Ep. 11: Patient Retention & Reactivation, Why Dentists Lose 50% of Their Practice
We all tend to focus on new patients, new patients, new patients, but how many existing patients are you losing out the back door? It’s probably more than you realize. So in this episode, we get into patient retention, recall, and how to calculate the potential of your hygiene department.
Topics:
0:13 – The cost of new patient acquisition vs patient retention
7:27 – The Hygiene Formula: Assessing the health of your hygiene department
12:55 – How you can use this to add 6 figures to your practice revenues
Links:
Download the Hygiene Formula Spreadsheet - https://www.mgeonline.com/hygieneformula/
The MGE New Patient Workshop - https://www.newpatients.net/
Listen to full episode :
Questions From This Episode
How much does it typically cost to acquire a new patient, and how does that compare to what's spent retaining one?
The average dentist in the US spends around $350 to acquire a new patient through direct mail, and about $422 through Google pay-per-click, real costs that can be improved with better marketing skill, but that's the rough baseline. What gets spent retaining that same patient once they're already in the practice is often close to nothing, sometimes just a few dollars worth of an employee's time.
What is the hygiene formula, and what does it actually measure?
A calculation that takes total unique patients seen over the last five years, multiplies by two to estimate expected annual recall visits, subtracts roughly 40 percent for natural attrition, and divides by the number of weeks the practice is open to show how many hygiene days the practice should be running each week. Comparing that expected number against actual recent hygiene visits reveals the practice's real compliance percentage.
In the episode's own example, what did a 31 percent hygiene compliance rate actually reveal about the practice?
A practice that should have been running 12 days of hygiene a week was really only running six, and of the roughly 4,800 recall visits it should have produced annually, it was only producing about 1,250, meaning nearly 70 percent of the patient base wasn't being regularly seen at all.
Why does dentistry have a genuinely unique advantage most other businesses would envy, and why is it so rarely used?
Most people already know, without ever being told directly by their own dentist, that they're supposed to see a dentist twice a year, an expectation built into the public consciousness through decades of Colgate and Crest advertising that any other business would love to have. Despite that built-in advantage, most practices put almost no consistent effort into actually reminding and bringing patients back in to use it.
What would it actually be worth to hire someone specifically to improve hygiene compliance?
In the episode's example, paying a dedicated employee $40,000 a year to get patients back on the hygiene schedule and raising compliance from 31 percent to 80 percent would add somewhere around $400,000 to $600,000 a year in collections, a return that dwarfs the cost of the position itself.
Episode Transcript
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How much do you spend to get a new patient? If you're an average dentist in the United States, you're spending about $350 for a new patient acquired through direct mail, real new patients who actually show up in your practice, and about $422 on average if you're using Google pay-per-click. Those numbers can obviously improve if you know what you're doing, you can tighten things up and lower that acquisition cost, but that's roughly the baseline. So now that we know how much you spend to get a new patient, how much are you spending to keep that patient? If you're the average dentist in the United States, little to nothing.
That's what we're going to talk about in this week's episode of Dental Business Rx, specifically how the average general dentist in the United States potentially loses half or more of their practice. My name is Jeff Blumberg, and I'm your host, flying solo this week, no guest, just me. This is a subject I genuinely care about, because in my view, it's one of the things done most poorly in the dental industry. If I had to pick the two most poorly handled things in dentistry, they'd be keeping your patient base active, meaning patient retention, and case acceptance. This week we're focused on patient retention.
Let me walk you through a scenario. Say you get me as a new patient, I'm 52 years old, not a bad patient at all, I'd like to keep my teeth, and I'm a reasonably compliant patient. Say I found you on Google searching dentist near me, your receptionist got me scheduled, and I needed an implant and a couple of crowns, a $5,000 to $6,000 case, maybe more, and you complete it. Now I go onto the recall schedule, due back in six months.
