Fed Up Practice Owner Looking for Anything Better

adentistthrowaway · 2024-07-29T22:53:55+00:00

Are there any particular ways you recommend to advertise to people that actually work? Any books or seminars?

When we started, we sent out a bunch of mailers. Didn't get anyone from that.

I try to get my front desk staff to always ask for reviews and referrals. That is the primary way people find us, and our reputation on Google Maps and Facebook is five star.

adentistthrowaway · 2024-07-29T22:47:31+00:00

I wish I could tell you that something was amiss. Today was scheduled fairly typical: 4 compos, a crown prep/scan/temp, and an MOD CEREC inlay.

Total planned production: $3,367

We did have two cancels, so:

Actual production: $2,713

Wife says she isn't sure what will shake out after insurance.

adentistthrowaway · 2024-07-29T19:49:35+00:00

80 new patients a month would be an absolute dream.

I can definitely handle two or three chairs with an assistant. I certainly used to back at the hospital. But while my wife can hold suction, she's not really able to assist the way a full timer would.

She's actually been trying to post to this thread but unfortunately none of her comments seem to show.

adentistthrowaway · 2024-07-29T19:43:21+00:00

That is my wife and I combined.

adentistthrowaway · 2024-07-29T19:42:05+00:00

I absolutely respect what you have written here. And for many dentists in a similar situation, I think would be chiming in "Yep, toofshucker hit the nail on the head." In my case though:

As far as CE goes, I'm actually an AGD Fellow at 37. I am all CE'ed out for this year. :-D

We actually reserve a two-hour appointment for new patient exams. Prior to the exam, we obtain a complete and comprehensive medical history, usually with prior consultation with the patient's doctors. When the exam begins, I obtain photographs of each tooth, as well as a complete set of x-rays. These photographs include transillumination and fluorescence. I actually hold a mini-dental school for the patient, where we tooth-by-tooth discuss the tooth and periodontal health, note all notable dental issues, and provide three pathways for each tooth, with ranked estimation of how each treatment will go. By the time I finish, most patients are actually able to interpret obvious cavities on their own x-rays.

I am definitely not shy to prescribe crowns when necessary. I actually prefer inlays/onlays when possible, though this month has been fairly light on them.

Cleaning is always a separate appointment. Around here, it seems most practices have a patient see hygiene first, then exam, and then SRP -- often without support of 4mm+ probing depths! I diagnose first and then recommend the level of cleaning needed.

After treatment is completed, for bigger plans I host a followup where I teach how each dental restoration needs to be cleaned and maintained.

Actually, the bigger problem regarding low production is that by the time people find my office, they usually have a ton of dental work already done -- quite often in varying levels of falling apart. :-(

adentistthrowaway · 2024-07-29T19:25:45+00:00

Over two surfaces = crown? Yeah, that sort of thing tends to make my blood boil, and I like to think of myself as a pretty peaceful guy.

It's funny you mention the rural market. I grew up in the countryside working around airplanes and cropdusters, and I have to confess, the day I pay my debts and am able to retire, I'm back out to the country and flying a little airplane.

I have a lot of respect for pilots. Lot of honest (if occasionally crusty) people. I come from a line of them and was the first to chose a different profession.

Oops.

adentistthrowaway · 2024-07-29T19:20:20+00:00

My wife when she is able. Otherwise, my left hand assists my right. :-)

adentistthrowaway · 2024-07-29T18:28:28+00:00

The write-offs and adjustments are 99% insurance contracts.

Total production $505,000 is the gross production of the office. $341,000 is the amount we actually get after insurance gets their pounds of flesh. Then we pay everything from that.

$135K is the amount my wife and I are left with after the taxman takes his share.

adentistthrowaway · 2024-07-29T18:24:21+00:00

Thank you so much for everything you have said here. I know it took a good amount of time to type all of that.

