"Why does dental treatment cost so much?"
For this, my second post, I am attempting to tackle what is probably the most frequently asked question of dentists in one guise or another : " Why does dental treatment cost so much?"
I am fairly certain that many readers of this post who are not dentists have a definite answer to this question on the tips of their tongues, and are most likely bemused that I would devote an article to exploring a question that they think has a fairly simple answer ..or 3: dentistry costs 'so much' because dentists don't care or because dentist's are greedy or because dentists compensate for not being medical doctors !
I don't believe that the answer is as black and white as those on many readers minds, and even at the end of this article, I am not sure if I'd have made the issue any clearer or not, but I have decided to approach the answer from a simple accounting perspective, namely :
Revenue (which is the fees that patients pay)
minus expenses (the cost of running a dental surgery)
= Profit (the dentists salary and re-investment fund)
To understand fees charged by dentists, it might be best to look at the expenses that a dentist incurs to provide that service to a patient :
I am not sure if the answer to the question is any clearer (but I did warn of that at the beginning of this article), though I hope that the information above does provide some points to consider from the perspective of a dentist.
I have considered the question of patient costs (revenue) by focusing on expenses, and I am sure that many will say that I have not considered the dentists salary (profit) - surely the dentist can take a hit on his profit to lower patient costs ? And the answer may be yes, but unlike expenses which are a high proportion of overheads at all practices, the profit earned by a dentist is not the same for all dentists even if the fees that they charge are the same. The reason for this is simple : the TIME taken with you the patient.
Consider the following very simple scenario (and the figures are not accurate, they are just to convey a point) : Dentists A & B each charging $100 for a comprehensive check-up and patient discussion. Both Dentists have an hourly overhead expense of $60. Dentist A spends 30 minutes with his patient exam for hourly revenue of $200 and Dentist B spends 60 minutes with his patient exam for an hourly revenue of $100. Simple mathematics shows that Dentist A has profited $140 for an hour and Dentist B profits $ 40 in the same time.
On a similar note, the question arises: why is it that dentists overseas charge less than dentists in Australia ? That dentists overseas charge less than dentists in Australia, I believe, is a misperception that has its roots in currency conversion being used as the basis for making that statement. Like anything else overseas (accommodation, meals, transport), if you are paying with a stronger currency , things will appear cheaper.
However, using myself as an example, a dentist who has practiced in South Africa and now Australia, from a dental perspective and in terms of currency conversion, I charge 10x the amount for an average filling in Australia as I did in South Africa -it still takes me the same amount of time and I use the same materials as I did then. Yet I do not have 10x the profit . Why ? Simply because as a percentage, it cost me about 65-70 % of my revenue from that filing to provide that filling in South Africa, and in Australia it costs me ...65-70% of my revenue from that same filling to provide that filling.
Food for thought:
I know I am going to have some very angry medical colleagues, but that was not my intention : my purpose was to show value - often it is forgotten that the mouth is just another part of the body, like the heart, lungs or limbs. The health of the mouth plays a role in determining overall health. Shouldn't we value the mouth as much as the rest of our body ? And if the value of oral health can be recognised, but the question of cost still exists, perhaps the question should be posed as to why those that decide what Medicare covers, do not recognise the role of oral health care.
I do not believe that most health care providers are out to 'milk' patients, and almost all of them would have a sound rationale for setting their fees.
That is why a dental consult is so important : it's your opportunity to see if your prospective long term dentist is providing value to you.
Below are 2 links that might provide further insight into the costs of dental care:
Thank you for reading.
Keep on smiling....
The Dental Consult and Examination
This is my first foray into blog writing, so I apologise to all readers if I have not followed blogging etiquette or fallen short in any way.
I have been thinking about writing this for a long time mainly because this blog can act as a means of imparting my knowledge and my opinion (which is based on education and experience) to anyone that is seeking it, with regards to my field of focus : healthcare particularly oral health and dental care. I hope that the information might at least in some small way increase awareness of measures to prevent disease as well as provide a basis for informed decision making when contemplating treatment and procedures.
I thought for a while about the topic for this first post and I decided on : The Dental Consult and Examination.
I chose this topic because I believe that throughout all branches of health care, this is the single most important appointment of all the appointments that a patient might have with a health care provider : it is the appointment where, from the healthcare provider's perspective, a diagnosis is reached. Correct diagnosis is the foundation of successful professional intervention - it does not matter how technically correctly the procedure (such as a filling or tooth extraction in the case of dentists), is carried out , if it is based on an incorrect diagnosis, it is likely to fail. Similarly, from a patient's perspective, it should be the most important appointment because this is where you learn about your state of health, where you get to ask as many questions as possible to evaluate risk against benefits of various options and, obtain fee and timeframe estimates. The consult and examination, almost always, also happens to be the cheapest interaction a patient is likely to have with any health care provider - it therefore provides very good value for the time and money spent.
