Dental All-Stars podcast discusses dental marketing in recession: adapting to labor market shifts, revenue cycles, and patient conversion challenges.
About Gary Bird
Gary Bird is the founder and managing partner of SMC. He brings in new patients for DSOs and dental groups. He is also the host of three podcasts: Dental Marketing Goat, where he provides actionable marketing advice; Full Arch Advantage Podcast, which focuses on closing more full arch cases; and Dental Rift, a weekly show that covers trending topics in the dental industry.
About Alex Nottingham, JD, MBA
Alex is the CEO and Founder of All-Star Dental Academy®. He is a former Tony Robbins top coach and consultant, having worked with companies upwards of $100 million. His passion is to help others create personal wealth and make a positive impact on the people around them. Alex received his Juris Doctor (JD) and Master of Business Administration (MBA) from Florida International University.
Transcript performed by A.I. Please excuse the typos.
This is Dental All-Stars, where we bring you the best in dentistry on marketing, management, and training. Here’s your host, Alex Nottingham. Welcome to Dental All-Stars. We are talking about dental marketing during a recession. Our guest is Gary Bird, and he is the founder and managing partner of SMC National. And Gary is super passionate about helping entrepreneurs succeed. We’re talking about the keys of
educating, really educating, not selling service, not sales. We love that talking about that in the green room. Please welcome Gary. Hey, thanks so much for having me on Alex. Super excited to have this conversation with you today. Wonderful, wonderful, wonderful. Okay, so topic being dental marketing during a recession. I asked you about some things you talk about and that just jumped out at me because we definitely are having some economic challenges, inflation,
hiring situation is very difficult. I may not have mentioned this to you, but we have a hiring service as well to help dentists. And that’s been very busy, but it’s been very hard out there. So hard to find people, competition, corporate dentistry, a lot of things go on, a lot of competition. Tell me about the situation, give me a background. Is this an issue? I suppose it is. And where do we go from there? Yeah, so let’s…
first frame what the problem is and why dentistry feels so much different now than it did before COVID. So before COVID, pretty much any dental office, if you just said, Hey, if I hit this hundred new patient number or 50 new bay or whatever the number was, depending on the kind of dental office that you had, you pretty much knew that you were going to have a financially great month. And that was pretty much a great strategy forever. Just hit these new patient numbers and we’re good and we’re going to be profitable.
That has changed. It’s not the same now. Well, why has that changed? Well, first of all, you said it, the labor market’s totally different. So you’re paying a hygienist double what you were paying before COVID. That really hurts you. And the cost of dental school has gone up. So associates are getting paid, have to be paid a lot more, and they’re looking for a lot more. So that changes everything as well. And then you have the cost of goods has gone up.
And then inflation has gone up as well. So that means your patients are probably buying less dental treatment or coming less often. And so when you get hit with all these things at the same time, the, the strategy of just get more new patients doesn’t necessarily work. You have to think a little bit deeper and you have to work through this problem a little bit deeper. And most dental offices are not sophisticated enough with their numbers because of the practice management software’s don’t allow you to extract basic
data like you would at my company and go into my CRM and see everything. I’m sure it’s similar to your company and any company out there, but in dental, it’s very nuanced and a lot of that has to do with the PMS structure. So you can’t pull a lot of the numbers and do a lot of the forecasting. Also, then you have revenue cycle management isn’t where it needs to be yet because you don’t, most dental offices aren’t doing accrual accounting. They’re doing cash based accounting, meaning
They’re collecting money today that came in six months ago from the insurance company. So this makes everything super complicated. So you have to understand those obstacles. You have to understand these walls before you can really step in and start to solve it. And so that’s the first step. So I’ll stop there and see if you have any questions on that before I move into now, how do you, if we understand those things, now how do we solve it? Well, I was very impressed. You’re talking about accrual versus cash-based accounting.
That’s very impressive for a marketing guru to know about that. Very advanced. Yeah, certainly, look, I said this before in some of the webinars that I do that just in general, dentists that have kind of been cultivated have thought if I build a great business they will come. The field of dreams, if I build it they will come. It doesn’t work that way. And my whole family are dentists and doctors.
