Before considering an associate, make sure you have enough patients. Measure the number of truly “active” patients. Start with key computer reports, including the past due recall report, the missed appointments report, and the unscheduled treatment report.

1. Generate a report of patients due for recall from today’s date to one year from today. Indicate that you are seeking to identify all patients with and without appointments on the report.

2. Tally the number of patient records in the computer system and divide that by the number of patients in the recall system. For example, if there are 4,759 patient records on file and 1,737 patients in the recall system, patient retention would be at 36%.

3. Now subtract the number of active patients from the number of total patient records in the system. Using the example above that number would be 3,022.

4. Divide that number by the number of months the records represent. For example, if you believe that active charts represent the period from 11/09 through 2/13 that would be 39 months. In this scenario, the practice is losing 78 patients per month.

Obviously the patient base is shrinking. Now what? For starters, don’t hire a full-time associate. Instead, implement a patient retention program and look carefully at clinical efficiencies. When it comes to clinical efficiency it can never be compromised, but it can almost always be enhanced.

“Act as if what you do makes a difference. It does.” That is one of my favorite quotes from American philosopher William James.

Oftentimes, it’s the little things – the seemingly insignificant actions – that make all the difference. Our opinions of each other are often shaped by them. Our perceptions of the products and services we purchase are influenced by them. And our views of the people who are selling or delivering them are directly affected by them. Those seemingly intangible influences that give us a sense or feeling that this business or that office is a quality operation, that those people are truly a caring team, or a trustworthy group. Simply said, it’s the little things that reinforce what your patients already want to believe. They are merely looking for confirmation.

Patient opinions and perceptions are shaped by multiple variables, many of which tend to be subtle and vague. Often it’s the intangibles that have a very tangible impact on your success and practice growth. Want to evaluate the “intangibles” in your office? Start with the obvious – staff attitudes. Conduct regular “attitude inventories.” Evaluate your staff’s routine communication with patients – tone, body language, their command of the English language. If you cringe or bristle, consider communication training for your team. Telephone training and practice scripts ensure that the “little things” don’t derail the big opportunities in your practice.

The “middle” can be a challenging place. It is often the point at which you’re too far from where you’ve come to turn back, yet seemingly still a long way from your destination. The middle of anything doesn’t seem to denote much that is positive: “the middle of nowhere,” “middle of the road,” and the dreaded “mid-life crisis.”

Similarly, the mid-point in a dental career can bring great uncertainty, many questions, and frustrations. As the financial struggles, personnel problems and patient issues persist, is it any wonder that mid-career dentists find themselves asking: “Is this all there is?” Where’s the excitement, the enthusiasm, the career satisfaction?

Consider your position on this mid-career path. Are you enjoying the view from the pinnacle of success? Or are you frozen in place, stuck somewhere between merely average and truly excellent? And, if you’re not where you want and feel you should be, are you willing to take the necessary steps to change it? If so, the question then becomes, how? Look at those areas most likely to be sending your practice, and consequently you, into a mid-career slump, starting with team education and training. Nothing will stampede over a struggling practice and pound it into further turmoil than lack of instruction. In fact, the single, biggest contributor to practice inefficiency, mismanagement, lost revenues, and career dissatisfaction is a poorly trained team.

Eighty percent of practices are losing more patients than they are gaining new patients. It’s easy to assume that patients you’ve had for years will continue to return, and it’s also easy to fall into the trap of thinking that those patients will raise questions and inquire about treatment options without your prompting. What happens far too often is teams fall into the “Transaction Mindset.” The patient is coming in for a routine oral hygiene appointment and exam. Everyone clicks into autopilot, after all this is merely a routine transaction. Wait! Wake up! This is one of only two contacts your office will have with that patient in the next 12 months. This isn’t a mere transaction. It’s your brief opportunity to strengthen your relationship with this patient.

In many cases, the six-month visit is the only time the dentist is going to have the opportunity to sit down with the patient and assess not only his/her their oral health condition, but also the individual’s oral health concerns and interests. What do you do during every routine visit to WOW the patients, further educate them on the importance of oral healthcare, and inform them of the services that your practice provides? Anything? In about eight months, you might be wondering why you haven’t seen this or that patient in your practice for a while. Can you figure it out? Maybe they were tired of being treated as simply just another “routine transaction.”

Consider the unspoken messages you and your team convey to patients, starting with the obvious: your smiles. Every time a patient comes into your practice, they are examining your smile. What does yours say about your dentistry, your team, and your philosophy of care? Case in point: A young orthodontist I know is building his practice alongside two very well established doctors in a mid- size city. He is a nice young man, but I can’t help wondering what impact his own crooked smile has on his patients’ decision to proceed or delay treatment – particularly his adult patients. How often are patients second guessing their decision to pursue $6,000, $8,000, $10,000 in adult orthodontic treatment when they sit down and have a conversation with “Dr. Allen.” After all, even “Dr. Allen,” the orthodontist, doesn’t have perfect teeth – and if anyone can afford straight teeth, they reason, it’s an orthodontist.

You and your team advertise your dentistry. If you’re selling smiles, everyone on your team, including you, doctor, should wear the beautiful smiles that excellent dentistry can create.