“Am I Spending Too Much on Marketing?”

flushing money

Feels like this sometimes, doesn’t it?

When most dentists ask me this, they usually are asking about their advertising spending, not their marketing, which encompasses much more.  And my answer is that it’s more likely that they’re probably not spending enough, or they’re spending it in the wrong places.

Tracking your results is essential to being able to answer this question.  You need to know the source of your patients, and this can be done primarily by making sure that the source–either promotion or existing patient–that a patient came from is entered in your PMS, so that you can run a production report on your advertising results.  And, more and more, you can track results back a few steps from there.

For example, with direct mail you can use a unique phone number that forwards to your main line, so that you can track exactly how many calls you received, not just how many patients you acquired.  And with Google, Yelp! and other digital advertising you can see a lot of data, particularly how many people clicked on your ad, so you can compare that to the new patient count.

But let’s get back to the main question.  There are only two reasons why you might be spending too much overall on advertising and promotion:

1. Your schedule is full for the next three to six weeks.  If you can’t see new patients within two or three days at the most, then you will be wasting money on advertising;

2. Word of mouth is not your number one source of new patients.  This the clearest indicator that the experience of being one of your patients does not inspire people to recommend you, and you need to fix that.

As far as your marketing/advertising budget, there are two ways to look at it: as a dollar amount, or as a percentage of your annual revenue.

As a rule of thumb, 5% of your annual revenue is a reasonable amount to spend on your advertising.  I know thriving practices that spend as high as 8%, because they know that their profitability is higher once they have paid their fixed expenses, so they can afford to invest in growth.

As a dollar amount, your marketing costs should range from $20,000 to $40,000 per year. This would be higher with a startup practice–perhaps double that amount–because you need to start building a patient base.

Here is how I would break down the spending:

1. Your Website.  This is the cornerstone of your practice promotion.  Even word of mouth patients are likely to visit your website before calling the practice.  And this is important to remember–your website is a work in progress.  It’s never done, because Google is looking every day at it, seeing what has changed. So you need a dynamic website, where content changes automatically and you can add and change content easily yourself.  For more on this, read my previous blog on websites.

Cost: $3000 for a new website, $75 per month to host and maintain it.

2. Social Media. This is a marketing cost, primarily.  You should be paying someone in your office to add posts, request them from patients, monitor and respond to them, and also keep track of online reviews. This cost is part of their pay, but 12-15 hours a month should be dedicated to this.  There are outside services that can do this, but they still need someone monitoring them.

Cost: $250 per month.

3. Discounts. This is part of your marketing cost, and often people forget that.  If you’re doing a free exam, cleaning and x-rays, the cost is not high if you have digital radiography, but it’s not nothing.  You still have to pay your hygienist.

Cost: $300 per month, assuming 10 new patients attracted this way.

4. Insurance plans.  Dentists often forget that this is a marketing cost.  You are discounting your work to attract patients through the plan.  This number is impossible for me to estimate for you, but I want you to be mindful of it as a promotional expense.  And you can calculate it fairly easily, since you know what you collect versus what you would have.

5. Advertising. This could be anything from bidding on AdWords to advertising on Yelp! or Facebook, doing direct mail, local newspaper ads, or even radio or TV.  Or referral programs like 1-800-DENTIST. I believe in doing everything that works. Keep in mind that the lifetime value of a new patient to your practice is substantial, and worth investing in. If you don’t get that yet, watch this video.

Cost: $1000 to 3000 per month.

6. Incentives. You should have a new patient incentive program for your team members. Nothing crazy, but $25 seems to be an effective amount.  There are systems like Viva that work very well in this area.

Other factors that would increase your advertising cost:

1. You don’t have storefront visibility to your practice. This could add 20% or more to your budget.

2. You have limited hours, or less convenient hours than your local competitors.

3. You don’t take any emergency patients.

Anything that limits the convenience and appeal to a new patient is going to diminish your results, making advertising more expensive. What else could you be doing wrong?  Several things.

Let’s start with your front desk.  If you have someone who is not personable, or who is over-screening the patients, or generally not skilled at converting callers into patients who show up, your advertising spend is being largely wasted.  Fix that first.

