Webinar: How to Grow a Practice in an Economic Recession Webinar

So what does the economic outlook look like going forward? This is certainly not new news to anybody on this call, but things have obviously been a bit turbulent in 2022, where we've seen the S&P 500 take quite a beating since January. So it's no wonder that according to a Bloomberg market survey, 48% of investors expect the US to fall into some sort of recession in 2023, and 70% think it'll happen between 2023 and 2024, right? So my question is, does it matter to the dental industry? Is dentistry recession-proof? Over the dozens of lists of best recession-proof businesses, medical and healthcare jobs always are at the top. To really assess and get to the bottom of this answer.

Let's look at some historical recessions and current data of today's economic state. First off, as of May, 2022, the average dentist schedule is still around 86% full. It's pretty good. Relative to January, that's up 9%, even despite the blow to the markets that happened just over the last few months. However, patient cancellations are up 3% from April. And that's not that surprising, right? It would be strange if the number of patient cancellations continues to grow just slightly, it wouldn't be strange. Why? Because Americans become more frugal in tough times. Pockets get tighter, right? During a recession, patients are likely to postpone medical treatments, which aren't urgent, right? This adversely affects the revenue of dental practices. Let's look here. During the Great Recession, you'll see patient visits for both general practices and orthodontics drop slightly from 2007 to 2010. Not to alarming levels, but nonetheless.
In the pandemic, 32% of Americans stayed clear of medical care because of expenses. So using both of these historical recessions, dentists can expect for a slight drop in patients, but still remain relatively optimistic. However, as many of you feel this in your day-to-day, most dental practices are understaffed. And finding help is really hard. 4 out of 10 dentists are actively looking for assistance and hygienists. And compared to before the pandemic.

Alec Goldman: More than 84% of dentists who are currently hiring are finding the recruitment of hygienists and assistants to be extremely challenging. So when dentists are surveyed, it's no wonder that dentist confidence in their dental practice to recovery is still pretty high at about 65%, right? Compared to their faith in the recovery of the US economy, which is down in about 22%. Dr. Lavine, a question for you. I'm curious, what are your thoughts? 

Dr. Lavine: I don't think we can use the term recession proof. Certainly COVID showed all of us how bad things can get. And all businesses, not just dental offices, certainly went down. Of course, it's hard to practice when you're building this close down for three months, but it's something that people I think need to be aware of. But what we've found, for example, I think you have to be cautious because the common way that people approach it is to say, well, I'm worried about the recession. I think it's gonna affect the number of patients that we have, so we're going to cut back.
And really what I found is with my business, when I was in practice for 10 years and with my IT business as well, when we started to really find that we were in a recession, we increased our marketing budget a lot. Cause we said, listen, you know, we need more new people coming in, you know, and you sort of get into this vicious cycle if you're not careful that you just keep cutting back on what you're doing and that just exacerbates the whole problem. So I wouldn't, you know, my advice is if you think, you know, if you believe that we were heading towards that, now is the time to think about what are you gonna do to increase bringing in new patients to your practice? Yeah, exactly. And we'll touch on a number of those strategies in just a bit. But Dr. Vien, just to pretty much what you said, like again, when we were asking the question originally, is dentistry or recession-proof business our answer at NextHelp? Maybe, but it just doesn't really matter, right? Like, listen, times may be tough now and get even more grim in the next couple of months, next year.

But patients can't avoid the dentist, right? We only have 32, maybe 31 teeth, whatever. A good percent of the population today still wants to take care of their teeth, even if money's tight, right? Sure, they might not visit every six months, maybe it's every year, maybe it's every year and a half. Either way, we go into a recession or not you need to be prepared, right? So today we will walk through strategies to grow in a recession for the variety of roles that a dentist plays, right? Being kind of the entrepreneur, the marketer and the technologists, because we want to ensure you continue growing at tough times. I love this quote from Adren Seddon, who is a F1 driver. He goes, you cannot overtake 15 cars in sunny weather, but you can when it's raining, right? This is your opportunity to separate yourself from the competition down the street. The dentist who pushed through and get through the other side of a potential tough time,those are gonna be the ones who are extremely successful. We at NexHealth wanna help, right? 

