Endo Mastery

Three reasons to love endodontic emergencies


In businesses that are driven by salespeople, you often see a motivational activity around ringing a bell when a sale is made. In car dealerships, for example, they often have the customer themselves ring the bell to celebrate their purchase. In endodontics, we’re not in a sales-driven business but there is one thing you and your team should metaphorically ring the bell for: every time you schedule an emergency patient who is in pain.


Dental pain is the entire reason behind dentistry’s origins. From the Middle Ages until the early 1800s, a person experiencing dental pain would visit their local barber for a tooth extraction. Then, in the mid-1800s, dentistry and barbering diverged as (obviously) separate disciplines, which unofficially makes endodontists the oldest profession among dental practitioners.


Even with all the advances in preventive and restorative care, emergency endodontic care continues to be a significant part of our practices. Today, however, we’ve come a long way from the crude extraction forceps of a barber, with advanced root canal techniques that can quickly eliminate the pain while saving the tooth.


Every time an emergency patient calls the practice, it’s a reason to celebrate as an endodontist … not to celebrate their pain but to celebrate why endodontics is such a great profession. Aside from historical recognition, here are three reasons why you should love emergency patients in your modern practice:

1. The patient is committed

Endodontists probably suffer the most from patients who really don’t want to be there in the first place. But an emergency patient in pain is highly motivated to receive treatment, and that means they are highly committed. In short, that makes them a dream patient in many respects and less likely to cause administrative, scheduling and financial problems.


An emergency patient fundamentally respects you as a specialist, which means they are going to appoint for the first possible appointment time that your team recommends, and they show up on time. That appointment should ideally be the same day they call, and you can reserve time in your schedule every day where emergency patients can be appointed.


Emergency patients are also more committed to their treatment costs and prepared to pay in full whether they have insurance or not. They won’t hesitate to use their credit card or sign up for third party financing if they need to spread their copay costs out over time.

2. Emergency cases are (usually) easy

From a clinical perspective, emergency cases are often relatively easy. They are frequently the kind of cases that you have done many times and that you can do very quickly and efficiently. That makes them among the most productive cases you have in terms of revenue vs. time required. Scheduling emergency patients on the same day is one of the best ways to make sure you meet and exceed your productivity goals each day.


When emergency cases are more complicated, one common reason is that they are a retreatment case. Over two-thirds of root canals in the USA are performed by GPs, and they usually don’t have the same clinical tools (like cone beam) or clinical skills that you have. When one of their cases blow up and they need to refer the patient, it’s a great opportunity for you to build your collaborative relationship with the GP. They will grow to see you as a clinical partner and that leads them to understand how much easier it would be if they just referred their endodontic cases from the beginning.

3. Referring doctors are appreciative

Regardless of whether retreatment is involved or not, referring doctors are appreciative when you can get their patient out of pain quickly, and the patient returns to their office singing your praises. They pay attention to patient feedback and they like to hear patients tell them how well they were cared for in your office.


In fact, organizing your practice around efficient same-day treatment for emergency patients in pain is one of the most effective referral-building strategies in endodontics. When you plan your schedule for same-day emergencies and you commit to referrers that you will get their patients out of pain on the same day—and you prove that consistently without fail—then referring doctors learn to count on you more and more.

They’ll refer more cases because they know the patient will return happy, quickly, and ready for a final restoration. And that kind of restoration is an easy, highly productive case for them too, so everybody wins.


Endo Mastery Practice Coaching can help you and your team optimize and master the scheduling, productivity and marketing of emergency care in your practice. For more information, visit https://endomastery.com/practice-and-team-coaching/

Trust in endodontic marketing


In the past month, we’ve witnessed an extraordinary example of how trust gets broken. Elon Musk’s nascent tenure as owner and CEO of Twitter has seen a flurry of changes that have altered trust:

  • The team doesn’t trust their leader after brutal workforce cutbacks and vastly increased work requirements on those remaining.
  • Advertisers don’t trust the service as a safe moderated place for their brands and have stopped buying ads.
  • Users and key influencers don’t trust the platform’s verification and are looking at other options.

