Ep. 168: The Four Keys to Unlocking Dental Practice Growth
Have you started planning for 2025? As we prepare for the new year, it is important to look at all areas of your practice and think about where you can improve. In this episode, Jeff goes over four essential strategies that can drive growth and success for your dental practice.
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DDS Clinical Implant Course - Implant Fundamentals Course — DDS Clinical
ABCs Seminars- https://www.mgeonline.com/mge-communication-and-sales-seminars/
Download the Hygiene Formula Spreadsheet - https://www.mgeonline.com/hygieneformula/
Phone Script - https://www.mgeonline.com/the-mge-new-patient-phone-scripts-ebook
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Questions From This Episode
Why does Jeff say a practice's facility doesn't actually drive expansion?
He argues that adding operatories or equipment only accommodates growth that's already happening, it doesn't generate new patients on its own. An empty operatory needs a patient in it before it needs a provider, and Jeff says he's seen large, well-built-out offices sitting empty and not even covering their own overhead because the space was built ahead of actual demand.
What are the four things Jeff says actually drive expansion in a general dental practice?
Delivery (both clinical quality and the service experience around it, like wait times and schedule realism), new patients, the hygiene and recall program, and sales or case acceptance. He notes the team and facility matter too, but function as prerequisites and accommodations rather than direct drivers of growth.
Why does Jeff say appointment availability can quietly sabotage a practice's marketing spend?
If a new patient lead has to wait two or three weeks for their first appointment, Jeff says the odds of them showing up drop significantly, especially for promotional leads without an existing personal connection to the practice, since a competing practice showing up just as easily in the same Google search might get them in within a week. He recommends practices be able to schedule a routine new patient exam within 24 to 48 hours.
What's the difference between treatment "presented" and treatment "accepted," and why does Jeff say the distinction matters?
He gives the example of presenting six crowns where a patient agrees to only two this year, planning the rest for future years, that's two crowns accepted, not six, even though many practices would record it as full acceptance. Tracking presented value against what's genuinely accepted right now, not agreed to in principle, gives a much more honest picture of a practice's real case acceptance rate.
Why does Jeff say having strong sales skills alone isn't enough to improve case acceptance?
Even a highly skilled closer needs the organizational structure, real time built into the schedule, to actually sit with a patient and walk through a treatment plan without feeling rushed. Jeff says a doctor might be the best communicator in the world, but without 15 to 20 minutes available even for a moderate case, that skill never gets the chance to be used.
Episode Transcript
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This episode will air on December 2nd, which means we're in the home stretch for 2024 and about to jump into 2025. Are you ready? By that I mean, have you at least begun planning for 2025 in your business? The problem is most people start planning in January of the new year, but January is already too late. By the time you've drawn up a plan, scheduled time to brief your team, and actually gotten everyone moving in the same direction, half or all of January is gone. You've already lost a twelfth of the year. So even though 2024 isn't quite finished, now is the time to start mapping out what 2025 should look like, your goals, and what actions or changes you plan to make to hit them. I'd also schedule when in January you plan to sit down with your team and brief them, the earlier the better.
To that end, if expansion or growth is a key part of your 2025 plan, where should you actually be focusing your attention? That's what I want to talk about this week: the four primary drivers of expansion in a general dental practice, how to figure out where your practice currently stands on each, and how to actually improve and sustain that growth. My name is Jeff Blumberg, and I'm your host.
Let's jump right into the four things that drive expansion or growth. The first is good delivery, good dentistry, and I don't just mean the clinical side, which I'm assuming you've got well in hand and won't get into here, but also things like adding services and the customer service side of delivery, wait times and the like. The second, and you probably already know this one, is new patients. The third driver is your hygiene program, and I don't mean your soft tissue management specifically, doing good clinical work is genuinely the most important thing in a dental practice, full stop. What I mean by hygiene program here is your recall program, your retention, how well you're actually getting patients to keep coming back. And the fourth is your sales, or case acceptance, potential.
