For example, if a dentist wishes to increase the number of patients making appointments for cosmetic dental procedures, the practice website, Facebook page, online directory listings, and so on should all include keywords such as cosmetic dentistry, laminates, veneers, ceramic crowns, and bleaching. This will enhance the likelihood that when a patient types: “cosmetic dentist, your town” into the search engine, your practice will appear earlier, and therefore will be more likely to be viewed in the resulting list as opposed to being buried several pages later. Google and other search engines use algorithms that search the Internet to find how often the terms listed in the search appear together with the most regularity to determine your ultimate placement in the search. Of course, there are also paid methods to obtain a more favorable placement in a search result, such as use of Google’s AdWords program, which allows you to purchase a high placement in searches that employ these terms. There are also a large number of companies that will perform SEO for a fee, and whether dentists choose to optimize on their own or pay someone else depends on time, budget, and personal expertise. Many practices today employ an individual solely to manage the practice’s electronic communications. Similarly, dentists wishing to advertise or promote the implant or pediatric areas of their practice can use the same tools.
Business websites have existed since the turn of this century and although they are an excellent tool for presenting information about a practice and as such are enormously helpful in attracting prospective new patients, they are not an effective means of communicating with existing patients (see the section on Internal Marketing).
The final tool for external marketing is the use of social media, such as Facebook. Facebook in particular has huge advantages over other forms of social media, because of its sheer number of members, currently approaching one billion users worldwide. The most desirable referral a dentist can obtain is one that is initiated by a satisfied patient. The referred patient arrives with a preconceived sense of trust and confidence resulting from the “missionary work” of your current patient who has related to them how exemplary you and your staff are, your convenient hours, and so on. A practice can never have enough of this type of referral. Despite marketing gurus extolling the wisdom of asking existing patients to refer their friends, acquaintances, and loved ones, many dentists are either uncomfortable with this or feel that the appropriate situation to do so rarely occurs. In order for a successful word-of-mouth referral to occur in the traditional sense, your “beloved” and satisfied patients must find themselves in a social setting with someone who not only needs your services but voices that need to them. Further, the patient must be willing to make the recommendation and hopefully have your business card or be able to remember your exact website address.
Social media sites such as Facebook have the unique ability to be considered a trusted referral. Facebook is unique because of the sheer size of its user base. The key to Facebook’s success for external marketing begins with getting “fans” (patients) for your office Facebook page. This gives it the unique ability to be considered a trusted referral. This can be accomplished by promoting your site everywhere your address and phone number appears (e.g., business cards, envelopes, online or print advertising, or reception area signage). Hopefully, your Facebook and website addresses will be identical (e.g., www.greatdentist.com and www.Facebook.com/greatdentist). Next, provide patients with a reason to “like” your Facebook page, either through offers for fans only, sending worthwhile news and information to their news feeds, or simply by virtue of the fact that Facebook provides the ability to engage and interact with the office when patients have general or specific dental questions. Studies show that each fan averages over 300 Facebook contacts or “friends” in their network. Because Facebook has significantly more members than any other social media site, the percentage of your patients who are members and the number of their friends who are members will be higher than on any other social media site. Because users of social media websites provide a tremendous amount of demographic information, the ability to selectively target an audience is greatly enhanced. An example of this is Facebook’s optional fee-based advertising platform, which allows practitioners to target an ad program using demographics including geographic location, age, gender, income, marital status, interests and many others. In addition, social media websites have the ability to follow connections among members, which can greatly amplify the number of people who will hear about a practice through this trusted referral system. An example is Facebook’s ad program that has the ability to market directly to the friends of your fans. If you attain 300 fans on your office Facebook page and they each have 300 friends, this results in access to 90,000 potential trusted referrals using this feature. Facebook will “pull” the name of their friend, who is a fan of your page, into the ad and insert the Facebook thumbs up logo with a message that their friend likes your practice (Fig. 26-2).
