Thursday, February 24, 2011

Associate or Ownership (cont)

Good comments. Thank you.

Associate vs ownership - let's break it down.

First, let's talk about ownership. There's the obvious: you OWN it. Owning means you had to buy something. Either you bought an existing practice or you bought a building and you bought all the stuff inside. Either way, it is expensive. Less expensive practices can be bought at the tune of $200,000 and can go up from there.

If you want to open up your own place, we are talking about renting or buying a place and then building it out (3 years ago price, that would have been about $175 a square foot). So if you want to build out a building that is 2,000 square feet, that is $350,000 before you see your first patient.

Chump change, you say. That is about $3,500 a month for a long time. I pay the bank about $3,200 a month for half of our practice and that is after taxes. So you own it, but it is going to cost you.

You call it a business expense, but when your office can't cover your business expenses, guess who bails out the office? You guessed it - the owner.

Being an owner, you learn about things you never knew existed (like employee tax). You learn how much having an employee really costs you. With taxes and insurance, that $18/hour employee costs you a lot more.

You learn things like triple net lease and depreciation. You know how much your supply company charges for equipment repair. You know exactly how many handpieces you have. You see everyone standing around and you start counting up how many dollars an hour you are paying them to have a conversation. You learn how much tree-trimming and new plants cost.

I called my advisor today to ask him who is responsible if I have a tree hanging over my neighbor's parking lot and a branch falls on a car in their lot. You learn how much property insurance costs. You learn how to handle a situation when someone slips in your parking lot. You become well-versed in how to handle people soliciting to you on a daily basis.

I know about how to run a staff meeting. I know now how to give a performance review and I know how it is never easy when there is crying involved. I know how to ask people into my office to talk to them about bad attitudes.

But owning also has its upside. You can't get fired. And there is, as Tom says, "autonomy." And I think with us owners, this is what it is really about - doing it our way. Dentists don't really play well with others. We are a fickle bunch.

As owners, we can buy the stuff we want. We have the color carpet that we like. We hire who we want. We can walk around the exhibit hall and say, "Hell yeah, I am the guy who buys stuff in my office."

When things go well, it is really fun. When everyone is working well together, when your patients are happy, there is no better feeling. People like you, your staff likes you and it is really good. And then one day, a long time after you open, you start to profit. When the bank account has money left over after you have paid all the bills, you get it.

Now, the smart owner would put this money away for the down times, to have a reserve fund (and hope to never use it). But if you have a reserve fund and you continue to profit, you get it.

But being an associate has a lot of things that most dentists desire. I think most dentists would prefer the tooth stuff to the business part of dentistry. I mean, why do you think a lot of dentists are selling their practices to corporations? They want someone to run the practice and let them do the teeth stuff. Associates get to do dentistry and not have to deal with the "other" stuff. Like our ghost writer said, he gets to go home and not think about the office. On the other hand, you can get canned and you can't always do it the way you want.

One thing that our ghost writer spoke of and our commenter Tom talked about is family. The ghost writer appears to not have a family; if you are a reader of the blog you have to know that family takes a lot of energy. And I have to admit that this does take away from my ability to totally focus on the practice. It may be a little easier to handle if I was single. And I do spend about 2-3 hours a week on a blog. A guy like me wears a lot of hats.

Okay, my fingers are tired. Did I miss anything?

Have a great weekend.

Gators vs Kentucky tomorrow - and the Cats haven't lost at home in 32 games.

Wednesday, February 23, 2011

To associate, or to own?

We have a doozie today, so I don't want to talk too much. But I have to tell you one story. Noah was at it again this weekend. He said he wants to be an inventor when he grows up. I said, "I think you would be a great inventor. What are you thinking you would want to invent?" He then went on to tell me that he wanted to invent a machine so we can interpret what ants are saying. No, this is not a misprint; he thinks it would be beneficial to humans to know what ants are saying.

I said, "What do you think they are saying that we need to hear?" He said, "Oh, no here comes a foot!!" I am telling you, this kid is a riot and he doesn't even know it. He did another beaut, but I will tell you about it on Friday. Today we have a special guest writer. This writer emailed me in a quandry and wanted the readers’ advice. This dentist is happy being an associate (and has been for 10 years), but feels like he/she might be missing something by not being an owner.

So this is what we are going to do: I want you to read the blog and think about it a second then give us your best advice. Today, I will say nothing (even though I have lots to say about this topic), but I will write a blog (on Friday) with my answer.

I've been an avid reader of John's blog now for close to 2 years now, and I’m really enjoying it. I hear John and others speak about the troubles and triumphs of owning a practice in today's world, but I can only relate so much, as I’m still currently working as an associate dentist.

