Dr Phillip Palmer, August 2012
A common business maxim that gets thrown around is that it costs 5-10 times more to get a new client (or patient) for your business than to keep an existing one and yet as dentists we often spend our time, energy and money marketing and advertising to get new patients to fill the gaps in the book. What about looking at how many patients are leaving you and why and how to plug these leaks in your practice?
All practices have a degree of patient attrition. What most practices don’t know is that it is really easy to measure this figure. In order to explain how to do this, I first need to introduce the concept of active patients. A patient is considered an active patient of yours if they have been in the practice in the last 18 months. They are counted as a single active patient regardless of if they have been in once or 100 times. Sure, there are some people that haven’t been in the practice for 5 years who still consider themselves patients of the practice, but these will be balanced out by the patients that you saw in the last 18 months who will never come back. Most of the major dental software packages allow a dentist to get the number of active patients the practice at the push of a couple of buttons.
If you get from your software the number of active patients your practice had a year ago (X), and add in the new patients you have seen in the last 12 months(Y), then the number of active patients you have now (Z) should be X+Y . Usually it isn’t. Usually it is the same as it was a year ago and sometimes less. This difference: Z-(X+Y) is your patient attrition over the past year.
We have found that the average practice loses 15-20% of their patient numbers every year. Why does this happen? Sure, some patients will die, and some will move out of the area. But no one would truly believe that deaths and patient moving out of area would amount to 15-20% of our patients.
So what is happening to the rest of our patients? Where are they going? Why are they leaving us? And what can we do about it?
Unfortunately dentists (like most business owners) have blind-spots when it comes to the weaknesses of their businesses, and find it hard to accept that the service their practice provides is not as good as it should be. We frankly upset our patients in a myriad of situations that may not be obvious to us as business owners but that we would not put up with ourselves if we were in the patient’s shoes. Below is a list of the top ten reasons why a patient may consider leaving your practice.
1. Running late
Time is valuable to all of us, including our patients. Patients don’t like it if they rush to get to their appointment on time, only to sit in your reception area or in the treatment room waiting for their dentist to be ready to treat them.
Don’t assume waiting is something patients expect as part of the deal when they go to the dentist. Take steps to let them know you understand their lives are busy and make sure that they don’t have to waste their precious time sitting around.
2. Chastising staff in front of patients
This may seem obvious, but happens more often than one would think. There is nothing so embarrassing for a patient (as well as for the team member) than to be present when a dentist’s employee is being criticised. Equally, it is a real confidence-builder to hear an employee praised by their boss in front of a patient. There is an old rule of “criticise in private, praise in public” when it comes to providing feedback for staff.
3. Poorly trained staff
Many dentists feel it is not worthwhile spending money training their staff. They often make comments like “what if you train them and they leave?” Frankly the converse is true...what if you don’t train them and they stay! Having untrained staff decreases the service level provided to patients and adds to the stress levels of the patients, other staff members, and especially the dentist
4. Not explaining your fees to patients before treating them
This is a big problem which is complicated by the fact that many dentists feel uncomfortable discussing fees with patients. Dentists need to remember the adage "inform before you perform'. Imagine going to any professional (or any service provider) and on leaving being told,without prior warning, of a substantial bill having been incurred. This is one of the biggest gripes on online review communities, and from the patients’ point of view, entirely valid. There are many times a dentist can't be precise with their estimation of costs, but at the very least, all patients should be given, a range of fees that their treatment may come to.
5. Talking technical jargon to our patients
Patients would like to understand what is happening in their mouths, and dentists typically use technical jargon when explaining treatment and options. The jargon does little to shed light on what’s happening for the patient and will often confuse them and build mistrust. Your patients will be far more likely to understand their situation and trust your solutions if you use simple English!
6. Having too little time for the patient
There is nothing better for the long-term dentist-patient relationship, than the patient feeling that the dentist always has time for them. That they are not ‘rushed through’ and given the feeling that the dentist is under time pressure.
7. Selling them solutions to problems they don’t perceive they have
Firstly patients don’t want their health provider ‘selling’ them anything. Let alone a solution to a problem that hasn’t even been explained to them. And yet many dentists do this regularly when they are charting. Often treatments are charted by the dentist when calling out to the DA, before the dentist has explained the issue to the patient.
8. Not being available at a time that suits the patient
Our patients may like us, may think our service is good, and our practice is fine in nearly every regard, but still leave us as they can’t get time during our opening hours to come and see us. Everybody leads busy lives these days, and lack of flexibility and availability can cause patients to look elsewhere, especially in an emergency situation.
9. Facility looking dated or messy
Like it or not the public will make judgements of every business based purely on appearance.
Your patients view the practice as an extension of you and your clinical abilities.
What judgements will they make of a practice that has a dated aesthetics, equipment, technology or furniture in the waiting room? What association will they make of a practice that isn’t clean or well-maintained.
10. The fees are perceived to be too high
When we look at online reviews of dentists anotherof the most common complaints people have of dentists has to do with the fees of the practice. In the absence of a relationship between the patient and the practice, then the only thing that can be measured by the patient is the price. If however there is a relationship and trust has been built between the parties, then patients will drive past many cheaper practices to go to the dental practice they trust. It is imperative that dentists develop skills and take time to quickly form relationships and develop trust with their patients.
Unfortunately, dentists only hear from the patients who keep coming back.
Most patients who leave, do so quietly, and without warning. And dentists usually don’t know why.
So how do you find out which of these are relevant to your practice? The best way is to ask your patients via anonymous patient surveys.
Then you can work on any weaknesses that the survey exposes. Practice surveys can as simple as a templated tick-a-box questionnaire left at the front desk or it can be emailed post visit.