In this episode, Jeff dives into the essential strategies for patient reactivation—an often overlooked yet powerful tool to grow your dental practice. We’ll explore how to re-engage past patients, the importance of staying top-of-mind, and how to effectively bring them back into your care. From personalized outreach techniques to leveraging technology and communication tools, we’ll provide actionable tips and best practices that will help you maximize your patient retention and reactivation efforts.
The MGE New Patient Workshop - https://www.newpatients.net
Download the Hygiene Formula Spreadsheet - https://www.mgeonline.com/hygieneformula/
Jeff Santone – jeffs@mgeonline.com
Blumberg Digital Reactivation - Text Marketing - Blumberg Digital
Listen to full episode :
Have a question for Jeff?
Fill out the form and he will get back to you.
Questions From This Episode
What does Jeff say is the real cost difference between acquiring a new patient and reactivating an existing one?
He points to a roughly $350 average cost to acquire a new patient through marketing, compared to about $38 in staff time, five phone calls totaling an hour at $38 an hour, to get an existing patient with outstanding treatment back on the schedule. He argues most practices pour resources into the expensive side of that equation while barely investing in the cheap one.
What are the only three legitimate reasons Jeff says a patient chart should actually be deactivated?
The patient has explicitly said they're not coming back, the practice has decided it doesn't want the patient back (following state dental board rules, ideally with malpractice carrier guidance), or the patient has passed away. He specifically argues against the older practice of quietly "purging" charts after a year or two of no contact, since no other type of business stops reaching out to a customer just because they haven't returned.
Why does Jeff recommend routing chart deactivations through the office manager or doctor rather than letting any staff member decide?
A newer or less skilled staff member might be the reason a patient said they don't want to come back, or may not have the standing to resolve the complaint, while a doctor or office manager the patient already knows has a real shot at addressing it directly. Without a routing process, he's seen staff simply mark patients inactive the moment there's any hesitation, permanently losing people who could have been won back.
How does Jeff recommend starting a reactivation effort, even with thousands of inactive charts?
Rather than waiting to hire a dedicated team, he recommends an immediate "all-hands action" where the whole staff pitches in, starting with patients who are both inactive and sitting on the incomplete treatment list, since that group offers the fastest return. He also stresses confirming real hygiene availability before making calls, since scheduling someone months out defeats the purpose.
Why does Jeff recommend reactivation as the first task for a new administrative hire?
The role has a short learning curve, both staff and patients already understand that a routine cleaning is a normal, low-friction ask, making it an easy way to train someone quickly. It also doubles as a real test of whether a new hire can actually produce results before handing them more demanding responsibilities, like answering new patient calls, which he says is a mistake to hand a brand-new employee first.
Episode Transcript
-
Take a minute and think about all the new patients you've seen in your practice over the last five or ten years. If you're the average dentist, you're seeing about 30 new patients a month, 360 a year. Ten years of practice, that's 3,600 patients. Fifteen years, 5,400. Twenty years, 7,200. And that's just at an average of 30 a month, if you're bringing in more, these numbers only get bigger. Sure, you're going to lose some of these patients along the way, but how many? When I survey a room full of dentists, 20 percent seems to be the generally agreed-upon, acceptable attrition rate.
So take that ten-year example, 3,600 new patients, subtract 20 percent attrition, and you should still have 2,880 active patients, call it 2,900 for simplicity. What does that actually translate to in real numbers? Start with hygiene. With 2,900 active patients, you'd expect at least 5,800 recall appointments a year, and that's a conservative floor, since it would be more if some of those patients are on three or four-month recall instead of six. If your office is closed two weeks a year, that's 50 working weeks, 5,800 recall appointments a year works out to 116 recall appointments a week. And I'm only talking about recall here, not scaling and root planing, soft tissue management, or new patients your hygienist might also be seeing.
If the average hygienist sees eight patients a day, 116 recall appointments a week is about 14 and a half days of recall hygiene alone. With a strong soft tissue management program and new patients running through hygiene too, that's probably closer to 16 days of hygiene a week, which, if you're open four days, means four full-time hygienists.
