Inside Dentistry
October 2007
Volume 3, Issue 9

Why, When and How to Market Your Practice

Allison M. DiMatteo

There’s never been a better time to be in dentistry. There’s greater public awareness today of what modern dentistry can do to help people prevent disease and retain more of their natural teeth for longer periods of time. There’s more knowledge about associations between oral disease and systemic health, and that may be helping to motivate consumers to see their dentists on a regular basis. The stigma surrounding orthodontics—for both children and adults—is waning. And of course, patients are increasingly seeking out quality dental care that’s esthetic and cosmetic in nature, either for when they need restorative work or when they want to boost the appearance of their smiles and looks overall.

If your marketing messages are appropriately targeted and your practice is well-equipped to satisfy an increased volume of patients—or perhaps a different kind of patient—then these potential new dental service consumers might be turning to you for their care. To this end, what you say about your practice is just as important as how you say it. There are many avenues to explore, including which of a dental practice’s services should be emphasized (eg, cosmetics, pediatric, orthodontic, periodontal, pain-free dentistry, or 1-hour restorations) or how much to promote the practice’s environment and personality.

"Dentists really need to decide what it is they most want to do in the practice, what type of dentistry is their passion," believes Timothy Breiding, owner of Breiding Marketing, LLC. "Once they know that, the key is to market that type of dentistry in a manner that hits the patient’s ‘hot’ button so they respond."

Dentists also need to know who they and their practice are and what their identity is, explains Penny Reed Limoli, co-founder of Dental Genius. She says dentists and their staff need to know for themselves what makes them different so they can then communicate that in their subsequent marketing messages. A practice’s uniqueness could be its level of experience, the fact that they’re open on weekends, or that they provide services that are different from their neighbor’s, Limoli explains.

And all of that taken together, explains Joe Lancellotti, founder of Camelot Marketing Services, Inc, helps establish the practice’s brand. In professional marketing, the definition of a practice’s brand is twofold and encompasses first the materialization of any information about the dentist, practice, and services offered (ie, name, logo, visual elements) and second, how the dentist has positioned the practice in the patient’s mind, he explains.

"Most importantly, branding in professional marketing embodies the patient expectations associated with a positive dental experience in the practice," Lancellotti emphasizes.

If you’re not sure what your own unique brand is or what you’re doing with your own marketing process, where do you turn? The dental industry is replete with fly-by-night marketing operations claiming to be able to teach you secrets you never knew. Just type in "dental practice marketing" in your Web site browser and literally hundreds of sites that are ready and willing to provide information about how to market your practice—for a fee—will be displayed.

"What scares me is when somebody approaches a dentist and says, ‘You’ve got to do this thing or these three things,’ as if that’s the answer," admits Roger Levin, DDS, chief executive officer of Levin Group. "There is no one type of marketing that works all of the time, and the truth is, marketing must be based on a sound strategy to get a decent success rate. What works for one person may not work for another, and what works in one environment may not work in another."

Dentists could spend a fortune just learning how to spend an even greater chunk of change on their marketing efforts. To help you understand your marketing options and evaluate the professional resources available to you, Inside Dentistry spoke with several dental marketing, practice management, and training/education experts and explored why, when, and how to start marketing a dental practice’s services, as well as what’s involved. With a reflective look at where marketing of the dental practice has been and a projected look at where it’s yet to go, they offer suggestions and recommendations for strategic planning, undertaking marketing activities, and readying the practice for growth and new patient business. When all is said and done—and conducted in a thoughtful manner—our experts agree that marketing your dental practice and its services will find you working in a busy and productive environment where you’re treating the patients and working on the types of cases you’d hoped for.

What is Marketing, Anyway?

According to Lancellotti, marketing is both a general attitude of the team members in the practice and a specialized function within the practice’s management structure. Marketing is responsible for investigating (ie, identifying and defining patient needs and wants); formulating plans that will satisfy these needs and wants; creating a favorable patient-centered environment; providing the proper services and educating patients about those services; and performing those services at a time and place—and in a form best suited—to profitably meet the patients’ needs and wants.

Not surprisingly, there are several misconceptions about marketing, Lancellotti says, one of which is that marketing is synonymous with advertising, promotion, and public relations. Those are all parts of the marketing mix, he says. Rather, marketing is a system that should be inculcated into the practice. "It’s not just a direct mail piece or a brochure," he says.

It’s Not Dental School Anymore

Dental school administrators like Sharon P. Turner, DDS, JD, dean of the University of Kentucky College of Dentistry, admit that more could be done in dental schools to help graduates prepare for the marketing aspects of dental practice. Marketing falls within the subject of practice management, courses for which are offered in the third and fourth years.