And I’m the black sheep. I’m the lawyer. And they just believe that we’re great at what we do. We should people should should, you know, work with us. It doesn’t work. It’s marketing. It’s all about marketing. I was watching this documentary about it’s terrible thing with the OxyContin company, Purdue. They were amazing marketers. The product was wrong, but they marketed it. They took advantage. But it just shows you that it’s.
You have to be quality. Look, in dentistry, you have to be quality just to play the game, to stay in business. Yeah. And then then it becomes, how do you do market yourself? How do you build your brand with respect to that? And because nowadays, because competition has increased, as you talked about, the labor force and so on, it’s gotten so it becomes more and more difficult. And then the recession. So I guess what I’m asking, Gary, is just the nuances. In general, it’s been different over the last. Gosh.
30, 40 years in general, as dentistry become more complicated, as there’d been more consolidation. But what does a recession add to it and inflation that’s unique to like what is looming? Yeah, so let me give you a super specific example right now. So normally you would say, hey, if I can just get to a hundred new patients and then my whole business model works. But now people are still, they’re hitting their hundred new patients and it’s not working. They’re ending up at the end of the month or the end of the quarter with less money in their pocket.
their owner doctor. So then, so then they’re going, why, why is that? Well, it’s all the things that I just listed. So how do you solve that? Well, in the old days, they would just go, well, hire another hygienist, and, and get another 50 new patients for the hygienist, and we’ll be great, or hire another associate, and we’ll be great. Here’s the problem. You can’t find a hygienist, you can’t get another hygienist just to come in. And so how do how do you solve it now? So then what you have to do is you have to add services.
and attract a different kind of patient to come in a different way. So let me just break this down for the audience. There’s only three ways for a new patient to come into your office, only three. So it’s either through the hygiene schedule, it’s either through the doctor’s schedule, or it’s through the consultant schedule, coming in for like a free consultation, right? That’s it. It doesn’t matter what other kinds of services you have, those are the only ways to come in.
So let’s go look at the hygiene schedule. So I have this conversation a lot with doctors where they go, I go, how many new patients do you actually want? Oh, we could take all of them. Give me all the new patients. Okay, well when is your next available hygiene appointment? 2024. And it’s like, so it’s like, oh, well, I can’t market. It’s impossible for me to market that. There’s no one looking for a dental appointment for get their teeth cleaned two months out. They’re looking two days out.
maybe three days out at the most. So that’s a problem, that’s a conflict. So, okay, then that means now we have to move to the doctor’s schedule. What can I get onto the doctor’s schedule? Oh, well, our doctors actually have room right now. Great, that’s a different kind of patient. That’s gonna be an emergency patient or something of that nature. Now there’s pros and cons of emergency patients. The pros are they need work right now. If I fall down, chip my tooth, and I call my dental office and they go, oh, I can get you in in a week, that’s not gonna work. So I’m gonna keep calling offices.
until someone gets me in right away. The downside is, is that typically they’re not, they’re not as, they probably didn’t listen to their last dentist and do the work that the last dentist told them to do. That’s why they’re having an emergency and they’re having pain and those kinds of things. Or they’re coming from another office like me where I fell, chipped my tooth, my dentist couldn’t see me. So there’s complications there that you have to realize. So there’s a high side that they’re probably gonna accept treatment right away. There’s…
more than likely it’s gonna be harder to get them to come into your office and stay. Then there’s the consultation schedule. This is the really cool one. This is where a lot of opportunity can be created. So if you have a treatment coordinator on your team or somebody on your team that has some bandwidth, you can have implants, full arch, clear liners, all come through that schedule and not muddy up your hygiene or your doctor schedule. And they can filter patients who are interested and who are qualified.
and then put them right onto your treatment schedule. But here’s the tricky part. These are totally different strategy to attract to your office from a marketing perspective than the GP patient. Two totally different kinds of marketing. So what a lot of people try to do is they go, well, I’ve been running Google ads or I ran SEO and this has worked for me to get GP. Just do the same exact thing for full arch or same exact thing for clear liners and we’ll be great. But here’s, it’s not the same. They’re a different kind of patient.
