In this episode of Dental Marketing Mastery, we go over the best practices for Pre-appointing Hygiene, what costly mistakes are made, how to categorize your best customers, and more.



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Podcast Highlights:

  • The black plague of dentistry: pre-appointing everyone in hygiene!
  • The fantasy of pre-appointing versus the reality of who will show up
  • How if you can’t get them in within 8 days, your chances of them coming in drop drastically
  • How to make your hygienist’s life easier
  • The types of customers who will show up for hygiene and the types who won’t
  • How do you pre-appoint?
  • How to reward your great patients
  • Categorizing patients who don’t show up, and how to get them in down the road
  • The best appointment slots for patients in category A vs. those in categories B and C

Podcast Transcription:

Hello, and welcome once again to the Dental Marketing Mastery series. This podcast is brought to you by and New Patients Incorporated. I’m Howie Horrocks, the Founder of New Patients Incorporated, along with me once again, as my friend and partner and the President of New Patients Incorporated, Mark Dilatush.

Howie: Hello, Mark, how are you doing today?

Mark: Hello, Howie. How are you doing?

Howie: I’m doing just fine.

Mark: Yeah.

Howie: Regarding today’s topic, I’m thinking, you know, I remember back a couple years ago, we did a talk at dental town and you got on the subject of re care and how this kind of messes up practices right and left. And I thought it’d be kind of nice if, you know, we could revisit that topic. And because I think it’s important, a lot of practices do it wrong? As it turns out, and I think everybody benefit from hearing your views on that. What do you think?

Mark: Ah, well, I think everybody would benefit from buying these three or four drinks, then hearing me talk.

Howie: Okay, pretend like I just bought.

Mark: So you’re unplug, now. Okay. I’m on plug. All right. This is another topic that a man I can’t tell you. Well, and it’s not like you don’t know this, how he I know you really have run into dentist who have called us and said, Hey, I want to market my practice because my hygiene is slow.

Howie: Yeah,

Mark: right. How many times have we heard that like, 37 dozen times? You’re right. Yeah. Yep. Okay, we’ve heard from the dentist, we keep getting missed appointments. So I want to market and I need whatever, 150 new patients a month. You know, in a single doctor practice that’s been around for 20 years. How many times have we heard that story?

Howie: Yeah, I can hear their back door swinging wide open.

Mark: Exactly. So this isn’t like, you know, this isn’t marks pet peeve. This is this is anyone who studied the business analytics and dentistry for years pet peeve, it has to be it’s, it’s a, it to me, it’s like a moral obligation to share the insanity. That has been plaguing dentistry. And sometimes I think I feel a little bit reserved, which is hard to believe, but I sometimes I feel reserved to really speak out about it. Because, you know, we, we get referrals from 50 management consultants out there. And yes, even some of them don’t understand why I rail against the black plague that is pre appointing 100% of your existing patients.

The Black Plague of dentistry can be defined as a dental office that pre-appoints everyone in their hygiene. And when I say everyone, let’s say anything over 90% just using math, just plain simple arithmetic will tell you that if you continue to pray a point 100% of your hygiene, your repair visits. As the practice is growing, just math will tell you that your schedule is going to get booked out. Because you don’t have the capacity. Now you don’t have the hygienist or the hours now to perform the work on this fantasy that you’re building out into the future.

Now, before I go too much further, I will tell you why dental offices love to pre appoint 100% of their patients six months in advance. The reason dental practices love to do it is because it’s easy. That’s the only reason anyone and with any business background in any business would ever, ever reserve 100% of their time out into the future based on a fantasy. Because it’s easy. So hopefully we have some follow up now on our podcast, and hopefully they have gotten to know me and maybe out of 100 people listening to this. What do you think how you think 10 or 20 of them are wincing right now. Yeah.

Okay, so here’s, here’s the, here’s the basic math behind it, let’s say you have 2000 I’m going to call them active patients. And 2000 active patients come in twice a year for require once every six months. So let’s say let’s just again, let’s just go into fantasy here for a little while, let’s say you your dental practice, in the history of dentistry has the best true recare compliance on the planet in the universe. Nobody’s better than you. So your true company clients is 70%.