"The problem with practice management when we teach it in the dental school curriculum is that it’s so abstract to the students because they’re still building their skills," Turner explains. "They’re still integrating the foundational biomedical knowledge they received about what happens to a tooth biologically when you cut on it, for example, that it’s often hard for them to really start thinking about the practical aspects of being a small business person who’s running a dental practice."

More and more, however, dental schools are enabling students to deal with financial and practice management realities, Turner says. Part of that is a function of cuts in state appropriations at most public dental schools, which forces administrators to examine their own clinical productivity and, in the process, work with students in terms of understanding the fiscal reality of what it costs to run a practice, she explains.

"Students now have to explore such questions as ‘How many patients will I need to come in at what fee base so that I can make the living I need to make?’ or ‘If I start a practice in Town A or Town B, what will the patient volume likely be?’," Turner notes. "That’s where marketing becomes part of the equation, and we should probably discuss this more than we currently do in the practice management course."

Lancellotti has been an advocate of incorporating curricula for practice management and marketing the dental schools for many years. In 1995, he helped initiate the first selective elective marketing course for seniors at the New Jersey Dental School. In 2004, a starter course was added for juniors, he says.

Once in practice, however, dentists usually rely on professional seminars, doctor study clubs, and associations for information and education about how to marketing their practices. In addition, Lancellotti says dentists may also seek out information from marketing books from inside and outside the dental industry, marketing newsletters from dental marketing companies and areas outside dentistry (eg, AMA News, Marketing Profs), and related blogs and sites with marketing information on the Internet. Marketing recommendations may also be found in dental distributor programs and the marketing programs supported by specific product manufacturers, he says.

Marketing Then; Healthcare Marketing Trends Now

For years, the predominant way most dentists advertised was an advertisement in the Yellow Pages, be it a quarter-page, half-page, or full-page ad, Turner recalls, that just let people know that they’re a dentist. Some dentists might have worked with "Welcome Wagon" to promote themselves among new residents in the area, and others would invest in mailers in coupon books. But mostly, she says, you’d find dentists promoting themselves in the phone book, sometimes with recognizable consistency in how they’d market themselves toward "cowards" and those prone to "dental anxiety."

With the advent of the cosmetic era and the development of better dental materials that look more esthetic and last longer, in addition to porcelain veneers that don’t require the removal of as much tooth structure, those ho-hum phone book advertisements have given way to big, bold words about million-dollar smiles and/or radio spots, Turner observes. What you see in local directories, however, is a product of where you are, she acknowledges.

"You’ve got people in Los Angeles and San Francisco or other enormous metropolitan areas where you’ll see a lot of elective and cosmetic services being advertised," Turner notes. "In Kentucky and West Virginia, we’re still fighting oral disease issues—basic cavities and gum disease—so what’s being marketed depends on where in the country you are, who your population base is, and what the socioeconomic level is."

According to William R. Gombeski, Jr, the editor of the American Marketing Association’s Marketing Health Services magazine and the director of Hospital Strategic Marketing at the University of Kentucky, today’s marketing activities among healthcare providers in general include many traditional undertakings. Among them are Yellow Page advertisements, new mover’s programs, advertisements in newspapers and regional, community, and neighborhood publications, and direct mail campaigns.

As they become more sophisticated, providers incorporate Web sites and graphic visual designs to represent their practices or organizations, as well as perhaps distribute newsletters to current patients and/or throughout the community, speak on television or write a column for the local newspaper, he says. They may also do speaking engagements, sponsor health talks or health fairs, or visit local schools and provide screenings.

"I think the things that work the most effectively are people-to-people activities in which healthcare providers have the opportunity to sell themselves and/or talk directly to people, so what works really well are educational seminars," Gombeski points out. "When our organization has held evening talks about a specific health-related topic, it’s not unusual for 15% to 20% of the audience to schedule an appointment right away to see that speaker, and usually another 5% or 10% will call that healthcare provider over the next month or two."

Such group encounters enable professionals to dialogue with an entire group and answer questions personally, he says. They simultaneously allow potential patients "to get to know you, see you, feel you, and hear you."

Why & When Dentists Market

Paul Homoly, DDS, founder of Homoly Communications Institute, has observed four reasons for which dentists would market their practices. First, if a dentist has fewer new patients than his or her capacity is designed for, then marketing can be used to build patient flow and increase the number of new patients seen per month.

"One of the greatest stressors in dentistry for the clinician is having an open schedule," Homoly explains.

Second, the dentist may want to begin to refine the practice’s technical mix, he says. For example, if a general dentist who mostly sees families and young children would like to perform more implant dentistry, then he or she may implement a marketing strategy to reach out to patients who are specifically interested in implant dentistry—or whatever specific technical service the practice is now focusing on, Homoly notes.

