Fix the leaky bucket before you spend on marketing

When a clinic gets quiet, almost every owner reaches for the same lever: more marketing. It’s usually the wrong one. The patients you already have are cheaper to bring back, faster to convert, and they’re sitting in your practice-management system right now. Most clinics have never worked that list properly, and they’re paying to fill a bucket that leaks.

I’ve watched clinics spend tens of thousands of dollars on advertising to get people through the door, and have nothing in place to bring those same people back three months later. It’s the most expensive mistake in this industry and almost nobody sees it as a mistake, because the money going out is visible and the money not coming back isn’t.

Attract, retain, refer — and everyone skips the middle one

There are three things a wellness business has to do. Attract new people. Retain the ones you’ve got. Get those people referring.

Everybody knows about the first. Most people want the third. Almost nobody works on the second, and the ones who do only remember when they’re slow — which is precisely the wrong time, because by then you’re trying to fix a June problem in June.

The work that prevents a quiet June happens in January. If you’re only thinking about retention when the schedule looks empty, you’re always going to be on that revenue roller coaster, and you’re always going to feel like the answer is more marketing.

Why the existing list is the cheaper option

This isn’t a moral argument, it’s an arithmetic one.

Someone who has already been to your clinic knows where you are, knows what you do, has a file, and has already decided once that you were worth booking. A stranger has to be found, convinced, and converted — and you pay a platform for the privilege of finding them.

There’s a second thing that gets missed. Your existing patients aren’t refusing to come back. Most of them simply haven’t thought about it. They meant to rebook, life happened, and three months went by. I have had patients tell me, when they finally got a message, that they’d literally been thinking about the clinic that week and just hadn’t got round to ringing.

That’s not a marketing problem. That’s a nudge problem, and it costs almost nothing to solve.

The reason it doesn’t get done

I’ll be blunt about this, because I’ve been on both sides of it.

The work is tedious and the person you’d hand it to doesn’t want it. Pulling the list of who hasn’t been in, checking whether they’ve already booked, excluding the ones who’ve moved or been discharged — it’s a slog. And then somebody has to make the calls, which is its own problem for reasons I’ve written about separately.

So it goes on the list of things to do when it’s quiet. And when it’s quiet, everyone’s stressed about it being quiet, which is not when people do their best work.

That’s the trap. The task that prevents slow seasons only ever gets scheduled during one.

What good retention actually looks like

Three things, and only one of them needs software.

Practitioners telling patients when to come back. Not vaguely. A specific recommendation, based on what that patient actually needs. A surprising number of practitioners won’t do this because it feels like selling — and I’d argue the opposite. Your patients don’t know they need you. You’re the expert. Withholding a recommendation because it feels awkward isn’t restraint, it’s leaving them to guess.

Something that catches the people who drift anyway. However good your practitioners are, a share of patients will finish a plan, feel better, and quietly disappear. That’s normal. What matters is whether anyone notices. A simple, human check-in at three months — it’s been a while, how are you feeling? — catches a meaningful number of them, because it turns out most weren’t avoiding you.

And a reason for them to keep coming. Memberships and packages do this well when they’re built around what a patient actually needs rather than what a clinic hoped they’d want. That’s a whole subject on its own, and one I’ll come back to.

The honest version

I’m a co-founder of a company that automates the second thing on that list, so take this with the appropriate salt.

But I’d tell you the same thing if we didn’t exist, and I did tell people this for years before we did: go and look at how many patients haven’t been to your clinic in six months. Just the number. Most owners have never looked, and the number is almost always bigger than they expect.

Then multiply it by what an average visit is worth to you.

That number is what’s currently leaking. It’s usually larger than the ad budget being proposed to replace it — and unlike the ad budget, you’ve already paid to acquire every one of those people once.

Fix that first. Then go and find new people, and you’ll keep more of them when you do.