Lessons learned from experience

Sept. 1, 2000
As a dentist of 20 years, I`d like to share with you some of the lessons I`ve learned along the way in my career.

Jerry W. Chernik, DMD

As a dentist of 20 years, I`d like to share with you some of the lessons I`ve learned along the way in my career.

First, always use a rubber dam. I use magnification and a rubber dam 100 percent of the time. I do all of my crown and bridge treatment under a rubber dam.

I am amazed at the number of dentists who do not use rubber dams. I refuse to work on any patient without one. I fervently maintain that the one proven way to improve dental health-care delivery in this country is to mandate rubber-dam usage by all dentists.

Secondly, I have no particular axe to grind with amalgam. I think it has been one of the most cost-effective, long-lasting materials that we`ve ever had in dentistry. All this talk about breaking cusps and recurrent decay - I`m just not seeing that in my practice! On the contrary, I am amazed at the number of amalgam restorations I see that are 20 years old or even older that are doing just fine. They are like the old Timex watches: "They take a licking, but keep on ticking." The only drawback I see is that amalgams are not esthetically pleasing.

Yes, I am doing more and more posterior composites. However, the following scenario occurs in my practice quite often:

Mrs. Smith comes in and says: "I don`t want that evil mercury in my mouth."

"Not to worry, Mrs. Smith," I reply. "You don`t have to have that evil mercury in your mouth. We`ll use bonded composite material."

But then I tell Mrs. Smith that her insurance company will pay only 80 percent of the comparable amalgam fee and that, because it takes me twice as long to do a similar-sized composite, the fee will be nearly double and she will have to bear the extra expense out-of-pocket. In almost 90 percent of the cases like this, the patient will say, "Give me the mercury amalgam!"

I then will remind the patient of his or her concerns about amalgam, but the patient usually will say, "I don`t want anything that the insurance company doesn`t pay for."

We also get a lot of "Doc, you say the fee for my molar root canal will be $900, the build-up will be another $225, and the crown for the tooth will be $850. That`s almost $2,000 for one tooth! Doc, are you out of your mind?!! Pull it!!!"

And so it goes. These two scenarios aptly illustrate what my dental school dean, Dr. Louis Terkla, said back in 1975 when I was an incoming freshman at Oregon`s School of Dentistry. He told us, "You ladies and gentlemen will have a tough row to hoe. People are now thinking of dental health care as a right, not a privilege, regardless of their ability to pay for it.O Your fellow dentists are not your real competition! Instead, we all are competing with European vacations, new cars, snow machines, RVs E you name it! In the same breath that Mrs. Smith tells me she cannot (or rather will not) afford my dental treatment, she is planning a vacation to Hawaii or buying a new jewelry.

So, as far as amalgam is concerned, I have no plans to throw it out anytime in the near future.

Thirdly, I have some comments about this talk of going Oinsurance-lessO in the dental office (requiring patients to pay the full fee at the time of service and then letting them hassle with the insurance company.) To put it succinctly, Ogood luck!O My wife is my office manager and receptionist. We both are firmly convinced that if we ever tried this, we would be out of business tomorrow E no ifs, ands, or buts!

We have enough trouble as it is just collecting the patient?s copayment at the time of service. We routinely hear, OCan?t I make payments on my 20 percent copayment?O (The answer is no!) The typical patient defines a monthly payment as $5 or maybe $10, if he or she feels like making it. The other thing we hear is, OMy last dentist just took what the insurance company would pay as his payment.O My wife continually tells patients who say this, OMrs. Smith, that is what is known as insurance fraud. My husband has no plans anytime soon to take a chance on losing his dental license and going to jail!O

Fourthly, we do not accept Medicaid ... ever! I?ve never wanted to incur the wrath of government agents with Gestapo tactics coming after me and indicting me under the RICO Act because I didn?t dot an OiO or cross a Ot.O Also, if a Medicaid patient decides to sue you (and many do!), the state government does not stand behind you whatsoever. (This is what is known as Ohold harmlessO in legal terms.) I understand that in some states, such as Minnesota, that dentists have to accept Medicaid patients as a condition of licensure. I?d quit first!

How can a state government that did not pay me one penny for four years of college, not one penny for four years of dental school, not one penny of over $300,000 in risk capital that I invested to set up my office practice tell me that I have to accept welfare patients in my private dental office? And we haven?t even considered the fact that Medicaid fees are abysmal, the paperwork is a nightmare, and welfare patients are notorious for failed appointments.

Here in Alaska, every man, woman, and child gets an annual dividend from the state. This year, that dividend is $1,770. Therefore, I?ve always felt like dental Medicaid is not even necessary in Alaska. Medicaid patients should pay for their dental health care out of their annual dividends.

Finally, at age 46, I could have retired from dentistry five years ago and lived the rest of my life off the $100,000 in annual interest income from our municipal bond portfolio. I find it sad to read studies that show so many dentists are financially unable to retire, even at age 65. If I ever thought that I would have to practice dentistry until I was 65, I probably would feel suicidal.

I now go to work because I want to, not because I have to go to work. There is a huge psychological difference between wanting to do something and having to do something. It colors every aspect of your life. I have peace in knowing that I could quit and not even think twice about it!

I no longer feel compelled to treat every patient who walks through the door. Being financially independent allows me to slow down, take my time, and not be harried by a fast-paced schedule. If a patient cancels or fails an appointment, fine! I just go back to my private office, sit down, drink coffee, and read a magazine. I love it!

Today, life is beautiful!

Jerry W. Chernik, DMD, has been in private practice in Wasilla, Alaska, for 14 years. He is a graduate of the University of Oregon`s School of Dentistry. Following dental school, he spent 6 1/2 years in the U.S. Army Dental Corps, the first three in Germany. He can be reached at (907) 376-0600.

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