by: Daniel Peters, DDS
Try not to smile when you think of the exact patient family in your practice that I am talking about. Mr. and Mrs. Tightwad come into your office for their “cleaning” appointments in mid- December. The hygienists check the charts and realize that they have not been seen in eight months despite their history of perio treatment and the fact that both the hygienists and doctor recommended three month recalls. Mrs. Tightwad presents with progressing perio and her usual downright nasty attitude. Mr. Tightwad presents with progressing perio and a failing ancient, huge amalgam on tooth #3. The hygienist works her tail off on Mrs. Tightwad, re- educates on perio disease for the 15th time, and urges a three month follow up appointment. The other hygienist works her tail off on Mr. Tightwad, re-educates on perio disease for the 15th time, urges a three month recall, makes the patient aware of the failing huge amalgam on tooth #3, uses the intraoral camera to display this condition to the patient, and does a fantastic job of educating him on the need for a crown on this tooth. The doctor comes into the room and does her exam on Mrs. Tightwad. She backs the hygienist up on the importance of maintaining the perio condition and does her best to educate Mrs. Tightwad some more as Mrs. Tightwad gets a nasty look on her face and rolls her eyes. The doctor then goes to the room next door to do her exam on Mr. Tightwad. Mr. Tightwad is alarmed by his perio condition and really does not want to lose tooth #3. He listens to the hygienist and doctor, agrees to a three month recall, and seems ready to schedule the crown on #3.
This couple then goes to the front desk to meet the scheduling coordinator. The scheduling coordinator first offers both patients a three month recall appointment. Mrs. Tightwad snaps that when you are on a fixed income, you are not able to spend that kind of money. The scheduling coordinator then goes on to re-educate yet again on the importance of maintaining perio. Mrs. Tightwad reluctantly agrees to four month recalls for her and Mr. Tightwad which will occur right after they return from their winter home in Florida. The scheduling coordinator then offers a core and crown appointment for Mr. Tightwad. Mrs. Tightwad immediately chimes in that they will talk about that at their next appointment. The scheduling coordinator again slips into education mode and does a great job making the point that if Mr. Tightwad wants to keep his tooth, a crown is essential. She even offers to rush the process along so the crown can be cemented before the couple leaves for Florida on January 2nd. Mrs. Tightwad again refuses and the scheduling coordinator feels sorry for Mr. Tightwad who has been staring at the floor during this entire interaction.
Mr. and Mrs. Tightwad head out the door into their new Cadillac which still has the sticker in the back window. This car has just replaced their two year old Cadillac. They do need a safe car to drive to their winter home in the Sunshine State after all! March rolls along and the Tightwads arrive home from Florida to find a postcard in their mailbox reminding them of their appointments in a couple weeks. Mrs. Tightwad calls the office and insists on moving their appointments back to July because when you are on a fixed income you are not able to spend that kind of money.
Mr. and Mrs. Tightwad come into your office for their “cleaning” appointments in July. The hygienists check the charts and realize that they have not been in for eight months despite their history of perio treatment and the fact that both the hygienists and doctor recommended three month recalls. Mrs. Tightwad presents with progressing perio and her usual downright nasty attitude. Mr. Tightwad presents with progressing perio and a massive hole adjacent to tooth #3. The hygienist works her tail off on Mrs. Tightwad, re-educates on perio disease for the 16th time, and urges a three month follow up appointment. The other hygienist works her tail off on Mr. Tightwad, re-educates on perio disease for the 16th time, urges a three month recall, makes the patient aware of the massive hole, uses the intraoral camera to display this condition to the patient, and does a fantastic job of educating him that this tooth is in serious trouble and that they will have to ask the doctor if she can save it. The doctor comes into the room and does her exam on Mrs. Tightwad. She backs the hygienist up on the importance of maintaining the perio condition and does her best to educate Mrs. Tightwad some more as Mrs. Tightwad gets a nasty look on her face and rolls her eyes. The doctor then goes to the room next door to do her exam on Mr. Tightwad. Mr. Tightwad is alarmed by his perio condition and really does not want to lose tooth #3. He listens to the hygienist and doctor, agrees to a three month recall, and is very disappointed when the doctor recommends extraction of tooth #3.
This couple then goes to the front desk to meet the scheduling coordinator. The scheduling coordinator first offers both patients a three month recall appointment. Mrs. Tightwad snaps that when you are on a fixed income you are not able to spend that kind of money. She then expresses dismay that the doctor cannot pull Mr. Tightwad’s tooth that same day. Mr. Tightwad stares at the floor.
Smiling yet because this couple are patients of yours? Perhaps dismayed, crying, or getting depressed instead? As I wrote the story above I had a mental image of the real Mr. and Mrs. Tightwad that I used to see in our practice. We all have them and they drive us all nuts. Is it any wonder that dentists get unsatisfied, depressed, and burned out?
The true issue in the vast majority of cases, when treatment that we and our teams recommend is rejected, has nothing to do with the patient’s ability to pay for the recommended treatment. It has everything to do with the perceived value of the recommended treatment. Truth be told, dentists compete very little with each other in the marketplace. Our true competition is companies like Starbucks, Apple, Amazon, and BMW as well as airlines, vacation destinations, and spas.
Next month I’ll cover how we go about building value to compete with our true competitors.
Side Note: The ADA just reported that in 2015 the average income for GP dentists was $179,960. For Specialists, the average income was $320,460 for the same period. For owner GP’s, the average income was $195,200. For non- owner GP’s, income was $132,370. When adjusted for inflation, GP income has dropped significantly since the peak in 2005 when earnings had a value of $219,638 when adjusted to 2015 dollars. This bothers the heck out of me. If you are experiencing this same alarming trend in your own situation, please give me a call and let’s talk about it.