Amol Nirgudkar, CEO of Patient Prism, returns to the show to talk about why new patients are worth so much more than existing patients, why even big DSOs so often struggle with marketing, and why now is not the time to stop investing in growth.
Connect with our Guest:
Amol Nirgudkar
CEO at Patient Prism
Website: https://www.patientprism.com/
📧 Attend our one-day CE-accredited course virtually, in partnership with BioHorizons. Acquire the expertise to effectively create, convert, and close more full-arch cases. The event is on May 10th, 2024. Visit ➡️ https://fullarchadvantage.com/
🎙️ Check out our 4 Dental Podcast ➡️ https://smcnational.com/podcasts/
📅 Upcoming Events ➡️https://smcnational.com/events
Amol Nirgudkar, CEO of Patient Prism, returns to the show to talk about why new patients are worth so much more than existing patients, why even big DSOs so often struggle with marketing, and why now is not the time to stop investing in growth.
Connect with our Guest:
Amol Nirgudkar
CEO at Patient Prism
Website: https://www.patientprism.com/
📧 Attend our one-day CE-accredited course virtually, in partnership with BioHorizons. Acquire the expertise to effectively create, convert, and close more full-arch cases. The event is on May 10th, 2024. Visit ➡️ https://fullarchadvantage.com/
🎙️ Check out our 4 Dental Podcast ➡️ https://smcnational.com/podcasts/
📅 Upcoming Events ➡️https://smcnational.com/events
GARY BIRD (00:00.864)
Right, we are live and I get to do really awesome things because I get to talk to really awesome people. And Amal today came on because recently he wrote an article that got a lot of traction and it was around marketing and what's going on, not just in marketing in dental, but marketing in the broader scheme of the United States and what's going on in the market of marketing. So Amal, why don't you just give us a brief overview of kind of what you wrote about and where you pulled it from and.
what you're seeing and how that's impacting dental.
Amol Nirgudkar (00:33.486)
No, thank you, Gary. It's always a pleasure talking to you on your shows. You bring incredible content to the industry and we appreciate that sometimes the content has to do with Starbucks coffee, but it's still very relevant. Very relevant to a lot of us who drink Starbucks coffee or how much it costs and all that. But, you know, I was, you know, as you know, we primarily are in the DSO space and dental organizations.
GARY BIRD (00:36.786)
Thank you.
Same to you, my friend.
GARY BIRD (00:45.184)
If you want to save some money.
Amol Nirgudkar (01:02.542)
And we spend a lot of time, not just building our software, but talking to leaders of these organizations about what they're facing as challenges. And all of a sudden we started hearing this chatter at the end of last year, starting in the fourth quarter that new patient flow is down. And we kind of knew anecdotally, we know, right? Okay, interest rates are high, inflation is high. We knew all that. And I started digging deeper into...
Like maybe I should write an article about what the overall industry is seeing in terms of new patient flow because as most people in healthcare, most executives in healthcare have determined that you have to have the right mix of new patients and existing patients in order to have good growth. And new patients are required. I just heard a survey by a very large group in our space that said,
GARY BIRD (01:48.882)
you
Amol Nirgudkar (02:00.59)
average value of a new patient, average revenue that a dental practice collects from a new patient for their group was about $13 .50 for the first year. It's not the LTV, that's not LTV, LTV is much higher, but average value. But they did the same thing, this was across thousand offices, right? $13 .50 was new patient, $3 .50 was existing patient.
GARY BIRD (02:13.408)
First 12 months, okay. No, yep. Yep.
Amol Nirgudkar (02:27.022)
So there is a huge delta between what revenue a new patient brings in versus existing patients. Now, if all your patients are in Delta Airlines and Flying Basic Economy, which is your existing patients, and all they're getting is the maintenance work, they're not doing a lot of restorative stuff and hygiene is not optimized, then what's happening is at some point you have to figure out, you have to fill the bucket with new patients. And when new patients drop, especially what...
GARY BIRD (02:43.232)
Yeah.
Amol Nirgudkar (02:56.846)
we saw was specialty was dropping, orthodontics was going down. We saw that
Amol Nirgudkar (03:05.344)
down 10 % a year for the last two years. Implants has taken a little bit of a hit. And so I'm like, all right, well, let's talk to people and let's... And I kind of, after talking to several people in the space, VPs of marketing, CMOs, COOs, CEOs, I kind of thought about three things that really impacted patient acquisition starting in 2023, and it's continuing in 24 as well. And that's...
