Dental Practice Heroes

The New-Patient Trap: How “More Leads” Can Hide a Leaky Practice

• Episode 617

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Ever felt like your dental practice would finally take off if you could just get a few more new patients through the door? That seductive thought might be keeping you from discovering what's really holding your practice back.

I learned this lesson the hard way. Two years into practice ownership, we were consistently seeing 75-90 new patients monthly with minimal marketing effort. The schedule was packed, production was strong, and colleagues were asking for my secrets. I genuinely believed I had mastered practice ownership—until I implemented dashboard software that revealed the harsh truth. Despite impressive production numbers, almost every other metric was failing. Patient retention was terrible. Case acceptance rates were dismal. Cancellations were rampant.

What makes this trap so dangerous is how effectively new patients mask these problems. When you're constantly busy with new faces, you don't notice how many existing patients disappear through the back door. When demand for appointments is high, cancellations don't leave obvious holes in your schedule. When enough patients say "yes" to keep you busy, low case acceptance rates don't trigger alarms. But these hidden inefficiencies dramatically slow your practice's true growth potential.

Once we addressed these fundamental issues, everything changed rapidly. We reached capacity faster, brought on associates sooner, and I reduced my clinical days while improving profitability. The math is clear: fixing retention keeps your marketing investments working longer; reducing cancellations frees your team from constant schedule shuffling; improving case acceptance lets you treat fewer patients while achieving better financial results. Rather than chasing more new patients to pour into a leaky bucket, focus first on plugging the holes—then watch how quickly your practice transforms when new patients become a growth accelerator rather than a band-aid covering deeper problems. Ready to discover what's really holding your practice back? Let's talk about creating systems that maximize what you already have.

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Paul Etchison:

I want to tell you about a hard lesson that I learned a long time ago. Now, about two years into practice ownership, I felt like we hit our stride. We weren't marketing at all, we were just doing SEO. That was the only thing that we were doing and we were like on the top of Google with the most reviews, and we were consistently seeing like 75 to 90 new patients every single month. So, as you can imagine, our numbers were really good. Our team was really busy and I mean, like when you're seeing 75 to 90 new patients a month, think about all the insurance breakdowns that you have to do, all the insurance plan entries, all the treatment plans, all the patients coming through your practice. I mean it's a lot through the flow of your practice. It's a lot on your front end, it's a lot on everybody, and when you're seeing that many new patients, you have so much demand for your schedule, so it's almost like you can't go wrong.

Paul Etchison:

I remember feeling like man, I have arrived, I'm a practice owner and I know what I'm doing, I'm successful, and I felt really confident that I was like the type of person that could now give people advice on practice ownership. I mean, look what I've done. And I had a lot of my classmates. They were reaching out to me. They heard that I was doing well. They're saying like, hey, paul, I hear you're killing it, what are you doing? And I got to be honest, it felt really good, I felt really important. And then I remember going to this seminar and I'm sitting there in the conference room and one of the sponsors comes up. They're showing their product, they're showing their software, and it was called Practice by Numbers and you probably know what that is nowadays because it's been around a long time. But this was something new when it came out that there was this software that could take all this data from your practice management system and put it on a dashboard. So I was like awesome, dude, this is great. I can't wait to see what our opportunities are. I can't wait to see how we're doing. So we signed up and we installed it and, dude, I was like I mean, my jaw hit the floor, like I had been fooled. I thought I was literally at that point, god's gift to practice ownership.

Paul Etchison:

And there was the evidence right in front of me. I had a whole bunch of issues. I mean I was doing like freaking horrible in every single metric except for, like, production and collections. I mean, we were doing good in that regard. But when you looked at the baseline metrics, like my attrition horrible. My case acceptance horrible. My patient acceptance horrible. My cancellations dear God, like they were horrible too. But these things, they weren't really obvious to me in the time because I mean, dude, we were seeing so many new patients and it didn't matter whether the patients were coming back to the practice or that we were losing active patients. It didn't matter that my case acceptance was so low and that I had tons of patients not saying yes to treatment, because I just still had so many patients to keep me busy. It didn't matter that our cancellations were so high because we had so much demand that we could always fill it the day of, so we were still busy.