Third, if the dentist is considering transitioning his or her practice (ie, selling the practice or bringing in an associate or partner), it’s oftentimes very good business sense to build the production of the practice through marketing prior to the transition, Homoly says. By marketing the practice at this time and increasing production, the buyer or new associate/ partner has more to buy, the seller has more to gain and there is less anxiety related to the numbers of patients that go around, he explains.

Finally, Homoly says there is a more humanistic reason that dentists would want to market their practices and services, and that is based on the fact that dentistry is good for the world.

"If the dentist doesn’t market the good news of dentistry, who is going to do that?" Homoly asks. "It’s good for the general public to know the good news of dentistry—that it’s available, it’s affordable, and that dentistry can help a lot of people."

However, Lancellotti has always felt that marketing should be a part of the dentist’s decision process from the outset, whether initiating a scratch/start-up practice, joining a practice as an associate after graduation, or buying an established practice. "It’s all about marketing investigation," Lancellotti says. "The location, the present and future demographics of the area, the current patient base, and the potential of the target audience the doctor hopes to attract—these should all be researched before the fact, not after."

How to Begin & What Could Be Involved

Our experts each have their own specific "very first step" that they recommend to dentists who are ready to market their practices. However, there is a familiar chord throughout, and it resonates with the messages, "Don’t go it alone," "Find someone you can trust," and "Ask colleagues what they’ve done, what’s worked, and what hasn’t."

Homoly advocates finding a mentor—someone who’s already doing what the dentist hopes to, and asking about what they’ve tried, what’s been successful, and what outside consultants they’ve used. Nothing is more dangerous, he says, than a dentist sitting down at the kitchen table with his or her spouse or team members who’ve never marketed and trying to figure out how to market their practice.

"That is the very worst way to do it. They will make huge mistakes," Homoly cautions. "They’ve got no experience, and they don’t know what strategies have worked and haven’t worked over time."

According to Lonnie Hirsch, founding partner of Healthcare Success Strategies, working with a marketing consultant can be very helpful when a practice has as its objective substantial growth or protecting their business investment against potential attrition or loss of patients to more competitive marketing by other practices. At that point, a good marketing company is important because they can look at the practice in terms of strategic planning, Hirsch says.

Also, once dentists have their clinical skills in place and their practice is financially stable, that’s when it’s smart to use a consultant for the marketing aspects of practice building, suggests Breiding. If you’ve already said to yourself, "OK, I’m ready to grow my practice," then consulting with a dental marketing professional is necessary to determine the best mix of internal and external marketing approaches, he says.

"It’s very difficult for dental practices to come up with their own strategic plan," Hirsch explains. "It’s akin to a dental patient deciding on their own what their treatment plan is going to be. They need professional guidance, advice, and expertise, and so do dental practices when marketing starts to become a more significant part of their business strategy."

Angie Skinner, co-founder of Dental Genius, says that what she’s found for most dentists is that marketing their own business is the most difficult thing that they do because there are so many distractions. They may have plans to do a Web site, change their logo, or initiate a direct mail campaign, but life gets in the way, she comments.

"The most successful practices generally outsource their external marketing and some of their internal components as well, so they can really focus on taking care of the patient as opposed to worrying about getting an ad in the newspaper on time," Skinner observes. "There are so many ‘nuts and bolts’ to a layered marketing effort and a lot of decisions that need to be made, and I think that’s why so many dentists fail to market. They may think they can do it themselves, but then life gets in the way."

The trick is to find a dental marketing consultant that matches your needs, your style, and your expectations. Every dentist, every city, and every market is different, and so are all consultants (See How to Choose a Marketing Consultant or Program, above). The strategy for every practice is different in almost every situation, and the course of action taken in marketing is determined by the dentist’s level of training, their practice financial situation, and most importantly, their comfort level with the various types of marketing that’s available for them in their market, Breiding explains.

"It’s difficult to identify the best ways for a practice to communicate their benefits, services, and differentiation because a lot of that is based on the opportunities that exist in that particular dental practice situation," explains Hirsch. "Some practices will be very active with external marketing to the general community. Other practices will see great opportunities inside their existing, established patient base to promote more visibility, help patients understand more about their range and scope of services, and encourage referrals."

Internal Marketing

To summarize the definitions and descriptions provided by our experts, internal marketing encompasses those actions, messages, and image makers based within the practice and directed toward patients or people already in the practice office, as well as contributing to potential referrals. These could include identity items such as logos, signage, the look of the office, on-hold messages, patient newsletters, patient communications programs, and brochures distributed to patients when they arrive or displayed in waiting rooms.

"All of the things a practice does when the patient arrives have a major impact on whether they remain as patients and/ or accept treatment," Breiding says.

Among the effective approaches for building a business from within is telling current customers—your current patients—about other services you offer that they might not be aware of, Gombeski explains. So, if you’ve added a new type of whitening product or you now do implants, for example, you’ll want to make current patients aware of that.

