Disruption in Dentistry: Implementing Digital Marketing for Dental Practices

Erick Cutler: Absolutely. So you know what, let's just jump in and get started. So at a high level, what exactly does digital marketing mean specifically for dentistry, and what sort of challenges can it help solve for a practice?
Ernie Cote: I recorded a video just the other day, and I started it by saying no sane dentists would ever spend money with an advertising agency, unless they were looking to get new patients or get more revenue per patient. It's really not about a website, or SEO, or reputation management, or any other crazy thing that we as digital marketers come up with to sell. It's really the only reason a practice would spend money with somebody like us is for one of those two reasons. They either want to get new patients from their surrounding area, or they want to sell a new service, and get more revenue from their patients.

So in our view, digital marketing is only as good as it can achieve those two objectives. And it's really about two sides of a coin, or maybe scales, if you think of it that way. One is all about traffic. It's getting the right traffic to the dental practice website. And the other is conversion. Because let's say for example, you advertise a new mover special. People new in the neighborhood can come in for a free exam or something. If somebody responds to that, and then they go to the main page on your website, you've immediately lost them because they weren't interested in the main page of your website. They were interested in this new mover special. Same thing if it's Invisalign or teeth whitening or whatever, you've got to make all that stuff tie together.

So we really look at it from the perspective of traffic and conversions. If you spend a lot of money getting people to come to your site through social and paid search and everything else, and they don't convert into something that you can use to get a new patient, or get more revenue per patient, then it's failed. So it's got to be two equal things. A traffic, and then conversions.

I had a great analogy today. I was talking with an oral surgeon. And he said he wanted to completely redo his website. And his complaint was that he didn't have enough traffic on it. And I was having a hard time with this analogy. And I finally said something to him that I personally thought was brilliant. I don't know. You ever played that game Would You Rather with your kids?
Erick Cutler:Mm-hmm.
Ernie Cote: Yeah. So would you rather eat your own boogers or have to write an essay on Benjamin Franklin, or whatever? So would you rather for a dentist practice. Would you rather have a mediocre looking office on a great corner, tons of traffic, everybody can see your sign, your parking lot's always full, or would you like to have the most beautiful office anyone has ever seen? It is the Taj Mahal of dental offices. It's stunning. And it's on a road nobody drives down and it's difficult to find. Everybody would love to have the nice office, but in reality, they want the traffic.

So it is our job to work that balance and not give somebody the Taj Mahal of a website, and then nobody ever comes to it and it doesn't make them any money. The money might be better spent to have an okay digital property, but lots of traffic driving by. So it's a mix of those things. It's not just about a great website. It's not just about top SEO ranking. It's not just about great social. It's really a formula of those different things.
Erick Cutler:Okay, so if you take the traffic and you take the conversion, right? And those things, then we start to think about that big thing that everybody talks about, patient experience, right? You hear that in every discipline of dentistry itself, really in business itself, but patient experience. So building on what you said about traffic and conversion, how can digital marketing strategies actually play, or I guess really how do they play into the overall patient experience?
Ernie Cote: Well, it's the very first thing, a new patient, it's the first impression they're going to get, right? I mean, the first physical impression they're going to get is when they walk into your office, but they're not going to walk into your office until they've been on your website. So it's going to be the very first impression that they get. And even prior to that, it's getting to your website. So let's say, for example, somebody found you on a list, best dentist in the area, or whatever. And that you have moved practice. You've added a phone number. You've changed emails, URLs, whatever, and that's not updated. And they're trying to find you, and they can't. That's a bad very first impression.

Let's say they can find you, that the number's right. And they go to your website, and it's very slow to load, or it doesn't look good, or you can't find the information you want, or whatever it might be. Or maybe you've got multiple offices and it sent you to the wrong location. Whatever it is. That very first impression that they get of you, other than talking to you on the phone, or actually walking into your office, is huge.

Speaking of talking to you on the phone, I'll give you a really great example. We have a lot of doctors that do sleep medicine. So are you familiar with sleep medicine? So if have sleep apnea, you might use an appliance. We had some doctors that wanted to advertise as a CPAP alternative. And I use a CPAP. I had figured out that I have sleep apnea. And I hate the darn CPAP. And I'm actually going to get an appliance soon. But let's say I was out there shopping around online, and I found CPAP alternative. And I find somebody, a dentist nearby, that does that.

