“My business has been doing quite well over the last several years. But now, I’m not alone in finding times are tough. I thought I could weather the storm, but the down economy is hitting me, like it is other dentists, I’m sure. What do you recommend a dentist do in a down economy to boost his or her business?”

Let me take you back in time, for a moment…

In the not too distant past, dental practices were beyond thriving. There was an abundance of new patients, who along with the existing patient base, were willing to follow through on recommended major restorative work as well as opting for elective cosmetic procedures. These patients either had the money or were willing to utilize third party financing and pay the balance off “interest free” over time.

The first storm that dentists had to weather occurred after 9/11. This catastrophic event created uncertainty in the minds of many, and as a result made patients more reluctant to go forward with major treatment, or jump on the cosmetic “smile makeover” bandwagon, as did their friends. But even as the trouble in the Middle East continued to brew, there was a small but not too significant drop in production for some dental offices. It became apparent that these events had an impact on the dental industry.

Ahh, but then dateline 2004: Our home values are climbing; Arizona is one of the most sought after locations in the country to live in; people are flocking to our state to enjoy the riches this land can offer. People are buying homes left and right! Dentists are setting up “scratch start” practices in communities destined to bring thousands of new homes and people with teeth to work on! Even though dental offices worked diligently to keep patients’ teeth healthy, it became much easier to rest on one’s laurels without having production slump.

Fast-forward to 2007: The beginning of the housing market decline. The bubble burst! Thankfully, not as big a burst as some other areas in the country, but it happened here in our own back yard. As a result, patients who “would have been” aren’t coming to the dentist’s door because mortgages have gone sour, over time their home isn’t built; sometimes foundations haven’t even been poured. Consequently, new dental practices in the anticipated high growth areas of the state began to dry up. Unfortunately, we haven’t recovered and the economy is setting records for being the direst in decades.

Sorry, this is reliving the nightmares that have been keeping us awake. But, reality is that we are facing a very unique series of events, which requires action on the part of dental practices in order to maintain previous profit levels or even to recover. Something must be done to keep the business vibrant, growing, and profitable, but what?

Staying afloat and even growing your practice in an economic slump can be accomplished, but you must realize you can’t go on doing the same things and expect to achieve different results. Change is necessary in that people who run a business must be willing to adapt to new concepts as well as re-committing to fundamental management principles and proven systems in order to bring themselves back up to previous productive levels.

The preeminent “Practice Pointer” in a down economy is, DON’T ASSUME! Don’t assume that the economy is affecting every patient across the board and “nobody can afford anything.” How do you know what the patient will say ahead of time? You don’t. Sure, there may be plenty of patients that will say something to the tune of, “Oh, times are tough, I can’t afford it.” But there are others willing to go ahead with treatment, including complete dentistry, and even smile designs. Know that patients may say “no”, but keep them engaged in the practice; don’t lose them long term. Leave the door open with an approach such as, “We’re here for you; when you’re ready (resources have rebounded, time is right, pain won’t go away, etc.) Call us. We’ll make room for you right away.”

Several of my management consulting client dentists in the Greater Phoenix area are keeping steady or have demonstrated better numbers this year than last year; …in a down economy! Proof positive that patients are saying, “Yes” to treatment even today.

The next thing to remember is obvious; continue doing what you do best, which is diagnosing disease conditions and recommending treatment that will solve the problem and make the patient well. Don’t compromise complete diagnosis and complete care. The doctor and entire team must continue with patient education and compelling case presentations for each patient. Are you confident that your staff members are skilled and even excel at case presentations? If the answer is no, now is not the time to save money and throttle back on continuing education. Keeping staff at peak performance levels can only enhance and advance the practice.

The backbone of general practice is the hygiene department. Without a Periodontal Maintenance system that is well organized and diligently orchestrated, an office will witness a decline in patient visits resulting in a decline in income. Moreover, in uncertain economic times, it’s very important to advance prevention as a method to keep patients in the practice. Consider the difficulty in trying to convince someone to come in for extensive treatment that they have already said, “No, I don’t have the money, the economy is terrible, …”. Re-direct the energy into encouraging them to maintain their current state of health with a routine (prophy, periodontal maintenance/exam/call-it-what-you-will) visit. It goes without saying, do not turn a blinds eye to the treatment that is still pending, keep encouraging the patient to remedy their dental malady albeit in a friendly, professional manner.

During these times, a meticulous inspection of the program in your office must commence immediately. First, don’t assume each and every patient in your practice has been contacted for his or her preventive care or periodontal maintenance visit. Inspect each patient’s history either through the physical chart or computer record to be sure they haven’t “slipped through the cracks”. Next, establish a program that will contact each patient and ensure an appointment is made to keep him or her on a maintenance schedule.

In my travels, I have found practice management software systems that have a recall program that assists the office in managing patient continuing care. I have also found that these systems are not watertight and patients slip through the cracks at times perhaps because people are running the software. Further, team members may leave the practice for one reason or another only to leave a system that was orchestrated properly in the hands of someone who doesn’t know it as well, used a different software program, or has a different way of running recall. Don’t Assume! Learn your software program and how it manages recall, inside and out. And if that means hiring an experienced trainer to come in and seal up the cracks, then do so. Then, be certain all patients are included in the database with their correct maintenance interval. If this means a physical chart audit to confirm the database is complete, so be it. You said your office had slowed down, right? What else is your team doing?

The next step is where the rubber hits the road. The old adage rings true today,

“Ideas are a dime a dozen; people who put them into action are priceless”!

