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Dentist2Dentist
Join Dr. Mike Miyasaki as he talks dentist to dentist about the trends, products, and clinical applications in dentistry today.
Dentist2Dentist
Overcoming Dental Insurance Challenges for a Profitable Practice
Get ready to revolutionize your dental practice in today's ever-changing market. Join us as we uncover the secrets to running a successful dental practice like a savvy business. In this eye-opening episode, we tackle the challenges posed by dental insurance and corporate dentistry, and explore strategies to adapt and thrive. From optimizing work schedules and building a robust patient pipeline, to reducing patient loads while maintaining profitability, we provide practical tips and valuable resources to boost the financial health of your practice. Don't miss out on this in-depth discussion that will reshape the way you approach dentistry.
Looking for ways to make your dental services more accessible and competitive? Discover the often overlooked strategy of offering internal payment plans. In this enlightening segment, we reveal how flexible payment options can not only enhance patient satisfaction but also ensure the financial stability of your practice. Clear communication about payment options, including upfront costs and third-party financing, is crucial. Tune in as we share practical approaches and insights, and explore the complexities of insurance reimbursements and patient payments. Don't let financial constraints hold your practice back – find out how to create win-win situations for both you and your patients.
Is it time to transition your dental practice to a fee-for-service model? In this thought-provoking episode, we dive deep into the challenges and considerations dentists face when breaking free from insurance contracts. Hear stories of dentists who have successfully made the shift and learn from their experiences. We discuss the importance of finding like-minded colleagues for support and explore the evolving landscape of dentistry in today's economy. Discover ten strategies to confidently transition your practice to a more profitable model and gain valuable insights into the sustainability of dental practice ownership. Don't miss this captivating conversation that will inspire you to take your dental practice to new heights.
Hi, this is Dr Michael Miyazaki, and I'm really excited about this podcast because this is number 12. We've been doing one of these a month and we've made it through our first year, which is pretty monumental. So we thank everybody that's been taking the time to listen to these podcasts and we hope you're getting something good or entertaining or some good information out of it, and we'd love to hear back what you want to hear, what things we could do better and if we're doing a good job. Let us know that too. This is part two of a three-part series. The last part was before our last podcast.
Speaker 1:Our last podcast, we had Dr Ron Rossi, and in that one, before the podcast before that one, it was Garrett Caldwell, ceo of the Pacific Asset Continuum and Core Dental Lab, and I talking about dental insurance, and it was me more or less reminiscing about what dental insurance was like when I started to practice. In this part two of three, what I'm going to do is we're going to talk a little bit more about why practices dental practices really have to be run like a business, how dental insurance is impacting some of the practices and it depends on the type of practice you have and where you practice. But dental insurance is here how corporate dentistry is impacting our profession. It just is not good or bad, and I think what we have to do is we as dental practice owners if you own or if you're an associate or if you're just a dentist in general working in dentistry just have to adapt. The business in general in any industry is always evolving, and so I think we have to evolve with it. I've been in practice now for 37 years and if I try to practice like I did when I first started dentistry, I would definitely be out of business. So enjoy this part number two or three, so you know.
Speaker 1:Going back to what, what this situation is doing to us is now that we have more corporate practices coming into the industry, they can market more. They, you know they do what corporate does. What I'm seeing in teaching is a lot of the courses we do are on even on Sundays, and that's because a lot of colleagues now are working on Saturdays. I mean what they're doing is they're working more hours to make more, not understanding that at a lower fee they may not even it may be costing money to even work the extra hours, and that's that's one of the hard things to get clinicians to understand is we're trying to take control of our fees not to hurt the patients. We still want to do what's best for the patient but we have to be able to survive.