I call the front desk, and I say, "Hey, I'm calling because I've got sleep apnea. And I understand that you guys can help me with my sleep apnea and my CPAP, and maybe replacing it or something." The front desk is going to say, "Oh, I'm sorry, sir. We don't do CPAPs. We can't help you. We don't replace CPAPs." Well, there's something there that's incongruent, right? So it's not just making sure that your online stuff is good and it gets somebody to the website. But when they call the number, your front desk has got to be educated on the whole campaign.

Or let's say that I found an ad about sleep apnea in an alternative. And I go, and it takes me to your homepage where I have to dig through to find out. Well, that doesn't help. I wasn't looking for a new dentist. I was looking for a sleep apnea alternative. I need to go to a page that's about sleep apnea. And I need it to be useful and friendly and engaging, and make me click a button for more information. And if I don't do that, then it's just been wasted dollars. So I would argue that the whole patient experience starts well before they call you, well before they walk into your office. It's being able to find you online. It's the impression they get of you online. And then it's being able to interact with you in a very efficient way online.
Erick Cutler:And I guess you could probably say that if all of that leading up to the moment that they either pick up the phone, or say more so, walk in your front door, if any of that experience up to that point is not good, then chances are you will not convert. They will not be walking into your office for any kind of procedure. Because all of that front experience that they had navigating a website and navigating a phone system or whatever it was, was not good.
Ernie Cote: Oh, absolutely. It's like any experience you have, right? If you're going to book a hotel, buy a car, pick an insurance company, I mean, anything you're going to do a little online work. And if it's difficult and cumbersome, you're going to go to someone else.
Erick Cutler:And that's unfortunate because they could be passing on the best dentist that they've ever been to that would have helped them more than any other dentist ever. But for the first part of that experience, they never got to them.
Ernie Cote: Yeah. I mean, that's absolutely true. It's like in the old days, it was the phone call or walking in the front door. Everybody spent so much time and attention on making sure that first impression when you walked in the door was great. That voice on the other line. I mean, I worked in a contact center in the early days, and we used to tell people to put a mirror in front of their cube and be sure and look in the mirror and physically smile when they answer the call. Because you can hear the smile in somebody's voice. Well, it's the same thing. When somebody comes to your digital property, it needs to smile. It needs to communicate that this office is friendly, it's efficient, it's got expertise, it knows what it's doing. And if the digital experience is all bungled, why would you have any confidence that everything else they do is on target, right?
Erick Cutler:Right, right. So then with that, what would be some of the current trends that you're seeing in the digital marketing space for dental practices? And even beyond that, is there anything new that you see coming into focus, say, over the next few years?
Ernie Cote: So a couple of trends. One of them is the crazy growth. You and I are here in Dallas, and I'm sure you've got listeners everywhere, but just using Dallas as an example, there're 1,000 new people a day coming into the Metroplex. Average dentist needs about 1,200 patients. So you've got lots of dentists retiring. In theory, and this is not exact math, but you could open a new practice every day just to handle the influx of new people coming to the Metroplex. And a lot of other cities are experiencing that. So there's definitely a growth need that that needs to be met.

The other trend is that dentist are beginning to understand, kind of going back to the conversation a moment ago, that just having a website is not enough, right? And Google has this thing they called the HiPPO effect. H-I-P-P-O. And that is the highest paid person's opinion. And in the business world, let's say you're looking to do a campaign, or a website, or whatever, social campaign. And you're all in a conference room. And everybody's looking at a couple of different examples. And they all turned to the end of the table and ask the CMO, "What do you think?" And that was kind of the old way of doing it. And it was the highest paid person's opinion. And that's who ultimately made the decision.

