Here’s what we’ve covered so far:
Today our article is about setting fees
2. Provisionalize – buildups and provisionals on the teeth that make sense to provisionalize first. If we are doing a full mouth and opening vertical dimension, we will likely provisionalize the entire upper arch first (we sometimes just build up the posteriors with composite), then a week or so later provisionalize the lower arch. Many times, we take impressions on the lower anteriors at this time. This will be 2 all day appointments in my office-1 for the upper and 1 for the lower. The patients are generally sedated for this appointment. If we had the provisionals lab-fabricated, there is a lab fee associated with this (lab fees are discussed below).
3. Quick appointment to show patients how to floss, clean and care for their provisionals. We also go over any changes that happened during the appointment, such as unexpected pulp exposures, etc. and revisit or change the plan if necessary.
4. Approval and adjust – We build in an approval appointment 2-3 weeks after the prep/impress appointment. It lasts about an hour and is the appointment where we select the shade for the permanent lower anterior restorations. We take impressions and photos of the approved provisionals.
If there are minor changes, we make them that day and complete the appointment as planned. If there are major changes, we reschedule another approval in a week. When there are no more changes, we send everything to the lab for fabrication of final restorations.
If this patient is a major bruxer or we are making major changes to the occlusion and there is a concern about the patient adapting to the new occlusion, we do not take impressions for the permanent lower anteriors at the provisional appointment; we allow the patient to wear the provisionals for 3-6 months before we take final impressions. We want to see how the patient does with the new occlusal scheme before making the permanent restorations.
We will see them once a month or so during this stage (or when they call with problems). The patients that wear the provisionals for 3-6 months then have an approval and impression appointment to order the final restorations.
5. Deliver lower anteriors, impress upper anteriors. The patient is not sedated when we start this appointment because we will try in the lower anteriors and we want the patient to look at them and approve them or decide on changes that need to be made before we bond them in (or send them back). After approval, the patient can be sedated.
6. Deliver upper anteriors, impress lower posteriors. The patient is also not sedated at the beginning of this appointment because we will try in the upper anteriors and have them look at the teeth and approve or tell us the changes that need to be made before we put them in (or send them back). After he or she approves, oral sedation can be given.
7. Deliver lower posteriors, impress upper posteriors. Depending on the patient, they may or may not need to approve the posteriors before putting them in. I usually do not sedate them before this appointment, just in case. I have a couple of very particular patients right now that I will definitely have approve their restorations before we deliver them.
8. Deliver upper posteriors, impress for NG. We usually do not sedate the patient for this. It is a half-day appointment.
Hopefully you know the hourly amount your office needs to make to survive and the hourly amount it needs to thrive. The way you figure out this number (roughly) is to take your monthly overhead + your salary + profit (or your monthly collection goal) and divide by the number of productive hours.
Remember, not all hours are productive. You will have some hours that are for exams, etc.
Just to make it easy, let’s say your overhead + salary + profit is $75,000 per month and you work Monday through Thursday 8-5 with a one hour lunch.
That’s 8 hours a day total minus the unproductive hours, say that’s 2 hours a day, making it 6 productive hours a day, which is 24 per week, 96 per month (may be different each month, depending on number of days worked).
Divide $75,000 by 96 and you get $781 per hour. We separate our lab fees out. We don’t include them in our overhead and we add them onto the case, so the case fee would be $781 per hour plus lab fees, plus cushion and difficulty. There are many ways to do this.
Some people have different hourly fees for diagnosis and treatment planning, in-office lab work and the dental treatment. Make sure whatever you do works for you and your office. This is just one way to do it and there are many. This is also a “simple” explanation of a subject that can be somewhat complicated. I hope this helps.
If nothing else, I hope it helps you be brave enough to consider this as a way to set your fees — if I can do it, you can do it! When we started setting our fees this way, for the first time our practice, we were actually profitable! When I have dentists call me for help with treatment planning and presenting large cases, especially if they are new at it, the tendency is to undercharge. They are afraid to charge for their time — I know I was…
But, I have noticed that patients generally accept the fees and pay them gladly if you believe in yourself and what you can do for them. It is also important to be able to build value and help the patient understand the benefits to them and the things that set you apart from other dentists.
Happy Fee-setting!!
