–Associates Article

PATIENT RETENTION DURING TRANSITIONS- How to Introduce the New Associate

Whether introducing a new dentist (also referred to as “Dr. New” in this discussion) as the “new associate”, “new partner”, or “new owner”, retaining the patients during the transition is the most important goal. For the practice owner (also referred to as “Dr. Owner”), the “how” to introduce Dr. New and accomplish maximum retention is of equal importance. By following a few simple recommendations, maximum retention is assured.

Concerns of the Practice Owner All practice owners, while introducing a new dentist, have several basic concerns. First is whether the new dentist has the required clinical skills to match or exceed those skills offered by owner. Whether the new dentist is being considered strictly as an associate, as a future partner, or as the new owner, most “current owner” dentists believe they are the best dentist in the community (and world) and therefore tend to set unrealistic expectations for the new dentist. They have set these expectations based first on their own egos and secondly, and more importantly, based on their genuine concern for their patient’s future “dental” well being. Their first concern is the foundation for two more concerns. They are fearful that if the new dentist does not have adequate clinical skills but is hired, the dentist owner faces an abundance of re-makes and the costs in dollars and time involved to repair the patient’s dentistry. Their third, and more significant concern, is the ultimate loss of the patient as a result of the problems incurred by the patient at the hands of the new dentist. If the above concerns are addressed and the decision is made that you are the right “new dentist” for their practice, the remaining concern is how to introduce you while preventing the loss of patients simply because the patients have been referred to the “new dentist” and patients are uncomfortable seeing anyone other than the owner. The best “introduction” protocols are different 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 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. Bottom line is, maximizing retention will be best accomplished by having the new dentist meet as many patients as possible through recall. 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 suggestion that Dr. New does the recall examination. 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 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, 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 10AM. 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 by Dr. Owner. If done successfully, after a couple of months, Dr. Owner will note holes starting 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 intended transition is a “role reversal”, i.e., Dr. New is hired initially as an associate but the intended outcome is that Dr. New will eventually purchase the practice and Dr. Owner will now become the associate, the introductory steps are the same as if this is going to be a 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 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 location to find that dentist. People like familiarity when dealing with new people (or in this case, a new dentist). 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, it is “helpful” to the new dentist to be personally introduced to the new dentist. The intended purpose of this “personal introduction” is of course 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, a very bad “marketing” first impression. 80 -90% of new patients come from existing patients in most practices, and the existing patients, feeling Dr. New is not capably of staying on schedule, do not refer. The existing patients quickly develop one of several opinions: Dr. New already is 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.  Even worse than just introducing patients to Dr. New, if Dr. Owner, as part of the introduction period, actually treats patients in addition to making the introduction, Dr. New does 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 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 and 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 be followed, three month (for patients with perio problems) or six month (for normal recall patients) advanced scheduling is imperative to maximizing patient retention. Whether the patients have been notified by letter that there is a new owner and/or that Dr. Owner has or is going to retire, the majority of these patients will in fact 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 and especially the hygienists that will be 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. This, coupled with advanced hygiene scheduling, is the most successful method of patient retention. The retention of the prior staff is another critical component, especially in a total ownership change accompanied by the retirement of the previous owner. The owner dentist’s endorsement of the new dentist is the final piece of insuring that the goodwill of the owner dentist is transferred to the new dentist and the patient loyalty and commitment to the practice is insured.