Speaker 1:And if you're having to write down your fees to the extent that and it varies from practice to practice, and so I think one of the things you and I talked about is this isn't for everybody. Everybody has to kind of assess their own situation and you have your macroeconomics, which are the things that we read in the newspaper and see on the news every day. But then we have the microeconomics, that kind of our practice. It could be our neighborhood or city, that economics could be different depending on where our practices are and how they're situated and branded, as you mentioned. Yeah, I think we have to be able to understand the numbers, as you mentioned before, because if our business is, let's say, pretty healthy, let's say the owner can take home 25%, so out of $100,000 of production done a month, the owner gets twenty five thousand of that which was pretty healthy. But let's say your practice that's modeled on the UCR fee, but now your practice is contracted with insurance companies and you're having to write down 30 percent, well then it gets really tight because your profitability was 25 percent, but now you're writing off 30% and so you're barely taking enough home to keep your doors open, and that's the goose that's laying the eggs is your practice, and so it does get challenging. When you look at that and I think you're absolutely right you know the owners. We have to run our businesses like a business and understand what the numbers are telling us. And if our profit margin was 25% with the UCR and we're taking a lot of different plans, we're writing down 40%. That means for every patient we're seeing, we're losing money possibly.
Speaker 1:So if I'm working evenings and I'm working Saturdays, I'm putting in extra hours to bring extra money home. I might actually be losing extra money because I'm open more hours and I think that's what clinicians have to see. You know, if you've got a team and you're open three days a week instead of five days a week, but you can keep those three days really full, pay your team and then the other days they don't need to get paid. Maybe they have side gigs or whatever's going on, or they just don't need that extra money. You're actually saving money because now your numbers are coming back into where they need to be. I mean, you've got three really productive days, you have a team that's there, you're going almost full capacity and that pulls everything back into line.
Speaker 1:If I open up for more hours and I'm taking these, take on cases where the reimbursement may below my profitability, then it's all for naught. So you know again, I think we have to understand the numbers. So what we started to do is start thinking about okay, so we have these insurance companies and we're writing down some of our UCR feed for a pipeline of patients. I said, but what if we could develop a pipeline of patients? We could do marketing. So, as I talked to different colleagues of mine, some of them will tell me yeah, you know, they're writing off 20 to 30,000 of the UCR because of the insurance compensation they're getting from whatever insurance companies. And I tell them that's the game you're playing.
Speaker 1:What you need to do is rethink this. If you rethink your business and let's say you were going to up your marketing and they go well, how much would I have to up my marketing? I go. It depends you have to create your website, do some SEO, do some social media. Marketing depends on the company redoing everything. It could cost you $5,000 a month and that was expenses we did not have 30 years ago. But let's say it's $5,000 a month because that's kind of a general marketing fee year, and again you're a $100,000 a month practice. That's about 5% going to marketing. Maybe today you're only paying $1,000. So you're paying 1%. So going from 1,000 to 5,000 seems like a lot.
Speaker 1:Well, if that 5,000 spend allowed you not to be contracted with insurance, so you would not have to write off the 20 or $30,000, let's split that to 25,000. Insurance, so you would not have to write off the 20 or $30,000. Let's split that to 25,000. So you're, you possibly could be making $25,000 a month more, but to make that you're having to pay $5,000 more. So you're now your profitability is $20,000. Would that not be a good trade-off? You know and again I think that's a trade-off that many of us don't think about, but I think that is good. So I think what dentists have to do today is they have to rethink dentistry. It's really about how much you have at the end of the month, not how much you produced. So what you produce minus your expenses is going to give you what you take home.
Speaker 1:And I told my team when we dropped insurance, all the insurance contracts, I said what you're going to see is there's a difference between activity and profitability. I said when we drop this, these insurance companies, our pipeline gets cut off. And what you're going to see is we're going to have openings in the schedule. I don't want you all to panic saying, oh you know, we have holes in the schedule. We used to be booked out for a month and now we're booked out for a week. I'm going to lose my job. I said no, what's going?
Speaker 2:to happen.
Speaker 1:What's going to happen is we're going to be less busy, less activity, but the profitability is going to go up to where it should be and because of that one, you know, we'll be less stressed, we'll be able to provide a better service to the patients that come in. And and I think again I mentioned before, covid kind of changed things up because when COVID happened we had to have more time between patients. You know, every patient got an hour of schedule. If you had a filling that might take 20 minutes, we were still booking you out for an hour because we had to disinfect the air and the chair and you know everything for you and what we've done is kind of kept the same. If you come in for a filling, it's an hour.
