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It is a very sad day for me. My good friend, Dr. AJ Monicelli retired from dentistry after 34 years of practice at the age of 60. Why did he leave a job that he was very good at and extremely well trained for? He too had spent more than a million dollars becoming an elite clinical dentist in Albion, NY, located half way between Buffalo and Rochester.
So why did my friend decide to leave?
Some would say that his neck and back had just become too painful to continue...but that would not be the truth. He is leaving because fewer and fewer people expect, demand,want and are willing to pay for excellent dental treatment. People want inexpensive, mediocre, insurance paid dentistry that starts to fail the minute they leave the dental office.
Dr. Monicelli retired because fewer and fewer people wanted him to restore their teeth and mouth the way they are supposed to be restored and after years of frustration and disappointment, he decided that the folks in his community were no longer worth his caring, concern and skill.
Trust me when I tell you that my profession cannot afford to lose one of the best. I told you a year ago that if we as a country refuse to buy excellence that it will cease to exist. And now there is an entire area of Upstate NY without an excellent dentist. I am sad about my friend AJ but I am also sad because I know that the same thing could happen to me
Wednesday, March 24, 2010
"I Liked You Better Before You Knew Anything"
Yesterday was an interesting day in my Troy, NY office. I saw three patients that have been with me for 30 years...THIRTY YEARS!!!! None of the three would ever consider finding a new dentist to treat them.
A fair number of my patients have transferred to other local dentists over the years because they were seeking dentists that would participate in their insurance. These patients were looking for mediocre quality at a low price and there is nothing wrong with that if that is what you want.
I started studying my craft...I mean REALLY studying...in 1992 and one of my patients asked to speak with me privately in 1995 as he was heading off to another dentist. He told me that he was leaving my practice and ended the conversation with, " I liked you better before you knew anything."
He wanted a dumb dentist? Did he also want to be treated by a cardiologist who didn't know anything? Or have his brakes on his car fixed by an untrained mechanic?
Patients that have been my patient for decades have witnessed an incredible transformation in me, my staff and my office.
My interest in dentistry and my passion for dentistry have never waned. My concern for and dedication to my patients has been constant throughout my career.
Does it surprise me that I have patients that have been with me for 30 years??? Not at all. What does surprise me is how any patient could LEAVE our office.
And that surprise and hurt will always be there.
A fair number of my patients have transferred to other local dentists over the years because they were seeking dentists that would participate in their insurance. These patients were looking for mediocre quality at a low price and there is nothing wrong with that if that is what you want.
I started studying my craft...I mean REALLY studying...in 1992 and one of my patients asked to speak with me privately in 1995 as he was heading off to another dentist. He told me that he was leaving my practice and ended the conversation with, " I liked you better before you knew anything."
He wanted a dumb dentist? Did he also want to be treated by a cardiologist who didn't know anything? Or have his brakes on his car fixed by an untrained mechanic?
Patients that have been my patient for decades have witnessed an incredible transformation in me, my staff and my office.
My interest in dentistry and my passion for dentistry have never waned. My concern for and dedication to my patients has been constant throughout my career.
Does it surprise me that I have patients that have been with me for 30 years??? Not at all. What does surprise me is how any patient could LEAVE our office.
And that surprise and hurt will always be there.
Tuesday, March 23, 2010
The 22 Year Old Gold Bridge
Twenty two years ago I placed a three unit all gold bridge to replace a missing first molar.
Over the years, my patient became self conscious of the appearance of the gold and wanted to replace my perfect bridge with a tooth colored bridge but the bridge was in excellent condition and there was no valid reason to replace it according to the patient's insurance rules. Well after 22 years of use, the gold finally stretched and we saw new decay on the x ray and we knew that the time had come to replace the bridge. Everything a dentist does will fail given a sufficient amount of time; all metals corrode and bend which leads to failure.
Folks think that dentistry is expensive and as I have said before, on the day that the check is written...the cost is high...So how much did it cost my patient to use her bridge for the last 22 years? EXACTLY 12 CENTS A DAY. And how much cheaper do you want dentistry to be?????
