In this episode, Howie and Mark discuss hitting dental practice plateaus. Is your practice growth stalled? Learn more about how to handle and anticipate future patient plateaus.
- Discussion of the various career plateau points for a dental practice
- When to add a hygienist to a starter solo practice
- Stalling at $800–850,000 gross revenue—and how to break through
- Referrals and insurance participation plateaus
- Aging patient base plateaus
- Relying less on insurance plans and more on marketing
- Transitioning into promoting your practice
- The always-increasing costs of business, combined with reimbursements going down—leading to plateaus
- Pre-appointment plateaus
- Recognizing when your team is too busy and overwhelmed, leading to practice stagnation, poor customer service, and less time for collections and booking future appointments
Hello, and Welcome once again to the Dental Marketing Mastery series. This podcast is brought to you by DentalWebContent.com 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, everybody. Welcome once again to our podcast. We’re, we’re so happy to be with you, aren’t we night now, Mark?
Mark: We are. We are always. I saw you speak. I spoke to a couple of dentists last week who listen to our podcast.
Howie: Oh, yeah. There were that many to?
Mark: Well, yeah. And it, it made me feel good. Because during the conversation, you know, you know how we get we tried it. We have we I guess we feel like we have to explain everything. Right.
Mark: And while we’re explaining things, they hurry you up. And they say, Oh, yeah, I know. I know. I listened to your podcast.
Howie: Oh, yeah. That’s cool.
Mark: Or Yeah, yeah, I read your book. I got this man. The more you know; you don’t have to explain it to me.
Mark: It was it. It really, really helped like it. They get it.
Mark: Know, they understand. Anyway, it was. I’m glad we do these podcasts.
Howie: Yeah. Yeah.
Mark: Little tiny bite sized chunks of information. Which know you and I are well past millennials. And, you know, so the, I think the millennials started this. They wanted everything in five second increments or less. Right?
Howie: Yeah. Pretty soon we’ll just be down to emojis and grunting.
Mark: But, uh, but, you know, we’re older. So, you know, there’s 20 minutes, 30 minutes, you know, and we can get into the meat of the topic. And,
Mark: so anyway, it’s good for it’s good for the treadmill. If you can get on a treadmill, put your earbuds in, listen to us for a half hour, you’ll get a good workout and you’ll get some good information,
Howie: Yep, get healthy too. Okay, today, we’re going to talk about plateau points in dental practices.
Mark: Yeah, just got off the phone a little while ago with one of one of my one of my favorite humans with a good all-around guy from Middle America on the cornfield somewhere. And he was a client of ours for about three or four or five years and then stopped, which is fine, and then re engaged us about a year and a half or two years ago. And it was the plateau points that caused the initial engagement, it was the plateau point that caused the disengagement, it was a plateau point that caused the reengagement and now he’s had another plateau point.
I feel like, you know Howie came up with this, it was great, it was perfectly topical for today’s topic with his plateau points. Um, the cool thing about dentistry is that the business of dentistry is that most of the normal plateau points are very recognizable, you can almost see them before you get there. And if you can see them before you get there, or as you get there, and you can prepare for them, you can blow through them to greater growth. And over the lifetime of a dental practice or a career could, you know, could be worth at least hundreds of thousands, maybe millions of dollars.
Let me go through kind of a maybe a career timeline of John or Jane Q, average dentist, as they buy or start their own practice. Typically, they’re the only one providing any of the work. In other words, cleanings or restorative or any kind of care patient care, it’s usually just them. So normally, the first plateau point you’ll reach is that, you know, when should I hire a hygienist? And the answer can vary depending on the scope of the dentistry that the owner is able and willing to provide. But let’s say it’s average, right? Maybe they farm out some third molars to an endodontist, then, you know, maybe they don’t do straight wire ortho, and they pretty much do everything else in house.
As soon as you can, as soon as you can fill up predictably, a day and a half to two days of hygiene, it’s basically time to get a hygienist. Because even if you’re just sitting there and you can still be productive promoting the practice, you can still be productive helping to manage the practice, you can still be going through treatment plans, you can still be following up with treatment you could meet as the dentist, you can be doing so many other more productive things. And your hygienist will and it’ll free up your schedule. And a couple of podcasts ago, we talked about stagnating a practice because you’re too full.
That’s the inflection point, you don’t ever want to get to the you don’t ever want to get your solo practice where you’re the only provider to the point where, you know, you’re booked out a week or a week and a half and you’re doing your own hygiene that you, you already have enough room for a hygienist for a day or two. And so as soon as you do, that’s your first plateau point, get yourself a high Genesis, the doctors who got them earlier are far better off than the ones who waited until they plateaued financially and then decided to take the jump. So that’s your first plateau. Your second plateau is going to happen. Somewhere around 800-$850,000 a year in gross production.
Howie: Yeah, you’re talking about gross revenue there, right? Yeah,
Mark: Yeah. gross revenue, right. Not net. Um, that is a pretty common plateau point for a solo GP, I think almost every solo GPS probably hit that plateau. Many of them are fine staying there.
Mark: The problem is, is that if you do stay there, I can virtually guarantee you your costs are going to go up.
