those calls convert, do you have enough hygiene or schedule capacity to actually see these people? Third, once they're in the chair, you need time for a proper exam and diagnostics. Fourth, you need enough doctor and treatment coordinator time to actually present treatment and get real acceptance, not a rushed version of the conversation. I've seen this play out exactly the way you'd expect: a practice doubles new patients from 30 to 60, expecting $50,000 in additional revenue, since generating the leads themselves turns out to be the easiest part of the whole equation, and ends up with only $10,000 to $20,000 extra instead. What happened? The doctor no longer has enough time to properly explain treatment to each patient, so presentations get cut short and handed off to the treatment coordinator earlier than ideal. The treatment coordinator, now also stretched thin, loses the bandwidth for both quality time with each patient and the follow-up calls they used to make with people who didn't accept treatment same-day. So that doubled new patient volume never translates into doubled revenue, because everything downstream of the front door got squeezed.
If your conversion rate is 50 percent, getting 30 new patients scheduled required 60 incoming calls. To get 60 scheduled, you'd need 120 calls, does your front desk actually have the bandwidth to properly handle double the call volume? If not, that alone can quietly sink the whole campaign, there's nothing worse for a prospective new patient than being put on hold repeatedly by someone who clearly sounds overwhelmed. You need to genuinely check: is there enough front-desk time to handle these leads well, enough schedule capacity to see them, and enough time to actually sell properly? If any of those are lacking, you'll need to expand them, maybe additional treatment coordinator hours, maybe restructuring how the doctor's schedule runs.
You see this play out a lot when a doctor buys another doctor's patient charts, since it feels exciting, "I just picked up 500 charts," and there's an initial bump in visits and collections. But that bump rarely gets fully captured, because the practice often doesn't have the facility time, personnel, or schedule capacity to actually maximize that incoming flow. Assuming you can genuinely accommodate the additional volume, great, but don't lose sight of the rest of the practice in the excitement of something new. Make sure hygiene stays maximized and that you can actually absorb the new patient flow you're generating.
A smarter approach is usually to ramp up gradually rather than jumping straight from 30 to 60. Go from 30 to 40, see how that lands. Move to 50, maybe that's when you add a second treatment coordinator. Push to 60, add another part-time front-desk person or a dedicated new patient coordinator, then move toward 70. Scaling incrementally like this tends to produce far more sustainable growth than a sudden jump.
One thing I forgot to mention earlier when discussing hygiene: we have a free download this week, our Hygiene Formula spreadsheet. You just plug in your own practice's numbers, and it's a great way to check the actual health of your hygiene department, compare it against where it should be, and see how it lines up with the new patient benchmarks I've given you today. It might reveal exactly why you feel like you need more new patients than you actually do.
That's all I have for you this week. I hope this helps. If you want to learn more about MGE, you can find us online at mgeonline.com or call us at (800) 640-1140. Folks, have a great week, and we'll see you at the next episode.