Episode #390: The “Hero to 5” Framework: Why Niche Positioning Builds Million-Dollar Dental Practices

Naren Arulrajah: This is the Less Insurance Dependence podcast show with my good friend Gary Takacs and myself, Naren Arulrajah,

Gary Takacs: We appreciate your listenership, your time, and most of all, we appreciate your intention to reduce insurance dependence in your practice. Our goal is to provide information that will help you successfully reduce insurance dependence and convert your practice into a thriving and profitable dental practice that provides you with personal, professional and financial satisfaction.

Don Adeesha: If you’ve ever felt like your practice is just blending into the background, one of the 20 dental offices patients scroll past without a second thought, then this episode is for you. Welcome back to the Less Insurance Dependence podcast. I’m your host, Don Adeesha, and it’s great to have you here with us Today. We are talking about one of the most underrated drivers of a fee for service success standing out, because when patients can tell the difference between you and the office down the streets, they default to whoever is willing to take their insurance. We’re going to dig into how practices break out of the trap from building a clear value proposition to owning a niche that makes you the obvious choice in your community. I’m joined once again by our very own co-host, Naren Arulrajah, the CEO of Ekwa Marketing, and someone who has helped countless dental practices build brands, patients actually remember and trust. Naren, it’s great to have you back on here again.

Naren Arulrajah: Thank you so much, Don. I think this is a really important topic and this might come as a surprise for you. Some of the answers I’m gonna give, it’s not how people think that’s hurting them, it’s just how they’re not thinking that’s hurting them. So I’m gonna hopefully change a few mindsets in terms of how you look at the things and having done this for 19 years, I kind of know what the traps are. So hopefully you’ll learn about some of those traps that might be holding you back, and hopefully after the episode you’ll make some changes and you’re better for it.

Don Adeesha: Wonderful. That’s what we like to hear. Perspective change. That’s what our audience are tuning in for. So let’s dive into it. In many cities, patients can find several dentists within just a few miles. So why do so many dental practices end up looking the same to patients?

Naren Arulrajah: That’s a great question Don. And I want to address it head on. I think the number one mistake, practice owners and any human being makes, especially based on my 19 years of experience working with dental practice owners, is they don’t put themselves in the shoes of the patient. They put themselves in the shoes of themselves. In other words, they ask their team members, they ask their wife, they ask their colleagues. And all these people are looking at it from the perspective of the dental practice owner, not necessarily from the perspective of the patient. Imagine you create a restaurant and you never think about the customer who’s going to eat in that restaurant. You’re not gonna cater to that customer, right? You need to be obsessed with the person who you are trying to serve.

Naren Arulrajah: So I think part of this happens because dentists are trained so much about what they need to do and how they need to think, and unfortunately, not even 1% of that training is on being patient-centric, being customer-centric, giving customers what they want. Rather, 99% is science and what you should do and could do and all that stuff. So I think that’s where I would start, like flip the whole thing and say, okay, if I’m a patient who wants to come to this practice, would I be happy? And there are different patients, and those different patients exist in different times. For example, I love sushi, but I’m not gonna eat sushi seven days a week. Some days I feel like eating sushi. Other days I feel like eating something else.

Naren Arulrajah: That’s the human nature. Now I have been not only running this company for the last 19 years, I still have my clients from 18, 19 years ago, but I also have been a dental patient for the last 19 years. My family has been dental patients. Looking at us, we had two young kids. They both needed Invisalign at some point in their life. They wanted beautiful smiles and became conscious of it. Maybe they were teens. So that’s one of the use cases. And we literally wanted them to find the best person to help them with their Invisalign. We lost some teeth. So implants was interesting. And we tried to understand all the options and the pros and cons.

Naren Arulrajah: Another one is we all have had emergencies. Like once in a while we all have some toothache and you’re in trouble, chipped tooth. Sometimes you go on a trip somewhere and you lose a tooth. I still remember one of my colleagues, we were supposed to meet up in Muskoka, a nice vacation spot, and he couldn’t make it because he had a toothache the previous night and his dentist was literally two and a half hours away from where he was.

Naren Arulrajah: So he literally gets up in the morning and gets into the car and goes to the dentist because that took priority over anything else. Like spending time with the friends, who cares when you have a pretty bad toothache. So I think you have to start thinking, and there are also patients that studies show are afraid to go to the dentist. They’re afraid of the pain of dentistry. So sedation dentistry is a huge opportunity. If you can make them feel comfortable, some people want beautiful smiles and some people have lost a lot of teeth and they want implants either so that they can live a better life or because they just don’t like looking at their mouth with all these missing teeth. So there are different kinds of people. And I think if you want to be successful as a practice, you have to pick who do you want to be a hero to.