Now when I say true compliance, what that means is, is that the patient pre scheduled and they actually came in on exactly the day at exactly the time that they pre scheduled six months ago. That’s what true compliance is. Okay. So let’s say that you actually own that dental practice that has the best performance in the galaxy. Do you have 2000 hygiene patients, they need 4000 appointments for the year. So okay, so that’s 70% are compliant. But what about the other 30?

What’s 30% of 2000 is what is that? 600. And if they’re coming in twice during the year, it’s not really 600. It’s more like 1200. Now remember, this is if you have the best dental practice in the entire galaxy, which nobody on this call, nobody listening to this podcast has. Okay, but let’s just pretend. So now you have 1200 people that you have to sift through on a relatively continual basis, follow up with get on the phone, with email, with text with smoke signal with whatever letter with postcard with whatever other ways that you reach out to your existing hygiene patients to get them to come in. You have to do that to 12 you have to do that 1200 times.

Now, here’s what normally happens. And I bet I’m going to get some winces after I say the fall. Here’s what happens. You pre appoint through, let’s say, years, one through seven or eight, until hygiene looks incredibly full. I mean, how proud to look at your schedule and say to yourself, dang, I got no room for like, five months. How we what’s the number one death now? With new patients coming in? If the hygiene book if they come through hygiene and the hygiene book is booked out five, four or five months? What’s the fastest way to ruin your marketing?

Howie: Well, what do we call that? That the magic number eight?

Mark: Yes, the magic number eight, if you can’t get them in with an eight work days, you are wasting your money. Okay,

Howie: You’re going to lose them.

Mark: You’re going to lose them. So. So one of the one of the bad things that pre appointing everyone does is it gives it well first of all, it gives a false sense of security to the dentist. Now most dentists will look at that and puff their chest out and say, Wow, I’m popular people like me, they’ll use that as a measurement of success. And what we’re saying is no, it’s a measurement of death.

Okay, that’s big, basically what we’re saying. Okay, so, so your schedule goes out, your chest comes out, you feel really good about a bad thing, so you keep perpetuating it. So what happens is, the doctor kind of panics and says, well, geez, I have one hygienists. Now her name is Mary can’t possibly How many? Look how far booked in a future Mary is I have to go get a second. Hi, Janice. So I’m going to go get whatever, Amy. Okay, so now Amy comes into the practice. So now Amy, is going to start to consume some of those 70% of real appointments and the other 30% somebody in the office has to fill for a nice book.

Well, the reality is, is that those 30% are fantasy. So the doctor is staffing hygiene based on a visual look at a fantasy. And what’s real is that said about at best, believe me, nobody on this listening to this podcast has a real compliance of 70%. But at best 1200 of those appointments in that appointment book you’re looking at are a joke. They’re not going to be there. They’re going to be gone. Okay, then the dentist goes out and gets another hygienist. So now they have two hygienists working. And all of a sudden, it’s kind of amazing, the doctor, all of a sudden, there’s going to be like a missed hygiene appointment each day, one and a half each day to each day.

So the doctor goes out and says, well, man, we need to, you know, poor Gail up at the front desk, she can handle everything and follow up with my burgeoning hygiene demand. So let’s go out and hire Heather. Okay, so Heather comes in. Now remember this name Heather, because this Heather used to be a really good possible employee until you put her in disposition. If you want to ruin an employee in dentistry. Put them in the hygiene coordinator position in an office that pre appoints 100% of their recare. And here’s why.

So you go hire Heather. Now remember, we hired another hygienist and we hire a person to administrate hygiene. So what’s happening to the doctors overhead? Is it going up or down? It’s going up. Okay. And then still, we’re not improving anything. There’s no more human beings coming into the practice yet. You’re just looking at a fantasy and you’re staffing for it. That’s all you’re doing. And then you’re feeling missed appointments. And then you’re hiring an admin either a new one, or you’re taking time away from an existing one, and putting them on the admin of your hygiene department.

Now, let’s go back to the 1200 people who are fantasies, you how long it takes to call tax, an email postcard, whatever you do multiple times to 1200 people. Now that 1200 only stays 1200. If your practice closes the door after the first year, what happens to that 1200 number does it go up or down? It goes up and it goes up exponentially. So poor Heather, she’s probably in her mid 20s, early 30s, you’re probably paying her 18-19 bucks an hour might be you know her first job and she’s all energetic and gung ho and really wants to do a great job. And you are sending her almost no possible way of succeeding. Because that snowball that she began working on is never going to get smaller, it will only get larger.