And you have to understand that and market to them differently to be able to get the, those kinds of patients to come into your office. Yeah. I really like how you think these things through you, you added another, besides being a lawyer, boo, I’m also MBA. And so you’re covering these concepts about, right. We talked about accounting. Now you’re getting into economics supply demand, right? So in many situations, they’re like, oh,
Yeah, I want more. Give me all the new patients. But can you handle them? Do you have the supply? You don’t have the hygienist. You’re booked up. OK. And just before we go any further, I have to say this. I’m compelled to say this, right? On my contract, no. But we’re all about, we’re a, say consulting, but we have an online training, right? We’re known for phone skills and scheduling, as well as K6, 7, 7. That’s what we do, right? We work with great companies like yourself that do marketing, bring them in.
And what’s really cool is there are a few marketing agencies like yourself that think things a little further through, not just throw at it, but you recognize that you got to be able to answer the phone. You got to be able to provide great customer service. You got to be able to, I don’t like using the word sell, but you got to make yourself the logical choice in case presentation for them to accept. And if you’re not trained, if you’re not trained…
in the processes and your team, you don’t have emotional intelligence or awareness. All this is going to be so inefficient. And I know, look, I know a lot of dentists will come to you and say like, just get me more new patients. That’s not going to fix the problem. Okay. Because if you don’t have, like you said, you don’t have anywhere to put it and you’re not going to convert it. We’re wasting our time. You’re not going to train your team. So the caveat here, and I know you would agree with this, of course, I can tell by your expression.
is you gotta be training your team. You gotta be great on the phone. You gotta make sure they show up and provide a great customer experience. So that’s the common ground there. All right, so let’s assume they’re doing it, which very few do. Actually, with a survey- I would say 98% don’t. 98% of the people listening right now don’t. You’re being really mean, 97%. That’s the study. I did the study with the AACD. Oh, did you really? Did you really do the study? I did.
I did a study with the American Academy of Cosmetic Dentistry and we found that 97% of dentists train less than once a week on customer service skills or not once a month rather, less than once a month. So only 3% are training more than once a month. We advocate 20 minutes a week. So I’m a little more generous than you, but you were close between two to three. Yeah, it’s pretty poor. So what’s exciting?
What’s exciting for those that are listening is we can say, wow, if it’s that bad, then if I can just be better than, like, there’s only few that are doing it, right? Because everybody worries about, they’re worrying about corporate dentistry, some corporate do it well, some don’t, but they’re worrying about all these factors. I always say that you can make the economics and the recession practically irrelevant if you do some of the basic things that we’re talking about, training your team.
Okay. And customer service skills, thinking through your process, being strategic, think about quality, not quantity. Yeah. A hundred percent. Let me, let me put some skin on this for your audience. I’m going to do a little exercise that I do when I speak at events and some of our events that we do. And this is, this is a, a really big, um, example that will help your audience understand from a personal level. So let’s pretend, and I want the audience to play along with this. Okay. Let’s present pretend you’re spending $10,000 on marketing.
And so, and let’s assume that your marketing is perfect, that it’s being perfectly executed and it’s getting the exact amount of responses that it should get for you. Okay, so what is the industry average in dental today, as you’re listening to this, of unanswered calls? Meaning, let me define that. During business hours, while you’re opening, while you’re opened and you’re practicing dental, how many calls are going unanswered? What percentage during that time?
Now I want you to put the number in your head audience. I want you to lock it in, okay? And do you guys, do you know Alex, this number? Of how many calls that you go unanswered. We have a statistic that’s more like how many don’t convert to an appointment. That’s my next, that’s my next. How many, you’re saying how many don’t even get answered to begin with. Ooh, that’s gonna be a good one. Tell me. Okay, industry average. And this isn’t just our number. I mean, we track.
hundreds and hundreds of thousands of new patient calls every single month, but I’ve also cross-checked this with other companies that do phone tracking and things like this. Right now, today, it’s 35%. Wow, a third? Don’t get answered. A third, don’t get answered. Now the doctor, I know what they’re thinking. I know they go, no, no, no, not my office. I hear Susan always answering the phone, but you don’t, yes, if you have two or one or two front desk people and they’re answering the phones, you don’t hear the other beep, beep, beep that they can’t answer, cause they have.
Call is coming in, they have people checking in, checking out, they don’t have enough bandwidth. They just don’t. And so 35% is industry average. So if you didn’t know that number, like if you don’t have that number documented, I would bet the farm on it, you’re in that 35% range. Okay, so let’s do simple math. If you’re spending $10,000 on marketing, 35% of it is going down the drain unanswered because if you don’t answer the phone, then guess what? You just, they just go to the next person.