I’m happily plugging along trying to practice dentistry better every day, just like the rest of you. I try to find the best balance between work and life away from work. I continue to feed my hobbies and attempt to lead as stress-free a lifestyle as possible, but, I’ve had a question on my mind, nagging me, recently. When is a good time to make the transition from associate dentist to owning a dental practice?

I read a response recently to the question "When are you ready to have kids?” The answer? NEVER! The point of that article was that no one is fully prepared for the life changes and responsibility of having kids, and not much can prepare you. So, is this the same thing with owning a dental practice? I truly don't know. I’m doing some thinking. Should I? Shouldn't I? Am I ready? Where do I start? Am I going to be a life-long associate? What do I prepare myself for?

I’m assuming that unless we're lucky enough to have great mentors through our careers, we usually make these decisions alone, based on educated guessing and our own research. We don't know precisely what to expect, but do our best not to have those "Boy, I wish I would have known about this earlier" moments. I'd really like to minimize those moments. What I’m looking for is some advice.

I've been an associate for close to a decade, and have worked in a number of offices. I have worked alone for about half of my career, and in group settings with other dentists for the rest. I’m in my mid-30s, debt-free, financially OK, and currently have tons of freedom. I’m not "tied down" by anything, so to speak. But I also realize that "freedom" is not all that it's cracked up to be. Here are some of my thoughts.

I do enjoy ALOT of the benefits of being an associate. I like leaving work, not having to think about the office until the next morning. I like not thinking about the office overhead. I like not having to hire and fire staff. I like taking a couple of 3-week holidays and not thinking about the practice when I’m gone. I like that the staff can relate to me without worrying about me being their "boss." I like that I don't have to really "market" myself or the office if I choose not to. I like not thinking about month-end or year-end (at least as far as a balance sheet is concerned).

I think about dentistry. I complain occasionally about staff, but that's really all. If I don't feel comfortable with a procedure, I see if the principal dentist wants to do it, otherwise I refer it. I don't think too much about collections, receivables, and all that jazz. Do I have it too easy? I’m not sure. I’m starting to look at guys who own their own practices, and really try to figure out what some of the benefits are, whether these guys are happier, and if it's for me.

Here's the flip-side. I’m starting to think "If this were my office, I would change this". I wonder how much income I am missing out on from not sharing in the hygiene revenue and the tax benefits of ownership. Money isn't everything, but the world today is a financially different one than I thought it would be.

I see new equipment and technology that I would like to try, but must use what is available to me. I essentially have to practice dentistry similarly to the principal dentist where I’m at. I go to conventions where salespeople ask if I own a practice, and I reply with "Sorry, but I’m just a lowly associate, sir". I’m kidding actually, that part really doesn't bother me that much. I wonder sometimes if I could put together (or make better) a dental team/staff than what I’m currently working with. I wonder if I would be a good boss.

So, I guess I have some questions to those of you out there. I’m gonna shoot from the hip. Tell me straight. Tell me I’m crazy. Tell me something. I do have one request though. If you could, please try to assume that the recession hasn't totally gotten you down. I’m not blind to the fact that times are tough right now, but I would really appreciate as many non-jaded responses as possible. I know that some of you might think I’m crazy for even considering buying a practice now. There are parts of the country (a lot of rural areas for instance), as well as in Canada, where the recession hasn't totally affected dentists. So, for the sake of optimism, try to assume that all other things are equal, so to speak. I would likely be considering a very reasonably priced, rural (or small city) practice with a retiring (or semi-retiring) owner. I’m not looking to purchase a high-end practice in a large city. Just an average, steady dental practice.

Ok, here goes. What were the biggest changes you had to adjust to? What did you really love? What did you really hate?

Did your income increase dramatically (or at all) when you transitioned to ownership? I’m not a high-producing guy, but making and efficient income is always important.

Can I kiss my 2 or 3-week vacations goodbye for a while (or forever) if I purchase a practice? Time off to enjoy other things is VERY important to me.

Does the power to call all the shots as an owner offset the freedom of virtually no responsibility as an associate?

How badly do staffing issues stress you? Have you learned how to delegate properly, and if so, how difficult is that?

Does it make a difference as to what age you make the transition to ownership?

Do any of you ever stare at your associate and envy the heck out of them? Not because they may have a gorgeous wife, but because they are not dealing with the responsibility that you are. Do you really appreciate your associate?

Do you ever feel "tied down" to your practice?

Basically, I want to know the nitty gritty. Do any of you regret the decision of purchasing a practice?

Would anyone recommend not buying an existing practice, but setting up their own?

Does ownership suit a married or single person better?

Do you actually practice dentistry differently as an owner? I mean, do you feel yourself pressured to "sell" dentistry more? Are you more aggressive as a treatment planner?

Are you happy with your current practice? I mean, is it the practice that you really dreamed it would be?

Ok, that's enough questions. I threw a lot out there. Obviously these are not questions that are easily answered, nor is it a topic that you can scan through quickly. Hopefully I’m not opening a big can of worms here...