Well, today, smart businesses don't do that. Smart leaders say, well, hey, just because I like blues, and I like whatever, what it's about is what do my customers like? What's going to engage them? And dentists are starting to see that same thing. That just because you like certain themes, certain ideas, certain colors, certain images on your website, it may not be what converts. So seeing, we were working with a lot of our customers on A/B testing. And the way that works is there's a very easy technology that you can use that if you and I go to Dr. Smith's website, you see one image, I see another. And then we go back and measure who stays on the site and the longest, who actually clicks in once for more information. And maybe the site that had the pretty flowers on it converts the best and the dentist hates flowers. I don't know. I don't know too many people that hate flowers, but you get the idea.

That there's this trend of beginning to understand if a practice is going to go spend all this money on social and print advertising, postcards in the neighborhoods, signage, sponsoring sports leagues, social search, all that, and then get people come to a site and it's not converting because it is tailored to that practice's taste versus what the new potential client actually wants, then it's a miss, right? It's wasted money. So that's a trend.

And then the third one, I would say that everybody is really beginning to understand is the power of reviews. That is huge. And I can talk about that for an hour. And I think it is worth talking about honestly. I think there's a lot that dentists practices ought to know about reviews, but that is definitely a trend that practices are seeing.
Erick Cutler:Well, when I think of reviews, I always think of it's before you would ask your friends, family, right? "Hey, who do you go see?" "Oh, I love doctor so-and-so. You need to go see them." Right? Well now, to me, the reviews expand that. It expands your friend and family network to strangers, but strangers that are now putting their experiences, there it goes, back to experience, right? They're putting their experiences out there so that you can review them, see how you would feel, and then make your decision about is this a doctor that I'm going to call or not call to set an appointment? So to me, it's the expanded new version of kind of the old friends and family network.
Ernie Cote: It's actually that amplified. It's that exponentially bigger. Because let's say that I go to Dr. Jones, and I don't like her. And you and I are in the same family and it's at Thanksgiving. And I tell you, and you don't go to Dr. Jones. The chances of you then having that conversation with 20 other people is very unlikely. Now, let's say you go visit Dr. Jones, and you leave a scathing review. The entire digital universe gets to see that. And by the way, most people go to negative reviews. Not because people are inherently negative, but they want to know, right? If you were going to go buy a car and it had 500 stellar, amazing reviews, and it had 50 that were really bad, where are you going to go?
Erick Cutler:You're going to go to the 50.
Ernie Cote: You're going to go figure that out. So it's both the positive and negative. So the negative side of that is, just as I described, a bad review can go on and on and on. And the tricky part of a bad review, dentist listen very, very closely for what I'm about to say, you have to be extremely careful in the way that you respond to a negative review because of HIPAA. So for example, my daughter, who's a feisty little thing, she got her wisdom teeth removed. It didn't go well. She called the dentist, said, "I'm hurting. I'm crying.

Can I come back in?" They said, "Yeah, come in at 11:00." They didn't see her till 12:30. She's in the lobby literally crying. She calls me and she's in tears. She's in so much pain. She goes in, they see her.
And like I said, she's a feisty thing. She got online and just ripped our family dentist a new one, and said, "How could you let a teenager sit in your office and cry for an hour and a half?" And right or wrong, I'm not saying it was the practice's fault. I think it was frankly. But what the dentist cannot do is say, "Zoey, I am so sorry you had to wait. There were these extenuating circumstances." Because they've just violated a HIPAA rule. They've admitted my daughter's a client. And they can't do that.

So the only thing they can say is we strive to see patients as quickly as possible, even in emergency situations. Sometimes things arise. We regret any time anyone has a bad experience, and we are looking at our procedures, or whatever. Never in that sentence did I ever address that Zoey is a patient. That's because I can't. So that's really important.

On the flip side of that, the good news side is I'm just going to get nerdy for a second and give you some statistics. And this is based on a Google and BirdEye joint study. And BirdEye is the company that we use for our backend reviews, we'll talk about in a minute. But 93% of consumers use online reviews before making a buying decision. 57 will only patronize companies with an average four star rating. And most consumers expect a business to have at least 40 recent reviews for it to be credible at all. So if you've got 100 reviews, and they're all stellar, and they're from two years ago, nobody cares. If you've got 10 stellar reviews from yesterday, nobody cares.

