Friday, January 29, 2016

An Objective View From 3,000 Miles Away

Bill was one of my first patients having been with me since around 1980; his wife became my patient 5-7 years later. They are moving to the Northwest to be closer to their son and recently bought a house near Seattle where some of the finest dentists in the country are located. Bill keeps returning to the Capital District because their house hasn't sold yet so he is still my patient. I saw Bill last week on his cleaning appointment and he told me that he had a message from his wife.

"She found a new dentist based on your qualifications (meaning a dentist that uses a rubber dam, takes a lot of continuing education, is not an insurance dependent dentist who 'pushes crowns' etc.
The dentist examined her teeth and made two comments:

1.You dentistry is exceptional
2. Your previous dentist is excellent.

As is characteristic of many of my long term patients, the wife has every tooth that she had when she started with me about 27 years ago and....she has NO crowns, the most destructive method of 'fixing' teeth.

I am truly honored by the comments of the Seattle area dentist. We all know that I am not perfect but during my entire career, I have tried to do the very best that I could to take care of you. It makes me feel good to know that my work is appreciated by those that know good clinical dentistry.

Do not listen to folks that say, "Dr. Benjamin is expensive." Cutting down your teeth for crowns is expensive and destroys your teeth. Placing strong, long lasting direct resins costs 1/3 to 1/4 the cost of a crown and keeps every millimeter of healthy tooth structure.

It all depends on what you value.

Saturday, January 16, 2016


Why am I congratulating YOU? I will get to that soon.

We had a big 'fight' on the dental forum that I joined a few  years ago. It is a group that would rather chat about politics or sports and less about dentistry...As I have told you before, most dentists don't really enjoy being a dentist. In fact, about 45 years ago the American Dental Association conducted a survey and the question was, "Would you be a dentist again."  The ADA was SHOCKED when 70% of the dentists said, "NO!" Twenty years later a similar question was asked, "Would you want your children to become a dentist?" and again, a resounding, "NO!"

So what was the fight about? There are basically three kinds of practices in the United States:
1. Fee For Service: The dentist does the treatment and you pay for the work. Sometimes the dentist submits your insurance form and waits for the payment and then you are billed for whatever your insurance company does not pay for. The emphasis on those remaining Fee For Service practices is excellence. (Not every FFS practice does indeed aim for excellence but the overwhelming majority do produce fabulous clinical dentistry.)

2. Insurance Dependent Dental Practice: The dentist signs up for some or all of the insurance plans and agrees to perform treatment for a huge reduction in fees.  The emphasis is to do as much treatment as possible to make up for the huge reductions in fees. Volume and speed are important in these practices.

3. Corporate Dental Practice: The dentists works for a large company which generally decides what treatment is performed to maximize profit.

On the forum, a large group of dentist said the Fee For Service dentistry only treats wealthy patients and that Insurance Dependent practices treat more patients  with reasonable  quality..

When we are just talking about quality of care and excellence, a Fee For Service practice delivers THE BEST POSSIBLE DENTISTRY....NO EXCEPTION. Which is why the best clinical dentists in the country are Fee For Service. When you are talking about taking care of a great number of patients then an insurance dependent practice does better because quality tends to be lower and fees are lower..."The old get what you pay for."

Those dentists like myself who are Fee For Service defended our style of practice by saying that there still remains a segment of the population that knows that average dentistry is not what they want and they will pay more for excellence. The overwhelming number of my patients are average middle class people who have been my patients long enough to know that HOW I take care of you has allowed you to keep the majority of your teeth your entire life with the fewest number of teeth destroyed with crowns. What the OVERWHELMING majority of the dentists on the forum said that I only took care of rich people so that my experience as a dentist did not count. They did not believe me that you care more about keeping your teeth than the cost of losing your teeth... They said I was spoiled because you were rich...They did not believe that YOU were more intelligent than average in that you value your teeth.

So why am I Congratulating YOU!!! Because all of my patients recognize that I am trying to take care of you, the best that I can and that I will always put your best care over my financial benefit.
You all know that excellent dental care is important and yes it costs more than mediocre care. Trust me...It was a tough week fighting YOUR BATTLES. lol

Perhaps that is why Dr. Banchs, one of the best root canal doctors,  tells me all the time, "You have the best dental patients. They are the most intelligent, the most engaged and understand that quality dentistry is what they want."

Thank you for being my patient. You indeed are the Best Dental Patients!!!!!!

Monday, January 11, 2016

Youth Lives in a Vacuum

I remember when I was young and I thought that I understood the meaning of life and everything else. We all (me included) know how wrong I was.

I was discussing different dental practice approaches with a very young dentist who has been practicing for 3 years. Our discussion included a fee for service practice (which is what my office is), an insurance model where all or most insurance is accepted and patients only have the dentistry that their insurance company approves or covers and the corporate model which is the department store of dentistry.

The young dentist who has neither the dental skills nor the experience to manage an office said on the forum that a fee for service dental practice is not the best for patients. My response was that all of the finest dentists in the United States ARE fee for service.

Please stay with me on this:

In 1961 dental insurance came onto the market as a benefit to employees. The limit was $1,000 BUT in 1961 $1,000 bought 8 and a third crowns which was an incredible amount of dentistry. Fast forward 56 YEARS and the limit on most dental insurance policies is either $1,000 or $1,500 which in today's world buys ONE CROWN....And back in the day, insurance covered 95% of the dentist's fee. (Aside: Imagine if you didn't get a raise for 50 years!!!!!)

When a dentist accepts many insurance plans including the very bad ones that cover 30% of the usual fee, you have to ask yourself, "How does the dentist make a living from the small amount that the insurance pays?"