Make me wiser. Help me avoid pitfalls. Enlighten me. Share whatever is on your mind.

I know we have a real mixed bag of readers. We have students, associates, and owners. I want to hear from everyone. I would even like to hear from our dentists that live in other countries. Think about it....marinate on it. Try to think outside your present economic situation. Then start to type. Then we will talk again about it on Friday.

Have a great Wednesday.

Thursday, February 17, 2011

I have a sore throat. Can you write me a script?


Things are still slow at the office, and it is really tight around here. I decided that I had to take away some benefits (not life-changing) to try to maintain the health of the practice long-term; that kind of went over like a turd in a punch bowl.

I mean, the staff is being pinched in all directions. There are fewer of them. There hasn't been a bonus in a couple of years. Medical is costing everyone tons of money (and it is going to get worse), and now I am taking away some of their vacation time.

But what am I to do? It sucks being the heavy. When everyone is making money this job is so easy. You are the bomb. But when it is tight, you are a jerk.

I saw a couple of movies last week. Repo Men was a futuristic movie. The premise is that organs are now made by a bio tech company so everyone that needs a transplant can get one. One problem, they are very expensive. So if you get behind on your payment, the repo men come and get back their property. Oh yeah. I thought it was good but they over did the gore way too much.

Then I saw The Secret in Their Eyes - a foreign film with subtitles. It was okay, but I had a headache after the movie from reading for two hours.

Noah had a beaut the other night. At the dinner, table we somehow got on the subject of being particular about people touching us. And then we asked who is the biggest germ-o-phobe in our family. Noah says, "I am."

He then made a disclaimer. "I am not a German-o-phobe. I am a germ-o-phobe." He wanted to make it perfectly clear that he didn't have a problem with Germans. Don't forget he, is 7. I didn't even know that he knew that there are more countries out there.

Today, I want to talk about something that we ALL have to deal with: people asking us to write scripts for them.

When you first get out of school, you think it is cool, so you write a script or two for your high school friends that have colds and sore throats. I mean, for crying out loud, it is just antibiotics. I know that these people are going to go to the doctor and they are just going to write them a script anyway.

But inevitably, this thing starts to snowball. Now your friends have friends and so on and so on. Then you have people you don't even know asking you for scripts. How about your staff? They have been battling a wicked sore throat for about a week. They are threatening missing work. You know that it is either viral and they are about to get better or it is strep. You know that if you give them a Z-pack or Augmentin they are going to be 100% in a couple of days. Then it is your friends from church. And then that angle starts to snowball.

First it is antibiotics, but every once in a while, someone will ask you for a pain killer. Then someone will ask you for a sleeping agent. How about a friend's pregnant wife? How about scripts for your wife? Or your kids? How about scripts for yourself?

Are you guys wrapped up in this vortex? Are you comfortable being people's physician? I am not. I did this for awhile and it became increasingly uncomfortable for me. I made it very clear early on in my career that this was not going to fly.

Listen, if someone is sick they should do to the DOCTOR. No if, ands, or buts about it. I know you are super important and you have a really busy schedule and all that, but GO TO THE DOCTOR. I know that money is tight, but I am not your doctor.
Now with the advent of "Minute Clinics" in our grocery stores or CentraCares or After Hour Pediatrics, there are no excuses.

For about 5 years now, I have had trouble sleeping. I am not a big sleeper anyway, I am thrilled with 7 hours. When I hit the pillow and I realize I am only going to get 6 hours it is not a problem. The problem is when my alarm is set at 5:45am and I get up at 3:45am, up again at 4:25am then up again at 5:15am, then I hear the alarm.

A week of this, and I am a son of a bitch to be around. Then after a couple of weeks of this I start to physically feel worn down and then I get sick. I know not sleeping is not healthy.

So I went to my doctor (what a concept) and he gave me some sleeping pills. Dude, have any of you tried this? It is the BEST stuff. I heard someone say once, "You don't even remember falling asleep." You wake up 9 hours later feeling like a million bucks. The only caveat is that you have to be able to sleep at least 8 hours - don't take it at midnight and set your alarm for 6am.

Now for me, I can't take it during the week because I know I am not going to get 8 hours. I can't take it on Saturday mornings because I run and get up at some crazy hours. So I will occasionally take it on Saturday night; a bottle of 25 might last me over 2 years.

A couple of years ago I was having sleeping problems. So I did the right thing and told my new doctor about this. I gave her the rundown and she was hesitant to write up a script (maybe because she heard of the people on sleeping pills getting in their cars in middle of the night and having wicked accidents and waking up after the accident, never knowing what happened). So, first she told me to meditate before I went to bed. I said, rolling my eyes, "I will give it try." After six months, I went back and told her again and she begrudgingly gave me sleeping pills. I took one regular pill and I went to bed fine, but I still woke up through the night. So, they didn't help.