However, thinking internally—within the walls of the practice—Linda L. Miles, founder of Linda L. Miles & Associates, notes that one of the mistakes that practices can make is spending a lot of money on marketing without training employees on how to treat the consumer who calls or walks through the office door. Properly managing the calls that come in or the new people who walk through the door is important to making that person want to become not only a patient, but a referral source.

"Every member of the dental team has to know when it’s their turn to be with that consumer or patient how to give them an exceptional experience so they will not only stay with the practice, but think about five other people they want to send for the same treatment," Miles emphasizes.

External Marketing

Traditionally, this type of marketing has included telephone book advertisements and print advertisements in newspapers and magazines. Now, other forms of external marketing include Web sites (although some also consider this among internal forms of marketing) and broadcast advertisements on television and radio, among others.

However, Limoli advises that if dentists really want to add more new patients to their practice, they need to implement a combination of external and internal marketing that includes training for the administrative team. "The team needs to clearly understand that every time they answer the phone, the goal is to get the new patient to come into the office, not to become a dental question and answer center," Limoli emphasizes.

Face-to-Face, Relationship-Building Marketing
As Gombeski suggests, other externally focused marketing activities could include public education campaigns, getting involved with the community, and oral health screenings.

Active vs Passive Promotion

Hirsch prefers to use the term "active" as opposed to "aggressive," which sometimes has a negative stigma attached to it. To explain the difference between the two, the same marketing vehicle—a patient information brochure—is used. Passive promotion would be placing the brochure in a wall rack with other literature for patients to take at their convenience if they’re interested, he says. If a dentist or staff member takes that same brochure and gives it to the patient, encouraging him or her to read it and explaining why it’s important and beneficial, then the brochure becomes a tool in an active promotion, Hirsch explains.

"Active promotion is marketing that is designed to push a message out, unsolicited, to either established patients or the community in which a practice is in an attempt to educate and motivate people to utilize the services of the practice," Hirsch elaborates. "If patients are already coming to you and you’re making information available to them, if they choose to avail themselves of it—but you’re not pushing it—then that’s passive."

However, this does not mean that active marketing is synonymous with push marketing, or that passive marketing is synonymous with pull marketing, Hirsch clarifies. On the contrary, push marketing is any marketing that is pushing an unsolicited message to a desired audience with the goal of attracting the interest and, hopefully, a response from that desired audience. Most marketing is push marketing, including newspaper and magazine advertising, radio commercials, TV commercials, direct mail, billboards, etc., he says.

Pull marketing is any marketing that takes advantage of a prospective customer’s current interest in pulling information about a specific product or service. Yellow Pages advertising or Internet pay-per-click advertising are both examples of pull advertising, Hirsch explains. These pull strategies, he says, are not passive at all, but require an active effort to be visible and noticed when the prospect is "pulling" in information.

Realistic Expectations—What Marketing Can and Can’t Do

Because there are different reasons to market the dental practice, there are different realistic expectations as far as what’s achieved through marketing, Homoly suggests. For example, if a dentist is trying to just bring in new patients, an expectation of accomplishing that through marketing is realistic, he believes, because there are several media that work extremely well for this purpose (eg, print advertising, direct mail).

"Obviously, the more you market, the higher the number of new patients that you can expect to get," Limoli says. "Ultimately what we look for as far as measuring success is how many more times the phone rang and how many more new patients we added to the practice."

On the other hand, patience is necessary much of the time in marketing. For example, if the dentist is looking to attract more complex-care patients (eg, large-scale restorative cases), then measuring the return on marketing investment might be more difficult, Homoly explains, because rarely do patients accept such treatment plans immediately. Rather, it could take a year or more before the patient accepts care.

However, marketing can’t fix problems, our experts agree. For example, if the front desk looks like a turnstile or the practice is in financial trouble, marketing isn’t going to raise money to fix those problems. An organized office, a stable financial structure, and clinical skills commensurate with the type of dentistry and established standard-of-care all should be in place before initiating marketing activities.

"It scares me when I see a dentist who wants to market in order to try and fix things," Breiding says. "There is no question that marketing can help raise your bottom line and give you the ability to enhance your practice, but don’t look at marketing as a quick fix."


The breadth of knowledge and expertise shared with Inside Dentistry about the topic of dental practice marketing suggests that a clinician’s marketing efforts should help them consistently attract more patients; communicate their messages in ways that make prospective patients interested in their practices and what they offer; be based on a plan that makes sense, is easy to manage, and is affordable to the practice; and attracts the type of patients they’re looking for.

"Once you start marketing your practice, never stop," encourages Homoly. "What I mean by that is once you develop a plan, stay with the plan. Refine the plan. Sustain the plan for the rest of your career, because marketing truly kicks in at about year 2, 3, or 4, when you’ve established your brand, established your message, and established your level of awareness in the marketplace."