Don Adeesha: Absolutely. So if you want to stop looking like every other dental practice, you gotta stop thinking like a dentist and start thinking like your patient.

Naren Arulrajah: Exactly.

Don Adeesha: Let’s talk a little bit about the value proposition. What does a clear value proposition beyond price actually look like in the real world?

Naren Arulrajah: Yeah, if we start with the patient and we ask the simple question — I can be a hero to five groups of people for five different situations. Who are those people? Who do I want to be a hero to? The reason I picked five is having done this for 19 years, if you only pick one, there might not be enough volume for you to be busy and profitable. So five — it could be three, four, or six. I’m just using five as a round number. For example, sedation. If you have a lot of people in your community who are afraid to go to a dentist and they have a lot of work, why not attract them? Why not — when they Google keywords like pain-free dentist or sedation — you show up again and again and you dominate. So whatever they type related to sedation, you are the practice that keeps showing up in that community.

Naren Arulrajah: And they can start reading the reviews of how pain-free the experience was and how they dreaded going to a dentist and with you, they got so much done and they’re so happy for it, because you just made them feel at ease. That’s an example of one group of people you can be a hero to — sedation. Another example, Invisalign. I know a lot of adults who didn’t fix their teeth when they were kids and want to do it later on once they have their own money. Invisalign is a great choice because it’s invisible. People don’t even know you are wearing it, as opposed to those metal braces. So you could say, I’m going to be the Invisalign practice for adults. Or you could say Invisalign for teenagers. So I’m giving you examples.

Naren Arulrajah: Veneers. A lot of people want that sparkly smile. Maybe they’re in sales, maybe they’re growing in their careers and they’re in customer-facing roles and they just need to look a certain way. Veneers could be another huge group of people you could be a hero to. People have gum disease and they are becoming more aware of the connection between gum disease and dementia and heart attacks. They’re in their forties and really paying attention to it. So you can really focus on attracting and taking care of those people who have advanced periodontal disease. And there’s a large number of them — millions and millions. Some people have sleep apnea and they don’t want CPAP and those kinds of intrusive devices.

Naren Arulrajah: Emergency could also be a successful business. Out of my 400 dental clients, I have a few who just do emergency type dentistry. They open long hours and have different associates. Anytime you have a need, when everybody else is closed, these people are there. And people feel loyal to that practice. Once they took care of them when they were in pain, where do they go next time? That practice. So general dentistry should be the bread and butter — one of the five things that many practice owners should focus on. Because once you have lifelong patients, they refer their kids, they refer their family, they refer their friends. Even when they move out, they come back because they love you and you are their dental family.

Naren Arulrajah: So these are some examples of who you want to be a hero to. Pick five, pick four, pick three, and really zoom in on them. Then really start asking — if I’m that patient who’s afraid to go to the dentist because of the pain associated with it, am I the one these patients are finding? Is my practice the one these patients are finding regardless of what keywords they type in? Are you showing up? Are you convincing them on that landing page that you are the best practice for them? Do you have videos that really help them fall in love with your practice? Do you have cases — dozens of them — showcasing how you’ve transformed someone’s life with Invisalign? What about your reviews? When I go to your reviews for sedation, are people repeating pain-free again and again?

Naren Arulrajah: When I go to your sedation pages, do I see reviews that talk about how they were afraid to go to a dentist and how they love coming here now? Connecting the dots across these four or five groups of people — every step of the way — whether it’s them discovering you, finding you, falling in love with you through the videos and the cases, and then finally reviews that confirm you are who you say you are. You are truly that sedation dentist. You are truly that Invisalign for teens dentist. And it’s not just you saying it, but the whole story adds up.

Naren Arulrajah: And of course it doesn’t finish there. The phone call comes in. How is the phone experience? When I call about sedation, is that person on the phone empathizing with me, really making me feel at home and making me feel like I made the right decision calling your office? So it’s just connecting the dots. Put yourself in the shoes of the patient and start looking at your website, your SEO, your phone experience, your reviews, and ask — is it all an A-plus for each one of those four or five groups of people I want to be a hero to? It sounds so simple, but nobody does it. Those who do it are running four, five, six million dollar practices because they figured it out.