Of the three stakeholders, the trust of advertisers is the most important since they are the true “customers” of the business. 90% of Twitter’s revenues come from advertising. When they stop spending, the company’s financial foundation is shaken.

Referrals and trust

In the endodontic practice, you have the same kind of vital relationship with your referrers. Your practice is driven by referrals, which means that GPs need to know they can trust you. If you take steps (like Elon Musk) that damage trust, you can expect referrals will go down. But the opposite is also true. If you take steps to increase trust, you can increase referrals.


What does a referrer need to trust about you? Clinical ability and taking care of patients are the top two, but that’s obvious. It’s safe to say that practically every endodontist has those two points covered. So, what are the less obvious trust factors that can influence marketing and growth? These are more discretionary and it’s your choice how much you commit to building trust in these areas. Can they trust you and/or your team to:

  • Always schedule an emergency patient in pain on the same day?
  • Answer the phone promptly in a welcoming and caring manner?
  • Calm a nervous or fearful patient before and during their visit?
  • Ensure patients have financial clarity and no payment surprises?
  • Speak highly of the general practitioner?
  • Support the GP’s treatment plan?
  • Provide treatment quickly and gently?
  • Call the GP directly if any patient leaves the practice unhappy?
  • Receive referral reports on the same day as treatment?
  • Ensure patients return to the GP as soon as possible?
  • Be available to answer questions about a patient case?
  • Make it as easy as possible to refer a patient?
  • Establish a friendly team-to-team relationship?
  • Visit their practice periodically with pop-by marketing gifts?

You might think that your practice is good at most of these things, but the question to ask is whether you are clearly reliable to the point where it becomes as equally obvious as your clinical ability.


Even some of the simplest things, like the pop-by marketing gifts, become much more effective when the GP’s team realizes they can count on it. That’s when you have established such trustworthy processes that they know, without a doubt, they will see you every month or two. Presence of mind at the highest level!

Most important trust factor

On the list above, there is one factor that is particularly important to drive growth in your practice. That is why it is listed on the top: scheduling emergency patients in pain on the same day.


When a GP can absolutely trust—without question—that their patient in pain will be seen and relieved of pain on the same day by you, then you become the easiest, most reliable and most obvious choice for their referrals. You end up getting 100% of their emergency referrals once that level of trust is achieved, which leads to getting 100% of all their other endodontic referrals. It’s the ultimate relationship-builder in endo.


Becoming a practice that can deal with emergency patients so responsively and nimbly takes effort. The schedule must be tuned and optimized to allow it, and the team must be prepared and know how to adapt for emergency patients throughout the day. And all this needs to be done in a way that isn’t stressful for you and the team. It should be effortless.

Endo Mastery Practice Coaching can help you enhance and grow referral relationships significantly. For more information, visit https://endomastery.com/practice-and-team-coaching/

Beating your endo competition



For every endodontic case that you complete in your practice right now, there are at least two other potential cases in your patient community that could be referred to your practice. That’s a significant opportunity for growth if you can tap into it.


However, even though that opportunity is available to you, it is also available to every other endodontist in your area too. Why? Because over two-thirds of endodontic cases are completed in GP practices without being referred. Truly, the competition in endo is not with other endodontists.

Factors that drive referral relationships

The question we are really facing is what moves a GP to prefer to refer endodontic cases rather than completing those cases themselves? If you think about your best referrers and analyze why they are great referrers, then you generally find they have one or more of the following mindsets:

  • They like you and see you as a trusted interdisciplinary partner.
    Everything begins with the doctor-to-doctor relationship, which is established both socially and clinically. If you look at the top GPs in your community who have busy and successful practices focused on high-value comprehensive care, none of them reach that level without embracing an interdisciplinary philosophy. That means they have optimized comprehensive treatment around a team of trusted specialists with whom they feel aligned clinically and that they enjoy working with.