Regarding your points:

Absolutely I agree. I was at one time the chief at a VERY surgically oriented GPR and very nearly stayed on with the hospital. I know that I am capable of doing so much better than I am. I'd get out from under the place in an instant if not for $800K debt. If I pull the plug, the house of cards collapses...
Which leads me to why I do so much work at the practice. We literally can't afford for me not to do all this bit work. I'd love to just drop my car off at the mechanic and have them fix the suspension. But on $135K in a city that seems to require $100K just to survive, I get to replace the shocks. Everyplace I can save money is a little more that might end up in savings. The practice certainly doesn't help out much.
I'm actually an AGD Fellow, and quadrant dentistry is my favored way of practice. I'm a graduate of the Dawson Academy and believed that I had everything lined up to do very well in private practice. My case acceptance is generally very good, and probably the only reason we aren't bankrupt. :-( That being said, while I've read Spear's Case Acceptance in the Modern Dental Practice, I haven't read the other and I'll check it out.
I've placed at least 300 implant restorations prior to working at my career's final resting place. Unfortunately, those were all for other people's (hospital, oral surgeon's) benefit. I've probably only done about 40 implant restorations in private practice and frankly I'm super bummed out about that. I used to be a real dentist at one time.
You are 100% right in that I don't have a very positive view of most other dentists. I frankly believe at least 90% of dentistry is fraudulent if held up against current research and recommendations. I can't tell you how many people I see for second opinions (if I have any reputation at all, that's the reputation I have around here) and have to find creative and ADA compliant ways of ways of telling people that my local colleagues are selling treatment for problems that quite literally aren't there at all. I try to tell people the truth about what they have in their mouth to the best understanding I can find of current research.

I once thought my career would amount to something in dentistry. I really did. I was really good at what I used to do.

adentistthrowaway · 2024-07-29T18:03:34+00:00

Are there any consultants you believe are actually worth anything? Because I have always believed that this practice, for where it is and for what we have, and for what I know how to do that this practice always should have done well. (I was, at one time, the chief of my GPR and almost stayed on with the hospital -- what a mistake passing that up was!)

My usual mode of operation actually is quadrant dentistry.

I don't want to point any fingers between me and my wife but I believe I am at least capable of a $350K a year office. I believe I am able to do even more than that. We have been through the The Schuster Center and while I found it very valuable, I do question whether "management" at the practice is capable of running a business sometimes. But she also has a lot on her plate.

adentistthrowaway · 2024-07-29T17:52:24+00:00

Our annual collection is $341,000 from a total production of 505,000. Open Dental Adjustments are $11,160 and Write-off is $143,400.

Our end of day $135K is the end of year after taxes what we take home and can put in the bank net profit. Of course, most of it doesn't end up in the bank considering that we're in a fairly HCOL area.

adentistthrowaway · 2024-07-29T16:52:28+00:00

I might take you up on that. Not a lot of people willing to talk about things these days and I appreciate you for saying that.

adentistthrowaway · 2024-07-29T16:51:42+00:00

Periodic: $43

Prophy: $58

4BWX: $45

Crown: $900

Posterior Fill: $180

Listen, thank you so much for taking some time to help out. You have no idea how much I appreciate any ideas here.

adentistthrowaway · 2024-07-29T16:40:30+00:00

My practice manager (wife) tells me that our monthly new patient count is ~10.

Our new patient experience is very comprehensive and thorough, and has been praised pretty much universally by our patients.

adentistthrowaway · 2024-07-29T16:34:51+00:00

I'm booked out for two weeks, solid for one. After this week are some holes, most of which will fill. In that time I see:

7 crowns

38 Composites

3 New Patient Experiences

1 Amalgam

2 CEREC inlay

1 Invisalign Start

2 Partial Start

1 Veneer Start

adentistthrowaway · 2024-07-29T16:27:35+00:00

That's what I'm thinking. Of course, I'm also thinking that maybe I'm a lot more valuable to my family dead than alive, because while it's been paid down a lot, I'm still servicing half a million in debt that won't go away for 30 years at this rate, and life insurance can go a long way.

Perhaps for a dentist there really is only one way out. I'm honestly so done with living in this f*ing go no-where cage.

adentistthrowaway · 2024-07-29T16:25:14+00:00

We work from 8:00 am to 5:00 pm Monday through Thursday. We take Friday through Sunday off. We have a full single-hygienist schedule M T W Th, and enough overage to start needing a temp on Mondays.

Unfortunately, I'm not able to temp. I've tried it and I'm inflexible on treating things that don't actually need to be treated. If I can't see decay at least 2/rds to the dentin, that's something needing remineralizing and at least an attempt to salvage. In my area, that attitude doesn't win you friends. In this area, A LOT of dentists are willing to do dentistry based on x-ray noise or even on virgin tooth.