Don Adeesha: So really packaging that value proposition as outcome-based rather than treatment-based is key here. Because a patient might be searching for, I have a broken tooth, I’m afraid of pain. They’re not searching for sedation in the clinical terms used internally. But if you’re able to show up for those exact words they use, that’s where the connection happens.

Naren Arulrajah: This is why it’s not just one keyword, it’s 30, 40, 50 keywords. Because you don’t know what the patient is going to type in. They could be typing Invisalign gone wrong because they’ve seen a horror story of a friend. So whatever the fears they have, whatever the questions they have, they’re going to type it in. You better be the one that keeps showing up again and again, not just for one keyword but for 50 keywords related to that thing. In a big city like New York, it could be a two-mile radius. In a small town it could be a hundred-mile radius. In that community, you better be the one that shows up for 40 to 50 keywords related to that particular service and that particular group of people.

Don Adeesha: Now Naren, some dentists try to offer everything to everyone. Why can positioning around certain treatments or patient groups be more effective?

Naren Arulrajah: We have heard this as children — when you try to be everything to everyone, you accomplish being nothing to anyone. And I see the same mistake that a lot of practice owners make. They just wake up one day, go to a conference, learn about X Y Z, and want to do X Y Z. But all the other things they already started — whether it’s Invisalign or sedation — when I look through the lens I just shared, which is are you dominating SEO, are you ranking for 40 to 50 keywords, is your landing page compelling, does it have videos that make me like you, does it have cases that make me believe in you, does it have reviews that tell me you are really good at that thing — the answer is F. So what’s the point of adding one more thing when you’re not already doing well at the four or five buckets you said are your top priorities?

Naren Arulrajah: If you can’t do all five, start with one. Fix all the problems with that one group of patients first. Whether it’s sedation, whatever it is. Get that done, get all pieces of the puzzle figured out, then go to the next one. It’s so much better to be really good at two or three things versus failing at all things. That’s why you end up with the mediocre practice that’s barely surviving, barely paying their bills, where the doctor is a slave to the practice versus the practice enriching the doctor. Everything changes when you really get good at this.

Don Adeesha: And that’s the end goal for a lot of our listeners here — to really have the practice enrich the doctor’s lives. Now Naren, how does visual branding and consistency play a role in making a practice memorable?

Naren Arulrajah: Visual branding and consistency is important for a couple of reasons. People today are very distracted. It’s so easy to distract someone. And the book I would recommend all of you read is called Don’t Make Me Think. It’s the bible on usability and user design for the internet by Steve Krug. Very tiny book, less than a hundred pages, easy to read. But what he’s saying is you don’t want to be distracting people.

Naren Arulrajah: So if you don’t have a brand guide for your website — all your headlines should have a certain color, a certain font, a certain size, all your call-to-action buttons should look a certain way — what branding guidelines means is you have consistent information you’re using to brand yourself. Consistent fonts, consistent colors. We do that with every one of our clients. Every single client has a brand guideline and everything we do is based on that. That way you don’t have to re-ask the same question every time you add a new page. The advantage is you are not distracting your clients.

Naren Arulrajah: Imagine if I go to one page and the heading looks one way, and on a different page it looks a different way. I get confused. I’m going on a tangent versus staying on point and trying to get what I want, which is — is this the right practice for me, and how do I call them and book an appointment? You want them to not get distracted. Not having consistent branding guidelines is a wonderful way to distract them in a way that does not work in your favor. I really believe in having branding guidelines and branding standards.

Don Adeesha: And that consistency really fosters trust.

Naren Arulrajah: Absolutely. Because then they know that you’re professional. Everything you do, you do it consistently. Why do people go to McDonald’s? Even though everyone knows McDonald’s doesn’t sell the best burgers — because it’s consistent. They know what they’re going to get. Even if you’re in Japan or a different country and you feel like you want a burger, you go to McDonald’s because at least you’ll know what you’re going to get. That’s why they are a multi-billion dollar company with billions of customers every year.

Don Adeesha: Now Naren, we understand it’s not all about me but rather about the top five groups of patients our clinics really want to be a hero to. What is the ideal patient buying process, and where do practices go wrong?