Thus, a trusted referral is passively harnessed without requiring your “missionary” patient to be in the same place at the same time as the potential new patient who is in need of your services. Dave Kerpen,2 author of the New York Times bestseller Likeable Social Media, calls this use of Facebook’s ad platform “word of mouth referrals on steroids!”
Internal marketing techniques encompass any marketing or communication activities that take place within the practice setting or that are directed at active or inactive patients with the objective of retaining them in the practice or causing them to become more active and to stimulate referrals. A few examples of internal marketing techniques that dentists have traditionally employed include presenting gifts or acknowledgements to referral sources, providing a comfortable, clean and attractive physical office containing the latest technologies, offering amenities to create pleasant waiting periods for patients such as wi-fi, coffee, hot towels, aromatherapy, and so on. Other examples are supplying educational items such as newsletters and brochures to stimulate patient interest in particular services offered. In addition, one should not overlook details such as showing respect for your patients’ time by informing them when the doctor is running late, offering to reschedule them if this would be more convenient, and a post-visit follow up call by the doctor or a staff member to make certain their visit went well. These are all ideas that make your practice more desirable than another office, increase the likelihood of patient retention and referrals, and when effectively employed allow the office to reduce its budget for external marketing as a result of more successful patient retention and increased trusted referrals from your existing patient base.
Another effective internal marketing tool is social media and the ability it provides to engage the existing patient base. Valuable information can be passed on through direct messages and links to Internet articles. The “human” side of the doctor and staff can be portrayed via posts about special achievements or outside activities, new techniques can be publicized, and the patient base can be engaged in meaningful discussions as well as have another outlet or contact point to the office for them to feel more connected to your practice. Hopefully a number of your patients and fans will consistently comment on most of your posts. This should provide an incentive to post useful content to engage them with, which will ultimately be seen by their friends who will learn about your practice. This is the most significant difference between a social media page like Facebook and a practice website. If, for example, you have completed a high-level implant CE course or purchased a CAD/CAM unit, you can, and should, post these items on your practice website. However, the effectiveness of this may be questionable because how many of your patients visit your website regularly and will ever see this content. With Facebook, when you post on your page about these items, they are “pushed” to your fans’ newsfeeds so that the information is actively sent to them as opposed to passively viewed on your website. Not only will more of your patients find out about the completed course or new equipment, but also they are likely to engage you about it. This will not only promote your relationship with them, but also potentially spread your message throughout their network.
Managing negative publicity
Even the most conscientious practitioner will inevitably encounter a disappointed or disgruntled patient. However, patients will often avoid verbal or telephone confrontations and instead “vent” to friends, family, and colleagues or leave the practice entirely. Social media, on the other hand, provides a more comfortable alternative for them to complain directly with the dentist. This keeps the problem “in house” and provides the opportunity to resolve the dispute and retain the patient.
It is inevitable, therefore, that there will be an occasional negative post on Google, Yahoo, or your office Facebook or Twitter page. Clinicians cannot remove a post from Google or Yahoo no matter how inaccurate it may be; however, they can encourage their satisfied patients to post positive comments on these sites proactively and thus dilute the negative comment(s).
Facebook provides the ability to delete negative posts, but this is often not an effective strategy. The goal should not be to please every patient we encounter, but to take note of these negative comments to learn about possible areas in which the practice or customer service can be improved. Usually these posts are placed by a patient who is unhappy but has not yet left the office and is frustrated by a recent negative experience. Deleting the post sends the message to that patient that his or her thoughts are irrelevant, and will usually result in the patient leaving the practice. Engaging the comment directly, either with a direct response or with a comment that you will telephone them to discuss the matter privately, not only addresses the issue for them, but also establishes to other fans of your page that you care enough to listen to criticism and that the Facebook page is a viable source for interaction. It also demonstrates your responsiveness and approachability. This is of tremendous value to patients who are becoming begrudgingly resigned to “leave a voicemail which will be returned by the doctor or staff member in 24 to 48 hours.”
The four Ps of marketing
The concept of the four Ps was first presented in 19603 and is still highly regarded, although from time to time a new “marketing mix” will be proposed to replace this classic formula. The basic principles are still sound and applicable despite the massive changes in the marketing landscape that have occurred since the 1960s, not the least of which is the advent of technology and social media.
