The marketing of the orthodontic practice has changed considerably over the past two decades. Marketing strategies can be much more sophisticated and diverse than simply building relationships with the area dentists and providing excellent customer service that leads to “word of mouth” referrals. Understanding the dynamics of the marketplace and how one’s career path fits into it is vital to achieving accelerated growth.
The newer orthodontist (NO) has many challenges, some of which depend on what career path he or she takes entering into the profession. Most NO’s have a very rosy picture of where they will be in 1, 5, 10 and 15 years. Certainly the future is as bright as ever for those graduating, but this does not necessarily preclude some significant hard work and extra effort to earn one’s way to the top. No doubt the NO had to work hard and sacrifice to become an orthodontist, but additional sacrifice is often required to grow a thriving business. This article will focus on the marketing difficulties and opportunities that face the NO’s when they start a practice “from scratch” (S-NO), enter into an associateship leading to partnership (A-NO) or purchase a practice (P-NO). Each one of these career paths has unique issues that may require a different strategy for achieving marketing success.
Significant patience is required for S-NO’s who start a practice “from scratch” as it usually takes 3-5 years before seeing significant growth. Few, if any of the area dentists will know them personally or have any way of judging treatment quality. Even the NO’s “bedside manner” and ability to handle the patient’s customer service needs will be questioned. Had the NO become a partner or purchased a practice the area dentists may conclude that there is a good likelihood that the same levels of quality and customer service would be maintained.
A simple principle of marketing is that “volume creates volume,” assuming that service is adequate. The practice that only has a few patients visiting each day has a much smaller chance of gaining referrals for its customers no matter how fabulous the service. Fewer patients means fewer missionaries who will be able to “sing the praises” of the outstanding service to their family and friends. The bigger practice has significantly greater ability to influence the neighborhood.
How many observation recall patients are ready to start the first year the S-NO is in practice? How many Phase 1 patients are ready for Phase 2? The answer is few, if any, while at the same time many New Patients may be placed on observation recall or go into a limited or early treatment resulting in very little profit.
Although the first years of an S-NO starting from scratch can be quite lean, I have encountered some that have blown away the averages. These doctors have been able to develop practices that require consulting help to manage their growth and scheduling within 2-3 years of opening their doors. In these exceptional practices I have seen four important conditions that set them apart.
The most important condition to accelerated growth is choosing the right location. Most NO’s seem to choose their area of practice based on personal issues rather than on a solid set business criteria. If location, location and location are the three most important things in real estate, then selecting the right area that can sustain the desired practice growth is vital to the NO’s success. Understanding the demographics of the area, pinpointing the major schools, significant growth areas and understanding the number of dentists per orthodontists is a vital evaluation before selecting a location. Fast growing practices are often found in under-serviced areas based on how many available patients exist who can afford the services offered.
A second condition to accelerated growth is developing an “image of quality.” How does an S-NO develop such an image if he or she has never finished their first case? The answer can be found in developing an outstanding image of the facility and forms, along with selecting staff members who will enhance a picture of professionalism and care. Unfortunately, a half-hearted commitment to creating an adequate facility or poorly printed forms may be the only criteria by which the S-NO will be judged. How are the patients and area dentists to judge the S-NO if it is not by his or her degree of commitment to excellence?
The third condition for these fast growing practices is usually found in their ability to “hit the streets” looking for starts. The primary opportunity will certainly be found in visiting the local dentists at any time of the workday with food items and cards given as gifts. The S-NO’s have a huge amount of free time to visit with dentists, lunch with them and even do them special favors. Street fairs and Expos provide an opportunity to set up a booth where the S-NO can do free screenings and give out complimentary advice. Dinner times are often used to build friendships with younger doctors and their spouses in the S-NO’s home. Schools become a resource for patients by performing hygiene classes and lecturing to PTA groups. Having to pay for an exaggerated overhead often propels these hungry S-NO’s to realize that success and failure depends completely on their energy, effort and creativity in exposing their services to the public and building relationships with key referral sources. Many dentists will reward their efforts if for no other reason than the fact that the NO has made a valiant effort to market the practice.
The fourth condition for developing a successful practice “from scratch” is the ability to capture the growth as it calls into the practice. Many practices could be 25-50% larger today if the orthodontist simply realized how important the telephone and the scheduling systems are to success. S-NO’s might try to “save a buck” and feel that they do not need to answer the telephone during business hours. This is an extremely dangerous belief as it often leads to New Patients calling and without a live receptionist available to answer the phone the patients call the second card that was given to them by their dentist. An excellent way of insuring that one does not lose out on any business is to have the phones forwarded to a second line in the home on days out of the office.
It is amazing how many smaller practices once they get busy tend to create a backlog of new patients, records and consults. This backlog creates an image that they are busy enough and the area dentists may move on to referring patients to someone who does not appear as busy. Dentists enjoy being needed by the orthodontist. The NO starting “from scratch” should be focused on properly handling the patients sent to them, providing excellent feedback on the outcome of the visits and insuring that the referral source knows how deeply appreciative they are for their help.
