Debra Engelhardt- Nash has been in dentistry over 30 years. She has presented workshops nationally and internationally for numerous study groups and organizations. She is a repeat presenter for the American Dental Association and the American Academy of Cosmetic Dentistry. She was a contributing editor for “Contemporary Esthetics and Restorative Practice” magazine and an editorial board member for Contemporary Assisting magazine and has written for a number of dental publications. Debra has been on several podcasts and conducted over 25 webinars for various groups and organizations. She has been honored twice as author of the year for her contributions to dental journals. Debra was also an instructor for the Central Piedmont Community College Dental Assisting Program and a guest instructor for Medical College of Georgia School of Dentistry.

Debra has been consulting since 1985 and offers in-office and skype training for dental practices throughout the country.

Practice Essential-Patient Retention


Most conversations about practice growth would have acquiring new patients right at the top of their list of things to do. For established practices, one of the vital keys to grow the practice is to keep hold of existing clients. What is the point of acquiring more new patients if the practice can’t hold onto existing ones?

Building and focusing on keeping your clients can be a significant way to grow your practice and save marketing dollars. According to Frederick Reichheld of Bain and Company:

• Studies have shown it is six to seven times more expensive to acquire a new customer than it is to retain a current customer and

• As little as a 5-percent increase in customer retention can increase profits by 25 to 95 percent.

Why do Customers (Patients) Leave?

According to work done at the American Society of Quality Control, the main reasons customers leave or stop doing business are: the following:

• 1 percent die

• 3 percent move to another area

• 5 percent influenced by friends or contacts to go elsewhere

• 9 percent lured away by competition

• 14 percent don’t stay because they are disappointed with product or service

• 68 percent because of an attitude of indifference to them. Further, research by RightNow Technologies indicates that there is a marked difference between the reasons that companies think customers leave and what their customers actually think.

According to their study, 73 percent of customers leave a business (your practice) because of a lack of customer service, while most companies view that it is 21 percent of the reason they lose the client. If these findings are true, they have major implications for your practice. They suggest that loss of clients is not about how good your product or service is or how competitive your fees are in the industry, but rather it’s more about how you treat your clients and how much you care about them.

These implications fall into areas that may need focus:

✓✓ Customer service involves everyone on the team

✓✓ Your relationship strategies with patients may need refreshing

✓✓ Taking more time with patients during their visits

Do you want to improve the retention of your clients? Here are a few steps to get started:

• Focus on relationship during the patient visit. The bulk of the conversation is about the patient – who they are, what they are looking for and how the practice may meet their expectations in a highly personalized way. Office protocols can wait. Patients will be more likely to comfortably comply with practice systems when they feel listened to and cared about. Appeal to the human side of doing business with the patient, and your office standards will be more inviting.

• Spend more time with patients during the recare visit. Many practices consider a large quantity of recare patients seen in a day a mark of success, and the less time required to treat returning patients a sign of efficiency. But further review may reveal that these patients are not referring friends and family or moving forward with treatment needs that have been planned. Introducing treatment possibilities during the recare visit should not happen occasionally. They should occur consistently.

• Give the patient something to talk about. Find opportunities to update the patient by telling them about recent treatment techniques and technologies that have been incorporated into patient care. Describe how these will enhance their experience and the results of their treatment in the office. Have you recently incorporated Velscope Screenings, the Inman Aligner or Invisalign? Do you have a new dental lab that you are working with and excited about the results of their work? Let your patients know. They may pass the good news onto friends. These steps may require systems review and team training. Be certain everyone on your team understands their critical role in gaining patient loyalty and treatment acceptance. Ensure you have enough time to do this properly by scheduling appropriate captive appointments that allows the correct time to treat the patient exceptionally well.

The Recall Renewal Exam

Patient familiarity can often lead to making inaccurate assumptions about patients’ interest in treatment. A history with certain patients may create bias in presenting treatment options and prevent the dental team to discuss elective treatment options with the same zeal and conviction applied to new patients. Some offices review the hygiene patients’ charts for the day with a “been there, done that” attitude. The doctor and hygienist may be internalizing that they know these patients would not be interested in cosmetic treatment or a review of an updated comprehensive treatment plan. They may even be afraid of offending long term patients if they emphasize outstanding treatment needs or introduced updated techniques and materials.

If patients are not informed of the treatment options now offered, they will never choose these procedures.

Time must be allowed to renew a patient’s interest in recommended treatment and introduced to new treament possibilities. This is an important role of the dental hygienist. In fact it is a critical responsibility of every team member.

Professional dental associations recommend that patients’ radiographs are renewed every three to five years. This would also be a good time to renew patients’ hygiene experiences. At this visit, practice philosophy is reviewed. Patients are reminded of new treatment modalities that have been incorporated into their care.

New baseline data is gathered and treatment plans are discussed utilizing visual aids. The conversations may go something like this:

“Mr. Benson, you have been a patient here since 1997. Can you believe it? Thank you for your loyalty. This is what we have done since then. It’s time to gather new baseline information, so today we are going to proceed as though you were new to the practice. We are going to review where you are now and talk about how we are going to proceed with your future goals.”

Being excited about treatment possibilities transmits to patients. The dental team must convey her

his zeal for the practice. Praising the doctor and exhibiting enthusiasm for what the treatment plan can offer the patient in dental health and appearance translates to the patient. When the staff is genuinely excited about the office, and apparently proud of the doctor’s care, it captures the patient’s interest. Patients like to be surrounded by a team of professionals that exude confidence and show interest in their care. The enthusiasm of the team captivates the patient.

The recall renewal examination is an appropriate time to rejuvenate the relationship between the patient and the practice.

Recall Return Rate

A healthy general practice maintains a minimum 80-percent recall return rate. This means that at least 80 percent of patients seen within the past two years are coming back for care. Reviewing the office recall return rate can determine the health of the hygiene department.

Calculate the number of available hygiene appointments throughtout the year. Since patients are seen at least twice a year, divide the available appointments by two for the approximate number of patients that can be seen. Example:

two Hygienists seeing eight patients per day during a four-day work week 50 weeks annually (200 days per year) equals 3200 available hygiene appointments. If the office has 2,000 active patients, the practice has an 80 percent recall return rate. But if this number is too low, the office may strategize how to increase hygiene appointment availability. Some of the options may be adding hygiene time, developing an assisted hygiene protocol to increase appointment effectveness or referrng more treatment to a specialist . It is important to insure that the practice has the capacity to serve the majority of active patients of record, in addtion to availabillity to serve new patients in a timely fashion. This is where restorative care will be discovered and fill the doctor’s schedule.

Knowing the practice recall return rate is a key in determining if the majority of patients are being utilized to fill the practice schedule, or if the practice is recycyling and relying on a smaller majority of patients to keep hygiene and doctor busy.

For patients who have fallen out of their recall cycle, they may be contacted innovatively through text or email reminders.

Companies such as Smile Reminder, Sesame and Demand Force provide this service to dental practices. Patients are more likely to respond to these methods of contact due to its ease of communication.

The Results of Improving Your Retention

• More business: Listening learning and paying attention will get better response rates from your patients

• Increased patient loyalty: Once you establish a stronger relationship with your clients, you can develop a partner like relationship. At that stage, you’ll be able to meet and exceed their expectations. The deeper the realtionahip, the more they wlll appreciate your relationahip with them and the less likely they will be to move their records elsewhere. They will also be more likely to refer.

Teams who are excited about the prospect of serving others seem to have many patients seek their help. Those who focus on enriching patient relations will assuredly find practice success.