When you’ve achieved your marketing objective, chances are you’ll also realize many financial and emotional rewards, Miles says. "If you focus on the patient first—and everything you and your team members say and do keeps the patient’s best interests at heart—then you’re going to make a success of your practice," she notes.

And according to Lancellotti, the timing is perfect for success in dentistry. With innovations like dental bonding, pit-and-fissure sealants, soft tissue management, porcelain veneers, invisible braces, implants, "and the incomparable benefits derived by dentists from primetime makeover television shows, you now have ingredients for a successful marketing mix," he believes.

The Inside Look From...
Without the useful and insightful comments shared by our interviewees, this Inside look at marketing the dental practice would not have been possible. The staff and publishers of Inside Dentistry gratefully acknowledge the following professionals, all of whom made valuable and practical contributions to this presentation.

Timothy Breiding
Breiding Marketing, LLC

William Flora, DDS

Private Practice
Greenleaf Family Dentistry
Elkhart, IN

William R. Gombeski, Jr.

Hospital Strategic Marketing Director
University of Kentucky
Editor, Marketing Health Services magazine
American Marketing Association

Lonnie Hirsch

Founding Partner

Stewart Gandolf

Founding Partner
Healthcare Success Strategies

Paul Homoly, DDS, CSP

Homoly Communications Institute

Joe Lancellotti

Creator, www.DoctorsMarketing.com
Founder, Camelot Marketing Services, Inc

Roger P. Levin, DDS

Chief Executive Officer
Levin Group, Inc.

Penny Reed LimoliAngie Skinner

Dental Genius™

Robert D. Marus, DDS

Private Practice
Bucks County, PA

Linda Miles, CSP, CMC
Linda L. Miles & Associates

Sharon P. Turner, DDS, JD

University of Kentucky College of Dentistry

Some Suggested Marketing Do’s for the Dental Practice
To best brand and market the dental practice, planning, persistence, and congruity—consistently providing the same look, message, and position to current and potential patients—are necessary, believes Joseph Lancellotti. With these components of successful marketing in mind, our interviewees provide some additional suggestions for what to include among the activities you undertake to promote your dental practice.

Roger Levin, DDS, explains that most dentists do not have any educational background in marketing, despite the fact that marketing can be one of the most effective tools for attracting patients and retaining them within the practice. Because they don’t have a marketing background, dentists often use a hit-or-miss approach, but if they don’t have a plan and consistency, the chances of success are very limited, he says.

"We encourage dentists to have a marketing plan," Levin says. "Otherwise, they’re trying a number of different things, and there’s no cohesiveness or synergy. Rather, they’re just reacting, and a lot of time and money is wasted."

Lonnie Hirsch explains that there is a difference between simply having a list of marketing ideas or options and having an organized, strategic marketing plan. He and his partner, Stewart Gandolf, "have seen practices get the most benefit from marketing typically when they’re working from a strategic marketing plan that’s based on an evaluation and selection of the right combination of marketing strategies and tactics for a particular business situation in a particular market at a particular time."

Lancellotti notes that ideally there should always be someone internal to the practice that is responsible for planning, managing, and supervising the marketing plan. Often dentists are not properly staffed to effectively take on the marketing responsibility, he says, and in most practices, the doctors have all they can do to manage the clinical aspects of the business. In those situations, an outside professional may be required, but usually a full-time candidate is not necessary, Lancellotti says. Rather, someone who works between 5 and 10 hours per week is more than adequate, he suggests.

Market to Patients’ Disabilities (Disability Rule)
Ensure that your message has a strong appeal to relieving a significant disability that the patient harbors, suggests Paul Homoly, DDS. "Marketing works best when it’s designed to relieve significant suffering," he says. "The deeper the disability (eg, fear of losing teeth, concern about advancing in career) that the dentist can market to, the greater the fulfillment they’ll achieve from their marketing."

Gear Some Marketing toward Current Patients
According to Levin, this will help generate referrals. "We still believe that word-of-mouth referrals are the best and most predictable way to attract patients," he says. "That does not mean the dentist should forgo other forms of marketing, but word-of-mouth is always the baseline."

Use Key Words Based on the Type of Patients You Want to Treat
Linda Miles says that many dentists are using the wrong key words in their marketing or when establishing their image. It might be working in terms of attracting new patients, she says, but it might also not be working in terms of getting the dentist the type of patients he or she wants. "I think the first thing they have to determine is what type of dentistry they enjoy the most and want to do more of, then target their marketing toward that," Miles says.

For example, many dentists continue to use descriptors like "family dentistry," when in fact they really don’t enjoy treating children and/or their practice production (ie, laboratory costs are less than 8% to 11%) is low, Miles explains. "I will tell you from experience that when practices get rid of the term ‘family dentistry,’ the 45- to 75-year-old patients start frequenting their practice," she observes.