Oh yes, I very carefully cut the bridge off and returned the gold bridge to my patient so that she can cash in her gold and probably get $150 which will bring the cost down to TEN CENTS A DAY FOR 22 YEARS....
There is nothing that a consumer can purchase that provides more value than great dentistry....NOTHING!
Over the years, my patient became self conscious of the appearance of the gold and wanted to replace my perfect bridge with a tooth colored bridge but the bridge was in excellent condition and there was no valid reason to replace it according to the patient's insurance rules. Well after 22 years of use, the gold finally stretched and we saw new decay on the x ray and we knew that the time had come to replace the bridge. Everything a dentist does will fail given a sufficient amount of time; all metals corrode and bend which leads to failure.
Folks think that dentistry is expensive and as I have said before, on the day that the check is written...the cost is high...So how much did it cost my patient to use her bridge for the last 22 years? EXACTLY 12 CENTS A DAY. And how much cheaper do you want dentistry to be?????
Oh yes, I very carefully cut the bridge off and returned the gold bridge to my patient so that she can cash in her gold and probably get $150 which will bring the cost down to TEN CENTS A DAY FOR 22 YEARS....
There is nothing that a consumer can purchase that provides more value than great dentistry....NOTHING!
Monday, March 22, 2010
Doing the Right Thing for the Right Reason
I will tell you that ALL dentists earn much more money doing crowns than by placing beautiful, strong, tooth conserving direct bonded FILLINGS. This is a fact.
Why would I place 5 fillings when given the opportunity to do 5 crowns? Because it was not in the BEST interest of my patient. You see, my patient has severe dry mouth which means that she gets lots of new cavities and tooth decay around a new crown means the crowns must be replaced while tooth decay around a filling means that we can repair the filling.
I recently placed fillings for my patient with dry mouth instead of crowns and posted the case on the ACE forum for comments and criticism by my peers.
What did my peers say?
Outstanding service!
This is geriatric care @ its finest. This is text book quality care.
Heck, these patients are NOT in a situation, in which insurance dictates fees, & generates an absurdly low fee for direct restorative care. You are positioned to take the required time & effort, & generate a fantastic direct resin service
I am honored that my peers recognize that I place my patients best interest ahead of MY financial best interest.
But isn't this why I became a doctor?
Why would I place 5 fillings when given the opportunity to do 5 crowns? Because it was not in the BEST interest of my patient. You see, my patient has severe dry mouth which means that she gets lots of new cavities and tooth decay around a new crown means the crowns must be replaced while tooth decay around a filling means that we can repair the filling.
I recently placed fillings for my patient with dry mouth instead of crowns and posted the case on the ACE forum for comments and criticism by my peers.
What did my peers say?
Outstanding service!
This is geriatric care @ its finest. This is text book quality care.
Heck, these patients are NOT in a situation, in which insurance dictates fees, & generates an absurdly low fee for direct restorative care. You are positioned to take the required time & effort, & generate a fantastic direct resin service
I am honored that my peers recognize that I place my patients best interest ahead of MY financial best interest.
But isn't this why I became a doctor?
I Didn't Do Anything Special
"Just wanted to send a big thank you to Dr. Benjamin for being so caring and thoughtful regarding Cass. Thanks for being an awesome dentist and person. :)" A....
My office philosophy has always been to do the right thing and to take care of my patients. I believe that I do nothing special when I put into practice my office philosophy.
In today's world, this apparently IS something special because patients have gone out of their way to comment on our office and to send notes of appreciation and gratitude.
If I were looking for a new dentist to take care of my family, I believe that our pursuit of excellence and our concern for our patients makes us an ideal dental practice.
My office philosophy has always been to do the right thing and to take care of my patients. I believe that I do nothing special when I put into practice my office philosophy.
In today's world, this apparently IS something special because patients have gone out of their way to comment on our office and to send notes of appreciation and gratitude.
If I were looking for a new dentist to take care of my family, I believe that our pursuit of excellence and our concern for our patients makes us an ideal dental practice.
Questions on Health Care
Should any of our children be unable to get health insurance because they had the misfortune to be born with a health issue?