Three things were, one was that it's interesting, and you know this more than I do, Google kind of changed some of the rules of the game last year. They eclipsed that old system that they had for analytics. There's a new analytics system. There is a whole host of changes that happened in the middle of last year that a lot of organizations were not agile enough, or they didn't have the marketing teams.
GARY BIRD (03:56.128)
Yeah.
Amol Nirgudkar (03:56.67)
that a lot of organizations were not agile enough, or they didn't have the marketing teams or the agency partners that were agile enough to change based on what the changes were happening in Google. Whether it's all that performance marketing stuff, the things that we took for granted, and the way that ads were placed, and all the different various tools that Google had, they're like, all right, we're gonna change that, in light also of all the privacy -related...
things that were coming about. So if organizations were not agile enough to change their targeting, their budgets, and all the things that Google had changed and their analytics based on the new, this is Google, whatever, 4 .0 ad ads, then all of a sudden, cost per lead started going up. And Google not only, I think, raised their rates, but if you didn't follow what they said, they raised their rates even more.
GARY BIRD (04:44.704)
Yeah.
GARY BIRD (04:52.48)
They did.
GARY BIRD (04:55.968)
Yep. What's a quality score? They've always had quality score, right? So it's like Google, the thing that people don't realize is like, if someone visits your Google My Business and kicks the call button and you don't answer and keep that on nice, nice water bottle by the way, and you don't, and they click the call button and you don't answer the phone during normal business hours, Google knows that. They see that you didn't connect that person. If they go to your website and they leave in five seconds.
Amol Nirgudkar (04:56.19)
So people are paying 40 % more. Right.
GARY BIRD (05:24.288)
They know that, and they search this specific keyword like dental implants and they go to your website and they bounce off it. Google knows that. So there's, there's always been a quality score and then they're going to charge you more for traffic plus inflation, right? Like everybody knows, Oh, inflation time to raise our rates. Whether you make a lot of money or not make a lot of money. Everybody raised their rates because there was an opportunity to raise your rates during this time. Now, the other thing that I've seen really hit these practices on it, love your thoughts on this. Cause I know you have a lot of boots on the ground in this area is that.
One thing that we've worked really hard on is like being able to split new patients into two buckets, patient referrals versus marketing. And the reason that we like to do that is most, and I'm saying this for the audience more so than you, Amal, I know you know this already, but it's like patient referrals are a byproduct of operational excellence where marketing patients have nothing to do with your operations, nothing besides answering the phone correctly. Um,
you could have amazing marketing and be the worst dentist ever, or you can be the best dentist ever and have the worst marketing and they're totally independent. And so what I see happen a lot of times is that as times get harder, offices aren't able to hire correctly because they're seeing more patients overall, but they're making less money overall. So they're not hiring the same way they used to staff. So the patient experience suffers and then they get less patient referrals. And then it's like stink. Our new patients are down.
So then you try to solve that through marketing, but marketing's a different ball game. They're two different levers. They're driven to totally different outcomes. What are you seeing like when you talk to these bigger practices, you know, these thousand location practices, how are they kind of thinking through that?
Amol Nirgudkar (07:10.142)
I think they're thinking it the right way for the, I think maybe for the first time in the industry where there's amazing leaders of these organizations now that are thinking about performance marketing. Like, what is the performance of our campaigns? It's not like we have this budget, we have a website, we're going to spend this money on that. We need to tie marketing to outcomes. And there is a big need for that. People want to spend.
the least amount of money to get the most amount of patients. There's a much better appreciation for the cost of acquisitions and cost of leads and all that stuff. So there is an appreciation for it, but here's what has happened though. That...
Sometimes in organizations that came together because a bunch of groups came together, a bunch of dental practice came together, they inherited like there's a group organization, you have 50 offices and let's say 50 offices came together as 10 different groups, right? 10 different groups had 10 different marketing. None of them talked to each other, right? None of them talked to each other. So there is no single source of truth understanding where the leads coming from and some offices are doing well. And so the challenge, I think,
GARY BIRD (08:06.848)
Mm -hmm.
