Dental service demand during the outbreak

[yappy]

everything you’re not happy about is already “solved” in most corporate medical offices And hospitals. Most doctors you see are run by large companies. The staffing of RNs, assistants, patients per hour, clocking in and out, supplies etc is all decided for you. The compensation for doctors is either hourly, RVU based or blended. But the math is already figured out to make it work. The business people are having these discussions, they just don’t include the doctor unless you aren’t falling in line.

Much as you suggested should be done on the sly and magically it will work in the dental Office but it’s just not realistic. Yes it can be taken to an extreme but everyone needs to understand the general costs of business and what it takes to keep the practice alive and thriving.

As I said, I'm not against good business practices or productivity. I'm against cheesy corporate BS that doesn't provide value. Using the team meeting to discuss a daily financial goal or beginning a CE with how much money a service can make you is stupid. Anyone who does these things, or buys into them, are not to be taken seriously.

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[TanMan]

As I said, I'm not against good business practices or productivity. I'm against cheesy corporate BS that doesn't provide value. Using the team meeting to discuss a daily financial goal or beginning a CE with how much money a service can make you is stupid. Anyone who does these things, or buys into them, are not to be taken seriously.

You might be forgetting that sales/selling is a part of dentistry. How can your sales staff sell if it doesn't know the sales targets? Staff usually don't have a great motivation to sell if they aren't incentivized to do so. You might be confusing sales with unethical sales, but the unethical part comes from the dentist, not the staff. You can present a treatment in many different ways, but it all starts with the proposed treatment.

 

[charlestweed]

The corp regional manager called me today to tell me that the company gets the green light to reopen ortho. Due to the CDC's social distancing guideline, we, orthodontists, cannot work side by side with the general dentists. The waiting room would be filled with patients. To avoid getting into trouble (since it's a big corporation), the manager asked me if I was ok with working on some Sundays and working from 2pm-9pm on the weekdays. They want the general dentists to work from 6am-2pm. And I will work from 2pm-9pm so I can use all 16 chairs and should be able to meet the social distance guideline. Without any hesitation, I said yes to her. It's better than staying at home doing nothing. Since my kids are not going to schools, I can see them pretty much anytime I want. Because of this Covid shutdown, every day seems like a Saturday or Sunday. Today is my first day back to work at my own office.....mostly emergency patients....I love it. My first day back to work at the corp will be Sunday May 31st. I am super excited.

 

[mmc12]

For those dentists opening soon for non-emergency dental care, are N95 masks going to be mandatory for dentists and assistants to wear?

 

[145bluz]

Yes.

 

[Cold Front]

The corp regional manager called me today to tell me that the company gets the green light to reopen ortho. Due to the CDC's social distancing guideline, we, orthodontists, cannot work side by side with the general dentists. The waiting room would be filled with patients. To avoid getting into trouble (since it's a big corporation), the manager asked me if I was ok with working on some Sundays and working from 2pm-9pm on the weekdays. They want the general dentists to work from 6am-2pm. And I will work from 2pm-9pm so I can use all 16 chairs and should be able to meet the social distance guideline. Without any hesitation, I said yes to her. It's better than staying at home doing nothing. Since my kids are not going to schools, I can see them pretty much anytime I want. Because of this Covid shutdown, every day seems like a Saturday or Sunday. Today is my first day back to work at my own office.....mostly emergency patients....I love it. My first day back to work at the corp will be Sunday May 31st. I am super excited.

Did you ask the lady who called you from corporate if there will be enough PPE’s for everyone that will work with you? A stockpile of N95’s, gowns, etc?

That would have been my first question before immediately saying “yes!” to coming back to work.

Safety for you and your staff first!


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[2TH MVR]

Did you ask the lady who called you from corporate if there will be enough PPE’s for everyone that will work with you? A stockpile of N95’s, gowns, etc?

That would have been my first question before immediately saying “yes!” to coming back to work.

Safety for you and your staff first!


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Yeah. I'm a little surprised that a California dental corp would open ortho so soon. Ortho is so full of issues due to the large number of pts we see and the typical open bay set ups. I just found out that I will be furloughed until the end of June. Could be longer. Sucks, but understandable. I just want a proper, well-thought out strategy to keep myself, the staff and the patients safe.

 

[charlestweed]

Did you ask the lady who called you from corporate if there will be enough PPE’s for everyone that will work with you? A stockpile of N95’s, gowns, etc?

That would have been my first question before immediately saying “yes!” to coming back to work.

Safety for you and your staff first!


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There is a 70+ yo orthodontist in our group. He had been hospitalized a few times in the past for pneumonia and other health problems. And he didn’t mind going back to work. For ortho, the disposable masks that we’ve normally used should be fine. This Monday was the first day that I re-opened my office. I have re-used the same the N95 mask. I put a cloth mask over this N95 mask. At the end of each work day, I washed the cloth mask and exposed the N95 mask to direct sunlight by putting it on my car’s dashboard. I made my assistants wear the N95 masks but they all complained that the N95 masks were too hot and too uncomfortable to wear. They said they couldn’t breathe through the masks. So they all went back to the regular disposable masks.

The corp manager actually wanted me to come back sooner. I will come back to work for them this coming Monday May 18th. And I won’t need to work for them on Sundays after all. Yay!

This is what my work schedule looks like for the rest of May.

 

[Cold Front]

Yeah. I'm a little surprised that a California dental corp would open ortho so soon. Ortho is so full of issues due to the large number of pts we see and the typical open bay set ups. I just found out that I will be furloughed until the end of June. Could be longer. Sucks, but understandable. I just want a proper, well-thought out strategy to keep myself, the staff and the patients safe.

Absolutely. Specially for your family who don’t want you to bring a contagion to them at home. Sorry to hear you being furloughed much longer... it definitely sucks. I’m sure you are not alone to be in that position at your state.

The state of Wisconsin Supreme Court overruled the Governor’s stay home order yesterday, and everyone was asked to go back to work. No healthcare strategy at all.

[youtube]


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[TanMan]

For those dentists opening soon for non-emergency dental care, are N95 masks going to be mandatory for dentists and assistants to wear?

Depends on your state. Refer to your state for requirements. I can't wait until they lift this requirement for n95s.

There is a 70+ yo orthodontist in our group. He had been hospitalized a few times in the past for pneumonia and other health problems. And he didn’t mind going back to work. For ortho, the disposable masks that we’ve normally used should be fine. This Monday was the first day that I re-opened my office. I have re-used the same the N95 mask. I put a cloth mask over this N95 mask. At the end of each work day, I washed the cloth mask and exposed the N95 mask to direct sunlight by putting it on my car’s dashboard. I made my assistants wear the N95 masks but they all complained that the N95 masks were too hot and too uncomfortable to wear. They said they couldn’t breathe through the masks. So they all went back to the regular disposable masks.

