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Where, Oh Where Have Your Patients Gone? Sandy Pardue

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Patients are falling through the cracks in the majority of practices, unbeknownst to the doctor and team. They are focused on getting new patients, and pay little attention to the gold mine available to them with a few clicks of their computer mouse.

New patients are vital to every practice, but what about the forgotten patients? I am referring to the patients that missed their last recall visit or haven't been in for awhile. Not only are they a hidden treasure, they are counting on you to take care of their mouths. Most consider you their dentist, even though time has passed. You could be losing up to 50 percent of your patient base each year. What actions have you taken to get them back to your practice and in your chair? What are you doing to retain these folks?

Out of Sight, Out of Mind
When I ask dentists how they would like to improve their practice, a common response is, "I need more new patients." They are concerned about new patient flow, but rarely communicate with the best patients, the ones that have benefited from their services in the past. Patients fall in the cracks for various reasons, the most common being the lack of an effective recall and reactivation system. Other reasons are little or no communication from the practice or inactivating patients too soon.

Think about your own life. Most of you will agree that a year passes quickly. Patients are not waiting anxiously for six months to roll around so they can come in for a cleaning and exam. Since they don't know what we know about dental health, going to the dentist is not on the top of their priority list. The more time that passes without hearing from you, the more likely they are going to end up in the chair of another dentist.

Patients should not be inactivated just because they haven't been in within 12 months. This is by far the biggest mistake I see in practices. In my experience the longer they stay away, the less likely they will return to your practice. If they don't hear from you, it is harder for them to muster up the nerve to return. Many times they are already embarrassed about their mouths. The more time that goes by, the more embarrassed they become about putting it off.

I've seen practices intentionally not reach out to patients because a year has passed and they now consider them inactive. When I ask about this, the team and the dentist offer excuses such as:
  1. "She missed her last appointment."
  2. Her insurance changed."
  3. "His recall card was returned."
  4. "She is always late for her appointments."
  5. "Recall cards never work."
  6. "If he doesn't want optimum dental health, we don't want him as a patient."
The above responses tell me that the doctor and team are missing a lot of opportunities if they don't reactivate these patients. They need to change their viewpoint and focus on the actions it takes to retain these folks.

It is our responsibility to educate patients about what will happen if they don't come in, if they put off treatment or if they don't get the treatment they need. This is not occurring enough and patients are falling in the cracks as a result.

When is it OK to Inactivate Patients?
You will hear a lot of different descriptions of an active patient down the dental pipeline. When you are looking at missed opportunities and potential patient flow, consider all patient records.

I recommend you only inactivate patients who fall into one or more of the following categories.
  1. The patient passed away.
  2. The patient has informed you that he or she moved out of town.
  3. The patient told you that he or she will not be coming back.
Continue reaching out to patients through mailings and phone calls if none of these conditions apply to them. They need a dentist and it can be you. They consider you to be their dentist if they haven't said otherwise. I can't emphasize this enough. If they have an emergency, they will call you if you have continued communicating with them. If you inactivated them and stopped mailing cards and letters, they will go find another dentist.

Many times patients leave practices and later come back after some time has passed, especially if they left due to insurance. When they leave, you should continue the relationship through mailings. I recommend that you continue sending seasonal letters, birthday cards and newsletters. The cost is minimal and it is a successful form of internal marketing. Quite often patients will check out another office and end up coming back to you. Teams need to be educated on this viewpoint, so patients can get the treatment they need and deserve. Too many patients are haphazardly inactivated. There might be a rare occasion where you dismiss a patient from the practice. Make sure you follow your state guidelines and keep good records. If you have to dismiss patients on a regular basis, you need to figure out why this is happening.

How to Retain More Patients
I can't think of a single practice with patients lined up outside the door with cash in their wallets, waiting to be next in the chair. Unfortunately it is not this way in dentistry. If you want to improve patient volume and retention, start by adding more value to visits and improving patient education. Work on building stronger relationships with your patients. Everyone on the team should know that the patients are the most important part of the practice. Nothing is more important than the patients. Communicate on a regular basis, be interested in them, take time to educate them and take the dollar signs out of your eyes. If you don't do these things, the current new patients will be falling through the cracks soon.

