The Rule of 40–40–20

Dr. Tyler Williams



Have you ever been solicited by an “online marketing“ company that claims “we are your one stop shop. We do it all!” 

Sound familiar?

If you haven’t yet, it’s only a matter of time. The problem with this claim is two things: one, there is no such thing as online marketing. Online is a technology, not a business. Two, be wary of people who claim that they are the one stop shop. As a dental professional, you know that even in a general practice, there are certain things that you will and won’t do, or are better served by another type of healthcare professional.

The same goes for marketing. On my team, I have multiple players: a copywriter, several virtual assistants, a printing company, a website company, and multiple other key team members and vendors to make everything work like a well oiled machine. I would not put all of my eggs in one basket, nor would I trust one company to handle all of these things. Plus, I keep two vendors in several categories because “one is the loneliest number,” and if one goes out of business, changes policy, or drops their service, I can’t afford to be hung out to dry. Neither can you!

If all of this sounds too complicated or painful, you aren’t marketing correctly. The bad news: you are leaving money on the table and patient needs unmet. The good news, however, is you have lots of opportunities available to you!

If you aren’t willing to learn to do this, or hire someone who will, you simply shouldn’t be a practice owner in 2021! Marketing is not selling. It isn’t pushy, or sneaky. Following up with your patient to see how they feel after an extraction or implant IS marketing. It’s building relationships and trust over a period of time. 

It’s better to be specialized, such as being a doctor of the mouth, rather than being generalized, such as a doctor of the entire body. When you specialize or when you niche out the services you do best, you are of greater value to your patients and customers. I’m not necessarily talking about being a board-certified dental specialist (although that is one way to do it), but rather to have certain areas of dentistry that you love and are well known for. When you do this, you will be happier, and you will make more money personally, and to share with your team. You will find satisfaction in your work and you are more fun for your team to be around. 

There’s an old marketing rule that still holds holds true today, which is the rule of “40–40–20.” It was created by Ed Mayer in the “Mad Men” era of advertising. This marketing rule suggests that 40% of any marketing piece you put out, whether online or off-line, is your list. The next 40% is the offer you make, and the final 20% is the creative (graphics, design, photos, etc).

Let me give you an example: each year, we send out an end-of-the-year “use it or lose it insurance campaign.” Although my office is not insurance driven, we are insurance friendly and we want the best care for our patients. Often a simple reminder of what our patients lose if they don’t act before December 31 is appreciated and helps them get one step closer to their ideal smile.

We’ve had as high as a 16:1 return on campaigns like this. You’d be hard-pressed to find that kind of return, that fast, anywhere in the stock market, or in real estate, or in some other speculative investment that too many dentists get trapped and lost in.

Here’s how the campaign works:

First, we send out a text message and an email to our list (remember, the most important and first 40% of the marketing campaign is the right list) and after we filter out people who are no longer interested, have moved, or opt out of the campaign, then we send out the direct mail piece a few weeks later. This could be a letter, or something creative that grabs their attention. 

Fear of loss is a huge motivator for people, so by simply calling your patient to let them know that as long as they act before November or December, you can squeeze them in and get their benefits utilized, then people are happy and appreciative of what you are doing.

By the way…

The reason that the 40% (your list) is so important, is that sending the right message to the right person is the key to a great campaign. Ensure you filter out your uninsured patients from this list because, they will just flag your email or letter as spam or not relevant, and may lose interest in anything else you send them because it makes the message much less personal and loses its luster really fast. Instead, make an alternative offer for your non-insured patients, such as to join your membership plan or savings club for the year and to give out an extra bonus like a tooth whitening toothpaste, or something similar.

Rule #1 of Marketing: Don’t ever be boring or you’ll lose the attention of your audience fast!

The email/text message (40% part of this formula, the offer) goes something like this:

“Hey Mary, this year is flying by! We noticed that you may still have some unused dental benefits that will expire when this year ends. If you’re still interested in a great new smile, contact us before November 1 so we can fit you in and maximize your benefits before they’re gone. Give us a call or reply to this message if you have any questions.”

It’s that simple and it works!

Now go out and do something about it!

Get your team together and make a game out of it, where you buy lunch, or have some kind of cash incentive or whatever for getting a set amount of patients into your office before the year ends. Help your patients save more of their teeth and avoid more root canals!

It’s a win-win-win for you, your patients, and your team. If you really want to take it to the next level, send a follow-up letter to those who don’t respond. Just because someone doesn’t respond, it definitely does not mean they’re not interested. Like you, they are busy with day-to-day life and sometimes they just need a few extra reminders.

Everyone responds differently to different types of media (the final 20% or creative part of your marketing). 

Hope you have a great rest of your year!


Dr. Tyler Williams is the founder of both Pinecrest Dental and Pinecrest Practice Growth. He is a proud husband and father of three.

He has written numerous articles for the Utah Dental Association, Dentistry Today, and Dental Economics. He is the author of three books, The Owner’s Guide to a Productive Dental Practice: 7 Pillars Every Dentist Needs to Grow in the New Economy, Reason to Smile: 11 Keys to your best oral health ever, and The Consumer’s Guide to Dental Implants: 3 Keys Every Adult Needs to Know About a Smile Transformation which can be found at major bookstores and on He is a real, “wet fingered dentist,” and has completed thousands of dental implant and restorative procedures.

Dr. Williams has been featured on ABC’s Good Things Utah, NBC News Radio, the ForbesBooks Radio podcast, The One Thing marketing podcast, Sirius XM Radio, UK Health Radio, KTALK Utah radio and in several national dental research publications, including reviewing articles for the Academy of General Dentistry’s General Dentistry journal. He has several published articles in online and print journals, including: Dental Economics, Dentistry IQ, ADA News, Dentistry Today, and The Profitable Dentist.

He has also been recognized as one of the most influential dentists in Utah by Kleer’s list of Most Influential Dentists in America. He also hosts a bi-monthly podcast called The Practice X-Factor.

He is currently the owner of Pinecrest Practice Growth, which helps practice owners create a prepaid dental practice, free of insurance dependency and poor financial health.

(To contact Dr. Williams, please email him at, text/call (801) 268-2323, or visit