E59: Podcast: What Is Your Time Worth?

Hello and welcome to Ascent Dental Radio, a program dedicated to the balance between the clinical aspect of healthcare and the business of healthcare. And now here’s your host, Dr. Kevin Coughlin.

Good evening. This is Dr. Kevin Coughlin. You’re listening to Ascent Dental Solutions with a focus on knowledge, education, development, and training. I want to give special thanks to Mr. David Wolf and Mr. Doug Foresta for helping me produce these podcasts. Without their expertise, these podcasts would not be possible. I also would like to send out a shout to VOCO who’s been providing me with the best in most up-to-date supplies, education, and training for my general dental practice and I can’t thank them enough for their expertise and also their ability to sponsor me for these podcasts.

Today the topic is “What is our time worth?” Many years ago, I went to a business seminar and I was told the difference between a laborer and a professional is that a laborer uses their brawn, their muscles, their back. A professional uses their brain. I’ve been practicing clinical dentistry for thirty-six years. As a matter of fact, I just completed another twelve and a half hour day, nonstop, doing orthodontics, implant surgery, temporomandibular joint treatment, surgical extractions. As a matter of fact, I removed twenty-two impacted wisdom teeth just today. The point of this is not to try to impress you with my knowledge or work ethics, but to tell you that my last patient today spent fifty minutes and out of that fifty minutes of conversation, 99% of it was based on what the insurance was going to pay and what it wasn’t going to pay, what was going to be covered and what wasn’t going to be covered. And I can tell you after thirty-six years of practicing extremely hard, like most of my compadres, it’s exhausting, day in and day out, to spend more and more time discussing what some individual’s insurance will or will not cover.

I’d love to tell you that I’m at a position financially that I don’t need to take any insurance. I actually don’t even have to clinically work anymore. I’m sixty years old. I have fifteen different dental practices. I have Ascent Dental Solutions. I’ve sold and resold to two managed service organizations, but I do enjoy practicing. But the frustrations of dealing with the day-to-day aggravation that I’m sure all of my listeners can relate to and appreciate. And the question comes in is during the last twelve months I’ve had an extensive amount of time dealing with lawyers, business attorneys, investment attorneys, financial attorneys, and the one thing that amazed me is they all billed by quarter hours. Whatever the fee is, whether it’s two hundred, three hundred, six hundred, or a thousand dollars an hour, they’re billed for their time. In dentistry, as in medicine, most of us are not compensated for our time. What we’re compensated is if our high speed is spinning. We’re either removing teeth, filling teeth, root canaling teeth, straightening teeth, and that’s how we’re compensated. And in my personal opinion, our expertise and knowledge, which is the treatment plan formulation, the diagnosis, is almost completely non-compensated for.

Here in the western Massachusetts area, basically, we have a limited exam, a periodic exam, and a comprehensive exam with a patient base of which about 65 to 85% are insurance-based patients. There is a standard fee and whether we agree with it or disagree with it, once you accept that insurance plan, you’re obligated to accept that fee. So in an evening appointment, like tonight, where fifty-some odd minutes were spent in the consultation, the reimbursement was $69. If you’re paying your dental assistant, like I am, between 25 and $32 an hour and then another $4 to $8 in benefits, and your dental hygienist between $40 and $44 per hour plus benefits of four to $8 on top of that, you realize how ludicrous it is to be able to spend fifty minutes on a consultation and be reimbursed $69. I would hope that the individuals listening to this get as much aggravation as I am and say -when do we stop and honestly say to ourselves, “We should be compensated for our time, our expertise and our knowledge.”? And that means whatever that fee is, my personal opinion is, adjust that fee based on your overhead, the amount of time you believe you should be compensated for and that fee should be set. If the insurance company decides not to cover it, then that patient is responsible for the balance and the free market will determine whether Mr. and Mrs. Smith want to stay with you or go somewhere else. I think all of us as businessmen and businesswomen in the practice of dentistry understand that you can’t spend fifty minutes and do an excellent comprehensive treatment plan exam and a development of a relationship and be compensated for $69, $49, $39, or even a $125 because mathematically it doesn’t make sense.

The answer is not simple. I personally believe the best approach for all practitioners, along with the patients receiving care, is to allow the market to dictate the fees and you set your fees based on your overhead, your expertise, and the value you place on your time. The patient will make a determination whether they’d rather have a five or a ten minute consultation that only addresses a single tooth rather than a comprehensive plan and that individual may only end up being reimbursed or paying that dental office the $69 fee. I do think that most people are looking for a fair treatment, a high value, on that treatment. In my opinion right now, I believe our profession is being treated more as laborers than professionals. I believe in my heart and in my soul, this is a mistake for the patient base and it’s a mistake for our profession. As we see the managed service organizations and dental service organizations growing at a rate of 18-25%, the reason for this is they’re taking advantage of our lack of acumen when it comes to business. They’re taking advantage of our inability to realize what’s going on outside our four walls. I think that our profession should be shaken up a little bit. They should realize what’s going on and say to themselves, “Enough is enough. We need to band together.” Realize what the strength, weaknesses, opportunities, and threats are to our profession and start saying to ourself, by educating our patient base, that, “It’s your insurance, it’s not ours. As a courtesy, we’re providing the information, knowledge and expertise to handle your forms, but ultimately, you’re paying us for our expertise and our knowledge.”

I realize during this podcast that I’m a little hot under the collar. I realize I’m slightly aggravated and I think you could sense that in my feel. However, in my opinion, there’s no one to blame but myself. No one is twisting my arm to accept these plans, no one is twisting my arm to not just give up and retire. I’ve elected to do it and hopefully share my thoughts and my recommendations to the profession through the podcast.

I would like to say, if you’re interested in feedback and more information, please feel free to email me at kevincoughlin@ascentdentalcare.com. I’d love to hear from you. Perhaps maybe instead of me always giving advice, I can receive some advice from some of our listeners.

It’s important that we take care of our profession because our profession is taking care of us. But I believe when we leave it to large corporations and organizations and insurance companies that may not have our best interest at heart, I feel we’re going to come out on the short end of the stick. I’ve been practicing, as I said, for thirty-six years, and I believe that it is a rewarding and wonderful profession, but some days it just gets to me as I’m sure it gets to you. In my personal opinion is action steps needed to be taken by me, have to be taken by me, if you want a change.

I hope you listened to this little rant and appreciate that although I come across as an expert, I have the same stresses, problems, and aggravation that all practices have. If you’re interested in more information, contact me through Ascent Dental Solutions with a focus on knowledge, education, development, and training. I want to give special thanks again to Mr. Doug Foresta and Mr. David Wolf for their expertise and providing the knowledge to provide these podcasts to you. And I also want to say special thanks to VOCO, continuing their good work and providing us with outstanding processes, procedures, equipment, and supplies so that we can provide the highest level of care and treatment. Thanks again for listening. My name is Dr. Kevin Coughlin. I look forward to speaking to you soon.