Should any of us be forced into bankruptcy because we develop cancer and either the bills or the cancer will kill us?
Should poor folks be allowed to take an ambulance to an emergency room at a cost of $500 to the taxpayers when they have a toothache?
Should society pay two million dollars to save an 11 oz baby?
What do you think?
Should any of us be forced into bankruptcy because we develop cancer and either the bills or the cancer will kill us?
Should poor folks be allowed to take an ambulance to an emergency room at a cost of $500 to the taxpayers when they have a toothache?
Should society pay two million dollars to save an 11 oz baby?
What do you think?
In a Concerned, Compassionate, Caring and Competent Way.
Concerned, Compassionate, Caring and Competent.
Isn't this what a doctor is supposed to be?
Where did we go wrong?
When did we stop caring?
When was it acceptable to place a Tee Time ahead of patient time?
When did it become acceptable to take a weekend orthodontic course and then call yourself an orthodontist?
Think about this.
Isn't this what a doctor is supposed to be?
Where did we go wrong?
When did we stop caring?
When was it acceptable to place a Tee Time ahead of patient time?
When did it become acceptable to take a weekend orthodontic course and then call yourself an orthodontist?
Think about this.
Saturday, March 20, 2010
The Reputation to Have
Susan's watch wasn't keeping the correct time so we took the watch to Frank Adam's Jewelers on the ground floor of 18 Division Street. Susan gave the young lady behind the counter all the necessary information and then I told her that I have an office upstairs. The young lady said, "Oh you are Dr. Benjamin....Everyone says that you are the best."
It has never been my goal to be the biggest dental practice in the area or to make the most amount of money...It has ALWAYS been my goal to try to be the best at what I do.
It is nice to know that the word in Saratoga is starting to get around.
I will do everything that I can to try to do the best possible work.
It has never been my goal to be the biggest dental practice in the area or to make the most amount of money...It has ALWAYS been my goal to try to be the best at what I do.
It is nice to know that the word in Saratoga is starting to get around.
I will do everything that I can to try to do the best possible work.
Friday, March 19, 2010
"Intensity is the price of excellence"
The world's most successful investor, Warren Buffet said,'"Intensity is the price of excellence."
That is another way of saying that if you want to be REALLY good at something, you have to focus on that one thing to the exclusion of everything else.
The first and only time that the American Dental Association surveyed their membership on the question, "Would you be a dentist again?" and 70% responded, "NO"
So that means that 70% of the dentists are NOT FOCUSING on their work and will accept mediocrity....or less.
Why would a patient select a dentist that does not enjoy what they do or would rather be doing something else? WHY?
You will get much better dentistry at a lower cost (when amoratized over the years of service) by selecting one of the top 15% of dentists...And that is a fact.
That is another way of saying that if you want to be REALLY good at something, you have to focus on that one thing to the exclusion of everything else.
The first and only time that the American Dental Association surveyed their membership on the question, "Would you be a dentist again?" and 70% responded, "NO"
So that means that 70% of the dentists are NOT FOCUSING on their work and will accept mediocrity....or less.
Why would a patient select a dentist that does not enjoy what they do or would rather be doing something else? WHY?
You will get much better dentistry at a lower cost (when amoratized over the years of service) by selecting one of the top 15% of dentists...And that is a fact.
The Invitation: SUNY/Buffalo School of Dentistry calls
Last Memorial Day Weekend I was invited to visit my Dental School so that I would learn what roll I would play at the school in the future. I met with the Dean and the Chairman of the Department of Restorative Dentistry to review recent events at the School. In November, the Dean and his wife (also a dentist) visited my new Saratoga office so see how a high quality and ethical dental practice functions. Last month, I was invited by the Chair of Restorative Dentistry to give an all day lecture to 7 of the top senior dental students which was extremely well received by our students. Last week, the former Dean called and invited me to come to the School, meet the new Dean and have dinner at his home. In addition, I will learn what my new position will be although I signed papers which said, 'Associate Clinical Professor.' I am looking forward to returning to my Dental School again in an 'official capacity' rather than as a 'visiting instructor.'
