Ep. 16: 6 Metrics for Practice Success, Pt 2
Special guest Jeff Santone is back to wrap up the six key metrics for assessing the health of your dental practice. In this episode, they focus on your measuring performance at acquiring and retaining patients.
Topics:
0:44 – What is “call conversion rate” and how do you measure it?
16:52 – How many patients are you losing? Measuring your attrition rate
Links:
Download the New Patient Call Log - https://www.mgeonline.com/np-call-log
Learn more about MGE - https://www.mgeonline.com
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Questions From This Episode
Why does Jeff Santone say the true purpose of marketing is just "making the phone ring"?
He argues that once a marketing dollar gets a patient to actually call the office, that specific investment has done its job, whatever happens next is a separate issue. That's why he recommends tracking every call at the point it comes in, rather than judging a marketing channel only by how many patients it eventually converts to new patients.
What information does Jeff Santone recommend including on a new patient call tracking log?
At minimum: the date and time of the call, which staff member took it, the caller's name and number, how they heard about the practice, why they're calling, whether they scheduled, and critically, whether they actually showed up. He built his version in Excel and printed a fresh copy every week so it never got accidentally overwritten or lost.
What does Jeff Santone say it means if an office reports an unusually high schedule rate, like 90 percent?
In his experience, that's often a red flag that staff are only logging calls that actually turned into a scheduled appointment, effectively keeping a "new patient scheduled log" rather than a true call log. Calls that don't convert, like someone asking about pricing and hanging up, need to be logged too, or the office has no real way of knowing its actual conversion rate.
How does Jeff Santone recommend a newer client quickly estimate their churn rate?
Pull the number of unique patients seen over a set window, he suggests two years as a fair standard, and ask how many of them currently have any future appointment on the books. In one example he shares, a doctor who'd seen 1,200 patients in ten months assumed nearly all of them were still active, when only 700 actually had a future appointment scheduled.
Why can a practice's churn problem go unnoticed even when the schedule looks completely normal?
If a practice is bringing in as many new patients each month as it's quietly losing to attrition, production and scheduling can look perfectly steady, masking the fact that a large share of the existing patient base is walking out the back door. Jeff Santone says both doctors and staff tend to badly overestimate how many existing patients are actually still active, since nobody is specifically tracking the number.
Episode Transcript
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Jeff Blumberg: Welcome to this week's episode. This is part two of two on Six Metrics for Practice Success, and I'm joined by Jeff Santone, MGE's New Client Services Executive. If you missed part one, that was last week's episode, I'd definitely recommend picking it up. Jeff, you're all hooked up over there?
Jeff Santone: Yeah, I think I'm good. Do you hear me?
Jeff Blumberg: Yes, alright, good. Just to catch everybody up, since some people might listen to this without going back to last week's episode, but I'd still recommend it, we covered four of the metrics last time: the basics, production, collections, new patients, and some really good metrics on case acceptance. The last two we're covering this week are specifically about patient volume. Why don't you start with the first one?
Jeff Santone: The first one I really like is call conversion rate, for new patients specifically. It's a bit of an unrealized potential, because we're looking at how many patients called the office who could have become new patients but didn't.
Jeff Blumberg: We actually did a whole episode on this, I think it was episode two or three, where we had you on to talk about the fact that the average call conversion rate in the US is only 23 percent. Which is just terrible. In other words, out of a hundred new patient phone calls, the average office only schedules 23 of them. We talked about the problem, since you were doing all those mystery calls, and then Sabri came on with solutions for how to improve that conversion rate. But we never actually talked about measuring it.
Jeff Santone: Right, so let's give everyone some real data on what to look for when you're assessing a practice on this. When we talk to practices, it's either they're doing it or they're not, and it's actually a good question we ask at the New Patient Workshop too: what's the actual purpose of marketing? Why are you here today, what are you trying to get out of it? Everyone says it's to get new patients, but that's not really the purpose of marketing. The purpose of marketing is to make the phone ring, that's it. Once the phone rings, marketing has done its job, that $10,000 you spent did its job. So there needs to be some way of tracking that to confirm marketing is actually working. You can't just assume someone walked in because of a postcard, that basically never happens, they're calling. Or someone tells you they saw a billboard and now you assume the billboard's worth every dollar. No, you need some actual mechanism: the phone rang a hundred times, how many people said they saw the billboard, whether they became a new patient or not, that's a separate question entirely.