As that date approaches, I get a text to confirm, and it turns out I'll be out of town that week, so I ask to reschedule for a month or two out. Then something else comes up, maybe your office closes that day for weather. Now I'm off the schedule entirely. Life gets busy, maybe your office gets busy too, we play a bit of phone tag and never connect, and a year goes by. This isn't unusual, it happens constantly. People get busy, people forget. Now two years have passed and I still haven't been scheduled. To some degree, that's on me as the patient, you'd reasonably expect me to call and get back on the books. But you'll see this happen with your own patients too, someone hasn't been in for two years, you point it out, and they're genuinely shocked, they'd have sworn it had only been a year. Time gets subjective in that regard.
But after about two years, you're doing a chart audit. I tend to get called early in these audits since my last name starts with B, but say my name starts with M instead, there's a real chance I never get reached at all, since people often start at Z and work backward, running out of time before they ever reach M. So you've decided you can't reach me, maybe you try once or twice, and eventually you deactivate my chart.
Now step back and look at how much actual effort went into trying to retain me. A couple of phone calls, maybe a postcard, maybe a text saying I was overdue, maybe a call when a last minute opening came up. An employee spent maybe 15 to 20 minutes total across several months trying to reach or reschedule me. Say you're paying that employee $20 an hour, that's roughly $5 spent trying to retain me, compared to the $350 spent acquiring me in the first place. And this isn't just about me personally, I'm simply an example, but it illustrates the real problem in a lot of dental practices. So much time and money goes into acquiring new patients, since new patients are treated as the default solution to production, while very little effort goes into keeping the patients who already know you, even the ones who aren't perfectly consistent about their own scheduling.
Now fast forward a few years. Say something else breaks, or a new problem comes up. Chances are, speaking personally, I'm going to call you. But if I've had no communication from your practice in the meantime, and a coworker happens to mention a great dentist they see, there's a real chance I check them out instead, purely because there was so little effort made to keep me connected to your practice.
Here's the interesting part about dentistry specifically: you already have something built into your business model that most other industries would kill for. Ask the average person on the street how often they're supposed to see a dentist, and they'll say twice a year without hesitation, that's not something your own patients necessarily learned from you, it's the direct result of decades of Colgate and Crest advertising. Any other business would love having that kind of built-in expectation, imagine if customers of a furniture store felt genuinely obligated to walk through the showroom twice a year just because that's simply what you're supposed to do. That expectation exists in the American psyche for dentistry specifically, and it's simply not being taken advantage of.
More importantly, if your actual purpose as a dentist is restoring and maintaining a patient's health, function, and aesthetics, you can't do that if you never see them. Your hygiene program isn't just a production center, it's the mechanism that keeps patients coming back in to maintain their health in the first place, which makes it central to both your practice's success and your patients' wellbeing. And since oral health is directly connected to systemic health, as you already know as a doctor, this isn't just about making it easier for someone to eat or chew, it's potentially adding real years to their life. This matters.
To show you how this might actually be playing out in your own practice, I want to walk through some real math, something we call the hygiene formula, which lets you check the overall health of your hygiene department. I'll use sample numbers first so you can see how the calculation works, and then you can run your own numbers through it afterward.
Say we're looking at a practice with one doctor and one and a half hygienists, roughly six days of hygiene a week, the office is open four days a week, with a four-day hygienist and a two-day hygienist. They run a soft tissue management program, and new patients are seen through hygiene as well. We'd start by asking the doctor how many individual patients they've seen over the last five years, we use a five year window the first time through, and you'll see why shortly. Say this doctor has seen 4,000 unique patients over the last five years.
We take that 4,000 and multiply by two, since every patient minimally needs two six-month recalls a year, some will need three or four month recalls instead, but we'll keep it simple at six months. That gives us 8,000 recall visits a year. Since this is an average practice that hasn't been especially strong at retention, we account for attrition and patients who've moved away or simply stopped coming back by subtracting 40 percent. Forty percent of 8,000 is 3,200, leaving 4,800 potential recall visits a year, based on everyone this practice has actually seen over the last five years.
