Patient Retention During Transitions
Dr. Gene Heller
When joining a new practice, whether it’s as an associate, future owner or partner, or as the new owner, the primary goal and concern is retention of the patients during the transition to a new dentist. Dr. Owner is equally concerned about patient loss during the transition, especially if this new relationship is going to be a partnership. The active patient base is the most important asset an existing practice has to offer. Retention is directly dependent on “how” Dr. New is introduced. By following a few simple recommendations, maximum retention is assured.
The Goal of Transition
The primary goal of transition is “Patient Retention.” The active patient base is the most important and valuable asset the host practice has to offer. It has taken eight-to-fifteen years to develop and represents full-time cash flow from the first day. Loss of this asset must be avoided above all, and both dentists have an equal interest in protecting this patient base.
The current practice owner is as concerned about retaining that asset as the new dentist is. Dr. Owner needs to be convinced that Dr. New has the required clinical skills to match or exceed those skills offered by Dr. Owner. Most “current owner” dentists believe they are the best dentist in the community (and the world), and therefore tend to set unrealistic expectations for Dr. New.
In addition to ego, Dr. Owner may also base their expectations on a genuine concern for each of their patient’s future “dental” well-being. They are fearful that if Dr. New does not have adequate clinical skills when hired, then Dr. Owner will face an abundance of re-makes and wasted time in dollars in repairs. But the primary concern of Dr. Owner is the ultimate loss of the patient as a result of the problems incurred at the hands of the new dentist.
The key to retention is “how” to introduce Dr. New while preventing the loss of patients. Most patients have been referred to the “new dentist” and many will initially be uncomfortable seeing anyone other than Dr. Owner. The best “introduction” protocols vary depending on whether the new dentist will be an associate first or whether the new dentist will immediately become the owner and the senior dentist will retire.
Introducing the New Associate
Whether this is an “associate only” position with no future ownership intended, or this is an associate position leading to a partnership or total practice ownership, the simplest and most effective way to introduce the new dentist is through the hygiene department. It is the least threatening way, from a patient’s perspective, to “meet” the new dentist. The bottom line is maximizing retention will be best accomplished by having Dr. New meet as many patients as possible through the hygiene department during the recall exam. Hygiene recall is the least threatening type of dental appointment available and it is rare that a patient would over-ride the hygienist and Dr. Owner’s suggestion that Dr. New does the recall examination.
Dr. Owner’s endorsement of Dr. New is the formal transfer of Dr. Owner’s “goodwill” to Dr. New. The hygienist is going to tell the patient that “Dr. Owner has asked” Dr. New to see the patient today for their check-up exam. The hygienist must further explain the “reason” Dr. Owner has made this request today is so that in the event Dr. New is the weekend dentist on call and the patient has an emergency, they will at least have met and will be familiar with each other. When Dr. New comes in for the exam, he/she repeats the same story- “Dr. Owner” has asked “me” to do your check-up exam today so that in the event I am the weekend dentist on call, you will have no concerns or reservations about calling someone you have never met.
If necessary treatment is subsequently diagnosed, when the patient is returned to the front desk, the patient will still be given the choice of which dentist will actually do the required treatment. It is critical that the appointment secretary correctly route as many of these patients to the new dentist as possible. The appointment secretary should always offer two appointments with the following parameters. “Mrs. Smith, Dr. New can see you next Monday at 2:00PM, or Dr. Owner can see you two months from now at 6:00AM (in other words, it is more difficult to see Dr. Owner and more convenient to see Dr. New).
Twenty-five percent of the patients, having had a very favorable interaction with Dr. New, will immediately schedule with Dr. New. Fifty percent will schedule with whichever dentist’s available appointment time meets their needs. The remaining twenty-five percent will specify Dr. Owner. No matter which dentist the patient wants to see, they are still a patient of record and the introduction has been made.
If this approach is followed, it must be carefully monitored. If done successfully, after a couple of months, holes will begin to appear in Dr. Owner’s schedule. This is the sign that it is time for Dr. Owner to step back in and begin doing more of the recall exams.
When the transition is a “role reversal,” i.e., Dr. New is hired initially as an associate. The intended outcome is that Dr. New will eventually purchase the practice and Dr. Owner will become the associate, hence the term “role reversal.” The introductory steps are the same as for a partnership.
For a future partnership, the intention is to introduce as many patients as possible to Dr. New. However, because Dr. Owner will not be leaving the practice, “all” patients do not need to be introduced before the sale is consummated. If, however, it is the intention of Dr. Owner to retire after the ownership change, then all patients must be introduced to Dr. New through the hygiene program prior to the sale and retirement.
