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: www.ada.org/freereports. 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.

j