management & marketing

©2012 JCO, Inc. May not be distributed without permission. www.jco-online.com

MANAGEMENT & MARKETING This column is compiled by JCO Contributing Editor Robert S. Haeger, DDS, MS. Every few months, Dr. Haeger presents a successful approach or strategy for a particular aspect of practice management. Your suggestions for future topics or authors are welcome.

Have you ever wondered what percentage of your patients comes from Internet exposure? Has your practice entered the world of social networking? Do you have a business Facebook account? If so, what kinds of material should you include on Facebook, and who is your target market? If not, how many of your colleagues are already using social networking as part of their marketing plan to attract new patients? These and other important questions are explored by Drs. Jamie Haas and Jae Hyun Park in the following column about social networking in orthodontics. The authors present a fine overview of how Facebook and other social media can bring potential patients to you and then direct them to your website for more detailed information. I would encourage you to learn more about these social media, track your new patients to see how they found out about your office, and determine your return on investment. This will provide valu-

Dr. Haas

Dr. Park

Dr. Jamie Haas is a postgraduate resident and Dr. Jae Hyun Park is Associate Professor and Chair, Postgraduate Orthodontic Program, Arizona School of Dentistry and Oral Health, A.T. Still University, 5835 E. Still Circle, Mesa, AZ 85006. Dr. Park is also an International Scholar, Graduate School of Dentistry, Kyung Hee University, Seoul, South Korea. E-mail Dr. Park at [email protected].

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able insight into the effectiveness of your computer presence and help you decide what to modify in the future. RSH

Orthodontic Marketing Through Online Social Networks

S

ocial-networking services such as Facebook, YouTube, Myspace, LinkedIn, and Twitter* are used not only for interpersonal exchanges among members of an online community, but for job networking, entertainment, and targeted marketing.1,2 The largest social-networking site, Facebook, was started in 2004 as a way for college students to communicate and connect; as of December 2011, Facebook reported more than 845 million monthly active users, making it the largest socialnetworking site in the world and the most visited website in the United States.3 Altogether, users spend more than 700 billion minutes per month on Facebook.3 Some of those minutes are spent viewing business fan pages—basically, interactive websites where people can communicate with businesses they frequent and “like”.4 As on a personal profile, a business page can be enhanced with applications that help the company engage with its audience and capture new audiences through friend recommendations, News Feed stories, Facebook events, and other means.3 *Facebook, Menlo Park, CA, www.facebook.com; YouTube, LLC, San Bruno, CA, www.youtube.com; Myspace, Beverly Hills, CA, www.myspace.com; LinkedIn Corporation, Mountain View, CA, www.linkedin.com; Twitter, Inc., San Francisco, CA, www.twitter. com.

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Fig. 1 Respondents’ reasons for not using social networking.

More and more businesses are moving be yond websites and using social networking to help advertise and market their services.5 Because of the interactive nature of the Internet, marketing is no longer a one-way communication between the business and consumer; the consumer now has a chance to respond on a personal level.6 We designed a survey to determine the prevalence of online social-networking programs among orthodontic practices and to help clinicians decide whether it would be advantageous to market their practices through such programs.

90 were female; there was a fairly broad distribution in terms of age and years in practice. Some 63% of the respondents had their main practices in large cities or metropolitan areas, and 68% said they practiced in communities with an average annual household income of $25,000-75,000. About 46% of the orthodontists reported 101-250 patient starts per year. Nearly 90% stated that more than half of their patients were children under age 18. By AAO constituent society, the largest geographic representation (24%) was from the Pacific Coast Society of Orthodontists.

Methodology

Use of Social Networking (Table 2)

A survey containing 25 questions regarding demographics and marketing through online social networking was administered by the AAO Gradu ate Research program, sponsored by AAO’s Part nership in Research program. This anonymous and voluntary survey was sent by e-mail to 2,447 AAO members; 455 orthodontists responded, for an 18.6% response rate. Analysis was conducted using Microsoft Excel 2007.** Results Demographics (Table 1) Of the 455 respondents, 365 were male and

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Fifty-five percent of the respondents reported using social networking to market their practices. Of this group, 60% had started using social networks within the past year, and another 30% had been using them for only two years. About 69% of the respondents who reported using social networking said they would recommend it to other colleagues, and fully 95% of all respondents thought the use of online social networking among orthodontic practices would increase in the future. A lack of knowledge about social networking was the most commonly cited reason (44.2%) for not using it (Fig. 1). Non-users also had privacy concerns (26.3%), were too busy to look into it **Microsoft Corporation, Redmond, WA; www.microsoft.com.