Speaker 1:If you come in for a crown because we do CEREC, so same day dentistry, maybe it's two hours. So it's longer appointments than we used to have, but there's really no rush, you know, and so we get to spend time with the patients, we really get to know them and we get a lot of patients that come back. You know they, like you mentioned, they'll leave because we're not contracted with their insurance, but they'll come back and say you know what we really like here is you guys spend time with us, or every time I come in I get to see you. It's not a different dentist, you know. They went off to another practice for a couple of years and every time they went in, every six months, they saw a different hygienist and a different dentist, and they didn't really like that. So, um, then again there's different, why.
Speaker 2:I'm not saying that that's wrong, but this is the direct. I think this is the direct effect, the indirect or direct, I guess the indirect effect of insurance but I think it is a directive, I think they're very aware of it is that what has happened is is that it's become very impersonal. It's become like getting your oil change at five minute jiffy lube, uh, versus going into the car dealer when they do a 32 point inspection and you know the service provider and maybe your car is getting a little old and they might take you in the showroom and show you a new car. You had a relationship even with your car dealer back in the day because they were able to spend time, because it was profitability, and I think that's the reason that patients do leave as opposed to finding money. In other words, I know for sure I will stay with my dentist if their prices. I don't think it for me, knowing, knowing what it could cost me to go to a strange doctor, that I don't know the value, it has to get exponentially higher before I'm going to think about not going to that same doctor. But now what? That's what insurance has done. Insurance has made getting your teeth cleaned and getting a filling a thing as opposed to a quality, as opposed to health care. I think they've made it casual and I think that the reality is is that you know.
Speaker 2:Again, go back to what I just said. It's what you're really talking about. You can produce more in the same amount of time. You can see 13 or 15 patients in a day, or you can see eight. Which patients are going to get better health care? Just by default, even if it's mental health care, that you go in and you feel better about your dentistry, feel better about your health, feel better that your doctor is serving you better. That's got value to the patient. So I think it is produce more, charge more or cut overheads. You can only do the other two so much Again, I think. To me it seems simple, mike. The reality is I go back to this Look at your income statement, figure out what your discounts are. We just had a doctor. I don't want to digress too far up here, but we just had a doctor in Southern California.
Speaker 2:One of our colleagues just go independent and Delta did exactly what you just said. Delta sent a letter essentially a litigious almost letter saying your doctor no longer supporting you, and so the flip side of that was a phone call to me and I said well, he said I want to write a letter to my patients. And so we wrote a strategic letter saying just what you said You're welcome to stay. Nothing has changed. We'll help you build your insurance. Your benefits are going to be probably pretty much the same. I don't have.
Speaker 2:You may know what the impacts of that practice were over the last three or four months, but there was a doctor who had finally had enough and finally said that's it. I'm excited about it Because they looked at their profitability and he's working five days and wants to take more time off. That was his motivation I need more time off. How am I gonna take more time off? And he realized that if he lost 30% of his patients, he could actually work one day a week less and make the same amount of money, and he would rather have had that day off in this case than the cash.
Speaker 1:So yeah, it's sort of seems pretty obvious to me.
Speaker 2:as long as you're over a certain minimum number, I guess, but I think most of the doctors that are in business and paying the bills, it seems to me that this will probably qualify them.
Speaker 1:Yeah, no, you're absolutely right. But one of the things because I get this question asked a lot is can I just drop insurance and I go? No, you cannot just drop insurance. The way you have to do is you have to do it in a very disciplined manner. Your team has to understand why and how are you going to do this.
Speaker 1:So once we the second time the first time I did it that way we just kind of dropped it cold turkey the second time we did go through a six-month process of talking to our patients about it. And I'll tell you it's so funny because when I look back in retrospect, I remember the first meeting that we had and we said, okay, this is what we're going to do. And we were all petrified. Nobody wanted to talk to the patients about how we would be leaving this insurance contract I'll leave all the names out of it, right how we were going to be dropping this insurance contract, because it was such a big part of our practice and we were just so used to telling patients you know, so-and-so is going to take care of it, go ahead and walk out, we'll bill. And then you know, whatever balance is left, we'll get it from you later, and now we had to tell the patients before the contract was terminated that you know we're planning to do this, this is why we're doing it, and it was scary, whereas today, you know, a few years later, it's just, I think, like you described, and we're kind of proud that we talk to they go no, we understand, you know what insurance is doing, because the patients go well, you know, we pay money into the insurance company. The insurance company pays some of that money out to those that provide the service, but in order for them to make the money, then they have to deny more of the services. Right, and I go that's right, you know. So that's why you had that tooth that we take an x-ray of and it's got 10 surfaces with old filling on it and we and we don't want you to break that tooth, we think it needs a crown and the insurance comes back and says, no, you know, we won't pay for that. And and a lot of um, what I've heard is insurance companies are now, because we have um, ai, a lot of insurance companies. Before we had human, um, uh, people looking at the records and now it's all done by AI, and so you know, you get kind of these kickback claims where you go.