Alec Goldman: So our first section is focused on the entrepreneurial part of the brain, the CEO, the individual who oversees the business. It's you, the dentist. Fundamentally, the most important advice we can give today is ensuring that you have your business metrics in place without metrics like your total number of patients.
Your active patient count, your annual attrition rate, or your annual patient growth. It makes it nearly impossible to prioritize your plans and how to grow. Believe it or not, it's reported that less than 5% of dentists practicing GPs know their active patient count, which sounds pretty crazy. Second, it's important to know your patients, your customer base, right? Not just them, the individual, but as a whole. It means knowing their demographics, like age and salary, knowing why they come to you, understanding how they heard of your practice. If it's word of mouth, Instagram, Google search, if there was any specific content that you put out there that resonated with them, it's important to know which customers are paying for what services, right? What we are finding at Ne Health, given our market research and conversation with lots of different patients, they want a digital experience, right? 80% of Americans think technology to schedule appointments and manage their communications would improve their healthcare experience. But three out of five wanted to be just like Amazon Prime, Uber or Instacart, and 30% would even consider switching providers just if they had online scheduling, right? This is ultimately why, the example on the right-hand side, this is why grants redentals switch from a Zocdoc to NexHealth. They wanted full control of their patient journey and to digitize it from end to end. Why does this matter? Because convenience is key, right?

That's really what technology is for. We need to ensure we are thinking about patient care in context of the whole journey, not just the service they receive in the seat, right? So our recommendation here is to what we call dog food, your own journey. It might sound silly, but check out the emails. Look at your social media. Are they easy to understand? Are they interesting enough? Call your front desk and try to make an appointment. Did somebody pick up or were you put on hold?
Put yourself in the shoes of your patient. So let's do a quick poll. How do you, how do your customers currently schedule an appointment? And Dr. Lavine, let's put your entrepreneurial hat on. What other advice would you give dentists here? 

Dr. Lavine: You know, the best advice I can give, and this was true when I was in practice and for my business now as well, you need to try to eliminate any barriers to entry. The easier you make it for people to contact you, the better off you're gonna be. And when it's the I find fashion, I live here in LA, and a lot of companies, a lot of businesses will supposedly have it easier that you can contact them. They'll say, hey, send us a text if you wanna set up an appointment or send us an email. And I would say the vast majority, 80, 90% that I've done that for, they never respond.

And then I think about it, and that was after hours. And you know, I got to leave a message and I'm ready to schedule. I know I've got my calendar sitting right in front of me. And I think understanding that most people work nine to five and they're worried, they're looking at their appointments and things that they're gonna do separate from the day-to-day life, they need to be able to schedule and be able to get in touch with an office on their time schedule, not necessarily on your time schedule. And you're certainly, when you look at the statistics, the vast majority, 87% of people said that they call the office or they text. And I'm pleasantly surprised to see that close to 20% do all of it also through booking appointments and requests through the website. But as I said, you really need to make it as easy as possible on their schedule to contact you.
Alec Goldman: Thanks. Yeah, totally agree. And again, our recommendation is to try out what your patients are ultimately going through. And it's a really enlightening way for you guys to understand and have empathy for what's going on. So that brings us to our second strategy, sorry, being the marketer, right? During a recession, more than ever, it's really important, for any business, I mean, just dental practices. Do whatever they can to stay on top of mind of customers. Why? Well, pretty obvious, right? First, we already live in a world of endless content and scrolling. Second, recessions tend to be stressful for everyone. And with so much content and stress to distract, it's really easy for a patient to forget to take care of themselves, let alone remember your business. Out of sight, out of mind type of thing.

And let me remind you, most businesses stop marketing in tough times, what Dr. Lavine mentioned earlier, right? It's often the first activity to cease. It takes less priority. This is a massive mistake, right? This is your opportunity. Our recommendation is to think about it holistically from awareness to appointment and ultimately to retention. And for those who think social media and other awareness channels are silly for dentists, let me remind you that 36% of Americans go to the dentist at least once a year. And it's gross, right? That's your opportunity to educate them on the problem. People need to learn the importance of what you do and why you uniquely solve that problem. Do it differently, right? At NexHealth, what we hear from most new customers is that they are currently using their marketing spend on awareness and interest tactics, the top two pieces of the funnel. Similarly, the patient journey, our recommendation, is to think about it holistically. What we continue to hear is that dental practices are spending a large portion of their marketing budget on things like SEO and ads, great websites that are gorgeous, email texting tools to drive appointments, but it's just not converting. Our rough estimates are that for every 1000 website visitors, you have about 88 of them that book and only 2% of those that will actually even return for re-care.