Most practices are not doing enough to keep patients coming back. I recommend a yearly reactivation project (See more on this at the end of the article). The lack of this type of system creates open time, low production and low morale. Patient reactivation and retention is especially important during slow economic times. The practices that have these systems in place continue to grow despite the economy.

Implement a recall system and put it in writing so it can be followed exactly, month after month. Employees come and go; you need to have the system that can be easily duplicated by the next person. Every patient should leave the practice with a future recall date or a future appointment. Find a recall card that is professional looking and represents your office well. Mail it to patients when they are due to come in. They will get it from their mailbox and be able to see it on the table, on the refrigerator, etc.

All patients who pre-scheduled their hygiene appointments should receive a card three weeks in advance stating the appointment date and time. The card should also mention how to change the appointment, as well as a request for advance notice if they want to change. You will have better success with pre-scheduled patients if you and your team continue to add value to the visits.

You and your staff should send hand-written notes to patients who haven't been in. Let them know you miss seeing them and you hope they are doing well. This is extremely beneficial. Purchase note cards with the practice name on the front and have each person in the practice send at least five cards a week to "lost" patients. Consider writing sample notes to help them get started and provide guidelines for them to follow. Have everyone keep up with who they are sending the cards to and how many. Make a game out of it. Build better relationships through communication, acknowledging referrals and patient education.

Train your staff on telephone etiquette and calling patients to schedule. Nothing will ever replace good human relations and human contact. Do you remember AT&T's tag line, "Reach Out and Touch Someone?" Have your staff reach out and touch patients that you haven't seen in awhile.

Learn How Many Patients in Your Practice are Overdue
The average practice has 750 to 1,000 patients overdue for their recall appointments. This is largely due to weak or lacking recall and reactivation systems. Patients get left behind because no one goes back to the past due list and they stop sending cards and letters. Most practices are surprised to learn how many people need to come in, especially when they have open time on their schedule most every day.

To learn how many lost patients you have in your practice you will need to generate a report utilizing your computer software. Find out how many patients haven't been in for six months or longer. Go back three to five years. You might have to call your software support to learn how to get the report you need. You will be surprised.

Action Steps for a Reactivation Project
Typically a practice will start thinking about doing a reactivation project when they are desperate for patients. The reactivation attempts should be ongoing for a consistent flow of patients rather than a desperate move.

If you can't afford to lose half of your patients and your back door is open, this project will help you regain some activity in the practice. Typically, we see up to 19 percent of the patients make appointments from this project.

Step 1: Generate and print a list of patients who have not been in for a least six months and go back at least three to five years.

Step 2: Choose recall cards to be mailed to them. It should look different than the standard recall card. A bright color works well.

Step 3: Our surveys show the following message gets the best response:

Dear Jane,
We miss seeing you in our office. As you know, when dental decay, gingivitis, periodontal disease or other complications are discovered in early stages, treatment is not complicated and costs are less. Please phone the office at (insert your phone number including area code) for a convenient appointment.

Step 4: Mail the same card to the same group of patients two to three months in a row.

Never Give Up
You can avoid the consequences of "out of sight, out of mind" in the future by communicating with your patients regularly in the following ways.
  1. Hand-written notes from staff and doctor
  2. A package with a toothbrush and floss
  3. Print newsletters
  4. Birthday card
  5. Recall and reactivation cards
  6. Telephone
  7. E-mail
  8. Invitations to special events
Share this article with your team. Work with them to implement a system to help close the back door and keep more patients. Focusing on patient retention will not only fill your schedule, it will provide a steady flow of patients and you'll have a much healthier practice.
Author’s Bio
Sandy Pardue is an internationally recognized lecturer, author and practice management consultant. She has assisted hundreds of doctors with practice expansion and staff development over the past 20 years. She is known for her comprehensive and interesting approach to dental office systems, and offers a refreshing point of view on how to become more efficient and productive in a dental practice. Sandy is director of consulting with Classic Practice Resources. She is also a consultant to leading dental companies for product evaluation and design. For more information, please e-mail sandy@classicpractice.com.
Dentaltown Magazine
April 2024
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