Well, today I’m going to talk about something that’s very dear to all of your hearts, and believe me, when I mention the word ‘green’ everybody thinks money. When I think about money, we all wonder about our fees. Let me just give you a little perspective about fees in general and then endodontic fees specifically.
Now, this is going to be a very important blog on the future of your success because if you’re not getting paid for what you do, you’re not going to either be doing it very well or you’re not going to be doing it for very long. So, let’s talk about fees because most dentists that approach me, they complain about two things. First of all, they always want to know how to get faster. Of course, that conversation is very steeped in… they must not be getting paid properly or adequately to compensate them for the time they spend, so they want to get faster. But, what that also could be interpreted as, is perhaps they don’t like their fees.
So, I’ll say it a different way, I have never met a dentist anywhere in the planet, in the last 30 years that has ever said, “My prosthetic fees are ridiculous. I do not like my implant fees. I do not like my restorative fees. I’m very miserable with my esthetic fees.” I’ve never heard that. Everybody seems to be quite happy and content with the fees they assess patients on a variety of clinical procedures that they do every day, but you do hear all over the world, “I take a lot of time to do root canals. Geez it was a really long system. Oh, it was really calcified. My god, it was even curved, maybe even recurved.” So, because of this, you get into these cases, all of a sudden, the clock is moving, the appointment is over, and now there’s maybe the indignity to try to finish the case, it’s not ready, or maybe you have to have the reschedule conversation. Of course, that costs a lot of money to reschedule patients. We’ll blog about that in another blog, just ahead.
So, back to fees… Let’s look at the historical reason why you’re probably pretty happy with most of your fees, but maybe a little unhappy with your endodontic fees. We only have to go back and look at history. If you look at the other time-honored specialties such as pediatric dentistry, restorative dentistry, which means prosthetics… if you look at perio or maxillofacial surgery… all these ‘specialty areas’ arose in the 1940s. In other words, the American Dental Association recognized those examples I just gave, and gave them specialty status way back in the 40s.
What does that mean? Well, when there’s a specialty program it means that students are accepted to become residents. Residents are obligated to do research. The research papers are then submitted to journals. Through a series of peer-reviewed observations, most times the students actually publish their articles. As the years go by, there becomes a body of evidence and this evidence begins to guide the clinician and the profession towards doing better dentistry. Because of better dentistry, because of the science, because of the validation, because of the evidence, fees kept pace with this newfound ability to have predictable science. But, remember, endo wasn’t recognized by the ADA until 1963. This is more than a decade and a half later.
So, what does this mean? Well, we didn’t have residents, we didn’t have research, and we didn’t have published articles. A lot of the early endodontics from the 40s, the 50s, and even the 60s was just pretty much do this because I said so. It would be written down on a napkin and passed to you in a bar, “I do this because…” So, there was a lot of anecdotal, do it because I said so. There wasn’t a lot of science. We didn’t have a lot of confidence in our abilities to produce long lasting results so we never assessed a very big fee because we didn’t even believe it ourselves. In fact, when it worked, we were thrilled, and when endodontics didn’t work and it failed… Well, nothing ventured, nothing gained. The fee wasn’t so big. So we had permission, if you will, to extract the tooth or do surgery or retreat it, or whatever was done.
So, my point is, we didn’t start off with a good, sound foundation on fees, and then once the science did come and once we did have the illumination of the best practice methods, the fees were already pretty well established and they were low.
So, what should you charge for a fair fee? A fair fee is that fee that a patient pays with gratitude and a doctor receives with dignity. That could be any fee. It’s not necessarily what the person is charging next door, what the person across town is charging… It has to do with you and your philosophy of how you approach clinical endodontics.
Let me give you a hint that I think can get all of you on the pathway towards having a fair fee. It’s very, very simple. This is a “Ruddleism”… I’ve been teaching this for years. It works. You probably just haven’t thought of it like this. I’m going to give you a formula. So, this is going to be a little mathematical formula that you can jot down and then we can talk about it.
The formula is: The cost for “Root Canal Treatment” plus “Restorative Treatment”, should at least equal the “Alternative Treatment”. In other words, if we can’t do a root canal treatment, we’re going to probably extract the tooth. So, the alternative treatment could be, if there’s a posterior abutment, it could be a 3-unit bridge, or 4-unit bridge, or whatever. Also, it could involve leaving the adjacent teeth alone and placing an implant, and after osseointegration, that implant could be restored. So, really the alternative treatments are a bridge or a restored implant. You need to know perfectly what those fees are in your community. I know you know what your fees are, but you need to know what everybody’s fees are and kind of have a composite feel for what a usual, reasonable and customary bridge costs in your community and what a restored implant costs. Once you know that, then you need to look at, what is my root canal fee for any given tooth and then add to that the restorative fee… You know, the optimally restored tooth with the biological width, with the ferrule effect… These are all things that we have to do. Sometimes the restored tooth needs a post. Most times it doesn’t. Are you going to need to do crown lengthening so you can get the ferrule effect? All these things are part of that consideration, but if you add those two fees together, namely root canal fee plus the restorative fee, I’m going to bring you bad news… oh yeah… and worse news.
So, what’s the bad news? The bad news is, when you do root canal treatment and restore the tooth exquisitely you’re making always less than the alternative treatment. What’s the worst news? The worst news is, it’s taking you a longer amount of clinical time to make less money than the alternative. So, not only does the equation not balance, but also it’s taking you a greater amount of time to execute the root canal treatment and restore the tooth than it is to perform the alternative treatment. So, good-bad news and worse news.
What’s the good news? The good news is, a problem recognized is a problem half solved. Just being aware of this formula and being in an active conversation to try to equal the formula will bring you greater clinical success, proper remuneration, and, you know what, happy patients.
So again, what is a fair fee? I think you could start from what is my root canal fee for any given tooth? What is my restorative fee? Add those two together and it should at least equal the alternative, because you’re doing the most righteous procedure our profession has a calling to do and that’s saving teeth. If we do these procedures well, the restored tooth that’s been endodontically treated, is the ultimate dental implant. Okay?
So, that’s my comments today about endodontic fees and I’d like you to get very proactive on training properly so you have the product on the shelf that you can deliver world-class endodontics that’s predicatively successful and then you can restore that tooth and get paid for it.
One last comment, I understand there’s a laboratory fee on both sides of this imaginary equation. When you do restorative, there’s a lab fee in there. When you do a restored implant or you do a bridge, there’s a lab fee. My point is, even if you take the lab fees out, you’re still making less money doing root canal treatment and the restoration as compared to the alternative. So, let’s get started towards financial success and economic freedom.