The corp manager actually wanted me to come back sooner. I will come back to work for them this coming Monday May 18th. And I won’t need to work for them on Sundays after all. Yay!

This is what my work schedule looks like for the rest of May.
View attachment 306444

I'm seeing a PPE revolution by the assistants and hygienists. I have to keep telling them to put on their N95s/faceshields but some of them are resisting/refusing. Glad to see you working again. Things are really looking good for ortho and GPs right now. Demand for 3rd's seem to have flattened out a bit, even with the OS's reluctantly opening. Traffic is back, people are tired of all this mask wearing and social distancing, and things are going back to normal.

 

[allantois]

It's embarrassing to see dentists advocate against wearing N95 masks

 

[allantois]

There is a 70+ yo orthodontist in our group. He had been hospitalized a few times in the past for pneumonia and other health problems. And he didn’t mind going back to work.

Talk about people who should retire and make way for new grads.

 

[TanMan]

It's embarrassing to see dentists advocate against wearing N95 masks

Have you worn N95s along with all the PPE that's mandated all day? If you haven't, try it, and then you'll see why some people would rather risk getting the virus than wearing N95s. Most dentists didn't wear N95s before all this came about. I don't advocate anything except to follow your state regulations. However, once we are no longer required to wear N95s, I'm not going to wear them anymore.

 

[allantois]

Have you worn N95s along with all the PPE that's mandated all day? If you haven't, try it, and then you'll see why some people would rather risk getting the virus than wearing N95s. Most dentists didn't wear N95s before all this came about. I don't advocate anything except to follow your state regulations. However, once we are no longer required to wear N95s, I'm not going to wear them anymore.

I haven’t worn N95 as I haven’t been able to get my hands on them. Still waiting for the shipment from China. Dentistry supposedly carries some of the highest risk of contracting the virus, where the surgical masks really don’t provide much protection at all. If you are willing to accept the risk of contracting COVID, then so be it, however I would expect better from someone with a medical background. Whether they lift requirements or not, the virus isn’t gonna be going away any time soon. It would have been better if people actually took this seriously, then we wouldn’t be in the position that we are in today. However, that ship has long sailed.

 

[Cold Front]

Depends on your state. Refer to your state for requirements. I can't wait until they lift this requirement for n95s.



I'm seeing a PPE revolution by the assistants and hygienists. I have to keep telling them to put on their N95s/faceshields but some of them are resisting/refusing. Glad to see you working again. Things are really looking good for ortho and GPs right now. Demand for 3rd's seem to have flattened out a bit, even with the OS's reluctantly opening. Traffic is back, people are tired of all this mask wearing and social distancing, and things are going back to normal.

I’m not bringing 70% of my staff back for their own safety and shortage of PPE, plus they are making double their income through pandemic unemployment assistance program through end of July - which will be extended through February if the Heroes Act becomes a law this month.

Safety first. Safety first. Safety first. That’s the motto at my practices.

As for me, I’m seeing 1 patient an hour to do molar Endo/crowns with the PPE we have. My state Medicaid insurance approved unlimited RCTs and PFM crowns (with build-ups) without any prior authorizations starting from this month. As a result, my production now is $2k an hour, and I only need to do this with 1 assistant 3 days a week, from 9-2p. I’m home by 2:15p. The other office associate is doing exactly the same. The less staff, the less office hours worked, the less risk for everyone. We adjusted to the pandemic.

Dentistry will change for good. Dentists who want to work like they use to are putting themselves in a HIGH risk experiment. Just because people are tired of staying home and want to go out and get back to their lives are exactly the opposite solution to the pandemic. We have to at least start seeing patients very SLOWLY and in SMALL numbers - and as a result with a very FEW staff.

Every state issued this strategy as their go back to work guidelines - so we should do EXACTLY that at the very minimum. States also understand the shortage of PPEs and how difficult they are to use for doctors and their staff, so we should only keep the staff that can use the PPE at the office. Those who don’t want to wear them, or have difficulty wearing them, SEND THEM HOME. They are breaking the state protocols, and in violation of the CDC and dental board guidelines. I can see lawsuits happening if employees get the virus at the office because they can’t keep their N95 mask on all the time, then get themselves sick and hospitalized, and end up with a large hospital bill. Then they blame it all at the dental office they work at.


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[2TH MVR]

I can see lawsuits happening if employees get the virus at the office because they can’t keep their N95 mask on all the time, then get themselves sick and hospitalized, and end up with a large hospital bill. Then they blame it all at the dental office they work at.


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I had posted in another thread the NEW FEEDING GROUND for personal injury attorneys . I guess they wore out the mesothelioma gold mine and milked it for everything they could. Imagine all these small business owners (small dental practices, et al) trying hard to 1. OPEN back up 2. Protect themselves, their staff and their patients. Infection control is not new, but this pandemic had brought it to the attention of all the bottomfeeders looking for a quick pay day.

It appears that the Republicans are looking at some bill to control the "frivolous" action of these bottom feeders as related to this pandemic.

Employees. The bane of private practice. So important yet so ready to blame a practice owner/Corp. The Corp I work for has a protocol with employees. There are monthly/quarterly online tests for infection control, sterilization procedures, how to deal with staff to staff confrontations, whisleblower directions, etc. etc. tests that are taken EVERY month/quarter and is documented in their employee log. Documented SEVERAL times. This is how Corp America works.

I would encourage all private practices to adopt a similar protocol. This keeps the information fresh for the employees and also offers a level of protection for the dentist owner.

 

[Cold Front]

I had posted in another thread the NEW FEEDING GROUND for personal injury attorneys . I guess they wore out the mesothelioma gold mine and milked it for everything they could. Imagine all these small business owners (small dental practices, et al) trying hard to 1. OPEN back up 2. Protect themselves, their staff and their patients. Infection control is not new, but this pandemic had brought it to the attention of all the bottomfeeders looking for a quick pay day.

It goes back to the concept of tort and the examples you mentioned. A lot of the covid risks in dental offices is factually driven and was clearly declared a potential health threat to the public by governor, states, CDC, dental boards, etc. Dentists have asked employees to rush and get back to work, in many cases, against their wishes or threatening them with losing their jobs if they didn’t - all of which can be proven by an employee. So if an employee gets sick - specially with the lack of PPE, they have strong case that the dentist called them back to the office and the dentist may or may have not known about the lack of PPE and testing at the office when they made the decision to call back that employee.

Then the question becomes protecting yourself against a potential civil lawsuit, and at minimum, a dentist would have to retain an attorney and fight this issue legally - whether they win it or not, it will cost a lot of time and money to endure that whole stressful process. Not every practice owner dentist is not taking this issue seriously... they just want to get out of the house and get back to work. Guess what? The dental office space they are going back to have become a virus and legal minefield.


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[TanMan]

I’m not bringing 70% of my staff back for their own safety and shortage of PPE, plus they are making double their income through pandemic unemployment assistance program through end of July - which will be extended through February if the Heroes Act becomes a law this month.