I knew I was in a bind. She had a problem writing me a script for the regular pills; what is it going to look like when I come back 3 weeks later (even though I had only taken one pill) asking for a controlled-release version.

I run with three people with script pads, so I asked one of them if he could write me a script for the controlled-release version. He said it wouldn't be a problem because I am in his office's system (I'm in the system for my vasectomy, just in case you are wondering).

A couple months later, I asked the other guy in the running group (who is from the same office), and he looked like he had a problem with this. You know, like he was uncomfortable with it. Then I realized something: I am that guy - the guy asking for a script. He said he would do it, but don't tell anyone. I wasn't going to tell him that the other guy said he would do it, no problem. I just took it and ran (and felt a little dirty).

I have let everyone know that I am not writing scripts anymore. My brothers and sisters call and ask me and I usually turn them down (unless I see blood). My friends don't ask me anymore. My staff doesn't ask me anymore (if they do, they come to me saying they have a toothache and it is making their throat hurt). The stream of people has almost stopped.

I am always so careful about giving scripts out. I know the local pharmacist fills a tons of scripts, and I wonder if they see what is going on. I wonder if they see my write a script for my dad and make a mental note. Or see me writing Augmentin for my mom, knowing that there is not much in dentistry for which Augmentin should be written.

You know how I feel about my reputation. It is almost an unhealthy need to be respected around town. And a pharmacist is definitely someone that you want liking you.

So... Am I wrong? Does anyone know a pharmacist? What do they say? Do you write scripts for everyone? (I don't care if you do. I want you to comment and tell me what your thought process is). Have you ever thought about it before? Are you now rethinking your script-writing? Have you cut everyone off? Tell me, tell me.

Have a great weekend,

Wednesday, February 16, 2011

I have always had "Soft Teeth"

Yesterday I had a 92 year old woman in my chair. She has been a patient of mine for about 12 years, and we have had a great relationship. She has always been so nice and gracious to us.

She is having some health problems. Her main problem appears to be her eyes; she has macular degeneration, and can't see very well. They have told her to stop driving (even though she made it to the office driving herself, probably hitting four cars in our parking lot). She is moving about 3 hours away to live with her daughter, and told us this would be her last appointment.

Before she left, everyone hugged her and told her how much we appreciated her and how much we like her. She then thanked us for taking such good care of her teeth, and that was it. It seemed like I was at her funeral but she was still alive. It was hard.

This makes life seem so short. Our mortality is so right in front of us in times like these. And as my 42nd birthday is a mere 4 days away (if you are looking to send me birthday cards with gift cards in them, you can get my office address off our website. I am not saying I am expecting that, but it would be real nice), I can't help but think of my life. It is going so fast.

I want a remote so I can press the pause button. I love my life RIGHT NOW. I don't want my kids to become teenagers (I heard their heads spin around). I love when David (16 months old) hears my voice and stops what he is doing and comes running.
I love coaching my kids and driving them to school/practice/church/whatever.

But hugging Mrs. Jones yesterday means it is all going to end, and 40 more years seems too short. I know heaven is supposed to be so much better than this and I know that Jesus is sitting up there laughing at my simple mind. But what I know is this and I like this, and to be totally honest, leaving here kind of scares me (but that is a whole other blog). I was told once that life is like a roll of toilet paper: it starts off really slow but at the end it goes really fast. I agree.

Sorry about that. On to today's topic.

I have a friend that is also a patient. Well, he was a patient first but we got along so well that it led to families coming over for BBQs and such. He has been to my birthdays and such, so you know, a good friend.

He has always had issues with his teeth. The first thing we did for him was about 6 fillings, a couple of crowns, and an implant. And he is in his MID-30s. "Okay," I said to him, "I don't know where you have come from, but we now have a clean slate." We gave him a thorough oral hygiene protocol: brushing, flossing, rinsing with chlorhexidine. He has jumped on board with the whole thing.

Let me back up and tell you that people come in all the time with what they call "soft teeth." And every time they say that, I am thinking this is total bulls@#*. "Soft teeth" is a term (to me) that means "I don't take care of my teeth and I eat whatever the hell I want, I drink whatever the hell I want and then go to the dentist and try to blame my teeth." People think they take care of their teeth but they don't.

I know you hear, "I usually floss all the time, but I haven't in a couple weeks because I ran out."

"I usually floss, but my gums started bleeding so I stopped."

"I brush all the time. Should I be brushing in the morning, too?"

You have sugar-coated candy with an energy drink shooter for breakfast. For lunch, it is a bologna sandwich with some kids' cereal in there (to make it crunchy, like The Breakfast Club) and wash it down with an alcoholic energy drink. Then for dinner it's bread, bread, and more bread, and oh a gallon of soda. They you let it sit in there and fall asleep on the couch and forget to brush before bed. Well, this isn't "soft teeth."

