This week, Jeff explores the crucial topic of managing recall patients within a dental practice. We’ll discuss how the hygiene department plays a central role in driving recall patient retention, from building strong relationships to setting up systems that keep patients coming back.
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Questions From This Episode
Why does Jeff say "number of recall patients" is a better health indicator than "number of hygiene patients"?
Hygiene patient counts include new patient exams and scaling/root planning visits, which inflate the number without reflecting genuine retention. Recall patients specifically means only people coming in for a true three, four, or six-month checkup, which is a much cleaner signal of whether existing patients are actually staying with the practice.
Why does Jeff say the standard "number of active patients" metric can be misleading?
It typically counts anyone seen within the last two years, even a patient seen once for an emergency 18 months ago who has no intention of returning. He recommends instead counting only patients who currently have a future appointment scheduled, since that's a much more honest picture of who's actually still engaged with the practice.
What's the math Jeff walks through to show how much hygiene growth a practice should expect?
Take your new patients for the year, subtract roughly 20 percent for expected attrition, multiply the remainder by two (the minimum recall visits per year), then divide by the weeks you work annually to get the weekly recall visits that should be added, and divide that by eight to translate it into hygiene days. For a practice bringing in 360 new patients a year, that works out to almost a day and a half of additional hygiene that should show up the following year.
Why does Jeff say it's easier to fix a practice with strong patient flow but weak sales than the reverse?
A doctor with plenty of patients coming in just needs to improve how they present and close treatment, something he says can often be improved within a week. A doctor who sells well but has very few patients coming in needs to rebuild new patient marketing, phone handling, and reactivation from scratch, which takes considerably longer.
What happens to a hygiene department if a practice doesn't actively work on retention?
Jeff says it naturally narrows down to only the most motivated "upper crust" of patients, roughly one in five, who would chase down a rescheduled appointment on their own. Since those patients tend to already have completed most of their treatment, a hygiene schedule made up mostly of them ends up with little left to diagnose, while the other four out of five patients quietly drift away without anyone actively working to keep them on the schedule.
Episode Transcript
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If you had to pick one statistic or KPI to demonstrate your practice's health, what would it be? Some people might say collections, others might say new patients. I was reading an article recently where the author suggested average patient transaction value. All of those matter, I'm not saying they don't, but none of them is the one I'd pick if you're a GP dentist and I'm trying to determine how healthy your practice actually is.
As a matter of fact, the one I'd pick is something almost nobody keeps track of. I was asking Sabri about this recently, since she interviews a lot of our newer clients when they first come on board, and according to her, maybe 2 percent of new clients can even give her a number for this statistic, let alone keep it regularly.
So what is it? If you're a GP, the stat that tells me how healthy your practice is isn't the number of hygiene patients, it's the number of recall patients. Notice I didn't say hygiene patients, I said recall patients specifically. I've touched on this before on the podcast, it's come up in a number of past episodes, but it's usually sandwiched in with a bunch of other material, since I'm normally talking more broadly about building out your hygiene department, going over ten or twenty things at once without much focus on this one piece specifically. So I wanted to do a shorter episode this week just to zero in on it, because this is a statistic worth actually keeping in your practice.
I want to cover what it is, though you've probably already guessed, there are a couple of nuances worth knowing, how to monitor it, how fast it should be growing, and most importantly, why it matters to your practice. My name is Jeff Blumberg, and I'm your host.
Let's start by defining it: number of recall patients. If you're old school like me, you might not love the word "recall," some doctors avoided it in the nineties and early 2000s because it sounded too much like a car recall, "we're calling you in because your crown didn't work" or something along those lines. Call it recall, a checkup, whatever term you prefer, for the sake of this episode I'm calling it number of recall patients.
So what counts as a recall patient? It's simple: a genuine six, four, or three-month recall visit, you can even fold periodontal maintenance in with the three-month recalls. That's it. It's not everybody who happens to be seen on your hygiene schedule. At least half of practices run new patient initial visits through hygiene, with the doctor joining for the exam, and you likely also have some form of soft tissue management program running scaling and root planings through hygiene too. None of that counts toward number of recall patients. This is strictly people coming in for a genuine three, four, or six-month checkup.
If you've listened to the podcast for any length of time, you've heard me call this a great statistic to keep. But why the big focus? There's a real reason behind it. It matters because it tells me the health of your business, it tells me how good your retention actually is, and it tells me whether you're heading toward growth or contraction. In the broader business world, you'd call this insight into the size of your customer database.
In dentistry, there's a term people usually reach for instead, number of active patients, and I don't know exactly where it originated, but to me it's a fairly arbitrary term. It usually just means how many patients have been seen in your practice within the last two years. In theory, though, you could have seen someone 18 months ago who's never coming back, and they'd still count toward your "active" number. I understand the reasoning behind using it, it comes up most when buying or selling a practice, since it's probably easier to get someone back in who was there two years ago than someone from five years ago. Fair enough. But someone who came in for an emergency visit 18 months ago and never returned is still counted as active, even though they're not really active at all.