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Haas and Park

TABLE 1 DEMOGRAPHICS

TABLE 2 USE OF SOCIAL NETWORKING

Sex Male Female

80.2% 19.8%

Age < 30 30-39 40-49 50-59 60+

1.8% 22.4% 23.5% 30.1% 22.2%

Years in Practice 0-5 6-10 11-20 > 20

17.1% 10.9% 23.3% 48.7%

Size of Community Rural (less than 20,000) Small city (20,000-50,000) Large city (50,000-500,000) Metropolitan (more than 500,000)

9.2% 27.4% 32.3% 31.1%

Average Household Income of Community Less than $25,000 1.2% $25,000-50,000 32.1% $50,000-75,000 35.8% $75,000-100,000 21.9% > $100,000 9.0% Average Number of Patient Starts per Year 1-50 5.6% 51-100 11.9% 101-250 45.6% > 250 36.9% AAO Constituent Society Pacific Coast Southern Midwestern Great Lakes Northeastern Middle Atlantic Southwestern Rocky Mountain


24.4% 17.3% 14.4% 12.4% 10.4% 9.5% 6.9% 4.7%

Users of social networking to market practice 55.0% Non-users: Plan to start 29.3% Do not plan to start 30.3% Not sure 40.4% When usage started: Within the past year 59.7% 2 years ago 30.5% 3-5 years ago 9.0% > 5 years ago 0.8% Users who would recommend to colleagues: Yes 68.8% No 3.4% Not sure 27.8% Respondents predicting future orthodontic usage will increase 95.0%

TABLE 3 MARKETING AND SOCIAL NETWORKING Users who have discontinued other forms of marketing: Yes 16.5% No 75.3% Plan to in future 8.2% Type of marketing to be discontinued: Yellow pages 76.8% Newspapers 33.9% Fliers 16.1% Magazines 14.3% Change in number of new patients: Increase 22.7% No increase 36.1% Not sure 41.2% Increase in new patients: 1-5 per month 85.2% > 5 per month 14.8%

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(24.2%), or felt there was no need (22.1%). Miscel laneous reasons for not using social networking (28.4% in all) included: nearing retirement, practicing at an educational institute or hospital, never advertise, do not agree with advertising, and just not sure of how effective it would be. Most respondents reported that the orthodontist (33.3%) and/or a marketing person (33.8%) ran their online social-networking programs (Fig. 2). A few used their treatment coordinators, frontoffice staff, associates, or the company Sesame Communications.*** Marketing (Table 3) Virtually all the respondents using online social-networking programs (99.1%) said they were on Facebook (Fig. 3). The next most common

form of social networking was YouTube (35.8%), followed by blogs; the least used program was Myspace (4.3%). Three-quarters of the respondents who used social networking for marketing had not discontinued their use of other forms of marketing, al though about 8% were planning to do so in the future. By far the leading candidate for discontinuation was advertising in telephone yellow pages. When asked if online social networking had increased their numbers of new patients, only 23% of the users thought that it had, while 41% were unsure. Of those who felt that social networking had brought in more new patients, 85% estimated the increase to be one to five patients per month. ***Sesame Communications sesamecommunications.com.

Inc.,

Seattle,

WA;

www.

Fig. 2 Managers of orthodontic social-networking sites.

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TABLE 4 SOCIAL NETWORK USAGE BY AGE AND COMMUNITY SIZE

Usage

Greatest Reason for Not Using Social Networking

Community Size Rural (under 20,000) 41.0% Small city (20,000-50,000) 57.6% Large city (50,000-500,000) 60.1% Metropolitan (over 500,000) 51.9%

Privacy Concerns (43.5%) Lack of Knowledge (45.8%) Lack of Knowledge (45.3%) Lack of Knowledge (44.6%)

Age < 30 75.0% 30-39 72.0% 40-49 53.4% 50-59 54.9% 60+ 34.5%

Not specified (100.0%) Too Busy (45.8%) Too Busy (35.4%) Lack of Knowledge (50.0%) Lack of Knowledge (56.1%)

Discussion Several authors have addressed website de sign and mass-media advertising in orthodontics, but none has yet studied the use of social networking.7 Paquette described methods of incorporating technology into the orthodontic practice, advising readers not to forget about social-networking venues that can be linked to practice websites.8 Revan kar and Gandedkar discussed Internet communication via e-mail and video interaction, concluding that technology is always evolving and that administrative efficiency is the key to productivity.9 In our study, the percentage of orthodontists using social networks in rural areas (41%) was well behind the percentage of users in large cities (60.1%). The main reason given by rural practitioners for not using social networks was privacy, as opposed to lack of knowledge among orthodontists in larger communities (Table 4). As might be expected, there was a correlation between practitioners’ ages and their use of online social networking—only 34% of respondents over 60 reported using social networks, and 56% of this group cited lack of knowledge as the main reason. The highest rate of social-networking use was in the under-30 age group (75%, but representing less than 2% of all respondents), followed by the 30-39 age group (72%). There may have been an inherent bias toward computer-savvy respondents in this study because it was conducted online and the response rate was relatively low. Still, there has been a noticeable trend toward social networking among younger orthodontists. Regardless of age, 95% of the practitioners surveyed felt that the marketing of orthodontics through online social networking would