Amol Nirgudkar (08:21.344)
a lot of DSO industries facing with right now, especially when you have a decentralized way of managing everything, is that you have 19 marketers in the kitchen trying to cook up. And now you're measuring same store growth across all 50 locations and you have 19 marketing people. Who are you going to ask a question? And what questions are you going to ask? And what are they going to measure?
GARY BIRD (08:43.232)
Yeah, and again, someone might spend $500 a month on marketing, but have 200 new patients a month because they have the best patient experience and they're at a good location. So then it's like, well, how do I do that? Well, if you pay double in rent and you train your whole team, like it's a very hard, I understand why people get so frustrated.
Amol Nirgudkar (08:59.646)
It is, and so what happens is then you just don't know what you're supposed to be measuring in the first place and what is important. So I think it's important for organizations and they're doing it where you kind of work with, you can do A -B testing. You have one partner, one other partner and see who does better. That's fine. But when you have 19 people, you have no idea. How does a marketing VP and a CMO,
GARY BIRD (09:24.64)
You have no idea, don't you?
Amol Nirgudkar (09:28.51)
going to make any decisions when they're having 19 people in their ears constantly. So anyway, the first thing was all these changes happened and it caught people off guard. Especially now, imagine you were like a four location group, you had a little marketing agency, maybe it was your brother -in -law, maybe it was somebody you knew at the church, whatever that might be. Somebody was running ads and it worked okay because guess what? What you said was,
GARY BIRD (09:49.184)
Yeah, someone in the office was running ads for you and you're posting on social. Yeah.
Amol Nirgudkar (09:56.318)
Maybe you got lucky, you had lots of referrals, right? And you don't have to depend on that. But all of a sudden now what's happening, some of the larger groups are starting up de novo's in markets where they're spending five, $10 ,000 in office per month trying to get new patients. So now cost per lead is up. You haven't made any changes. And the worst thing that happens, so that's that, so you're getting less number of leads. The second thing that happened,
was interest rates had risen to their all -time high. They still are. And...
Amol Nirgudkar (10:34.59)
They said, all right.
Amol Nirgudkar (10:39.486)
significantly, let's cut down marketing. And marketing was one of the big things that got cut down from P &Ls. So now all of a sudden marketing went from hopefully 5 % to 2 .5 % of revenue.
GARY BIRD (10:55.424)
So wait Amal, you're telling me that people cut their marketing budget and their new patients went down? Wild. We get this all the time where people are like, I gotta, I gotta, we, our P &L's out of hand. We gotta cut back marketing. We're like, okay, no problem. Here's the results you're gonna see. And they're like, okay, cool. And then a month later, they're like, what's going on? Yeah, your new patients went down cause you cut your marketing budget. What? Well, do SEO. It doesn't, it doesn't.
Amol Nirgudkar (11:01.406)
That's right. Yeah, well, that's right. It is it is so.
Amol Nirgudkar (11:16.958)
That's right.
GARY BIRD (11:24.128)
work like that for five locations or 10 locations with separate brand. Yeah, you don't.
Amol Nirgudkar (11:25.118)
Yeah. Let me turn it on. Let me turn it on. There's no SEO to turn on. Right. But, and so, so cost per lead goes up 40%. Marketing budget goes down by 50%. What are you going to see? What are you going to see? Like leads drop like that. Right. Leads drop like that. And then, and then the third thing. So the first thing, the changes in Google. Second thing was the marketing budgets went down. And the third thing was.
that all of a sudden, just like you've done the coffee things or the grocery store thing, well, inflation is finally hitting, it's hitting them, right? It's hitting people. And the last thing you want to do right now is, I wrote another article this week, but like, people are, average American is only having like $8 ,000 of income left over after paying everything, right? That doesn't include any healthcare emergencies, that doesn't include anything else with their kids.
GARY BIRD (12:04.96)
hitting the consumer super hard. Yeah.
Amol Nirgudkar (12:23.87)
and everything else. There's not a lot of money left over to now take on specialty stuff, right? To take on, oh, let me do my crown. Let me do my stuff. And, and, and, and, and,
GARY BIRD (12:25.344)
Yeah. No.
