The Fee-For-Service Practice: How to build a lawsuit-proof practice

What does running a successful fee-for-service practice have to do with avoiding lawsuits? I attended a risk management seminar presented by my malpractice insurance carrier that was all about things you can do to avoid getting sued.

They had some very valuable tips, such as keep clear and precise documentation, know when to refer, get a thorough medical/dental history, don’t get in over your head with a specialized procedure, and know all the materials that go into your lab-processed restorations. I wanted to raise my hand and add what I feel is the most important tip of all—your relationship with your patients. (I didn’t raise my hand, but it did get me thinking on my drive home.)

Relationships: The cornerstone of fee-for-service success

Relationships are what it’s all about. They’re the secret behind having a superstar staff that makes your life easier, and they’re what drive the engine that’s your dental practice. I consistently receive letters asking how to create a fee-for-service practice, and my answer always starts with relationships. Being the best dentist possible, having integrity, and caring about the well-being of your patients creates meaningful relationships.

I just celebrated 40 years of running my very small, high-quality, relationship-based fee-for-service practice, and it’s had many challenges, but thankfully, many more joys. The most joy comes from being there for my patients over the years through their many life events. This takes time and authentic caring, and I honestly don’t know if that’s possible in an insurance-based practice where you run two to three chairs, are rushed for time, and are trying to make up the insurance discounts with higher volume.

Providing the highest quality dentistry possible, really listening to your patients when they have a concern, and even returning their money if they’re not satisfied are the best ways I know to avoid a lawsuit.

Beyond that, I’ve often said that what I love the most about my dental practice, besides being able to provide the best dentistry possible, is the life lessons I learn daily from my patients. Many of these people I’ve known for close to 40 years and we’ve developed tremendously satisfying and impactful relationships. Let me give you an example of a meaningful interaction with my patient, Herb, that has stuck with me.

A lesson from Herb: Why dentistry is about more than teeth

Herb and his wife, Carol, are two of the patients I’ve known for 40 years. Herb is a witty, intelligent 93-year-old and his wife is close to 90. They were in their mid-50s when I met them, and I was 27. Back then Herb was a jaunty, cool guy who was successful at his job and loved listening to jazz. His wife was a sweet and creative artist. They were completely devoted to each other.

That was then and this is now. Herb is still sharp as a tack and extremely clever, even if his body is going through its expected unwinding. It’s obvious he still takes pride in his appearance and dresses with an eye for fashion.

Carol is a different story. She’s had Alzheimer’s for at least 10 years and lives at home with Herb as her sole caregiver. The last time I saw her was more than year ago and she had no idea who I was. We had enjoyed many conversations over the years, but all that was forgotten and I was just another stranger to her.

Herb has lost many teeth due to decay and aging and has recently been struggling with a new upper denture. He was recently in for an appointment and was more quiet than usual. I fixed his denture, and we made small talk until I asked about Carol. He paused and said, "Thanks for asking," as if not many people did anymore. He said that she has good days and bad days. On the good days she still recognizes him and reads him the paper since his eyesight has diminished.

He told me he’d found some pictures of the two of them and he’d forgotten what a beautiful woman she was. And with that, the tears came. I gently squeezed his shoulder and remarked that Carol was lucky to have him as her husband, caregiver, and lifelong friend.

When Herb left, I thought about my wife. It’s a second marriage for both of us. A very wise friend told me that the key is to try to make her happy every day. But Herb has taught me an even stronger lesson. I want to savor every moment I can. I want to hug my wife tightly as often as I can and appreciate her beauty inside as well as out.

I apologize for getting a little philosophical and personal. But this’s what having valuable relationships with your patients does for you. It makes theirs and your life fuller. And by the way, these patients will be much more willing to follow your recommendations for complete dentistry that may cost thousands of dollars purely because they trust you.

Thank you, Herb, for being a true gentleman and inspiration. And thank you to my patients for providing me with teachable moments every day.

Editor's note: This article appeared in the November/December 2025 print edition of Dental Economics magazine. Dentists in North America are eligible for a complimentary print subscription. Sign up here.