Practice growth will be significantly affected by any limitations in facility size or problems related to staying on time with each visit and total treatment time. These factors severely limit the practice from capturing the growth. Practices will grow to their level of perceived competence and then stop growing or even decline. Strategically adding chairs, reception space and designing an effective scheduling system are all critical to getting from average to super success.
For the S-NO who ventures out on their own the rewards can be great, but the time, stress and difficulties can be greater. Only the highly motivated NO should consider such a move and only when he or she feels they have discovered an untapped gold mine of an area. Cases of S-NO’s going into bankruptcy are unheard of, yet the marketplace is strewn with offices that have fallen into the pitfalls indicated above and can only produce a less than average growth pattern. In these cases the NO should strongly consider establishing a second location, or better yet, look for another practice to assimilate into his or hers.
The second approach to accelerated growth and super success for the NO is to become an associate/partner in a practice that already has a strong growth pattern. Today’s formulas for valuing practices and forming partnerships are often tremendously favorable to the A-NO. Which other business is willing to bring in a partner with little or no cash, limited expertise and guarantee a large salary while it gives away 33-50% of its value? This is the opportunity afforded hundreds of NO’s each year as they join successful practices that already have developed a strong stream of referrals, both internal and external.
A drawback to this approach often becomes very evident to the senior doctor 1-2 years into the association when he or she begins to complain that the A-NO is not bringing in any significant growth of their own. Growth often happens naturally in these practices as the doctor time and availability increase. Unfortunately, it is seldom that this consultant has seen an A-NO be able to show loyal referral patterns from the area dentist before their 5th year. Although this issue is beyond the scope of this article it seems that two major issues related to this interesting pattern are evident.
The first issue is that when the A-NO arrives in a large practice he or she is limited in the number and types of potential referral sources that they can cultivate. Most of the area dentists have already formed their loyalties for or against the senior doctor. If they are presently referring then they are no longer candidates for the A-NO to prospect. A second group may not be fond of the senior doctor and may not refer to the practice for this reason no matter what efforts the NO expends. The “practice from scratch” NO does not have the limitations of a senior doctor’s existing referral patterns.
The second issue appears to be that the A-NO in this approach is significantly busy learning the practice’s treatment technique and is often trying to see more patients than they can competently handle. The days may create a certain fatigue that the S-NO does not have to face. There is also the possibility that the A-NO who desires a long-term partnership is not as aggressive or competitive as the NO’s that seek other approaches. An NO who does not like the idea of having to build and sustain a large practice should seek a partnership in a thriving practice that may not require a large investment of time, energy and determination to help it continue to grow.
Certainly one of the key contributions that the A-NO will make to marketing is to enhance customer service by freeing up the senior doctor to do more internal and external marketing. Helping the practice to stay on time along with being able to see patients on a normal rotation, especially New Patients, are all vital contributions to allow the practice to capture additional growth. In most cases the success of the partnership often rests on the ability of the A-NO to convince the senior partner that they are truly working the marketing systems, even if the results are not to be seen for 3-5 years.
Developing a game plan is critical to keep the A-NO focused and the senior partner pacified. This game plan should consist of dividing up all of the area dentists into three categories: 1) Those who primarily refer to the practice; 2) Those who most likely will never refer to the practice; and, 3) Those who may be candidates for increased future referrals. Obviously it is on this last group that the A-NO would concentrate his or her attention, beginning by prioritizing the dentists based on practice size, personality and proximity in age to the A-NO. The senior doctor’s input in helping to create this marketing game plan is invaluable.
What should stand out is a group of dentists who the A-NO believes are his best chance for building a referral relationship and an order of priority. The higher the priority level the greater the need for attention and the greater the proportion of the marketing budget. Present referral sources should also get an appropriate amount of attention, but those that the senior doctor feels will be a waste of energy should not be pursued.
It is not possible to cover all of the marketing strategies possible for developing dental referrals. What should be emphasized is that each dentist should get one or two preliminary visits during their work day with food items and brochures or business cards in hand. Once a spark of a relationship is established, the A-NO will try to set up a lunch meeting to review with the dentist their specific desires as to how they want their patients treated. Any opportunity to send thank you notes or simply notes concerning a special comment in the conversation is important to relationship building.
The younger dentists may be encouraged by the A-NO to join together to form a study club that might be held in the orthodontic practice every two months. Special speakers could be arranged, especially focusing on orthodontics. The food, wine, and beer should be generously provided by the practice and hosted by a few of A-NO’s more social staff members. Simply having a “fun night” of poker or a mini-golf tournament on a Friday morning sponsored in part by the A-NO can be extremely valuable in terms of relationship building.
It is vital for the A-NO to make the best of every opportunity possible to make contact with the priority dentists. Patient concerns, notes about the dentist’s hobby or affections, newborns, health problems and birthdays all provide fertile ground for planting relationship seeds. Remember, this cannot only be done with the same 1-2 dentists each and every week. All of the dentists on the priority list must be cared for in this way as the A-NO is often at a severe disadvantage; so many of the area dentists are already in, or permanently out, of the practice’s referral patterns.