Direct your team to contact each patient who is not yet scheduled encouraging them to maintain their current state of dental health and make an appointment! Begin with a phone call first; and consider calling at a time of day that stands the best chance of reaching the patient. Yes, that means late afternoon and early evening. Have the right dialogue in place, rehearsed, so that the telephone contact has impact and positive results. A written script is handy, one that is encouraging without being too overly zealous. Second step is a postcard, sent two days after the first phone call. Third is another phone call made no more than one week after the postcard. Last contact is a nice letter that asks the patient to contact the office when they are able to confirm contact information and active status. Send this letter out the week following the second phone call.

Make a commitment to this project and be sure to follow a tight schedule. Don’t let a lot of time pass between phone calls and written correspondence. Additionally, depending on the size of the practice it may be prudent to begin with a block of patients and work through 50 or so at a time.

I trust the thought behind this is obvious to you. You are investing in time, which you certainly have on your hands. And, patients are more willing to come to the office for a routine “cleaning and check-up” since their out-of-pocket investment in these services is less than it would be for major treatment. Wouldn’t you agree it’s more difficult to get people today to come in for six implants and 14 units of crown and bridge than it is for a cleaning?

Lastly, in today’s uncertain economic times, non-productive use of time is not allowed, and not an option! Heck, this should apply whether the economy is down or not! Dental team members are getting an hourly salary to work, not read magazines or make personal phone calls. If you have a “Morning Huddle” spend time discussing what needs to be done during down time in the schedule. The dentist or office manager should keep a list of work items that could be accomplished so that jobs can be directed right away.

Supply use, if not monitored correctly, can be a drain on a practice. Having the staff be frugal in what is used can be a money saver. Designate one employee who is responsible not only for ordering supplies, but also in overseeing usage over the course of the ordering period. Taking note of the inventory of supplies already on the shelves so as not to over-order is important too.

Re-visit Internal Marketing

The dental team must be diligent in core internal marketing techniques. Three mainstays are asking for referrals, re-visiting previously diagnosed conditions that require treatment, and performing care-calls. Here is a helpful guide on these three to make sure the techniques pay off right away.

When asking for referrals, have an idea of what you will say so that when the occasion presents itself, it’s not foreign. Try to formulate your own style behind these sample scripts:

“Mrs. Herbert, thank you for the trust and confidence you place in us for your care. Please know that we always welcome new faces in our practice. If there is anyone you know that may benefit from modern dentistry, please direct them our way. We will take great care of them.”


“Mrs. Herbert, I’d like to ask your help. As you know, our goal is to help as many people become as healthy as possible. Sadly, the American Dental Association reports that 50% of the adult population does not visit the dentist regularly. If you happen to know someone that could benefit from modern dentistry, please send them our way. We will take great care of them. Thanks for your help”

Also, after a patient has completed treatment, use the occasion to praise their commitment and parlay that into a marketing opportunity:

“Mrs. Herbert, now that we have completed treatment, let me commend you for making a commitment to your health. It would be great to help other people like you. We always welcome new patients to the practice, feel free to refer our office to your friends and neighbors, we’ll take great care of them.”

Lastly, look for an opportunity to suggest referring patients to the practice. Have you ever had a patient who compliments you, a team member, or commented positively on their experience in the practice? If so, turn it into an opportunity,

“That’s so nice of you, thanks very much. And if you know of anyone who is looking for a great dentist, send them our way and make sure they tell us you sent them, we’ll take great care of them.”

When patients return to the office, for any reason, be it for periodontal maintenance, for completion of treatment in progress, or for further treatment as planned, re-visit previous treatment by following this guide:

  1. 1. Ask the patient specifically about the treatment performed on their last visit.
  2. “Mr. Smith, last time you were in, we took care of that tooth that was bothering you on the lower left side; how’s that feeling today?”
  3. 2. Clarify that the treatment performed was satisfactory and the patient is pleased with the outcome: “Oh, my, yes, I totally forgot that you put a crown on that tooth; it feels great!”
  4. 3. Document this conversation in the patient’s record to show the treatment was successful.

In most cases, the patient will be happy and indicate they are satisfied with the work. Use this as an opportunity to recommend referring someone to the practice. Then, continue the appointment. In the unlikely event the patient is not happy, spend whatever time is necessary to ensure their concerns are documented and understood. Then, work immediately to resolve the issue before beginning any further treatment.

By far, the most successful form of internal marketing is calling patients on the evening of treatment, or placing care-calls. Call any patient who has received an injection in your office on the evening of their treatment. This is a 30 second public relations phone conversation that must be made by the doctor:

“Mrs. Jones, this is Dr. Herbert calling. It was nice to see you today; how are you feeling?”

Harvey Mackay, who wrote “How To Swim With The Sharks Without Being Eaten Alive”, and “Beware the Naked Man Who Tries To Sell You His Shirt”, said it best,

“People don’t care how much you know, until they know how much you care about them.”

The entire purpose of this call is to demonstrate to patients that you care about them. Don’t consider calling only difficult treatment patients; I strongly recommend calling any patient who has received an injection. Most patients will be very pleasantly surprised by the call. Most likely, their doctor before has never called them! The obvious message is that you care about them.

To sum up, there is camaraderie amongst dentists, so don’t hesitate to talk to fellow practitioners; you may be able to pick up on some worthwhile tips and good advice can be shared between offices. It is also important to keep abreast of the news to keep yourself and the staff on their toes. But don’t stress too much, worrying about the news and the daily stock report will do nothing to change it. Put the energy that you would have spent worrying into action instead.