MARKETING FOR A SUCCESSFUL PRACTICE
Marketing refers to the wide scope of moving goods or services from the producer (dentist) to the consumer (patient). It includes all business activity to achieve that movement, including selling, advertising, and promotion. With proper marketing, one may achieve branding of the practice to further promote the uniqueness of the practice.
Marketing has two basic forms: internal and external. Internal marketing includes all activity to promote the practice that initiates and targets those patients already within the practice with the goal to have those patients generate a referral base to your practice. Forms of internal marketing may include:
1. “Welcome to the practice” letters
2. “Thank you for the referral” letters
3. Office brochures
4. Floss cards, toothbrushes, or other items with your name embossed on them.
External marketing is advertising your practice to the public. It is any notice given in a manner to attract public attention. Forms of external marketing may include:
1. Advertisements in the yellow pages
2. Newspaper ads
3. Television and radio ads
4. Dental referral services as a co-op marketing
5. Internet ads
6. Listings in preferred provider and health maintenance organizations (PPOs and HMOs), insurance groups, or panels where the lists are available to the public.
All types of marketing should be directed to the type of patients you want. For an obvious example, you would not market an orthodontic practice in a 55-and-over community. Always keep in mind that whenever you promote your practice, whether it is internal or external marketing, the image of whom you are and what your practice stands for is at stake. Your image, your practice, and your income depends on it. Poor-quality, commercial advertisements only disparage your professionalism and create a poor image of dentistry as a profession (see Chapter 16).
Branding your practice is a way to show its uniqueness, such that patients will think of your practice first when in need of dental services. It is more than a logo, symbol, ad, or saying that represents your “brand.” It is the sum of all promises and perceptions a practice wants its patients to believe about the practice’s products and services. It must be tied to the practice’s uniqueness—the unique value of the practice as it relates to the patient. To brand a practice one must focus on the strengths of the practice and promote those strengths repeatedly over a reasonable amount of time (on average, 3–5 years), with the hope of achieving a practice brand recognition.
Advertising is relatively new to dentistry, being allowed since 1979. There have always been dentists who advertised, even in the early years of dentistry. One noted dentist advertised himself as “Painless Parker” in the early 1900s. He showed that advertising does pay: he ended his career with 30 West Coast offices, employing 70 dentists and grossing $3 million per year . In the late 1970s the Supreme Court began to view professional bans on advertising as unfairly restricting competition. After the problems with business as a result of a recession in the 1980s, the California Dental Association began promoting member dentists with the slogan, “We’re the dentists who set the standard.” This was quickly abandoned, as it was a statement of superiority. Then, in 1999, the Supreme Court held that the Federal Trade Commission had jurisdiction over nonprofit organizations and that price advertising was allowable if it was exact, accurate, and easily verifiable. This was followed by the American Dental Association (ADA) joining with Intelligent Dental Marketing in 2007 to make professionally developed advertisements available for its members . This was abandoned by 2010. So how does a dentist ethically advertise his or her practice?
The ADA Principles of Ethics and Professionalism clearly references advertising: “Although any dentist may advertise, no dentist shall advertise or solicit patients in any form of communication in a manner that is false or misleading in any material respect” . It also gives advice on what constitutes “false or misleading.” “With this in mind, statements shall be avoided which would:
a. Contain a material misrepresentation of fact
b. Omit a fact necessary to make the statement considered as a whole not materially misleading
c. Be intended to be likely to create an unjustified expectation about results the dentist can achieve
d. Contain material, objective representation, whether express or implied, that the advertised services are superior in quality to those of other dentists, if that representation is not subject to reasonable substantiation” .
There are basically three types of advertising available to dentists in marketing their practice:
Comparable advertising makes statements that compare one dentist to another dentist. These are usually statements of quality or superiority and are normally seen as being inconsistent with the various codes of ethics. These types of comparison advertisements may be easily misinterpreted by the public. Competitive advertising normally involves offering more products or better services at the same or lower price than that of a competitor. These are usually seen in ads with discount coupons, special prices for certain services, or even free services to entice a new patient. These ads are allowed by the various codes of ethics but with great scrutiny and adherence to guidelines of the various state dental codes and statutes. Informational advertising is the most common. It contains information regarding the practice, the dentist or dentists, staff, and services available. It is generally used to inform or to educate the public on various dental topics and practice information. These types of ads are most likely to conform to the various state codes and statutes.