Howie: Yeah, don’t they always?
Howie: Expenses are going down.
Mark: Yeah, I mean, you can run a business on Gee, I hope for the first time in history, my costs go down you can do that. Okay.
Howie: We wouldn’t Recommend.
Mark: We wouldn’t recommend it. Right. So, um, so at about 8-850. Now, you can stay at 850 for three or four years and then say, say to yourself, Hmm, I can’t get off this. This wall, I can’t get past this fence. I can’t get, you know, beyond this barricade, like what’s going on? And then you run around and you kind of you look at your staff, you look at yourself, you take leadership courses, maybe you go out and look for new services to offer implants, sleep apnea, what sedation what have you, okay, you think it’s you internalize it, it’s all your fault. Come back for all these courses. And the end of next year you do as 850.
Howie: And then you shift yourself off to the nearest psychiatrist.
Mark: That’s right. Well, it wasn’t you to begin with?
Mark: it really wasn’t. It was it was. There’s a lot of things involved here. So, let’s take them one at a time.
Howie: It could be like, Well, actually, one of eight things, I think, is what we’ve narrowed it down to once upon a time,
Mark: Right? It’s actually it could be a combination of any one of Howie is right, like seven or eight things, right? So, we can go down this list. And we can say, all right, so if you’re getting your new patients primarily through referral and insurance plan participation, which by the way, we visited an office in Philadelphia, this is the exact same story with him. And if you’ve been doing that, and not spending any money to promote your practice outside of referral and insurance participation, and you reach capacity. In other words, you’re booked out, you’re booked out 8, 10 work days, your new patient numbers have leveled off, your patient base has aged, that’s actually one of the eight, you have an aging patient base. In other words, everybody’s fine. All you’re doing is cleaning porcelain.
Okay, there’s no more dentistry to find, right? There’s no new blood coming in or not at least no new Good, good blood coming in. If you combine all those things, and then you assume that insurance reimbursement is going to go down. In other words, there’s downward pressure on them paying you and there’s zero upward pressure on them paying you, then sooner or later, you’re going to come to the point you’re like, yeah, I’m working just as hard as I used to for less money. And it’s true.
Okay, so that inflection point, that story I just told, you know, that, um, it’s a very common plateau point. I mean, it’s, that’s actually probably the most common plateau point. Um, that might be the time when you as you’re approaching that where you say to yourself, you know, what, I’m going to start relying less on insurance plans for my new patients, because their, their reimbursement is on a downward spiral. And I’m going to maybe start to transition my way into promoting my own practice and gaining the revenue bump there. Maybe I don’t want an associate at this point in my career, maybe I don’t want to partner, maybe I just want to be my own boss.
But I want to make more money for the exact same amount of time that I’m spending at the offices that are losing money every year, or having to work harder for the same money. Because the only thing there is your staff because they have you know, they have 3% increases because of the earth made a complete revolution around the Sun every year. And they get more money regardless. And if they don’t, they’re going to wind it up because they have it. So, your costs are going up your reimbursements going down. So that’s a pretty good indication, especially if you’re busy. That you’re about ready to hit a plateau.
Howie: Yep, actually, we’ve hit a plateau point ourselves. We’re going to be going away for a commercial break. Don’t go away. We’ll be right back.
Let’s play as snappy at about us. Hello, everybody. This is how we Horrocks and along with me is Mark Dilatush president of new patients Incorporated. How you doing Mark? Hey, how are you? How are you? This is the part of the podcast where we get to brag about our company. Yay. So sometimes it gets lost and all these podcasts what New Patients Incorporated actually does. We have? I don’t know how many podcasts 7581 a week for well over a year.
And all of you listen to these a half hour at a time and it you might lose sight of what we do. So here’s the short answer. We do everything we’re talking about in these podcasts on behalf of our clients. Okay, we know the podcasts are there for our clients, of course just so they understand what the heck we’re doing. But also for the doctors who are do it yourselfers. If you’re not a do it yourselfer, and you want someone to do this for you, newpatientsinc.com, there’s an icon in the dead center at the top of our homepage where you can get a complimentary marketing plan, a series of questions will need to be completed.
And once you complete that, we will analyze your market area, develop a marketing plan and get on the phone with you discuss all the sections of the marketing plan just to make sure you understand a couple of things, what you’re up against, what your expectations should be, and what market Howie would do if we owned your dental practice.
Howie: All right, we’re back now.
Howie: Here we are at the plateau.
Mark: Yes. So we went through the When should I get my hygienist plateau, then we went through the, hey, when should I start to maybe think about this marketing thing, after I use insurance to help build my practice up to a point where I’m busy for eight days. You know, if I’m booked out eight days a week, I know I’m busy enough to do that. So, okay, that’s another inflection point. There’s another one here that we, we again, this was today, and I think was Friday, we had another conversation with another dentist who was going through exactly the same thing.