Here's the Google side of it though. Oh, by the way, 75% of businesses don't even respond to Google reviews. Here's why that's so important. Google's algorithm is always changing. And one of the things that Google does is they look at the number of reviews, the positive negative ratio of those reviews, and listen closely, does the business respond to those reviews. And if so, how quickly? So as an example, you're Dr. Erick, and you get a number of reviews every week. And you go in, and let's say they're mediocre reviews, and you respond to those. And you say, "Hey, thank you for coming in." Again, same way. You can't admit they're a patient, but you can say, "It's always so good to see our patients that we haven't seen in a while," whatever it is, without admitting they're a patient. And you do that.

Let's say that Dr. Ernie, on the other side of town, also gets some reviews, but he doesn't even bother to reply to them. And maybe my reviews are even better. Google's going to give you more search ranking credit, because it's an indication to Google that you are participating in the reviews. You're active as where I'm not. So it's the number of reviews. It's how recent they are. It's are they positive or negative? It is does the business respond to them? And how quickly does the business respond to them? So it's really, really critical to be on top of those.

Another thing that's really interesting is, not to get in the weeds of the way Google does its rankings, but if you want to outrank the dentist practice in your town, there are a number of things that you need to do. And one of those is you need to have fresh content. You need to be blogging. You need to be updating your website. Those things. Well, if I'm your patient and I leave you a review, Google looks at that as new original content for your site. So Ernie goes in and leaves a review for Dr. Erick. Ernie has just contributed new content that Dr. Erick gets credit for. So it helps you in an SEO ranking perspective.

So it's just becoming so critical for new patients and existing patients, and it's becoming critical from a Google perspective. What we have done is we actually integrate with our dentist practice's PMS systems, the practice management system, so that when somebody checks out, they automatically get a text and an email asking them to leave a review. Unless the practice doesn't want them to. Let's say that cantankerous patient and the practice knows I'm going to leave an ugly review just because that's the kind of person I am. They can choose for me not to get that, but everyone else does.

We started doing that four or five months ago now. Our average, and we've got over 200 practices, the average is a 63% increase in reviews. We've had one practice that had a 270% increase. And it makes perfect sense, right? If your front desk remembers to ask you to leave a review, which they're busy and they got a line of people and the phone ringing and trying to schedule your next appointment, it's the last thing on their mind. But if it's automated, every single time somebody checks out through the project management system, they're prompted, naturally, you're going to get more reviews. When you get more reviews, Google likes it. And you respond to those, Google likes it. So it's just something that shouldn't be ignored.
Erick Cutler:And so, again, with all of that, I see how it becomes a snowball effect. I mean, the more reviews improves your SEO. And then every response to those reviews is yet another improvement. And so it just keeps building on itself over and over again.
Ernie Cote: Absolutely. That's right. And so practices that are not taking advantage of it, it's kind of they're not doing anything wrong, but by not being active in reviews, they're ceding, not seeding S-E-E-D-I-N-G, C-E-D-I-N-G, they're giving their competition a leg up online. So it's not just a matter of not doing it. And hey, I'm not going to do it. Well by not doing it, you are allowing your competitor who is to begin to beat you online.
Erick Cutler:So I've heard you talk before about the five states of a practice. So I was kind of hoping, maybe just briefly, could you kind of just run down for us what the five states of a practice are? And how might a digital strategy, marketing strategy, be different for each one?
Ernie Cote: So as I've talked to our customers and our prospects, there are two ways to approach a conversation with a dentist. And it is either me or somebody on my staff spewing to them all that we do. Website, and SEO, and PPC, and organic search and paid search, and programmatic, and list management, reputation management. And I mean, the list goes on and on, right? And it doesn't mean anything to them, right? And it shouldn't. Because that is me telling them what I can do, which is not the right way to start a conversation. I mean, a dentist wouldn't sit down with a patient, and say, "Hey, Erick. I want to let you know I can do crowns. I can do fillings. I can do root canals." And you're like, "Hey, I don't care. Let me tell you where I hurt. Let me tell you what my issue is."

So the same way for us rather starting a conversation by telling everything that we do, we really need to start the conversation by asking the practice, "Where are you today? What's the state of your business, and where do you want it to be in X number of time?" Excuse me. So after many conversations like that, I've kind of put the buckets in five states.