So, how do you actually measure up? If you're the average dentist who's been practicing ten years, you probably have one, maybe two full-time hygienists, and you might even struggle to keep them busy. But based on the math, you should have four. So where is everybody? Where did all these patients go? It sounds like they've become, for lack of a better word, inactive. Would you agree?
So what do we do about it? Do we purge these charts, a word I genuinely dislike using, but it's the one that's stuck around in the industry? Or do we work on getting these patients back, reactivating them? I think you already know where I land on that, and that's what I want to dig into this week. My name is Jeff Blumberg, and I'm your host. This is going to be a genuine deep dive on reactivation and keeping your patient base active, something of a definitive guide. We'll look at how to reactivate patients who've gone inactive, and just as importantly, how to keep patients from becoming inactive in the first place. This is truly one of those areas where the effort you and your team put in now can pay off for the rest of your career.
Where do we start? First, you need to know whether you actually have a problem, and how big it is. There are two ways to check, a simple way and a more precise one. The simple way: look in your practice management software at how many of your total patients have a next visit date after today. It's not a difficult report to pull, if you're not sure how, call support for Dentrix, Eaglesoft, Open Dental, whatever you're using, they can walk you through it easily. Say you pull that report and find you have 5,000 total patients, and only 800 have a next visit date after today. That means you're running at about 16 percent active, and roughly 4,200 patients are essentially unaccounted for.
The more precise way is something we call the Hygiene Formula, a spreadsheet you fill in with three basic numbers, and it calculates your exact hygiene compliance rate, how much of your patient base is genuinely active. This episode is really targeted at general practitioners specifically, since it assumes you're running a hygiene program, an oral surgeon obviously wouldn't be thinking in these terms. One thing worth noting about the Hygiene Formula: earlier I mentioned the 20 percent attrition rate most people agree on, but the downloadable formula itself actually builds in a more conservative 40 percent attrition rate across your total career charts. So if you've been practicing 16 years, you'd subtract 40 percent instead of 20, a wide margin of error. Even with that generous buffer, when doctors run their own numbers through it, their hygiene compliance rate still usually comes out looking pretty rough.
So those are your two options, check how many patients have a next visit date, or run the Hygiene Formula, a free download, I'll put the link on the episode webpage. If you'd rather talk it through with someone, our Vice President for Expansion here at MGE, Jeff Santone, is happy to help, you can email him directly at jeffs@mgeonline.com.
Once you have a general sense of how bad the situation actually is, that number matters a lot for figuring out what action to take next. Two things worth mentioning here. First, if you've listened for a while, you know we put enormous effort into new patient acquisition industry-wide, probably the single most searched dental marketing term is simply "dental marketing." I'm not against that, you should absolutely be pursuing new patients. But the amount you'll spend acquiring a brand-new patient is far more than what it costs to reactivate an existing one, and unfortunately that's not how most practices are set up to think. Say it costs $350 to acquire a new patient through a postcard or Google Ads campaign. You do all that work, convert them at the front desk, they show up, accept some treatment, get placed on the hygiene schedule, miss the appointment, and then quietly drift away with nobody putting in any real effort to bring them back. Meanwhile, all the ongoing effort goes toward getting even more new patients.
How much would it actually cost to get that same patient back? Say it takes five phone calls totaling an hour from an employee you're paying $38 an hour. That's $38 to get a patient who still needs treatment back on the schedule, compared to the original $350 spent acquiring them. That gap represents a massive amount of waste, and it happens constantly. Looking at how private practices are generally run in this country, this is one of the most poorly managed parts of the business, enormous spend on acquisition, almost nothing spent on retention.
