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Patient attrition: 3 steps to finding a hidden gold mine

June 1, 2019

Brett Wells, DDS

For most of us, “attrition” brings to mind parafunctional habits, occlusal guards, and worn dentition. However, there is another form of attrition that we should be even more concerned about: patient attrition.

In part one of this article published in the May issue, we identified the problem of patient attrition, and outlined a three-phase approach to mitigating it: analysis, prevention, and reactivation. We discussed how to analyze your practice to determine the extent of your attrition issues and spotlighted three prevention strategies to get you on your way.

In part two, we spotlight two more effective prevention strategies, and then discuss how to reactivate those patients who have already left.

Phase Two: Prevention—don’t let them leave

As we mentioned in part one, the best way to solve the problem of patient attrition is to not have the problem in the first place. Of course, there will be some patients who will leave your practice no matter what you do—they’re moving out of the area, etc. But most of the time, if you make a concerted effort to focus on retention, you will find your attrition rate numbers declining. Here are some more focus areas I’ve found to be particularly effective:

See your patients on time. I know—this is a struggle. The balance between keeping our schedules full and giving our patients a great experience with little wait time is something that we all deal with, but it’s something worth working on. Studies show that for every 10 minutes you keep your patients waiting, there is roughly a 10% reduction in the likelihood that the patient will recommend your practice to a friend.1 Patients who are seen after their scheduled appointment times also have lower satisfaction levels with their dentists and are less likely to return for follow-up care.2

If you are running late, you should relay this to the patient immediately. Giving gift certificates for local coffee shops or other tokens of apology goes a long way in tempering your patients’ frustration.

It’s also important to measure your timeliness. You may discover that, for example, one hygienist is more likely to run behind than another, or maybe you tend to run behind schedule more on Tuesdays than on any other day. This information can help you pinpoint where you need to improve.

Make sure everyone leaves with an appointment. A recent unpublished study on increasing practice production by the Levin Group Data Center found that their top 25% offices had higher preappointment rates than the lower 75%. More specifically, practices that produced over $1 million per year had 92% or more of their active patients on the schedule for their next appointments.

Dental Intelligence, a dental practice management software company, has also found that the most important factor in reducing patient attrition is to improve hygiene preappointment rates. The average hygiene preappointment rate across all of their clients for the first three quarters of 2018 was a dismal 58%. Its analytical team determined that, for a mature dental practice, an increase in the hygiene preappointment rate of just 10% could lead to doubling a practice’s active patient count in five to seven years. Reread that last sentence, and let the importance of preappointments sink in.

Every attempt should be made to make sure your patients have their next appointments scheduled before they walk out the door. If they don’t have the ability to make their follow-up appointments that day, then have a system in place to follow up with them to get their next appointments scheduled.

Applying these prevention strategies in my practice—along with those outlined in part one—has dramatically reduced our attrition rates. The great news here is that none of these strategies are difficult to implement—a little focused effort and planning can go a long way to help your practice as well.

Now that we’ve reduced the patients leaving your practice, it’s time to focus on getting those patients who have already left back in your chair. If you think of your practice as a bucket, we’ve repaired the hole in the bottom (or at least made it smaller), and now it’s time to scoop up the water that leaked to the floor. It’s time for reactivation.

Phase Three: Reactivation—call it a comeback

You’ve looked at the numbers and become aware of the large number of inactive patients in your practice. Now pick yourself up off the floor, and let’s come up with a game plan to get them back in your chair.

Per Dental Intelligence, the national average for reactivating inactive patients is a mere 20%. While one in five seems like poor odds, this number can be improved through smart reactivation strategies. Before starting, though, we need to change our mindset—we should look at these inactive patients not as failures but as opportunities.

I spoke with Laura Hatch, the founder of Front Office Rocks, a dental front-office training company, regarding systems that she recommends to get these patients back into your office. She first wants to remind us that the cost of reactivating these patients is far less than the cost of acquiring new ones. These are people who have been in your office, are comfortable with your team, and are much easier to get back in the door than someone who has never seen you before.

Your first step should be identifying someone in your office to be in charge of reactivating your past-due patient base. Once you have identified this person (or team), make sure to give him or her time each day or each week to work only on reactivation. Companies such as Dental Intelligence make it easy to filter and assign unscheduled/inactive patients to individual team members who are responsible for following up and calling the patient.

Next, identify your unscheduled/inactive patients and determine how likely they are to return. Someone who hasn’t been into your office in 10 years is far less likely to return than someone you haven’t seen in 10 months. I recommend starting with patients who have been seen in your office in the past six months and left without scheduling their next appointment. Move on in six-month increments all the way up through patients whom you haven’t seen in three years. You can go as far back as you would like, but three years seems like a logical stopping point.

Chances are, some of these inactive patients will have left your practice because they don’t have insurance and feel like cost is now an issue. In my case, our office offers in-house membership plans through DentalHQ (see part one for more details on how membership plans can help with the prevention phase). Explaining the affordable monthly payments has already gotten some patients back. The easy-to-use tools, such as templated reactivation emails, and easy-to-understand cost structure really helped those patients see the value in our office. Membership plans can be exactly the “hook” you need to reactivate fee-for-service patients.

Once you’ve identified the group of patients you will reach out to, Laura recommends that you contact them at least one time a month both with a phone call and an email or text. Of course, the phone call is likely to go to voicemail, but leave a message! It is important that the patient hears that the doctor and team are concerned about them and want to get them scheduled.

It might take a while, but Laura says that “it is important that it is done at least once a month so that the patient is reminded regularly about the importance of coming back and that we miss them. We want to get the message across to them that they are important to us and always welcome back.”

Final thoughts

Patient attrition is a huge problem in our profession. Most of us are spending thousands of dollars annually on outside marketing efforts to fill our schedules while taking for granted the patients we already have. Before spending another dollar to fill our buckets, we must fix the leak.

This is a very correctable problem and doesn’t have to cost you any money to fix. As dentists, we have a tendency to get set in our ways and become complacent with the business side of our practices. I know I sure did.

As insurance reimbursement rates go down and the prevalence of corporate dentistry increases, we must begin to analyze and measure our practices to compete and stay profitable. By combining a well-thought-out marketing plan for new patients and creating well-defined systems to reduce attrition and address reactivation in our practices, we can all achieve explosive growth and increased profitability.


1. Gritters J. The cost of long wait times. AthenaInsight website. https://www.athenahealth.com/insight/cost-long-wait-times. Published July 3, 2017.

2. Inglehart MR, Lee AH, Koltuniak KG, Morton TA, Wheaton JM. Do Waiting Times in Dental Offices Affect Patient Satisfaction and Evaluations of Patient-Provider Relationships? A Quasi-experimental Study. J Dent Hyg. 2016;90(3):203-11.

Brett Wells, DDS, is a practicing dentist and founder of Wells Family Dental Group in Raleigh, North Carolina. More recently, he founded DentalHQ, a software platform that lowers attrition rates by enabling dentists to easily create and automate their own in-house membership plan.

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