So now you’re at $6,500 of marketing. Perfect, assuming the marketing’s perfect, okay? So now what is the average conversion rate when you do answer the phone for not all patients for just marketing patients, just marketing? And most people don’t track this. Most people track everybody and that’s a problem. And I’ll explain why that’s a problem in a moment. But let’s just boil it down. It’s 50%. The average conversion rate for a marketing new patient coming to your office
is gonna be around 50%. And that’s just if you never, your front desk, they have some training, but there’s no accountability there. The reason that co-mingling marketing with patient referrals, so right, let’s say take an office, they have a hundred new patients a month, and 50 of them are coming from marketing, and 50 of them are coming from patient referrals. Patient referrals or doctor referrals convert at about a hundred percent. Why? Because someone else already did the selling.
So if I go to you Alex and I say, you say, man, I need a dentist to go to. And I go, Alex, you should go to ABC Dental down the street, they’re amazing, they’re the best. You’re gonna convert. Yeah, it’s different. You’re gonna convert, even if the front desk doesn’t even know what they’re doing, you’re still gonna go there. Because I told you that they’re amazing. But the marketing patient, not so much. So you actually have to have coaching to get above that 50%. And then not only coaching, you have to have accountability.
answer, this is how you answer the phone. And then, and then you have to hold them accountable to get that percentage up. Otherwise, because this is the thing that most doctors don’t realize, new patients calling into your office and scheduling is just more work for the front desk with no upside. And they’re already slammed and stretched thin anyways. So losing a couple people here or there to them is not a big deal. They don’t care. Yeah. I remember when my wife used to work for my father’s office, that’s kind of part of the genesis of why we started All Star.
They didn’t want to answer the phone. They were so happy. See, she was the new patient coordinator and she specialized on only the phone call. They never missed. If a phone rang, she would answer or they would forward to her. They never missed during business hours. It’s interesting the number you put. Again, you’re a lot meaner than I am, but you’re probably right though, is I look at the number as only 35%.
calls convert, which is what we’re talking about. And wait, you said 50% convert was the number you gave? 50? That’s the average of a marketing lead. OK. I found 35%, but I didn’t count for the 35% that didn’t even. So let’s just, so what I do, I have a business growth formula. And essentially, this is very similar. We can just focus on this as part. But if you want, let’s assume you’re
100% of people show up, 100% accept treatment. Let’s just assume that, never happens. But if we focus just on this, if you want to make a million dollars and using what you’re saying here, and we reverse engineer it, only half of them convert, okay, you need two million in opportunities and only one third were answered, you need the marketing company to generate you $6 million in phone calls for you to make a million.
Well, we haven’t even got to the no show rates on these, which jump as high as 30%. And I know everybody here is going to be like, no, no, no, no, no. No show rates 5%. But no, they’re not, they’re not accounting for one to 30%. Yep. The marketing. And you’re right. The marketing leads are the other tougher ones. You’re right. How you segment it because they don’t know you. And so again, that’s 6 million. If you’re saying, uh, let’s just use, so you said a 30%, right? So don’t show up.
So then now that number goes up even higher. And then if you don’t accept treatment, so you might be at around 10 million in opportunities for these marketing leads to get a million out of it. Here’s the crazy part. Here’s why dental still works even with all this stuff that I’m telling you and dentists are still in business. Because if we were running a restaurant and I just gave you all these numbers, you’d be out of business in three months, like done. Like no one would loan you money. And dental still works because even on these averages that I gave you, we still see people get
three to one, four to one, five to one ROI on general dentistry. Then you get it out in full arch, you’re getting, all you need is one case to accept and you’re getting like a 10 to one ROI. I heard an executive from a well-known lab who told me the reason corporate dentistry is so hot is they see how inefficient dentistry is and how much money they say, listen, I know I can.
require you and I’m much more efficient than you are, I’m going to get more money out of it even though I got it because they’re paying dentists good money. They’re paying them three to $500,000, but they’re working in my courses and they’re making because they’re taking up that inefficiency. They’re making the monies on all those inefficiencies that they can fix. They have an economies of scale and so on. What I see in dentistry and you see this is you’re going to have a split, right?
