Thoughts on the 1999 fee survey

As the office manager for a general practice dentist, I enjoy reading Dental Economics and found the article "The 1999 Fee Survey" in the December issue very interesting. For the most part, your article mirrors what I have been telling my dentist for almost a year - that general dentists are not charging the true value of their services. For some unknown reason, most general dentists seems to be willing to relegate himself or herself to the status of a second-class citizen in the health-care com

David Greene

Woodland Hills, Calif.

As the office manager for a general practice dentist, I enjoy reading Dental Economics and found the article "The 1999 Fee Survey" in the December issue very interesting. For the most part, your article mirrors what I have been telling my dentist for almost a year - that general dentists are not charging the true value of their services. For some unknown reason, most general dentists seems to be willing to relegate himself or herself to the status of a second-class citizen in the health-care community. This is a shame.

I do have to take exception with one point you seem to both applaud and suggest. I base this exception on knowledge I have gained from being on the business front of the practice and in the dental trenches when it comes to the real world.

In your article you say "...dentists have not become more flexible in extending credit" and "With more flexible financial arrangements, dentists can improve case acceptance of comprehensive treatment plans."

This approach sounds good in theory, but in reality it rarely works. Most general dentist`s offices can`t afford to double as a finance company, and that is exactly what you are talking about. Just because a patient comes into a dental office for treatment doesn`t mean that he or she pays the bills on time. Should the general dentist run a credit report before extending credit? I think not. And at what point is a payment plans discussed - before the work is started or after it is completed? Do we have the patient sign a formal agreement for the payments? I think you can see that the idea of the general dentist financing dental work isn`t as simple as it appears.

On the rare occasions when we have agreed to bill a patient or work out a payment schedule, we have found that we have to continually "remind" the patient to pay as agreed, which takes valuable staff time and office resources. In one instance, we had to file a lawsuit to collect and, since there was no written agreement covering legal costs, we lost money even when we won the case. As a practical matter, most dentists turn over their uncollectible accounts to collection agencies, which take between 40 and 50 percent of whatever they ultimately get. In cases like this, the dentist most likely ends up losing big-time, considering overhead and outside costs on a case.

I also feel the comparison made about people financing a car and/or home to financing dental work is not well-taken. The primary difference in these instances is that if payments are not made when financing a car or home, the security company can retire the debt. The car can be repossessed or the home can be foreclosed. If a dental patient doesn`t pay, the dentist can`t repossess the crown or take back the bridge - a fact well-known to the patient. I have heard dentists talking about patients who have had thousands of dollars of work done and began paying in small partial payments. When the work was completed, the patient agreed to pay in installments, but never did. Most patients know that the dentist, just as a medical doctor, can`t ethically stop treatment because the bill isn`t being paid, right?

I feel a much better solution is to let the patient finance his or her dental work with a credit card. If a patient has a financed car or home, he or she has a credit card. If a patient doesn`t have a credit card, there`s a reason and, most often, that reason is that the patient is not a good credit risk. So why should the general dentist given credit when multi-million dollar-backed banks have refused it to the patient? Wake up and smell the N2O and let`s use a little business logic here.

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