Next, we look at how many weeks a year the practice is actually open. Say it's open 50 weeks a year, out of 52, with the doctor taking two weeks off. We take that 4,800 and divide it by 50 weeks, giving us 96 recall visits a week the practice should be seeing. If the average hygienist can reasonably see about eight recall patients a day, 96 divided by 8 works out to 12 full days of hygiene a week that this practice should be running.
Here's the important part: this practice currently runs six days of hygiene, so you might assume they're at roughly 50 percent of where they should be. It's actually worse than that, because remember, this scenario already has the hygienists handling soft tissue management, scaling and root planing, and new patients alongside recall visits. Those 12 days represent recall visits alone, new patients and soft tissue management sit on top of that. So the practice should be running 12 days of hygiene, but it's not even truly running six full days of recall within that six.
From there, we want to know this doctor's actual compliance percentage. They should be seeing 96 recalls a week. So we'd ask the doctor to check their actual average, I like using a four month window since it's a large enough sample, but let's use the last three months here. Say they're averaging 30 recalls a week over that period. Divide 30 by 96, and you get a compliance rate of 31.25 percent. Just over 31 percent of this practice's patient base is being seen on any regular basis in hygiene, meaning nearly 70 percent are not.
You might think some patients are simply on an annual schedule rather than six months, and that's true for some, but even accounting for that, out of 4,800 potential recall visits, this practice is really only producing about 1,250 a year, 30 a week, at 31 percent compliance. That means roughly 70 percent of this practice's patients are either irregular, not showing up at all, or effectively gone. And remember, this doctor is still getting some new patients and referrals in the meantime, but they spent real money acquiring those patients in the first place, and comparatively little keeping them once they arrived. That's the core problem.
Let's extrapolate further. At 31.25 percent compliance, seeing 1,250 recalls a year instead of a potential 4,800, what would it actually mean to get that up to 80 percent compliance, roughly 77 recalls a week? I won't walk through every step of that math on a podcast, but the answer comes out to roughly an additional $450,000 a year in hygiene production alone. And that doesn't even account for the treatment those returning patients would need once they're back in the chair. If you had to present a treatment plan to a patient who's already been in your practice before versus a brand new patient, which would be easier to get accepted? Nine times out of ten, it's the existing patient, even one who hasn't been especially consistent about showing up.
So the real point here is that simply providing great customer service isn't enough on its own to retain patients, that's often the instinct, if we treat people well, they'll naturally want to stay. Unfortunately, that alone doesn't hold up. You need a continuous, consistent series of reminders, and someone actually has to put real effort into it to make sure patients actually come back.
I'm often asked how much effort that actually takes. Go back to the scenario I gave you: a doctor who should be seeing 4,800 recalls a year and is only seeing 1,250. If they paid an employee $40,000 a year specifically to get on the phone and schedule hygiene patients, and that employee brought compliance from 31 percent up to 80 percent, that would add somewhere around $400,000 to $600,000 a year in collections, once you factor in the dentistry that comes with those returning patients, for a $40,000 investment. That's genuinely one of the better returns available in a dental practice.
I've seen a number of MGE clients handle this exceptionally well, and when it's done right, it can be an enormous boost to the practice. Most importantly, it actually gets people healthy, which fulfills the whole reason you're there in the first place.
That's my take on this for this week's episode, I wanted to keep it relatively short. I do have a downloadable spreadsheet of the hygiene formula on the episode webpage where you can plug in your own numbers and see your actual hygiene department compliance. We also cover this subject in real depth at the MGE New Patient Workshop, which you can find at newpatients.net, I'll have that link on the episode webpage too.
Otherwise, folks, put some real attention on your hygiene department. If you'd like help with it, you can call us here at MGE at (800) 640-1140, or email me directly at jeffb@mgeonline.com. I'll see you at the next episode. Thanks.