Meanwhile, your first hygienist is nice and busy, your second hygienist is struggling, both hygienists start to get more openings in their day, and everybody stares at Heather as if it’s her fault. It’s not Heather’s fault. Nobody in the world could possibly do her task. She’s following up with people who aren’t, they’re just not going to comply to your recare. Only offices just keep churning these people. Now here’s the other enormous caviar that gets added to this. It exacerbates it and accelerates the insanity. If you take everything I just said.

And then you add in marketing advertising that uses price incentives. As a result, the person to pick up the phone 70%, you’ll never get close to 70% compliance with those types of patients, those types of patients responded to your offer, guess what offer they’re going to respond to you next time. Those patients are far, far less compliant to require than a good solid, good quality new patient who came into your practice for some other reason besides a price incentive. So now we have Heather working on at best 1200 accounts.

If you add to that, the fact that the office uses price incentives mainly to promote dentistry. And you bring in patients who really you know, their whole value point with dentistry is price. There’s really no other value. There’s no other decision making on their part guess. Guess what’s going to happen to your recare compliance on the back end there.

All right, now, let’s recap. Here’s the scenario. Dr. Smith has this practice High dentist one doing good but has a bunch of openings, high dentist two slow has also has openings. Heather, almost a full time position running chasing after 1200 people or more and you know it’s going to grow. And if Dr. Smith promotes based primarily on price, you know, it’s not 1200 you know, it’s like 2800. Okay, it’s, it’s physically impossible for Heather to call, communicate with whatever with 2800 It’s impossible. She’s never gonna be able to catch up.

Meanwhile, what happens is that the doctor goes to the hygienist and says, Hey, and we have so many openings, the hygienists as well go talk to Heather, because that’s what they do. And then the doctor goes to Heather says, Heather, what’s going on when you came in, you know, you were keeping up. But now look at all the openings and hiding. And Heather, the otherwise great employee just kind of throws her hands up in the air and goes, geez, Doc, I don’t know, I don’t know what’s going on the dockets.

Dissolution with Heather and fires, Heather, none of this would have was Heather’s fall, the whole thing was set up at the very beginning by the dentist, the dentist said, I’m going to pre appoint everybody. The reason I’m going to pre appoint everybody is because I don’t know, my friend doesn’t have or some management consultant said I should. And what I’m telling you what how he’s telling you what everyone on this end of the earth, anyone who’s ever looked at data from dental offices will tell you that if you pre appoint 100% of your real care patients, this scenario that I just laid out for you is inevitable. You will not be the first person to skip it.

Howie: You know Mark won’t get it? It seems just correct. Right? I mean, patient is leaving, of course you want to get their name in the book. Yeah, I think that dentist think that commits them. And so they feel good about that commitment for the feet for future income. But of course, it doesn’t commit. Anybody that does it? No,

Mark: No, it doesn’t commit anything. And now the audience is probably saying, Well, if we don’t pre appoint, what do we do? Yeah, good question. Okay. That’s a great question. Okay, here’s what you do. You reward your great patience. And you let them pre appoint, and you make it a perk. Because Mrs. Jones, I see that you made this appointment, and you kept it on the data time that you originally made it.

So you know, we’re going to do this time, we’re going to let you go out six months from now. And so select the best day and time for you to schedule the next appointment. Those are your eight patients, of course, you pre appoint those. But anyone who disappoints off and comes out of the a category goes into the b category.

You don’t pre appoint Bs. Thank you just rescheduled. Why would you prefer? Why would you look at it this way, if you were an airline, and I just made I booked a seat on one of your flights. And I called you an hour before the flight set off, dude, I can’t make? Would you automatically just take another seat on a different flight? For me? Would you just take my money and just up? Or my need for a flight and just automatically apply it to a different flight? If you were an airline? Of course you wouldn’t. And there’s a real good business reason why? Because I just disappointed. Okay, what you should do is take my money, that’s what you should do. Okay.

But no, here’s what you do a patient’s absolutely pre appoint all of the patients, you have to go back to do what you were doing before. Mary, I see, I see that we had to reschedule you this time, that’s fine. I know things happen, life gets busy. Here’s what we’re going to do. About three weeks before you’re due for your next exam and cleaning and professional teeth cleaning, here’s what we’re going to do, we’re going to send you a postcard and we’re going to send you would texts are going to come from heaven. And when you get those, give us a call them and let us know the best day and time for you. And we’ll see if we have any openings for you.