You'll notice I didn't mention your team, and I didn't mention your facility. The team is sort of a given, if you don't have a good team, none of these four things are going to happen well regardless of how good a dentist you are, a weak or understaffed team means things fall apart somewhere along the way. But the facility is worth addressing directly, because people fixate on it. They'll think, I need to add another operatory to expand. I've touched on this in prior episodes, when's the right time to add a chair, and I've seen people add equipment, chairs, or features to their practice thinking that alone drives expansion. It doesn't. What it does is accommodate expansion, and if it's not handled correctly, it can actually become an obstacle rather than a driver. If you're a two-operatory practice already running at capacity and you want to add a hygienist, that's about accommodating growth you've already generated, it's not what's generating that growth in the first place. I've seen people reason, I'll build four more operatories and patients will just show up, but they won't, not unless someone's actually calling them in. You need to be able to accommodate patients, sure, but an empty operatory doesn't accommodate anyone by itself, you need a provider in it, and before that, you need a patient to put in it. I've seen plenty of large, beautifully built-out offices sitting empty and not even covering their own overhead. Your facility doesn't drive expansion, it accommodates it, or blocks it if it's mismanaged. It's these four things, delivery, new patients, hygiene, and sales, that actually drive growth. As you grow through these, you'll naturally need to hire more people, more assistants, more hygienists, treatment coordinators, a new patient coordinator, whatever the case may be, but that hiring supports the growth these four drivers create, it isn't the source of it.
So as part of your growth planning for the new year, I'd suggest looking honestly at where your practice stands on each of these four points. Let's run through them.
Starting with delivery, I won't get into the clinical side, that's squarely your department as the doctor, you're the one who determines what your patients need and makes sure they get it at the appropriate standard of care. But there are adjacent things worth examining. Maybe you're currently referring out procedures you'd like to bring in-house, which might mean picking up a new clinical skill, placing implants, for instance, if you aren't already. If that's the case, put it on your 2025 docket, the earlier the better. We partner with a company called DDS Clinical that runs basic and advanced implant courses, I'll put a link on the episode webpage if that's something you want to look into, since expanding what you can confidently deliver clinically increases both your revenue potential and what you can offer patients.
The other thing worth reviewing isn't the clinical process itself, but everything surrounding it. I'd look at how well your schedule actually holds up in practice: are you staying on schedule, or is the schedule more of a suggestion? How long are patients actually waiting, how often does someone wait more than ten minutes? How often are you dealing with cancellations or no-shows, since that tends to throw the whole day into disarray? These aren't part of the clinical delivery itself, but they directly affect it. Say a procedure genuinely takes two hours to do properly without rushing, but you're scheduling only an hour and a half for it. Two things happen: you're rushed, and you'll likely still take the full two hours anyway because you're going to do the job right, which means the next patient, already scheduled for that hour-and-a-half mark, ends up waiting, or you rush through their procedure too. It's tempting to pack the schedule as tightly as possible, but there has to be a realistic assessment of how much time procedures actually take relative to how much time you actually have in a day. We've done a whole series of episodes on scheduling, and we have a scheduling course on our online platform, DDS Success, called The Art of Scheduling Productively, along with a free seminar of the same name, I'll link both on the episode webpage if you want help tightening up your schedule or building out real scheduling policy. This is usually where practices run into trouble, not in the dentist's clinical ability, but in everything surrounding it.
Second is new patients. I've covered various parts of the new patient process extensively in past episodes, but here's what I'd check first: how many new patients are you actually getting per month, and is that number growing, holding steady, or declining? Obviously, if you want to grow, that number needs to be moving up. From there, I'd break it down further: where are your new patients actually coming from? How many referrals are you getting? If you've got three or four thousand patients and you're only pulling in one or two referrals a month, that's an area that needs real work.
I'd also look at how each of your specific marketing efforts is contributing to new patient numbers, which requires actually tracking where new patients come from. It sounds obvious once someone explains it, but very few practices actually do it consistently, since it takes real effort and usually requires delegating the tracking to someone else. It matters because if one channel is performing well, you can pour more resources into it. Say you're running a billboard, a Google ad campaign, and a Facebook campaign, just as an example, and you notice Google is performing extremely well, Facebook is doing okay, and the billboard is essentially wasted money. I'd redirect that billboard budget into Google, put a bit more into Facebook, and work on improving the Facebook campaigns specifically. If a marketing campaign genuinely isn't generating responses, something needs fixing, and by "fixing," I don't mean stopping all marketing, I mean diagnosing and correcting whatever's actually broken.
Assuming responses are coming in, the next thing to check is conversion. When a prospective new patient calls, how good is your receptionist at actually getting them scheduled? If that number is below 50 to 60 percent, that needs work, regardless of the justifications you might hear, "they were just bad patients," or "low dental IQ," or "just shoppers." Shoppers can absolutely become good, loyal patients. So first, track your responses, then track how many of those responses actually make it into the appointment book. If that conversion rate is sitting in the 20 to 30 percent range, you're letting a lot of real opportunity walk out the door, and setting aside the wasted marketing spend for a moment, that was a person who reached out specifically looking for help, and never even got the chance to meet you. We have a phone skills ebook with basic call-handling scripts and ideas, I'll put a link on the episode webpage if your conversion rate needs work.