Back to my friend. He has stuck with the plan we gave him and things are not that much better. His gums are still not beautifully pink like people on this routine usually are. So when he comes in for an exam and we tell him things don't look that good, he kind of gets dejected. You know the face that says, "This sucks, I work and work and I do everything you tell me to do and it still is not that good."

I sit him up and tell him that it is what it is. You have something going on that is beyond everyone's control. I think you are one of two people in my practice that I tell, "Do the best you can, but you are going to get decay. It is always going to be a battle and if you didn't do the regime that we gave you it would be a lot worse. You are going to do everything you can, but you are still going to get cavities."

I will be as conservative as I can, but don't get mad at me when I tell you it is time to fill a cavity. I tell him that I don't know why it is happening, but we will continue to communicate and try new things as they come out.

Do you have patients like this? We do rinses, we do fluoride trays, high-concentration toothpaste. Nothing seems to work. They claim they have cut out the soda and are strictly water. What else can I say to them?

I just read an article in this month's AGD impact about Proactive Prevention and I learned about a lot new things I might start trying.

Have you heard of these Salese™ lozenges? Me neither.

How about pilocarpine lollipops? GlyLic™ lollipops? Arginine mouthwash? Anyone doing a saliva analysis? Do you have your patients brush with baking soda - straight?

These are all new to me, but what the heck? I am going to try it. I just don't want to be writing a blog 25 years from now telling you about that I just finished putting in 12 implants for my friend.

How is it with you? Am I the only one that feels helpless to these kind of patients?
Have anyone with "soft teeth?" What are you doing about it?

Have a great Wednesday. See you in a couple of days.

Friday, February 11, 2011

Introverts....I don't get it. (ghost writer)

Happy Friday to all of you.

I called that dentist that was rumored to be closing his doors (I had a friend call me and tell me I should reach out to him). I don't have a cell number or anything, so I just called his office.

It was early, like 7:30am, and much to my surprise, the office number worked and he had his regular message on it. I don't know how these things work. Do they keep the number for awhile? Is he still trying to keep his head a float? Now do I need to call him? I feel for the guy. And it is real awkward thinking about what to say but...

"Dentistry from the Heart" is right around the corner again; we are doing it March 4th this year. If you are new to the blog, "Dentistry from the Heart" is a day when we open our doors to serve anyone that needs dental care for free. We have 8 operatories in our office that we fill with dentists and see as many patients we can from about 6:30am to about 4:30pm. Last year we saw 132 patients.

We try to make it fun. We ask local restaurants to donate food for the volunteers. We have churches set up in the parking lot and BBQ all day. We have a DJ that plays music in the parking lot. We have local people, who are not patients, ask if they can help. It is truly a community event. This year a radio station asked if they could bring their van and broadcast from here. That should be fun.

These ghost writers have the craziest stories. We all have been here. Lets get right to it.

I went to this party recently, and a lot of my family was there, including some of my cousins. Now, the extrovert gene is not rampant through my extended family. In fact, this cousin that I am going to talk about is very reserved. She would come into the house and not say hello, she is so quiet. I even asked my mom if she didn't like me because she would come into my house and not say anything.

"No, she is just quiet," my mom would say. This blog is going to be about being quiet or shy or introverted or whatever you want to call it.

She and I don't know each other too well because they have always lived out of town and she is considerably younger than I am (I think she might be 24 years old). She is now engaged and at this party with her new fiancée. At one point in the evening, it was just the three of us in a room, so I started to strike up some conversation.

I asked him about where he went to school and I got a one word answer. I asked him about his degree and I got a one word answer. I asked him about where he was living and I got a one word answer. I asked how the two of them met and it was the same thing. This went on for about 10 more questions and I got about a sum total of 15 words. I knew where this was headed, so I stopped.

When I saw my mom again I said, "I didn't think Maria would ever find someone as quiet as her, but I think she actually found him." I told her the story about me trying to get to know him and him having none of it. She said that it is hard to come into someone's home that you don't know and be indoctrinated into a new family.

"Yeah," I said, "especially when someone from the family tries to get to know you and you won't answer his questions."

Come on now, I get being shy (no, I don't, but humor me here). I get how a big loud Italian family could intimidate you. But, we are all adults here. Twenty-four is an adult, and when someone talks to you you are supposed to talk back.

If you have kids, you know how they can be spacey. They are watching TV or playing on their GameBoy (I know they don't call it a GameBoy anymore but I don't know the new games) and some adult is talking to them and they are ignoring the adult. The parent should say, "Billy, an adult is talking to you. Put that game down and talk to them."

Or when a teenager is getting their teeth cleaned, and you come into the room for a recare check and say, "Hey Tommy, how the heck are you?"

And they say something like a grunt. And you say to your staff after they leave, "That kid is a punk."