Naren Arulrajah: So let’s say you have identified your top five groups of patients. Step one of the buying process is they have to find you. Let’s say Invisalign for adults is one of those groups. When they type in those keywords — 40 to 50 keywords related to Invisalign in your community — are you showing up at the top of Google? Google controls 95% of the market. So when you get an A with Google, you’re pretty much covered. Don’t ignore ChatGPT and the other search engines because they also matter. But still 95% is Google. Are you ranking for 40 to 50 keywords in each one of those top five groups? Having done this for 19 years, most of you will get an F. You’re not even ranking for five keywords for these things. Fix it.

Naren Arulrajah: Don’t sit on it. Because if you don’t fix it, your next tomorrow, your next month, your next quarter is going to be as bad as your last one. Second — when I go to that landing page, do I see a welcoming video? Hey, I’m Dr. Smith. I’ve been helping adults with Invisalign for the last 12 years. Look around my webpage, you’ll see many different cases. We would love to help you — call our office. Simple. Just make people feel welcome. Just say hello using simple language. That’s the beauty of video today. In the old days, video meant sending someone a tape. Now they can watch your videos on a mobile phone anywhere, anytime. Use it. Take advantage of it.

Naren Arulrajah: Of course, highlight those cases. There should be four to five cases where you can walk people through — this is what the patient looked like, this is what they look like now, this is what we did. Simple cases. Four to five. The more the merrier. If you have 15, that’s better than 10. If you have five, that’s better than one. Keep at it. So once you figure out your four or five key areas you want to dominate, build those cases and build the SEO so you want to get to an A. If an A means ranking for 40 to 50 keywords, where am I today? If an A means a dozen before and afters, where am I today? Keep at it.

Naren Arulrajah: The next piece is Google reviews. Do you have reviews that talk about this particular thing on a consistent basis? And do you keep getting more and more Google reviews? The only area where I think most practices are doing okay. Try to get at least 10 love letter reviews every month. They’re doing okay in terms of getting reviews, but they’re not getting paragraph or love letter reviews. So continue to get love letter reviews. Try to get 10 or more five-star love letter reviews every single month.

Naren Arulrajah: And last but not least is the phone experience. The average dental practice in the US is only booking one out of three new patients — 33%. That means if you’re getting a hundred new patients calling your office, especially for high-value services, very few are booking. Why? Your team doesn’t know what to do. Nobody’s tracking them. Nobody’s telling them how good or bad they are. So they just keep doing what they did yesterday and getting the same results. One out of three booking today, one out of three booking tomorrow. One of the things we do for our clients is track the calls, tell them what their conversion rate is, and when they’re not doing well, help them improve. The benchmark is 70%. At least 70% of your new patient calls should be booking an appointment.

Naren Arulrajah: To summarize — are you ranking on SEO? Most of you will say no, you’re not ranking for 40 to 50 keywords in each one of those groups. Second, how’s your landing page? Most of you will not have a dozen before and afters. Most of you will not have a simple welcome video. Third — Google reviews — you are doing well. Keep getting more, but try to get paragraph-level reviews. And the last one, which most of you are also getting an F on, is conversions. The average in the US is one out of three. Get it to 70%. Find out what your conversion rate is. Your marketing company should be providing this. Fix these things and you’re going to do really well. Don’t fix these things and you’ll go in circles.

Don Adeesha: Really appreciate you for sharing those benchmarks with our listeners there Naren. Let’s say for at least three of the five areas, our practice owner is doing poorly. Where should they start?

Naren Arulrajah: I think it’s very hard for human beings to find their own problems. So I would say book a marketing strategy meeting and have our team help you find out for your top five procedures, or top five groups of customers you want to be a hero to, how are you doing with SEO? Are you ranking for 40 to 50 keywords in each one? If you’re ranking really well, that’s great, keep doing what you’re doing. But I guarantee you 90% of you are not doing well — I’ve done this for 19 years and I know what the state of things are. That’s where I would start.

Naren Arulrajah: The second is look at your landing pages. Again, the marketing strategy meeting. Book that meeting. We’ll help you understand how you’re doing with your landing pages. Not only will we look at you, but we’ll also look at your top competitors so we can compare and contrast and say, what can we learn from them? What are they doing better than us? What are we doing better than them? So we can customize our plan to get the most out of it. I think booking that marketing strategy meeting — the link is lessinsurancedependence.com/msm — is the best way to go about solving this. That would be my recommendation.

Don Adeesha: Amazing. Thank you very much Naren for that wonderful insight. And that is a wrap for this episode on the Less Insurance Dependence podcast. Thanks for listening in and we’ll see you on the next one.