  • Treatment in your practice is more convenient for patients and less stressful for the GP practice.
    While most endodontic practices typically have a schedule that plans for a certain number of emergency same-day treatments, that is not the case in the GP practice. The typical productive GP is usually scheduled 2 to 6 weeks in advance. They often have two hygienists seeing patients every day, which require hygiene checks in addition to the patients scheduled in the doctor’s chairs. It’s very difficult to carve an hour or more out of those tightly scheduled days for an emergency endo, and it’s easier to refer.

  • Treatment in your practice results in better clinical outcomes.
    You see the limited results of GP-performed endo all the time: missed MB2 canals that blow up, retreatments, separated instruments, and cases where the doctor simply realizes they are in over their head. Every time they refer a case where they get in trouble, it’s an opportunity to help them realize endodontists provide a faster and more predictable clinical outcome with a significantly reduced risk of a failed case or need for retreatment. It’s generally not possible for them to rise to your level: They lack the clinical techniques plus all the specialized technology and tools we have in our practices, such as CBCT, microscopes, etc.

  • Endodontic procedures dilute the GP’s productivity.
    GP practices grow differently than endodontic practices. In endo, we grow by focusing on efficiency because most of the core procedures that we perform have relatively the same economic value. In a GP practice, at a certain point adding more patients does not result in any more growth. There is an upper limit to how many patients can be retained in hygiene, after which GPs need to focus on case acceptance for less frequent but larger cases, such as quadrant dentistry, esthetics and discretionary care, and full mouth cases. These cases feed into the interdisciplinary mindset mentioned above, but it also results in the understanding that any GP time spent on endodontic treatment would be more productively utilized on comprehensive restorative care.  So, for economic reasons, it is better to refer out endo.

It is all about the relationship

While we think about GP referrers every day, GPs rarely think about us in the same way. We’re part of a treatment plan generally, but they don’t usually view the success of their practice as dependent on referring to us.


The most important things you can do is provide excellent, responsive and timely patient care (especially for emergencies), build up your doctor-to-doctor relationships through personal interaction, and back that up with a great marketing system to stay top-of-mind with referrers.


When we can nudge GPs over time by understanding what leads them to prefer to refer endodontic care, we become the specialist for all their endodontic treatment needs, which potentially triples the number of referred cases they send now.

5 steps to winning referral relationships

To achieve a steadily growing practice from year to year, marketing must be a priority. For most endodontists in established practices, the most powerful opportunity to grow is with existing referrers, which is the point of “relationship” marketing. Here are 5 core factors that should drive your relationship marketing strategy:


The purpose of any marketing strategy is to create opportunities for growth. Growth in an endodontic practice is driven by the number of cases completed, which is dependent on the number of cases referred. There are only two ways to increase the number of cases referred:

1: Have a marketing coordinator

Many endodontists are haphazard about marketing: squeezing it in when they have time and letting it lapse when they feel busy. A haphazard approach creates haphazard results. Developing strong referral relationships takes consistent attention and effort every week, which is why you need a marketing coordinator.


The marketing coordinator is responsible for representing your practice to your referring doctors and their teams. A marketing coordinator must be outgoing, friendly and joyful, and easily interacts and connects with others in a personal and empathetic way. They must present themselves well and have great communication skills when they visit your referring offices.


For a typical one-endodontist practice, the marketing coordinator will be an existing team member who is allocated the equivalent of a half a day per week to be out of the office visiting referrers. On these visits, they will drop off little referral gifts and surprises that create delight in referring offices and continually move your practice into the top-of-mind position.


Marketing coordinators must be very organized to plan marketing activities, strategically select target referrers to visit each week, and order/prepare marketing gifts, lunches in referring offices, etc. The whole focus on the marketing coordinator is to consistently implement marketing activities that create visibility and value for the GP-to-Endodontist relationship.

2: Have a marketing budget

Marketing needs a budget and most endodontists underspend on marketing while wondering why their practice isn’t growing. In relationship marketing, you’re focused on the long-term relationship, which means your marketing budget should be calibrated to the long-term value of a referral relationship. In marketing lingo, this is called the “marginal net worth” of a referrer.


Consider a GP who referrers one case every month valued at $1350 over a 25-year period. That works out to 12 months x $1350 x 25 years = $405,000. Given that lifetime value, how much should you spend on marketing to nurture and maintain GP relationships?