Establish a Budget
Levin notes that dentists may have a great marketing plan, but they may not be spending enough to make it work. What’s more, they need to be careful not to spend all of the marketing dollars at the beginning of their efforts to avoid "running out of steam" just as their marketing is starting to produce results. "In other words, create a plan and roll it out gradually," he says. Additionally, he recommends that as a practice grows it should increase its marketing expenditure annually to support the larger business or practice.

Penny Reed Limoli advises that marketing needs to be a regular line item that’s budgeted similar to the phone bill or utility bill. To make a marketing investment in the practice, dentists shouldn’t consider marketing a one-shot expense.

"If you want to get great results, you don’t just do a single sporadic shot of marketing and hope to hit the bull’s eye, then decide that maybe you’ll do marketing again some other time," Limoli emphasizes. "Marketing has to be a way of life as far as the business part of your practice is concerned."

According to Lancellotti, in the United States the median general dental practice has gross billings of $488,000 and the median gross for specialists is $675,000. "If you estimate marketing budgets of between 2% and 5%, there is between $10,000 and $23,000 for general practitioners and $14,000 and $34,000 for specialists," he explains. "Depending on their production forecast, that may not be sufficient."

Stick with the Plan
Those marketing experts Inside Dentistry spoke to agree that once a plan is in place, dentists need to stick with it long enough to realize results. In fact, many dentists quit the marketing process very early when they don’t achieve instant results.

"Many dentists spend a lot of money on marketing, but they don’t give it a fair chance to work. They may put one ad in their local, upscale magazine or newspaper and if they only receive two calls, decide they aren’t going to run it anymore because it was very expensive," Miles says. "But the truth of the matter is that in marketing, a consumer needs to see something anywhere from 5 to 7 times in order to take action. So, the biggest mistake they make is not giving things enough time."

Track and Measure Results
Dentists engaged in marketing activities need to measure the results of those efforts, Levin advises. "Many people spend a lot of money on Yellow Pages advertising, for example, but never measure the result to find out if they’re losing money year after year that could be spent quite differently," he explains.

After all, marketing success can be defined first by the return on investment that’s realized and second by the creation of a consistent inflow of new patients, Levin explains. To determine the return on investment, he advises dentists to track the number of patients that come to the practice as a result of any specific marketing activity, even if there is a number of different types taking place.

"This means polling new patients to find out how they learned about the practice, tracking the answers and then looking at production per patient compared to the specific marketing activity," Levin says. "And, keep in mind that what works today may not work 6 or 12 months from now."

Therefore, based on what the dentist learns from tracking and measuring says about different marketing activities, Levin cautions dentists not to continue spending big money on an activity that’s not delivering a return on investment.

How to Choose a Marketing Consultant or Marketing Education Program
There is a tremendous number of continuing education programs, seminars, online venues, and assorted dental practice marketing experts all competing for the attention, time, and money of clinicians eager to market their practices in new and better ways. When you’re ready and willing to navigate uncharted waters, how can you be sure the person you’re consulting with and/or the program you’re investing in will steer you along the right course? Our experts offered some advice about how to seek out and evaluate a dental marketing consultant, as well as how to embark on the marketing journey overall.

1. Talk to your colleagues. Timothy Breiding suggests having an open discussion with specialists in your market who don’t overlap with your general practice or type of dentistry to find out about what kind of marketing they’ve done. "Don’t be afraid to call somebody in your area that has done some marketing and pick their brain," he says. "When I have questions, I go to my peers—other marketing people—and the same can be true for dentists."

2. Check references. Asking for references and calling them to ask about their experiences with a particular consultant will give you an indication of the quality of their work and the helpfulness of their services. "If you ask someone if they would rehire XYZ Consultant again and they don’t say yes, that would definitely be a red flag," says Angie Skinner. "You want to find out what happened and get testimonials from other former clients."

Additionally, try to determine if the consultant’s philosophy matches your own, advises Linda Miles. Many times dentists have told her they’ve worked with different consulting companies "that are so money-driven that they turned them off," she says.

3. Review their portfolio. When evaluating a consultant, look at what they’ve done and for whom, and what they’re currently doing. "Look for a level of expertise in a very specific niche, whether it’s to just dentistry in general or, in this case, dental marketing specifically," advises Lonnie Hirsch. "You don’t want to have somebody learning on your time and your dime."

Skinner echoes those recommendations, noting that dentists need to find out if the consultant understands the industry. "Find out how much experience they have and review a portfolio of their work to see what they’ve created for other dentists so that you can be sure you’re of the same mindset," she adds.

If you can leverage the experience of consultants who’ve worked on what you’re looking for with not one or two dental offices, but preferably hundreds, then their services could be valuable, Hirsch says. Additionally, he recommends looking for consultants who can provide strategic input, not simply reactive marketing suggestions.