I am honored to have attained a sufficient amount of knowledge and expertise in the field of fine restorative dentistry to teach the next generation of dentists.
About 30 years ago, there used to be an ad on television with the slogan, "You have come a long way baby."
Indeed I have.
I am honored to have attained a sufficient amount of knowledge and expertise in the field of fine restorative dentistry to teach the next generation of dentists.
About 30 years ago, there used to be an ad on television with the slogan, "You have come a long way baby."
Indeed I have.
Teaching and mentoring
During the last 18 years, I have dedicated my professional life to learning as much as I can and to that purpose, I have taken more than 2500 hours of continuing education and invested 2.5 million dollars. Spending money on one's hobby is easy to do.
For the last 5-10 years, I have been teaching and mentoring other dentists so that they can learn to take better care of their patients.Why would I do this and 'What's in it for me?' I do this because it is the right thing to do; I certainly have nothing to gain financially by helping my young colleagues. In fact, I have "complained" to one of my good friends and colleagues that by helping the other dentists, that I am giving away all of my "secrets" to which he responded:
Have no fear there is no one who can do what you do they would never take the time you do nor would they get the same results
That says it all. I help my young colleagues because it is the right thing to do and there is no risk to MY professional success because most dentists lack the love and passion for what they do.
Teach on!
For the last 5-10 years, I have been teaching and mentoring other dentists so that they can learn to take better care of their patients.Why would I do this and 'What's in it for me?' I do this because it is the right thing to do; I certainly have nothing to gain financially by helping my young colleagues. In fact, I have "complained" to one of my good friends and colleagues that by helping the other dentists, that I am giving away all of my "secrets" to which he responded:
Have no fear there is no one who can do what you do they would never take the time you do nor would they get the same results
That says it all. I help my young colleagues because it is the right thing to do and there is no risk to MY professional success because most dentists lack the love and passion for what they do.
Teach on!
Wednesday, March 10, 2010
Not Again
Yesterday I had a consult with a beautiful young woman of 36 who had 6 poorly done (ok ugly) veneers placed in 2002 by a dentist in Syracuse, NY. Last month a local dentist convinced the patient that he could give her the smile of her dreams by placing 10 porcelain fused to metal crowns. What the dentist actually did for the patient was:
1. Remove a lot of beautiful and irreplaceable natural tooth structure
2. Place 10 dark, opaque, short crowns
Was the patient happy? No!!!
Were the patient's expectations met? Absolutely not!!!
Why did this happen and why is that we read about the plane crashes, the perforated intestines during routine colonoscopy,failing root canals and ugly cosmetic dentistry cases ON A DAILY BASIS?
WHY???????
The book 'The Outliers' provides us with much of the answer. Supposed 'experts' who haven't studied the required 10,000 hours to become a master at what they do are passing themselves off as true experts. In dentistry, we joke about a dentist who is an expert after taking a weekend course and doing the procedure exactly once.
If you find excellence by chance...consider yourself extremely lucky. Excellence will require that you do some investigation on the internet, invest some time in asking around and your willingness to not only demand excellence but be willing to PAY FOR EXCELLENCE.
Excellence requires more time and costs more. Where have I heard that before????
And let me give you a hint: Your insurance company will NOT PAY FOR EXCELLENCE....But YOU sure can.
Like Nike says: "Just DO It." And if you are unwilling to pay for excellence, you will spend three times what excellence costs in trying to correct your problems as a result of mediocrity or worse.
1. Remove a lot of beautiful and irreplaceable natural tooth structure
2. Place 10 dark, opaque, short crowns
Was the patient happy? No!!!
Were the patient's expectations met? Absolutely not!!!
Why did this happen and why is that we read about the plane crashes, the perforated intestines during routine colonoscopy,failing root canals and ugly cosmetic dentistry cases ON A DAILY BASIS?
WHY???????
The book 'The Outliers' provides us with much of the answer. Supposed 'experts' who haven't studied the required 10,000 hours to become a master at what they do are passing themselves off as true experts. In dentistry, we joke about a dentist who is an expert after taking a weekend course and doing the procedure exactly once.
