Wednesday, April 18, 2012

I Can't Afford You

Hey everyone,

I hope things are going good for you. It has been crazy here. I am speaking on Friday, so I am so freaking out. I added some new material about the science of bonding and (I don't know if you know this), but I am not that scientific. So I have to learn this stuff and I am totally going out of my comfort zone. But then I move on down and talk about composites and realize I don't really talk about science here. That means I am going to have to learn this, too. I just want it to be great.

Anyway, it seems I forgot to put up the x-ray on Friday. I was talking about when to crown a cracked anterior. I told you that I won't consider it until I start seeing radiographic evidence of the crack. Well, look at this one.Pretty crazy, huh?

I met a very nice 65-year-old patient yesterday; we got along great. This patient came in for a new patient exam after having not been to a dentist for about 8 years. They had really nice teeth, with no decay and pretty good dental work in the past.

The last thing I do in my exam is a full perio probing. I was surprised to see that they had quite a few 6mm pockets. Turns out that in the past, they had lost both of their lower first molars. The upper first molars super erupted. So when the dentist went to restore the lower endutulous areas with bridges, the dentist also restored the upper first molars too. The dentist did root canals and then put crowns on them and did a very nice job. But all around all the dental work are 6mm pockets with bleeding.

I educate my patients on gum disease in the pre exam interview. I have a chart and I walk through the disease process to get them to understand their mouth. They are able to follow along with what I am going to do in the exam. By the end of the probing, if I have said, “Six, five, six, six, six, three, six, three,” the patient knows we have to talk.

I sat this patient up and we talked. I told them that I thought this was treatable non-surgically but that was going to take some work. I recommended a gross debridement and then two quads of root planing. This patient went up to the counter, made some appointments, and left.

They called about an hour later and said that they really liked the office but couldn't afford the work. This particular patient had dental insurance (but not very good insurance), and we guesstimated that they would pay a little less than half. So, out of pocket, a tad over $300.

This brought up much discussion in our morning huddle. I started to hear all the things the staff have been hearing. “Oh, I don't trust anyone to work in my mouth except Dr. Gammichia. But I get my cleanings at the clinic down the road." One patient got their x-rays at the insurance dentist and then got their cleaning here.

Here is my thing. We still have some work to do in the educating of patients. A cleaning is not a cleaning. But how would they know that? Is an oil change an oil change? Well, it is to me. And I know that it is not the same at every garage. Is a loaf of bread a loaf of bread? I think if you ask Merita and Country Hearth, they would say no. To me a loaf of bread is a loaf of bread. Probably terrible examples, but you get the idea.

My patients should know when the cleaning appointment is 60 minutes here but when they are rushed out of the clinic on their insurance in 15 minutes. That cleaning might consist of just a polish, or worse, having been cavitroned and then that’s it. It is what it is. So this patient is going to go to the dentist on "the list.” What will their mouth look like in four or six years? It will be a lot worse, and they will get shipped over to the clinic's perio surgeon. And that is going to cost a lot more than $300.

I know not everyone can afford the dentistry I can offer. I know that the economy is totally in the crapper. But I feel like I am fair. I have a service that is second to none (well, close to it), and we do work here that we are proud of. We get people better. Listen I am not crying a river. I have awesome patients that love me. And they tell me too (which makes my head really swell). I have a wonderful practice and love coming to work. I love my staff and I think they love me. Things are really good here But this is definitely an issue.

On the other hand, I had a patient came in today that works at an RV dealership here in Orlando. They sell RVs that range in price from $5,999 to $500,000. Guess how many they sell in a month. I have asked some patients that question today, and all the answers were all about the same. They all guessed somewhere between three and 10. The guy told me that in an average month they sell 100, with about 30% being of the larger, expensive kind. This was shocking to me. I can't sell 10 crowns a month to people that need them for their health, but they can sell 100 RVs a month?

What do you think? Are you hearing the same thing? Let me know.


Anonymous said...

Make your explanation more immediately relevant. "People with perio problems often have bad breath- have you found this to be an issue for you?" "Like the biblical story, your gums are the rocks or the sand that hold your teeth together - and at the moment your gums need some work."

Anonymous said...

Re the Xray, are you sure you haven't got a vertical root fracture there? I'd be stepping very carefully around that tooth with a probe and suspect at the relevant point you will fall off the crestal bone into a narrow deep crypt.

David said...

I'm going to start selling no one is complainging about the cost of an RV.

Bjorn Button said...

Great post. It sounds like you have a great reputation among patients. The insurance issue is such a damper to building a stronger client base. I fortunately have had good dental insurance in the past so I could go to any dentist I liked. I would personally pay $300 if I knew it would keep my mouth pain free for a few more years.

Lori Bartels-Tobin said...

I can completely relate! It's very frustrating when the client values something other than their health, it's all a matter of priorities. I own and operate a private-pay specialty stroke rehab clinic in St. Petersburg. We are one of 2 in the United States, and so many people would rather get discount treatment in bits and pieces that's much less effective. It's mind-boggling, but it's all a matter of priorities our belief that we can find something "just as good" for less money.

John @ said...

Money is always the issue but paying $300, I guess that's reasonable. And that RV patient sure is making a lot of money!


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