"In the category of marketing, everything a practice does should be in the service of achieving specific objectives," Hirsch explains. "Throwing something out there just to try to make something happen usually has a disappointing result."

4. Examine the resources the consultant has to help implement marketing plans. Hirsch says practices should also look at what resources the consultant has to help them execute marketing ideas effectively, rather than just give them ideas and send them on their way. "Also, what methodologies do they apply or help the practice apply to track results and return on investments for the marketing dollars that are being spent?" Hirsch asks. "Many consultants will tell you that they can do great things, but they never really structure those services to be measured because they’d prefer that they weren’t measured."

5. Review meeting/seminar materials before you go. If you’re evaluating a seminar or marketing education program, William R. Gombeski, Jr, suggests calling ahead of time to request materials and an in-depth review of what will be covered so that you can try and assess whether it will meet your needs.

6. Consider programs affiliated with recognized professional organizations. Gombeski admits that he’d feel much more comfortable going to a marketing program that’s conducted in conjunction with professional organizations—such as the American Dental Association—that are respected within that particular healthcare field than those that are not. Such a connection would tell him that it’s probably going to be a quality program, he says.

Creating Patient Referrals
According to William R. Gombeski, Jr, among the top most powerful and effective approaches for marketing a healthcare practice is word-of-mouth referrals.

"If you deliver a great experience, your patients will tell others," Gombeski says, explaining that word-of-mouth "marketing" comes first from just providing great care to current patients.

Marketing takes on many different facets, including the office’s image, the dentist’s image, the team’s image, and their own personal smiles, explains Linda Miles. There’s also the technology in the practice, she says, because technology-savvy patients prefer to go to a technology-savvy practice.

"Marketing should never stop—especially internal marketing," Miles believes.

Roger Levin elaborates that if current patients are happy, they become loyal and they’re more likely to spread the word about a practice. However, to ensure that a practice generates word-of-mouth referrals, it needs to have highly efficient business systems in place that ultimately lead to high levels of patient satisfaction; create a total "Wow" experience that the patient appreciates beyond just the quality dentistry they received; and make patients aware that the practice wants referrals.

Gombeski notes that the latter point can be accomplished either face-to-face during an appointment or in a reminder letter.

"Probably 5% to 10% of people you talk to will follow up in the next month and recommend someone," Gombeski says. "If they’re happy with you, they’ll want others to take advantage of your service."

Levin emphasizes that making patients aware that the practice wants referrals is a proactive rather than a passive process. "Patients today need to know that the dentist would like them to refer, since many patients think their dentists are so busy that they’re not even taking new patients," he says.

When doctors and their team members use specific scripting so that they become comfortable talking about referrals, Levin says there are often significant increases in the number of patients referred to the practice each month.

However, a caveat of word-of-mouth referrals is that they usually yield the same type of patients a dentist currently has, explains Paul Homoly. For example, if a clinician is interested in changing the technical mix of services that his or her practice offers, word-of-mouth referrals might not be the marketing tool appropriate for this endeavor.

The Tales of Three Practices
The dental practice marketing experts who spoke to Inside Dentistry included finding a mentor, talking to colleagues, and asking fellow dentists in the area who’ve undertaken their own marketing initiatives about what’s worked for them and what hasn’t among their recommendations for how to begin the marketing process. We’ve done just that—spoken with different dental practitioners to find out when, why, and how they decided to initiate their marketing endeavors, and with what kind of results. Here are the stories of three different clinicians and what their activities helped them accomplish.

Greenleaf Family Dentistry in Elkhart, Indiana, currently sustains between 4,000 and 4,500 active patients who keep general practitioner William Flora, DDS—the only clinician in the practice—steadily busy. With two front-office staff, 3.5 hygienists, and 3.5 dental assistants, his practice focuses on general dentistry, although he does offer some special services that proved noteworthy in terms of marketing his practice’s distinguishing features.

"I’m one of the few dentists licensed to IV-sedate people for dental procedures, so we emphasize that," says Flora, who has been practicing dentistry for 15 years. "And we place our own implants and cosmetic restorations, but we treat everyone from children to adults."

Differentiating himself with those special services is not a marketing tactic that Flora learned while attending the Indiana University Dental School, he admits. In fact, he says he didn’t learn anything about marketing his practice during his dental school years.

So, after he established his practice in the Elkhart area, his "marketing" efforts consisted mostly of word-of-mouth referrals and phone book advertisements. But in the past few years, Flora says he’s actively undertaken purposeful marketing activities under the guidance of a professional dental marketing consultant in order to "get the word out that we do IV sedation and implants, which differentiates us from other dentists in the area."

To date, Flora’s Greenleaf Family Dentistry has invested in newspaper and local magazine advertisements that have yielded what he calls a "so-so" return on investment. Today they’re getting ready to try billboard advertising to see how that works.

