Quality of dentistry is not affected by the amount charged.
"I know one guy who charges a fortune and his work is terrible".
It's a myth.
It's a myth propagated by insurance companies. It's a myth propagated by government health systems. And it's a myth sometimes propagated by those in receipt of such.
It is true that we all know of cases where someones fees are very high due in part to excellent marketing, excellent personality, and excellent sales skills, that are perhaps not followed up by similar skills in actual clinical dentistry.
This does not prove the reverse
Over the years I've been influenced by a number of people that dentistry can be done very fast for the same quality, if only you have the right mindset, and the right systems. I'm embarrassed about the recalls from that era.
Certainly there are efficiencies that can be gained by well trained staff and following methodical processes in the actual procedure. There are also efficiencies that come from being experienced and generally getting things right first go.
By far the three biggest costs in any dental procedure are:
1. The time spent consulting, gaining informed consent, and developing an appropriate treatment plan carefully tailored to the patient.
2. Time spent making sure each step of a clinical procedure is done correctly before moving on, and documenting it so you are sure it's correct.
3. Time spent by the dentist and the technician making sure the lab work is correct.
I didn't include materials. In some countries, the materials themselves are a big cost.
If you give the best of all three of these, and you don't charge more, then the person who pays for the quality is you. You pay by having a reduced income.
Sometimes it is better to have a smaller income and enjoy what you do more. Sometimes it leads to resentment.
Perhaps the technician themselves are the example. I have used high priced technicians that are unreliable. However, I've never had a good technician that was cheap. I've used cheap technicians or outsourcing labs that other dentists have told me are good, but they weren't. Sure, things dropped in, and contacts were good. But ramp speeds were obviously not controlled judging by the number of veneering porcelain failures. Colour was always too opaque. Textures were always formulaic. The things that take time and can't be production lined.
And so it is in dentistry
In the vast majority of cases, what we can achieve is limited by the amount we charge.
We can make up a little bit in higher volume if our practice is not busy since our overhead will reduce with greater volume. However, once our books are pretty full, then something has to give.
Perhaps the injections get faster and more painful. Perhaps there is no time to retake the impression if there is a bubble. Perhaps we cannot afford to tint our CEREC even though we like our lab to tint restorations. Perhaps we go straight to an all in one bonding agent without removing plaque and etching the enamel first.
Sometimes clinics specialise in a single procedure and have a production lined consultation process that seems to arrive at the same treatment plan for every patient. Then the cuts are being made in the informed consent and appropriate treatment planning process.
I know in my own practice that there are certain things I cannot do (yet, or maybe ever) because of the limits on what my population can afford to pay or perhaps by what I'm personally able to charge.
NOW, it is important to realise that there is nothing wrong with different levels of quality at different prices. In fact, it is important for the population to have this choice.
However, don't kid yourself. You can achieve different things if you charge 1000 Doluros (fictional currency) than if you charge 500. And it is important to think carefully about what compromises you have to make to achieve your current pricing structure.
If you are contracted by insurance or government to achieve things at a certain price, then you will be able to make up some in volume, but it is quite likely you will have to "build it to a price". Just make sure that you don't build it to a standard that endangers your license.
It's always worth remembering that those that create the system you work in, whether it's corporate dentistry, government dentistry, contracted dentistry, or just your own practice, will not be held responsible for what you as a health practitioner do. You will be.
So multiple prices and qualities are good. But don't mythologise that you can achieve perfection with pennies.
The most expensive thing you give is time.
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