How much should you spend on gifts for referring doctors?

Set a modest baseline that every referring office gets, add more where there are more people to thank and deeper relationships to keep up, and keep every gift a thank you rather than a payment for a referral. In a 2017 Ohio survey in The Angle Orthodontist, general dentists reported an average of $860 a year in gifts from all the orthodontists they work with, or about $320 among those who did not also get free or discounted treatment (Angle Orthodontist, 2017).

What does the research actually say about gifts and referrals?

The best data comes from a study published in 2017 in The Angle Orthodontist by Al-Mahdi and colleagues, who surveyed general dentists from the Ohio State alumni list and got 254 valid responses (full text). A few findings worth knowing:

• Gifts are normal. 85% of the dentists said they had received gifts from an orthodontist.
• Most gifts are small. Treats like cookies, bagels and flowers were by far the most common. Gift cards, restaurant meals and holiday open houses each came up for roughly a third.
• Bigger referrers got more. The number and value of gifts correlated with how many patients a dentist referred. The authors are clear that this "does not imply causation." Busy referrers may simply get thanked more often.
• Quality comes first. 83% ranked quality of outcome and patient satisfaction as their top reason for referring. Discounted treatment for the dentist, family or staff, and low treatment fees in general, ranked among the least important reasons.

A January 2025 JCO editorial lands in the same place. Citing a 2022 study in the American Journal of Orthodontics and Dentofacial Orthopedics, it notes that dentists mainly weigh treatment quality and patient satisfaction, and gifts have little effect on whose referral pads make the cut (JCO, 2025).

How do you set an annual gift budget?

Start with last year's referrals by office. Pull the referral report from your practice software and list every office that sent at least one patient in the last 12 months.

Then pick a yearly total. There is no industry standard figure, so base it on what you spend today and what a typical referred case is worth to you. Keep in mind the survey averages are what one dentist got from every orthodontist combined, not one practice's spend. Split your total three ways:

1. A baseline for every office. Every referring office gets the same small amount, enough for a holiday treat for the team and a handwritten card.
2. A top up for deeper relationships. Extra for larger offices and long standing partners, because there are more doctors and staff to thank and more visits planned there.
3. A welcome fund. Money set aside for new offices and new associates who have not referred yet, so meeting them never competes with thanking your regulars.

How should the budget scale by tier?

Here is a fictional example. Picture a practice that sets aside $5,000 for the year and sorts its offices into tiers by how many people there are to thank, how long they have worked together and which visits are planned. Gift value should never be set by, or change with, the number of patients an office refers.

The numbers are invented. The shape is the point: nobody who sent you a patient goes unthanked, and new offices have money waiting for them. When an office's referrals dip, keep its baseline in place and treat the dip as a reason to visit, not a reason to stop. Our guide on why a dentist stops referring covers that conversation.

Recheck the tiers every quarter. Offices add doctors, new ones appear, and the budget should follow.

How do you track who got what?

Keep one running list per office with the date, the gift, the cost and who delivered it. That way one office doesn't get three holiday baskets while a newer referrer gets nothing.

Pair each gift with a personal note or a short text from your own phone; our thank you text templates for referring dentists make that quick.

What keeps a gift on the right side of the rules?

A gift should thank a relationship, not pay for a patient. A few guardrails worth following:

• Never tie a gift to a specific referral. The Angle authors point out that the ADA and many state dental boards forbid fee splitting, and they call a gift for each referral "certainly problematic."
• Skip free or discounted treatment. The same authors argue that free or discounted orthodontic care for a dentist, family or staff goes beyond an appropriate thank you.
• Know your patient mix. The federal Anti-Kickback Statute covers anything of value given to induce or reward referrals of services paid by Medicare, Medicaid and other federal programs (HHS OIG). If you treat Medicaid patients, ask a healthcare attorney how it applies to you.
• Check your state board. Rules on gifts and referral arrangements differ by state.

None of this is legal advice.

Common questions

Should the whole team get a gift, or just the dentist?

The front desk and hygienists often decide which card goes in a parent's hand, so many practices plan team gifts like breakfast or a lunch alongside anything personal for the doctor. Count both against that office's line in the budget.

Every referring office and every new one, on one list

Occlu reads the referral reports you already export, so you can see every office that sent a patient this year, and it flags likely new offices nearby to welcome. To try it, become an Occlu founding practice.

Or email us at info@getocclu.com

Sources

• PubMed Central: PMC8384365
• The Angle Orthodontist (2017): Gifts from orthodontists to general dentists
• Journal of Clinical Orthodontics (PDF)
• HHS OIG: Fraud and abuse laws