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2020 state of the dental practice: Q&A with industry expert Fred Joyal

One of the most respected voices in dental practice management talks about the business of dentistry and reveals the key to success: the patient experience.

Fred Joyal has just entered his fifth decade helping define and shape dental practice success. In the mid-1980s, Joyal and his business partner, Gary St. Denis, co-founded 1-800-DENTIST, now the nation’s largest dental referral service.

In his role as CEO for 1-800-DENTIST, Joyal identified what it takes to develop and maintain a thriving dental business. Over the past 30-plus years, he has shared his leading expertise in dental practice management, with a strong focus on how dentists and practice owners can craft an optimal customer experience for patients. Joyal has written two books on the subject: “Everything Is Marketing: The Ultimate Guide for Dental Practice Growth” and “Becoming Remarkable: Creating a Dental Practice Everyone Talks About.”

A PatientPop senior consultant, Joyal recently shared his insights during a live-stream interview. Here is some of that conversation, seen by a nationwide audience of dentists and dental practice providers.

Q: Many markets have seen a shift to corporate dentistry. How do you think the bigger corporate brands are affecting the smaller private practice today?

Fred Joyal: This is the fastest-growing segment of dentistry: group practices, this consolidation of practices. Almost all of them have convenient hours, generally take all the insurance plans, and are run like businesses. They tend to figure out the best locations to be in, things like that. They’re really changing the face of dentistry.

Q: If you’re a smaller practice, how do you offer a competitive edge?

Joyal: For a dentist to compete now, they have to create a facility that’s more convenient. That generally means having two or three dentists working, so you can have more hours, and maybe a couple of specialists. This is really the ultimate strategy: a multi-specialty practice that’s open 70 hours a week, takes some insurance plans, and gets people in and out as fast as possible. That’s what’s never changed: People want to see a dentist as little as possible.

So, the dentist has to be competitive, have better hours, and use technology and great systems. But, most of all, they have to create a great patient experience. It’s a very personal thing, to just lay back and let somebody in your mouth. It scares people.

One of the things we learned at 1-800-DENTIST very early on is people have as much anxiety about finding a dentist as they do going to one. If they find one they like, that they’re comfortable with, and trust, they’re going to stay with them.

Related: 5 competitors practices face and how your practice stacks up

Q: If that two-dentist practice can add only one or two specialties, is there a key specialty they should look for?

Joyal: It really depends on the market. If you’re going to have somebody there all the time, it would be an endodontist or an oral surgeon. However, more and more, technology is allowing general dentists to do more endodontics.

You would possibly have an orthodontist come in one or two days a week because you don’t want to refer out orthodontics if you don’t have to. You want to retain that income. It’s a very good product and it makes people happy.

Find something that, when people leave, they feel better, rather than just feel they maintained themselves and their teeth. That’s one of the problems with dentistry about getting great reviews online — it’s hard to have a fantastic experience at a dental practice. When you have to get veneers, your teeth straightened, or dental implants… then you’re going to rave about the practice. Otherwise, you’re going to rave about how wonderful the people are. How compassionate the dentist was, how unique their technology was. That they got you in and out so fast and with a lot less pain.

Q: When you don’t have a “before and after” procedure, the positive experience comes down to customer service?

Joyal: Yes. It’s like maintaining your car. There’s nothing exciting about getting your brakes done, but if they get you in and out of there in 45 minutes, that’s kind of exciting. That’s how you do it when you know the experience itself isn’t going to be fun but is important.

Q: You talked about patients having the ability to find the right dentist. Part of what we do at PatientPop is to help that dentist get found more easily online, and convey a first impression that’s going to be meaningful and influential. In the years you’ve been in the industry, how has the search for a dentist changed?

Joyal: We’ve watched a steady evolution. Let’s call it 30 years from the Yellow Pages into all sorts of advertising, and now into online search. You’ve got online search for websites, social media, and review sites. People are using one, two, or all three to determine who they’re going to see. So you have to have a website that is appealing to somebody who’s really coming there once. You also have to reinforce that site with good reviews, particularly on Google.

Read: How modern patients find and select a practice

You have to remember that Google is always going to be the giant. In the past five years, people have gone from reading reviews to looking at the number of reviews and the star rating. Many of them are done at that point, that’s their assessment. “I see four-and-a-half stars, over a hundred reviews, good enough for me.” They may read one review, but they want to see fresh reviews and a lot of reviews — and that rating matters.

Q: What’s the key to hitting those numbers? For instance, the average star rating is going to come down to the experience you’re delivering to that patient or that group of patients. 

Joyal: It’s always going to be how that experience measures up against previous dentistry experiences. Is it faster? Is it more comfortable? Is it affordable? Is it more convenient?

That convenience goes into scheduling. It’s an OpenTable world at this point. People want to be one and done. When they go to a website, they want to make an appointment and pick a time, and they don’t want somebody to call them after. That’s why they’re avoiding calling the practice: They want to get it done. More and more consumers are expecting to make an appointment online and dentists have to adapt to that.

Also see: 5 reasons your practice must offer online scheduling

Fred Joyal of PatientPop and 1-800-DENTIST

Q: Are there other conveniences that dental patients really latch onto?

Joyal: There’s some great technology that gets them out of the practice faster. There’s CAD/CAM technology that does a crown in a single visit, so you never have a temporary. That’s a huge thing. With the technology for implants, it’s now possible to do a single tooth implant in one visit, from extraction to replacing the tooth.

Q: That’s saving money for the patient, but I assume it’s also saving resources for the practice?