Before undertaking any marketing plan, be sure to review your state dental law and codes of ethics so as to follow any necessary guidelines.
Attention must also be given to the applicable ethical principles of patient autonomy, beneficence, and veracity, as discussed in Chapter 17. These ethical principles are directly affected by dental advertising. The patient’s right to self-determination must not be infringed on by misleading advertisements. Dentists, having special knowledge and having gained the public’s trust through a social contract, can easily mislead a vulnerable patient and take advantage of the patient’s right to self-determination with advertisements and clever marketing. To uphold the patient’s autonomy, the marketing employed by the dentist should never take advantage of the patient’s vulnerability . It can easily mislead the patient’s decision making. A dentist should always promote beneficence and not promote his or her self-interest at the expense of the patient’s well-being. Care should be given such that an advertisement does not shift the primary goal from patient information/education to increasing the dentist’s self-interest/income.
Dentists also must be truthful in their promotion. The veracity of the advertisement should support the professionalism of dentistry. Some state statutes have placed conditions, disclosures, and disclaimers on the promotion of nonacademic or nonhealth degrees. This includes fellowships earned from various dental organizations. The ADA Code of Ethics states that “some organizations grant fellowship status as a token of membership in the organization or some other form of voluntary association. The use of such fellowships in advertising to the general public may be misleading because of the likelihood that it will indicate to the public attainment of education or skill in the field of dentistry. Generally, unearned or non-health degrees and fellowships that designate association, rather than attainment, should be limited to scientific papers and curriculum vitae” . Recently, Florida courts have ruled that the Florida state statute that restricted advertising a general dentist’s bona fide membership, credentials, and awards, such as nonspecialty fellowships from nonacademic organizations not recognized by the Florida Board of Dentistry, violated the Florida and U.S. Constitutions . This ruling makes way for the advertisement of earned fellowships in organizations such as the Academy of General Dentistry, the American Academy of Implant Dentistry, and the American Academy of Cosmetic Dentistry in the state of Florida. Other states are likely to follow.
Patients’ vulnerability may be broken down into the type of consumer (patient) who is receiving the advertisement. There are many types of consumers. Patients may be classified into three types:
1. The skeptical patient
2. The thoughtful patient
3. The gullible patient.
The skeptical patient does not believe in anything that is self-promoted. It is very hard to get a skeptical patient to fully trust an advertisement, and thus these patients are not heavily influenced by advertisements whether or not they are false or misleading .
The thoughtful patient may question the information in an ad and the source from which it came. Being a reflective, questioning prospective patient, they project a “show me or prove it” attitude . Today’s highly sophisticated marketing may have a tendency to mislead a thoughtful patient, especially since the source is thought to be from a highly respected professional dentist.
The gullible patient will most likely be influenced by a misleading ad, since he or she tends to believe most advertisements, especially those from a trusted professional. The gullible patient must be protected from misleading unethical advertisements. Developing an ethical advertisement so as to not mislead a gullible patient protects all prospective patients regardless of the type of consumer he or she is. By protecting the gullible patient, our social contract is upheld and continues to allow dentistry to be a profession. Hence, dentistry must maintain a wide scope in the meaning of what is misleading.
The information given in an advertisement not only formulates an image of the dentist and his or her office but also affects the patient’s decision-making process. When professionals publicly compete with one another, each advertising him- or herself as a better service provider than his or her peers, patients may infer that not all professionals are trustworthy . When professionals publicly compete for patients through advertising, it raises the question in the minds of the patients as to which dentist is better or more competent, when all dentists should be equally competent through licensure . The patient’s vulnerability should be kept paramount and the advertisement should not slide into a superiority competitiveness or even puffery, which is exaggeration concerning the quality of goods or services.
When the economy is in a recession, as was seen in the late 1970s and early 1980s, advertising becomes more competitive. Typically, when individuals offering the same professional services are located in the same community, the advertising becomes more intense and competitive. The result is that once-ethical professional advertisements begin to shift toward more competitive advertising, possibly approaching puffery. Guarantees or warranties begin to appear in various ads. This also raises a legal situation of misrepresentation of the dentist’s experience. If the dentist misrepresents his/>