If you find excellence by chance...consider yourself extremely lucky. Excellence will require that you do some investigation on the internet, invest some time in asking around and your willingness to not only demand excellence but be willing to PAY FOR EXCELLENCE.
Excellence requires more time and costs more. Where have I heard that before????
And let me give you a hint: Your insurance company will NOT PAY FOR EXCELLENCE....But YOU sure can.
Like Nike says: "Just DO It." And if you are unwilling to pay for excellence, you will spend three times what excellence costs in trying to correct your problems as a result of mediocrity or worse.
Monday, March 8, 2010
"Excellence" in 10 Minutes
Excellence in 10 minutes is an oxymoron if I ever heard one. An oxymoron is when you combine two terms that don't go together such as 'excellence' in a small amount of time...Excellence IS EXCELLENCE even if it takes all day to achieve.
Why am I making a big deal about this?
A few days ago I spoke with a patient who told me that he went for his regular colonoscopy and when he awoke, he was told that the doctor had perforated his intestines, a life threatening event. The New York Times ran a front page story a couple of years ago stating that many GI specialists were spending only 10 minutes performing a colonoscopy but those GI specialists who took 30 minutes found 3 times the amount of polyps.If time is about money...then what we are seeing is that doctors and dentists are doing "the best they can" as FAST as they can...Is that an oxymoron or what?
Some dentists do the exact same thing; the 59 minute root canal or the 2 hour veneer case. What is the problem with this??? Failure or an unhappy patient is frequently the result. How long SHOULD a root canal take? Until the canal system of the tooth is absolutely clean. And how long should a veneer case take???All day if necessary to produce the desired functional and esthetic results
So where have we gone wrong? Everything has become about the MONEY. But you already knew that.
Why am I making a big deal about this?
A few days ago I spoke with a patient who told me that he went for his regular colonoscopy and when he awoke, he was told that the doctor had perforated his intestines, a life threatening event. The New York Times ran a front page story a couple of years ago stating that many GI specialists were spending only 10 minutes performing a colonoscopy but those GI specialists who took 30 minutes found 3 times the amount of polyps.If time is about money...then what we are seeing is that doctors and dentists are doing "the best they can" as FAST as they can...Is that an oxymoron or what?
Some dentists do the exact same thing; the 59 minute root canal or the 2 hour veneer case. What is the problem with this??? Failure or an unhappy patient is frequently the result. How long SHOULD a root canal take? Until the canal system of the tooth is absolutely clean. And how long should a veneer case take???All day if necessary to produce the desired functional and esthetic results
So where have we gone wrong? Everything has become about the MONEY. But you already knew that.
Friday, March 5, 2010
What Others Say About Our Work
I spoke with the designer of our new Saratoga office this afternoon just to keep in touch. Sue Barrett is one of the finest designers of beautiful dental offices in the United States. We chatted about the economy and she said that things appear to be turning around for her firm but she definitely sees less of a demand for palatial dental offices costing millions of dollars...Sanity is returning.
Towards the end of our conversation, she said to me that since she met Tricia and me, she has looked at cosmetic dentistry in an entirely new light. What she told me is that she sees lots of people walking around with 'cosmetic dentistry' but that is the problem...She can identify the artificial nature of the dentistry. Sue said that our office has set a new standard of excellence in cosmetic dentistry for its beauty and our ability to mimic the naturalness of nature.
I can think of no higher compliment for our work.
My job is give our patients the best possible dentistry with regards to fit, function and fabulous esthetics. I am honored when people in my profession or associated with the profession compliment our work.
Towards the end of our conversation, she said to me that since she met Tricia and me, she has looked at cosmetic dentistry in an entirely new light. What she told me is that she sees lots of people walking around with 'cosmetic dentistry' but that is the problem...She can identify the artificial nature of the dentistry. Sue said that our office has set a new standard of excellence in cosmetic dentistry for its beauty and our ability to mimic the naturalness of nature.
I can think of no higher compliment for our work.