Here's a quick exercise if that doesn't feel concrete yet: pull up your incomplete treatment list and scan the names. Find someone from two or three years ago you remember clearly, Bill Jones, say, a genuinely nice guy who needed a couple of inlays and a crown you'd treatment planned but never completed, maybe he did some other work, maybe he was maximizing his insurance benefits that year, whatever the reason, he was scheduled for his next hygiene visit and never showed. He's still sitting on your incomplete treatment list, with very little effort spent getting him back. Here's the question: would it be easier to sell Bill on completing his remaining treatment, or to convince a brand-new patient to accept treatment for the first time? In most cases, a patient of record is a much easier sale than a new patient, because they already know and trust you.
And here's something genuinely worth sitting with: patients who haven't been in for three, four, five years, you might assume they've found another practice, moved on, decided they don't want to come back. In a lot of cases, that's not actually true. These patients still think of you as their dentist, or at least you'd hope they would, and you've probably had the experience of someone showing up after years away and you say, "wow, Bill, it's been five years," and they're genuinely surprised, "really? Has it been that long?" In their mind, you were still their dentist the whole time, they just got busy, life took over, and their oral health simply wasn't a high enough priority, something a little education and outreach can genuinely help with. It's basic human nature, we tend to assume people who've drifted away have actively rejected us, when usually they just got busy.
So two things to keep in mind here: getting these patients back is genuinely good for them, especially to make sure existing work is being properly maintained, and it directly serves your retention, your hygiene program, and the core purpose of your practice. From a pure numbers standpoint, patients of record are simply easier to sell to and more responsive when you reach out, since there's already an established relationship.
So, step one, figure out how bad the inactive patient situation actually is. Before you start contacting anyone, you need to know when a chart should actually be deactivated. I covered this briefly in a very early episode, but to summarize: there are only a few legitimate reasons to deactivate a chart, and this runs counter to what a lot of people were taught. When I first entered the industry, standard practice was chart audits, if a patient hadn't been in for two years, you "purged" the chart, not a great choice of word, but that's what it was called. Maybe the office called twice, nobody answered, and the chart just got set aside, especially back when everyone used paper charts.
That's a genuinely poor practice from a business standpoint, one of the worse ideas I've encountered. No other business operates that way. Think about every email list you've ever joined by making a purchase somewhere, if you don't come back, the store doesn't stop emailing you or sending catalogs, they keep at it because you gave them your information. The same logic should apply to patients, we want to keep contacting them because we want to serve them. So when would you actually deactivate a chart?
There are really three legitimate reasons. First, the patient explicitly says they're not coming back. This can take different forms, maybe they just don't like the office and are done, fine. Or maybe they say, "Doctor, I'd love to keep coming here, but you dropped my plan, and I need to see someone who's still in network." We'll deactivate that chart too, but handle it a bit differently, I'll get into that in a moment.
One important note on this first reason: if someone doing reactivation calls gets told "I'm not coming back," should that staff member have the authority to just deactivate the chart on the spot? That depends. If it's your office manager or a longtime scheduler who genuinely understands how you run the practice, maybe. But even then, I'd want a defined routing process any deactivation has to go through. Here's why: say someone doing reactivation calls me and I say I don't want to come back, and when asked why, I mention I wasn't happy with my last visit. A newer staff member might not be equipped to go any further with that conversation, it should route to the office manager or the doctor. The doctor might recognize the name, "oh, Jeff, I remember him, I heard you weren't happy with your last visit, what happened?" and actually have a real shot at resolving it, since they have context I don't. You don't want someone walking around upset with your practice for a reason your own business created, if it can be avoided. I've seen offices hire someone for reactivation with no routing process at all, where a newer staff member just clicks "inactive" the moment anyone hesitates, possibly because that staff member isn't especially good on the phone and is inadvertently upsetting people. I wouldn't want that person to have unilateral deactivation authority, instead, they log the note, and it routes to the doctor or office manager, who can call and at least attempt to resolve the issue or win the patient back.