And that is, um, and these two things happen almost simultaneously. It’s when you’re a solo GP, and you have to fold, let’s say, a 35 hour a week GP and you’ve got around 60-65 hours a hygiene. And you have the one person at your front desk, and maybe you have another person that comes in and helps that person now. That’s another inflection point. And it’s often overlooked. And that’s there, there’s the practice, that’s your $850,000 practice I’m describing right there.
Okay. And one of the things that could fix that problem is you’re understaffed, and we ran into two of these just last week, where we have a doctor that has 20 to 25 patients coming through that front door every day, for three days out of the four days of the week, and poor Mary up at the front desk. Um, you know, kind of looks like those Asian girls with the sticks and the plates in Cirque du Soleil.
Right, she’s sitting up there trying to put her fingers and all the holes in the water and they’re leaking, and she’s trying to do our jobs, John is probably a really, really good employee trying to do the very best she can. But I mean, she can’t, she can’t possibly handle that much that many patients, that you’re throwing out. And that’s another that’s pretty common mistake. As practices reach these plateau point, is they don’t really recognize when they’re overwhelming their business staff. And if you overwhelm your business staff, you’ll stagnate your practice, everyone.
Howie: Not to mention, you know, complaints about poor customer service and that sort of thing going on,
Howie: Then you’re in trouble,
Mark: Right? 30-31 years in dentistry, and that happens every single time. Every time, you’ll, they just they can’t do it and you already know what they’re going to put off, they’re going to put off the stuff that doesn’t that they don’t like to do. And normally, that’s collections and following up to get more appointments and put more production in your book. And what are the two things you want them to do? collect money and put more appointments in your book. Okay.
So, you know, so that’s another really critical piece of the solution to get blow through a plateau point. So even if you do transition out of some insurances, maybe if you do ramp up your dental clinic marketing, if you do all those things, what I’m saying is, don’t overlook the team aspect to this, because all the marketing in the world, you know, isn’t, isn’t going to get your front desk person to be able to process more than 19 humans through your office every day and do everything just not going to happen. And even at 19, that person has to be the best.
Mark: They’re 80% the best and she’s only going to be able to handle 16. Okay, so you’re literally you’re overwhelming that person, and you need to plan for it if you if you’re going to get through these transitions. Normally, normally, when this happens, what you do at the front is and you know, I have to take my word for it. But I’m just giving you what I’ve seen work, I don’t know how many hundreds of times in my career.
When there’s one person at the front, you know that person’s kind of the do all person because they have to be because there’s nobody else to do it. Right. And when there’s two people in the business office, then typically what you’ll do is you’ll split delegate duties based on two lines, financial and scheduling. So basically, you’ll have a scheduling coordinator and a financial coordinator. If you have two people in your business office and one person’s focused all day on getting and keeping your schedule blocked. Right.
And the other person is there all day making sure that people have treatment plan console’s people are being followed up on insurance plans or insurance claims are being paid on time. And she follows up with those that don’t, and not too many people have AR issues in in dentistry anymore. But, you know, if you do have any outstanding balances, following up on those going through the financial options with patients when they come at a treatment console, so on and so forth. That’s pretty much what you do.
To blow through that 850, 8 to $900,000 a year. Insurance Plan type of you know, a broad practice, arm Normally, if you do all those things, in concert with each other simultaneously. That’s why it doesn’t get done. It’s a lot. It’s not one thing, it’s never one thing. The only thing the only one thing that is true is that it’s never one thing. There are always multiple tweaks that you have to make to blow through the you know, blow through these transitions. And once you go through these, you can get a single doctor practice I have single doctor practices that do no hell, we know him that do 2 million a year.
Mark: Um, but they’re, they’re rare, they’re very rare. You know, I’m going to say you’re somewhere in the 14-15 range, right with, with two dentists, maybe not necessarily full time. And once again, you’ll reach another plateau. And it will be almost for the same reason with the staff. But you’ve already gone through that. So, you’ll recognize it and be able to adjust for it and but the next one will be um, you know, Marks version of the day, which is pre appointment. Pre appointment will stagnate your practice at some point in your career, just went through another one today. Doctor calls and says I’m not getting enough new patients, we look ‘Yeah, booked out three weeks, why they pre appoint everybody and go through the whole scenario. Stop doing that, you know, start blocking your schedule for new patients, the whole nine yards.’
That is going to happen to all of you at some point in your careers. So, whether you’re at an inflection point or a plateau point now or you see one coming, or what the heck, you just want to do things better. I’m not pre appointing everyone is your next move. Actually, that’ll, that’ll help you avoid even hitting the plateau. If you do it ahead of time, but, but that causing a lot of a lot of practices to plateau, especially now that we’re into recovery.
It’s just like unclog a sink. You got to get the 30-35% of the patients who are not compliant to your recare out of there to free up and allow more new patients to schedule through your dental clinic marketing, through your referrals, through your dental clinic website, through whatever marketing you’re doing, whether you’re doing it through us, you’re doing it through somebody else. It just frees it up so that patients that do want to be new patients, in your practice, have an opportunity to get into your schedule in a reasonable amount of time.
Howie: Great. Well, that’s, that’s much good advice, Mark. Thank you. And we’re going to call it a day here. And we’ll see everybody next week. Okay. Thank you. Bye now.