You could also be spending too much on a particular marketing approach. Every medium will have diminishing results eventually, either as you increase the budget to too high a level, or over the course of time. Direct mail, for example, will almost always over-saturating a market eventually, and you need to stop for a few months. (1-800-DENTIST would be an exception, because we’re constantly modifying our advertising approach to compensate for this.)

You could be using a promotional approach that gets lots of calls, with very little conversion into real patients, or low production on them.  The wrong type of patients means either the message is wrong, or you aimed at the wrong target audience, or the medium is wrong.  I consider Groupon a classic example of this, and though a few people made it work, I’m glad it’s faded away from the dental world.

My main suggestion is to get professional help. Advertising as an industry is changing at a dizzying pace, and it’s all any of us can do to keep up. And get someone who works in the dental industry.  People behave very differently when it comes to dentistry, ( in case you haven’t noticed!) and you want a resource that understands that.

A good practice consultant and also your product distributor rep should both be resources for you to find the best help, and to make sure you’re getting the best results.


Creating Your Panoramic Photo Images

A dentist asked me recently, regarding Facebook Timeline photos, “What camera takes pictures that wide? It’s crazy!”  I took out my iPhone 5 and said, “This camera. And Apple just sold another 15 million of them this week.”  I then showed him the “panoramic” option on my phone’s camera.

Of course, Facebook allows you to reframe an uploaded photo, but the picture needs look right when it is cropped deeply at the top and bottom, and you can only adjust up and down.

But then, wouldn’t you also like to add your logo, or some other message on the photo?  How the heck do you do that!?!?

Amazingly easy, even for us old folk.  First, you sign up at the website www.canva.com.  The tools on this site are FREE.  Their goal is to sell you the rights to uses images, which they provide very inexpensively.  But you can upload your own pictures and combine them, add text to them, frame them, all sorts of things, in a nearly idiot-proof environment, and not pay a dime.

The home page looks like this:

Canva front page

You can create any shape you want, and they have the templates for practically everything, from Facebook ads to Timeline photos, your Twitter heading, website images, your thumbnail photo, your business cards, whatever.  You just upload the pictures you want to work with (and it stores them for you forever as part of your media library), and then you can drag it into the template you want, stretch it, move it add another photo next to it if you want, or super-impose one onto another.

Then you’ll want to add text, and they have all different fonts and colors to choose from.  If you’re color blind, like me, get some help with your choices. Or you can drop your logo onto it. Now just save it, download it, and then upload it to whichever site you made it for.

You can also use Canva to design Facebook contests and promotions, and they have templates for those and many other things.  They also have millions of photos that you can access, and you only pay $1 for each premium element you use for your design.  That’s cheap.  Especially since the rest is free.

You can get way trickier if you take some of the tutorials–framing photos, changing background colors, drawing on the image–but for now you have a simple solution that makes great-looking images.

I did this for my Facebook book page in about three minutes,and the template made sure I knew exactly where the thumbnail photo was going to appear over it, so I could get it looking right the first time:


I still recommend you get team photos professionally done, do nice photos of your office, and take good thumbnail photos of yourself. But now you can dress them up and personalize them easily.

You can also use it to design printed materials, if you’re still into that sort of thing.

I haven’t found any photo tool that’s easier with such versatility. Give it a try!

On Being Helpful, by Katherine Eitel

Every once in a while, one of my colleagues in the dental world really nails something so precisely that I think it should be shared far and wide.  This is Monday’s post from Katherine Eitel, on her blog, Monday Morning Stretch.  Most of the people I associate with are extremely helpful by nature, but often we fail because our communication is wrong, or mis-perceived, or our efforts over-enable rather than help someone to grow and solve their own problem.

In her blog post, which follows, Katherine presents a simple, brilliant, four-step process for offering help in the best way.  Read on!