Second legitimate reason to deactivate: you don't want the patient back. You're well within your rights here, but make sure you follow your state's Dental Practice Act exactly, your state dental association will have a copy, often available online. I'd also recommend talking to your malpractice carrier before formally dismissing a patient, in my experience, they're usually relieved to hear you're not calling about being sued, and happy to advise on best practices to avoid any claim of abandonment.
Third: the patient has passed away, in which case the chart obviously gets deactivated.
That's really it, three reasons: they've told you they're not coming back, you don't want them back, or they've died. I've even seen cases where a patient moved two or three hours away and stayed active simply because they visit their old area every few months and keep seeing the same dentist while they're in town, that kind of patient shouldn't be deactivated either.
Now, back to that patient who says they'd love to stay but had to leave because you dropped their plan, I wouldn't cut off all contact with them. I'd pull them off active recall calling, meaning staff isn't repeatedly trying to schedule them, but I'd absolutely keep them on any newsletter or general mailing list. Why? Because plenty of patients who leave for network reasons end up trying an in-network office, dislike it, and come back anyway because they'd rather pay the difference than stay somewhere they don't love. I want to stay in that patient's mind throughout that whole period. A piece of mail costs 60 or 70 cents, that's a worthwhile ongoing investment to stay visible and recover some of those patients down the line. This is a case where you're not spending active staff time calling, but they absolutely stay on your communication list. Someone who says they're never coming back and it's truly unresolvable, you can remove from the mailing list. A deceased patient, same. But anyone who left specifically over an insurance or network issue, or anyone you simply haven't been able to resolve otherwise, keep them on that list.
So, you've assessed how bad the situation is, you know when to actually deactivate a chart, and critically, you've built a routing process through the office manager or doctor so someone with real authority and context reviews any deactivation before it happens. Now, how do you actually start reactivating?
That depends partly on how large the problem is. If you've got four, five, or six thousand inactive charts, that's a lot of work, and I'll get into how much effort that really requires in a moment. But I wouldn't wait until you've hired a dedicated team to start. Begin right now with what I'd call an all-hands action, exactly what it sounds like, everyone contributing to the reactivation push, regardless of how many inactive charts you're dealing with.
Say you've got 5,000 total charts and only 800 to 900 active. Call a staff meeting: "we have 5,000 charts, only about 900 are active, we need to go after the other 4,100 to 4,200." Where would I focus first? Patients who are inactive with no next visit date and who are also sitting on your incomplete treatment list, since that's where you'll see the biggest immediate return. Say you've got 1,500 patients out of that 4,200 who are both inactive and carrying incomplete treatment, start there, since bringing them back through hygiene creates real opportunities for additional treatment presentations and revenue, on top of the fact that these patients genuinely need the care.
I'd also orient the whole team around why this matters, not in a forced, rah-rah way, I'm not big on needing to artificially motivate people to do their job, but genuinely connecting the effort to your practice's actual purpose. If your practice mission centers on improving patients' oral health, and by extension their systemic health, quality of life, and even life expectancy, there's plenty of research backing that connection, then patients simply can't benefit from that mission if they're not showing up. That's the real reason to go after those 4,200 inactive patients, or at least the 1,500 sitting on your incomplete treatment list, you're their doctor, and helping restore their health is genuinely the job.
From there, some staff will already know how to book a hygiene appointment, likely your front desk and possibly hygienists handling recall. Others, dental assistants, for example, may never have made a reactivation call and will need at least basic training, which whoever currently handles this, front desk, hygienist, or office manager, can typically provide in about 20 minutes. Role-play a few common scenarios, how to answer typical questions, how to actually schedule the appointment in your software if they're not already comfortable with it. Then figure out when these calls actually happen, maybe an hour a week, maybe two, worked into the existing schedule.
From there, I'd build a simple flow chart so nobody gets tongue-tied or confused on the phone. Focus initially on your incomplete treatment list patients with no next visit date, those with a scheduled next visit don't need a call. These patients generally fall into one of four categories: they're not actually overdue for hygiene yet, just needing their next visit scheduled, they're overdue but it's been less than two or three years, they're overdue by more than that, or, a fourth category, they came in as new patients, were recommended some form of periodontal therapy or soft tissue management, never accepted it, and so never actually made it onto the hygiene schedule at all.