Jeff Blumberg: If I can jump in for a second, I think this is done really poorly across the industry. There are call tracking systems, and beyond the fact that most people don't even listen to their own recorded calls, which we covered a lot in episode two, I'd survey new clients and usually find maybe 20 percent, or less, regularly listen to calls. But even the call tracking system itself doesn't give you all the data you need. Not every new patient calls off that dedicated new patient number, especially if it's a referral, say I become your patient, the number I actually have saved is just your regular office line, not some tracked marketing number.
Jeff Santone: Right, so someone actually has to track all the calls coming in manually.
Jeff Blumberg: I just wonder who actually does that.
Jeff Santone: That's exactly what we're trying to teach them to do at the New Patient Workshop. Even the best offices are going to miss logging a call here or there, that's expected. But if you do at least the bare minimum, put a new patient call tracking log at every phone that could handle a new patient call, you're at least training the staff around the idea that when a new patient calls, you want that information captured. First and foremost, you need the log itself. Second, you have to make it genuinely safe for staff to make a mistake, it's okay if they forget one, nobody's getting their head ripped off. I think a lot of these things go unreported out of fear, fear of losing a job, getting yelled at, being disciplined in front of other people. So I always make it clear: the most important thing is filling out the log, whether the patient showed up or not is a separate, totally relevant, but separate question.
Jeff Blumberg: So what would this log actually look like?
Jeff Santone: I ran mine on a weekly basis. This is where I'll get a little detailed, even for a GP office, but you'll appreciate this since you like numbers. It's one of the few statistics in the entire organization that actually predicts the future of the organization. The more phone calls I get this week, the more new patients I'll get next week. There aren't many stats in a dental practice that work that way, most are just a snapshot, this is what happened, period. So I ran almost every office I owned or operated heavily off that call log, because I could predict a problem coming and course-correct faster, make sure we weren't about to hit a dip.
What I found valuable: I kept it labeled, built in Excel, formatted landscape.
Jeff Blumberg: So you used an actual spreadsheet, not a paper log or a PDF?
Jeff Santone: I built it in Excel, then printed it out fresh every week, because I didn't want it overwritten, deleted, or lost. We were a big enough office that I only needed the one, but if I were smaller, I'd have had one at every phone, and rather than trying to consolidate it all onto one sheet and losing data in the process, I'd just staple them together and call it done.
Jeff Blumberg: So we've got this spreadsheet, we'll make it available for download, both a printable version and the digital Excel version, on the episode webpage. What information actually needs to be on it?
Jeff Santone: To keep it simple for yourself, and I mean this in the laziest, most efficient way possible, I had my rows numbered, I think I could fit about 40 to a sheet, front and back, so I could quickly total up how many calls we got, sometimes 80 calls in a week. Then date and time, so if I do have call recording and want to go pull a specific call, I've got the timestamp to find it. That's really the whole point of call tracking, you see ten calls logged and none scheduled, that's when you go pull those recordings and find out why.
Then the staff member's initials, whoever took the call, quick and simple. From there, the potential new patient's name and phone number. How they heard about us, what made them call, were they online, what did they specifically search, did they see the billboard, hear the radio ad, whatever it was. If you only run a handful of ad channels, put them right at the top as columns so staff can just check a box, and the totals sum automatically at the bottom. I always finished with "why are you calling," since that opens the door into the actual conversation. Then: did you schedule, yes or no. And most importantly: did you actually arrive. A lot of people will schedule, that's not hard, but did they show. That can completely change your real number, you might think you're at 80 percent and actually be at 60. It also lets you pinpoint exactly where things are breaking down, whether it's the scheduling conversation itself or people scheduling and then not showing up, so you can debug further from there.
That was the log I ran, and to me it was gold, worth its weight in gold. I scanned it into the cloud every week and kept the physical copy in a three-ring binder for the year, then filed away until I actually needed it. That log represents real unrealized potential: if I'm getting 40 calls a week and I'm just not that good at scheduling, and I'm only getting 10 people in the door, that's 30 patients a week I didn't capture, 120 a month. I'm never going to convert all of them, but maybe I could have gotten half, 60 more new patients that month. It's a huge unrealized opportunity in the practice, and it's a conversion ratio where doubling it literally doubles your new patients. That's exactly what we cover at the New Patient Workshop: how to actually answer the phone, and how to make that log work for you.
It's actually a fun log too, because it lets you debug your marketing the same way we talked about solving mysteries last episode, where's the mystery in case acceptance, well here's the mystery in your marketing, why aren't we getting new patients? I look at the log to find out.