Speaker 1:I don't understand why you would not, you know, allow us to do this. But I think patients are getting wiser, you know, and there will be those patients that just say you know, I've got to do it, my insurance company will cover. And then you have other patients that say, well, you know, what I want is I want the best care I can get. You know, so they will. And we tell them we're going to maximize the use of your insurance. It's just we're not contracted with your insurance company and I think that's the big thing. You know, we don't say we don't take insurance, we say we accept all insurances. It's just we're not a contractor, provider of any insurance plans, but we're going to maximize the use of your insurance.
Speaker 2:Do these patients then ask you at that time that the procedure might possibly take place the same day that they're in the chair where they're diagnosed and you have time to do it that time? Or are you always rescheduling your patients because patients want to know what the cost is going to be?
Speaker 1:Yeah, you know, I think it's the same. I would say probably 65% of the patients will say, yeah, go ahead and do it, you know we'll figure it out after it's done. And probably 35% are like, well, can we get it pre-authorized? And so I have a better idea what the numbers are and we're like sure you know that's good, I mean it's you know, whatever the patient feels comfortable with we feel comfortable with, we always tell them it is hard for us to you know, if it's a thousand dollar crown, it's hard for us to tell them that insurance is going to reimburse them $650, $750, $900. We don't know. And because we're not a contractor provider, most of the insurance companies well, the major one we're talking about won't help us help the patient and so, yeah, it makes it very difficult.
Speaker 1:But hey, everybody hope you're enjoying this and as we're talking, I just want to kind of make remind everybody that if you want more information about the courses that we teach, you can go to the T-H-E, pac, p-a-c, P, as in Paul A-C dot org and get some more information about the courses we teach. And if you are interested in a dental lab the dental lab is core, c O R R, dental design. You can go to the Pacific aesthetic dental studiocom and and learn more about core dental lab, or you can just type in core dental lab and I think you'll get the same information, but the website is wwwpacificesthetic, with an A-E to start aesthetic and then dentalstudioscom, so pacificestheticdentalstudiocom, just to learn more.
Speaker 2:One of the strategies that dentists don't often think about but I think is really overlooked which is offering payment plans internally. So think about it, and I want you to comment on this. For me as a business guy, I naturally feel like how can I make it easier for my patient to choose me versus a discounted doctor when it comes to paying the bill? So if I'm discounting my $1,000 per round to $650, but I'd rather go to Mike, but I don't have the $1,000. What if I charge the patient $650, which is the reimbursement they get from Delta, for example, and let them make payments to me? So I don't know how this works out for you, but I don't lose a patient.
Speaker 2:I already have 35% more time in my schedule because I have lost patients. I am planning on filling those spaces in the future by marketing to patients that want to work with me as a doctor as opposed to somebody else, but in the meantime, there is that gap. So you're either going to go fishing or flying or you're going to work. What about telling your patients, hey, I'm willing. You know on these procedure that you're challenged with. I'm willing to carry some of that and allow you to make payments at the office. What's your opinion of that and have you done any of?
Speaker 1:that? No, you're absolutely right. So let me answer that. When I get to kind of the, there's like 10 steps that I recommend clinicians take. But you're right on about that. You identified that right.