Now what happens when they are 24? Hey, you are an adult. You are a college graduate (in psychology, which was one of the one word answers I got out of him). You are in the big leagues now. When an adult is talking to you and you don't talk back, you are flat-out being rude.

You are telling me, "I don't give a crap about you and I don't want you in my life at all. And while I am thinking about it, bug off."

The money world is mostly about relationships. When you interview for a job, you are going to have to talk to people. You are going to have a boss that is going to want to talk to you. You are going to have colleagues that are going to want to talk. If you are selling something, hey guess what? Yep, you are going to have to talk. If you want to be any sort of leader you have to talk to people. And with this in mind, a short conversation with your future cousin-in-law doesn't see like a big deal.

Now, again I know that everyone isn't a loud extrovert like me. And everyone doesn't have to be like me (as awesome as it is). Do we have some introverts in the audience? Are you happy being quiet?

Do you know you are quiet and wish you were more talkative? (I am not talking about being able to sit on a beach and read a book and let all your cares go.
Even I love doing that. I am talking about being uncomfortable talking to people you don't know.) Is this something you had to grow out of?

I know I am sounding so pompous and ignorant, but I don't know too many introverts.
And the craziest thing is I think my daughter might be an introvert (especially because both my wife and I are high extroverts and so are both of her brothers).

I am looking forward to your feedback.

I am glad I am not the only one with crazy stuff going on.
It is going to be a bball weekend for me. I am going to the Gator bball game tomorrow and then the Magic vs The Lakers on Sunday. Have a great weekend.


Wednesday, February 9, 2011

Can you help my friend? (ghost writer)

Well, I have heard about another one - another reputable dentist in Orlando shutting his doors. When I heard who it was I was, shocked. He is a good guy, a family man. I feel terrible. This is a guy I went to school with; he was in the class ahead of me.

Now, he did have a pretty extravagent lifestyle (at least, this is what it looked like to me). He lives in one of the fancy neighborhoods in town. He bought his practice about 3 years ago. His office was in a high-rise downtown and it was so nice. I went to his office for a study club once and I was talking about it for a week. I don't know if I should reach out to him. I don't know if he would take my call. I don't know what I would say. It just sucks. Oh, life is so much fun, isn't it?

I watched a couple of movies this weekend and they were both pretty average (I give them both 6 toothbrushes). It's Complicated, with Alec Baldwin and Meryl Streep, and Extraordinary Measures, with Harrison Ford and Brenden Fraser (about a parent and a scientist who join up to try to find a cure a fatal childhood disease). Can someone please suggest a good movie to watch? I am just putting movies in my Queue that I know are going to be average. I am looking for something better than average. Help a brother out.

Let's get to this ghost writer's crazy story. You are going to love it...

So I got this thing going on at work that is so crazy that I have to tell you about.

I have a patient who has been with me for about 7 years or so. He has been a really good patient. He came in wanting to fix his entire mouth. We did some things that made his teeth look nicer and he was happy. There I go, saving people money again.
It seemed like he liked the way we did things here. He always seemed to finish his appointment and stay to talk because he just liked it here.

He is divorced, and I think he started a relationship with a woman from another state. He liked us so much that he sent her here (she had nice teeth too). They got married and she moved down here about 3 years ago.

He comes to me and asks me if I wouldn't mind helping him help someone out. He knows this girl that is a bit down on her luck and he wants to help her. I am always up for helping people, so I was game.

He goes on to tell me that she is missing a front tooth and he wants to know what it would cost to get a new tooth there. Turns out, she is having trouble finding a job because she doesn't have a front tooth. Now I start feeling bad and want to help her, as well. We talk about getting her a flipper and how much that would cost.

We get her in here and have a look. Well, things are not that easy. She has been missing #9 for a long time. And #8 has moved into the middle of the space. She has #8 right on the middle of her face and there are spaces on both sides of it.

This, whichever way you slice it, is going to be tough. I thought about talking to an orthodontist about just moving this thing back into place. I sent her home so I could think about it and make a couple of calls.

It seems that it is going to cost a lot of money. But we brought her back anyway to take more X-rays. Along with being in the middle of her face, #8 was traumatized and partially evulsed when she was a teenager. After the X-ray shows the peri-apical pathology, now we are talking root canal. In order to save this tooth, we are talking about $4500 and about 18 months. Not exactly what this guy had in mind.

I suggested we take it out and then just do what we had planned in the past (a flipper). As an aside, I am never one to say take teeth out, but this was an extreme case. I took some diagnostic wax-ups and it turns out that the lower incisal teeth touch her palate. Not a big deal except when you are thinking of putting acrylic there. Now the flipper is no longer an option.

Then the plot began to thicken.

It took a month or two to get all this done. In the meantime, he comes to me and asks me not to call his home and mention any of this. I asked him if he was keeping this from his wife.

