Do good vs. look good

For the past three weeks, I've been working for a dentist in Livermore.

At first, it seemed great. He had good systems, well trained staff, and cable TV in every room.

Three weeks later, I've found myself in hot water for doing good instead of looking good.

For example, there was a crown where the buildup came out in the temporary--meaning that the crown would be unsupported. He was furious that I built up a new buildup, took another impression, and reappointed the patient.

He told me that he would have simply cemented it in place.

Why I want my own practice

Over the past couple days, I've been thinking why I want a practice.

Why do I want one?

Pro's:
Quality control - I can use good labs, good equipment, and train great people.
I want things at top quality.
Creative control - I can dedicate the practice to the very best dentistry available.
Better tax write offs - my biggest "optional expense" is training and equipment for my patients. My second expense is cool stuff to show my appreciation for people.
It's be nice to deduct this from my overinflated taxes.

Why it's a bother:
Labor costs - wages get higher; benefits cost more, especially health coverage; sick pay. The Bay Area is a very expensive place.
Taxes - Obamacare medical device tax 2.7% on everything we buy. Business tax. Payroll tax. City tax. State tax.
Liability, lawsuits - California has some of the highest number of lawyers. There are hundreds of opportunities to get sued over stuff like a kid slipping in front of your office.
Marketing/Competition - the SF Bay Area is a super saturated market full of tons of dentists. Frankly, it'd be easier to compete anywhere else (except LA).
Staff issues - the new assistant is hungover and the front desk decided to ditch work for a new boyfriend. These issues happen more often than you think.
Paycheck - as boss, I'm the last one paid. Frankly, some days I'll be paying money to keep the place open.

I'm probably crazy, but I still feel that the end goal is worth it.

Some days are crazy...

If you've never read it, "Kill as Few Patients as Possible: And 56 Other Essays on How to Be the World's Best Doctor" sounds like a joke.

Instead, it's a funny, insightful book.

Today felt like the chapter "death by appointment book."

Crazy patients, we all have them. Generally, we can survive one or two of them without a sedative.


However, today I had a bunch. I had the lady that wants a denture to look 20 years younger, a highly dental phobic principle, a surly, self-absorbed assistant, and no real power to do anything.

The patients would come 10 min late with a thirty minute variance. Some came early by 15 minutes. Some came late by 30 minutes.

Additionally, my setup would be missing something critical. For my extraction, the assistant had no periosteal elevator, no scalpel, no forceps. For the bridge prep, my handpiece stalled midway, and the assistant didn't have the right impression tip. During my prep, she would disappear to chat with the girls. This was frustrating to say the least.

This really highlights the value of a good system, good staff, and patient management.

Personally, I can't understand healthcare workers who see work as a just a 9-5 job. I see patient care as a sacred trust where I will do no harm. If they are accommodating, I will happily bust my ass to serve them.

Man, crazy.
Tired.

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.