A better way to determine how many patients you genuinely have is to count people who actually have a next visit scheduled. That's your real active patient count, your real database, in business terms, because these are people who are actually coming back. You might have 4,000 "active" patients on paper, but only 1,300 of them have a next visit booked. What's happening with the other 2,700? Maybe they'd come in if you called them, but right now, they don't have anything scheduled, so they're not truly active.
So how quickly should this recall number be growing? A lot depends on how many new patients you're averaging per month. Let me walk through some basic math, since this is really the part I want you to focus on, this is genuinely a game-changer if you start tracking it seriously.
Say you're averaging 30 new patients a month, 360 for the year. Out of those 360, what percentage would you expect to never see again? Whatever number you just landed on for yourself might differ from what I typically hear, but when I run this exercise at seminars, the average answer is usually around 20 percent, people can generally picture losing about a fifth of their new patients. So: 360 new patients, lose 20 percent, that leaves 288 patients who are expected to stick with the practice long term.
Take those 288 and multiply by two, since that's the minimum number of recall visits you'd expect from each of them in a year, you'll likely get more, since some will be on four-month recalls or three-month periodontal maintenance, but let's stay conservative and use two. 288 times two is 576 potential recall visits generated over the following year just from that one year's worth of new patients.
Broken down weekly: assuming you work 50 weeks a year, 576 divided by 50 is about 11.5 recall visits per week that should be added to your schedule in the new year, purely as a result of the new patients you brought in the year before. If a hygienist sees roughly eight patients a day, that works out to a bit over 1.4 additional hygiene days per week. So the big picture: 360 new patients last year, minus 20 percent attrition, should translate into almost a day and a half of additional hygiene added to your schedule this year. If you were running four days of hygiene last year, including scalings and new patients within that count, you should now be running close to five and a half.
How often does this actually happen? Pretty close to never. You'll see it occasionally, especially with an active MGE client who's got everything firing on all cylinders, but for the most part, with a newer client coming in, hygiene just stays roughly flat, maybe they've added half a day, and openings persist anyway.
I want you to really sit with what that means. If you saw 360 new patients last year and haven't added roughly a day and a half of genuine recall hygiene, not scalings, not new patients, since you obviously need to keep bringing those in too, something is wrong. If your hygiene schedule has stayed essentially the same, or you've only added half a day, you are losing patients.
It's one thing for me to just say that, people can nod along and move on. I want you to really confront it through the lens of how much work goes into getting a patient in the first place. Think about what happens with a new patient: you pull out all the stops, the practice tour, meeting the doctor, making sure they feel genuinely well taken care of. You might spend hundreds, even thousands of dollars to acquire that patient, or it's a referral from one of your best existing patients, either way, real effort went into landing them. Then they land on the recall schedule, and you never see them again. You're actually losing people. And here's the frustrating part: the effort required to land a brand-new patient is far greater than the effort required to keep an existing one, someone who already knows you, likes you, and likes your staff is a much easier appointment to bring back than a total stranger. I'm not knocking new patient acquisition, you absolutely should keep pursuing it, but shouldn't you be putting at least as much attention into keeping the patients you already have? If your hygiene department isn't growing, you're not retaining patients, either they're not seeing a dentist at all, or they've gone somewhere else.
So run that math yourself: take your new patient count from last year, subtract 20 percent, multiply by two, and divide by the number of weeks you work per year. That tells you how much hygiene you should be adding weekly. If you're not seeing that growth, something's wrong.
Why does this matter beyond the raw numbers, even setting patient health aside for a second and looking at it purely from a practice management perspective? The beautiful thing about the hygiene department is that it's your built-in check-in mechanism. Say you place an implant and a crown for me. How do you know I'm maintaining my oral health afterward if I'm not under active treatment? What mechanism do you actually have to see me again? The hygiene department. I'm more or less programmed, thanks to Crest and Colgate, to show up twice a year, that's just something people do. When I come in, you get eyes on me and can confirm I'm actually maintaining my health. In that sense, the hygiene department is integral to your practice's whole mission, restoring health, function, and aesthetics, which is the mission for most dentists. Without an active hygiene department keeping me on recall, you have no idea how I'm actually doing, not just whether new problems have developed, but whether I'm maintaining the work you already did.
From a business standpoint, if hygiene is continuously growing, you'll have a steady, reliable flow of patients. Here's a thought experiment: given two practices to fix, a doctor who's genuinely great at sales but has almost no patients, or a doctor who isn't great at sales but has a huge amount of patient flow, which is easier and faster to fix? The second one, every time. A doctor with strong patient flow just needs help learning to sell, that's something I can improve in a week. A doctor who can sell beautifully but has nobody coming through the door is a much bigger project, you need new marketing, phone outreach, reactivation efforts, real patient acquisition from scratch. The flow itself is the harder thing to build.