A good guideline is that 3% to 5% of practice revenues should be dedicated to marketing. That budget gives you the flexibility to allocate funds for new referrer outreach, for weekly and monthly referral gifts for regular referrers, for periodic lunches and dinners with referrers throughout the year, and for special gifts to acknowledge and thank your top referrers.

3: Express appreciation and gratitude

The marketing coordinator’s activities are the foundation, but the heart of relationship marketing is expressing appreciation and gratitude to referrers consistently and personally. That means that you find the opportunity for some kind of communication to thank the referring GP.


It doesn’t have to be a big deal, but it must be a continuous ever-present part of the tone that you and your team communicate with referrers and their team. “Thank you for sending Mary to our office!”, “We love your patients. Mary was a pleasure to have in our office!”, “I really appreciate your referral and Mary was very happy!”, etc.


Since so much of our life is digital now, you can find easy ways to communicate these messages: email, texting, social media, case summaries, whenever you’re on the phone the GP or office, etc. When doctors know they are important to you, they want to stay important to you.

4: Make referrals easy and effortless

Ultimately, when a GP makes a referral, they want to do so without any worries. They want to know their patient will be cared for promptly and compassionately, the clinical result will be predictable and at a highest level, and the patient will return happy and ready to continue restorative care.

The easier you make the referral process for the GP and their team, and the better you can return the patient meeting all expectations, then you become an obvious and effortless choice for the referrer. Here’s some tips:

  • ● Be available for same-day emergency appointments for patients in pain.
  • ● Have a referral card or referral kit in the GP office that answers all the patient’s immediate questions and makes sure cases are referred right.
  • ● Ask the doctor’s clinical preferences with respect to whether they want you to place final fillings, do build-ups for crowns, place temporaries, where they prefer you to refer if the patient requires an extraction or implant, etc.
  • ● Appoint the patient back to the GP office while the patient is still in your office at the completion of treatment.

5: Have great patient reviews

Finally, nothing speaks louder than a happy patient who returns to the GP. Create a wow experience for patients that exceeds their expectations in every way, that they feel privileged they were referred to you, and that they express to their GP how fantastic their time in your office was.


The details in the experience matter. You never want patients upset about a delay in getting an appointment (especially if they are in pain). You never want patients uncertain about how long treatment will take in your office. You especially never want patients confused or unprepared for their financial responsibility.


If you do these things right, and your team projects kindness, caring and confidence to help the patient through their natural hesitancy about root canal treatment, it’s pretty easy to impress them. As you know, most patients already express surprise that their RCT was so quick and painless compared to their preconceptions. That’s the perfect opportunity to ask them for a 5-star review, and give them a card with a QR code they can scan with their phone to post a review on Google or Yelp right away.


Let’s first discuss why CE lectures for your referring GPs are a good strategy for marketing your endodontic practice.


The purpose of any marketing strategy is to create opportunities for growth. Growth in an endodontic practice is driven by the number of cases completed, which is dependent on the number of cases referred. There are only two ways to increase the number of cases referred:

  • ● More referrals from new referrers
  • ● More referrals from existing referrers

Obviously CE events that you host for your GP community are opportunities to meet and establish goodwill with doctors who are not referring to you yet. Greeting them, talking to them during the break and after the event, and sending follow-up communications are all opportunities to start building a referral relationship.


For existing referrers, keep in mind that no GP should have a goal to grow their own practice by doing more endo themselves. The speakers and topics you choose should reflect that. By engaging GPs in growth around comprehensive restorative dentistry, they should come to realize that endodontic cases create a higher risk for clinical failure and lower level of personal profitability if they do those cases themselves. So, endo cases are best referred out as a matter of routine.