Now, you do have the oddball, and I know we work with some DSOs that are great with customer service and they hold that line, but you’re going to have a split for the most part of some of these corporate practices that are going to get to the lowest common denominator and people are price sensitive. Dentists, even though, and they’re very efficient. Now, the dentist that will be successful, and many of them are fee for service, we help them get to that, is that…
you have to listen to what we’re talking about. You have to be good, not just at the marketing, but the business skills. You got to think this through and you have to clear these inefficiencies, especially if you’re smaller and you want to be quality. Because if you want to be quality, you’re going to invest in good people, right? So, you got to get rid of these inefficiencies. And the recession, what I think the recession does is it just…
It’s kind of like you said, you can be so inefficient. And when the economy is great, everybody’s making money. It’s funny. You’re like, oh, buy this stock, buy this mutual, we’ll buy this. It’s like, listen, in a good economy, every stock is doing well. You know, it’s like, of course it’s gonna do well. But when it’s not, so the point is, is when the recession happens, it really shows you how, where you’re weak and where you need to improve. And some don’t make it, but some it just shows how difficult it once was and is.
100%. Yeah. And you have to figure these things out if you want to grow. That’s the other thing is that a lot of dental offices have reached this class ceiling, I call it, where they’re just like, man, we’re just not growing. And the reason they don’t, the reason they’re not growing is they, they don’t even see the Delta between here’s our attrition. Here’s how many new people we’re bringing in and simple business, right? Like if you’re bringing in 10 new patients, but you’re losing 20 every single month. True. And you can’t see that you literally can’t see that.
because the data is all mingled together and everything’s mixed together, you’re slowly dying. And you’re like, why am I not growing? I spent more on marketing. I got more new patients. Why is it still not working? What is it working harder, not smarter? Yeah, exactly. Yeah, the, definitely see that going on. And it’s, look, it’s hard for, I do have compassion. I know you do too, Gary.
You know, we specialize in business. We get to play business all day long. We don’t have to go to the office and drill. And you know, I know I grew up, my father being a dentist, it’s difficult. And most dentists are not conditioned. They didn’t go to dental school to be a great business. I mean, you and I, I’m sure at least like I speak for myself, I love business, right? And I enjoy that. I cultivated that. That was my passion. So I got to do the one thing that I love to do. With dentistry, they want to do the clinical stuff.
And you’re right, the practice management software isn’t geared towards that, but they don’t want to look at that. Actually pro probably the practice management software was built by dentists because they don’t want to see that stuff. They want to see veneers, crowns, fillings. That’s their happy place. It’s happy. And they don’t, and I’ll tell you, dentists run from the front office. They don’t want to be there. They don’t want to talk to people there. They just want to do, they want to show here’s my patients. And I get it.
That’s your inclination, but that’s where it’s important to partner with companies that can help you, coach you. I’m big on coaching and consulting. We do that. We have online training. You got to have a great marketing company like Gary and companies, not just not just marketing companies that are just going to send you leads. It’s they they coach you. They get you to think because they’re not stupid. They know. And we were the same way. We have perfect reviews. We do that because we’re very careful who we bring on.
And if they’re not a good fit, here’s your money back. You know, just go, let’s be friends, you know, whatever. But the idea is you got to pick people that are going to tell you things you may not want to hear and be willing to hear it. And those are the dentists that will thrive and will be able to overcome these situations. So we don’t even think of ourselves as a marketing agency. Actually, we were at Dykema and our booth said, dental marketing agencies are dead. And the reason that we said that is because
I do this again in front of audience, right? I had a, we did a bootcamp at Dykoma and I asked people how many pitfalls are there between when the patient clicks on an ad until a patient is saying yes in the chair. People are like five, 20, 30, and I pull up this board and I show them in a funnel style, here’s all the pitfalls that we track.
Cause we have a CRM that we’ve built that we use to track everything and everything that’s going on with the patient that integrates with the PMS. So we track all this. There’s over a hundred pitfalls and each of those hundred have subcategories anywhere between five and 30. So you’re talking about hundreds and hundreds of pitfalls that the patient could potentially fall through. Most of them are invisible and to the practice. So…
when we tell people dental marketing agencies is dead, what I mean by that is if you’re just like, hey, Mr. Marketing Person, send me leads and we’ll take care of the rest, there’s a chasm of about a couple hundred things that that patient can fall through. Your front desk isn’t watching for those things. Your treatment coordinator isn’t thinking about those things and the marketing company is not either. And so we call ourselves a growth partner. What that means is, is this is truly a partnership. So can we deliver a hundred new patients? Absolutely.