Train staff on how to handle each category. Not overdue, simply schedule the next hygiene visit. For the "overdue" categories, this is where state regulations matter, in some states a hygienist can't perform certain services or even see a patient without the doctor reviewing them first, especially if they're overdue past a certain threshold, sometimes requiring a full new initial exam. You'll need to know your own state's rules here, since that directly shapes your flow chart and appointment scheduling. For the fourth category, patients who never made it to hygiene because they declined recommended periodontal therapy, I'd keep it simple and just schedule them to come back in and see the doctor for a fresh exam.
Once everyone's trained on those four categories, set real targets, a specific number of patients you want scheduled per week to start meaningfully rebuilding your hygiene schedule. One more thing before turning people loose on the phones: check your actual hygiene availability. If you've got eight or nine staff genuinely excited about this reactivation push, and then discover there are no hygiene openings for the next two months, that's a real problem, "we'd love to get you back in, when's the next opening?" "March" isn't going to land well. Make sure you actually have room to put these patients once they schedule. This varies a lot by practice, you might already have real openings coming up, or you might need to add an extra hygiene day. If adding a full day feels risky since you're not sure you'll fill it yet, pick a specific day six weeks out and commit to filling it, using a temp hygienist if needed, then repeat that same day weekly going forward.
I'd also make this a genuinely multi-channel effort, not just phone calls. Text messages, emails, physical mail, personalized letters from whoever's handling the outreach, and a regular practice newsletter. Keep the newsletter simple, an 11x17 sheet folded twice, roughly the size of a large postcard once folded. I personally prefer a homemade newsletter over a generic, canned template, it feels more genuine and I'm more likely to actually read it if I recognize the organization. Content can be simple: practice announcements, a new associate joining, a staff member having a baby, a short, approachable article from the doctor on something like how periodontal health connects to cardiovascular health, or oral care tips for young kids, a current new patient special, or a seasonal promotion, whitening discounts, that kind of thing. I'd send this quarterly to your full mailing list, which includes patients who left specifically over network participation, but not patients who've told you outright they never want to come back.
When you can't reach someone by phone, follow up with a text, an email, or a personal letter, "Hey Joe, I've been trying to reach you, it's been about two years since your last cleaning, we'd really like to get you back in, give us a call to schedule." There are also ways to extend your reach further. We've had Dan Brown on the podcast before, our resident marketing expert and a partner at Blumberg Digital, our digital marketing agency, they offer a genuinely useful, reasonably priced bulk reactivation texting program, I'll put a link on the episode webpage.
It's also worth checking whether your existing software, or a dedicated patient communication platform, supports direct self-scheduling. Tools like Adit or Care Credit let a patient click a link in a text or email that drives them straight to your website, where a scheduling widget pulls live availability from your practice management software, letting them pick their preferred hygienist and an open time slot directly. Most of these don't write the appointment straight into Dentrix or Eaglesoft automatically, instead, when you come in the next morning, you'll see a pending request, "Jeff wants Sally next Thursday at 3," which you approve, and the patient then gets their confirmation. Something like this can meaningfully reduce the number of actual phone calls needed, probably resolving 10 to 20 percent of your inactive list on its own.
Think of it as capturing your low-hanging fruit, patients who don't need much convincing, maybe it's already been on their mind and they just hadn't gotten around to calling, and the moment they get a text or email, they go ahead and schedule themselves. I'd absolutely make that as easy as possible for them. That said, don't mistake this for a complete solution, it categorically won't handle your entire inactive list on its own. You still need to roll up your sleeves for the rest, phone calls, texts, emails, some patients might take ten calls before they finally schedule, but even that is still far cheaper than acquiring a brand-new patient, and it's keeping your existing patients active, which is really the whole point.