Finally, a few words of admonition for the A-NO are in order. Although marketing to dentists is primarily a relationship issue, it also requires some sales ability. You must sell yourself without looking foolish and overly aggressive. Humility is a necessary component to building most relationships and if the dentist feels overpowered or he is made to feel insecure, he will not enjoy a continued relationship. Arriving for a lunch in a Ferrari usually sends the wrong message. But a simple request expressing one’s need for his help often will produce desired referral results.
It is always best to treat people the way they want to be treated. If the dentist says he is too busy for lunch, breakfast should be suggested. If he is not interested in breakfast, ask if it is acceptable to drop by the practice to get acquainted. “No” does not always mean “no,” but when it does it is important to back off and try another approach. Perhaps one can get to the heart of the doctor by getting to the heart of his staff. The key to success is to regularly, every day, make a systematic attempt to cultivate long term relationships by truly caring for the priority dentists. The A-NO is in the advantageous position of being able to give significant help to the younger dentists. This help in getting their careers started will be repaid many times over in the years to come. If you are truly trying to help them, they will enjoy helping the NO in return.
The Purchasing NO (P-NO) has decided advantages in creating accelerated growth over the S-NO and the A-NO:
First, the Purchasing NO has acquired a volume of patients that he or she can develop into a tremendous source of referrals by applying outstanding internal marketing ideas and exceptional customer service. It is not unusual to find senior doctors before they retire beginning to “wind down” and diminish their focus on patient and parent needs, up-to-date facilities or forms and communicating consistently with parents. The debanding gifts and celebrations, joking around and motivation contests may have all disappeared. The P-NO has a terrific opportunity to make an immediate impact on marketing by delivering a new level of enthusiasm and caring throughout the organization. This energy and excitement alone often is contagious as it spreads to staff and to patients.
Secondly, the P-NO is not limited in his or her work to develop new dental referral sources. The dentists who loved the senior doctor and referred large numbers to the practice can easily be maintained by continuing the same or greater level of contact and outstanding care for the patients. Also, many of the dentists who did not have a good relationship with the departing doctor are now open to be developed as referral sources. Every dentist in town is now a possible referral source and this requires the P-NO to expend considerable energy “wining and dining” to create lifelong relationships with breakfast, lunch, dinner and sporting events. All of the suggestions written above for marketing dentist referrals apply to the P-NO.
Thirdly, the P-NO has ideally purchased a practice with outstanding staff who will help him or her market the practice. This advantage over the S-NO is gigantic and is also a modest advantage over the A-NO. To have terrific staff who support the marketing program gives an “image of success,” even if the practice is still quite small. Developing this “image of success” is a mandatory part creating accelerated growth as it creates credibility in the practice and gives the referring dentists and patients the confidence to share the good news of a dynamic practice. It would not be surprising to discover many dentists thinking, “If that P-NO has such a wonderful person working for him, she must be good!” The A-NO often does not get the same support from the staff as their loyalties may remain with the senior doctor, at least until the A-NO has earned their respect.
Fourthly, the P-NO is completely at the helm of his or her ship and can create the vision and set the action plans unencumbered by a senior doctor. The P-NO also has the financial resources that the S-NO often does not have and can make quick, correct decisions without having to worry about what a partner might be thinking. The game of marketing orthodontics is not doing one or two things right, but instead, is the ability to do one hundred and one things well, and in a timely manner. The basic personality style of many orthodontists precludes them from making quick and effective decisions as they become paralyzed with analysis. Having one leader simplifies the process of decision making and makes it much easier to move the practice forward.
Lastly, the P-NO is perhaps the only one of the three approaches who can seek out the expert advice of a consultant and take full advantage of their outstanding systems and ideas. The S-NO may feel they cannot afford a consultant and the value of the consulting process is diminished because of the low volume of patients and limited space and staff. The A-NO is often precluded by the senior doctor from seeking new and up-to-date ideas as she and her most senior staff may not be interested in any significant changes. The consulting process done correctly can provide huge momentum in propelling the P-NO’s practice forward as it helps create the new vision, establishes systems to handle the growth and provides proven marketing ideas that will lead to accomplishing the goals. While the S-NO battles to “re-invent the wheel” and stands around waiting for the phone to ring, the P-NO is able to work his or her way quickly out of debt and into the top 10%. Seeking out expert advice allows the P-NO to work smarter, not harder and achieve his or her goals in a shorter time.
In conclusion, it should be obvious that each career path choice for the New Orthodontist provides some opportunities and pitfalls. Each NO must choose the approach that will best serve their short and long-term goals. It is best to always keep in mind that accelerated growth and being on the top of the profession is not everything in life. When the Newer Orthodontist creates a right balance between aggressively pursuing a career with keeping the priority of his relationships, especially with time and care for the family, only then can true success be achieved. For the S-NO living in a particular community with family may be a significant factor that dwarfs the need for super success. For the A-NO who may be the wife and mother of a family, managing a large practice on her own may be a nightmare and the leadership of a senior partner is ideal. It is said, “Be careful what you wish for,” as those wishes often come true and with all success comes the danger of a life out of balance. Relationships are the most important things in life and the sooner we learn this important lesson the more successful we truly will become.
Ken Alexander, Founder