Safety first. Safety first. Safety first. That’s the motto at my practices.

As for me, I’m seeing 1 patient an hour to do molar Endo/crowns with the PPE we have. My state Medicaid insurance approved unlimited RCTs and PFM crowns (with build-ups) without any prior authorizations starting from this month. As a result, my production now is $2k an hour, and I only need to do this with 1 assistant 3 days a week, from 9-2p. I’m home by 2:15p. The other office associate is doing exactly the same. The less staff, the less office hours worked, the less risk for everyone. We adjusted to the pandemic.

Dentistry will change for good. Dentists who want to work like they use to are putting themselves in a HIGH risk experiment. Just because people are tired of staying home and want to go out and get back to their lives are exactly the opposite solution to the pandemic. We have to at least start seeing patients very SLOWLY and in SMALL numbers - and as a result with a very FEW staff.

Every state issued this strategy as their go back to work guidelines - so we should do EXACTLY that at the very minimum. States also understand the shortage of PPEs and how difficult they are to use for doctors and their staff, so we should only keep the staff that can use the PPE at the office. Those who don’t want to wear them, or have difficulty wearing them, SEND THEM HOME. They are breaking the state protocols, and in violation of the CDC and dental board guidelines. I can see lawsuits happening if employees get the virus at the office because they can’t keep their N95 mask on all the time, then get themselves sick and hospitalized, and end up with a large hospital bill. Then they blame it all at the dental office they work at.


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Yep. You can stick to the moral highroad especially with the Medicaid goldmine you got handed. It's like the Texas Medicaid Ortho goldmine. It's amazing that your medicaid patients all show up every hour; in our first few months of opening and in the mills I used to work for, we had high cancellation rates for Medicaid patients. Shoot, if I was doing 2k for every rctbucrn and they all showed up and guaranteed payment, I'd be probably do the same thing too.

To those practicing in the real world, drain the equity out of your office and protect your assets. Asset protection is all about structuring your assets BEFORE you get hit with lawsuits. Anticipate what your enemy is looking after and make it difficult for them to find, search, and pierce your protections. You should always have plan A through Z to anticipate scenarios, including your employees getting sick and dying (not your fault, of course). If you're in Texas, don't worry, tort reform makes medmal unpalatable for most attorneys except for the starving ones.... and the starving ones usually are starving for a reason. If they do send you a threatening letter, call their bluff. They won't pursue it because of the costs of pursuing, the return, and the risk of losing a case (time/money involved).

I have accepted that I will get the virus at some point. I'd rather get it while I'm still young than when I'm older. I understand that many older dentists are deftly afraid of this virus, but I don't think I should be bundled up with them yet.

 

[Cold Front]

Yep. You can stick to the moral highroad especially with the Medicaid goldmine you got handed. It's like the Texas Medicaid Ortho goldmine. It's amazing that your medicaid patients all show up every hour; in our first few months of opening and in the mills I used to work for, we had high cancellation rates for Medicaid patients. Shoot, if I was doing 2k for every rctbucrn and they all showed up and guaranteed payment, I'd be probably do the same thing too.

To those practicing in the real world, drain the equity out of your office and protect your assets. Asset protection is all about structuring your assets BEFORE you get hit with lawsuits. Anticipate what your enemy is looking after and make it difficult for them to find, search, and pierce your protections. You should always have plan A through Z to anticipate scenarios, including your employees getting sick and dying (not your fault, of course). If you're in Texas, don't worry, tort reform makes medmal unpalatable for most attorneys except for the starving ones.... and the starving ones usually are starving for a reason. If they do send you a threatening letter, call their bluff. They won't pursue it because of the costs of pursuing, the return, and the risk of losing a case (time/money involved).

I have accepted that I will get the virus at some point. I'd rather get it while I'm still young than when I'm older. I understand that many older dentists are deftly afraid of this virus, but I don't think I should be bundled up with them yet.

My practices are 1/3 medicaid, 1/3 private, and 1/3 FFS patients. Surprisingly, the cancellation and no shows are about the same for all 3.

Most Medicaid patients walk to my offices. They live within a mile from the offices, so they only cancel or don’t show up when the weather is bad. This group generally have transportation issues, so if my practices were further away from their homes, the cancellation and no shows would be higher. Also, my offices aren’t built like the typical Medicaid offices, most new patients don’t actually think we accept Medicaid, which makes them choose my offices over other Medicaid offices. Majority of my Medicaid patients have been in the country less than 5–10 years, and I speak their languages (about 5 languages). So again, there are few factors that goes into why Medicaid patients cancel or no shows as stated above. Every Medicaid community is different, and most dentists just lump them together as one group that they should avoid seeing for the reasons you mentioned.

Each state also has a different Medicaid program and covered services than other states, so dentist participation rates varies from state to state. The state here changes the covered services and fees every few years - mostly due to the state budget. Before covid, we had a surplus state budget and now they have allowed more adult services to be covered in dentistry. It was really bad 5-10 yrs ago due austerity measures by the state, and now its suddenly really good, it actually took me and many other dentists who accept Medicaid by surprise.

Not to get off the original topic, but I think dentists will fall into 3 groups when they re-open their practices:

1. Those who didn’t really like dentistry, or close to retirement or simply their business numbers wasn’t strong enough - and now it’s even more difficult to do dentistry under covid world will just have a plan to exit the field soon. Either by not renewing their leases, throwing the towel if they owned their building or have other passive incomes. This group will predominantly be older/empty nesters (high risk group for covid) and usually have no/minimum debt.

2. Those who have more energy doing dentistry than Group 1, worked 15 to 30 years, have a young family and a thriving practice to support will go back to work cautiously but determined to see patients. They are financially more eager than Group 1 dentists, but less than Group 3. Most will (should be) follow covid safety guidelines strict to the letter. They will be busy seeing more patients as Group 1 sees less patients and as Group 3 struggle to go back to work.

3. This is the group that scares me. They are mostly young (under 35), have a lot of students loans and other debt. Most of them are not married or have kids. They are more likely to take risks and will not take the covid guidelines seriously - or as much as the older groups do. They will have a lot of jokes and laughing about the whole situation. However, majority are associates and will be the last group of dentists to go back to work as their hours are reduced over the next few months, until the new normalcy sets in for their employer dentists.


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[charlestweed]

I had posted in another thread the NEW FEEDING GROUND for personal injury attorneys . I guess they wore out the mesothelioma gold mine and milked it for everything they could. Imagine all these small business owners (small dental practices, et al) trying hard to 1. OPEN back up 2. Protect themselves, their staff and their patients. Infection control is not new, but this pandemic had brought it to the attention of all the bottomfeeders looking for a quick pay day.

It appears that the Republicans are looking at some bill to control the "frivolous" action of these bottom feeders as related to this pandemic.

