Why Do Patients Leave?
It used to be a commonly held belief that roughly 50% of the general population visited the dentist regularly - at least once, if not twice, a year. Today, barely a third of the population visits the dentist. There are certainly a multitude of factors that have influenced the decline. But the “why” is far less important than the “what,” as in what are you going to do about it?
Too often dentists and their teams aren’t paying attention to patient retention. They look at the schedule that appears full. They see the number of patient records in the system and assume most are active, until reality crushes their happy illusion. The money isn’t there for new technology. The doctor has to cut back on continuing education and team training because revenues are tight. Patient numbers are falling, leading to lower treatment acceptance and dwindling production. But why are patient numbers falling?
Doctor and staff are often blissfully unaware of what prompts patients to leave. As far as the dentist knows, there haven’t been more than a couple of concerns or complaints expressed here and there. But the fact is few patients will actually complain, and those who do are probably loyal patients who want to help correct a perceived problem. They actually care enough to say something. The rest just look the other way, or worse yet, walk away. If those loyal patients who had the courage to say something feel that their concerns are ignored, they are far more likely to feel that the practice does not value their patronage. They too are likely to leave, and the impact of their departure will ripple across the practice in ways many dentists never even consider.
After all, it is these patients who are most open to your treatment recommendations. They see the doctor and the team as their partners. They keep their appointments. They pay on time. They happily refer new patients. They understand the occasional bad day in which the team may run behind. They are forgiving of a minor error on their statement. They don’t look for a new dentist because of a slight infraction. They recognize that occasionally fees will increase. In short, they trust the dental team and they value the care that they receive.
So where do you find more patients like these? Within your existing patient rolls. The key is to maintain the patients that have already chosen your practice and maximize the relationships you have with them. But before you can do that, you need to better understand why those who have left your practice did.
You would be surprised by some of the reasons former patients have given for leaving a practice. The hours are not convenient. There’s no place to park. The doctor hurts me. I don’t understand the bills. They don’t accept my insurance. They changed a practice policy. They don’t answer the phone. I can’t leave a message. They charged me for a missed appointment. They are always trying to sell me something. The fees are too high. They can’t keep staff. They told me I have to go to a specialist. They don’t listen to me. They don’t like each other. The bathrooms are dirty. The person at the front desk is rude. The doctor’s always stressed.
While many of the concerns patients raise could be addressed with a few adjustments, oftentimes dental teams choose not to take patient concerns seriously. Rather they dismiss them as the patient’s problem. After all, that’s much simpler than addressing practice systems or changing staff procedures. And nothing could be easier than to blame the patient. “You know that Angela Sims is just like that obnoxious Mr. Banner. He always seems to have a problem with something. Whatever happened to him anyway?” Ah yes, little do they realize that the patient’s problem is the practice’s problem.
In other cases, teams will make what they consider to be improvements to practice systems or procedures but give little thought to the impact on the patients. “Our automated phone system helps us to virtually eliminate interruptions during the day. The patients just leave a message and we call them back as soon as we can.” In this case, the team’s idea of efficiency is the patient’s idea of inaccessible. Patients want to talk to a real person, right now. Nothing erodes essential practice/patient relationships (translation: patient retention) like poor service.
For more information on this topic and more, visit my blog: The Lighter Side
Interested in speaking to me about your practice concerns? Email email@example.com
Keep Hope Alive in Tough Times
Leadership is hard work, especially when you feel anxious about the future. It’s easy to let yourself fall into the sinkhole of doom-and-gloom thinking. From time to time, we all experience negative thoughts. Ups and downs are a part of life. But successful leaders maintain a healthy perspective and a hopeful outlook. Not that smiling and thinking positive thoughts will increase your revenue overnight, but you will affect your bottom line by being mindful of your mental and emotional energy.
The recent advances in neuroscience indicate that thoughts have energy. The way it works is that we operate our lives based on assumptions, our mental models. These are the ‘rules’ we follow to make decisions and choices in our life. For the most part, assumptions are unspoken and operate at a subconscious or even an unconscious level. What you believe ultimately becomes your reality. Henry Ford said it best: “Whether you think you can or think you can’t, you’re right.”
If you focus on problems and obstacles, you will find yourself moving further into a downward spiral. But when you redirect your attention to appreciate what you already have, you attract more of the same. When you amplify your strengths and create images of where you want to go, that energy propels you to new levels of success and achievement.
It’s normal to wonder if your production numbers will improve, but don’t give way to decisions based on fear. The best way you will weather tough times is to keep yourself and your team focused and fired up. Be objective and deliberate. Avoid knee-jerk reactions. The worst decisions are usually the ones that are made quickly. Evaluate the need for lay-offs carefully, not emotionally. The same is true for pay cuts. It’s far better that you make sacrifices in your own salary than to risk actions that diminish your employees’ morale. Every minute your employees spend wondering or worrying is a minute your patients are being ignored.