increase further. Social networking is an excellent way to interact with patients and their parents. It has been estimated that 3.9 million women with children use the Internet for social connections through blogs and networks.10 One of the fastest-growing demographics on Facebook is women age 25-44,3 which would include the majority of mothers seeking orthodontic treatment for their children. By capturing the interest of both children and parents, social networking can become a successful marketing tool for an orthodontic practice. In our study, almost every orthodontist who reported using social networking was on Facebook. Nearly half of these users reported offering raffles or prizes on their Facebook pages, and 70.4% posted pictures of their patients or orthodontic cases. A number of offices (32.7%) even included patient-education sections on their Facebook pages. Other sites, such as YouTube, allow orthodontists to post educational videos. Some practices make daily or weekly updates on Twitter or blogs. While the majority of orthodontic practices still depend on their websites for online communication, many are beginning to augment these sites with social networks. A major difference between websites and social-networking programs, however, is that social-networking participants are no longer passive spectators, but can express their opinions—which can be a double-edged sword.4 Of course, the administrator has the power to remove inappropriate or extreme comments. A practice might even learn new ways to improve its patient management and care. Our study indicated that 26.3% of people who do not use social networking are concerned primarily about privacy (Fig. 1). Facebook business

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Fig. 3 Most-used social-networking programs.

pages do offer certain privacy controls, and a page administrator is able to warn a fan, remove a fan, or permanently ban a person from the page and remove all content that person has ever posted.3 On the user side, administrators do not have access to the personal accounts of Facebook users or other content that does not reside on their business pages, which should alleviate any concerns about privacy on the part of patients. Another reason given by respondents for not using social networking to market their practices was simply that they do not agree with marketing and advertising orthodontics in general. This may not be surprising, considering that the ADA did not amend its code of ethics to remove restrictions on advertising until 1979.11 Since then, the number of orthodontists who market their practices through mass media and other means has been gradually increasing. Some practitioners believe advertising devalues the quality of their treatment in patients’ minds, but Edwards and colleagues found that the majority of patients did not have a negative association of media advertising with the quality of orthodontic care.11 Still, orthodontists are always well advised to maintain a professional posture in all forms of marketing.12 Social networking is actually less about marketing and more about interaction. It enables practices to engage and communicate with their

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patients about new treatment technologies, events, contests, or anything of interest.13 As our study indicates, it is a growing trend that will only be come more significant in the near future. REFERENCES 1. Clark, L.A. and Roberts, S.J.: Employer’s use of social networking sites, J. Bus. Ethics 95:507-525, 2010. 2. Thompson, L.A.; Black, E.; and Duff, W.P.: Protected health information on social networking sites: Ethical and legal considerations, J. Med. Internet Res. 13:1, 2011. 3. Facebook Fact Sheet, http://newsroom.fb.com. 4. Holzner, S.: Facebook Marketing: Leverage Social Media to Grow Your Business, Que Publishing, Indianapolis, 2009, pp. 5-17. 5. Dunay, P. and Krueger, R.: Facebook: Marketing for Dum mies, Wiley Publishing, Inc., Indianapolis, 2010, pp. 10-11. 6. Meadows-Klue, D.: Falling in Love 2.0: Relationship marketing for the Facebook generation, J. Direct Data Digit. Mktg. Pract. 9:245-250, 2008. 7. Wallin, W.S.: Does your web site draw new patients? Am. J. Orthod. 136:746-751, 2009. 8. Paquette, D.E.: Use of technology in the orthodontic practice: A day in the life, Am. J. Orthod. 136:607-610, 2009. 9. Revankar, A.V. and Gandedkar, N.H.: Effective communication in the cyberage, Am. J. Orthod. 137:712-714, 2010. 10. Joshi, P.: Harnessing the power of the mom blogger, N.Y. Times, March 15, 2011, p. B3. 11. Edwards, D.T.; Shroff, B.; Lindauer, S.J.; Fowler, C.E.; and Tufekci, E.: Media advertising effects on consumer perception of orthodontic treatment quality, Angle Orthod. 78:771-777, 2008. 12. Greco, P.M.: Truth in advertising, Am. J. Orthod. 139:429430, 2011. 13. Pattison, K.: How to market your business with Facebook, N.Y. Times, Nov. 11, 2009.

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