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Through the lens of this term as a noun and not a verb, “churn” refers to the rate at which businesses shed customers and new customers are acquired. Churn is to clients and patrons as “turnover” is to employees. In the dermatology universe, customers are patients, the business is your practice, and the health care space is rife for unfavorable or undesirable “churning.” Factors such as persistently increasing costs are incongruous with supporting continuity of care and the lasting partnerships forged between patients and quality dermatologists.

In its analysis of US health care systems, Buxton reported that churn in the industry exceeded the new patient growth rate—48% vs 45%.1 “Obviously,” noted the provider of technologies for customer tracking, “these numbers would significantly impact the sustainability of any organization over time.”

The first step is to understand where your practice stands regarding churn. Is it really a problem? You need to confirm that the churn challenge goes beyond a mere sense that you may have. You can take a deeper dive, analyzing churn at different locations within your organization or as related to different associates or members of your team. These variables can provide real insights into practice “wins” and areas that could use improvement.


Now, just as you cannot treat what you do not know, you need to have the information (or data) to make an appropriate “diagnosis” about your churn. Leadership with another rehabilitation-focused health care technology brand, WebPT, encourages managers and specialists to crunch the actual patient visits with the anticipated patient visits. Your expectations may be based on realistic assumptions and need not be the result of extensive, strategic goal-setting initiatives.

One may reasonably assume that a patient will return for follow-up visits to see how given products or new regimens are working to heal their skin. Or, for those patients who don’t return for follow up it is only natural to anticipate that they will at least retain their routine skin checks and screenings. With these numbers in hand:

  • Subtract the “actual” number from the “expected” number
  • Divide this total by the expected visits
  • Lastly, multiply the result by 100

Voila! You have a “churn rate.”

You can take a deeper dive at the numbers to arrive at more detailed information about this vital indicator of sustained practice performance. For instance, this calculation could be made when assessing each doctor’s churn based on respective visit counts. Or, churn could be evaluated by office location or even based on a specific day or time of day. The intelligence derived from information that is likely at your fingertips (without much hassle) can tell you a great deal about the “pain points” within your practice.


The pain points that surface while assessing churn may have absolutely nothing to do with an associate’s or staff member’s “bedside manner” or so-called “likeability.” Instead, the numbers may reveal pain points that you have never considered or have not considered since day 1 of your practice. However, these overlooked or under-reviewed factors are holding your practice back in the present.

Such constraints could have everything to do with accessibility, including the hours an office may keep. Are these hours not “tracking” with your demographics? Is parking a tremendous hassle? There are so many factors that can influence whether a patient looks for “greener pastures.” These challenges have nothing to do with the skill and personality of your doctors and other talents.

Regarding demographics, when was the last time you really considered the type of patient that you want to have? Just as savvy health care consumers “vet” their dermatologists and other providers, so should savvy clinician-entrepreneurs “vet” their “goal” patients. These patients should fit the services, culture, and overall approach of your team and practice like a glove.

To properly improve the churn rate on this front means that you must be intentional in the individuals you attract and the communities you build from the get-go. That way, you are not playing “catch-up.” If you start to evaluate the type of patients coming through the door after a red flag has been raised about the churn rate, you are taking a decidedly reactionary approach. You want to get ahead of the problem, something you likely tell your patients as it relates to their skin concerns. To be proactive on this front, revisit “where” you may be marketing your services and expertise.

  • Does the reach of your publication, website, community venue, or other promotional campaigns extend to those “goal” patients who will keep their recall and follow-up visits as expected? These are the patients whose relationship with you will grow over time as they see the value of your services, and especially as techniques, products, and technologies evolve.
  • Furthermore, it is not sufficient to merely assess by “outlet” or by the platform that is singing your praises. It is also important to evaluate by the parameters of your marketing campaign or promotion. The event, time of day, or other variables could be the “problem”—not the partner organization itself.
  • Also, a deeper dive into churn can tell you a great deal about shortfalls in taking viable opportunities to extend your reach. It may also suggest that the techniques and technologies need to be better nurtured, or you may be perceived by your goal patient base as a “dinosaur.”

For technology, we are not merely referring to what you do best, such as the procedures or tools used to improve patient comfort, convenience, and outcomes. We are also referring to those technologies and tools applied to manage your patients, team, and practice. These tools are essential to support all the elements that can favorably affect patient churn. How you communicate as an organization and track “vitals,” such as patient and employee schedules, can make or break the satisfaction that your valued talent/workforce derives from its workdays.

At every turn, consider churn. To build on a few of the aforementioned common pain points:

  • Do not underestimate the value of patients, as they are your best “brand advocates.” Ms. Jones may not be singing your praises online simply because you did not ask her to! Yes, it can be just that simple. People want to feel as though they matter and their voices are heard. A simple reference to putting in a good word on social media can do just the trick to get more referrals through the door. And it does not cost a dime!
  • Intentionally solicit feedback. At the risk of sounding like a broken record, when was the last time that you asked Ms. Jones how her previous visit went? When was the last time you sought out her likes and dislikes? Do not take your valued patients for granted. Show them how much they are valued. These patients can be revealing, bringing strengths to build on and weaknesses to work on, and the mere act of asking and keeping the dialogue going further endears patients to you.
  • Consider substantive practice management investments that will make life easier for everyone. If you have thought about expanding telehealth, Artificial Intelligence, voice assistants, or cybersecurity efforts, there is no time like the present to move forward. These investments can have real implications for the long-term sustainability of your practice, no less by avoiding costly compliance failures or breaches that could bring your life’s work to the brink.
  • Many of the previously mentioned technologies can be characterized as “patient-facing”; however, for those behind-the-scenes efforts, it pays to let patients know the investments you are making in areas such as data privacy. The same principle should be applied to other areas of your practice—from investments made to operate in a more sustainable (waste less, conserve more) fashion to good works in the community that may otherwise go unnoticed because these leads don’t bleed.

Generally, if the effort builds more time into your schedule to “be” with patients, that is a good thing! After all, that is what patients crave so much of; they want your time. They want to feel human. They do not want to be treated impersonally when dealing with such personal and emotional matters as the health and aesthetics of their skin. Otherwise, when you do not take the time, they will not make the time to revisit you. Their time will be spent elsewhere, at another dermatology practice, if they go back to the dermatologist at all for the care that they need and want.

1. Buxton. What’s your churn? A smart approach for patient retention. Accessed May 15, 2023.

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