Employees. The bane of private practice. So important yet so ready to blame a practice owner/Corp. The Corp I work for has a protocol with employees. There are monthly/quarterly online tests for infection control, sterilization procedures, how to deal with staff to staff confrontations, whisleblower directions, etc. etc. tests that are taken EVERY month/quarter and is documented in their employee log. Documented SEVERAL times. This is how Corp America works.

I would encourage all private practices to adopt a similar protocol. This keeps the information fresh for the employees and also offers a level of protection for the dentist owner.

This is one of the advantages of working for the corp. They are very good at following the state's rules and regulations. I've learned a lot.

Today is my first day back to work at the corp. There are only 37 patients for the whole 8 hours, which is about half of what we normally saw before the Covid shutdown. There are 2 chairside assistants + a sterilizing assistant. It should be a very easy day. They gave me this commercial face shield, which needs to be disinfected with cavicide after treating each patient, and a N95 mask to wear. For gowns, they use the reusuable washable fabric (polyester?) medical gowns. I also ordered some of these reusable gowns for my own offices to save money and to solve the PPE shortage problem.

 

[charlestweed]

I’m not bringing 70% of my staff back for their own safety and shortage of PPE, plus they are making double their income through pandemic unemployment assistance program through end of July - which will be extended through February if the Heroes Act becomes a law this month.

Safety first. Safety first. Safety first. That’s the motto at my practices.

As for me, I’m seeing 1 patient an hour to do molar Endo/crowns with the PPE we have. My state Medicaid insurance approved unlimited RCTs and PFM crowns (with build-ups) without any prior authorizations starting from this month. As a result, my production now is $2k an hour, and I only need to do this with 1 assistant 3 days a week, from 9-2p. I’m home by 2:15p. The other office associate is doing exactly the same. The less staff, the less office hours worked, the less risk for everyone. We adjusted to the pandemic.

Dentistry will change for good. Dentists who want to work like they use to are putting themselves in a HIGH risk experiment. Just because people are tired of staying home and want to go out and get back to their lives are exactly the opposite solution to the pandemic. We have to at least start seeing patients very SLOWLY and in SMALL numbers - and as a result with a very FEW staff.

Every state issued this strategy as their go back to work guidelines - so we should do EXACTLY that at the very minimum. States also understand the shortage of PPEs and how difficult they are to use for doctors and their staff, so we should only keep the staff that can use the PPE at the office. Those who don’t want to wear them, or have difficulty wearing them, SEND THEM HOME. They are breaking the state protocols, and in violation of the CDC and dental board guidelines. I can see lawsuits happening if employees get the virus at the office because they can’t keep their N95 mask on all the time, then get themselves sick and hospitalized, and end up with a large hospital bill. Then they blame it all at the dental office they work at.


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I actually don't want all of my 6 P/T employees to return to work and pay them for sitting around doing nothing.
To maintain the social distancing rule, I can only book 40-45 patients per day instead of the usual 60-100 patients/day. With the 2 F/T employees (a manager and a chairside asisstant) that I currently have, I only need 2 additional P/T chairside assistants per work day.

 

[Cold Front]

To maintain the social distancing rule, I can only book 40-45 patients per day instead of the usual 60-100 patients/day. With the 2 F/T employees (a manager and a chairside asisstant) that I currently have, I only need 2 additional P/T chairside assistants per work day.

Charles, How do you see other ortho offices are faring? In terms of pts/day after the lockdown? % of current employees vs pre-covid? And how long do you expect this current plan to last before things get back to normal?


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[charlestweed]

Charles, How do you see other ortho offices are faring? In terms of pts/day after the lockdown? % of current employees vs pre-covid? And how long do you expect this current plan to last before things get back to normal?


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Most of my colleagues from the orthotown forum have not reopened their offices. For a few ortho offices that reopened, they have only taken care of their existing patients who have loose/broken ortho appliances.....no new patient consultation, no start. For the first 4 days, I had also taken care of my existing patients only. I started 1 new case yesterday.

Some orthos and general dentist friends of mine have complained to me that some of their employees refused to return to work. It's because they have been getting a lot more money for being unemployed than working. I was very surprised that none of my 2 F/T filed for unemployment when I told them that I could only pay them 32 hours/wk. Now that we are back to work, each of them get paid the usual 40-45 hrs/wk again.

I don't really know when things will get back to normal. I guess when we develop the vaccine or when Covid-19 go away on its own like other pandemics in the past. Right now, I just want to work and save as much as I possibly can.....in case the government decides to shut down the country again.

 

[Cold Front]

Most of my colleagues from the orthotown forum have not reopened their offices. For a few ortho offices that reopened, they have only taken care of their existing patients who have loose/broken ortho appliances.....no new patient consultation, no start. For the first 4 days, I had also taken care of my existing patients only. I started 1 new case yesterday.

Some orthos and general dentist friends of mine have complained to me that some of their employees refused to return to work. It's because they have been getting a lot more money for being unemployed than working. I was very surprised that none of my 2 F/T filed for unemployment when I told them that I could only pay them 32 hours/wk. Now that we are back to work, each of them get paid the usual 40-45 hrs/wk again.

I don't really know when things will get back to normal. I guess when we develop the vaccine or when Covid-19 go away on its own like other pandemics in the past. Right now, I just want to work and save as much as I possibly can.....in case the government decides to shut down the country again.

I hear you. These are trying times, and watching too much news and following the covid restrictions on the economy pretty much daily have somewhat clouded my judgement on the human limits of staying home. I now agree, even though life is all about taking risks - that the latest data shows that the pandemic is not as bad as it was initially believed to be, and that’s mostly credited to the lockdowns that subdued the spread.


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[DrJeff]

Typing this from my desk at work, in what is "day 1" of a full office reopening (granted we're going at a reduced volume to allow for extra time to work through all of the PPE differences, patient movement in/out/around the office, as well as letting the staff have a few extra minutes so they don't feel rushed through the new "normal"

Overall - fairly smooth. Some of my staff, who were quite apprehensive over the last week or so since my business partner and I informed them of our intent to reopen today, have definitely "settled down" once they got their gear on and started working on patients again, and found out that while it's a bit different, it's far more the same as it was before.

Patient wise, the schedule, even if we weren't going reduced right now (and for roughly the next 10 days as we work through some likely patient flow changes we'll make once we see how our plans actually work verses how we thought they would), we're at maybe 2/3rds of "normal" right now. Not terrible, not great, but certainly better than the last 8 weeks of emergencies only.

Living in CT, where we're still relatively speaking "locked down" compared to many parts of the country, I would imagine that once many parts of my state start to reopen, and the public sees that what is often the doom and gloom that they fear will happen with reopening, hopefully won't, then their confidence will go up, and the schedule will get closer to 100%.