Joyal: It is. But the patient leaves with a finished product in one visit, a chewable tooth, so to speak. That’s a big deal. Implants have been around 30 years or more, and have gone through much evolution. It used to be a very complex surgery, with six months of healing. The fact that technology allows this implant to be placed so perfectly, the end design of the implant itself, and that the crown can be built right there, at that moment, to fit. That’s huge.

Q: If that person is old enough to have experienced something more drawn out, this is special. 

Joyal: If they have a bridge, if they have dentures… Implants are a solution to dentures that’s vastly different. Two generations ago, people our age expected to be missing virtually all their teeth. You and I are interested in missing no teeth and sure as heck are not wearing dentures as a solution 10 years from now. That’s what’s great about dentistry: There is a much better solution. There are a variety of solutions.

Q: When we talk about practice growth at a dental practice, it could be expanding your number of operatories or, as you mentioned, trying to add dentists and specialists. As an expert, what do you tell dentists is the best way to get that return on investment (ROI) on what they may have spent on equipment or an added dentist at the practice?

Joyal: If you have technology like CAD/CAM, that sort of technology pays for itself with five or six patients getting a crown in the month. The ROI on having an appointment scheduler right there on your website is there because you’re not going to lose 10, 15, 20 percent of the people, who are looking for an instant solution — and that number just keeps going up. It’s not a few people who want to make an appointment. It’s a few more every day, every week.

You have to be efficient in using your time because a dental practice is a surgical suite. It’s not like a physician’s office, where every appointment is pretty much the same. There are all sorts of different things going on in a dental practice, and it’s about how efficiently you get people in. 

Don’t make them wait. Time passes really slowly in the waiting room because you’re about to not have something fun, right? So there’s a certain anxiety level. The more you reduce or eliminate paperwork, that you get them out of that waiting room and into a place where they’re going to see somebody who’s going to take care of them… all of that turns into ROI.

Check out: 5 ideas to make waiting more pleasant at your healthcare practice

Q: You mentioned having a website that will set you up for success. How do you know what to emphasize or prioritize based on having new services, or needing to fill a gap in your patient base?

Joyal: The website has to have all of this information, very accessible, very searchable. That includes building keywords, videos to explain something, or a video that has a tour of the practice. You also need somebody like PatientPop saying, “Make sure you don’t overload this part of the site with video because it’s not going to load fast enough on a phone.”

The nuance of websites now has become so complicated, and the moving target of SEO is such a challenge. But it’s essential. If Google doesn’t offer you as having these services and conveniences, as someone who’s unique, you’re not going to get the patients out of it.

So, information has to be properly embedded into your website in a searchable way. It should be in your Google profile. It should be in your Yelp profile. Put pictures, video, new-patient offers, and all of that stuff into those sites. It has to be there.

Your digital presence is so critical. It’s your 24-hour signage, right? It’s on all the time, whether you like it or not, and your reputation is being built whether you like it or not. So the more you take control of it, the better off you are.

Look: 6 essential elements for great dental website design

Q: I have a patient acquisition question: In surveys we’ve conducted, acquisition is a frustration more often for dentists than physicians. Could you lend some insight into why that might be? 

Joyal: It’s because the medical side with physicians is insurance-driven. It’s always, “Who takes my insurance?” and often very specific to a specialty. Is it a urologist? Is it an orthopedic surgeon?

The dentist is in a broad category. The dentist wants to think of him or herself as a surgeon and, if they just get better and better clinical skills, the patients will come. They’ve been told that in dental school, but it’s not true. That’s not what attracts patients. Patients aren’t saying, “Tell me about all your continuing education.” They’re saying, “Wow, this place looks really nice, and you seem really nice, and your team seems really friendly, and this technology is really exciting.” You have to create an experience that makes them want to talk about you.

Q: Whether they’re talking about you to one person or they’re posting a review online…

Joyal: Right because, now, when people talk, they talk with their thumbs. It’s going online, and it’s likable and shareable and searchable — and undeletable, which is the scary part for sure.

Q: Where do you see the dental practice going in the next five years to a decade? 

Joyal: I think we’re really coming into a golden age of dentistry, in part because of technology, in part because this new generation of dentists has adapted to the idea of technology in every way and understand the importance of convenience.

There are more and more dentists that understand a multispecialty practice is the strongest format. Trying to sustain a solo practice 10 years out is almost impossible. You’d have to be a high-end boutique cosmetic practice. A multispecialty practice that gives a great experience, has great technology, and is very convenient is always going to be a defensible model.

The DSOs [dental service organizations] will continue to grow because they are helping a lot of underserved people — they’re not necessarily a force for bad or good. They are helping more people, and I think more people care about their teeth.

Another big thing is that the connection between oral health and overall health is finally becoming reinforced over and over and over again. But health insurance doesn’t cover your mouth, so people think “How important can it be?” Of course, it’s incredibly important. But it’s not a mystery part of your body, it’s an opening with all sorts of soft tissue. You’re very vulnerable to disease and, every year, we hear about some new disease that’s directly linked to poor oral health.

I think as people realize this, they’re going to take care of themselves more and more starting with their mouths. And people are going to live longer and longer. I expect to live to at least 150, and I’m going to be eating out at least four times a week no matter what. So I want my teeth for that, you know, and my hair.

Q: It comes right back to what we’re seeing everywhere in healthcare: the patient power, the patient getting more opportunities to take control over his or her health.

Joyal: There’s more knowledge out there. More ways to get a variety of care that is about staying healthy, not about getting fixed. I think that’s a great shift.

For similar content, check out the blog post “4 out of 5 dentists can improve their practices by doing this one thing.”

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