My job is give our patients the best possible dentistry with regards to fit, function and fabulous esthetics. I am honored when people in my profession or associated with the profession compliment our work.
Thursday, March 4, 2010
I Could Not Say It Better
Captain Chesley "Sully" Sullenberger the pilot that safely landed a plane in the Hudson River retired yesterday after 30 years with USAIR. Sully made some damning statements about the airlines and other professional pilots.
To quote extensively from a CNN Report:
"I have been fortunate to have followed my passion for most of my life, working in a profession I dearly love."
Pilot experience requirements and pilot fatigue are among his chief concerns, he said. Outdated regulations and regional carriers that compete on the basis of cost, consequently hiring less experienced pilots, contribute to the profession's problems.
"Each generation of pilots hopes that they will leave their profession better off than they found it. In spite of the best efforts of thousands of my colleagues, that is not the case today," Sullenberger said in his written statement.
Sullenberger leaves his profession in worse shape than when he started "by any measure," he said.
Why am I telling you about this? And What does this have to do with Dentistry and my profession?
EVERYTHING!!!!!!!!!!!!!!!!!!!!!!!!
When cheap is what patients demand then low quality is what they will recieve which means that it will AWAYS cost more to redo the dental treatment and teeth will be lost. Perhaps Sully was referring to the regional airline that lost a plane and 48 lives when two inexperienced and poorly paid pilots crashed a plane in Buffalo last year.
I have recently started to see dentistry that is reminiscent of some of the work that we used to see in the 1970's and before the modern era of dentistry. Root canals ineptly done, undiagnosed periodontal disease, 'bonded white fillings' that failed before the first bite of food touched the tooth and beautiful natural tooth structure that is removed for crowns and onlays simply because insurance pays more for crowns than for beautiful, strong and tooth conserving bonded white fillings.
So what is this about? Sully said it best," Regional carriers (DENTISTS) that compete on the basis of cost, consequently hiring less experienced pilots (DENTISTS OVER-TREATING, PERFORMING TREATMENT THAT THEY ARE NOT COMPETENT TO DO, USING CHEAP LABS AND MATERIALS) contribute to the profession's problems.
What Sully and I are telling you is the same thing. When the public doesn't want to pay for quality the results will be lost teeth and lost lives.
To quote extensively from a CNN Report:
"I have been fortunate to have followed my passion for most of my life, working in a profession I dearly love."
Pilot experience requirements and pilot fatigue are among his chief concerns, he said. Outdated regulations and regional carriers that compete on the basis of cost, consequently hiring less experienced pilots, contribute to the profession's problems.
"Each generation of pilots hopes that they will leave their profession better off than they found it. In spite of the best efforts of thousands of my colleagues, that is not the case today," Sullenberger said in his written statement.
Sullenberger leaves his profession in worse shape than when he started "by any measure," he said.
Why am I telling you about this? And What does this have to do with Dentistry and my profession?
EVERYTHING!!!!!!!!!!!!!!!!!!!!!!!!
When cheap is what patients demand then low quality is what they will recieve which means that it will AWAYS cost more to redo the dental treatment and teeth will be lost. Perhaps Sully was referring to the regional airline that lost a plane and 48 lives when two inexperienced and poorly paid pilots crashed a plane in Buffalo last year.
I have recently started to see dentistry that is reminiscent of some of the work that we used to see in the 1970's and before the modern era of dentistry. Root canals ineptly done, undiagnosed periodontal disease, 'bonded white fillings' that failed before the first bite of food touched the tooth and beautiful natural tooth structure that is removed for crowns and onlays simply because insurance pays more for crowns than for beautiful, strong and tooth conserving bonded white fillings.
So what is this about? Sully said it best," Regional carriers (DENTISTS) that compete on the basis of cost, consequently hiring less experienced pilots (DENTISTS OVER-TREATING, PERFORMING TREATMENT THAT THEY ARE NOT COMPETENT TO DO, USING CHEAP LABS AND MATERIALS) contribute to the profession's problems.
What Sully and I are telling you is the same thing. When the public doesn't want to pay for quality the results will be lost teeth and lost lives.
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