Feels good to have my full staff back and working on patients, it's different for sure, but also very similar in how it feels

 

[Cold Front]

Typing this from my desk at work, in what is "day 1" of a full office reopening (granted we're going at a reduced volume to allow for extra time to work through all of the PPE differences, patient movement in/out/around the office, as well as letting the staff have a few extra minutes so they don't feel rushed through the new "normal"

Overall - fairly smooth. Some of my staff, who were quite apprehensive over the last week or so since my business partner and I informed them of our intent to reopen today, have definitely "settled down" once they got their gear on and started working on patients again, and found out that while it's a bit different, it's far more the same as it was before.

Patient wise, the schedule, even if we weren't going reduced right now (and for roughly the next 10 days as we work through some likely patient flow changes we'll make once we see how our plans actually work verses how we thought they would), we're at maybe 2/3rds of "normal" right now. Not terrible, not great, but certainly better than the last 8 weeks of emergencies only.

Living in CT, where we're still relatively speaking "locked down" compared to many parts of the country, I would imagine that once many parts of my state start to reopen, and the public sees that what is often the doom and gloom that they fear will happen with reopening, hopefully won't, then their confidence will go up, and the schedule will get closer to 100%.

Feels good to have my full staff back and working on patients, it's different for sure, but also very similar in how it feels

CT now holds the official title “the last state to re-open” - according to an article I came across earlier.

How should you be thinking about the high unemployment and deep economic uncertainties that face the communities you draw patients from? I understand this could vary from blue vs white collar patients, but how do you see this economic period impacting the type of treatments you provide to your patients? Specially when 27 million Americans lost their health insurance over the last couple of months, many of them lost their dental plans too. Do you have a short strategy to navigate around that if it becomes an issue for your practice?

Also, will your hygiene production go down due to new aerosol guidelines? I think you being back to 2/3 level of your practice is great and encouraging.


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[DrJeff]

CT now holds the official title “the last state to re-open” - according to an article I came across earlier.

How should you be thinking about the high unemployment and deep economic uncertainties that face the communities you draw patients from? I understand this could vary from blue vs white collar patients, but how do you see this economic period impacting the type of treatments you provide to your patients? Specially when 27 million Americans lost their health insurance over the last couple of months, many of them lost their dental plans too. Do you have a short strategy to navigate around that if it becomes an issue for your practice?

Also, will your hygiene production go down due to new aerosol guidelines? I think you being back to 2/3 level of your practice is great and encouraging.


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Honestly my business partner and I are going to "hope for the best but plan for the worst" as we look towards the remainder of the year as the economy starts to open back up.

Honestly I don't think anyone really knows what things will look like in the post COVID-19 crisis world, other than it's going to be different. Will it be say 5% different? 15% different? 50% different? Who knows.

Just anecdotally listening to my patients that have been in so far, the majority of them seem to feel that the Government way over played this situation, and frankly just want them (the government) to get out of the way now.

The demand to get back to/towards normal from what I have seen in my small cross section of the world, seems to be there. Only time will tell what my practice will look like, how many employees I will have, how my annual production will be effected, etc?

Lots of uncertainty, and frankly for so many of us in the profession, and our strong tendencies towards wanting to plan out and control most everything, this is certainly challenging and frustrating!

 

[2TH MVR]

With all the necessary Covid-19 requirements .... I cannot see dental business operating the same from an economic POV. In my small world working for a dent Corp .... there was always the push to increase production in order to pay for everything. I get that. Same as private practice. One financial Corp employee once told me that in the ortho area ....to break EVEN .... we needed a minimum of 2 starts a day. Most days we get that, but there are plenty of days we do not get those 2 starts.

Now. What I envision is wholesale changes to the ortho environment. I mean we used to see 60-80 patients a day in a small open bay set up. Not sure how I can see that many patients given the new guidelines. So everything is pointing towards less patients seen. Additional infection control measures. This all adds up to less production which in turn potentially means ............ I will be getting a pay cut. Nobody ever wants to earn less money. I don't.

The flip side to this is that things will be better for ortho. Improved clinic areas. Less patients, but we still start the necessary minimum of 2-3 starts per day. Better overall care with fewer patients being seen. No pay cut.

Still furloughed through next month. I guess I will find out. Probably going to review my resume and be prepared to keep my options open.

 

[Cold Front]

Honestly my business partner and I are going to "hope for the best but plan for the worst" as we look towards the remainder of the year as the economy starts to open back up.

Honestly I don't think anyone really knows what things will look like in the post COVID-19 crisis world, other than it's going to be different. Will it be say 5% different? 15% different? 50% different? Who knows.

Just anecdotally listening to my patients that have been in so far, the majority of them seem to feel that the Government way over played this situation, and frankly just want them (the government) to get out of the way now.

The demand to get back to/towards normal from what I have seen in my small cross section of the world, seems to be there. Only time will tell what my practice will look like, how many employees I will have, how my annual production will be effected, etc?

Lots of uncertainty, and frankly for so many of us in the profession, and our strong tendencies towards wanting to plan out and control most everything, this is certainly challenging and frustrating!

It’s definitely a fog of war for dental offices for the foreseeable future.

Does your office charge a PPE fee for every appointment?


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[charlestweed]

With all the necessary Covid-19 requirements .... I cannot see dental business operating the same from an economic POV. In my small world working for a dent Corp .... there was always the push to increase production in order to pay for everything. I get that. Same as private practice. One financial Corp employee once told me that in the ortho area ....to break EVEN .... we needed a minimum of 2 starts a day. Most days we get that, but there are plenty of days we do not get those 2 starts.

Now. What I envision is wholesale changes to the ortho environment. I mean we used to see 60-80 patients a day in a small open bay set up. Not sure how I can see that many patients given the new guidelines. So everything is pointing towards less patients seen. Additional infection control measures. This all adds up to less production which in turn potentially means ............ I will be getting a pay cut. Nobody ever wants to earn less money. I don't.

The flip side to this is that things will be better for ortho. Improved clinic areas. Less patients, but we still start the necessary minimum of 2-3 starts per day. Better overall care with fewer patients being seen. No pay cut.

Still furloughed through next month. I guess I will find out. Probably going to review my resume and be prepared to keep my options open.

My cousin, who is a MD anesthesiologist, complained to me about this as well. The surgeons, whom he works with, also complained. Because of the new Covid infection control requirements, they see fewer patients, work longer hours, and get paid less. One good thing that came out of this was he got a small discount on his malpractice insurance premium....fewer cases = lower chance of getting sued.

I think corps still make money even with fewer patients and ortho starts per day....not as much as before but still a lot of money. The steady income flow from the HMO's and the productions from their general dentists are more than enough to pay rent, staff/doctor salaries, and other fixed expenses. Whatever their in-house specialists produce is pure profit.

For us, practice owners, we will see significant decrease in revenue. People have lost their jobs and insurances. I had 2 starts scheduled earlier today at my office and both of them cancelled.....the GP only did the deep cleaning on half of her mouth and the other start patient was no-show. The good thing is I still have a steady income from my associate job and I only have a home mortgage balance of less than $300k (the only debt I have) to pay.