GARY BIRD (12:32.672)
Yep. And Dennis hate finance companies in general, like as a whole, like the industry's like notoriously bad at using financing. So you're not really, and the perception, this is one thing that I've noticed recently too, is that the perception of cost to the patient on treatment is totally out of touch with what the actual touch it. Like if I said, Hey, Maul,
you're going to go buy a Louis Vuitton bag. You kind of know how much you're going to spend a lot of money on that. Hey, go buy a new car or go to a nice hotel. You know, generally, how much those things cost. When you ask a patient how much a crown is, or an implant or all on four, they're at like 10%. They say the number that's not even close until they get educated, right? So you have this value perception gap, as well as a lack of financing opportunities because offices don't want to offer those. Now you don't.
give the patient anywhere to really go when they do want the treatment from you.
Amol Nirgudkar (13:31.582)
And that's what it is. It's now all of a sudden, now less patients are seeking treatment because they're like, you know, let's just wait. Let's postpone some of this consumption. And so everybody, all of a sudden, leads are down because all these things are happening. In fact, in fact,
I think organizations should be focused right now on, okay, how do we optimize our marketing better? And how do we really focus on those new patient leads? And this is not the time to reduce your marketing budgets. And I say that, that's right. This is not the time to reduce it. It is not because it is...
GARY BIRD (14:09.6)
I'm not, I didn't pay him to say this guys, just FYI. I didn't, I didn't buy it. This is not a paid advertisement.
Amol Nirgudkar (14:17.726)
I mean, I can understand if wasteful marketing, go ahead and get rid of it. If there's no ROI to marketing, okay, well let's stop that. But...
GARY BIRD (14:25.024)
Yep. Meaning so just so the audience what he means by that is, is if you can show an outcome from it, if you can say, Hey, every time I spend $200 a patient walks through my door, or in buys this much treatment, if they buy $500 on the first visit every single time, so I'm putting 200 in, I'm getting 500 back. And then over the year, I'm going to get 1500 back. Do that to the moon, like do that to the moon. But if you're just like, Oh, yeah, I'm just doing I did some stuff on social media. This is what most dentists do.
Amol Nirgudkar (14:35.166)
Yeah.
GARY BIRD (14:52.448)
I did some stuff on social media and I bought some like covers on the the coffee things down at the local and I put up a banner at the baseball game and it's like, okay, well, you're not going to really grow from that you can't really measure a lot of that stuff.
Amol Nirgudkar (15:05.95)
And that's it. I think, I think, um, 2000.
The estimate is the industry will be.
growth standpoint. So what are you going to do? Now we're still in March, we have three more quarters left. What are you going to do now? How do you... And then you have... Everybody has budgeted anywhere between 5 % to 10 % growth in their budgets.
GARY BIRD (15:29.728)
And in every single market, almost every market, there's very few exceptions, there's a big DSO that is gonna spend, I had one of our team members that used to work at Heartland, they did a whole presentation on how Heartland launches De Novos and how much they spend. And it's somewhere between, depending on the market, 20 to $50 ,000 a month.
Amol Nirgudkar (15:33.982)
So they're not gonna magically come. And so what we have to do is figure out how do we make.
GARY BIRD (15:59.584)
And so for DeNovos, right? And then you're like, well, I'm going to spend $2 ,000 and launch my DeNovo. Okay. You know what I mean? Like you're, there's, there's, you have to have people gone are the days that you can just run your ads on your phone and get 150 new patients because you're competing against big companies with big budgets and big people that only like with us, we only focus on dental. You would kick my butt in another industry, but you're not going to kick my butt in.
in dental. Like we, this is all we do. We have all the data. And so you have to work with people who understand dental, who are going to be able to set you up and compete. You can't do it part time.
Amol Nirgudkar (16:38.078)
It is true. And the world is changing rapidly too, right? With AI becoming the forefront of everything that we're doing. Sometimes we know it, sometimes we don't. But a lot of the changes that are happening in the ads universe, content marketing is becoming important. You've got to have good content coming out constantly for SEO. There's no way to turn it on right away.
And you have to be able to, things are going to move faster in the AI world. You have to optimize in real time. And any organization that you guys work with that doesn't have this approach of, we're going to pivot when we determine the things to be pivoted. And it needs to be, you have to have an agile marketing approach. Most organizations have not had, have had this one approach to marketing for years and years and years. And it has worked out well.
when money was cheap, when referrals were plenty, when people were spending money on dental services. But we have to redo it again. We have to now, that $8 ,000 that's left over, we have to now say, how much of that's going to dental? If we don't convince them continuously through content, through advertisements, through all the optimizations, then here we are going to be stuck in that 0 % growth rate.