Paul Etchison:

But you see, this trap it's so easy to fall into because new patients they mask all of the inefficiencies in your practice and while many practice owners they should be of the inefficiencies in your practice and while many practice owners they should be focusing on their systems and all the little things, they get seduced and they're drawn to the new patients, because increasing the new patients really has the power to mask all the bigger problems in your practice and it feels like you're doing the right thing. So you feel like you're making positive strides for your practice, in which don't get me wrong you are. That's a great way to improve your practice, and a lot of people, I think, would say it's not the easiest way, but there's a lot of other things that you could be doing that's a lot easier than getting more new patients. So that's what we're gonna be talking about today why chasing new patients might save a crappy practice in the short term, but it's not a good long-term solution and what you, as the practice owner, are really missing out on by not focusing on the right things. So, if you've ever felt like you could really turn a corner in your practice if you just had a few more new patients, I hope that, listening to this today, you might reconsider and possibly try a different strategy, something that's gonna be a lot easier to do and it's going to help all of your existing patients in the process.

Paul Etchison:

Now you are listening to the Dental Practice Heroes podcast, where we teach practice owners how to create a team-driven practice that gives them more profit, more satisfaction and more time off to do the things that they love. I'm Dr Paul Etchison, author of two books on dental practice management, dental Coach and a practicing dentist who shows up just two or three days each month to see patients, while managing a nearly $6 million practice in the south suburbs of Chicago. I created a practice that's great because it runs without me, and I want to teach you how to do the same. Okay, so, like I said, new patients cover up the problems in our practices. It hides our leaky buckets. When we see more new patients, it's really hard to realize all the opportunities that you're missing out on and these hidden losses that we have, like retention cancellations, weak case acceptance, weak dollar per hour, production numbers, lower collection percentages basically any metric that we should be tracking as owners.

Paul Etchison:

If we're seeing a lot of new patients, it isn't very obvious unless we are actually digging into the numbers. So you could stay in ignorance and just not look into the numbers and just believe that you have a great practice, just like I did. So I mean, is that okay? I mean you might be saying who cares? Like I mean you're still busy, like why do you care? Well, I was busy, I was super busy, but once I fixed the holes in the bucket man. Things changed really quick and let me explain. Because when we changed that, we got to capacity so fast that I was able to quickly bring on an associate. I was able to quickly cut down my days. And I was able to quickly cut down my days and I was able to personally see less patients and, as a practice, see less patients. I mean, everything got better when I focused on those little nitty gritty metrics that we should all be checking anyways. Though my numbers were good because of the new patients, in reality I really slowed down the overall practice growth because I was losing so many patients and I was really missing out on so many opportunities.

Paul Etchison:

So first let's talk about retention. If patients don't return to your practice, then that means that every single marketing dollar that you spent to get them was wasted. That means that your hygiene team has to see another new patient to replace them. It means that you are delaying the time in which you can add your first associate. That's like the first big stage we want to get to. We want to add that first associate because that's what unlocks a lot of freedom for us. Now I've done the math for you. Okay, I did this on a spreadsheet a while ago is if you can see 48 new patients per month, okay, we'll just say 50 to make an even number. If you use the DPH Black Scheduling System that we teach in our coaching programs, then you should get a full-time hygienist to full capacity by eight months. That means by your second recall cycle you should be able to bring on another full-time hygienist. So now, if you're seeing like 80 new patients a month, dude, it comes way quicker. So this was me and I remember I was seeing like sometimes 90 new patients a month and I didn't bring on my first associate to like three years in which, if you do the math, is way, way longer than it should have been. I should have had an associate within before I got to my second year of being open, but the reason was is because I didn't close that back door.

Paul Etchison:

Now let's talk about cancellations. Now, if you're seeing a ton of new patients, you're going to be able to fill all the openings as people cancel. So this won't piss you off as much because you're still going to see a full schedule. But what you won't see is all that time and effort it takes your team to fill these slots Time that could have been spent doing more productive and more valuable tasks to grow the practice. So what you don't see is when some patient called your practice to get in but they couldn't get in because you didn't have availability, so your team had to put them on the ASAP list. So it's not just the call to reach out to them to fill the opening, it's also the call that came before that that put them on the list in the first place.

