Nationwide Survey Explores Why Consumers Change Dentists
Women more likely than men to switch dentists due to patient experience & cost
The COVID-19 pandemic had profound effects for the dental industry during 2020. Temporary office closures were widespread and, even after re-opening, a February 2021 poll reported overall patient volume was down by nearly 20 percent. At the same time, personal protective equipment (PPE) costs have risen while consumer spending on dental care has been projected to decline 38 percent in 2020 and 20 percent in 2021. Together these circumstances have produced substantial financial pressures on dental practices and made the issue of patient retention all the more urgent.
To explore the factors eroding dental patient retention, a survey of over 2,000 adults across the United States asked, “Which of the following issues would make you change your dentist?” Six concerns were offered as potential answers. The issues included economic considerations (“Cheaper prices from a different dentist,” “Dentist not in-network for your insurance”), general patient experience (“Dental appointments start late,” “Dentist criticizes your teeth or oral health,” “Inconvenient location”) and the absence of a service specifically accommodating patients with dental anxieties (“Sedation dentistry not offered”). Poor dental work was not provided as an option within the survey since it was assumed that an egregious quality issue was an obvious justification to change dentists.
Each survey respondent had the option of selecting one or more of the six concerns, or rejecting them all as a basis for leaving a dentist. The options were in randomized sequence across survey respondents to minimize an answer bias based on the option order.
What The Survey Found
More than half of respondents (53.8 percent) identified one or more conditions that would make them switch dentists. The selection rate for the individual reasons to switch dentists ranged from 30.5 percent to 7.5 percent and, as mentioned above, a single respondent could choose more than one reason to change dentists.
Survey results and supporting commentary for each of the conditions for dentist switching is provided below.
According to the American Dental Association’s Health Policy Institute, 59 percent of adults between the ages of 19 and 64 have private dental benefits. An additional 7.4 percent have dental benefits through the government’s Medicaid program. However, having insurance coverage does not guarantee insurance acceptance. For example, government-supplied dental coverage from Medicaid and the Children’s Health Insurance Program (CHIP) is accepted by less than half of dentists (43 percent) according to the American Dental Association.
With respect to insurance coverage, three-in-ten (30.5 percent) survey respondents selected “Dentist not in-network for your insurance” as a reason to change dentists. Higher costs is the assumed rationale for avoiding out-of-network care. Out-of-network care risks the patient paying full price for dental services (in the case of HMO dental plans and discount dental card programs) or higher out-of-pocket costs.
Out-of-network status was the single most common survey response for changing dentists. Women were more likely than men to indicate out-of-network status as a reason to change dentists. 34.1 percent of women responding to the survey selected this answer as compared to 26.5 percent of men.
General Patient Experience
Three of the potential answers to the question “Which of the following issues would make you change your dentist?” concerned problems with general patient experience: inconvenient location, dental appointments beginning late, and the dentist criticizes the survey respondent’s teeth or oral health. One or more of the above patient experience problems was a basis for dentist switching among 27.7 percent of all adults surveyed. When examined separately, the rate at which Americans viewed each issue as a condition for changing dentists was:
- Inconvenient location (17 percent)
- Dentist criticizes your teeth or oral health (10.9 percent)
- Dental appointments start late (9.7 percent)
As illustrated in the below table, the study found men were slightly more likely to cite an inconvenient dental office location as a reason to change dentists while women were slightly more likely to cite late starts for appointments. However, the big divide between women and men on patient experience centered around criticism from a dentist about the patient’s teeth or oral health. Women were twice as likely as men to cite a dentist’s criticism of their teeth and oral health as a reason for seeking a new dentist. 14.3 percent of surveyed women gave this answer compared to 7.1 percent of men.
Table: Patient Experience response rates to the question “Which of the following issues would make you change your dentist?”
|Patient Experience Issue||Women||Men|
|Dentist criticizes your teeth or oral health||14.3%||7.1%|
|Dental appointments start late||10.3%||9.1%|
Two of the survey answers pertained to financial issues associated with dental care: a dentist’s network status (addressed earlier) and the scenario of a different dentist offering lower prices. 10.5 percent of adults surveyed indicated that cheaper prices from another dentist would motivate them to switch practices. Women were 52 percent more likely than men (12.6 percent vs 8.3 percent) to indicate lower costs were grounds for switching.