GARY BIRD (18:04.128)
It's like the got milk generation, right? So Amal, we grew up watching commercials, got milk and all the famous people had, they did commercials with milk mustache because they drank milk and they had what? Amal, what did the milk give them? They gave them, do you remember the commercials? Yeah, strong bones. It gives you strong bones. Now later it's like, well, dairies, it's kind of processed a lot and they take a lot of the vitamins out. We're not really sure how good it is for us, but we all drink, we grew up.
Amol Nirgudkar (18:20.126)
bones with his bones with his strong bones yeah
GARY BIRD (18:33.12)
drinking milk because the milk industry as a whole, spent a ton of money to pay famous people to talk about the milk industry. And you see it with beef now, like what's for dinner beef, you know what I mean? And we see these industries where they come together. Dental has had that a couple of times, but it's been big players like Invisalign or Clear Choice that have kind of educated the market for us, but there's still not education around the dental industry the way that it should be.
Amol Nirgudkar (18:34.238)
That's it.
GARY BIRD (19:02.272)
in a cohesive way, everybody's kind of doing it themselves.
Amol Nirgudkar (19:06.462)
That's it. I think the industry has a long way to go to get more people into this ecosystem. And I think marketing plays a big role there too in getting people who have never been to...
GARY BIRD (19:16.288)
How could we do that Amal? How could we do that? How could we get dental to all come together and get some basic understanding of how much money they save by just doing their basic dental cleanings and doing the basic dental treatment that they're supposed to do.
Amol Nirgudkar (19:31.902)
I don't think we're gonna get alignment at the organization level. I don't think so. We're not. I think these bigger DSOs are gonna do it. Like, you know, Pacific talks a lot about the oral systemic link and they've done a good job at PDS to educate.
GARY BIRD (19:34.496)
Hahaha!
GARY BIRD (19:39.04)
Ehhhh
Amol Nirgudkar (19:51.678)
their audience and an overall audience about how important it is to get your cleanings done and how your overall health is related. But I think the dentist that will succeed going forward will need a more sophisticated strategy with marketing. Your content has to be fresh. It has to resonate with the problems of your audience. It needs to be your ads have to be absolutely checked, double
check, triple check, tested every week, every month to make sure that they're driving the right leads into the funnel. And it's no longer a passive sport, right? It's very much an active sport. It's not like betting. You can't just like bet.
GARY BIRD (20:31.776)
Yeah, you can't set it and leave it, no. You have to have somebody, you have to be working on it constantly or someone on your behalf has to be working on it constantly. And then you have to be able to measure the outcomes from it. So if you're just spending $5 ,000 and you can't measure outcomes, you're just, you're spinning your wheels.
Amol Nirgudkar (20:49.694)
And that's it. I think that's my, what I'm seeing today within patient prism, we see the efficacy of marketing and we're seeing leads kind of decline in many cases. And we're like, wow, what is happening in it? And I think organizations are feeling it. I think it's what my prediction is. I think you are starting to get a lot of calls in Q3 when the first two quarters are like, oh my God, because there's still that hope.
GARY BIRD (21:10.176)
When the pain's too much.
Amol Nirgudkar (21:19.648)
that the honeymoon period we had in 21 is gonna return back. The honeymoon period of like, oh my God, everybody's in a Zoom call, they need dentists. Everybody was in a honeymoon period. So there's overutilization of dental services in 21 that went into 22 as well. 23 started declining and then we had inflation and everything else going on. But that's it. I think people need to be more cognizant about.
marketing and performance marketing. And that means that you have to understand what you're spending, what you're getting out of it. And you have to partner with people that actually treat this like an active sport. Not something that you said and forget because there's no AI way out of marketing. There's no chat GPT way out of marketing.
GARY BIRD (22:00.832)
Yeah, I keep seeing those ads where it's like this girl's running her computer and she's like, I used to stress out about all my marketing, but now AI does it all for me. I'm like, come on, bro. We're not there yet.
Amol Nirgudkar (22:13.598)
Okay. Okay. We're not there. We're not there yet. I think it's going to be a long, long way before.
GARY BIRD (22:18.24)
Yeah.
