Volume 69: Patients, Patience, Patients

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What do your patients think of you and dentists in general?  I recently heard this from a client, “I had a patient in one day last year. Since I wasn’t very busy that afternoon, I re-presented a huge case to him. Although he wasn’t sure about moving forward, I finally convinced him that this procedure was a good idea, proceeded to complete the procedure, and I had a very profitable afternoon. That is what efficiency and case presentation skills are all about!”

By the way, I never saw that patient again.  Anonymous Dentist.

Recently there was an awards night dinner where a semi-retired prosthodontist was honoured for an amazing 40+ year career. The dentist was smart, engaging, and gave a great speech. In his speech however he was very critical of the dental profession over the significant changes that have occurred during his career. He cited results from a recent IPSOS poll that confirmed that the public trust in dentists is at an all-time low, and near the bottom of the entire population!  It seems the reasons are varied, but came down to the fact that more and more, dentists are being perceived as business people focused on billings instead of treating basic patient needs.

I am somewhat surprised by these facts, as I am typically very impressed by the quality of the dentists that I meet. I am very impressed with their honesty and how they seem to have a sincere interest in the care that they provide to their patients. But unfortunately the poll results indicate that there is room for improvement.

How did the evolution happen? 

I think that one of the major reasons for the public trust issue is related to the increasing competitiveness of the profession.  As you are aware, the percentage growth of the number of dentists in Canada grew by at almost three times the growth of our overall population. This increase in population is even more pronounced in urban areas, which means that patients are in high demand, and there are fewer patients per dentist. In addition, dental offices are forced to operate more efficiently to maximize the use of their resources. 

As a result of fewer patients, dentists may feel the need to be more aggressive in treatment plans in order to generate more revenue. This aggressive nature may in fact be hurting their practice, and contributes to this poor reputation. It is well known that many patients leave their dentist because they felt they were being pushed into treatments. In some cases, treatment was accepted, but the patients felt remorse over being taken advantage of. In addition, we have had a stream of associates tell us that their employing dentists are pressuring them into finding extra treatment and procedures just to generate revenue.

We all understand that there are additional financial and competitive pressures today, but if the practice philosophy causes your patients to become less loyal and leave your practice, it is a problem. In addition, some patients may not leave, but they will not develop loyalty. Since over 70 per cent of new patients are from internal referrals, it is critical to retain as many loyal patients in the practice as possible. An unhappy patient who has not developed loyalty will certainly not be referring their friends or families to your practice, nor will they accept further treatment plans in the future. 

We see many dental practice owners who are happy to report that they get over 20 new patients per month, but in reality aren’t growing. Why? They have also lost that many patients who weren’t satisfied with the practice. While most patients may leave the practice for legitimate reasons, this is an important statistic and this information should be collected and evaluated, as it represents honest and important feedback. 

Based on an analysis of recent dental practice sales, we can tell you that high per patient billing practices typically do not realize extra value when the practice is sold. Based on recent sales, practices with billings of $800 per patient or more sell at a discount versus a similar practice with more conservative billings. Although the extra billings generate income, the value of the practice is moderated if the billings or procedures are not reproducible by market buyers. Furthermore, if an aggressive billing approach is causing patients to leave and not develop loyalty, the result is a reduction in practice value.

An approach to stay busy and to build more patient loyalty is to develop additional skills, technology and education that enables you to offer additional treatment when appropriate for your patient. This additional skill set may provide additional patient flow as it may be unique, and may provide a broader array of services to existing patients.

In terms of creating practice value, an approach that is proven is the development of a practice with strong hygiene, patient education, and preventative programs. I reviewed recent sales of similar larger practices and found that practices that had strong hygiene programs billing $200 per year or more per patient sold for approximately 20-25 per cent more than practices with hygiene billings of $175 per year per patient or less.  

There is a fine line between case presentation and aggressive presentation, and in some cases, patients need that little push, because of legitimate oral health concerns. The overall message is that current market statistics prove that a conservative approach with an emphasis on prevention helps builds patient loyalty, adds more new patients, and builds sustainable practice value. One other fact about a conservative approach is that the work that you defer today because the patient wasn’t ready will still be available for you tomorrow or in the future.

Patients treated with patience, leads to more patients.