Jeff Blumberg: Let me be a little cynical for a second here, because I've seen this play out three different ways. I've seen offices that keep the log religiously.
Jeff Santone: And I'll comment on that in a second, since I'm very familiar with this pattern.
Jeff Blumberg: I've also seen it where it's "oh, I forgot, oh, I forgot, oh, I forgot," over and over, no malice behind it, it just doesn't get kept up. And then others where it's, "why do I even have to do this, isn't the computer supposed to handle it," like we're living in Star Trek or something.
Jeff Santone: Right, because the computer doesn't do this, it can't, you still need an actual human to do something like this. But part of the issue in every one of those cases really comes down to a key implementation point: when you introduce something new, you have to keep reinforcing it, over and over. The example I'll often give a client is starting a new daily meeting, a morning huddle. You do it one day, skip the next, do it again the day after, by day four, people just won't show up. Not everyone, but some. I've had my own morning meeting since 1998, and if it ever gets moved out of my office into the conference room, I'll have people wander in going, "wait, what happened, I got moved?" Because when you place something there consistently, it becomes real to people. So if they're introducing a call log, they have to keep reinforcing it, do this, do this, everyone fill it out. And if someone still isn't doing it after that, then you've got a different, separate problem to deal with.
But you're right, the value of this thing is unreal, because nothing else captures this information. What I loved about it, and any owner would appreciate this: your Google rep calls and says it's time to re-up your ad account, and now you're wondering, is the marketing actually working, is it really not working? Go to the call log and find out. Turns out Google made the phone ring 70 times last month. Let's see who actually took those calls. Looks like Mike handled 40 of them and scheduled zero. Julie handled the other 30 and scheduled 15. So Mike's off the phones, Julie's the one who needs to be on them. You've just debugged your marketing in an instant, it wasn't a marketing problem at all, it was a staffing issue. And that's exactly what we teach at the workshop, it's not that Mike's banned from the phones forever, just go listen to four of his calls, write down what he's missing, drill him on it for an hour, done, Mike's back on the phones. That's the real value: figuring out whether it's your staff that isn't working, or the marketing itself that genuinely isn't working, and knowing which marketing spend to actually cut.
One caveat worth mentioning, this was always my red flag indicator: I'd sit down with an office and they'd proudly tell me, "we have a 90 percent schedule rate." And I'd laugh, because what you actually have is a new patient scheduled log, not a new patient call log. Someone's only adding a name to it if the call turned into a scheduled appointment. So John Doe calls, asks the question everyone hates, "what do you charge for a crown," gets told "it's hard to say without an exam," pushes, "well how much roughly," gets a number, says thanks, and hangs up, that call never gets written down at all. It should. At minimum, log John Doe, note whatever number you got off caller ID, and if you're lucky, catch that it came in through a Google paid ad, so it's not fair to say Google's not working, Google did its job, the front desk just needs to know how to actually handle that conversation.
Jeff Blumberg: And that's another built-in check, if your schedule rate is running unusually high, what was your cutoff?
Jeff Santone: Anything over 80 percent was my red flag. If I had 10 calls and allegedly 8 got scheduled, or 100 calls and 80 scheduled, either I had the single best receptionist in the history of receptionists, or something wasn't being logged correctly. Meanwhile the show rate might tell a completely different story, say the schedule rate looks great but the actual show rate is more like 60 percent, that's a separate problem to solve. But that call log was genuinely gold, the single most valuable statistic I tracked daily as an office manager, right alongside what's scheduled for production and collections. I could look at it and immediately know: are the phones ringing, what's actually happening, and it opens the door to doing something about it.
I tell people at the workshop, if you get good enough at this, you'll know your rhythm, say you consistently get 40 to 60 calls a week. It's Wednesday and you've only had two. You have a problem, and you know it on Wednesday, you don't have to wait until month's end to realize something broke.
I'd go through a whole debugging checklist when that happened. My first move was always calling every single phone line myself. Funny example: the phones just stopped ringing one time, so I started calling in, we'd just added three new Verizon lines, going from four lines to eight because we needed extra capacity for the fax machine, insurance companies still require faxes in certain cases, believe it or not. Turned out the lines weren't rolling over properly past line four, so if four people were already on hold, every other caller just hit a busy signal. Had to call Verizon and get it fixed. Those are the kinds of crazy troubleshooting checklists you end up running, but I only caught it early because I knew, by Tuesday or Wednesday, we were already running below our average call volume for the week.