Edit: The start patient, who didn't show up, called us today to reschedule. Yay! She mistakenly went to my other office location because it's where I first saw her for consultation. She told us that she wanted to start tx at this office location, which is closer to her work, and she forgot about this request. I also did 2 more consultations today and both of them sheduled to start next week.

 

[Cold Front]

I will be getting a pay cut. Nobody ever wants to earn less money. I don't.

The flip side to this is that things will be better for ortho. Improved clinic areas. Less patients, but we still start the necessary minimum of 2-3 starts per day. Better overall care with fewer patients being seen. No pay cut.

Still furloughed through next month. I guess I will find out. Probably going to review my resume and be prepared to keep my options open.

Sorry to hear that.

I’m seeing ortho being exposed the most to the downside of going back to work. Their open bays system, the frequency of appointments needed, one of the most delay-able treatments in dentistry (non disease dentistry) and so on. With less associate dentists going back to work, it will definitely dampen the whole “referral of new cases” process for many orthodontists in the coming months, possibly longer. I don’t mean to underscore the situation you are in, but many of my ortho friends are in similar situation as you - and many are in private practice.

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[allantois]

Why do orthodontists need to see so many patients given the price of treatments and low overhead? I don’t think ortho will be the hardest hit specialty plus patients often self-refer.
Now I can totally see general dentists trying to keep endo and implants in house and no one self refers to endo or perio/OMS

 

[Cold Front]

Why do orthodontists need to see so many patients given the price of treatments and low overhead? I don’t think ortho will be the hardest hit specialty plus patients often self-refer.
Now I can totally see general dentists trying to keep endo and implants in house and no one self refers to endo or perio/OMS

Historically, most Pedo and Endo cases are performed by general dentists in this country. Ortho will bounce back in the long run, because very few general dentists do them.

IMO, general dentists will become like grizzly bears from here on - and move upstream in the river to catch as much fish as possible to keep the usual referral cases in-house, but they will not touch ortho cases or possibly delay them until the dust settles. I can see the desperate orthodontists choosing heavy marketing, enticing and sending referral gifts to their local general dentist this year. I believe this happened in 2008 - [mention]charlestweed [/mention]and [mention]2TH MVR [/mention]can confirm this.

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[charlestweed]

Why do orthodontists need to see so many patients given the price of treatments and low overhead? I don’t think ortho will be the hardest hit specialty plus patients often self-refer.
Now I can totally see general dentists trying to keep endo and implants in house and no one self refers to endo or perio/OMS

If you and your chairside assistants can handle a lot of patients in a day, then why not? Efficiency is key. Because you can see a lot of patients a day, you don't have to work a lot of days and use the free days in the month to work at your other offices or work for the corp to earn more money.

Now with the new Covid requirements, I have to spread my patients out. There are 5 chairs in the open bay. To maintain the social distance rule, I have to skip chairs and can only use 3 of them. I also have 2 private tx rooms so I my office can see up to 5 patients at the same time. You are right. Ortho patients self-refer.

 

[DrJeff]

1 week now into the full reopening of my office in CT. Quite pleased so far with what I am seeing. Schedules either staying full (hygiene that was already booked) or filling in quite rapidly (my partner's and my schedule that was rather empty after 9+ weeks of emergencies only and no hygiene checks during those 9 weeks to keep the schedule full weeks out.

Patients have been very appreciative and amenable to the changes in protocols we have implemented with respect to bring them into and out of the office and the extra gear we need to wear while working. The vast majority of the patients that I have talked too seem to really want to get back to "normal" and often tell me that they feel that in a state that just started Phase 1 of a 4 phase reopening plan likely to last through late Summer, that the steps the government is still taking in CT are too drastic for the overall risk this disease poses to the majority of society.

Cautiously optimistic that the end result of this won't be all doom and gloom right now, and that while I probably will never again be able to practice without wearing a faceshield, the rest won't be that much different than before in a few months.

Hope the others going through reopening in this thread are also seeing similar, mainly positive experiences in their own practices!

 

[allantois]

Every Joe has now become an expert on infectious disease

 

[DrJeff]

Every Joe has now become an expert on infectious disease

CT is an interesting state when it comes to CV19.

We have 8 counties, 3 of them, Fairfield (which borders the NYC metro area), New Haven and Hartford Counties account for approximately 80% of the total cases in CT (roughly 36000 cases out of about 41300 total cases statewide and about 90% of the total just under 3800 deaths in the state). Up in the Northeast Corner of the state where I live in Windham County, we have 0.8% of the total cases in the state (371 cases out of 41300 as of yesterday total cases) and 0.3% of the deaths (14 out of 3770 total in CT as of yesterday), so it doesn't surprise me at all that my patients are questioning some of our Governor's tactics and continued heavy restrictions and slow reopening as a "one size fits all" approach to the state. I certainly don't get the impression that they feel that they're infectious disease experts, as much as they're just adults, looking at the information presented to them and looking at the actions taken and the effects that they have had on their day to day lives, especially in a region where for various reasons, we just haven't been hit very hard by the disease process. Seems more like some critical thinking skills rather than the psuedo infectious disease expert feelings

 

[Cold Front]

1 week now into the full reopening of my office in CT. Quite pleased so far with what I am seeing. Schedules either staying full (hygiene that was already booked) or filling in quite rapidly (my partner's and my schedule that was rather empty after 9+ weeks of emergencies only and no hygiene checks during those 9 weeks to keep the schedule full weeks out.

Patients have been very appreciative and amenable to the changes in protocols we have implemented with respect to bring them into and out of the office and the extra gear we need to wear while working. The vast majority of the patients that I have talked too seem to really want to get back to "normal" and often tell me that they feel that in a state that just started Phase 1 of a 4 phase reopening plan likely to last through late Summer, that the steps the government is still taking in CT are too drastic for the overall risk this disease poses to the majority of society.

Cautiously optimistic that the end result of this won't be all doom and gloom right now, and that while I probably will never again be able to practice without wearing a faceshield, the rest won't be that much different than before in a few months.

Hope the others going through reopening in this thread are also seeing similar, mainly positive experiences in their own practices!

Good to hear. It’s almost like the barbershop and hair salon effect. Everyone who was scheduled or was hoping to be seen by a dentist during the lockdown is now part of the first wave of patients going to the dentist now. Even though it’s only been 1 week, a 2-4 months period would give a better “back to work” picture. Hoping that first week trend continues for you.


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[2TH MVR]

My extended furlough is over starting next month . I'm scheduled to see patients 7 days in June. 10 days in July. The company is slowly ramping up. I normally work around 12-16 days per month split between 3 locations. I was getting a little worried. Had I been permanently layed off .... I somewhat joked to my wife about getting a job at Costco.

Previously I applied for unemployment benefits. For whatever reason ... my benefits were pending some issue. Well ... they've been pending for the last 2 months. Oh well. I felt somewhat guilty of applying for benefits when there are so many families that truly rely on those benefits.