BEING HELPFUL, by Katherine Eitel

Someone near and dear to my heart is struggling.  She is lost in what seems like a life without options or choices.  Feeling powerless, she is caught in a vicious cycle of despair, depression, and exhaustion with no end in sight.  The conversations and common experiences of her daily life as well as larger world events seem to confirm the immediate and unchangeable reality of the decline of decency and corruption of mankind.  In this state, she feels a loss of hope and sense of tired resignation.

I understand it.  I’ve been there.  But my world (the same world actually), at the moment, looks very different.  I see constant evidence of the generosity and courage of the human spirit.  I see bright minds creating amazingly creative solutions to age-old problems.  I observe a groundswell of people shifting to a new way of communicating, negotiating, perceiving, and operating in the world we live in all around me.  I see possibility in my work, my relationships, my income, my health, and my personal life that seems more expansive and prosperous than ever.  It’s just where I am right now.  But I have beeniStock_000036434580Small where she is and at that time there were people who were where I am right now. They tried their dead-level best to help me.  A lot of them failed and a few thankfully succeeded.

At the same point in time, we hold different views of the same circumstances.  Case in point:  My friend and I both flipped through a new local magazine recently and both commented on something in it that had caught our attention.  She noted the materialistic focus on wealth and luxury and how wholly out-of-touch the publication was with the real world.  I noted the fantastic enlightenment for me that there were so many pioneers, artists, activists, athletes, and iconic entrepreneurs of national and world acclaim living right in my hometown.  Of particular note to me was a quote by a local wedding and commercial photographer who is in demand not only locally but on international shoots such as Slovakia and the South Pacific, “My work has opened up a whole new world of travel and it’s all tied in with families and love.  I don’t think of myself as being in business, I think of being in pursuit of a wonderful, fulfilling lifestyle.” 

Here’s my point.  I’m making no judgment about where my friend is other than to say that it pains me to see her unhappy, depressed, and feeling so powerless.  At one point or another, most of us will find ourselves in a spot just like this.  The question on my mind this week was, “How can I help her?”

In the past I would have lectured incessantly on the virtues of positive thinking, making peace with “what is,” living in gratitude, and on and on and on.  But this week I decided to be thoughtful before I offered my help and my opinions.  I went for my morning walk and crested the most strenuous hill where my blood always pumps wildly, my endorphins kick into full release and my view is 360 degrees of beauty… and where I seem to get my most valuable ideas and inspiration.  I asked the question there.  How can I best help my friend?  How can I show her all the possibility, hope, and joy that is immediately available to her?  How can I help her find her own power again?

The answer came swiftly and boldly.  (And I laughed out loud knowing my Monday Morning Stretch had just been written.  I’m telling you, I’m mostly just a conduit for this stuff!)  The clear, resonate message that entered my mind was this:

1.  Model it.
2.  Offer it.
3.  Support it.
4.  Release it.

It’s so perfect, I get chills just remembering and writing it.

1.  Model it.  Before you preach it, you need to do it and master it yourself.  Be the unashamed, unwavering, ongoing, living example of prosperity, joy, gentle strength and self-powered happiness.

2.  Offer it.  When you do decide to speak, do so gently by simply offering an alternative to consider.  Remember that your truth is not the truth, it’s simply one truth.  Your ideas and beliefs are just that… yours.  There are as many right ways to address a situation as there are people on the planet.  Softly offer an option that has worked for you without any hint that this is the only right way.

3.  Support it.  Hold them in your mind not as the struggling, helpless friend you currently see but rather as a fellow traveler on the path of life who must be “here” to ever see or learn their own strength and abilities to get over “there.”  Hold them in the knowledge that it’s all perfect in its unfolding for them.  See them, speak to (and of) them, and treat them as someone you know they can, and will ultimately, become.

4.  Release it.  Model, Offer, Support, and then… let go.  Move on.  This is not your life or your fight.  We’ve intersected somehow with those we care about to support and be supported in turn.  But inherent in the word intersection is the idea that we are moving through this interaction on the travels of our own life.  At their best, these intersections are learning or re-affirming moments for us… as much as for them.