Okay, that’s what you do with your B patients now, your be patients are either going to be there either going to move back to A. Other words, if they actually keep their next appointment when they scheduled it. At that appointment with the hygienist can go all look, I see your major appointment, you kept it at the original time. That means I can have you reserve your best day and your best time at your convenience, six months from now you make them in a patient again.

But at that B patient makes an appointment and then breaks it and reschedule it, they go down to C. C is we’re going to send you a card and if you’re available, give us a call. And when they call, you know they’re not offered, you’re not going to offer a see patient, the 6pm hygiene appointment on a Tuesday, you’re just not you’re going to offer them the 3pm on a weekday, some appointment that’s really difficult for you to fill, but you’re a and b patients are going to get those premium slots, okay, now, here’s what’s going to happen.

If you do it that way, and you only pre appoint your As, you’re really only going to pre appoint about 35 40% of your patient base. And I know that’s going to make you feel bad temporarily. But what it’s going to do is it’s going to give you a really good look and an accurate schedule. Your schedules now real, it’s not a fantasy. So you can hire producers, hi, dentists, based on reality, not a fantasy. You can hire a hygiene coordinator based on reality and not a fantasy. And what will happen here’s what here’s what ultimately what happens is the doctors overhead goes down because obviously they’re not paying for it so too many hygienists to fill the actual time. And the admin the administrative over forehead actually goes down because a lot of those functions with the B and C patients are automated.

You’re not gonna sit there and call see patients for the rest of your life and activate them. There’s no reason to call them they’ve already proven to you the type of patient. They are. Now, again, the king of this the top of the pyramid, is if the patient or if the office is what promotion they’re using to generate new patients. What type of patients are you bringing into your practice? Remember Groupon? Howie?

Howie: Oh, yeah,

Mark: remember all the dentists and how crazy they were for Groupon number here. You know, here, here’s how it works. Uh, you know, you put up a deal, and however many people to get the deal. You know, you give them like, 50% of that money. And then the patients come in. And you know, maybe we’ll see them again at some other poor. Well, come on.

Howie: That’s like advertising proceed patients.

Mark: Yeah, came on. I mean

Howie: we don’t we don’t hear much about Groupon these days. Do you

Mark: hear anything of it? And who was the one on the dental forums who was saying are really seriously? Yeah, they don’t do it, guys. Don’t do it. And gals don’t do it. Okay, but they did it anyway. And then and then you hear the success story. I got 1000 patients and then you know what, six, nine months later? My hygiene, my hygiene schedule is blown out. Well, of course your hygiene schedule is blown out because you bought in 1000 shoppers, your pre appointed them for six and seven months later. And now none of them are coming in.

And you probably hired two or three hygienists to cover the time because it looks so nice in your schedule. doesn’t make any sense. So here’s the bottom line. The bottom line is your repair percentage, your recare compliance, your administrative overhead to manage require your missed appointments in your daily number of missed appointments and your hygiene profitability is going to be dictated by really two things. One, not pre appointing everybody and to bringing in higher quality new patients who actually comply to recur. So that’s my rant. I hope I didn’t offend anyone. today.

Howie: Oh, he probably did.

Mark: I probably did

Howie: that’s okay.

Mark: It’s not my intent to do that. I, I don’t, I don’t communicate this from an angle. Like I’m not I just nobody, there’s not enough money in the world for anyone to pay me to consult as a dental consultant anymore. Okay, so if I don’t have an angle, so I give you this information and say, people look, look at what you’re doing to yourselves. It’s not even somebody else doing it to you. Okay, you’re doing it to yourself. And there’s nothing worse than avoidable stupidity.

Okay, so it’s just insane it’s totally insane and it’s nothing that any other there’s no other I could maybe a hairdresser like that. I don’t know I I go and get my haircut. And they make me a pseudo appointment. You know, eight weeks from after I get my haircut. And but they constantly have to follow up with me. Maybe that’s another industry that might pre-appoint. But I don’t know any other industry that Priya points and believes it makes any sense.

Howie: Right. Well, thank you, Mark.

Mark: You’re welcome. I hope I didn’t make any enemies from this. Hope I made some friends.

Howie: I don’t think so. Anyway, that’ll be it for today, my friends and we’ll talk to you again soon.

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