Amol Nirgudkar (22:20.638)
I love AI, that's what we do, but it's not there. The point is organizations need to really think about budgets right away. And the one last thing that we're seeing is there is a greater appreciation for collaboration between marketing and operations. And again, marketing can drive all the good leads in your funnel. You can't put them in the chair for the next five weeks. It's so...
GARY BIRD (22:32.8)
Hmm.
GARY BIRD (22:48.16)
That's a big thing right now. Industry average is two to three weeks right now for a dental appointment, which turn up your marketing if you want, just know that you're going to have huge losses on the show rate on the marketing patients are going to just no show at 20, 30, 40, 50 % because you're putting them way too far out and you can't get the emergencies in. You can't get urgency in. Like it's, that's a tough problem.
Amol Nirgudkar (23:05.342)
So.
Amol Nirgudkar (23:10.942)
No, we tell them at Patient Prism because we look at that data, right? On a real time basis of like, you're turning away all your high value leads and you're giving them appointments four weeks out, five weeks out, six weeks out sometimes. You have to figure out a way to squeeze them in. You spent $300 to drive an implant lead that's going to spend $5 ,000 in your office. You have to figure out a way to get them in that week and get them on some column.
somewhere in your organization and figure it out because Again, you don't have unlimited money. You can let go of these leads that are going on. So marketing and ops collaboration We're spending a lot of time at patient prism Kind of helping collaborate like okay. Well, we got to make sure It's a good lead lead gets converted, but then lead also gets appointed and shows up and actually spends money It
GARY BIRD (24:05.248)
Welcome to the business world. You gotta, no more cross our fingers and hope. You have to actually work each section. And you used to be able to get away with all that stuff. It used to be just turn it on, you're good, but not gone in those days. Yeah.
Amol Nirgudkar (24:16.67)
It's a much more sophisticated economy today. And I think AI has a lot to do with it. The sophistication is increasing and competition is rising. I think it's going to be a great decade in dentistry over the next 10 years. I think the people who are going to win are the ones that are really agile.
GARY BIRD (24:37.344)
Yeah, it's always, it's always been that way in dental, like even through COVID it was the top 10 % absolutely exploded. The bottom 10 % just took a beating and the middle 80%, 70 % they, they kind of slow, slow burn, you know what I mean? A slow burn in the wrong direction. And that's what it's been in every number that I've looked at everything, every stat that I've looked at. That's been the case. And I know you've been at the forefront and trying to help people with this. I'm also, I appreciate you coming on.
What if someone wants to reach out to you and get connected and learn about what you do? What's the best way to do that?
Amol Nirgudkar (25:09.95)
I think go to patientprism .com and I have a new newsletter that I'm writing every couple of weeks. When you go to patientprism .com, click on CEO Pulse.
And I am writing these articles every few weeks in conjunction with my conversations. So I have a conversation with a bunch of executives. They tell me what the problem is. I investigate that thing like a journalist. I write the article and I share it with everybody because I feel it's a service I can do to the industry. So subscribe. You can go to ceopulse and patientprism .com and just put your email. It'll subscribe and you'll hear from me at least every 10 days. If you think...
GARY BIRD (25:24.576)
And they're really good.
Amol Nirgudkar (25:50.046)
You need help growing the business and kind of calibrating marketing, sales and operations. Give us a call, do a consultation. We'll tell you that either you need us or you don't. And we'll give you a good demo of how we're helping organizations really calibrate this stuff in a time of uncertainty. So thank you so much.
GARY BIRD (26:06.72)
Awesome. Awesome, man. I appreciate you coming on.
GARY BIRD (26:13.952)
All right, three, two, one. All right, let me just film the intro really quick. Three, two, welcome back to another episode of Dental Marketing GO. I'm your host, Gary Bird. I'm the founder of SMC National where we help you create, convert and close more new patients so you can grow the way that you want, but you can't grow if your mother, sisters, brothers run in your marketing and you think you're gonna compete against all these big DSOs that are spending tens of thousands of dollars on their marketing. Gone are those days. And today I have Amal who's the CEO of Patient Prism.
and he has something that he's gonna share with you that he's been talking with some big DSOs and what's going on in the industry. And at the end of the show, he's gonna give you something that has a ton of value. So make sure you listen all the way to the end. Stay tuned.