Speaker 1:One of the points goes back to your question. So, because you brought it up, when it comes to the payment plans, you've got to have clear options because with well, in the case of Delta, you can't assign the benefits, which means that if we do a thousand dollar crown and we tell the patient to be a thousand dollars, delta will send you a check. When you get the check, mail it back to us. A lot of times it doesn't happen, and it's not necessarily the patient's fault, you know they, they get a crown done and two weeks later this check shows up in their mailbox for $700 and they, wow, delta, dental sent me $700 and they just cash it, you know. And then maybe a month after that, the office finally gets the EOB saying that so-and-so has reimbursed $700. So then we have to call the patient and say, hey, can we get the $700 from you? And the patient's like but it was made out to me, you know. Then you have to go through and explain that all and so what we do. You know.
Speaker 1:What you have to do is you have to tell the patient hey, the crown's a thousand dollars. We're not sure what Delta is going to pay you, but they're going to send you the reimbursement check. So if you put on your credit card today, you'll probably get the reimbursement check in two weeks before you're required to pay the $700 on your credit card. So you'll get the reimbursement back so you can pay it. I don't have to worry about paying interest on your credit card, but what we have to do is the fee's $1,000. So we have to collect $1 dollars today. You'll get the 700, 800, 900 back from delta, but it's going to go directly back to you. They're not going to send it to our office like they have in the past. In the past they would send it back to us and then we would uh, look at the balance credit, whatever the reimbursement was, and then call the patient up and say hey, sally, you know they paid 900 on your thousand dollar crown. We need to collect a hundred dollars and sell it back. Here's my credit card.
Speaker 1:It would take too much, too heavy, and so one of the things I'll just allude to right now is that, yeah, there's two parts to this to answer this, but I'm just going to just tell you. You have to have your payment options well scripted out. So when the patient says, okay, tell me how this is going to work, your front desk can say, well, you know, payment upfront, cash, credit card. Maybe they're going to use a third party financing. You can do that. Maybe you're going to allow payments, maybe not, things like that. So you need to have that worked out with your front desk so that when the patients do ask that question, there's no hamming and hawing or feeling bad about what you're trying to do. It's just like oh yeah, that's a great question. It's a thousand dollars. We typically collect that up front.
Speaker 1:Patient says, well, I don't have a thousand dollars. Well, can you put in your credit card? I don't have a thousand dollars available of credit on my credit card. Okay, Well, you know, can we look at care credit? Perhaps I don't want to do that. Well, you know, you've been a patient in our practice for 30 years and we know this is something that's different. So I'll tell you what can you pay? Half it today and half it when you come back to get the crown, or if it's not a same day service, or maybe you break it up for them because it's going to take a while for your patients to get used to this pay now and then get reimbursed by the insurance company a couple of weeks down the road.
Speaker 1:So just to kind of answer that question since you asked. It can be a kind of a complicated answer, but if you're prepared for it, it's not difficult, it's not. You just have to be able to be prepared for it. So next time we get together I'll describe the process of how we did it and how it's working out now.
Speaker 2:Good, good, no, I think that's important. So, mike, so sum up this last hour just really quickly. No-transcript, forget it. Externally, send a letter letting them know that you're excited to be able to provide them high quality services, independent of insurance or any influences that insurance may have. Everything remains the same. We still have payment options, you still have insurance. We'll talk about it on your next appointment, just to let you know this has happened. And then, if you get anything from Delta, please don't misunderstand it You're still welcome here as a patient. We still consider you our patient, because Delta did send a letter that all but said you could no longer go to that doctor, which was completely untrue.
Speaker 2:So I think that was, I think, the planning part of this. Run your numbers, decide you want to do it, then plan, do as much planning as possible On the actual economic side of it with your team, as you talked about with your team. Settle them down so they don't panic, maybe even strategize about your marketing strategy. You know, sit down and talk about what you're going to do, moving forward, and then, obviously, communicate with the patients more, most communication you could do the better and then incorporate the 10 steps that you're going to talk about in the next, in the next podcast hey, you did a great job.
Speaker 1:You distilled all the steps down but you know.
Speaker 1:I think talking about that and going back to you know, like the Pacific aesthetic continuum and such, when you're making these kind of changes, it's so much easier to do it when your colleagues around you are doing similar or they think similar. You know that's for me it makes it easier when I'm around other doctors that have either gone through this or are really planning. You know they don't think negatively about this. It's something they want to do and we're able to share ideas and support each other. I think it's very, sometimes very difficult if all all the buddies that you hang around with you know they all take insurance and when you say I'm thinking about dropping insurance, I go, no, you can't do that. Well, they don't want you to do it because they can't do it. And then you're like, oh, then you start kind of taking steps back and well, maybe I shouldn't. You know that doubt starts to creep in. That I will tell you.