Help your employees deal with their fear. Be an open communicator about your decisions to reduce expenses. If you announce that you’ll no longer be providing beverages in the staff refrigerator, some of your staff may wonder if they’re next in line to get the ax. You may see soda pop, coffee and donuts as unnecessary or a place to save a few dollars. However, to your staff it could symbolize an unwillingness to “feed” them emotionally. The intangible costs could easily outweigh the monies you want to save. If it’s crucial for you to take this kind of action, explain the decision with objective facts. More importantly, tell them that by reducing some smaller expenses you are maximizing your plan to keep everyone on board and at the same pay level.
Continue to invest in training your team. “Dumbing down” the practice is a short-term solution. Be judicious about where to spend training dollars but don’t defer essential skill-building. Remember that your practice has a great opportunity to position itself for the future. If the schedule is lighter now, use the time to advance your employees’ knowledge. Engage in team building activities that lighten spirits and keep morale high.
Focus on ways to improve customer service. And pay extra attention to the patients you’ve got. This is an excellent time to show you care by spending more quality time with everyone in your office. Crank up your ‘personal touch’. Just like you, your patients are concerned about their pocketbook. Research shows that people will continue to spend money when the perceived value is high. Find small but powerful ways to give T.L.C. treatment. In doing so you’ll build stronger loyalty with better patients, and eventually more referrals.
Work on yourself. Effective leadership overrides tough circumstances. Be disciplined. Develop a plan and stay the course. Your employees will model your behavior, so be calm and optimistic. Whether it’s greater emotional composure or more encouraging remarks to others, the impact of just one small modification holds tremendous possibility. If you’re having trouble staying positive, get a coach - someone who will be an objective sounding board and source of support. Just as physical trainers improve performance in athletic competitions, coaching offers ways to enhance professional effectiveness.
Times may be tough, but you have a choice about how you will respond. You can impact your practice in a powerful way. Plant your feet. Talk more with your employees and your patients. Include others in your decisions. Reach out for support and help. Be hopeful in your thinking and your actions.
Dr. Haller provides training for leadership effectiveness, interpersonal communication, conflict management, and team building. If you would like to learn more contact her at firstname.lastname@example.org
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Offices across the country are beginning to see a number of “Baby Boomer” patients reaching retirement. Many people who anticipated retiring in 2008 or 2009 held off because of the stock market and poor economy, and they are now comfortable with where things are and are getting ready to retire. It is important for your team to be aware of these patients’ up and coming needs - including the fact that they may lose their dental insurance at age 65.
It can be a good idea to start educating and preparing your patients for the future. This may start as early as age 60. For example: you and your hygienist notice at the morning business meeting that your patient “Tammy” is coming in, and she has just turned 60 years old. Tammy may be thinking about retiring at 65. She has a lot of large fillings that have become older and will need to be replaced within the next 5-10 years. Your team has been monitoring these fillings for a couple of years, and now is the time to start getting some of them done.
Although the fillings are not urgent, Tammy needs to be informed about why she should start moving forward with replacing them. The hygienist may inform her: “Tammy, you have a lot of large fillings that we are monitoring and they are starting to look suspicious. I am going to have the doctor come in and do an exam to see if we should start replacing some of them. They will need crowns and since we only have five years before you lose your insurance we may want to start getting some of these done. This will allow you to maximize your insurance benefits over the next five years, and hopefully prevent you from having to pay for a lot of crowns in the future.”
When the doctor comes in to do the exam, s/he will look to see which fillings are in need of being replaced with a crown, and will start by treatment planning those for the year. The doctor will also verbally inform the patient of all the fillings that will need to be replaced over the next five years and the hygienist will make a “to-do list” in the clinical notes.
Tammy may want to have the crowns done towards the end of the year, as long as they are not urgent. This way if one of the other large fillings needs attention or if an accident happens, she has not used all of her insurance at the beginning of the year. At the next hygiene appointment, the doctor and hygienist will continue to move forward with replacing any large fills. This may be true of amalgams also.
There are two important things that need to be done before a patient loses insurance coverage at retirement or age 65:
When a patient is about to lose their insurance coverage, I sometimes estimate the cost of annual treatment for them. I ask how much their current monthly insurance premium is, then I add the cost of either two hygiene appointments or four periodontal maintenance appointments and an fmx and one crown and divide by 12. I also do the same thing without the crown. I tell them if they put this dollar amount away in a separate account each month, they probably won’t even use it all on treatment and will save money. I close the conversation with this comment: “There is a reason insurance companies are some of the wealthiest businesses in the country, and it’s not because they are giving away all their money providing treatment for patients.”
Just because your patient population is getting older doesn’t mean you have to lose them as patients. Educating them early, before they retire, will help to maintain them as long-term cash patients.
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