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Edited on Tue May-03-05 04:36 PM by drbtg1
The stuff I could write about finding a dentist, and the practice thereof, could fill a book. Or at least a primetime soap opera.
"...and now it's time for another exciting episode of 'As The Drill Turns'"
Yeah, I see stuff like "cosmetic dentistry", "laser dentistry", "mercury free dentistry" and such along with "Saturday appointments available" and "credit cards accepted". It's advertising, a way to make more money than the other dentist down the street. Unfortunately, I also see the continuing education courses that tell dentists how to push this stuff.
Now, don't get me wrong. I definitely think there a need for dentists to take continuing ed courses on business and marketing. A dental practice is a business, after all, with responsibilities to employees and local and state authorities. After dental school, we get thrown to the wolves, knowing dentistry but zip about the other parts of the practice. While I believe dentist should stay independent business-wise (I'd hate to think of the Wal-Marting of medicine), unfortunately, I think this leaves dentists prey to marketing folks.
Here's something you may not know: I'm sure you've heard of Scientology. Well, they have a division, Hollander Consulting, that does consulting for dentists. They're coming at us from everywhere.
I recently went to a continuing ed course, primarily for dental material review, but as usual, they talked about a wide variety of subjects. One of the subjects was digital photography. Not radiology, not x-ray. This was photography, with the digital Canon camera. Again, I believe there's a place for this, for records, for communicating with dental labs, for showing patients before and after photos, et cetera. But this lecturer (also big on "cosmetic dentistry") went a little farther. After finishing a case, he'd take the after photo and while the assistant was finishing up, he'd run to his private office, open up Photo Shop (or whatever), and make an 8"x10" picture of "after" with a little "before" in the corner. And he'd hang it up in the hallway for the patient, and pretty much everyone else, to see. "See, don't you look great now?"
Now, you might be wondering how the dentist got away with it. I mean, isn't there patient privacy rules, HIPAA laws, and such. Well, when the patient was filling out the patient info and health history form, in the fine print was a line about a photo release for purposes of advertising. Pretty sleazy, huh?
And this was the lecturer! The guy put forth as the example, the standard bearer.
Looking at your post, it seemed the biggest problem was financial, insurance and otherwise. Unfortunately, insurance is a headache from my end, too. I am a "participating provider" in a few plans, which can cap what I charge if, in the insurance company's sole opinion, my regular fee is too high for them (and that opinion varies greatly from insurance company to insurance company). This may have been part of your old dentist's "winnowing" process (not justifying it, just giving background). I still take "assignment of benefits" (where insurance sends the check to me at the patient's option) which many of those consultants tell dentists to stop and get total payment up front. I also wait for insurance to pay their end before billing the patient for the balance if the estimated patient balance is low enough (say less than $100). This kills my accounts receivable, but I hope some patients appreciate it (I know many think it's an entitlement. Oh, well. I don't expect sympathy.)
I also do something that is increasingly rare, extend credit to patients. I know some dentists will use third parties like CareCredit, but I do that in-house. Basically, I'll allow people, once treatment is satisfactorily completed, to make even payments over about six months if they need it. No late fees yet, no interest.
Unfortunately, some folks take advantage of that and try to ditch their responsibility. I'm not talking about people who get on hard times. Those folks will talk to us, keeping the lines of communication open. However, some folks, once work is done and they start getting bills from us, turn a deaf ear. I don't mean not sending in payments, I mean not even talking to us. That's when we have to start our collection routine (and people here are free to critique it). Once the account is past due and we've heard nothing, they get a first collection letter, very polite. After two weeks and nothing, a phone call (which usually is left on the patient's answering machine). Another two weeks and nothing heard, the second letter, somewhat stronger than the first. Another two weeks and nothing heard, the second phone call. Two weeks, third letter. Two weeks, third phone call. After two more weeks, the final letter. And then two more weeks. Four letters, three phone calls, the regular monthly billing statements and no communication from the patient. This is when I get to review all the collection attempts and lack of response. Unfortunately this is when they usually get sent to the collection agency. I don’t like this, but I can’t imagine a regular credit company being that patient.
Does this leave me open to risk? Yep. As of today (opening the collection file), people who have been sent to the agency owe me $11,995.50. Awful lot of money to me.
Now some of these people haven't completely disappeared. One of them, who owes $1,366.40, I know exactly where he is. After I finished work on his wife, he decided to kill her. Okay, ALLEDGEDLY killed her. Sitting in jail right now. Collection agency told me this would be uncollectable. I kinda figured on that, as we were following the story in the newspaper, but I was rather surprised when a family member of the guy called up, not to settle the balance, but to cancel this guy's six-month cleaning appointment. So, let's see now, killed his wife (allegedly) but had enough manners to give me 48 hour cancellation notice. Go figure.
