1. No net growth in active patient base.

Every practice will have active patients that become inactive for various reasons. Let's say a practice acquires 200 new patients each year, but every year about 200 patients become inactive. The result is zero net growth to the active patient base. Eventually practice revenues will stagnate. Fee increases will only take this practice so far. You cannot keep increasing fees to drive revenues or you will price yourself out of the market.

2. Competition coming into an area that was previously a better market.

Many practices in great market areas can grow themselves without any help from us. But, if the market area you are in is that good chances are it won't be a secret for very long. Other dentists will move into town and set up shop. If the area has normal new home growth each incoming dentist represents a degradation of the overall doctor/patient ratio. Therefore there are fewer quality new patients to go around.

3. Competition starting to become more effective marketing/promoting their own practice.

Don't be alarmed when you see other dentists in your area marketing their practice. It doesn't mean their marketing is effective! There's about an 80% chance they are just trying a few things on their own to see what works and what doesn't. The bottom line is they're doing something (effective or ineffective) to promote their practice. This is another indication that the doctor/patient demographic in the area is getting worse and more dentists are becoming proactive in their advertising efforts.