So if you're keeping a phone log, you can track total call volume, cross-reference it against call recordings, see who took each call, who scheduled, and who actually showed. You can diagnose a problem, or just as usefully, figure out why things are going well. That total column might show, wow, 50 calls this week, word of mouth is clearly working, 20 people mentioned a specific referral source, and word of mouth is about the best new patient source there is. So you can look at your marketing spend and say, this channel's genuinely earning its keep, or, this one's doing nothing, cut it.
That call log is hugely important, but it only covers one side of it, the unrealized potential on the front end. The other side is true churn, patients you had who are now gone, which is what we're getting into next.
Jeff Blumberg: So that's our first metric for this episode, new patient call conversion rate. You can download the call log from the episode webpage, start tracking it, and keep it disciplined. You'll miss a call here and there, sure, but that should be the exception, not the rule. Now, you brought all these people in, where do they go? You mentioned churn rate, can you explain what you mean by that?
Jeff Santone: What I love about the general dentist model, compared to a specialty model, is that there's an actual trajectory to it, you can extrapolate forward, predict roughly what the practice will look like six months from now based on what it's doing this month. We know that because we're supposed to have a solid recall program running. When I talk about churn rate, I mean patients who've quietly fallen off that recall cycle entirely, where did they go? In the tech world, churn rate just means what percentage of your customers you're losing, dropping off. It's actually really easy to calculate for a dental practice. I think you covered this in a past episode too.
Jeff Blumberg: I don't remember the exact number off the top of my head, but I believe it was called "Are You Losing Patients?" We walked through exactly how to calculate patient loss in that one.
Jeff Santone: Right, but that ran clients through the full hygiene formula. With a brand-new client, you can't really do that yet, that data's not readily accessible early on. When you just want a fast read on churn rate for a newer client, here's the easiest way I've found: you can run it on whatever timeframe you want, a week, a month, year to date, three years, totally your call. If I were picking a window for a new client, I'd go back two years. It's a reasonable expectation, someone who was in the practice two years ago should still reasonably be considered part of the practice.
Jeff Blumberg: And that lines up with how "active patient" typically gets defined, without getting into the full definition from that other episode, but by convention, when you're purchasing a practice, the standard used for an "active patient" is usually whether they've been seen within the last two years.
Jeff Santone: Right, and as a buyer, that's a genuinely fair number. As a previous practice owner myself, I'd have been completely ruthless and gone back five years, but that's a different conversation. As a purchaser though, if you couldn't get someone back in from three years ago, you shouldn't be counting them as active. So two years is a fair, standard method.
Say we pull the number for two years and find 2,400 unique patients seen in that window. Then I always ask: of those 2,400, how many currently have an appointment scheduled into the future, beyond today? We cut off at today, since anyone in the chair today is presumably already getting appointed. That's a great indicator of your churn rate.
The example I actually use at the New Patient Workshop didn't even need the full two-year window. I sat down with a doctor, not an MGE client, and asked to pull some numbers. This was only about ten months into the year, 2020, so more of my work was happening remotely then. They'd seen 1,200 unique patients year to date. That kind of data is genuinely easy to pull from most practice management systems, if you know where to look.
So I asked the group at the workshop to guess: out of those 1,200 patients, how many do you think currently have a future appointment scheduled? The first time I ran this exercise, I honestly expected people to guess optimistically, like all of them. And owners genuinely do tend to guess close to a hundred percent.
Jeff Blumberg: So you actually sat down with a real doctor and looked at their real numbers?
Jeff Santone: Yes. 1,200 patients over ten months. Out of those, only 700 had a future appointment on the books.
Jeff Blumberg: So roughly 60 percent, meaning about 40 percent simply never came back.
Jeff Santone: Right, out of 1,200 patients, only 700 had anything scheduled going forward. When I put that same question to a room, "out of 1,200 patients, how many do you think are currently scheduled," the doctors in the room usually guess close to a hundred percent. Practically one for one, because they're genuinely oblivious to it.
Jeff Blumberg: What about the staff?
Jeff Santone: The staff usually guess much closer to reality, in the range of a hundred to three hundred. They know, because they're the ones sitting on the front lines seeing it happen. This ties directly into your hygiene numbers and where your patients are actually going. Picture a doctor bringing in 50 new patients a month, feeling like business as usual, we're just as busy as we've always been. Meanwhile they're also quietly losing 50 patients a month, but since new patient volume offsets it exactly, nobody notices. Everything feels fine, couldn't be happier. That's exactly when you have to point out: you just lost 500 patients over the last ten months. "Yeah, but I gained 500 new ones." That's not actually a win, that's a treadmill.