I guess, even though I'm in my 30's, my collection procedures make me a dinosaur. But I do okay. And I can sleep at night.
Financial arrangements are something you’ll need to talk about with the staff at the new dentist’s office and find what’s acceptable for you. But don’t be afraid to check out multiple dentists. Ultimately, you should be comfortable with your choice and that may take some looking.
Obviously if it was me, I’d be looking for things I can’t adequately explain here. But here are some items you should be able to find out on your own. You might not be able to limit your search for these items to just phone calls though.
-advertising. Does the dentist do a lot of external marketing? Radio ads? Cable TV ads? A big yellow pages ad? WHY? The most referrals I get is still word of mouth. Why does this dentist need to attract so many patients outside the practice? Practice just starting? Dental mill? Large turnover of patients? And how is the dentist paying for all that advertising?
-referrals from other patients. Referrals from friends are great, but also consider the quality of the referral. If the person is a lawyer or clergyperson, chances are the dentist was on his/her best behavior. But if the dentist did well with parents AND children (where there’s little profit), I’d put more stock in that.
-referrals from the dentist to specialists. Who does the dentist refer to for specialty work? He/She may do some of it themselves, but the more they try to keep work in-house, the more worried I get. Jack of all trades, master of none. Why do they need to keep all they money-generating work away from highly trained specialists…oh, never mind.
-patient chair. Is the chair comfortable? I don’t mean is it new or old. Old chairs can be reupholstered. But is it a nice pseudo-leather chair that you can sink into or is it hard as a rock? Just an indication of the dentist’s concern for your comfort. (If the chair is cloth, walk out. It can’t be properly disinfected between patients.)
-toothbrush. Did you get a new toothbrush after your cleaning? Many do, but did you get a brush brand you’ve heard of before? If it’s a cheap no-name, it’ll probably do okay, but I start wonder what else is the dentist cheap about? -assistant. How does the dentist get along with the chairside assistant? Maybe you heard of the Ann Landers advice (or was it Dear Abby?) that told people on a first date in a restaurant to be mindful of how your date treats the waitress, because that’s how he’d eventually treat you. Well, similar line of thought. If the assistants looks like they want to bring in an uzi…
-staff. What does the staff think of the dentist? Would they (or their spouses) have work done by that dentist? Good question to ask if you see them outside the office. (But if the staff is prepared with business cards and practice discount coupons, forget it. They were already taught what to do here.)
-sterilization. Ask to check out the spore test results for sterilization. But give them a heads up. Not too many people ask, and with all the paperwork dental offices do, it may not be something readily available in the 5 seconds at the end of a cleaning. You should know, but you don’t need a “PITA” label from the staff.
-treatment scheduling. Can you just do a single filling first and let you get comfortable with the dentist or will the dentist throw a tantrum if he can’t do multiple restoration right off the bat?
-temp crown. If the person you got a referral from had a crown done by that dentist, how did the temporary crown do before the permanent crown was put in? I don’t mean did it break (that could be the patient biting too hard on something). I mean did the temp crown stay in or did it fall out one, two, three times before the permanent one got put in. Yes, permanent crowns get permanent cement, but also it should have a certain inherent retentive quality based on what the dentist did to the tooth underneath, the design of it. The temp crown can be a harbinger of that.
-one day crown. Does the dentist have one of those machines that mills a permanent crown while you wait. At this time I’d stay away from it. There’s basically one company making them. It’s very new, and I’d like to see how the restorations from it do over the long haul. Unfortunately, the machine’s very expensive. About 90 grand. That’s not something that would be ditched if it was substandard and I’d hate to be married to that if it becomes a lemon. Besides, I like having the opportunity for human feedback at a dental lab for current work and learn about upcoming technology that wouldn’t necessarily fit that machine.
-dental mills. Just stay away. I’d want my work to be done by the guy/girl in charge, not by somebody getting a crappy percentage of collections. That person may eventually become a good dentist, but I don’t need to take the risk.
-composite restorations. In keeping with the thread's topic, what does the new dentist use. For my money, I'd want him to be comfortable with both, not one or the other. Lets me know the patient gets the choice on filling materials (most of the time anyway, once in a while, one material or the other is preferred) and that the dentist is comfortable with his technique for filling posterior teeth, especially since doing composites on posterior teeth is much more technique sensitive.
Good luck!
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