Model, Suggest, Support, and Release.  I plan to practice these with my children, parents, friends, colleagues, clients, and partner.  They were a gift to me and one I pass along with gratitude to you.  This week, focus on someone for whom you can see a greater person within than they can currently see for themselves and practice these four ideas of being as much for yourself and your own growth as for theirs.


So, pretty darn amazing, isn’t it? If you know Katherine, she truly does model this positive behavior.  And I plan to apply these steps in my own interactions and intersections with people. I hope you found this as valuable as I did. Thanks, Katherine, for allowing me to share it on my blog!

The Myth of the “Google First Page Guarantee”

Most likely, if your website is more than two or three years old, it needs a serious refresh, if not a total redo. And there are a lot of website companies out First Page Now Poster 1there willing to build you a site and “guarantee” to get you on the first page in a Google search.

There are a number of reasons why that is not possible, and the promise is a false one.  But the primary reason is this: Google gives different results to different people based on their search history.  In other words, you could be sitting there on your laptop, and do a search for “comedy clubs in Baltimore”, and your spouse could be sitting next to you using her iPad, and do the exact same search, and you would get two different results.

That’s because Google has built a profile on you based on your previous searches, and tries to decide what your preferences might be.  Their goal is to give the best possible result for you,  and they have a number of tricks to figure that out. This is not unlike what Amazon does, offering you recommendations based on what you previously bought and viewed.

The fact is that Google gives search results based on anywhere from 400-800 bits of information, much of it variable, particularly location, but most of them Google does not tell us, as they don’t want companies “gaming” the search and stealing the clicks.  Also, different devices and browsers affect results.  For example, if you use Google Chrome, it’s looking at your Google+ page to see what you post, share and comment on relative to that search.  All in milliseconds, of course.

So what does that website designer mean when they make this “promise”? They mean that they can get you to appear on the first page of Google on one computer, one time, and they are going to take a screen shot to show you that it happened, so they can bill you for the website and keep your money.

Why do they promise this?   Because that’s what dentists tell them they want.  Of course. Who doesn’t want to be on the first page?  But when half the dentists in your area have a website, you’re not all going to get on the first page, unless the screen is the size of a movie theater screen. And even if you do appear today on the first page, it won’t mean you’ll be there tomorrow. Or an hour from now.

So what’s a dentist to do?  The operative principle is to have truly relevant, ever-changing  content on a website that is visually appealing and easy to navigate. It used to be that you just needed relevant content. (Of course what I’m talking about here is appearing organically, or naturally, in a search, not bidding on AdWords to show up there.  But even when you bid on AdWords, your site needs to be relevant to the search criteria to appear.)

What is going to happen is that, as people get more and more sophisticated in their searching, they are going to put in more detail in the search box, otherwise they will get too many results, and none of those will be precisely what they’re looking for.  So, for example, instead of searching for “dentist Spokane” they will search “dentist 99026 Saturday hours reviews CEREC”, and get a much more refined SERP. (SERP stands for “search engine results page”, which is an acronym you will start to see more and more.)

This will mean that the more relevant, precise content you have in your website, the more Google will be able to offer you as a first page result when people get this specific.  Google is also advancing to the point where you can ask detailed questions, rather than just putting in keywords, and get relevant results.

But remember where I mentioned that Google wants “ever-changing content”?  This is where your website most likely needs to change.  You need to be able to have reviews appearing automatically, and easily change various texts, images and videos on your website. This has become essential.

And be aware that it has been well-documented that people are making judgments about the quality of your dentistry based on the quality of your website. It doesn’t matter that these two things are factually unrelated–this is what they do with most businesses, and it often makes sense to do so. This is why your website needs to look fresh and modern, and be easily navigated.

I hope this gives you some insight into the escalating importance of having a high-quality website, while also making you suspect of anyone promising you magical results.  Good luck!

P.S. I’m doing a free webinar on September 10 where I go into deep detail on everything you need to be doing to satisfy Google on your website.  It’s free, and if you want to register click here.  Also, it will be recorded, so if you can’t make it at that time, register anyway and we will send you a link to the recording.



Being Present versus Being Efficient

Many people can teach you systems and logistics to make your practice more efficient. But the most important result of those improvements should be that they allow you to focus completely on the patient you are with at that moment. In the psychological vernacular, you can be present for that person.

