I want to get better as a clinician. I want to make enough money to pay everyone and maybe keep some money for myself. I want to have a place that is nice to come into. I have to worry about marketing the practice. I need to make sure the sprinklers are working outside so the grass doesn’t die. (Speaking of the grass, that reminds me: I need to ask the lawn guy to trim the hedges next time he is here.)
I have aging computers that need to be replaced. Come to think of it, my compressor is pretty old, and so are my autoclave and my vacuum system.
I feel my hair turning gray as I type this.
Things would be so awesome if the schedule was jammed-packed every day and all of those other things would work themselves out. Like everyone’s practice schedule, my schedule kind of ebbs and flows. I try not to think about it, because I know that the next month can be gang-busters. But for me, my schedule has been more lemons than lemonade for the past month or two.
And then Phil came in.
Phil is an interesting guy. He is an unassuming guy — one whom you would never know to be wealthy. He has told me he doesn’t work. His exact words: “I just manage my money.”
He came in for recall last week, and he had some beaten-up second molars. I said, “One day, you are going to need full coverage on all of them.” After he thought about what I said for a second, he said this: “I have been coming here for 25 years. I pay cash for all my work. I want to do all four crowns at once. What is the best you can do for me?”
What would you say?
I told him that I would take 10 percent off. He looked at me and shook his head. He said, “I want 20 percent.” I told him I had to think about it.
Here was my thought process:
This really is a good patient and family.
Lately, the schedule has been more lemons than lemonade.
I don’t usually negotiate.
I am doing just fine, and I don’t need to do these crowns.
He wants to give me something like $4,000 cash for a couple of hours of work (minus the overhead).
My fees are my fees.
It would be like if I offered a 15 percent coupon.
Am I cheapening my work?
He could go somewhere else.
I thought about it, and I said, “Yes, I will do it.”
I said yes for so many reasons. It had nothing to do with my schedule. I thought the patient was looking for an “I appreciate you as a patient” moment.
If I had said no, it would have put a strain on our relationship. And also, I didn’t want to leave that kind of cash on the table. I am a business man, after all.
So for that day, I made a patient happy. I had a good production day. I knew that I could pay my staff, and if the autoclave went down, I might have had a little extra to fix it.
Now I just have to worry about the other 364 days.
John Gammichia, DMD, FAGD
Things would be so awesome if the schedule was jammed-packed every day and all of those other things would work themselves out. Like everyone’s practice schedule, my schedule kind of ebbs and flows. I try not to think about it, because I know that the next month can be gang-busters. But for me, my schedule has been more lemons than lemonade for the past month or two.
And then Phil came in.
Phil is an interesting guy. He is an unassuming guy — one whom you would never know to be wealthy. He has told me he doesn’t work. His exact words: “I just manage my money.”
He came in for recall last week, and he had some beaten-up second molars. I said, “One day, you are going to need full coverage on all of them.” After he thought about what I said for a second, he said this: “I have been coming here for 25 years. I pay cash for all my work. I want to do all four crowns at once. What is the best you can do for me?”
What would you say?
I told him that I would take 10 percent off. He looked at me and shook his head. He said, “I want 20 percent.” I told him I had to think about it.
Here was my thought process:
This really is a good patient and family.
Lately, the schedule has been more lemons than lemonade.
I don’t usually negotiate.
I am doing just fine, and I don’t need to do these crowns.
He wants to give me something like $4,000 cash for a couple of hours of work (minus the overhead).
My fees are my fees.
It would be like if I offered a 15 percent coupon.
Am I cheapening my work?
He could go somewhere else.
I thought about it, and I said, “Yes, I will do it.”
I said yes for so many reasons. It had nothing to do with my schedule. I thought the patient was looking for an “I appreciate you as a patient” moment.
If I had said no, it would have put a strain on our relationship. And also, I didn’t want to leave that kind of cash on the table. I am a business man, after all.
So for that day, I made a patient happy. I had a good production day. I knew that I could pay my staff, and if the autoclave went down, I might have had a little extra to fix it.
Now I just have to worry about the other 364 days.
John Gammichia, DMD, FAGD
In situations like this, I'll use base metal instead of hi noble if it's a PFM or use one of those distant lab coupons for a cheap zirconia crown. Then I'll use the hand polishing tips instead of returning the crowns to the lab for a glaze after adjustments. A discounted price merits discounted product.
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