From a geographic perspective, price sensitivity (as captured by this response) was most prevalent in the western United states. This answer was selected by 13.8 percent of respondents living in that region, which was a response rate 31 percent higher than the national average. The region least interested in price was the midwest where 7.8 of respondents selected the answer.
The uninsured are most exposed to the prices dentists charge. The American Dental Association’s Health Policy Institute estimates 33.6 percent of U.S. adults lack dental benefits. However, even the insured face considerable costs even with an in-force dental plan. Approximately eight-in-ten dental plans are Preferred Provider Organizations (PPOs) and these plans commonly have a cap (e.g. $1,500) on how much the plan will pay for dental care within a year. These plans may also charge a percentage of the cost for major dental work (as opposed to a flat-fee copayment). This percentage is known as a coinsurance fee. For example, if the price for a crown is $1,500 and the coinsurance fee is 50 percent, the patient will be responsible for paying $900. Consequently, dentists offering lower prices in this scenario will benefit a person even though they already have insurance.
Researchers estimate 36 percent of the population suffer from a fear of dentists, with an additional 12 percent of the population being characterized as experiencing an extreme dentistry fear. Sedation dentistry, otherwise known as “painless dentistry” or “mild sedation dentistry,” is the use of medication to relax a patient who suffers from considerable anxiety regarding dental procedures. The level of sedation varies according to need, and deep sedation using general anesthesia requires a dentist’s completion of the Commission on Dental Accreditation (CODA) program in this practice.
Despite the prevalence of dental fear (nearly half the population), a lack of sedation dentistry was the least common basis for which a survey respondent would change dentists. Only 7.5 percent of adults surveyed said the absence of sedation dentistry would motivate a dentist switch. While there was some difference in response rates, this issue was the least frequent rationale for dentist switching among women and men alike.
There are multiple questions raised by this result. For example, are Americans with dental fears aware of sedation dentistry as an option to alleviate their anxiety? Additionally, are Americans with extreme dental fears avoiding dentists altogether, thus making the question of switching dentists irrelevant?
Given new patient acquisition is accompanied by considerable marketing expenses (e.g. direct mail, social media placements, online reputation management, etc.), the retention of existing patients is of paramount importance to the financial health of dental practices. Many of these practices still suffer from the financial stresses brought by the COVID-19 pandemic and may face further revenue challenges if another COVID-19 spike occurs and reduces patient volume.
The results of this survey identify a variety of issues that can contribute to patient attrition and lost revenue. With less than half of surveyed adults not giving a reason for changing dentists, dentists should give considerable attention to the extent to which these six issues may apply to the majority of their patients. Making adjustments, when necessary, can be an inexpensive means to preserve their existing base of clients and increase word-of-mouth referrals.
Report data is based on 2,110 respondents to a nationwide multiple choice survey conducted from July 20, 2021 to August 17, 2021. The single-question survey asked adults in the United States, “Which of the following issues would make you change your dentist?” Respondents had the option of selecting one or more of the seven following options:
- Sedation dentistry not offered
- Inconvenient location
- Cheaper prices from a different dentist
- Dental appointments start late
- Dentist not in-network for your insurance
- Dentist criticizes your teeth or oral health
Below the aforementioned six options, there was an additional option for “None of the above.”
Answer options for the survey question were displayed in randomized order across respondents. 2,788 options were selected by 2,110 adults responding to the survey.
The survey was displayed to adults located in the United States who visited websites within the Google Surveys Publisher Network. Respondent demographics were collected to approximate the age, gender, and geography of adult internet users in the United States based on the US Census Bureau’s 2015 Current Population Survey (CPS) Computer and Internet Use Supplement. For more information on the survey’s audience and data collection, see the linked white paper. Race, education, income, and other demographic factors were not examined. The margin of error across this survey’s responses is estimated at +1.7%/-1.7%.