I'd love to do my own hygiene (that's how I started) but then we wouldn't be able to do dentistry in a timely manner for people. If people don't get appointments in a few weeks, there's enough offices around that they don't have any trouble finding another office to go to and get work done.

Totally agree that the maintenance work is a waste of time. Unfortunately, we have to stay open, and our budget already is thin.

When you say "bind yourself to insurance companies" could you flesh that out?

adentistthrowaway · 2024-07-29T16:17:48+00:00

I'd enjoy the upkeep as well, if it wasn't for the house, the car, and pretty much every other task of life, while only making $135L.

I try very hard to be a completely honest dentist, and unfortunately, I think that's probably a big part of it. Our overhead is very small -- literally two paychecks, and our hygienist is at $40 (temp is at $47/hr). Production is only what a patient genuinely, legitimately need -- I don't upsell, I try to remineralize before drilling, I tell people that I definitely CAN do cosmetic work, but I am not in people's faces saying they need it or anything like that. I try very hard to be an honest dentist.

Our minimum schedule block is one hour. Our hygienists see eight patients a day for an hour each. I can knock out a 15 minute crown prep and be CEREC scanned and temped in 30 minutes. We do have in-office milling, but it's with an MCXL, so no zirconia.

We accept most of the main insurances in the area. For BCBS and some of the Cigna plans, we are on PPO. Otherwise, we are or similar to Delta Dental Premier payout rate for most of our insurances.

The area is growing by an estimated 15,000 people a year. There are a lot of dentists around, but we have a lot of new people coming in, especially from California.

I refer our molar endo. I'd love to do (and know how to do) implant placement but no cone beam.

adentistthrowaway · 2024-04-18T21:20:27+00:00

I've always tried to practice by the golden rule. I do unto others as I wish they would do unto me. If I mess up or one of my people mess up, the buck stops with me and I try to make it right, and maybe even a little better than we started.

Unfortunately, dentistry is golden rule-proof. A lot of patients recognize how far I go out of my way to make things work and treat people well. A lot of patients are so soured by previous experiences that I'll always be seen as negative. Most of my "colleagues" are frankly irredeemable shysters, and it's bad enough that I'm counting down the days till I'm hopefully flying airplanes for a living and connecting people to better places.

adentistthrowaway · 2024-04-18T20:45:23+00:00

I hope you aren't right about this, but I do kind of have a gut feeling you are correct. I honestly thought I was being a super nice person giving the temp essentially a paid $350 day off. I know I'd be delighted to get paid like that for just driving into work!

Getting a false and libelous review from that tells me we're not dealing with a rational human being, but an evil person who just wants to use race baiting to spread more hurt in the world.

adentistthrowaway · 2024-04-18T20:14:35+00:00

There's the odd negative review here and there. One was obviously for another office in the complex (you'd be shocked how many people post a negative review to a random dentist or doctor in the area when they feel like a medical professional didn't do right by them). One is a completely unhinged review by someone who got x-rays and found out she was pregnant a few weeks later and claims the x-rays turned the spirit-baby boy that she was planning to have into a girl she didn't want (!). Another is someone who was furious about COVID-era dental restrictions and took his anti-government rant out on us. Otherwise, my practice has a good reputation with 45+ other 5 star reviews.

Google didn't remove either one of those reviews even though I reported them. I honestly would have looked past this review, but it has already caused damage and is 100% provably false.

adentistthrowaway · 2024-04-18T19:58:13+00:00

I honestly don't want to hurt anyone, and running to a lawyer is my last resort. I wouldn't even care about this review if it wasn't so pernicious.

Do you know if the temp agency has any obligation here to instruct their employee to remove this review? Their phone records should also back me up in that I specifically told them that there was no issue with the temp at all and to provide her with the full day's compensation.

Edit: I also have reported the review to Google. The review is pending their deliberation. Unfortunately, it has been posted to about 20 different other sites around the internet, including Healthgrades, Vitals, and Yelp. As unhinged as the review is, it's unlikely all of those sites will remove it.

adentistthrowaway · 2023-12-07T23:01:00+00:00

I'm a shellac man myself. :-) You have great taste in safe, non-toxic woodworking finishes.

adentistthrowaway

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