Marketing tips for successful events

A great speaker and topic are not enough to drive high attendance. You and your Marketing Coordinator need to execute a promotional strategy where you blanket your entire GP community with invitations, and follow up. Here’s a recommended approach:

  • ● If your local dental society has a regular newsletter, arrange an announcement in the newsletter at least a month in advance and continuing up until the event.
  • ● Alternatively, there may be a local Facebook group or online forum for dentists where you could also have an announcement.
  • ● If there are some influential local study clubs, make sure you communicate with their leaders to share your event details.
  • ● Four weeks before the event, mail out an invitation flyer or postcard to every GP on your contact list.
  • ● Two weeks before the event, your Marketing Coordinator should begin to visit all your referring offices and pop by as many non-referring offices as they can to drop off the flyer/postcard in person.

“I just want to make sure the doctor saw the mailer we sent out. You should have received it last week. I can register the doctor right now if they would like.”

  • ● In the final week before the event, your Marketing Coordinator should revisit any practices that you particularly want to connect with if they haven’t registered. For example, a large GP group practice that doesn’t refer to you would be worth a follow-up effort.
  • ● At the same time, you personally should call any of your key referring doctors who have not registered yet. You want as many of your top referrers as possible peppered throughout the audience so they can influence other doctors seated around them.

Like anything, successful events are driven by an effective system. Considering the expense of the speaker, venue, and catering, it’s worth the special effort to ensure a full house.


The lifeblood of every endodontic practice are those A+ referrers who send multiple cases every month. But referrers like that don’t grow on trees. Often it takes years to build and nurture those high-value relationships, which all start from the same place originally: as new referrers to your practice.

  • ● Plan to host a lecture or two with an outside speaker on topics of interest to GPs and at no cost to them. This lets you blanket your entire GP community with invitations to attend. Plan at least 3 rounds of invitations: 4 weeks, 2 weeks and 1 week before the event. One of those invitation rounds should be your marketing coordinator stopping in at each office to hand-deliver information about the program and inviting doctors to register to attend directly with them.
  • ● At lecture events, you can position yourself by welcoming everyone at the door as they arrive, introducing yourself individually (as well as on stage when you introduce the speaker), and mingling afterward. Great marketing always begins by establishing that personal doctor-to-doctor relationship, even if it is ever so lightly done in this kind of group event. Plan for and prepare a follow-up communication after the lecture event that gives you one more reason to reach out to attendees. For example, it could be a related article, an article you have authored, or your personal summary of the highlights of the program.
  • ● Another great way to position yourself is with your local dental society, which you should belong to and ideally volunteer for one of the leadership roles or to captain a key project. This is a great way to interface with other doctors who are not part of your referral base.
  • ● Dental society involvement also gives you insight into new GPs in the community. When you identify a new doctor, have your marketing coordinator drop off a gift basket with a welcome message at their practice. Your dental supply rep can also be a good source of information about new arrivals.
  • ● Look for other creative ways to create open invitations for GPs to meet you. Some endodontists choose to involve themselves with local charities or community projects, and communicate to doctors about ways they can get involved in those important causes. You can also consider some kind of annual open house in your practice that is themed around certain holidays or concepts. For example, involving your whole team in decorating the practice for Halloween or the 4th of July, along with costumes, etc.
  • ● Look for opportunities to sponsor events or host events, such as an annual dental picnic/barbecue, golf tournament, fishing tournament, or sporting event. The ultimate level of this is when you create a tradition that everyone in your local dental community looks forward to each year.
  • ● Marketing throughout the year is also important. Your marketing coordinator can plan to drop by one or two practices of potential new referrers that are nearby whenever they are visiting one of your existing referrer offices. That could be as simple as just saying hi and introducing themselves, dropping off your business card or referral kit, or maybe a small inexpensive gift annually such as a gift box of a half-dozen cookies or cupcakes from a local bakery, or a $25 coffee gift card.

However it happens, what you are always on the lookout for is that first referred case. That is the moment that matters, and it gives you a personal reason to connect with the GP and start building your doctor-to-doctor relationship. You can simply thank them for the case, find some clinical aspect of the case to discuss, or use the opportunity to have a full introduction call (or meet for lunch) to get to know them better.


Building clinical trust and value is always the foundation of a great referral relationship. The energy you put into first creating opportunities and then meaningfully connecting with new GP referrers is one of the most important priorities for your long-term success.


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