Next, and this is something people often overlook, and it applies to both new patients and hygiene: availability. Say you're running plenty of marketing, generating a good number of calls, but your conversion rate is still weak. The first thing worth doing is listening to some of those actual phone calls to figure out why, maybe the receptionist isn't handling them the way you've asked. But in a smaller, though still meaningful, number of cases, the real issue is simply availability. Your receptionist handles the call perfectly, gathers all the right information, and then the first available appointment is two or three weeks out. That's a real problem, because you're spending real marketing dollars to drive demand into the practice, and then you can't actually accommodate it. It's a bit like pouring water into an already-full pitcher and wondering why it's spilling everywhere and going to waste. If someone calls for a routine hygiene appointment, just moved to the area, looking for a new dentist, they should ideally be able to get on your schedule within 24 to 48 hours. Some people hear that and assume it's unrealistic, but it can be done, you can set aside dedicated blocks or slots for exactly this purpose, and fill them with other work if a new patient doesn't come along to fill it. The longer you make a promotional lead wait, as opposed to a referral, who tends to be more patient since they already trust your practice through a personal connection, the more likely they are to simply not show up.
Here's a scenario worth sitting with: I decide I need a dentist, search "dentist near me" on Google, ask around and get no personal referral, and find your practice, 1.3 miles from my house, decent-looking photos, a normal website. I call, hear about your new patient special, your receptionist is genuinely great, and then I'm told the next opening is three weeks out. Will I keep that appointment if I even make one? Maybe, depending on how badly I want in, but there's another practice listed right below yours on that same Google search, also a "dentist near me," and that might end up being my next call instead. I might not even bother canceling with you, I might just no-show the appointment I already made, because that other practice can see me next week. That kind of availability gap affects your new patient numbers far more than most people realize. A simple way to check this yourself: ask your front desk directly, if a patient called right now for a routine exam and cleaning, how soon could we actually get them in? If the honest answer is one, two, or three weeks out, that's a problem worth fixing.
Third is hygiene. I did an extensive episode last week specifically on hygiene and reactivation, long enough that it broke our usual 30-minute mark, which I don't think I'll repeat this week, so I won't rehash all of it here, but it's worth a listen if you haven't already, since you likely have more patients slipping through the cracks than you realize, and that episode walks through exactly how to win them back. Here's the short version. Say you have 5,000 charts. We have a free download called the Hygiene Formula that lets you plug in a few numbers from your own practice management software to see exactly how your retention stacks up, I'll link it on the episode webpage, but here's the general shape of the math: 5,000 charts seen over the last five years could represent up to 10,000 potential recall visits a year, assuming each patient comes in twice annually, conservatively, since some come every three or four months. Subtract a fairly generous 40 percent for attrition, that's 4,000, and you're left with roughly 6,000 potential recall visits annually. Working 50 weeks a year, that works out to about 120 recalls a week, or 15 days of hygiene, or eight patients a day, and that's recall alone, not counting soft tissue management or new patients seen in hygiene. So if your practice is only running four or five total days of hygiene a week including everything else, you've got a real gap, and it's a significant area of lost opportunity for a lot of practices. Definitely worth checking out last week's full episode and downloading the Hygiene Formula as part of your 2025 planning.
That covers our first three: delivery, new patients, and hygiene. Now, sales. This is a topic I've covered extensively in its own right across multiple episodes, but there are three basic things you need for effective sales. First, you need something to sell, in your case, a patient with diagnosed treatment. Where does that come from? Exactly the two things we just covered, new patients and hygiene. More new patients means more to diagnose and sell, and a genuinely active, growing hygiene department means a steady stream of treatment to present. As something of an aside, I've seen practices that should be running 15, 16, or 20 days of hygiene only running three or four, and when I ask the doctor about it, they'll often say there's simply nothing to diagnose in the patients they are seeing in hygiene. But if they're only running at 20 or 30 percent of their actual hygiene potential, the real question is, where is everyone else? They're not coming in, nobody has time to call them, and in most cases, those missing patients are exactly the ones sitting on the incomplete treatment list. The most motivated tier of your patient base, a genuinely small percentage, shows up like clockwork and will even chase your office down if a hygiene visit gets canceled due to weather or a scheduling conflict. But the rest of your patient base needs a bit of work, someone has to call them, motivate them, and get them back in, and because that outreach usually isn't happening consistently, your hygiene department stays small and it looks like there's simply nothing left to diagnose. Compare your incomplete treatment list against your list of patients who aren't showing up for hygiene sometime, you'll see a lot of overlapping names.
