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3 Ways Patient Attrition is Destroying your Practice

By John Schwartz on September, 18 2018
John Schwartz

Losing patients sucks.    

The day a new patient books an appointment is the beginning of the end.  No patient is as loyal as you would like to think. If you think you have loyal patients and your practice is not growing year over year, you don’t have loyal patients.  

Most practices have no idea how loyal their patients are.  Each year patients disappear -- good patients. And then practices are forced to fill these holes by doubling down on patient acquisition costs. The process continues to repeat the next year with more churn.  Churn kills slowly over time and it forces practices to make bad decisions.  Here are 3 of the most common and preventable (read to the end!) ways practices are causing their own patient attrition:  


#1 Not identifying at-risk patients early enough

By the time you notice that they haven't booked an appointment in a while, it’s too late.  A longer delay between visits is a trailing indicator of loyalty and it means this patient is already likely with another practice or isn't very excited to come back to yours.  The key is to identify and engage the patient before they make the choice to check out your competitors.


#2 Assuming most patients lost are due to insurance

It's not always about insurance. You're guaranteed to be losing patients in ways other than a change in or loss of insurance. It’s a convenient lie that that dentists and office managers tell themselves, making it easier to avoid the problem and keep working. In a study done by Northwestern University and CHRISAD, the top factors in choosing a dentist are honesty, cleanliness, and trustworthiness. Insurance doesn't even break the top 10. In addition, almost 50% of patients find their dentist through word-of-mouth while only about 20% find a practice from insurance recommendations or lists. Also, 40% of patients don't have insurance anyway.

And if most of your patients are only staying because of their insurance... those are not loyal patients, and you're going to lose them the second they have a suboptimal experience. If this sounds familiar, don’t worry, everyone faces this one.  But know that you have choices.

Ask yourself the hard questions -- there is likely another reason the patient is leaving.  I know this sounds like a simple approach, but what if you really applied it?  What if you tracked these reasons and discussed them with your team weekly? (you can use MRKTmetrics Professional to help do this)


#3 Confusing history with loyalty

Just because you have patients that have gone to your practice for 20 or 30 years does not mean they are loyal to you today. A bad experience (billing error) combined with a friend telling stories about how her dentist uses lasers and has such nice hygienists can be enough. I suggest spending time on Yelp and Google reading reviews of other dentists. Suffice to say, until you can measure loyalty and understand what is driving your patients, the attrition will continue.


Net Promoter Score is a leading indicator for patient loyalty

But, how do you identify the tipping point for that patient who is about to bolt?  How do you know when they are in trouble?  You ask them a simple question…

“How likely are you to refer my practice to a friend or colleague (on a scale of 1-10)?”

The responses you get will neatly segment your patients by loyalty:

Promoters (9, 10):

Practice advocates that will tell their friends about you.  They have real passion for your practice and are your source of word-of-mouth marketing.

Passives (7,8):

These are your “satisfied” patients, but they are tricky because their loyalty can be easily swayed by better prices or offers.  They are not passionate about their relationship to your practice.

Detractors (0-6):

Unhappy patients that hurt your practice by sharing their thoughts with friends and family.  They are most vulnerable to churn.  The good news is that if identified early and engaged, there is a good chance you can save them and move them up the loyalty chain.

Imagine being able to segment your entire patient base into these three loyalty buckets -- you would be able to immediately address the concerns of your Detractors and leverage the positive sentiment of your Promoters to acquire new patients, thereby reducing your cost per new patient in the process.  You would have a growth machine.


Net Promoter Scores Correlate Positively with Practice Growth

According to Bain & Company:

In most industries, Net Promoter Scores explained roughly 20% to 60% of the variation in organic growth rates among competitors. On average, an industry’s Net Promoter leader outgrew its competitors by a factor greater than two times.

Because NPS helps you drive new patients AND save existing patients (vs. your traditional churn model), it leads to significant growth opportunities for practices that apply it.  Loyal patients tell their friends and family about your practice. It’s estimated that every 5 Promoters you have will deliver 1 new patient (20%). Along with your ability to spot at-risk patients, this turns revenue growth from linear to exponential.  

Here is a graph tracking a hypothetical practice with an average annual patient spend of $400 that is churning 10% of its patients annually and adding 12% back through marketing (starting with 2000 patients). The blue line represents what can happen when that practice adds an NPS program to identify and nurture detractors and promoters over time--before they churn:

Screen Shot 2018-09-19 at 10.03.59 AM

Does your practice face any of these struggles with churn?  How are you addressing it currently?  Feel free to share in the comments section.


MRKTmetrics Professional can help you be competitive in this volatile market. Learn more about our Net Promoter Score tools that will measure your patient loyalty, help you stop losing patients, and turn your happiest patients into your best marketing strategy.

John Schwartz

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