At least we're hearing of some positive movement towards some level of normal.

 

[charlestweed]

My extended furlough is over starting next month . I'm scheduled to see patients 7 days in June. 10 days in July. The company is slowly ramping up. I normally work around 12-16 days per month split between 3 locations. I was getting a little worried. Had I been permanently layed off .... I somewhat joked to my wife about getting a job at Costco.

Previously I applied for unemployment benefits. For whatever reason ... my benefits were pending some issue. Well ... they've been pending for the last 2 months. Oh well. I felt somewhat guilty of applying for benefits when there are so many families that truly rely on those benefits.

At least we're hearing of some positive movement towards some level of normal.

I am glad to see you back to work again. Today, I started 3 new cases.......I am so happy. Everything has gone very smoothly. Most patients have been very happy to come back. One thing I don't like is I can't shake the patients' hands.....and the new patients can't see my face (because of the stupid mask I have to wear all day).

This is my work schedule for June: 25 days/month (12 days/month at the corp and 13 days/month at my own offices). For the job at the corp, I get paid the same (fixed daily rate + bonus). But for own my offices, I have to work more days (13 days/month instead of the usual 11 days/month) and make less because I have to book fewer patients per day in order to maintain the proper social distancing. I only bring back 2 of the 6 P/T employees so my overhead should be significantly lower. I don’t have to spend extra money on PPE because I use washable fabric medical gowns and I re-use the N95 masks.

 

[allantois]

My extended furlough is over starting next month . I'm scheduled to see patients 7 days in June. 10 days in July. The company is slowly ramping up. I normally work around 12-16 days per month split between 3 locations. I was getting a little worried. Had I been permanently layed off .... I somewhat joked to my wife about getting a job at Costco.

Previously I applied for unemployment benefits. For whatever reason ... my benefits were pending some issue. Well ... they've been pending for the last 2 months. Oh well. I felt somewhat guilty of applying for benefits when there are so many families that truly rely on those benefits.

At least we're hearing of some positive movement towards some level of normal.

Don’t ortho patients need to come in every month? Are they squeezing everyone in fewer dates?

 

[Cold Front]

Don’t ortho patients need to come in every month? Are they squeezing everyone in fewer dates?

I’m thinking that too, cheaper overhead for the corporation/employer. Lean and mean approach. Or maybe there is a state capacity rules for businesses, no more than 50% of their normal pre covid volume.


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[Cold Front]

This is my work schedule for June: 25 days/month (12 days/month at the corp and 13 days/month at my own offices).
View attachment 308069

That’s a pre covid schedule. Will your daily volume be full busy days too? If not, what % of your pre covid daily volume will you be seeing in June?


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[charlestweed]

Don’t ortho patients need to come in every month? Are they squeezing everyone in fewer dates?

They book patients, who called and were more concerned about missed appointments, first. For other patients, they’ll have to wait another month. Patients don’t need to seen every 4 weeks. It’s ok to see patients every 6-8 weeks. I, however, prefer to see my patients every 4 weeks.

 

[charlestweed]

That’s a pre covid schedule. Will your daily volume be full busy days too? If not, what % of your pre covid daily volume will you be seeing in June?


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About 75%. Since the reopening of my office in May 11th, I have only seen around 30-40 patients/day on the weekdays and 55 patients/day on the one Sunday that I worked. Before the shutdown, I saw 50-60 patients/day on the weekdays and close to 100 patients/day on the weekends. It’s the same for the corp office where I work at…only around 40 patients/day instead of the typical pre-Covid volume of 60-70 patients/day.

Before the Covid, I was off every Thursday and every other Tuesday. Now, I have to work on those days to make up for the lower patient volume per day. I work harder for less money. Well, it’s still better than staying at home doing nothing.

 

[Molar Whisperer]

About 75%. Since the reopening of my office in May 11th, I have only seen around 30-40 patients/day on the weekdays and 55 patients/day on the one Sunday that I worked. Before the shutdown, I saw 50-60 patients/day on the weekdays and close to 100 patients/day on the weekends. It’s the same for the corp office where I work at…only around 40 patients/day instead of the typical pre-Covid volume of 60-70 patients/day.

Before the Covid, I was off every Thursday and every other Tuesday. Now, I have to work on those days to make up for the lower patient volume per day. I work harder for less money. Well, it’s still better than staying at home doing nothing.

I commend your work ethic. Hope all goes well for you and your clinics.

 

[2TH MVR]

Don’t ortho patients need to come in every month? Are they squeezing everyone in fewer dates?

I’m thinking that too, cheaper overhead for the corporation/employer. Lean and mean approach. Or maybe there is a state capacity rules for businesses, no more than 50% of their normal pre covid volume.
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Technology and revenue in ortho has always been about fewer patient visits with the longer appt intervals. It just makes financial sense. You charge X which is divided by the number of times you see the pt. Fewer visits means higher revenue per pt visit which equates to lower overhead required. I did this also in private practice. On easy Phase 1 cases or easy cases .... pts were seen every 6-8 week intervals. This is seen by most pts as an advantage: less time at the ortho office, less time for kid to be out of school, less time off work for parents, etc. etc.

Our Corp mandate calls for 6 week intervals. But I have complete control over this. Most extraction cases towards the end of tx (finishing) is 4 weeks. If Pt missed alot of appts and we need to catch up. 4 weeks. Impacted cuspid cases. 4 weeks. Treatments not progressing on time. 4 weeks. Everything else is 6 weeks. I'm guessing @charlestweed probably see his pts every 4 weeks in order to collect the monthly payment at each appt. In Corp. Collecting money is not my job . My job is to finish the patients within the time frame of their estimated treatment time. I do not allow patients to go over their original tx time. This happens mostly due to pts not showing up for their appts and/or lack of wearing their elastics. Longer tx times brings in more chances for root resorption, caries, etc. etc. etc.

Yes. Pre-Covid19 .... my days were heavily booked. Not an issue since most ortho procedures are simple and fast. If I need more time .... I set up the next appt for 60 minutes and request an early day appt. Now. Seeing a large number of patients will require a different clinic setup. That's up to Corp. As long as I get paid the same (daily minimum plus bonuses) I don't care. @charlestweed mentioned that he will have to WORK HARDER AND MORE DAYS (as if a person can work any harder than him) to make up the difference in fewer pts seen per day. I get it. He's doing exactly what he has to do, but this covid19 is just another setback for dentistry and particularly orthodontics. Everyone here knows that I am not a big fan of lower ortho fees, the proliferation of DSOs, DIY aligners, etc. etc. This covid19 is just another financial headache thrust on the backs of dentists.

High DS debt. Increasing DS tuition. Lower fees. Lower insurance reimbursements. Large Corporations looking to save money by offering cheaper (for them) HMOs to their employees. Increasing DSO footprint. And now? Covid19 affecting how we practice dentistry and the related costs associated with this, All of this fuels lower compensation for us dentists.

