Friday, January 27, 2012

All You Care About is Money

I know, I know. I told you I wasn't going to talk about money again for awhile. Has it been awhile?

Lately, I feel like I am getting some flak for "being expensive" or because "all I think about is money." But I feel like I am a fair, conservative dentist. I try to be the guy that saves people money.

Sure, my exam is thorough and when we are done taking a full mouth series and a Panoramic (which I don't charge for), the exam can be in the $225 range. But I think I am doing a pretty good exam. Perio charting (which most 50-year-olds have never had done), oral cancer screening, looking around, looking at their bite and teeth and joints. We have a sit-down conversation in a consultation room. Patients get my time. Isn't that what patients want? To feel like they are being cared for and not rushed? Or do they just want the $55 x-ray and exam done by the big teeth corporations? I think they want the former.

After I do a thorough exam and find some cavities, I tell them that they have some restorations that are broken (I show them the big broken filling with the intraoral camera; I am not making things up here). And I think that I can do a filling and restore that tooth to good again. No, I don't think you need a crown (which most dentists would do at 500% the cost of a filling).

My fillings are expensive. But are they really? I do a better job than the schmo down the street (if you are a dentist down the street from me, I like you; I am just being creative with my words). I use the BEST products. The filling I do is superior. So I am $20 more than another dentist. Maybe it is $50. Didn't I just tell you that most dentists would put an $800-$1,100 crown on this?

So when I hear from my staff (I never it hear it from the patient. They tell my assistant the person answering the phone) that all I care about is money. WHAT?! Are you fricking serious? I go to the best continuing education. It costs money to have a nice facility and good staff members. And all this costs about $20 more per filling.

Look, I get that money is a big issue. I get that dentistry is expensive. I know. But I feel like some people are killing the messenger. I am who I am. I am the dentist that does really nice work and hopefully the dentist that people go when they want to like their dentist and feel cared for. I am not a regular dentist, and it will cost a bit more. But for patients to come here and say that all I care about is money? Well, that hurts.

I am going to stretch here and tell you I am like the Hilton. The Hilton is a beautiful hotel. They have awesome beds, great sheets and pillows. They have great staff that say, "It is my pleasure." They have things in place to make you feel so good. And after a stay there, you feel special. Then you check out and say, "Man, that was a little bit more than I meant to spend."

Then the next time you try a bargain motel. You don't have a very good night’s sleep. You are just a number there. You get the bill and don't think anything of it. But you start to think, "Remember that Hilton? Yeah that was really was nice."

You can't blame the Hilton for being more than you wanted to spend. We as dentists feel like we are being thorough and find stuff. Then the patient always thinks we are trying to find stuff that doesn't exist (you aren't doing that, are you?).

It might be a bad time for them, I know. But if you look at me through a microscope, you are going to find warts. And maybe I used to just brush it off. Maybe now I am a bit more sensitive to criticism. I don't know.

I am trying to make this place worth the $225 exam and the extra $20 filling. It would be easy to just lower the price and work faster and make people feel a little less special, but I don't want to do that. I want people to say, "Remember Dr. Gammichia? Yeah, he really was nice." Or even better, "I love my dentist and I will stay there forever."

I am not bitter. Just sensitive, I guess. I will keep at it.

Have a great weekend.

Beer me,


Anonymous said...

Just get over it. You will always be too expensive,unless you do it for free. I have found out over the years if you really don't care if the pt does the treatment plan then the pt picks up on that vibe and realizes you don't want just their money. I simple tell them you have a cavity etc, here is the cost let me know when you want to take care of it. We never call people to schedule any treatment except a recall and a reminder of any appointments made. We do not sell anything or brow beat them. The pt must be the one to want the treatment enough to call me. There is no treatment plan coordinator or presenter. It works for us. To tell the truth if the pt doesn't care then neither do I. At this point I really don't need the money so badly I have to persuade someone to give it to me. If they do the treatment great if not that is fine too. You would be really surprised how people can read you.

Dr. Andy said...

By sit-down conversation in a consultation room do you mean not in an operatory? I hope that is not what you mean. That is like being called into the principal's office. Did you like being called into the principal's office when you were growing up?

I know consultants say you should give 1 hour exams and discuss findings in a seperate room. But that is why they are consultants and not successful/busy dentists. Want to be busy? Give the public what it wants. Not what you think they should want.

What do they want? An honest dentist (you're good there) who does the exam and tells them what they need. They do not want a dentist who spends 20 minutes looking around digging for work and then has to talk to them in private.

My 2 cents

Anne said...

First, let me tell you that your blog is very well-written and a joy to read. Kudos to the Academy of General Dentistry for sponsoring the blog and most of all to you for taking the time to write it. Second, I am not a dentist. Having faced some major dental work this year, I set out to do some research and, in doing so, found your blog (I also found another really good blog called The Curious Dentist at

Third, from my viewpoint as a patient you are definitely on the right track. Understanding what the options are, the pros and cons and the outcomes that one might reasonably expect are very important to me. I am willing to pay more for the education. My experience has been that most people mistrust when they are "clueless" and know it. Many people distrust financial planners -- I don't because I have a good working knowledge in that area. I generally distrust auto mechanics, though, because I have no idea whether what they're telling me is accurate. A phrase that has always rung true is the old Syms Store commercial where Sy Syms said “an educated consumer is our best customer.”

At the end of the day, some people are going to appreciate all that you bring to the party (let's call them the thoughtful, intelligent people) and others won't -- and they may be the ones that shop at the discount store either because they must or because they'd rather have more "stuff" rather than the best stuff. Just don't let the turkeys get you down!

Anonymous said...

As a dentist who has been practicing for only 3 years, I have battled this issue several times. I spend more money and time on my CE than on anything else voluntary at this point in my life. I have had to choose between a "great course" and a vacation. All for the sake of improving products, skills and patient care in the hopes that I can distinguish myself from that dentist down the street. I am disappointed however, to find that may not be sufficient for patients to accept higher fees or longer appointments. Patients of this era seem hurried and like the earlier commenter mentioned, skeptical(or confused) of too much information or simply don't care whether you use the Triodent matrix or a Toffelmier (It's been so long, I can't even spell that!). They care about how long the appointments/treatment will last, and how much will they have to spend in order to still be able to afford the huge TV they had planned for Christmas.

I practice like you do, but I'm starting to think that the "extras" in our care may not be as fruitful as I once thought they were.

gatordmd said...

I have definitely had a better week.
I wanted to share this email I received last week.
This email reenforces everything you and I are trying to do.


Just wanted to send you a note thanking you for exceptional service and
staff you have. I started out taking with Michelle and Heidy who were very
helpful, then had Kellee perform my services and she is quite remarkable in
how she performs her job.

The exam and talk we had before I had anything done also was a pleasant
surprise. In all my years of going to dentist's, I have never had a dentist
sit down with me and explain what you would be doing, looking for, etc.

You have a first class operation and people and you have a new patient for
as long as I'm in the area! My wife will be visiting and become a patient
soon as well.

Over the last few years we have experienced quite a bit of financial
hardships and turmoil due to the industry I'm involved in. We are still
uninsured but working towards obtaining insurance again and hopefully we
will have soon. I knew I needed dentist attention since it had been a couple
of years since I had been to a dentist. I couldn't be more pleased about
your people and operation and wanted to let you know.

Thanks for making an unpleasant experience actually pleasant! Or at least
more pleasant than anticipated.

Wow, huh.
So not only do we get patients that reject our way but also other dentists telling us the way we are doing it is stupid.
Then you get one of these letters.
Hope this helps.


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