"We keep track of everybody and how they are referred here, and most of the time we can get a pretty good idea from that of what’s working," Flora explains. "Some people will see the ad and then also ask other people about us. But our best marketing is still word-of-mouth; next is probably either the phone book or the local magazine."

It took about a month from when Flora initiated a new marketing activity until a new patient entered the practice who said he or she learned about the practice from that message, he said. And compared to what his practice was like before he initiated his purposeful marketing efforts, Flora says he is seeing more IV sedation, implants, and cosmetic patients because that’s who they’re targeting; those are their demographics.

"Our production has increased because implants and IV sedation cases are bigger cases than fillings and cleanings," Flora explains.

For readers considering engaging in marketing activities of their own, Flora offers some advice. "I think in all marketing aspects, you have to look at the return on investment," he says. "From whatever you’re putting out there from a marketing perspective, you need to get a return on investment and keep track of where the leads are actually coming from in order to gauge whether or not those activities are working and whether or not you should continue or modify them."

Roger Levin, DDS, shared with us the story of a Levin Group client that was a $1.1-million general practice, but its overhead was 88% due to its marketing expenditures.

"This dentist was basically buying his growth, and by the time he sought our assistance, he hadn’t had a salary in about 3 months, and before that it was very low," Levin recalls. "When we met him, he was using a business model he’d created in which he was feeding his practice by spending almost as much money as it took to generate the production the practice was doing."

After analyzing all of the marketing activities that were taking place, Levin Group developed a new marketing plan that was streamlined to be more cost-effective. Those activities that were not gaining a return on investment were eliminated, and a few new ones were added. Nine months later, the practice’s overhead dropped down to 70%, and the dentist was still producing, annualized, at about the $1.1 million level.

"To get this practice back on track, all it took was some analysis and redistribution of the dentist’s marketing dollars, as well as changing which marketing tactics he was using," Levin recalls. "Really, it took a strategic approach to the marketing plan to turn the situation around."

Robert D. Marus, DDS, has been in private practice for 22 years. When he opened his own practice 12 years ago in Bucks County, Pennsylvania, which is in the corridor between Princeton, New Jersey, and Philadelphia, that’s when he first realized he’d need to reach out and start marketing in order to generate patient flow.

"I wasn’t accepting insurance as payment," he says. "It was fee for service only."

Marus admits that when attending New York University College of Dentistry, he didn’t learn much about marketing his dental practice because—in fairness to the dental school—his professors were focused on helping students pass the board examination. So, when he opened his own practice, his marketing activities included some basic Welcome Wagon advertisements, some phone calls to new homeowners in the vicinity, and word-of-mouth referrals.

That’s how Marus marketed his practice until 2000, when he received his accreditation from the American Academy of Cosmetic Dentistry (AACD). After that, he said, he felt more confident in terms of "being able to deliver the goods when it came to cosmetic dentistry. That’s when I started to break out my marketing externally and internally."

On the external side, Marus developed his Web site and a very short, 10-minute DVD that explains his smile makeover process. He started to do more social networking in the community, while always continuing to keep up word-of-mouth referrals. Many specialists in the area had seen the work he’d done because they would also see his patients, so they became a source of referrals also, Marus says.

Internally, he created a business and office culture that was very inviting, one that people would want to go to and in which posters and books of the dentistry he’d performed were available for someone to review. Marus explains that he wanted his office to leave people feeling, "Why would I go anywhere else? This is where I want to be."

"I was interested in creating several channels to feed the pipeline for new patient flow, and when I look at everything, word-of-mouth referral is still strongest," Marus observes. "The other activities do bring patients my way—whether it’s the Web site or the TV show I did on Comcast—but word-of-mouth still comes up number one."

On the internal side, once an activity was implemented, it took a matter of months for it to produce the type of marketing results Marus was hoping for. As an example, when patients came in for cleanings, they might see a poster of the smile he’d completed for the television show or some photographs of other cases. It took a few months, he said, for their trust to develop.

"People are obviously cautious," Marus says. "It’s a big step to have your smile done, so people want to make sure that they’re comfortable in your chair, and that can take a few visits."

With 1,500 practice patients, Marus’s practice is definitely larger now than it was before his accreditation from the AACD. He focuses on cosmetic dentistry, but the practice is fed by the general practice pool of patients, he explains.

When asked what advice he would share with other general dentists about marketing their practices, Marus notes that his own activities were based on his confidence level, which was bolstered by his AACD membership and, ultimately, going through the accreditation process, which is itself education and skills-based.

"To me, I think it’s about confidence and the ability to do the work and be able to give the patient what they want in terms of their smile or any dentistry," Marus explains. "You know that you can do what needs to be done, and that’s important."

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