And this is where technology can reduce friction with online booking and ensure that patients actually make their way from the website, ultimately into your dentist chair, right? Improving your patient conversion and ultimately giving you more qualified patients ready for treatment. So our recommendations from a marketing perspective, from top of funnel, you must constantly post on social media. You must ensure that you're developing blog posts and newsletters to improve findability on Google and leverage retargeting ads, right? Many dentists are doing generally the top of funnel tactics at some capacity. Middle of funnel, it's really about reducing booking friction for patients. The moment they act on an ad or email, they need to do it right there. They don't wanna have to get on a phone, wait, have to call back later, right? It needs to be actioned on right away. Then once they have the booking appointment in place, creating an engaging pre-appointment text and email sequence, with reminders, digital forms, getting them to remember and commit to actually showing up there a lot of time. And lastly, the bottom of funnel, this is honestly a really good place to start, right? Acquiring a new customer can cost five times more than retaining an existing patient. So thinking something like sending an email to your inactive customer base with a promotion and make it super easy for them to book with a scheduling from that very email, right? So with these tactics, how do you make your messaging really resonate?

We have five thoughts here, but one, be educational in your marketing. Explain why making two visits a year is so important to your health from awareness perspective, right? Show them why you are different. Two, be consistent, post frequently, and make sure your content has the same consistent brand visuals so they really recognize you when you're on social or a variety of different channels. Three, be thoughtful about the best times to reach them. Typically that could be before or after working hours. They're not gonna respond in the middle of the day. Four, be personal. You and your team are at some level of the product, right? Be proud of that, literally. Be in the content, the photos, the videos. That's what they wanna see. And five, don't be too pushy, right? Like we don't wanna be too salesy. Money's tight and tough time, so we wanna make sure that we have empathy there. Dr. Lavine, before we move on to our third strategy, did you wanna add anything from a marketing perspective?

Dr. Lavine: No, I mean, I just wanted to reiterate what you said and I can use myself as a good example that I was very fortunate up through COVID. I had never done any quote unquote marketing. I mean, I guess I was doing sort of organic stuff but I write articles in dental economics and other magazines, DPR, I post on dental town but I never really had to do any form of marketing. And once COVID hit and I saw that, you know, offices were taking a hit, that they were being a lot more frugal. I said, you know what, I, I'm not going to wait, uh, you know, for things to really get bad. And I just really increased my marketing significantly doing webinars and sending out email blasts and, um, writing articles, you know, more articles and just doing everything I can. So I would really highly encourage you. Like it's, it's counterintuitive. And you'd be like, Oh my God, my income is going to go down. I don't have money to spend on marketing.

You do have it and you really, really need to think about it before the recession hits, um, to make sure that you've got that constant flow of, of, patients coming in. Cause if you wait too long, it's just, like I said, you're just in this death spiral that, uh, people aren't coming in. You don't want your practice to be a sieve where, you know, everyone that comes in leaves, uh, that's just not really helpful. So, uh, nothing beyond that. Cause I think you hit a lot of the main points are pretty well. Cool.
Alec Goldman: As we mentioned earlier, recruiting dental hygienists and assistants continues to be really challenging for dentists, right? You mentioned that four in 10 dentists were recruiting dental assistants and hygienists just this past May, right? So what does that mean? It means that your staff, they're currently, they may be a little overworked. Put yourself in their shoes for a second, right? Physicians spend nearly like 50% of their time in their PMS, just manual desk work really only 30% of time with patients. They have to support the entire patient journey from appointment bookings to reminders to forms to welcoming them in the office and treating them with a lot of care, right? Getting you paid and doing it all over again for that patient's next visit. And oh yeah, doing it for all of your patients, right? You think about all of those tasks, like let's call it what it is. It is hard to be present when you are distracted by an endless array of patient obligations, right? Providing care at scale, like 24-7, every day to patients who you don't know, you may not like, who are hard to please, like that's really hard work, right? This is why we encourage you to think about it, to think about what's called the EDAB method, to make sure you and your staff can focus more on the most valuable tasks and keep busy work tasks at a bare minimum, right? This is how it works. That's EDAP, so eliminate, delegate, automate, batch. So this is how it works. One, for any task that isn't necessarily a big priority, first ask yourself, can and should I eliminate this task? Right, two, if someone else can do the task faster, better or cheaper, delegate it. 