Sadly, many patients seem quite happy to forego this very important interaction with their healthcare provider (in my experience of dentistry, anyway), often requesting telephonic quotes for procedures ('fillings', 'cleanings', 'extractions') rather than requesting costs for an examination and/or consultation. I often answer the telephone at my practice, and even after all these years, I still struggle to convey the value of a dedicated consult and examination to many patients. The matter of telephonic quotations is a topic on it's own, and I will not digress.
Every healthcare provider will chose his or her own approach to the examination and consult based on their experience, preferences and scope of practice. Below is the 'programme' summary that I provide to my dental patients at the time of the appointment being scheduled, so that he or she has an idea of what to expect :
Your Dental Consult
A consultation appointment is the most important interaction you have with your health care provider whether that is a dentist, doctor or other health practitioner.
The success of health management has its foundation in a correct diagnosis. To arrive at a correct diagnosis, a practitioner needs information. This information is obtained by talking and, very importantly, listening to you the patient. Various histories are taken and reviewed, an examination takes place and tests and investigations are carried out. All the data collected is reviewed and a diagnosis and treatment options are arrived at. A discussion is then had with the patient who decides how he or she wants to proceed.
As a patient, you should ask questions. Never agree to treatment from a position of doubt or ignorance – you must be happy and understand all aspects of the plan such as risks, benefits, alternative choices and costs (time and money). It is perfectly acceptable, and in fact recommended, that you seek a second opinion or take time to make your decision. Unless it is advanced states of infection, pain or trauma related, with dentistry, there is usually freedom to take some time to sit in the comfort of your home and think about how you want to proceed.
From the patient’s perspective, the consult is important as it is an opportunity to:
Internally – Examine gum, cheek, palate, floor of mouth, tongue, throat, teeth.
The dentist is looking for signs of anomalies – lumps, ulcers, decay, gum disease, crooked teeth, fractures, loose teeth, plaque, bleeding, pus. Each tooth and its surrounding gum is assessed and details recorded.
When carrying out an examination a dentist will use touch, pressure, eyesight and instruments (there are instances where sound and smell can also be used). Sometimes separate consults are necessary for specific disorders such as crooked teeth or gum disease.
3. Record collection
Photographs – you see what the dentist sees. They are good for planning and discussing your case with you.
Impressions for models of your teeth – these create a 3 Dimensional replica of your teeth. Again they help with planning and discussion but can also be used to create mock-ups of what your treatment result could look like.
X-rays – very valuable. Shows us areas not visible to the naked eye – the supporting bone, the pulp, depth of certain cavities. Usually small x-rays are taken in the surgery. Depending on your needs, a full set could be up to 12 x-rays. Sometimes a larger x-ray, taken from outside the mouth is required (for example to assess wisdom teeth or your TMJ’s). These may require you to visit a radiologist. X-rays are 2 dimensional representations of 3 dimensional teeth so they have some limitations but are still more than adequate for everyday dentistry. In instances where more detailed x-ray information is required, a CT scan which is a 3-Dimensional x-ray can be requested from a radiologist.
Additional fees usually apply for records over and above your consultation fees.
A discussion with you around findings – problems, implications, causes, future prevention, treatment choices, risks, benefits, costs, answering your questions.
Sometimes the dentist, like you, may need to think about what he should be advising as an approach to your care, and he may request you return for a chat at a subsequent visit. Usually no fee is levied for that additional visit.
Food for thought......
Often it is expected that a consult includes a scale (‘check-up and clean’). However, as can be seen from the above, a thorough consult requires time. If your oral health is relatively straight forward, there usually is enough time for that clean. However, if you have complex oral health issues, there should never be an attempt to ‘squeeze-in’ a cleaning with the consult. A consult is an investment in your health and is educational and informative. A scale is a procedure and should not be prioritised if is at the cost of long term gains – wouldn’t it be better if you were first made to understand how you can avoid needing that clean in future? Give a man a fish…. Or teach a man to fish?
Thank you for reading this attempt at blogging. For my next topic I hope to provide my ' two cents worth' by attempting to provide insight to what might be the most commonly asked question by dental patients : ' why does dental treatment cost so much? '.
P.S : We have a Comprehensive Examination Offer at Dr Fill Dental
Pranesh has been a dentist for over 15 years. He is the owner of Dr. Fill Dental in Point Cook, Victoria, Australia where he combines technology with experience for best patient outcomes. He has also authored the book EAT TALK SMILE - A Guide to Oral Health and Dentistry for the Patient.