Most dental practice owners believe growth comes from one thing: more new patients.

And while new patients matter, there’s a much bigger issue quietly draining profit in the background—one that rarely shows up on a P&L and almost never gets discussed. It’s patient attrition.

Every year, most dental practices lose 30–40% of their patient base. The practice stays busy. The schedule looks full. Marketing appears to be working. Yet growth never compounds.

That’s because new patients aren’t stacking. They’re replacing the ones who are quietly leaving. This revolving door is one of the most expensive—and most overlooked—profit killers in dentistry.

The Mathematics of Attrition (and What It’s Really Costing You)

Let’s start with the math, because once owners see the numbers, this problem becomes impossible to ignore.  

Imagine a practice that averages 30 new patients per month. On paper, that sounds healthy. Those patients should return in six months, and as they do, the practice should grow.

Now factor in hygiene.

A hygienist can see roughly eight patients per day. If patient retention is working properly, adding 30 new patients per month should require the practice to add approximately four days of hygiene every single month on a rolling basis.

That’s what real growth looks like. But in most practices, it doesn’t happen. Hygiene capacity stays flat. The schedule feels packed but never expands. Doctors stay busy but don’t add providers. Owners keep pushing marketing harder, believing the solution is more leads.

The truth is simpler—and more frustrating. Existing patients are leaving at nearly the same rate new patients are coming in. In other words, many practices have an attrition rate equal to their acquisition rate. Even if attrition were 50%, it would be concerning. But many practices are losing 30–40% of patients every year without realizing it.

Now let’s talk money.

The average cost to acquire a new dental patient today is roughly $300. That patient is worth about $1,000 in their first year. Over a long-term relationship—often ten years—their lifetime value typically falls between $3,000 and $5,000.

Here’s where attrition becomes devastating. When patients leave early, the practice never realizes that lifetime value. Marketing dollars are spent repeatedly just to stay in the same place. Growth stalls. Profit evaporates.

Practices aren’t just losing patients—they’re wasting money they already spent to acquire them.

Why This Problem Goes Unnoticed in “Busy” Practices

One of the reasons attritions is so dangerous is that it hides in plain sight:

• The schedule looks full
• Phones keep ringing
• The team stays busy

From the outside, everything appears fine. But busy does not equal healthy.

When acquisition simply replaces attrition, the practice runs harder without moving forward. Owners feel constantly pressured to produce more, market more, and push harder—without understanding why growth never materializes.

Many practices assume:

“That’s just how dentistry is now.” It’s not.

Attrition at this level is not inevitable. It’s the result of systems breaking down quietly over time.

Why Patients Are Actually Leaving

Patients don’t leave because they wake up one day and decide they dislike the practice. They leave because the system lets them.

The most common causes of attrition are surprisingly basic:

• Patients leave without a future appointment
• Cancellations are not rescheduled
• No-shows are not followed up
• Next steps are unclear on the doctor side

In many practices, hygiene performs relatively well because six-month recall is expected and routine. Patients are conditioned to return.

The doctor side is where attrition hides. Patients often leave the operatory without a clear timeline, a scheduled follow-up, or accountability assigned to make sure it happens.

Over time, those patients quietly disappear—not because they chose to leave, but because no system pulled them back in.

This isn’t a motivation problem. It’s not a communication problem.

It’s a systems problem.

The Report That Tells the Truth

Fixing attrition starts with visibility. One report reveals almost everything: the patient master report, specifically the last date seen field.

When practices print this report and compare last date seen with future appointments, patterns become immediately obvious.

Patients whose last visit was in 2021 or earlier aren’t inactive—they’re gone.

By counting how many patients were lost each year and comparing that number to new patient acquisition, practices finally see their true net growth.

For many owners, this is the first time the reality of attrition becomes clear.

The Six-Month Rule That Changes Everything

There is a simple standard that dramatically reduces attrition when enforced consistently: No patient seen in the last six months should leave without a future appointment.

If a patient walks out unscheduled, the system failed—not the patient. Once someone leaves without an appointment, both the practice and the patient forget.

That patient eventually becomes a “reactivation project,” which requires time, staff, and effort most practices don’t have. Preventing attrition is far easier—and far cheaper—than trying to reverse it later.

Morning Huddles: Where Attrition Is Either Fixed or Ignored

One of the most effective places to stop attrition is the morning huddle. Practices that retain patients consistently use the huddle to:

• Identify patients on the doctor side without future appointments
• Assign a specific team member to schedule them
• Hold that person accountable for completion

This shifts retention from “someone should do it” to “someone owns it.” Attrition decreases when responsibility is clear.

Why “Just Schedule Them” Works

Patients frequently say:

• “I don’t know my calendar.”
• “I’m not sure where I’ll be.”
• “I need to check my schedule.”

The solution is simple: schedule them anyway.

Appointments can always be moved. Patients who aren’t scheduled often disappear. When patients leave without appointments, they fall out of the system entirely. At that point, even the best recall software can’t help.

Hygiene Isn’t Perfect Either

Even in well-run hygiene departments, attrition sneaks in.

Most practices find:

• One to two patients per hygienist per day without firm future appointments
• Patients who believe they are scheduled but aren’t
• Gaps that compound over weeks and months

Small leaks add up quickly.

Use the Systems You’re Already Paying For

Most dental practices invest heavily in practice management software designed to automate recalls and reminders. Those systems only work when appointments exist. No appointment means no automation. No automation means attrition increases.

When patients are consistently scheduled, technology does what it was designed to do—keep patients coming back without constant manual effort.

The Bottom Line 

Attrition is not a marketing failure. It’s not a staffing issue. It’s not a patient behavior problem. It’s a systems and execution issue.

When practices track attrition, schedule deliberately, and assign accountability, retention improves naturally. Hygiene expands. Marketing dollars work harder. Growth becomes predictable.

The revolving door can be stopped—but only if it’s acknowledged and once it is, profitability follows.

If you want to find out more about MGE, you can find us online at mgeonline.com or call us at (800) 640-1140.