So the question becomes, once your staff is working through the incomplete treatment list with no next visit date, you likely still have two or three thousand other inactive patients. Do you need to hire someone specifically for this? Let's run some basic numbers. Say you have 5,000 inactive patients. First question: how many calls could one person realistically make in a day if reactivation were their entire job, accounting for some mix of texting and emailing too? Most people land around a hundred, some say up to 150, you could technically dial 200, but if you're not actually reaching people, what's the point? The more you're genuinely talking to people, the lower your raw call count naturally goes, but hopefully your scheduled appointments go up.
Say it's a hundred calls a day. With 5,000 inactive patients, that's 50 business days to get through the full list once, roughly three months at 17 working days a month. That's too slow. Ideally, I'd want patients called weekly until they either schedule or explicitly tell you they're not interested, frequent enough to stay on their radar without becoming a nuisance, daily might be excessive, but weekly feels reasonable. At that pace, covering 5,000 patients weekly means 5,000 calls a week, and at a hundred calls a day per person working five days a week, that's ten people, which might genuinely be unrealistic for your situation. The point is, the actual effort required to properly work through a large inactive list is usually more than people initially assume.
If you're looking at five, six, ten thousand inactive patients and hiring five or ten people feels completely unrealistic, and for most practices, it is, here's what I'd suggest instead: hire one or two people for an entry-level reactivation role and start there. This is a role you can generally train someone into within a single day, for a few reasons. Both your staff and the patients they're calling already understand that seeing a dentist roughly twice a year is simply expected, getting a cleaning is broadly viewed as a positive, routine thing to do, not some complex procedure you're asking someone to commit to. Appointment types and lengths also tend to be fairly consistent, which keeps the training simple.
I'd actually recommend this as the very first task for any new administrative hire, rather than the more common approach of immediately putting a brand-new employee on the phones answering incoming calls, which is honestly a mistake. You're spending real money on marketing to generate those calls, and then a prospective patient ends up talking to someone brand new who doesn't fully know the practice yet. Your receptionist is effectively your partner in marketing, that role deserves someone already up to speed. If I hire someone new and want to see whether they can actually produce, I'll start them on reactivation, get them on the phone, see if they can schedule patients. If they can, I know they're capable of contributing elsewhere in the organization. If, after a few days, they genuinely can't manage to schedule a basic hygiene appointment, they're probably not going to succeed in a more demanding role either, so there's real value in finding that out early.
And if you hire, say, three people who end up fully clearing your inactive patient backlog, that's a great problem to have. What do you do with them once that project's done? In most cases, hygiene is now considerably busier as a direct result, so one of them might become your hygiene coordinator. Or they pick up practice PR work. If someone's genuinely productive, you'll find a place for them, trust me on that. And clearing out that backlog essentially bakes in real growth for the practice, if you go from one and a half full-time hygienists to four, you as a solo practitioner likely can't keep up with that volume alone anymore, you'll need an associate. This genuinely spurs practice growth.
One more thing worth keeping in mind: roughly 70 percent of your revenue should be coming from patients of record, not just hygiene revenue itself, but the treatment those existing patients actually need. This is a real growth multiplier if you take it seriously in your business. It's also a genuinely good place to start new hires, since the learning curve is short, and it tells you quickly whether someone's actually capable of producing results, something worth taking seriously, the way other businesses generally do with customer retention. For whatever reason, that priority has slipped in dentistry specifically, but the practices that genuinely make it a priority tend to grow far more stably and consistently over time.
This ran longer than usual, I'm close to the 40-minute mark on my timer, but it's a topic worth taking seriously, which is why I went into this much detail. If you have questions, feel free to email me directly at jeffb@mgeonline.com. Don't forget, I've got the Blumberg Digital link and the Hygiene Formula link on the episode webpage if you want an honest read on where you actually stand, and if you need help with any of this, you can also reach out to Jeff Santone directly at jeffs@mgeonline.com. If you want to find out more about MGE generally, you can email us at info@mgeonline.com, 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.