Your Dental Practice's Best Referral Source May Be Your Competitors


One dentist explains how early in his career, he came to the realization that his most powerful referral source wasn’t any of his external marketing efforts, but rather his competitors. Either your practice is a recipient practice, like his, or it’s a donor practice. You definitely don’t want to run a donor practice.

Early in my career, I realized my best referral source wasn’t the direct-response mailers, new-resident programs, website, care-to-share programs, signs, or even location. To my surprise, it was the orthodontist and two other general dental practices down the street.

In a town of 19,000 people, 35 miles north of Dallas, we were getting 15-20 new patients per month from our competitors. How could that be? Why would so many patients in a town where everyone knew each other decide to leave their long-time dental practice to come to the new kid on the block?

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Maybe what I had been taught in dental school wasn’t true, that patients will bond to a dental practice for life. In fact, Fortune found that 87 percent of patients will change their physician over a $5 difference in fee. Is it any surprise that they would leave a dentist for money, lack of concern, poor hours, location, lack of competence, or a single bad experience?

Welcome to the era of donor and recipient dental practices. Fail to inspire your patients, and they will seek treatment elsewhere. Make every step of the patient experience perfect, except for the last one, and they’re gone. Patients today vote with their feet. If you are seeing the back of their heads, you are doing it wrong.


There is no way to get better at giving patients what they don’t want.

The worst thing you could ever do is to push treatment on patients without happily giving them what they want. Let that small fact elude you, and you will find yourself on the fast track to a mediocre, unfulfilling career.

You need to realize that if you are not growing, then you are not meeting your patients’ needs. If you cannot inspire your patients or if you are not growing, then you become the donor practice in your area. Take a moment and see if you can name a practice in your area that is a donor practice. If you can’t think of one, then it’s you. The donor practice has no idea that they have this effect on their patients. It is always the poor economy, terrible location, poor dental IQ, or the inability to find quality staff that is blamed for lack of growth.

I expect that all my practices should grow regardless of the economy, and they do. The recipient practice grows, inspiring their patients to refer everyone they know.


An increase in cancellations and no-shows. Your goal should be less than 10 percent. What’s causing this? You are not convenient, and did not sound caring and compassionate over the phone. Maybe you have unappealing hours or days. Or your fees create such a hassle that patients make an appointment never intending to keep it.

Receiving few or no direct referrals. Your goal should be 60 percent minimally. This is the one black or white symptom. Few referrals spell disaster.

Patients want second opinions. This is usually the result of being too assertive, instead of giving a balanced case presentation. If you want the treatment more than the patient, you have crossed the line. There should be no selling in dentistry. Give them what they want and tell them what they need.

You’re over-emphasizing marketing. You spend a greater and greater portion of your income on external marketing to maintain your numbers. Recipient practices do not need to market and donor practices should not market. Don’t look for an external solution for an internal problem. Spend money and time on marketing when you have few internal referrals.

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Patients complain about price. You must keep comparables comparable when it comes to fees. Stay in the 80 to 90 percent for your area. Always give the patient what they want first, then, work at giving them what they need. Bundling your fees and treatment plan incorrectly make you look like a dentist turned time-share salesman.

High staff turnover. Our office was fortunate to average more than 14.5 years for each employee. High turnover is a symptom of lack of leadership and systems. Get it right and the patients and staff will stay. If your patients see a different face every six months, they will wonder why, and they are right.

Assisted hygiene. Assisted hygiene does work to ramp up the hygiene department, but make sure you have the right assistant in that role. It should be the best assistant in the office. Maybe even the one you can’t work without. If done incorrectly, you will see fewer patients following through with treatment plans because of a lack of trust that was once created by your hygienist spending the time to adequately explain treatment and listen to what the patient came in for. I have seen few offices that do this correctly.

Poor financial arrangements. The largest and most-used health care patient financing company is not the best just because they pay the ADA hundreds of thousands of dollars a year to receive their endorsement. Add Wells Fargo, and Chase to your options and watch the acceptance rate soar.


Routing slips. These can be produced by most dental software and allow you to follow each patient through the office. Patients may first contact you by phone and then arrive at the office for the first time. The routing slip follows them through your office. At some point, you will find a point at which the patient does not go to the next treatment step. Identify this point and you can correct the system or staff member and eliminate the blockage. Don’t and it is “Donor Doomsday.”

Exit interviews. Whether it is with a staff member that does not work out, or a patient who to a different practice, you can benefit by taking the time to call and find out why. Great leaders find the problem and deal with it immediately.

Comment cards. These anonymous cards allow you to learn of potential problems from every patient you see. Email me ( and I will send you one. Assume that if one patient mentions a problem, there are 100 more patients who were silent and felt the same way. Ninety-six percent of patients will leave without saying anything if dissatisfied. Learn of and deal with the problem and most will stay.

Create a system for cancellations and no-shows. Email me and I will send you our cancellation and no-show system that we have used for over 30 years.

Record and monitor your calls. This applies to calls inside and outside of your office. The No. 1 piece of technology in your office is the phone. If the staff does not come across as caring and compassionate, the patient will never show up to let the doctor mess up the relationship.

Spend the time to create great systems and inspire your patients and staff, and there is no limit to practice growth.

Michael Abernathy, D.D.S., is the founder of Summit Practice Solutions in Dallas, Texas. He founded Summit Practice Solutions in 1991 to help other dentists duplicate his success. Abernathy also runs a multi-office dental practice based in McKinney, Texas. He can be reached at or 972-523-4660.

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