The first is a practice that has a lot of chairs to fill. It's somebody who just opened a new practice. They're either just out of school, they bought a practice from somebody who is retiring, and they've got a bunch of chairs to fill. They just added a new associate. And now suddenly they've got twice the staff, and not twice the number of patients. They moved into a new area. I talked to a dentist not too long ago, a client of ours, who had just he and his wife had decided they were going to move into a new city. And it was like starting over. Lots of chairs to fill. So if that's where they are, and I know that, I know the strategies to implement, to say, "Okay, here are all the things that we do for a practice that quickly needs to fill a lot of seats." So that's one stage.

The next stage is a practice that maybe is that practice I described a moment ago, but five years down the road. They now have got a pretty steady flow of traffic. But that practice would like to see, they've got five chairs and four of them are typically filled. And man, they really would like to get that fifth chair filled. Plus they know that just over attrition, people moving, deaths, whatever reason, the same people filling those four chairs are not always going to be there. So they need to take care of some attrition as well as really kind of fill that fifth seat as much as they can. Well, that's a different level of investment. That's a different strategy. So we're not going to throw the kitchen sink out them. We're going to say, "Okay, well, these are the tactics and strategies that we would use to fill that chair."

A third one, kind of the evolution of that, would be that practice that went from having a lot to fill to a few to fill. Now they've got all their chairs filled, and they're looking for some new revenue sources. They're saying, "Hey, I don't want to be in the office five days a week. I don't want to be in the office four days a week. When I am off skiing, I still want there to be some revenue streams back at the office, or I want to be doing procedures that are higher revenue. I want to start doing Invisalign for example."
So that is somebody who's got all their chairs filled, but they're looking for more revenue per chair. So they're looking to upsell and add services to their clients. Well, that's also a different problem, right? Because now we're not advertising to get more people in the practice, because he's got all the business he can handle, it's targeting those patients with upsells. And so it's a different strategy.

So then the fourth is a specialist who depends on referrals. So an endodontist, periodontist, oral surgeon, and they're looking for referrals from general practices. That's a different thing, right? If I'm an oral surgeon and my business depends on referrals from other dentists, I want to be sure that not only my marketing dollars, but my web presence is geared towards that audience as much it is my new patient or my existing patient. Maybe those were even two different sites. But it's a different way of approaching the business. And it's a different way of spending advertising dollars. It's a different animal. So it's not a one size fits all.

And then the fifth one is, and we have plenty of these, these are doctors who say, "You know what? I've been doing this 20, 30 years. My business is just great. I'm happy with it. I'm not looking to make any big investments. But I do want my customers to have a good online experience. I want you to make sure that when they hit my website, that it's clean and efficient and professional, and they're going to get the same online experience on my site as they would if they were in my office."

So I'll just kind of end it like I started it. The options are we can stop and listen, and say, "Hey, where are you today?" We can make some recommendations. I always ask someone I'm talking to, "What are your five to 10 year roadmap? What's the goal?" And it's typically one of those things I just said. They want to add an associate. They want to ramp down hours. They want to start doing sleep or some sort of cosmetic thing. And by knowing that, we can say, "Okay, well, let's figure out a strategy to help you fulfill that business need." Versus saying, "Oh, buy this from me. Buy this from me. The latest trend in digital marketing is this." Well, if that doesn't apply to them, who cares?
Erick Cutler: Right. It's like you said before, it's starting the conversation by asking the questions, finding out what's important to them. And then moving in that direction versus just spouting everything that you could possibly do under the sun, and having them say, "Yep, that doesn't even apply. You're not listening. You don't even know what I need."
Ernie Cote: I would just be really candid. The barrier to entry to start a digital agency is very low. Unlike you, if you're going to go be a partner in an accounting firm, you got to have a CPA, right? You got to know accounting. There're just things you have to do. If you're a dentist, there's a lot of training you got to do, right? To open a digital agency, you just got to have the tenacity to go start it and go get some clients and build a business. So there are a number of agencies out there that that's what they do. They know the digital marketing world. And I respect that all day long.