Speaker 1:All of us that have ever done this, we all had the same doubts. Uh, when there's this big of a shakeout going on within our industry and our industry today is nowhere near where it was 30 years ago Um, I, I am. I'm always telling my wife I go. You know, I just have to remember that I I tried to sometimes make dentistry what it was when I started, and I have to look, make dentistry what it was when I started and I have to look, step back and go. It's not that anymore and I've got to figure out the steps that I take with.
Speaker 1:My business has to be able to work in the current economics of our profession. But one of the things I would say is is if you can hang out with like-minded individuals, those that are learning, those that are acquiring new skills, those that have a better chance of, if they elected to, to get off the contracts with different insurance companies, I think that they'd find it much easier than hanging out with colleagues that are afraid to make that move. And I'm not saying anything bad, negative, about those that elect to stay in insurance. Everybody's got to decide what they feel comfortable with. But you know, there's about 10% of the dentists out there that I think, and some of the stats that I've looked at that are fee-for-service, and if you want to be one of the 10%, now's a great time to do it.
Speaker 2:Well, it seems to me, Mike, that we're coming full circle. I think we're about 270 degrees now. Okay, pretty soon we're going to be talking about how to compete with your local doctors in your community that are all independent. Right now, only 5% or 2% are independent and everybody else is stuck on this insurance thing. But as everybody gets off of it and becomes way more profitable, then we're going to start getting saturated with profitable doctors and we're going to be right back where we started. Uh, and what do you think again?
Speaker 1:I don't want to make this longer, but you should tell us what you, how you think the insurance companies are going to react to this. Oh, you know what. So, um, so you know, our dream always is that if all the dentists got together and said, hey, we won't let insurance companies do this to us, you know, we want to be able to run our business the way we run it and insurance be, I think, what it was intended to be back in the seventies, where they were going to help patients be able to afford the treatment. I think that would be great. But until we all step back and say, hey, no, if 200,000 dentists put our arms around each other's shoulders and say let's just go back to insurance companies and say we're going to take our industry back, you know, you can. You can be part of dentistry, you can. You'll get premiums and those premiums can be pulled together to offset some of the costs of the dental treatment to the patients. Hey, that'd be great, but we're not going to let you dictate our fees.
Speaker 1:Because I mean, you know the reality of it is when you look at it from a practice owner's perspective if what a hygienist makes today after all the expenses and taxes and everything like that. Again, let's use high round numbers. So I agree these are high, but maybe it's $60 to $70 an hour and the reimbursement for a pro fee is let's just say I'm trying to figure what a good ballpark fee would be let's say it's $100, just for round numbers. So if we said that total cost of a hygienist, just wages, was, let's say, $60 to $65, we put together the cost and this is part of that business analysis. Okay, what's it cost for the sundries?
Speaker 1:You know all the, the patient, bib and everything like that the rent, the time it takes to change that room over for that hour of chair time the hygienist uses the chair. How much time do the front desk have to spend to schedule a patient in that chair? How much time do we have to spend to collect the payment from the patient? And you look at the business overhead costs, it could be well over what they're getting for the prophy and so, yeah, I just think now is the time that clinicians have to really look. Well, practice owners have to look at that, and I think even you know one of the things that kind of gets frustrating is when we have partners or associates in our practice and they don't quite understand that. You know, a lot of associates are getting 25 to 30% of what's produced and that's assuming that the practice is making 30% on what the associate's doing. You know, if we're making 30% off the crown the associate did and we're paying the associate 30%, then it's a breakeven transaction for all of us.