The components of the four Ps of marketing your products and services include:
Determining a fee schedule for services rendered is one of the most difficult tasks facing any dentist. Dentists can adopt a strategy of differentiation, setting a relatively high fee for services justified by superior quality and added extra value. To be successful the higher fee must be perceived by the customers of the practice or potential customers as a worthwhile investment compared with lower fees offered by the dentist’s competitors. Using some of these strategies, dentists can create the perception that the value for their services is fair.
Price competition is another approach to determining fees. “Cost is everything” and fees are set relatively low, or set by insurance companies that the dentist affiliates with such as in PPOs. Dentists adopting this strategy will have an easier time generating new patients and keeping busy, but will have to treat more patients and work longer hours to earn the same income as their higher fee charging peers and will generally not be as successful in retaining patients. Of course, these two examples demonstrate the opposite ends of the spectrum; most practices will fall somewhere in between.
When it comes to setting fees, dentists have three options. Cost-plus is the most analytical method and the one generally employed by most practices. The process involves the calculation of fixed costs (those unaffected by the number of patients treated) divided by the number of hours the office is open to determine the fixed hourly cost of doing business. Determination of variable costs is more challenging but will include extra staffing during busy times, inventory utilization that is based on traffic (both administrative and treatment related), and procedure-specific costs such as laboratory fees that do not apply to all services. The total hourly cost of doing business is then divided by the number of practitioners who generate revenue (dentists, hygienists) to determine the hourly fees that must be generated to break even. At this point fees for each procedure are calculated by determining how much hourly profit the owner wants to generate and the time that each procedure takes to complete. This exercise needs to be repeated semi-annually to be certain that fees are consistent with expenses.
The second most common method employed is market pricing or benchmarking. This approach requires the availability of fee information from comparable practices, which can then be customized as desired. This is a simplistic approach that does not take into account differing costs of doing business and profit goals as well as many other factors, which can vary among offices, such as the time required to complete procedures.
The last and arguably most effective approach involves a combination of the two methods. Each practice should know its cost of doing business but if, after carefully determining a fair price using the former method, the resultant fee varies greatly from the prevailing fee, an alteration upward or downward might be indicated for individual procedures. As counterintuitive as it sounds, undercharging can often lead to reduced sales and numerous studies have shown that consumers’ perceptions of the quality of service are diminished if the service is underpriced. Overpricing a service may also lead to reduced sales, but creates a dilemma when the fee in question has been calculated to be fair using the cost-plus method. It might be necessary to raise marketing awareness of the special skills the dentist might possess to justify the fee or to lower the cost of producing a particular service to allow the fee to be reduced and maintain the desired profit.
Once pricing is set, special pricing that is either provisional or permanent may be established to influence consumer purchasing on select services. Examples of this might include two-for-one whitening for a soon-to-be-married couple or complimentary whitening when bundled with orthodontic aligner therapy. Although these offers may minimize profits, they often lead to additional purchases by the consumer.
The range of payment options that an office offers will also influence treatments that a patient purchases. The number of patients who can afford a large immediate cash outlay for a cosmetic treatment plan is smaller than the number who can afford a smaller monthly payment expanded over time. The willingness of an office to either extend credit or pay an upfront commission to a patient financing program will increase the treatment acceptance on larger treatment plans. The 5% to 6% commission payable by the office on financing through companies such as CareCredit and CitiHealthcard is recouped by the smaller number of cancellations during the course of treatment because of patients not having the available funds to make a payment at the time of their visit.5 Factoring in the cost of same-day cancellations is one of the most difficult calculations an office has in accurately setting fees for services.
Dentists often have misconceptions about the thought process that occurs when patients choose the office where they will have their dental care. Patients are not actually paying for the quality of dentistry, but rather the perception of the quality they receive. This perception is formed by many of the non-dental aspects of the patient experience and can ultimately determine what treatment a patient will consent to and purchase.