DEBRA MILLER, Director of Coaching


Every endodontic practice is aware of who their “A” referrers are. Those are the GPs who regularly, predictably and reliably refer most (if not all) endodontic needs identified in their practice to you. “A” referrers are usually a relatively small group of GPs (10 to 15 for most endodontists, and sometimes less). However, they have an outsized impact on productivity in your practice simply because they send so many cases. The “A” referrers group can often contribute as much as 50% of your practice revenues. So, if you lose one of these referrers, they are very hard to replace (which is why we work so hard to protect those relationships).

A high-risk time for losing one of these referrers is when they are older, and they are approaching retirement. Here are some nightmare scenarios:

  • The older doctor sells the practice in a straight-up buy-out, and the new doctor takes over without any history, loyalty or relationship to you. If they are new to the community, the new owner may want to “try out” a number of different specialists. If they have previously practiced in the community, they may have someone they are already accustomed to working with.
  • The older doctor brings in an associate with the intention to eventually sell the practice to them in an equity associate transition. To help get the associate get up to speed and productive, the doctor starts redirecting all routine endodontic treatment to the associate rather than referring it.
  • In the same scenario, even if you are still receiving more complex cases from the older doctor, as the associate builds their patient base and begins to refer their own patients, they may forge an endodontic referral relationship with someone other than you. The associate is likely significantly younger than the older doctor, and possibly significantly younger than you. They may feel they can relate better to a younger endodontist (perhaps someone they know previously from dental school or while they were associating in a different practice).
  • The older doctor merges their practice into a corporate dentistry network where all referrals are directed to “in-house” endodontic providers. Sometimes those providers are not endodontists, but rather a GP with an endodontic focus who travels from practice to practice in the corporate network. This scenario can easily happen 10 years or more before the older doctor plans to retire completely since it allows them to cash out their practice value early.

Any referring doctor on your “A” list who is within 10 years of retirement should be considered an “at-risk” referral relationship. From that point on, it is especially important that you engage in marketing strategies and relationship building that allow you to be one-on-one with the doctor multiple times every year. Don’t just delegate to your marketing coordinator. The personal touch is especially important here, especially if you’ve worked so long together and know each other so well professionally that you essentially collaborate on autopilot with minimal communication needed.

One-on-one relationship building could include lunches and dinners, invitations to sports or other events they have an interest (when possible with respect to COVID-19), activities you have a shared interest in (golf), becoming involved in a charity or community group they like to support, and various kinds of referral appreciation strategies such as seasonal gifts or trips together.

The point of these activities is to create a closer personal bond that allows you to ask about their future plans in a conversational and non-suspicious way. It should be as easy as talking to a friend where you are interested in what is best for them, and they are equally interested in what is best for you.

Once you know their plans, you can then respond that you will miss them a lot and they will be irreplaceable in your practice after such a close working relationship for such a long. You’ll also have a door open to ask for a powerful introduction to any new associate or buyer. This isn’t about being manipulative but instead about being genuine about your respect and value for each other.

Of course, eventually they will retire and you will experience some kind of fluctuation. Hopefully it will be minimized because you’re prepared and you have a professional understanding to support each other’s success.

This also emphasizes the importance of great marketing strategies for your “B” and “C” referrers (as they are commonly called) so that you are always creating upward momentum in those relationships … and eventually they replenish and add to your “A” list. It’s an investment in growth that pays off year after year once those relationships are established and strengthened.


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