Speaker 2:So let's think about Mike the DDSO comes in and buys your practice. Maybe they're the ones that are the jokes on them because, at the end of the day, they're very smart people and they're looking at. They're looking at EBITDAs and they're looking at multiples and they're looking down the road at being able to sell this thing. There's an automatic built in that they're going to sell it because the money needs to be invested. Built in that they're going to sell it because the money needs to be invested. That's part of the part of the problem is there's a comfort level with these big investment groups that they know that when they buy something they're going to have a buyer to sell it. But the reality is is I mean, you can look at this as an independent or you can look at selling to it out to a DDSO or a DSO group, because at the end of the day, with the DSO groups, with one of our colleagues recently called me and said that the DSO group is having to align themselves with the business professionalism required or ethicacies required to sell it to the next investment group. So all of the associates now have to go. They can no longer build the associates under their license. They now have to build them as associates, which means they go from the premier down to the HMO, which is 35% cut, which takes a $1 million practice down. He's doing 30% down to 700,000.
Speaker 2:The billing's 35% less, which means the associates making less money, which means that associates now insecure of staying in the practice. It means that the income, the revenue, has to be replaced by either volume or by new patients, with the doctor that is billing at the premium and the DSO is now waving a stick saying do more, do more. So something has to give here. I don't know if you and I are the only ones who are kind of getting this, but do you see what I'm getting at? There's no free lunch. At some point you have to charge a real fee and collect a real fee, or else you know, or something has to give and I don't know how. Again, I don't want to change the subject.
Speaker 1:Maybe I'm confusing everybody here, but you get where I'm going with this. I mean, yeah, well, I think in that mall you're talking about, let's say, your crown. Again, round numbers, you're a thousand dollars per crown. But now, uh, then you've got an associate doing that crown. The associate gets 30% of that, but then you have to write down 35% of that $1,000. And so now the practice owner you mentioned the associates making a little bit less because they're getting 30% of a lesser fee but now the practice owner is dropping it 35%. Then, given what's left over, 30% of that's going to the associate and what the practice owner's left with, you could be underwater on that procedure and that's why-.
Speaker 1:You're guaranteed underwater, yeah, and that's why I tell my colleagues I say there's a difference between activity, doing a procedure and profitability. And I'm not saying that we should. As I mentioned before, we want our fees to be fair to the patient. We're charging the same for a veneer today as we charged for a veneer almost 20 years ago. We've got to stay in business too, and so just whatever is fair. But I think our colleagues that are out there and I see them all the time that are stressed and, as I mentioned, they're working more hours. They're working evenings till seven or nine and, as I mentioned, they're working more hours. They're working evenings till seven or nine, and they're working on weekends and Saturdays, which means now I have to lecture on Sundays because I can't even take Saturdays off.
Speaker 2:See, you're running out of days of the week. Maybe they need a new day of the week. They get an eight day work week and it's all good.
Speaker 1:I see so much more of that because as I travel around the country I'm just watching the trends and I'm and I feel bad for my colleagues. You know I mean they, we got into dentistry to live a different type of life and now it's just been so commoditized down that quality of life starts to suffer from that. You know, I tell people, you know you could, you could have so many other professions and make $200,000 a year without the stress of running a practice or, you know, dealing with a patient getting in there with endo files and putting files into people's nerves and stuff like that. You know, and I don't know, maybe it's clickbait, but it was saying a manager at a fast food restaurant is making $174,000 a year now and I think wow. So I just think dentistry, where you know we just had to watch our profession.
Speaker 1:You know people say, well, why you know all the teaching you do, why don't you just do what you do? And that would give you maybe an advantage over your colleagues and I go. But that's not the name of the game. You know the game is to lift all ships. So what we're out there doing is we're trying to provide information, education, everybody, to improve the entire profession so that we don't have one boat that's getting higher than the others. It's like let 's just all go up together and I think that's the.
Speaker 2:That's the point of these podcasts and I've been. The audience listening needs to understand that. You know our job is to we're trying to educate. We're talking. We're talking about a lot of things, but the goal of these podcasts and the pack is to educate and create questions and create doubt so that there can be change, positive change, and I encourage, first of all. Thank you, mike, for sharing all of this and taking your time to do this. And at the PAC you can sit down and talk with Mike about these things and I think you brought the most valuable part of having being involved in a study group, being involved with the pack, uh is having colleagues that you can reach out to.