But we come at it with a little different approach that says, let's approach this about growing their business the way that I want to grow my business. And if somebody's selling something to me, I don't want them to come to me and do what an old boss I used to have, he called the show up and throw up. The show up and just tell everything you know about everything you've ever learned. It's just a bad approach. And it's very self-centered.

And I think the thing that's different about us is that I've run a digital agency in the past, so this is not my first rodeo, is that it is much smarter to say, "All right, where's your business today? What do you need? Where do you hurt? How can I help you?" In the same way that a dentist would say to a patient, "Hey, Mr. Patient, I'm looking at your mouth. I see what's going on. You got any pain anywhere? Are you flossing enough?"

And it's us saying to them, "Hey, we're going to use our lens and look at your digital presence. And we're going to tell you what we see, what we think, what we find. But we also have to know where you are, right?" Maybe a patient is not ready to do a procedure because their daughter is graduating from college next year, or next week, and they're not going to do it. Maybe they're going to wait to do something because they run out their deductible and they're going to wait to a new year. It's not just the health of their mouth, but it's what's going on in their lives. And the same with us. It's not just the digital health of a practice we're looking at, but where does that practice want to be? And that's important for us to know. And the only way you figure that out is by asking. So that's always our starting point.
Erick Cutler:So kind of continuing that then, like you said, I mean every practice is in a different spot and every practice is going to have a different need. So if you did come up against a practice, someone who approaches you, and let's say that they have limited resources or a limited budget to spend, what are just a few tips that you could help them or give them that would help them compete in the digital stage and the digital marketing area? Kind of help them compete against the DSOs and things like that. Where's a good general starting point?
Ernie Cote: The starting point is know your digital market, know your competition. And when we have a new client come in and we ask this question, inevitably, the doctor, who he thinks his online competition is, is different than his actual competition. So if you're a dentist, and every morning you drive by your competitor, or drive home and you see cars in their parking space, that's your competitor, right? Or they're somebody that you know across town and their business is doing well, or you've swapped patients before. They're your competitor, right?

In the digital world, maybe not so much. Because in the digital world, nobody knows your competitors, or they only know what they see online. What they see is how much effort another practice puts into its digital marketing. And if you've got somebody that you don't think is a competitor at all, because maybe they're a lousy dentist and they're a bad part of town and whatever, but the digital universe doesn't know that. If they're advertising, their awareness is good, their reviews are good, they're your competition. Even though in your mind, they're not your competition.

You might have a dentist that you think is your competition, but that person's not doing anything online. You could easily online go steal their business all day long. So you got to know who your digital, and you got to know your universe. We have some practices that are very rural, and their patients drive in for 20 miles away. The digital market. And then we've got people who might live in the middle of an urban area, and their patients are coming from two miles away, three, four, six miles away. We need to know that because that is very relevant on how we spend our advertising dollars.

We need to know how the market perceives what their specialties are, what practices they like to do, what practices they don't want to do. Procedures I meant. What procedures they want to do, what procedures they don't like to do. All that's important so we can build that into their digital campaigns. So that's where I would tell them to start is to instead of know thy neighbor, know thy digital competition. So that's thing number one.

And then the thing number two is, they're going to know where they are in those five stages, but to think about it and communicate that. Because if they're talking to somebody who doesn't ask, that should raise a red flag, that the person ought to ask. And if they don't ask then, then the practice needs to say, "Look, here's where I am. What do you do for somebody in my state?" And if the answer is, "Well, we throw everything and the kitchen sink at you," that's somebody that's thinking about their own revenue, not the longterm success of their client. So those are the two things, if I were a doctor starting out, new practice, new town, maybe just new strategy, I would say, all right, let's tap the brakes and figure out who am I really competing against out there? What does my online universe look like? And where am I today, and where do I want to be tomorrow? And build all that into the strategy
Erick Cutler:Well Ernie, all of this was great. Really enjoyed our conversation today. So thank you very much for your time, and for sharing all your knowledge and expertise with us. Really appreciate it.
Ernie Cote: It's been my pleasure. Thank you so much.
Erick Cutler:And thank you for listening to the EisnerAmper Podcast. Visit eisneramper.com for more information on this and a host of other topics and make sure to join us for our next EisnerAmper Dental Dialogues Podcast.