The Professional Advisory

  1. One Year Later

  2. Dealing with Unsolicited Offers

  3. Covid-19 Practice Sales Update

  4. When is the Right Time to Sell Your Practice and Why?

  5. Partnership Pitfalls

  6. The Real Cost of a Dental Practice Set-up

  7. Smaller Practice Realities

  8. Dental Market Update - 2019

  9. Creating Your Own Most Valuable Practice (MVP)

  10. Small Practice Economics

  11. The Market is Very Efficient

  12. How Can Dental Practice Values be Rising and Declining?

  13. Hygiene as a Value Driver

  14. The Value of a Good Team

  15. Is it Time to Move?

  16. Staging A Dental Practice

  17. The High Cost of Dying

  18. Deal-Busters

  19. Patients - Attract and Retain

  20. Should I Stay or Should I Go?

  21. Is There a Buyer for Every Practice?

  22. Good, Better, Best - The Market has Spoken

  23. Smooth-Sale-ing

  24. Buying Time

  25. Patients, Patience, Patients

  26. A Real Patient

  27. Why Do a Practice Valuation? I'm not Selling

  28. Irrational Exuberance or The New Normal?

  29. Do dental equipment and dental technology affect a practice value?

  30. Finding and Being a Mentor

  31. Bigger is Better

  32. Dave's Top Ten List for Buyers (Vendors should read this too!)

  33. How Well Do You Know Your Practice?

  34. Dave's Top Ten List for Vendors

  35. What will happen to dental practice Values in the next 10 years?

  36. Your Premises Lease is an Important Asset

  37. What are Associates Thinking?

  38. There is Life Outside the GTA

  39. When Is the Right Time to Sell My Dental Practice?

  40. Mergers are a Viable Option

  41. Is Your Associate an Asset or a Liability?

  42. Has your Practice Facility Kept Up With Your Billings?

  43. The 100 per cent of Gross Myth

  44. The Past, The Present and The Future

  45. Caveat Emptor

  46. Overpaid Long Term Staff

  47. Selling your Practice in Stages

  48. A Potential Pitfall of Selling Shares

  49. Value in Your Practice Through Balance

  50. Only Trusted Staff Can Defraud You

  51. To Own or Not to Own Practice Real Estate? That is the Question.

  52. Coping With A Large Patient Base

  53. Successful Dental Practice Transitions

  54. Taking Care of Business

  55. The Investing Dentist Phenomenon

  56. Two areas to focus upon that could negatively impact the value of your practice

  57. Organize your Debt in Order to Sell your Practice

  58. Having a Better Team

  59. How Do I Prepare My Practice For Sale

  60. How Do I Prepare My Practice For Sale? Part 3

  61. How Do I Prepare My Practice For Sale? Part 2

  62. How Do I Prepare My Practice For Sale? Part 1

  63. Advice to My Son or Daughter Graduating from Dental School

  64. Transition - What to Expect

  65. Discussion on Digital X-Rays

  66. Partnerships and Shotguns

  67. Strategic Planning - How to Get Started

  68. Calling All Vendors - Practices have Gone Up in Value

  69. Purchasers: Expect to Pay More for a Practice because of Lower Professional Corporation Tax Rates

  70. Matrimonial Practice Valuations

  71. Purchaser's Guide to Affording a Practice

  72. Location Improvements Throughout Your Career

  73. Small Practice Valuations

  74. Partnerships – The Best and The Worst

  75. Changing Location When the Opportunity Comes Along

  76. Visual Presentation of Your Practice

  77. Presentation of Charts

  78. Your Premises Lease Can Be Your Worst Enemy

  79. How to Select an Appraiser for Your Practice

  80. How Are Your Billing Ratios?

  81. It Pays to Invest in Your Tangible Assets

  82. The Importance of Separate Financial Statements

  83. Five Time Frame Levels to Sell a Practice

  84. 12 Suggestions to Safeguard Computer Data

  85. How to Buy a Visible Practice

  86. Why is there a shortage of good practices today?

  87. The Importance of Equipment in the Purchase of a Practice

  88. The Balanced Practice

  89. Will My Practice Be Saleable in The Future?

  90. Buyer Be Aware

  91. Excess Profit - The Second Key

  92. Patients and Profits are the Keys

  93. Plan Ahead