Speaker 2:And dentistry is a lonely business. We talk about that all the time. And if you don't have a place that you can go to talk about, not just learning new things or learning new materials or but to talk to other doctors that are doing new things and different things, so you can. So you can. You know sort of curve the curve, the liability of change, and share new ideas and experiences. That's what you're doing here with us today and that's I really appreciate that the time and I hope the listeners do. I hope, if anything, if we haven't confused everybody and this isn't clear as mud right now the the hopefully the one thing to get out of is that they can always contact us anytime. My phone is always turned on if you pick up the phone and call me or email me. I know, mike, I know you're receptive to this, I know they can come to the study groups up in Northern California and I know we're planning to do a program, I think, back east next year in Chicago and Florida.
Speaker 2:But I would just encourage doctors to get around other doctors that are doing these kinds of things and listen and it's time to change. It's time to change Just like when we were doing discretionary procedures. You know, after we did veneers, then implants came out. So it's like, okay, we don't need to change our practices, we can just do implants. Then, after implants, we can do ortho. We don't need to change our practices, we can make a lot of money. Now we're running out of things to do. No-transcript. Why are you doing this? You're repeating it again. You're losing money by creating a new process in your practice and working hard at it and you're out there actually losing money doing it. So I think, I think we have to take a big step back and just make the practice healthy. I think that's what you're saying, yeah.
Speaker 1:You know? One more comment to that is is you know, we we pride ourselves in the United States of having a free market system, while the insurance reimbursement system is kind of thrown a wrench into all that, so we don't really have a free market. And yeah, you know, when you think about it, if we go some somewhere back to that where we let the market decide what fees should be charged and things like that, I think that would be a much better way than doing it the way that we're doing now. But this is a game that we've been playing for the last 50 years.
Speaker 2:So 50 years ago, maybe a little bit more than that, I guess they had a Boston Tea Party Taxation without representation. I mean, at the end of the day, you know you're not, the patients aren't being represented.
Speaker 1:You're not being represented, but they've got enough of a bite on on all of us that thousands of dollars and loses, but somebody who drops thousands but makes millions back. And you ask them well, how did you do that? They go well, I've got a system and you look at the game and you know these are very smart people and you know there's movies made about them and everything. There are people, like usually mathematicians, that will figure out the odds and how to play the odds and they can actually make money. And I think some of us look at those that have gone fee for service, like in the Sacramento area, you know you kind of look at because we're so insurance dependent on this one company, insurance company. They think, wow, you know, I can never do that, just like when I go to Vegas, I can never win money at the tables. But then somebody says but there is a system, there's a system you can follow.
Speaker 2:Yes.
Speaker 1:But I don't think I'm smart enough to implement the system, or I don't know how to do it, and so I think there are answers out there, and you just have to find the right person to help you.
Speaker 2:So cut everything out for the last 15 minutes and put that in Mike, because that's a good, a better analogy, better analogy, yeah, but I think I think there are answers and there's ways to actually make it work.
Speaker 1:And you know, there are those dentists you know in our town that are fee for service and they exist and they're happy and they're they're, they've got good growing practices. And so you know, if it were the reverse, where people dropped insurance and then they were out of business in six months and they could not grow, then then we'd be back saying no, don't do this. This is not a good thing. But because there are so many dentists, clinicians that do get fed up and there's more and more today than I think ever before, because the screws have been getting so tight around our practice profitability that there's more and more dentists changing their relationship with insurance. So I think that just goes to prove to you that almost anybody can make the change and they can do it successfully. So don't be afraid, just jump right in there.
Speaker 2:Well, Mike has the answer. So you got to tune in for the next one because Mike has the 10 strategies that you can change your practice over and be confident it's going to work.
Speaker 1:Yeah, Basically, there's 10 steps I now recommend you know, because I've had a chance to go through it twice and I've had a chance to go back and look at it retrospectively what could I have done? What would I have changed? And I do. I have the 10 steps that I would recommend.
Speaker 2:Thanks, Mike. All right, I can't. I want to hear the 10 steps.
Speaker 1:Okay, hey, we hope you've enjoyed this part two or three had a great time just reminiscing how Dell Insurance has changed and just sharing some ideas about how we have handled that, and I hope you've garnered some good ideas. And if you've got some better ideas, please share those and we'd love to share it with our listeners. All right, we'll see you next month where we will actually talk about the steps that I would recommend a practice consider if they're thinking about decreasing their dependence on dental insurance. All right, thank you very much.
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