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PH: That’s right. You’re better off doing 2
units at a time on six to eight different patients.
Or even on that patient!
MD: Even on that patient. Spend six years doing
two crowns at a time. Your kids will be fatter,
right?
PH: Absolutely right. And that is something
dentists miss all the time. I missed it early
in my career, Mike; I’m sure you missed it,
too. We were so in love with the process of
fixing teeth that we didn’t really see or feel
the bigger picture. When dentists hit their
40s, their backs begin to get sore, their eyes
begin to go. You can’t make up for lost ground
very easily. You are not the practitioner
from 40 to 50 or 50 to 60 that you were from
20 to 30 and 30 to 40. You won’t have the
same energy, you won’t have the same eyesight,
and you won’t have the same stamina.
The earlier dentists learn to set their
fees relative to complex care, the easier it
will be for them to accumulate wealth, to
be able to build a profitable practice and
to have what they really deserve. The practice
of dentistry takes a lot: We capitalize
our own businesses, we hire the people, we
manage the facilities, we do the dentistry,
we empty the plaster trap. We do a lot of
things. And improperly set fees can drag you
right down.
MD: That makes a lot of sense. So, to do that
12-unit case correctly, the 12 times the singleunit
crown fee is the baseline.
NET FEE:
Sum of (Patient Fee - Lab Fee - Office Overhead)
Dentist’s Time
PH: That’s right, that’s the baseline. You said
it earlier, Mike: That’s your base pay. Now you
look at, where should the fee be? When you
look at the sweet spot, I’ve got it set at about
$326 per hour. And that’s net fee per hour.
MD: Define net fee per hour for us.
PH: Net fee per hour is the patient fee minus the lab fee
minus the lab overhead divided by time.
That $326 represents my net fee per hour when I’m doing
3 units all in a posterior quadrant. That’s the safe sweet
spot right there. Now, when we cross the line and start
doing rehabilitative dentistry, where we’re doing those
four variables, now our net fee has to be greater than
that sweet spot. Here’s why: Because if it’s not greater,
we’re not profiting at the level that the risk demands. If
you were an investor and you were to invest in something
that is safe, like U.S. Treasuries, you would accept a
lower return on investment because you’re not making a
tremendous risk in the marketplace. But what if you were
invested in a very volatile, risky investment? What type of
return would you expect there based on risk?
MD: It’s got to be higher.
PH: It’s got to be a lot higher. When you start doing rehabilitative
dentistry, you’re making an investment in a risky
business. Therefore, your net fee per hour must be greater
than what you’re doing on a lower- or no-risk case.
MD: In one sense, these complex cases are sort of volatile.
There are just more things that can go wrong versus a singleunit
crown.
PH: Mike, they always go wrong!
MD: It’s just a matter of getting it right in the end!
PH: That’s right! Even in the end, it can’t be right all the
time. I did rehabilitative dentistry for 20 years, and I can
think of very few cases. You sit down and treatment-plan
a patient. Let’s say you’ve got 12 units of root canals and
implants and all sorts of moving parts in the mouth. You
treatment plan that case out, you get your treatment planning
form out and you color in all the teeth, color
in all the arrows, you get it all done and you
add it up. Now, what’s the probability that the
treatment plan is exactly what you’re going to
do at the end of the case? It’s about zero. There’s
always stuff that will change. We’re going to pursue
excellence. This is a great treatment plan
and I practice in a very excellent way and this
is the way it’s going to be. Dream on! There’s no
amount of excellence that’s going to compensate
for change of host resistance or act of God or anything
else that goes on.
MD: It reminds me of that old thing, how a plane flying from
Los Angeles to Hawaii is off course 99 percent of the time,
constantly correcting for the winds. But hopefully the pilots
get that plane down where it needs to be in the end. It’s a constant
matter of adapting to the environment. Build-ups you
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