The second thing you need is actual sales skill, being able to close, handle objections, and communicate effectively. The third is the organizational side, having your schedule structured in a way that actually gives you time to sell. Here's something worth reconstructing if you haven't tracked it already, and it's not difficult: look at the last one or two months of treatment presented, not diagnosed, since you may have diagnosed things you haven't formally presented yet, versus treatment actually accepted. And it's worth being precise about what "accepted" really means. Say you present six crowns to a patient, and they say they only want to do what insurance covers this year, two of the six, with the other four spread over the following two years. Many practices would record that as all six crowns accepted, since the patient agreed to eventually do all of them. They didn't. They accepted two crowns, that's what they're actually committing to right now. So if your crown fee is $1,200, six crowns presented is $7,200 worth of treatment, and two accepted is $2,400, meaning your acceptance rate on that case is 33 percent. Accepted means the patient has agreed to move forward right now, not at some point down the road.
Where would I want to see that acceptance rate sit? At the very low end, 33 to 40 percent is worth improving on, ideally you're closer to 50, 60, even 70 percent. And here's the interesting part: if you're spending twenty minutes with a patient explaining a full treatment plan anyway, an additional five minutes handling objections properly could be the difference between closing two crowns and closing all six. On that same $1,200-crown example, that's an additional $4,800 in production for roughly five extra minutes of conversation, and the patient walks away with everything they actually needed addressed rather than just the two crowns insurance happened to cover that year. It's a genuinely rare, fully win-win-win scenario: the patient gets fully healthy rather than partially treated, your collections improve because you're doing the complete treatment plan rather than a fraction of it, and you get the satisfaction of actually getting your patient to full oral health instead of just checking off what insurance allows this year.
So take an honest look at how much you're presenting versus how much you're actually getting accepted, using that same real definition of "accepted." Ask yourself a few direct questions: are you genuinely comfortable presenting treatment and discussing the fee, not just the clinical explanation, but actually sitting with the financial conversation? Are you comfortable presenting a full treatment plan, even a large one, rather than holding back out of concern it'll overwhelm a newer patient? And honestly assess your close rate. If it's not where it should be, or you find yourself struggling with objections or holding back on full presentations, that's an area genuinely worth investing in, since it can have an outsized effect on your practice. This is where I'd point you toward the MGE Communication and Sales Seminar, I'll link it on the episode webpage, the average revenue increase for doctors who go through it is $288,000 a year, but beyond the number, you get to deliver complete treatment to patients who actually want and understand why they need it.
Now say sales itself isn't the issue, and you're genuinely comfortable presenting. The next question is time: do you actually have enough of it to properly walk a patient through their treatment plan and answer their questions without feeling rushed or like you need to be in the next operatory already? And I don't just mean for large cases, full-mouth reconstructions or All-on-X, I mean even a $4,000 case. Do you have 15 or 20 minutes to properly explain that to someone? Because $4,000 might not sound like much in the abstract, but if a patient earns $60,000 a year, that's roughly a month's worth of income, and helping someone genuinely connect the value of the treatment to that kind of financial commitment takes real conversation, not a rushed summary. If you don't have the time built into your schedule for that, or you consistently feel pressed while trying, that's the organizational side of sales falling short, and it's worth solving alongside the actual sales skill itself. You could be the best closer in the world, but if you never have the time to actually close, none of that skill gets used. We cover this organizational piece directly in the Communication and Sales Seminars too, how to actually structure your schedule to support selling, not just how to sell.
So those are the four drivers: delivery, new patients, hygiene, and sales. There's a lot to think through when you're building out a growing practice. Clinical quality and a strong team are foundational and go without saying, but these four areas, delivery beyond the clinical work itself, new patients, hygiene, and sales, are what actually drive your practice's expansion. I hope this gives you something concrete to work through as you start planning for 2025. Don't forget the downloads on the episode webpage. If you want to know more about MGE, you can find us online at mgeonline.com or call us at (800) 640-1140. Have a great week, I hope you had a happy Thanksgiving, and we'll see you at the next episode.