Retention After a Total Sale
Patient retention after a total practice sale wherein Dr. New has never met any of the patients must follow a different procedure. We see an average 90-95% retention rate even in the case of a new dentist buying a practice, never meeting any patients before the sale, and the senior doctor immediately retiring. The reason for this is actually fairly simple.
There is only one thing scarier to a patient than changing dentists. That is changing dentists and going to a new “unknown and unfamiliar” location to find and meet the new dentist. As if that were not hard enough, there are also no familiar faces at this new location. Even if Dr. Owner is gone, Dr. Owner’s staff remains. When dealing with new people (or in this case, a new dentist), anything familiar makes the process easier. If the patient has to change dentists anyway, most patients will give the new dentist at least one try. All that is required is the endorsement of the selling dentist. This simple endorsement will transfer the goodwill and subsequently the patients to Dr. New.
One of the questions we are continually asked is, “Must the retiring dentist stay around to introduce the new dentist?” There are two opinions regarding this. The first is yes, for up to six months, the new dentist will find it “helpful” to be personally introduced to the patients. The intended purpose of this “personal introduction” secures patient retention. After more than twenty years of observing this practice in action, our experience has been that this actually has the opposite effect.
Many patients are actually lost because they are upset that Dr. Owner is there but will not see them. Or, the time needed for the introduction causes Dr. New to run behind schedule, instilling a “bad marketing” first impression. In most practices, 80-90% of new patients come from existing patients and the existing patients, feeling Dr. New is not capable of staying on schedule, stop making referrals. The existing patients quickly develop one of several opinions: Dr. New is already too busy and cannot stay on schedule, or Dr. New is too inexperienced to stay on schedule, or if a referral is made, the referral will have their time wasted waiting for Dr. New. The outcome in all instances is the same: “No” referrals from the best referral source, the existing patient base.
If there are only enough patients for one dentist, Dr. Owner actually treating patients is even worse than just introducing patients. Dr. New will not have enough treatment to render. Dr. New will experience significant financial difficulty as the result of losing the typical 35% revenue that the previous Dr. Owner is now paid as an associate. The rule of thumb we use in total practice sales is that if Dr. Owner is going to leave the practice in less than a year after the sale, we do not want or need Dr. Owner for a single day. 
What is required is a brief four or five paragraph letter (click here) announcing the retirement of Dr. Owner and introducing Dr. New as the hand-picked successor. The first paragraph is Dr. Owner’s announcement. The second and third paragraphs are Dr. New’s introduction including Dr. New’s family information, educational background and qualifications. The last paragraph is Dr. Owner’s good-bye, coupled with Dr. Owner’s endorsement and encouragement that Dr. Owner’s patients continue to seek services from Dr. New.
The Importance of Advanced Scheduling
One of the rules of dental practice patient management and retention is that all patients leave the dental office with both another appointment scheduled and a personalized “reason to return.” All patients need a scheduled hygiene appointment. No matter if this is an associate-only position or what method of sale is going to follow, advanced scheduling is imperative to maximizing patient retention (three months ahead for patients with periodontal problems or six months for normal recall patients). Regardless of whether or not the patients have been notified by letter that there is a new owner and/or the upcoming retirement of Dr. Owner, the majority of these patients will keep their hygiene appointments and use them as a means to meet the new dentist.
This non-threatening first introduction allows the patient to make their own assessment as to whether they will want to continue seeing Dr. New. It is the staff, especially the hygienists, that will be the most instrumental in retaining and transferring the goodwill of Dr. Owner to Dr. New. At the time of transition, patients already scheduled three/six months in advance for hygiene will most likely keep their appointment. If the practice is not scheduling hygiene three/six months in advance, this must be started as soon as possible. If the practice is already scheduling six months in advance, the hygienists must concentrate their efforts on re-scheduling all patients to be seen three/six months in advance (in other words, any patients who are not scheduling six months in advance).
Introducing the new dentist through the hygiene recall program “at the request of Dr. Owner” is the most successful method of introduction. Coupled with advanced hygiene scheduling, patient retention is practically guaranteed. Keeping the prior staff is another critical component, especially in a total ownership change accompanied by the retirement of the previous owner. The final piece of insurance is the owner dentist’s endorsement of the new dentist, most commonly in the form of a letter. With all these steps in action, patient loyalty will not falter, and everyone’s commitment to a successful practice is insured. ■
Dr. Eugene W. Heller is the vice president of Professional Practice Transitions, a nationwide dental practice sales and consulting organization. He can be reached at 1-888-477-8552.