This also explains something you may have heard me say before: without active effort to keep patients coming in regularly, your hygiene department naturally devolves down to just the people who are genuinely, intensely motivated to show up, the upper crust of your patient base. And that upper crust isn't necessarily the nicest patients, or the wealthiest, it's simply the ones who pay the most attention to their own oral health. That's maybe one out of every five patients, the ones who'd chase your front desk to get rescheduled if you had to cancel them for weather or a closure. What about the other four out of five? Some might genuinely be a poor fit you don't want back, but most fall somewhere in the middle, patients who, if you cancel them and don't proactively reschedule, simply won't chase you down themselves, not because they're bad people or don't care about their teeth, just because it's not as high a priority for them as it is for your most dedicated patients.
If you put zero attention toward your hygiene department, or toward this statistic specifically, the only patients who show up reliably end up being the ones who already completed all the treatment you recommended. So when one of them comes in for their recall checkup, there's often nothing left to diagnose, they already did the implant, the crown, whatever it was. If you're not actively working your hygiene department, that's exactly what it becomes: a room full of patients with nothing left to treat. You look at your schedule and wonder where your next treatment opportunity is going to come from, and conclude it must be new patients. It's not just new patients, it's all the existing patients you're not actively keeping on the schedule. I've said this before: compare your incomplete treatment list against how many of those patients actually have a next visit booked. You'll typically find that number is small, not because those patients are bad people or don't care, but because nobody is actively working to keep them on the schedule.
So how do you monitor number of recall patients week to week? Just look at your schedule and count anyone who's a genuine three, four, or six-month recall, filtering out new patients and scalings. That might be 20 or 30 in a given week, and you can track it weekly or monthly. Over time, that number should be trending upward, since you're continuously adding new patients to the practice. If it's flat, something's wrong, and you're losing people. And losing people doesn't necessarily mean dramatically, if you asked me on the street who my dentist is, and I hadn't been in for a checkup in a year and a half, I'd probably still say your name. But if you leave that relationship dormant long enough, eventually I'll end up somewhere else, maybe a toothache hits while your office happens to be closed, I go somewhere else, hit it off with the new dentist, and just never come back to you. So all the effort you put into getting patients through the door in the first place needs an equal amount of effort to keep them coming back.
So please, start keeping this statistic, number of recall patients, weekly and monthly. And run the exercise I walked through earlier: take your new patient count from last year, subtract 20 percent, multiply by two, divide by the number of weeks you work annually, that tells you how many recall appointments you should have added per week. Divide that by eight to see it in terms of hygiene days. If you haven't hit that growth, you're not retaining patients the way you should be.
So what would I actually do about it? Generally, the first step in fixing any problem is becoming aware it exists. Here's a quick, unrelated example: say I have a genuinely bad habit of talking over people, someone starts speaking and I just cut in. If a friend pulled me aside and pointed it out kindly, not calling me a jerk, just flagging that it's happening and it bothers people, I might think, you know, you're right. Do I still slip up occasionally afterward? Sure, old habits, but now I'm aware of it and actively working to control it. Solving any problem starts with recognizing you actually have one.
So start there. Begin tracking number of recall patients. Work out how many days of hygiene you should have added, and should be adding now that we're early in 2025, and see whether you're actually keeping pace. If you are, well done. If you're not, and you need to work on your hygiene department, a couple of things worth doing: make sure you're actually retaining the new patients you're bringing in now, and you'll likely need to dig back through your existing patient base and put real effort into reactivation, it often takes more work than people expect. I've covered this in other episodes, including a more recent one called A Definitive Guide to Patient Reactivation, that's episode 167. There's also episodes 45 and 46, called Getting Serious About Your Hygiene Department, and the very first episode I did on this general subject was episode 11, on retention. We also have material on our online platform, DDS Success, covering exactly how to do this, and we go into it further at the MGE Scheduling Seminar, I'll put links to all of it on the episode webpage.
That's where I'd start: begin tracking the statistic, figure out how many hygiene patients you should have added this year, and see where you actually stand. Because once you're aware there's a problem, you can start doing something about it, and your practice becomes a lot easier to run once you've got real patient flow coming in on top of your new patient flow. And most importantly, the first step in actually maintaining your patients' health is simply getting them to show up.
A bit of a shorter episode this week, I wanted to focus on just this one thing. I hope it helps. If you have questions or want to learn more about MGE, you can find us online at mgeonline.com or call us at (800) 640-1140. I'll have those links on the episode webpage. Otherwise, folks, have a great week, and we'll see you at the next episode.