Finishing implant training with Misch

I'm finishing S5 with Dr. Carl Misch, the world's best implant guy.

It'll be a while before I see him again, as well as friends I've met during the continuum.

I hope to spread some of this information to counter a lot of misinformation spread by unscrupulous people.

How will I celebrate?
A glass of wine with Misch!

CEREC- faster, cheaper, but is it better?

Today, I'm taking Dr. James Klim's CEREC class.

For me CEREC is a mixed bag.

Likes:
1. It's fast.
No temps. I hate temporary restorations! They break. They fall off. It takes a lot of work to make them look good.
2. It's quickly replaceable.
If it breaks, I can replace it in under an hour. Try that with anything else.
3. It's fun.
CEREC lets me control the margins and occlusal at chair side. I can look at my preps at 3000x.

What I don't like:
1. It doesn't last.
Gold is king. Gold lasts forever. Gold is the only material that offers the level of accuracy and fit that lasts a lifetime.
2. It's not great esthetically.
Hand stacked porcelain with multiple cutbacks are beautiful and stay that way. CEREC crowns lost chroma as the glaze wears off.
3. It's oversold.
CEREC and Invisalign are often sold as the answer to everything. This is because buyers (especially big dental corps) often need to recoup the costs of investment.
With CEREC, costs start at around $150,000 to get the technology.

How to get good service--what not to do...

Today, I have a case of what *not* to do.

A patient called insisting that we see his kid. He was an HMO patient. We essentially didn't cover the procedure that he insisted on.

He wanted it for free.
He threatened to sue.

He spent over an hour trying to cow us into submission. He threatened a lawsuit. He threatened to get Delta involved. He insulted every member on the staff. He called us unethical elitists who are against the poor. He was condescending as all hell.

For the record, DON'T do this.

For the past two years, I was involved with the Berkeley Free Clinic, Random Access Missions, Missions of Mercy, the Sacramento Continued Education Committee, Give Kids a Smile, and the board of a study group.

I would have done the fillings for free if he showed up on time, and had some respect for my staff.

I'm going for a run after work.

Going back to posting

I'm going back to posting.

Previously, this would be a bit involved. Sit at computer. Turn it on. Go online. Find blogger website. Log on. Find small button. Type stuff. Agonize. Delete. Retype.

I'm not doing this anymore.
Instead, I've got an app!

Expect more posts.

Working on the road

I'm writing this from a drive-by Starbucks in Stockton.

For this week, I'll be doing some temp work for one of the corporate chains in California.

It's a pretty busy schedule with quasi-borderline treatment planning.
A lot of the work is subpar. A lot of it is rushed.
It'll be things like 4 quadrants of scaling and root planing and a crown in one hour.

In the mornings, there is a "huddle" that consists of assigning each dentist a production number.
We're expected to make that amount of money.

The assistants don't really know what's going on.
It's fun for them, because they do more than the usual suctioning.

However, for us dentists, it's pretty gruelling.
We're expected to do quadruple the usual private clinic production at HMO rates.
We're expected to do it to the minimum standard of care.

It's a numbers game. We are supposed to make at least 4 times what we cost to the company.
Otherwise, it's a loss.

I'm glad that I'm just a temp, an I intend to stay that way...
Because here, you get what you pay for.

Faking it

At the place where I'm renting space, I've been helping out with billing when I'm not seeing patients.

Its a test of patience. I've been learning that insurance seriously screws us over more than I thought. On the patient's side, there are always additional costs: increasing % responsible, increasing deductable limits, and the same coverage cap since the 1970's. On our end, we doctors get paid way less each year.

I'm not going to get myself in trouble by stating the actual amounts in question ("confidential" according to the insurance companies), but it's sometimes as stupid as 30% reimbursement or nothing.

Moreover, the music is driving me nuts!

I really, really can't stand the muzak that is playing down here. As a jazz, R and B, rock, indie, (anything but muzak), it's pure torture to listen to the Chipmunks Christmas carol play every five songs. It's pure smaltz with a double dose high fructose syrup.

While I can't do too much about the ripoff known as insurance, I will try to have music that doesn't suck.

Buying my first practice

For the past 18 months, I've been working as an associate under the pay as an "independent operator."

Essentially, this means that I'm working much harder for far less pay, relatively little control over quality control, and I'm taxed twice thanks to Obama. I've found many, many taxes that I have to pay on many levels that I never knew existed.

On the plus side, this has slowly taught me to think like a businessman. I've learned to think as not only a dentist, but also a receptionist, office manager, assistant, and accountant. I've learned about quality, profitability, and the concept of working capital, as I've scraped by from check to bill, to student loan.

It's about time for me to buy a practice and make it official.
I am a dentist. Hear me squeak.