"Well, I am here talking about teeth and I told her that," he replied.

I said, "Dude, don't lie to your wife."

He said, "From now on I want, all the bills sent to my email address and only call me on my cell phone."

Then, of course, one of her teeth are blowing up in the posterior. We had an appointment to take some of them out, but before she could get here he calls me saying her tooth is hurting. I call in some meds. Then he comes by with an envelope of cash saying that she is going to pick it up. It is to help her pay for the meds. Hmmm.

Next thing you know, she is calling me up saying that she is having excruciating pain, in that doped-up, high-as-a-kite, I-need-a-fix voice. When she gets to the pharmacy and finds out that I called in Vicodin, she calls my office and asks them to ask me if I would call in some Percocet.


Now things are starting to become a bit clearer. There is some serious trouble in this whole thing. Now our minds start to go wild. Is there some hanky panky going on here? Are we aiding and abetting? Is she a prostitute? Is he a customer? Maybe, at the least, he has a girlfriend.

I know what you are thinking - I need to get rid of this patient. Like I said, he is a great patient and he has been for a long time. So he has a girlfriend that he wants to help. So what if she has a drug problem? Everyone that has a drug problem has to be fired? Remember a couple of months ago when John worked on a drunk patient? This is just like that.

I say no. I say as long as you are not doing anything wrong, it is his problem. We really don't know what is going on. We can assume, but are we going to attack this guy's actions because of circumstantial evidence? Come on, I know he is guilty but...

What do you think? Please don't judge me.

I am so glad all this stuff just doesn't happen to me. Have a great Wednesday. See you Friday.

Friday, February 4, 2011

You need a new battery... and a lollipop.

I thought about it, and I think I agree with Elizabeth on Wednesday's blog (that was posted on Thursday). Maybe "You are expensive, but worth it" is one of the best compliments someone can give you. Especially someone that has lived through the Great Depression. They recognize that money is not always going to be there, but she chooses to spend her here. Thank you Elizabeth for opening my eyes.

About the Wednesday/Thursday thing - It turns out that the whole staff at the AGD was told to stay home because of the blizzard they had in Chicago. You know it is bad when snow stops people in CHICAGO from going to work. And I know it seems easy to just post a blog, but it is more than just me that makes this thing happen. I have my whole entourage (I am huge in Europe).

I started watching It's Complicated with Meryl Streep and Alec Baldwin last night. When I got it in the mail, I was like, "Why did I get this?" But it has turned out to be pretty funny. I will let you know.

As you well know, I hate being ripped off. And one of the most notorious professions for ripping off is the auto mechanic field. I used to go to a local garage that I really trusted. This was like solid gold. You would take it in for an oil change and you would get an oil change. The car was hesitating and it would turn out you need a fuel filter. Easy.

There was no, "Well, I think you are having trouble with your sphitzer valve and it is the relay to the carbon fuel relay switch which could lead to more issues with your shocks, which really need to be replaced."


But this place changed ownership and the first couple of times I brought my car there, I started getting the, "Well, yes, you need an fuel filter but you also need this this and this." I started to lose my trust in them.

We found another shop right up the road from our house that we have started using. We use it for oil changes, tires, alignment. Luckily that is all we've needed. A couple of years ago, my truck started starting slow. I took it in and got a new battery - a good battery that came with a full two year replacement warranty.

A couple of years later, my truck was starting slow again. I let it go for a couple of months. I am a busy guy and I didn't want to go in and have it checked out (AND I still don't have a place that I trust).

But then one day, during the Christmas break, my truck didn't start. I jump it and we run over to the shop. They check they're computer and I bought the battery 29 months ago. It has a two year full replacement warranty and it is prorated after that.

My blood is starting to boil but I am maintaining. Mostly because batteries are supposed to last longer than 29 months and I bought the more expensive battery because I didn't want to deal with this s!@#%t every 29 f#@$%^ing months. So he starts to break it down for me...

The cost of the battery is $109. With your prorated warranty, you will get $26 off. But the battery disposal fee is $7 and this and that and this and that and...
It would probably do you some good to replace the terminals because they are in pretty bad shape and probably causing the problem.

What am I gonna do? My car isn't starting. I got my kids in the car. If I tell them to forget it, is my car going to not start? I mean, we have this whole day planned to go and shop for Mom. Do I go to the discount auto parts store and buy a new battery that is going to cost me $75? All this worrying and getting pissed off for $25.

I know it isn't rational, but it is not the money. It is the non-personal service. I just don't like it. I want the service that I give. Someone comes in and has a filling done by me. I know their name. I know about them. I know that in two years if they came in with the filling broken or chipped or something they are getting a new filling for free. I tell everyone that I will redo any filling of mine that is 5 years old or less. Now if they came in and it was 5 years, 3 months, come on... they are getting it for free. They are also getting, "I appreciate you being such a good patient and I am sorry this didn't last." And I am not even worrying about it. In fact I think it is good for business to do this. But with this shop, it is by the book, and that kind of bugs me.