But if you don’t have phone bandwidth, if your team is not trained, if your treatment coordinator isn’t up to speed, if your doctors are over treating or under treating, the business model falls apart. So we work through that upfront before we start the relationship. And we actually are going to ask you, how many spots do you have open on your calendar before we even have a conversation? We’re gonna secret shop your front desk and we’re gonna listen to them and go.
They’re not up to speed. Are you okay with us training them or using somebody like you to train them? We don’t, we’re Sweden. We don’t care who, how they get trained. That’s good. We just want them to have the skillset. Oh, I will say though, Sweden, take a side on this though. Service training, not sales training. 100%. Yeah, it’s giving people the option to be able to figure out if you’re the right option for them to get the dental work that they wanna get done.
Now, now, Gare, I’m going to put a link in the show notes to your wonderful podcast. And I got a chance to listen to it. You have a few of them. I know that the the the marketing one is very popular. And yeah, that’s fun. And now tell me, let me ask you this. Tell me a little bit about you, Gary. I know I did a very short introduction, but what got you into being doing what you’re doing? What drives you? What’s your passion?
That’s awesome. So, um, great question. So I actually asked this question of every guest that comes on my podcast and they’re all in the dental industry. How’d you get into the dental industry? And here’s the fascinating thing that I have found. Dentists and hygienists are here on purpose, usually because of their family members and pretty much everybody else is here by accident. So I stumbled into the dental industry on accident. I was a marketing person. Uh, I started in 2008 during the recession. Uh, I started my own business. I was doing emo marketing, which was like,
cutting edge at that time, no one, there was no software’s out yet to help people, uh, send out emails. So I was doing that on their behalf and I bumped into a dentist and they said, can you help me with some of the different marketing stuff that you’re doing? And I said, yes. And we helped them go from 80,000 to over $400,000 a month. They went from one doctor to four doctor over several years. And they started referring us to a ton of dentists and we were able to repeat that over and over and over again.
And through that, we finally decided, you know what, we need to only be dental. So I lopped off half of the company and said, we’re just focusing on dental. And then since then we’ve continued to niche down where now we’re at the point where before we start working with somebody, we’re just like, okay, how many new patients do you want and what kind of patients do you want? And so we have events that we do where we’ll educate dental offices on how to market for a clear liners, full arch.
GP, PETO, whatever kind of patients you want, we’ll teach you how to do it yourself. And if it’s complicated and you go, hey, I don’t have the manpower or the time to do that, then you can work with us. That’s kind of our strategy. And my passion is really just growing. So our company, why is we’re always growing. What that means is, first of all, our team, we want them to always be growing, our team members. We want them to grow personally and professionally. We want to create a work environment where they love being, they want to be here.
and that creates a great experience for our customers. Second, we want to help our clients grow. We want them to grow and their team to grow as well. We do that through coaching and marketing. And I will say this, just so you know, Alex, if someone comes to us and goes, just coach us without the marketing, we don’t do that. Marketing, our marketing clients, we’ve realized there has to be some kind of coaching. So again, use Alex, market with us or use whatever, like we just want you to win. So…
We do whatever it takes to help you win because we’re a growth partner. And then lastly, if we do those two things, if our team is growing and they’re excited to be here and our clients are growing, then our company will grow as a by-product, not as a main goal. And we’ve been on the Inc 5000 list three years in a row, fastest growing companies in the United States. We just made the list for the third time, top thousand, something we’re super proud of, wasn’t something that we set out to do, but again, it’s a by-product of
that kind of thinking of, okay, if we help our team, if we help our clients, then a by-product is our company’s gonna grow. Music to my ears, beautiful. Thank you, Gary, so much for being on the show. And remember to follow us on Apple Podcasts, Spotify and YouTube. Get the episodes as they are released, share with your friends. And until next time, go out there and be an All-Star. We hope you enjoyed this episode of Dental All-Stars. Visit us online.