I have been thinking a lot about this. I have come to a conclusion... it is not CERAC I have a problem with.
Okay let me tell you about this meeting. It was a presentation that was going to demonstrate CERAC.
Let me back track to about 3 years ago. I went to an all day meeting put on by Patterson to introduce the CERAC. The dude spent the whole day (8 hours) talking about how great the machine was and how much money you can make with this machine. He answered every one's questions about money. What perplexed me is there was almost NO clinical photos. An all day lecture about dentistry and no teeth pictures. There wasn't any talk about how this benefits his patients. There was a lot of talk about how it is only one appointment, (which, don't get me wrong, I think is a HUGE benefit) but time is not something that moves me to make any decision. But that paled in comparison to the money talk.
So I left there with a bit of a bad taste in my mouth.
Since then I have dabbled on Dentaltown. I was a voyeur in the CERAC threads and my opinion really changed. There are some guys that are masters of CERAC. My faith in my fellow man was restored.
I didn't care what they were charging, they were spending time and working to make a product better for their patients. Their was no talk about how much money they were raking in. Only talk about improving their care. There was a lot of pride in their work.
Am I babbling here? Am I making sense? I work hard everyday to improve my product and be fair to my patients. I feel like if I do this well, I will make money. And it really turns me off to hear people talk about my profession as JUST a means to an end. Not a career of treating people and helping them with their dental needs.
Now back to the meeting.
They talk about how doing CERAC was the best decision they ever made. Then they started to show some of the before and afters. I was not impressed.
I was sitting next to a guy that I know that has a CERAC machine (This guy is my friend, I openly talk to him about this). As the dentist is presenting I asked him how is the insurance accepting these. He says that the insurance is only paying on 3/4 crowns and crowns, so you have to charge out everything as one of those. Hmmm?
I asked him how much to do a restoration. He says that everything is the same price regardless of the procedure, $800. Hmmm?
He also says he doesn't do many fillings anymore? Hmmm?
The dentist was doing MOD fillings with CERAC. The dentist was doing OL fillings with CERAC.
I was thinking to myself, "What is wrong with just doing a filling?" and I had some visions of an $800 charge and a little insurance fraud to go with that.
I don't have any problem with doing fillings with CERAC. But are people charging filling prices for fillings?
A different friend was telling me he worked for a dentist that would do CERAC fillings and charge $300 for them. I think this is fair. You are doing a filling that is indirect. You have overhead. A price a bit more than my price for a filling, I have no problem with this.
My problem is everyone thinking this is standard of care. If you are removing a old small DO amalgam, a FILLING is the standard of care. Have we gone away from this and no one has told me?
Now I have showed you some of my work. I can count on two hands how many of my filling I have replaced. I have been doing fillings at this office for 13 years. I have done over 10,000 fillings and have replaced just a few (I understand other people might be replacing them, but...). That is a pretty good clinical study.
I can tell you from a bunch of conversations I have had with other dentists, and the anti CERAC world, the sediment is there is a lot of over treatment going on.
The dentist is told in order to pay for the machine they have to do 13-20 restorations a month. Now don't you think there is a lot of counting going on in some offices?
I may be different, in fact I know I am different, but I don't know how many crowns I do in a month. I have never counted. But I can tell you sometimes I do 15 in a day but I can also tell you I have done 1 in a week. I am a general family dentist so my schedule can look very different day to day. Somedays I will do 3 New Patient exams, a couple of fillings on a child. The next day I could do 3 root canals. The next day I could see an elderly lady that has all sorts of root caries and then see her daughter to do 4 fillings on. I do what comes in. Somedays my production will be $15000 (pretty rare) somedays it will be $1500. I don't really count.
I try to make it so my overhead is not so high so I don't look at the schedule and say, "Damn! only 2 crowns today." (Don't get me wrong, I have some days that the schedule gets me down but it usually isn't about money).
Now, some of the users of CERAC misuese it and ruin it for the good guys. And I know the guys that are doing it right are cringing when people have this opinion about something they love and are passionate about.
They also realize that some dentists are using it for financial gain first and then patient second.
Then at the end of the lecture some guys around me are talking to each other, "Are you going to get one?", "I don't know. Are you going to get one?"
What!!? Did you guys just see the same presentation I did?
I find myself doing a lot more all porcelain onlays and 3/4 crowns qutie frankly, I love doing them. So I start thinking to myself, if I am doing 15 crowns a month by myself or if me and my partner are is are doing 15 together then we would definitely be thinking about a CERAC machine.
I am excited about maybe having a CERAC machine someday. But I can assure you it will not change the way I see teeth. They will still be white not green.
Have a great weekend,
Rest on Sunday,