What It Takes to Turn an Orthodontic Practice Around

The three factors that helped an orthodontist stop a 3-year decline and reignite growth.

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By Roger P. Levin, DDS

Even thriving orthodontic practices can lose momentum. For Sara, an established orthodontist, the warning signs appeared gradually—fewer new patients, fewer referrals, and rising competition from new orthodontists in her area. What first seemed like a temporary slowdown became a 3-year decline. Unsure how to reverse the trend, she set out to understand what had changed and what strategies could restore growth.

Sara: The Case Study

At 47,Sara realized that many of the friendships she’d formed with other parents in her community had drifted as their children grew up. She was also facing new competition from two young orthodontists who had recently moved into the area and were aggressively marketing, especially online. Furthermore, these new (younger) orthodontists had connections with other families who currently had children in the local school system.

When Sara contacted me, her practice was down by $250,000 and showing a 3-year trend of decline. At first, she thought the decline was temporary, until the third year, which she described as her “wake-up call.” She wanted to take specific actions but was unsure about what those actions should be. She had met other orthodontists that had spent significant money on advertising only to find a limited return on investment. As a result, she was nervous about what to do and even a bit scared. She was, however, clear about her main goal, which was to turn her practice around.

After analyzing Sara‘s practice, we found very specific areas of opportunity. Although you can’t improve an entire practice at once, there are definitive strategies that in the right situations will increase practice production. 

What the Analysis Revealed

What our analysis of Sara’s practice showed:

1. Sara had been experiencing significant staff turnover since the pandemic. Several of her staff members never came back to work and several others had retired or moved in the last 4 years.
2. Sara had done virtually no marketing. Her marketing program consisted of games, toys, and contests for kids. She did not have any big events, outreach to referring doctors, or involvement in the community. As Sara described it, she just didn’t have the time or motivation to put her personal time into those activities.
3. Sara did not really know her numbers. She didn’t realize the level of decline each year until late in the year when her CPA firm gave her specific feedback and information. She did not track numbers weekly or monthly because she had always “done okay.“ She now realizes that she was not paying attention in the right way to her practice, which was trending downward in production profit.
4. The competitors did appear to be having a direct effect on Sara‘s practice. When we looked at her referral base, it became clear that referrals were sparse across the board—from patients and parents to referring doctors, social media, and the broader community. Marketing categories weren’t something Sara had ever really considered.
5. We evaluated the level of customer service in the practice to be at a score of 6 out of 10. Like other parts of Sara’s practice, her customer service was okay, but not good or excellent. Sara felt that she and her staff were nice to patients and provided excellent clinical care; however, she gradually came to realize that clinical excellence alone does not compensate for other aspects of the practice.
6. Sara reported that she was somewhere between extremely fatigued and completely burned out. The decline of the practice and attempting to figure out how to turn it around was wearing her out and she did not feel she was making any progress. Additionally, she had a parent who was not well and she was acting as a part-time caregiver. As a result, Sara needed to improve her energy level and feeling of well-being. As she said, “I used to love going to work, treating patients, and creating beautiful smiles. Now I feel that there are some days that I’m just going through the motions.”

The Plan

The first thing we did with Sara‘s practice was to analyze the referral base and, to the best of our ability, understand where referrals were coming from and how much they had declined. As is typical of our clients, Sara did not have good information about the source of her referrals, so we used a guesstimate approach to identify her referral patterns and seek out opportunities. We quickly found that Sara’s best opportunities were not in going head-to-head with her newest competitors on social media, but rather in focusing on referring doctors and the community.  

We knew we could quickly strengthen customer service and internal marketing among current parents and patients, but we also needed to tap into areas where new practices weren’t competing as heavily or effectively. We implemented a targeted marketing program focused on referring doctors, with messaging tailored to Sara’s practice and designed to reach parents, patients, and the wider community.

Key Areas of Focus

Our plan focused on the following areas:

• Strategies. We developed 15 marketing strategies built around a branding campaign that generated excitement, interest, and positive feedback. For example, we launched a giveaway for young kids, promoted in a positive, fun way, that had children coming to the practice asking, “Do I get a stuffed animal?” While we recognize that a stuffed animal alone does not create referrals or new starts, we know it does establish an image of fun, energy, and positivity.
• Contacts. We coached Sara on how to reach out to referring doctors every day and often through delegation to a key team member. Sara began to communicate with doctors to thank them for referrals and send before/after cases photos, testimonials, and reviews.
• Reviews. We helped Sara create a powerful review request program that added over 220 positive reviews in 12 months. These were then used to create trust and validate the level of quality and care provided by the practice.
• Customer service. The team was trained on five-star customer service and quickly came to understand that referring doctors and their teams were also customers and needed to have a five-star experience as well. Scripting strategies began to prove effective. For example, any time a referring doctor or practice contacted the orthodontic practice, scripting included, “We are delighted that you called. You have an excellent practice, and we love seeing your patients. We will do our best to be of help to you.“ Follow-up was also built into the systems and processes to thank referring doctors, provide feedback, and promote lunch-and-learn events hosted by Sara.
• Systems/delegation. We carefully structured her day-to-day systems to make them as efficient as possible and maximize delegation. Two team members were replaced with more experienced team members, and they were able to take some of the responsibility from Sara. This allowed her to join a gym, which helped increase her energy and decrease her stress.

The Results

After 12 months, Sara was on track to reverse her downward trend. Of the $250,000 in practice decline, $190,000 was added back by 12 months, $340,000 by 24 months, and $500,000 at 36 months. This reversal is very typical of the production enhancement pattern that takes place when excellent marketing and strategies are put in place that fit a specific situation. In addition to experiencing great financial results, Sara‘s turnaround had enabled her to begin to enjoy orthodontic practice again, which had an overall positive effect on her practice, staff, and patients.

Lessons Learned

Any orthodontic practice can perform well if it follows the right principles, so it is critical to understand where the opportunities lie. If Sara had gone head-to-head with her new competitors using only social media, it is unlikely she would have experienced these results. By identifying where she could most effectively market with less competition and take advantage of the experience and stature of her practice through a new branding and communications program, she was able to turn around her program. This case study can benefit any orthodontic practice, but it’s important to identify the right opportunities and strategies. OP

Photo: ID 86397772 | Concept © Denisismagilov | Dreamstime.com

More articles by Roger P. Levin, DDS:

• Growing the Practice by Reaching the Adult Orthodontic Market
• The Office Manager as Chief Operating Officer for Orthodontic Practice Success
• Want to Retain Your Orthodontic Staff Long-Term? Start With These 3 Tips
• Do Your Team Members Like Their Jobs?