Paul Etchison:

So when you start looking at everything from a per patient transaction like how much time does your front desk spend to get through one patient transaction, like one appointment, one check-in, one check-out, one scheduling, one treatment plan presentation, one payment and you just look at it from that stance we are spending a ton of time on making those appointments. If we have to do those things like once, twice, three times if you had somebody on your schedule that's now canceled, you scheduled them, they called the cancel, now you got to schedule them again. So these things add up You're spending extra time on that per patient transaction sometimes three, four phone calls for one appointment, and it's not only wasteful when it leaves a hole in your schedule. So what I'm saying is that, even if it doesn't leave a hole in your schedule, it's still wasteful. All right, let's talk about case acceptance. 80 new patients a month doesn't mean anything if only 50% of them are saying yes to treatment. I mean I could have had way better case acceptance and seen like half as many patients, and it would have been the same result monetarily with a whole lot of less work.

Paul Etchison:

But this was me. I was completely blind to the reality of my practice. It wasn't that great. We just saw a lot of new patients. So it felt like throwing up the air quotes busy. It felt really busy. It felt like we were successful. It felt like we were growing.

Paul Etchison:

But in truth and in reality I mean practice growth comes from optimizing and improving everything that you already have. So you need to fix the inefficiencies. Now I want you to think about this If you have a horribly inefficient practice and you double your new patients, you're more or less just doubling your inefficiency. So I remember when I discovered this. I mean we had a meeting, so all of us are sitting in the waiting room and that's where we would have our meetings, and I'm mentioning hey, I looked at that software and it's time for us to work on some areas of the practice that really need attention. And again, I know that we would have noticed if we weren't so busy with new patients, but my team and I we looked at these numbers, we made a plan, we got to work and we did it system by system, improving everything and optimizing it. And this is exactly what we do with our clients at Dental Practice Heroes. So if you are looking for someone to help you create and execute a plan that's going to fix all the inefficiencies in your practice, man, we would love to help you do that. Set up a strategy. Call with me dentalpracticeheroescom. So you need to plug the holes in your practice and once you do, you start to get this multiplying ROI and it can be huge If you can get more patients to say yes to treatment, if you can keep more of the appointments on the schedule and keep people in your recall system so that they never leave your practice. That produces huge effects without any additional new patients at all. So here are your tactical takeaways for today that I want you to remember Make sure you're measuring, make sure you're checking your numbers.

Paul Etchison:

I can't tell you how many coaching clients I bring on that aren't even looking at their numbers, I would say it's about 50, 60%. We need to be looking at this and if you don't, if you're not looking at it, that is going to be your limiting factor right now. So look at your numbers, do not fly blind. You have to have a pulse on your practice's health. Make sure you're auditing the retention, the cancellations, the case acceptance, the collection percentage, the dollar per hour, production. You've got to look at all these things and I'm not somebody who's personally huge on numbers, but I am huge on those numbers.

Paul Etchison:

Okay, I think a lot of these softwares go into way more detail than we need to run a great practice, but you still need to focus on the basics and you got to fix the leaks in your bucket before you pour more into it. So don't go and kickstart a ton of marketing and spend all this money to pour more liquid into that bucket if your bucket still has holes. I mean you're going to be throwing these patients into an inefficient system and you're going to lose a lot on it. There's gonna be a lot of lost opportunity, so you're just wasting money Now.

Paul Etchison:

Lastly, use new patients as a growth accelerator, not as the crutches that cover up the inefficiencies in your practice, which is what most of us are doing, and I was guilty of it too. So I want you to remember high new patient flow can really give you a false sense of success. True growth comes from maximizing what you already have. So ask yourself if you doubled your new patients tomorrow, would it actually grow your practice or would it just cover up your inefficiencies? And if you want help fixing all those inefficiencies, let me and my coaches at DPH help you do it All right. Thank you so much for listening today and we will talk to you next time.

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Dr. Paul Etchison

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