by John Jameson, DDS
Dr. Charles Barotz has a cosmetic/restorative, fee-for-service practice in Denver, Colorado. He has published in Dentistry Today, Journal of the Colorado Dental Association, Crown Council News, and The Profitable Dentist. He has been interviewed for two monthly audiotape series, sponsored by The Profitable Dentist and The Richard Report. Dr. Barotz also is the moderator for both GenX and DentalTown dental forums. Dr. Barotz's office was a finalist in the annual Cosmetic Practice of the Year contest co-sponsored by the Levin Group and Dental Economics. He can be contacted at (303) 595-4994 or [email protected].
Dr. Jameson: Dentists often fail to comprehend their full worth as dentists. Dr. Barotz, what can dentists do to realize their full worth, both as dentists and as leaders?
Dr. Barotz: First of all, dentists largely are technicians — technicians who have to run a business. Every dentist should read the E-Myth series of management books by Michael E. Gerber to get an idea of what usually happens when technicians are thrust into the position of running a business.
Dentists often do not view their services from a value and benefit standpoint. We tend to take a myopic view on the procedure only, without factoring in the benefit of the procedure. If we focus more on the benefit of what we do for individuals, it would increase our sense of self worth to an extent that we would feel comfortable asking more of patients financially.
Dr. Jameson: Yet, asking more from patients goes beyond the personal comfort zone of many dentists. How can clinicians reconcile this desire for better valuation of their services without violating their comfort zones?
Dr. Barotz: I think we must first ask, "Where do we fit in?" We also must examine what other professionals, or even some blue-collar workers, earn for the services they provide.
Dr. Jameson: Do you think dentists feel guilty for charging for their services in some cases?
Dr. Barotz: I do. I think there's been a history established as far back as dental school that, for many people, we somehow are not worthy.
Most professions place an hourly valuation on their services. Hygienists average around $35-plus per hour. Plumbers and carpenters make more than $50 per hour. Attorneys make anywhere from $200 to $350 per hour. If we factor in everything a dentist does — diagnosis, treatment, health maintenance, and prevention — our services easily are worth $1,000 per hour.
Dentists above all need to increase their confidence about the services they provide. They need confidence to persuade customers about the benefits of treatment, and to clearly demonstrate to their patients how their lives will improve after treatment.
Dr. Jameson: Adding on to the treatment mix that we offer our patients is one way dentists can increase the value of their services. What are your ideas about how doctors can regularly learn new procedures to help them grow — professionally and personally?
Dr. Barotz: One of my goals as a practitioner was to learn a new procedure every four to six months, usually one normally performed by specialists, and I still believe in this kind of learning. Constantly learning and doing something new forces dentists out of their comfort zones. If we don't occasionally do things that we are uncomfortable with, then we are not growing — either professionally or personally. I started my career by doing endodontics. Nowadays, endodontics has become so much easier, especially with the new rotary instrumentation manufactured by Tulsa Dental, that every general practitioner can feel comfortable doing at least some endo cases. Think about it: The amount of revenue lost to this kind of referral would probably pay for a new Lexus!
Perio is another area that dentists can learn to increase their treatment mix. I used to be intimidated by periodontal surgery due to the fear of what would happen if I ran into a furcation. But the continuing-education courses I took showed me how to grow bone in the furcation. With the right education and training, most dentists can perform periodontal surgery, although it's not for everyone. There have been enormous advances in perio treatment these days. Products like Endogain (an enamel matrix protein) used in conjunction with a curette like Bidenti make these procedures fairly straightforward. If these kinds of procedures work for you and you enjoy performing them, then it's foolish to refer them to another practitioner.
Dr. Jameson: Let's talk about a phrase you've coined called "Becoming a Super Dentist."
Dr. Barotz: I've been called "super dentist" because I don't need (or want!) to flood my office with the same types of patients and do the same types of procedures day in and day out. If all I did was bond veneers, or crown and bridge and fillings — I'd go crazy. I love the continuous stimulation of doing perio one day, then cosmetics the next. It keeps my life interesting, and it keeps me pumped up after practicing dentistry for 22 years. I still look forward to coming to work every day, and it keeps my staff motivated as well.
Patients benefit from a "super dentist" because they don't have to keep re-establishing a rapport with myriad specialists. They can stay within the boundaries of the relationships they have already built with their dentist and continue the trust that has been established over time.
Dr. Jameson: How can a dentist who has acquired new skills and expanded his treatment mix build it into his fee structure?
Dr. Barotz: Fees should be market-driven. Dentists could take lessons from professional sports. If a team starts winning and selling out every game, ticket prices go up accordingly. Yet, too many dentists need the security of being booked two or three weeks in advance. That's like the sports team that never raises ticket prices when thedemand is high. In 20 years, I've never been booked more than two or three days in advance. Tom Peter's definition of a quality practice is not only one that delivers a technically superior end product, but does so consistently and efficiently. The dentist who is constantly booked two weeks or more in advance needs to raise his fees by about 30 percent. Or — even bolder — raise them 50 percent and get those bookings down to two or three days in advance.
Reducing the number of days booked in advance also allows dentists to take advantage of "impulse" patients. Dentistry — especially cosmetic dentistry — is usually about impulse. A young lady may feel fine about her teeth one minute and hate them the next. You want to be available the minute she decides, "I simply have to do something about my teeth!" And if you are booked solid for three weeks, you're going to miss the opportunity. People are busy, and if they are forced to bend their schedules too much, they will go elsewhere.
I'm known for my denture technique. My fee for dentures is roughly eight times my crown and bridge fee. There are some who disagree with this. But in determining my fee, I compare the overall patient benefit of a finely made denture vs. eight units of crown and bridge work. This belief in no way is meant to belittle the importance of an eight-unit smile makeover for some patients. I perform these regularly. But for many patients, it's a question of function. When I can take years off of a patient's face, dramatically improve function, and eliminate pain with a finely made set of dentures, the benefit to the patient far exceeds that of eight units of crown and bridge.
I recommend that every dentist establish a value-based fee schedule. Once patients see how highly their dentists value these procedures, their perceptions about the value of what you are providing will go up. I charge for a set of dentures what I would charge for eight units of crown and bridge — and my patients' appreciation has increased eight-fold! I get letters from patients daily that attest to how their dentures have improved their lives. They are grateful! It's a positive, self-perpetuating cycle that will keep dentists motivated and excited about their careers.
