management & leadership

New Patients Are the Worst!


How much did you spend last month trying to acquire new patients? $1,000? $3,000? $5,000? More? How much in the last year? Gulp! That’s a lot of money spent on marketing. Did your investment pay off? How can you know? Is there a way to measure whether what you spent resulted in a sustainable & profitable increase in new patients? Here’s a bigger question – Is adding new patients even the best way to grow your practice? The truth might hurt a little, but it’s time to talk about your “leaking bucket.”

The Leaky Bucket

Take a look at this graphic:

Notice the growth and trend lines? This practice is adding lots of new patients, so everything should be good, right? Look again. They are losing more new patients than they are acquiring, which has led to a declining patient base and little or no profitability. No practice can withstand this for long. How would you fix this? Keep adding new patients? Increase your marketing? Lock your back door? This is a classic “leaky bucket” problem. Imagine a bucket full of holes being filled with water. Your job is to get all of that water to another container without losing a drop of water. Not going to happen, right? No matter how fast you run, or how much water you put into that bucket, there’s a 100% chance that you are going to lose some water, and probably lots of it. The only way to stop the leaks is to plug the holes!

The Problem With New Patients

Isn’t adding new patients the fastest, most direct way to increase production and revenue? It would certainly seem logical, but let’s explore this assumption using the power of data.

There are only two ways to increase production in a dental practice.
That’s right, only two: Increase the total number of patients, or increase the amount of production per patient per visit. According to Dental Intelligence Senior Analyst Christopher Toyn, “In the first 4-5 years in a practice there is a lot of volatility in growth. After this, most practices plateau.” This is when panic can set in and the impulse, understandably, is to increase marketing spend in order to drive more patients to the practice.

“Most practices do pretty well in adding new patients,” said Toyn. “What they don’t do as well is retain and reschedule both new and existing patients. Even with high growth in new patients, most practices also have a high new patient attrition rate, which leads to a plateau or even a decline in overall growth.”

So why are new patients “the worst?” It’s probably important to add here that new patients aren’t really bad. Of course not. New patients need dental care just as much as existing patients do. Adding new patients is a great way to build and grow your practice, if done as part of an overall growth strategy.

Here’s what data from thousands of U.S. based practices tells us about new patients:

  • They have a much higher rate of appointment cancellation.
  • They’re more likely not to accept and/or schedule treatment, and also more likely to cancel before receiving needed treatment.
  • New patients are harder to retain, more likely to leave when a new offer comes along from another dentist.
  • Extra time is needed to “onboard” new patients, which impacts production per hour. Office tour, developing relationship, insurance verification, paperwork, getting to know staff, etc.

The reality is – so many practices are trying to fill a bucket that is full of holes. Instead of stopping the holes from leaking, they keep trying to fill the bucket with water (new patients.) Instead, they should first stop the leaks (focus on scheduling/treating existing patients) and then, if there is still room on the schedule, they can try and add new patients.

The Secret is…
there is no secret

So, if adding new patients isn’t in fact the best way to increase production and grow your practice, what is? Is there a proven, reliable approach to accomplishing these important goals?

Gary Takacs shared this experience with us from LifeSmiles Dental Care, a practice he owns in Arizona. He asked his office manager about how many of their patients were currently scheduled. “All of them!” was her immediate response. He had seen the data beforehand that indicated otherwise, so he pressed her – “All of them? As in, 100% of our active patients have an upcoming appointment?”

We ask this same question of thousands of practices around the country, and none of them ever say less than 70% of their active patients aren’t scheduled.

Gary’s office manager was shocked when he told her that in fact, only 40% of their active patients had a scheduled upcoming appointment. Many practices are even lower than this. So what’s to be done? Of all your active current patients, how many currently have a scheduled appointment? This is where your most important growth opportunities are hiding. The number #1 metric you should be looking at is pre-appointment %. If you’re not looking at this every month, you are wasting dollars.

Back at LifeSmiles Dental Care, they went from 40% pre-appointment to over 90% in just one year. Once they had the right information, they could take the right action to correct the issue. But when they were driving blind, they didn’t know how to correct the problem. How did they make such a dramatic improvement in just 12 months? They started by focusing on hygiene re-appointment. This has been one of the most significant impacts on the % of patients that are getting rescheduled.

Take a look at this graphic. It measures the re-appointment percentage by provider in an actual dental practice. What stands out?

Did you say “the orange” one? Why? Because she isn’t rescheduling hygiene patients. But who SHOULD stand out? The yellow one! Instead of focusing on the weakest performer, shouldn’t we focus on the strongest performer? In this practice, she’ll be the one who can show your team, including “Miss Orange,” what she is doing to get patients scheduled, and to help others to do the same. Here’s what happened in this practice when the owner did just that:

This practice focused on the top performer and used her experience to help the entire team to improve, including the person that had been underperforming a year earlier. Even she became one of the top performers. How cool is that?

Another metric to focus on is broken appointment percentage. Often, we walk in the door on Monday and discover we have a bunch of cancelled appointments or no-shows. But we should be even more concerned with the number of those cancelled appointments that haven’t been rescheduled.

How many of your cancelled appointments have been rescheduled? Do you know? Do you know how to find out? When reviewing this number, often 50% or more of patients who cancelled an appointment haven’t been rescheduled.

Let’s say that right now you only have 20% of your active patients with a future scheduled appointment. You should be jumping up and down with excitement! This means you have HUGE opportunities!

Are you spending time, money and energy on trying to attract new patients when there is likely much greater value to your practice from rescheduling existing patients who don’t have a scheduled appointment? Some practices have millions of dollars in unscheduled treatment with no focus on recapturing those patients.

Now What?

Here are some steps to get you started:

  1. Discover where you are: It’s hard to measure progress if you don’t know what your starting point is. Before you spend a lot of time and effort on marketing to new patients, first discover where you are.
  2. Plug the holes: Identify what your current percentage is. How many patients are rescheduling their next appointment after a hygiene appointment?
  3. What is your plan for recapturing those patients? How will you measure your efforts?

How do you see this information? Who should be making these phone calls? What is the right system for recapturing cancelled/unscheduled patients? How do you determine which patients are the most important for you to call? Determine what your system will be, implement it, measure how it’s working, make adjustments as needed, and continue to monitor progress. And don’t forget to celebrate success!

Are you ready to see how your practice is really doing?
Dental Intelligence is ready to help.

To get your no-cost practice check-up (a $1,295 value) as one of your Progressive Dentist member benefits, visit Dental Intelligence today.


As CEO of Dental Intel, Weston oversees the strategic direction of the company in offering Practice Intelligence tools to thousands of U.S.-based dental practices. He also manages Dental Intel’s revenue growth and future expansion plans, and most importantly, dedicates a large part of his time and energy to being personally involved with the company’s clients, dentists and dental practices as they use the power of data to improve patient care, build practice culture, and enhance the provider’s quality of life.

Weston also served for over 10 years as a co-founder of and principal partner with Lunsford Peck Certified Public Accountants in Provo, Utah, providing services for nearly 2,000 medical and dental professionals.

Dental Intel, Inc. is a cloud-based Practice Intelligence software company in Provo, Utah, that provides dentists, dental practice owners and dental practice team members, dental coaches and consultants with an easy platform to discover, understand and act upon meaningful information. Dental Intel’s technology connects directly with practice data sources, including Practice Management Software and Financial Software, to bring measurable, real-time performance metrics to every member of the practice team.