The answer:
1. They run from room to room and see 2,3, or 4 patients at the same time.
2. They try to do as many crowns as possible because crowns are the most profitable.
3. They pay their staff as little as possible so that there is high turn over
4. They use the cheapest labs and dental materials.

So how does MY fee for service practice compare?
1. I see ONE patient at a time minimum 1 hour
2. I do as few crowns as possible and try to keep all of your natural tooth structure.
3. My staff is one of the best paid and you know that because you have seen them for DECADES.
4. I try to use excellent labs and some of the finest dental materials made.

So, from a patients standpoint, where do you think that you could possibly receive the best care? Fee for service practice or an insurance based practice?

 I guess it depends how much you value YOUR teeth.

(Aside: If insurance paid the same amount of care as in 1961, the limit on your dental insurance would be almost $10,000)

Sunday, January 10, 2016

Thomas Friedman Writes a Column (Not Political)

I have read Tom Friedman's columns in the New York Times for approximately forty years. Sometimes I agree with him and sometimes I don't. (My Dad worked for The Times in the Circulation Dept. so I had to read the paper.)

I have said many times if we see the problems of America only in terms of Democrat, Republican, Liberal or Conservative, we will never solve our problems...We have to open our minds, as if we were running a business and ask ourselves two questions:

1. What is the problem?
2. What are our options to solve that problem?

This is exactly how we deal with issues in our office...No preconceived ideas and no limits on our solution options.

Well Tom Friedman wrote in his Friday column that if the next President is going to be successful, he/she will have to use some of the ideas from the Democratic side and some ideas from the Republican side because, he reasoned, both sides have valid ideas but neither side alone has the solution itself.

Oh my, there IS an adult in the room.

I told you that it was not a political blog.

The Same Old Story

One of my patients is an interior designer with a specialty in lighting. A new restaurant wanted to open and consulted with my patient. Although they loved her ideas, they thought that it would be too expensive to hire her for their project.

Susan and I went out late Saturday evening for some wine, cheese and music at one of our favorites, One Caroline Bistro. I saw my patient there and she came over to chat and that is when she told me about the new eating establishment. Had they hired her, they would have been open last August but because they didn't see the VALUE in hiring a designer, the restaurant has still not opened. When the designer met the owners of the 'soon' to open place, they said what you might expect:

"If we had hired you, we would have opened when we planned to open."

This is NOT an unusual story...I hear it all the time. Hiring great people does not COST you money, it SAVES you money. Look how much revenue was lost by NOT hiring the interior designer.

The same thing happens in our office. Patients that come in for a consultation  think that we are overcharging them and that they can have the same treatment done in another office much cheaper.


Many Americans have forgotten what their parents told them:

"You get what you pay for."

Like most other things that we buy, it is always about cost verses quality. In professional services, it is about Time and Talent.

Something else to think about.

Tuesday, January 5, 2016

"I Want to Thank You"

I walked into Trish's (my hygienist) room to see a long time patient for an exam. May Lou has been my patient since my first office in Tamarac Plaza  38  or 39 years ago and in all of these years I have placed about 6 or 8 direct bonded fillings and one onlay. She has not lost a single tooth and she has no crowns, which has to be a record for any dental office given the fact that many dentists look for any reason to place a crown.

After our usual greetings and a Happy New Year, Mary Lou said, " I want to thank you for keeping all of my teeth.  I have friends who are my age who are wearing dentures and I could not bear having a denture."

The overwhelming majority of my patients who I have cared for between 25 and 35 years have almost every tooth that they first came to my office with. Even though I have won an international  contest for one of my cases and have gained an international reputation for the work I have done, my greatest accomplishment has been to help the overwhelming majority of my patients to keep their teeth...and do it with the fewest possible number of crowns (which destroys teeth.)

I am honored to have been allowed to take care of my patients for almost 4 DECADES. Caring for you IS my Life's Work.

(Aside: If you think it is about the money, you don't know me or my staff.)

Friday, January 1, 2016

Corporate Dentistry

You are going to start hearing a lot about Corporate Dentistry in the very near future. What is Corporate Dentistry? Aspen Dental is but one early model.

I guess that you can compare Urgent Care in the medical side of health care as the closest example of Corporate Dentistry. That means that you will see 'a doctor' rather than YOUR doctor. You will be examined by someone who does not know you and really does not care to have a relationship with you. "This is my problem and I need someone to fix it at 8 pm" is perhaps why we go to an Urgent Care type of medical practice.

Do you really think that the BEST physicians (in the world) would ever work at a walk in medical center? Do you really think that the physicians truly care about your long term well being or do you think that they just want to put in their 8 hours and get paid?

Corporate Dentistry is on the near horizon. Why is that?
1. Dental Schools have not changed their curriculum since I was in school 40+ years ago...They teach 2 years of basic science courses before a student starts treating their dental patients. The reality is that young dentists know very little dentistry in a world that is sooooo dentally advanced. This means that they may have very few options except to enter the Corporate Dental world...Especially if they owe between a quarter and a half million dollars for their education.
3. Many dentists have started putting their OWN best interest ahead of your best (oral health) interest.That means if dental care is only about the money then  the line is blurred between what is a quality private dental practice or a Corporate Dental practice.
4. Too many patients are too concerned about their dental care being totally or almost totally paid for by insurance. When care is ONLY about the money...Corporations that care only about making money is the answer.

No one will convince me that a a Corporate Dental office can come close to providing a higher quality of dentistry than a private dental office  with a highly educated, passionate dentist as the care giver..

I care passionately about taking care of you and giving you the best possible dentistry that I am capable of doing. I doubt that a dentist in a Corporate Setting can make that statement.