Holy Batman. Such a negative, doom and gloom post. I'm starting to sound like @Cold Front .

 

[charlestweed]

Technology and revenue in ortho has always been about fewer patient visits with the longer appt intervals. It just makes financial sense. You charge X which is divided by the number of times you see the pt. Fewer visits means higher revenue per pt visit which equates to lower overhead required. I did this also in private practice. On easy Phase 1 cases or easy cases .... pts were seen every 6-8 week intervals. This is seen by most pts as an advantage: less time at the ortho office, less time for kid to be out of school, less time off work for parents, etc. etc.

Our Corp mandate calls for 6 week intervals. But I have complete control over this. Most extraction cases towards the end of tx (finishing) is 4 weeks. If Pt missed alot of appts and we need to catch up. 4 weeks. Impacted cuspid cases. 4 weeks. Treatments not progressing on time. 4 weeks. Everything else is 6 weeks. I'm guessing @charlestweed probably see his pts every 4 weeks in order to collect the monthly payment at each appt. In Corp. Collecting money is not my job . My job is to finish the patients within the time frame of their estimated treatment time. I do not allow patients to go over their original tx time. This happens mostly due to pts not showing up for their appts and/or lack of wearing their elastics. Longer tx times brings in more chances for root resorption, caries, etc. etc. etc.

Yes. Pre-Covid19 .... my days were heavily booked. Not an issue since most ortho procedures are simple and fast. If I need more time .... I set up the next appt for 60 minutes and request an early day appt. Now. Seeing a large number of patients will require a different clinic setup. That's up to Corp. As long as I get paid the same (daily minimum plus bonuses) I don't care. @charlestweed mentioned that he will have to WORK HARDER AND MORE DAYS (as if a person can work any harder than him) to make up the difference in fewer pts seen per day. I get it. He's doing exactly what he has to do, but this covid19 is just another setback for dentistry and particularly orthodontics. Everyone here knows that I am not a big fan of lower ortho fees, the proliferation of DSOs, DIY aligners, etc. etc. This covid19 is just another financial headache thrust on the backs of dentists.

High DS debt. Increasing DS tuition. Lower fees. Lower insurance reimbursements. Large Corporations looking to save money by offering cheaper (for them) HMOs to their employees. Increasing DSO footprint. And now? Covid19 affecting how we practice dentistry and the related costs associated with this, All of this fuels lower compensation for us dentists.

Holy Batman. Such a negative, doom and gloom post. I'm starting to sound like @Cold Front .

Seeing patients at longer interval is definitely a smarter way to run your business.....you work less and make more…..lower overhead, and less wear and tear on your chairs and equipment. Since I don’t have great business and people skills like many of my colleagues and I practice in a very saturated market, I have to target mostly low income patients in order to survive. It’s easier for me to convince the patients, who live paycheck to paycheck, to accept treatments when I offer them affordable financial option: low down payment, low monthly payments, no credit check required. Many of these low income patients don’t even have a bank account.

Yes, the #1 reason for seeing my patients every 4 wks is to collect the monthly payments from patients. At my ortho residency program, I saw patients every 4-wks. All the corp offices that I have worked for also book patients every 4 wks. So I am used to seeing patients every 4 wks. By seeing patients more regularly (every 4 weeks):
- I can monitor the compliance. If I can catch the patients not brushing or wearing elastics, I can notify their parents early….and thus, prevent delays in treatment.
- Loose brackets can be repaired sooner. Fewer emergencies and fewer upset patients.
- Because I see patients more regularly, I don’t have to do a lot of work at each visit. For many cases, I can just retire (which only takes 10 seconds of doctor’s time and 2-3 minutes of the assistant’s time) or work on 1 arch and retie the opposing arch. I can then use the time that I save for doing reties to repair loose brackets for other patients.

I remember when I started my first office, a Unitek sale rep tried to convince me to buy the company’s self-ligating “smart-clip” brackets so I could save time by not having to see patients every 4 weeks. I laughed and told him saving time wasn’t my number #1 priority….I had plenty of free time. Since it was a brand new practice, the #1 priority at that time was to get as many new patients to accept treatments as possible so I could keep myself busy.

 

[Molar Whisperer]

Seeing patients at longer interval is definitely a smarter way to run your business.....you work less and make more…..lower overhead, and less wear and tear on your chairs and equipment. Since I don’t have great business and people skills like many of my colleagues and I practice in a very saturated market, I have to target mostly low income patients in order to survive. It’s easier for me to convince the patients, who live paycheck to paycheck, to accept treatments when I offer them affordable financial option: low down payment, low monthly payments, no credit check required. Many of these low income patients don’t even have a bank account.

Yes, the #1 reason for seeing my patients every 4 wks is to collect the monthly payments from patients. At my ortho residency program, I saw patients every 4-wks. All the corp offices that I have worked for also book patients every 4 wks. So I am used to seeing patients every 4 wks. By seeing patients more regularly (every 4 weeks):
- I can monitor the compliance. If I can catch the patients not brushing or wearing elastics, I can notify their parents early….and thus, prevent delays in treatment.
- Loose brackets can be repaired sooner. Fewer emergencies and fewer upset patients.
- Because I see patients more regularly, I don’t have to do a lot of work at each visit. For many cases, I can just retire (which only takes 10 seconds of doctor’s time and 2-3 minutes of the assistant’s time) or work on 1 arch and retie the opposing arch. I can then use the time that I save for doing reties to repair loose brackets for other patients.

I remember when I started my first office, a Unitek sale rep tried to convince me to buy the company’s self-ligating “smart-clip” brackets so I could save time by not having to see patients every 4 weeks. I laughed and told him saving time wasn’t my number #1 priority….I had plenty of free time. Since it was a brand new practice, the #1 priority at that time was to get as many new patients to accept treatments as possible so I could keep myself busy.

How bad are your people skills? I must be worse than you and I usually can talk to anyone. If you can convince patients that have low income and no bank acct to accept your treatment, you are a master salesman. From prev posts, if you can control and keep your overhead low, you are a master businessman.

 

[charlestweed]

Thank you for your kind words.

If I set up my office in an affluent area and target the same class of patients that most of my colleagues are targeting, I would not make it. I would love to charge high fees like my colleagues.....who wouldn't want to make more and work less? I know my own limitations and weaknesses and therefore, I set up my offices in low income areas and attract the type of patients, whom my colleagues don't want to treat (medicaid, HMO, Hispanic, Asian patients etc).

I've learned how to keep the overhead low from my jobs at the corp. I bought the same ultra-fast dry heat sterilizer (only 12 minutes per cycle) that the corp used so I didn't have to buy a lot of instruments. I have re-used the same Hu Friedy ortho wire cutters for more than 13 years. I also bought the same cheap x-ray machine that the corps used.