And three, never ever delegated tasks that can be automated. And four, lastly, you can't eliminate a task, can't delegate to someone else, can't automate it, then batch. So think about your email. This is a, email is a great thing to batch. Just get it and knock it all out. So let's use an example. Let's take patient forms, right? One, you definitely can't eliminate these. Like these are the lifeblood of your business. Two, currently they are often delegated to the staff at the desk. This is what's causing them to do a lot of work. But three, it can certainly be automated, right? There are technologies like NexHealth that eliminate all manual data entry to streamline the patient intake form, right? That whole process, how? Well, let's look here. First, NexHealth will text or email the digital patient forms to the incoming patient. Two, the patient bills it out when they do that from home, not in your waiting room. Three, the data that they send back, that's sent to NexHealth.
And because NexHealth synchronizes with your PMS in real-time, the data from the patient form goes directly into your PMS. What's key here is picking a platform, a communications platform, that syncs with your PMS in real-time. I cannot say it enough. Without a real-time sync, there are still many error-prone manual steps of actually getting the data from the form into the right fields in the PMS. And anytime you have to change data in the PMS, you're going to have to change the data then you'd have to go back and see your communication system. And that's what causes the double work. That's what causes frustration for your staff. It's having to manage multiple systems and making sure that the data over here is the same as the data over here, right? This is ultimately what's a big waste of time. So when systems are not synced in real-time, again, dental practices just spend far too much time on the manual repetitive admin work, just desk work, right? Like managing paper electronic health records as we just talked about, and scheduling patient visits.

Following up for re-care, reminding patients to pay, it's a lot of repetition, right? So our recommendation here is to look at your patient journey and think about the EDAP method. What parts of your journey can you better automate, right? Dr. Lavine, a question for you. What are common tests that you think you could have back in your time that are delegated or automated in an office? And how can we offer some additional advice on how we can help dental practices become a little bit more efficient. 

Dr. Lavine: Yeah, so basically everything on here. When I was in practice, one of the things that would drive me crazy was that we didn't have online forums or anything like that. So I had my medical and dental history forum. I would send it to the new patient. I'd say, please fill this out, bring it in. We got smart after a while and realized not everyone's gonna do that. So we would schedule them 15 minutes earlier than their actual appointment. But people would come in, the majority of them. And if they had the forms with them, they were blank. More often than not, they didn't have it with them. And I'm just sketching 45 minutes for a new patient exam, 30 minutes into that exam, they're still upfront filling out their paperwork. And it just aggravated the crap out of me. Just because I said, I wish there was a system that would eliminate that step so that they could just do it somehow that we could get it, get it into our system.
Oone of the things that you kind of showed that the slide, which I also found a little annoying is that a lot of the third party programs out there can capture that information, but it's in a separate file. They'll capture as a PDF or something based. It's not actually going into the practice management software, which I think is really critical. I mean, we want to try to eliminate the number of software programs that people use. So everything that you're showing up, like you said, it's all about these positive touch experiences for the patients that's critical. I also wanna just go back to what you were saying that you showed a slide before about, I think it was 40% of companies are understaffed or hiring. It affects all industries and I'm not so sure that's gonna get better anytime soon. And I was talking to you guys before we started the webinar. As a perfect example, I flew up to Toronto last week for six days to visit my family. Most of you probably know I'm from Canada. And at LAX, I had to wait an hour and 45 minutes to check my bag in. They only had two agents for two flights, you know, coming in. We land. We had to wait an hour on the tarmac because they didn't have an agent that could go to the jetway. We get through customs. We're waiting another hour for our baggage because they don't have enough baggage handlers. And then I was leaving yesterday. The incoming flight was a little bit delayed, make an announcement like, hey, we can't clean the plane because there's a wheelchair patient on the plane and we don't have anyone yet with a wheelchair to come get them. That person, it took an hour from the time of that announcement before someone showed up with the wheelchair to get them off, get us onto the plane. And then the pilot comes on and says, well, we're really sorry about this, but because of the delay, we've exceeded the number of hours that we're allowed to be ready or on the plane. We have to get new pilots.

So I'm going to be a few minutes and then a few minutes later to come on and say, well, sorry, it's going to be three hours from now. I ended up leaving six hours late. So it's not just dentistry, it's an all industries. So I agree with the concept here is that you just spend most offices are understaffed and you can try your, you know, when I look, when I'm looking for new people as I have been the last year or so, I'm getting honestly like.
I mean, I'm just getting people who are clearly unqualified to be, you know, working for me. If you accept the reality that finding people is going to be a challenge for the foreseeable future, then really your only solution, you showed that slide before, is automation. The more things that you can either delegate, which is, I said, it's going to be a challenge if you don't have people to delegate it to, but more critically to automate. I just think that that's really where people should be focusing their energies right now.