I think it was Christmas time and we were totally overspending for the kids and everything else. We were going on this vacation and we didn't have any money saved up. The office was slow and not seeing any recovery in the works and everything was piling up on me. And then my truck doesn't start.

I just wanted to go in there and them to say, "Mr. Gammichia, I see that you and your wife Hilda are long-time valued customers here. I see that the battery didn't last like it should have. We will take care of that for you, no problem. I will get Billy Bob here to take care of this as soon as possible. Can I get you a drink, while you wait? Is it okay if I get a couple of lollipops for the kids?"

Yeah, maybe that is a pipe dream. All this over a $100 and a battery. I think I need an anti-anxiety or something. I mean, it is a 10 year old truck with 172,000 miles on it and I am complaining over $100?

All that aside, it would have been nice for them to offer me a drink. And a lollipop.

Have a great weekend.

P.S. I had to send a patient to the oral surgeon knowing that the bone lesion he had was a recurrence of his leukemia. That was a tough one.

Makes the battery story sound even stupider.

Tuesday, February 1, 2011

You're expensive, but worth it.

Just so you know, it is 79 degrees here right now. It is a gorgeous day. I know most of you are dealing with some really crappy weather, so I thought I would rub it in.

I am reading a book called Without Hesitation: The Odyssey of an American Warrior. It is a memoir of The Chairman of the Joint Chiefs of Staff. He was the highest ranking military man during 9/11. I don't know too much about the military, so I thought I would give it a try. It is okay, but it is dragging.

One of my favorite books is The Glass Castle by Jeannette Walls. Well, I heard that Jeannette Walls was speaking for the United Way next week. I called and bought tickets. I then found out it is for their annual Women's Leadership Conference. I don't care. I think the girl/guy ratio is so going to be in my favor. Anyway, I think it is going to be great.

TV - Modern Family. It is a must.

Movies - I just finished watching Death at a Funeral and Hot Tub Time Machine. How much do you really expect out of movies like that? They were pretty funny. That is about all that you can expect - a couple of laughs.

I had a patient (who has been a patient of mine for about 8 years) say to me (for about the hundredth time) that I was expensive but worth it. And all weekend this has kind of chapped me. Being a bit more expensive than the next guy doesn't bother me that much. I feel like I do really good dentistry and even better service, so I feel like my fee is warranted.

Now let me tell you about this woman. She lives in the neighborhood right next to the office. She was about 70 years old and came to me because she had heard great things about the practice. I don't think she had been to the dentist in a while and the reason I know this is because 7 of her front teeth were black with decay. She said, "I need them fixed."

Now, most of us see a 70 year old with black teeth because of decay and we are thinking crowns. I looked and looked and I thought, let me try to see what these look like after I remove the decay. To my surprise, I thought that I could fill them.

They would be big fillings and would be pushing the envelope as far as what composite can do, but it was worth a try. Now you can say to yourself, "Damn. There goes $6,000," but I was thinking I will get a raving fan out of it and when these big fillings fail or need more attention in 10 years or so, well then we will be there for her.

I did about 7 facial fillings, and if you ask me, I think I did an awesome job. Well, I sit here and tell you that they are not looking like failure is eminent. She is now 80 and the damn fillings look fine.

Now we are here, and she is saying that I am expensive. My cleanings might be $8 more than the next guy's, but they're about the same as other decent dentists around. My crowns are probably more but she has only had one crown. Yet here we are with her saying I am more expensive. The way I look at it, I saved her about $6,000 by taking the more conservative route. At $8 more per cleaning, she would have to get her teeth cleaned 750 times before we were even.

I guess the thing that chaps me so bad is she doesn't say how ethical I am. She doesn't say how conservative I am. She doesn't say that I am caring or go out of my way for people. Is it okay with you guys for someone to say you are expensive but worth it?

Okay, as I am writing this I know I sound like a baby (again). What I am mad about? She comes here and has been a patient for 10 years. She likes me. She sends her friends here. This is what I want out of patients, isn't it? So now, am I telling you that all I want is perfect patients? Well, yes and no. I don't want a patient to say, "I like you but..."

Am I expensive? Yes, but all dentists are. Dentistry is expensive. But let's compare apples to apples. If you go to a conservative guy, it could save you a ton of money in the long run. Just ask Mrs. Cohen. No, wait, she doesn't even see that.

Have a great day.

How did you like that blog that is short and to the point? I am running to give a lecture to the UCF ASDA pre-dental organization. I went the Gator game last night. 9pm game that went into overtime (we won, thank God). We got in our car at 11:40pm and we still had two hour ride home. I am totally dragging today.


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