Jeff Blumberg: At that point are you even functioning more like a specialist than a general dentist?
Jeff Santone: In a way, yes, and it's not a fun way to run a practice, but that's exactly what some of these doctors have unintentionally built: a new-patient-only business, constantly banking on fresh new patients just to replace everyone who's quietly leaving. So the moment they hit one slow new patient month, it really hurts, because they're already behind, the hygiene schedule starts opening up, and meanwhile hygienists are commanding $65, $70 an hour in some markets because demand is so high and you have to retain them.
Jeff Blumberg: I heard $70 in Southern California recently too.
Jeff Santone: And $65 in McLean, Virginia. That's only $15 shy of what a general dentist makes hourly in some cases. Not knocking anyone, demand is demand, but that's a wild number.
That churn rate metric is easy to calculate and genuinely valuable to track. If you were running a scratch practice from day one, you'd already be watching it closely. Where it tends to slip is once these doctors get genuinely busy, and I don't want to take anything away from that, they're heads-down through 10x loupes focused on something the size of a pinhead, and they have to trust their team to be watching the bigger picture. That said, you can't just hand that entire responsibility to staff, because as you pointed out, the team often doesn't actually know the real number either.
Jeff Blumberg: Which is funny, because you said the doctor guesses close to a hundred percent, and so does the team.
Jeff Santone: Right, everyone assumes it's roughly a hundred percent, since business as usual feels stable, nobody's actually watching the number itself. And it's worth saying, most practice management software can technically get you this data, some better than others, but the software companies don't exactly make it easy or intuitive to access, it's often buried in proprietary backend reporting. I used to tell doctors all the time: Patterson Eaglesoft, for example, has a patient master list, nearly every practice management system does, that's genuinely where I sourced most of my own data. On screen, it might only display seven columns, but if you export it to Excel, there can be 80-plus data fields attached to a single patient record, one of which is simply "last date seen," and another "next scheduled appointment." From there, sorting that list is trivial. If someone hits a snag figuring it out, a quick call to Dentrix or Patterson support will usually walk them right through it.
It really comes down to a simple headcount exercise, and these small metrics add up to a lot. Little things like this can genuinely make or break an organization.
Jeff Blumberg: And it can create a situation exactly like you described, someone genuinely believes they're doing fine, when in reality patients are walking in the front door and quietly out the back, and they have no idea, because on paper it all nets out even.
Well, this was great. So: new patient call log, start tracking that conversion rate, and then take a real look at your churn rate, how many patients you're actually losing, which you just gave everyone an easy way to calculate. You'd recommend a two-year window?
Jeff Santone: I'd lean toward two years, but honestly, even just looking at this week alone is useful: how many unique patients came in this week, and how many of them have a future appointment on the books? It's not a huge sample size, but it's a real, immediate indicator. Ideally they'd go back to the start of this year at minimum, two years if they're being thorough, three years if they're feeling brave, five years if they really want to know the whole truth.
Jeff Blumberg: Nobody's doing the five-year version.
Jeff Santone: I'd personally love to see it, but realistically, even just pulling this year's numbers is a great start. If you're listening to this in the car on your way into the office, when you get there, pull up how many unique patients you've seen so far this year, and how many currently have a future appointment scheduled, and see what your real number actually is.
Jeff Blumberg: And if anyone runs into trouble pulling this data or implementing any of it, you're happy to talk it through.
Jeff Santone: Absolutely, give me a call.
Jeff Blumberg: You can reach Jeff directly by email at jeffs@mgeonline.com, or call us at (800) 640-1140. We'll also have the link to download the new patient call log, along with everything else we mentioned today, the New Patient Workshop and the rest, on the episode webpage. I think that about covers it, any last thoughts?
Jeff Santone: Just one thing worth adding: this is really only part one of the exercise. Once you know where you actually stand, the next question is, what's the bare minimum we should be hitting six months from now? Turn that into a real challenge for the organization, get the whole office involved in hitting it. That's honestly one of the fun parts of being the owner, turning it into a game: "team, here's how many patients we should realistically be seeing six months from now, let's go hit that number." Money can absolutely be part of the reward for the staff, but you have to give the team something concrete to actually aim for.
Jeff Blumberg: Absolutely, that helps a lot. Jeff, thank you so much for joining me on this one, and folks, I hope you got something out of this, it's always fun talking with you, Jeff.
Jeff Santone: Always fun, thank you.
Jeff Blumberg: And we'll see you at the next episode.