You don't have the time…

The days of simply hanging your shingle and expecting everything to work out are just a memory.

by Roger P. Levin, DDS


The days of simply hanging your shingle and expecting everything to work out are just a memory. Not long ago, a dentist could graduate from school with a reasonable amount of debt, open a practice, have the practice grow consistently, repay debt, and garner a profit that supported a comfortable lifestyle. While some dentists did not necessarily save enough toward retirement, the opportunity to accumulate income was always available throughout their careers.

Today, a great deal has changed. Dentists are experiencing higher debt with much longer repayment periods. As dental school costs climb higher, the debt incurred by dentists has shot up to record levels. When combined with the current recession, increased competition, and, in some cases, lower insurance company reimbursements, these "game changers," which I wrote about extensively in the October issue of DE, have created a more challenging environment. As months and years roll by with flat or decreased production, dentists do not have the time to wait to grow their practices.

New methods for a new economy

Every type of business, including dentistry, faces new realities. The strategies for growing a dental practice even a few years ago are no longer working. The fact is that new realities call for new methods. To grow in today's economy, practices must get more out of what they already have. They should:

1. Adopt the 3-Step Accelerated Practice Growth Method

The latest Dental Economics/Levin Group Annual Practice Survey indicates that the number of new patients enrolling in dental practices has declined by nearly one third over the last several years. Obviously, dentists don't have the time to wait for things to simply get better. They must be proactive by adhering to the 3-Step Accelerated Growth Method, which consists of:

I.Targets – Metrics to be achieved that are set and assigned to individuals so that accountability takes place.

II.Systems – Step-by-step, documented operations are established and the team is trained to work with them. Systems should include checklists to make current and new staff members more productive and efficient in their jobs.

III.Value creation scripting – Scripts that train the team to not only communicate information to patients, but also influence them. The objective is to have patients make appointments, follow through with treatment, pay balances, adhere to office policies, and refer others.

The 3-Step Method represents a prime example of dental practices doing more with what they already have. For example, consider one target that Levin Group teaches its clients -- double the average production per new patient. Most practices bring in new patients through the hygiene department. The doctor conducts a relatively brief new patient exam, completes any identified treatment accepted by the patient, and the patient is placed in a dental hygiene program. While reasonably effective, practices that wish to increase production must take another approach.

Imagine a scenario where the first new patient phone call is tightly scripted to build value and create trust. These elements are rarely part of a new patient phone call, as Levin Group identified in a recent study of more than 500 front desk conversations. While virtually all of the front desk people were courteous and focused on scheduling the appointment, most participants did not attempt to create value or trust in the practice, the doctor, or the team.

If you feel that your office is the exception, ask yourself, "Does the patient know any more about my office or me by the end of the first phone call?" In most instances, not enough value is built for the practice.

2. Implement strategies for follow-up

Patients are contemplating recommended treatment much longer, and they frequently put it off. When this occurs, they often do not follow through at a later time. At that point, these patients simply fall off the practice's radar.

Most practices have either nonexistent or poor follow-up systems. Practices need to institute:

  • 1-day rules -- Most practices have a growing number of patients who are overdue for appointments. When patients are overdue by one day, a follow-up program should be in place to ensure these individuals receive an immediate phone call. Levin Group refers to this as a 1-day rule.
  • Rule of 3s -- If the patient is not reached, the 1-day rule shifts to the Rule of 3s -- three phone calls once a week for three weeks, three emails for three weeks, and three letters for three weeks. Using these techniques, Levin Group clients reclaim approximately 85% of all patients who are overdue for appointments.

These strategies are about reestablishing communication. Dental practices need to create regular contact with patients that results in higher patient retention and interaction with the office, which will lead ultimately to increased production.

3. Ramp up patient referrals

Your current patients are the most reliable source for finding new patients, and they should be referring in much higher numbers. I suggest a target of having 40% to 60% of patients referring at least one other patient per year. If a practice falls below this target, it would indicate an ineffective marketing program. Whether it is fee-for-service or insurance patients, a properly implemented marketing program will stimulate referrals. These patients like and trust the practice and are more than happy to refer others.

To increase patient referrals, Levin Group recommends effective marketing that includes:

  • Implementing a minimum of 15 ongoing strategies throughout the year to drive patient referrals. Less than 15 strategies results in inconsistent referrals.
  • Budgeting 3% to 6% of last year's production for your internal marketing program. This allows for the best return on investment.

The old saying, "Out of sight, out of mind," holds true in marketing. For that reason, dentists need to have an effective marketing program that promotes their practices often and consistently.

4. Redesign case presentation when necessary

For example, it is usually unwise during a new patient's first visit to present treatment if it exceeds $1,000. That is simply too much, too soon. Remember that two or three appointments may be necessary, depending on case size relative to the level of fee. At one time, many dentists would not have devoted so much time to presenting cases. Today, different circumstances demand different approaches.

Remember that current patients have a great deal of dentistry remaining to be completed. In fact, information culled from the Dental Economics/Levin Group 2012 Annual Practice Survey indicates that only 18.8% of procedures in general practices are for elective services. The untapped potential in nearly every practice is enormous.


Dentists today simply do not have the time to fix their practices. We have entered an era when dental practices are more challenged and complicated than ever before. In addition, dentists are dedicated to treating patients throughout the day and have little time to thoroughly analyze their practices' strengths and weaknesses, and they certainly do not have time to create or supervise changes. This is one of the reasons that practices are performing poorly in the new economy.

Dentists also do not have the time to wait out the current economy. Dental practices will never go back to the way they were just a few short years ago. They will be able to perform extremely well and increase production rapidly if and only if they are treated as businesses that leverage effective methodologies and management systems.

There has never been a time in dentistry that is more pivotal than the one we currently face. Practices that embrace proven methods of ensuring practice growth will be assured of a bright, productive future. Those practices that do not address these issues will be waiting for improvements that will never arrive.

To learn how to run a more profitable, efficient, and satisfying practice, visit the Levin Group Resource Center at -- a free online resource with tips, videos, and other valuable information. You can also connect with Levin Group on Facebook and Twitter (@Levin_Group) to learn strategies and share ideas.

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