Wednesday, January 11, 2012

How Much is Enough?

Back in the swing of things, I hope. Well, I am going to get right to it.

As you know, I am going to start lecturing. Every day I think of another way to relay my message about being conservative. I know that money drives people.”I might not make enough if I do this kind of dentistry.” What am I going to say to these people? If you are doing a lot of crowns, you are going to stop? I have to be able to tell them that they can make enough money.

But how much money is enough money? I went to the ADA's research center; they have all this data put together that they will email to you or that you can just look up, and it’s free: I looked up what people make. I figured if someone is doing a bunch of crowns and is making $310,000 and I tell him that the average income of a dentist in his/her area is $180,000, they might see things a little clearer.

If I know the average salary in my region of the country is $179,920 and a dentist is making $250,000, “how much is enough" gets put into perspective. I know, I know. Your pathologist friend is making a lot more than you but guess what. You are not a pathologist, get over it. (That is a shout out for Connie.) Now that this is established, I will go to the numbers.

There is no question that doing fillings is harder on the body than doing a crown. There is no question that you need to do fillings on many more teeth to make the same kind of money that you make doing crowns. Personally, I don't hesitate to do a filling because I believe that it is the best thing for the patient (it is my job as a presenter to possibly get them to agree with me).

Let’s break this down. I schedule 90 minutes for a crown Temporary time is included in this. Then the cementation appointment is usually 30 minutes. So I have two hours in this procedure, and I charge $1200 for a crown. That is easy math: $600 an hour. But don't forget the $200-$275 it takes to make the thing, and then the impression materials. So we’re down to what, about $475 an hour?

Now, all you non-dental people, don't get all crazy. These numbers look great, but don't forget all the insurance we carry, the rent, the employee wages, the employee benefits, electricity, supplies, etc. I am not saying it is bad, but we don't make $475 an hour. I am letting you see behind the curtain. If I get lots of nasty comments, then I won't ever write stuff like this.

Let’s compare this to fillings. On Friday, I did a photo shoot with one patient. It was a perfect example of what we could do with fillings. I took photos of all the stuff we did, of the teeth, and I also took pictures of the clock.

It was a 2 p.m. appointment: 3-MO, 4-MOD, 5-DO. After some normal pleasantries, we got going at about 2:06. Injections and then drilling. I have to admit: these were easy. The fillings were breaking down, but there wasn't too much decay or real breakdown. I took out the amalgams and decay and took pictures at 2:18. Fill 'er up, take pictures. 2:32. Clean-up, finishing, polishing, check occlusion, repolish and then seal. Take pictures. 2:41. They turned out great.

I will say it took 45 minutes. I usually don't schedule this tight so I think his appointment was probably an hour (maybe a little more). But for this exercise, let’s say an hour. In my office, this is $240, $280 and $240 for a total of $760. There was no lab bill, just some supply cost (not as much as impression material). So basically, $760 an hour. Okay, maybe all fillings are not that easy. I did a DO and an MOL this morning that took me 90 minutes. That is $520, which is about $350 an hour. So fillings might range from $346 to $760 an hour.

What if the patient only needs one filling? I usually book 30-40 minutes for one filling. It doesn't take me that long, but I allow time for greeting, anesthetic, filling, polishing, saying good-bye. The minimum filling appointment is 30 minutes. Sometimes it might be a facial filling for $180. Say you do that all day. That is 16 half an hour appointments doing 16 facial fillings. This is a $2,900 day. But don't forget you have broken the rooms down 16 times and you may have had a decent production day, but you are dog tired and your assistant is really ticked at you. I guess there are worse things we could do.

All this to say that fillings are, and can be, profitable. Trust me, I am telling you this from experience.

What do you think? Do you agree?

Hope you are having a great week.



Anonymous said...

John, I appreciate your conservatism and humility. BUUUUUUTTTTT at the same time you have mentioned numerous times about being stressed out about money. To me that means you're not making enough. There are many easier ways in life to help others and make "just enough" money. Why spend all the extra time and effort putting off real life to not be done worrying about money all the time once you get beyond dental school (not to mention the financial risk taken on at all stages in a dentist's lifetime)? If we need to increase reimbursement on direct restorations and decrease it on crowns to make conservative treatment more feasible, then let's do it. Graduating at age 28 with $250,000 of debt does not make me very receptive to the "you're taking advantage of your patients to make more money than you should" sentiment.

Marshall S. Dicker DMD, FAGD said...

i have been reading your amusing and interesting comments for quite a while now.....
i had wanted to respond previously
but never did, even tho i thought some other entries required more,
intense comments.
i dont agree with most of your blogs....but as far as " conservative dentistry " goes....
just practice as if you were in Dental School....when more than 40 % of the tooth is gone due to caries, previous restorations or a combo therein.....
a cast or lab made restoration is
proper, neccessary and required....
you can make all the statements about..." well how can i charge for that " and " i want to be a good for patients finances, what they can afford etc.


when the over restored tooth goes bad....fracture, endo neccesary etc
the patient will remember YOU were the last one to work on that tooth
and YOU are at fault.....

compound it by the patient going to another Dentist, who says " this
should have been a crown originally "......then u are really sunk.

IF you believe Dental School diagnosis and treatment is the highest level of care.....then practice that way now....
you can't go wrong doing that and YOUR way is a slippery downgoing slope.

gatordmd said...

To the first commentor....
First, thanks for commenting. I appreciate you reading and being apart of the blog.

I was trying to explain, which I didn't do a very good job at, is that if you are making $50,000 more than the average dentist in your region and you are still complaining about money....then it could be you.
Your lifestyle is making your job challenging.
When you have bills from your big house and fat car and the top schools and you are stressed about money, then things might have to change at home NOT at work.

So now that you are young making financial decisions at home. Think about what you are going to have to do at work to pay for that.
Home bills start to cloud your judgement sometimes.
I get that. I deal with it all the time.

Thanks again,

gatordmd said...

Now to Dr. Dicker,

First, thank you for being a part of the blog.
I appreciate you and realize that my way is not the only way to do things.
I think it is important for us to help each other and make each other better.

Now to comment on your comment...
"IF you believe Dental School diagnosis and treatment is the highest level of care"
Well, I don't think it is the best way.
I think the fixed prosths books were written 30 years ago.
The perimeters that dictates when a tooth needs a crown is very outdated. It is a good start but definitely outdated .
And I do appreciate your sediment about being the last one to work on a tooth and when it goes bad I am on the hook.
And I totally agree with that, but my stuff is not failing (at least the stuff that I see and that is all I can go on).
They are not breaking. The teeth are not coming back broken in half and unrestorable.
Now, I am not going into this blind thinking that all my stuff is going to last forever.
I will inform the patient. I will explain to them the filling vs crown debate and tell them this is my experience.
They appreciate my explanation and definitely appreciate saving the money.

Thanks again,
Keep reading and keep posting

Dr. Andy said...

Just so you know you can only get the ADA reports if you are an ADA member. For the growing number of us who are not members that link won't work.

Anonymous said...

One more reason to consider becoming a member.....


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