Thanks to www.bizarrocomics.com

Thanks to www.bizarrocomics.com

Why is that so critical?   Because we are all keenly aware when someone’s attention is completely on us.  It’s also critical because so few people are actually present with each other these days.  This cartoon is a fairly accurate indictment of our ADD behavior.

And in the practice of dentistry, where anxiety, apprehension and misinformation abound, genuine caring for the patient as an individual is even more critical.  I believe it is foundational, because most patients, in order to suspend all of their irrational beliefs and behaviors regarding their oral health, have to trust you.  Being present creates that trust.

So what does “being present” really mean?  And how exactly do you get there?  In essence, being truly present means that when you are with a patient, whether you are the dentist, hygienist, assistant, treatment coordinator or receptionist, your attention is 100% on them.  You’re not thinking about the next patient.  Or the next piece of equipment you’d like to buy. Or that sandwich in the refrigerator calling your name.  You’re listening, talking to, and focusing on that person.

And the first step to achieving this is deciding to do it.  Next, you need to eliminate distractions.  This is a practice in and of itself, almost like a meditation, where you do not let other thoughts interfere.  And you can only do this when you have effective systems in your office, where the flow is controlled and sequenced properly, and people know their roles and complete them.  It is a team effort that creates the possibility for each of you to be fully present.

It means stripping away your internal noise, or at least ignoring it, and eliminating your external noise.  Interruptions are not tolerated, (not even Facebook messages!)  Is it easy? No. What life skill is? But as I said, the result is a foundation for a deep, long term relationship of trust with your patients.

Otherwise, what happens is we flit from operatory to operatory, from exam to case presentation, phone call to email, always thinking about what we have to be doing next.  This is how most of us live our entire lives, not being in the moment, but thinking about the past or the future.

We live in a world of massive distraction, making it harder and harder to focus all the time.  And, in my mind, all the more necessary.  And when you are present, it has become so increasingly rare that people respond to it, sensing instantly that your attention is not divided.  And it’s powerful.

One of the things I like most about our training for 1-800-DENTIST call center operators is that for each call, they learn to put all their focus on that caller, forgetting about what else is going on in their lives at that moment. They forget about the annoying call they may have just finished, and don’t think about the traffic on the ride home. They are truly present for that person as an individual, with individual needs and concerns. We train this because we have learned it makes a huge difference when someone is trying to choose a dentist and has no idea how to make that decision.

Sound like a bunch of New Age nonsense? Okay, from a purely business standpoint, being present is good marketing.  In any service business, when a person feels someone’s focused attention, they are more receptive.  In your case, being more receptive means patients accepting treatment now instead of putting it off for six months, or a year, or indefinitely, which doesn’t benefit them at all.  You are helping them make a good health decision, sometimes in spite of themselves, and your being present is an integral part of that.

Of all the highly successful dentists I know, I can safely say that every single one of them has mastered this skill.  Some came to it more naturally, but each one of them, once they saw the potency of it, made it an essential part of their practice behavior. And then built a team that behaved exactly the same way.  And the systems and efficiencies they built into their practice all support this. And it has yielded the best kind of success: a thriving practice with healthy patients who appreciate the relationship they have with the dentist and the team.

They also use automation and software whenever possible to free themselves up from repetitive or unnecessary distractions.  One of the main benefits of PatientActivator or applications like it is that it allows the front desk team to focus more on the patients who need their attention.

And good practice coaches can help your team prioritize and streamline your daily activities. On the right under “Fred’s Favorites” you can see who I recommend to help you accomplish this.

Of course, you’ll always need to be highly efficient in a dental practice–each professional only has 35 hours a week to deliver care–but what will make those hours most productive, providing the highest degree of care, is your ability to capitalize on those efficiency systems by being totally present with each patient.

And who knows, you may find that once you master this at work, you’ll be more present with your partner, your children, your friends, and everyone you meet.

For more on this process of being present, I highly recommend you read this post from one of my favorite blog sites, Brain Pickings.


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