I guess it all boils down to your pt population, GP, orth, endo, perio, omfs, or pedo they all need pt's to earn thier income. There is also a huge learning curve in pvt practice in terms of managing the office and learning what insurances cover and how much you get paid per procedure. I like doing all my surgical procedures but i'm quickly finding the limitations of what i get paid back because some insurance companys would not pay a GP to do specialist's procedure!. There is also the experience factor and reputation, as is the case w/GP's, specialist w/ more experience will definitely be more known locally and should have more pt's to work on, the gpr program directore where i was doing my residency is a periodontist (army trained w/ tons of experience) he did not have his own practice but rather worked for 2-3 different practices, he was getting paid 50% off of collections working 3-4 days/week. I believe he used to say around 1000/ day was his daily average for the year (working in uPscale bethesda,MD).
$1000 a day is quite a bit more reasonable (albeit a bit low) for a periodontist. 50% collections, however, is nice--almost too good to be true. As a GP working as an associate, I get paid 35% of collections and that's considered very good. At 50%, I'd top $1500 a day easily.
I've never run into an insurance company refusing to pay me for "specialist" work that I do. In fact, it would make more sense that they'd
prefer that I do it because I charge less for it.
Seriously. Did you see some of the fees that these perio guys claim to charge for their work?
$2000 for an implant? My practice charges $1600.
$1300 for one quadrant of osseous surgery (a procedure you could train a chimpanzee to perform)?
$375 per quadrant of scaling and root planing? We have our hygienists do that at $175 per quadrant!
If those fees are accurate averages, then it is clear that periodontists are overcharging their patients. There is no excuse for the specialty to exist to begin with--GPs can and should be trained in dental school or at least in one year of mandatory residency to perform
all the surgeries performed by periodontists. Deep down I think periodontists know this, but refuse to admit to it. Despite this, they not only have the gall to try and
force us to refer to them (see the new AAP referral guidelines), but they have the audacity to charge patients horrendous fees for perio services. They are pushing for a monopoly on perio-disease so that they can price-gouge. As a doctor who cares about his patients' health and pocketbooks, I have a problem with this. The rare occasions in my practice where I refer a patient to a periodontist or an endodontist, my conscience tugs at me because I know that they're going to receive a financial mugging--especially with perio.
And moreover, where does a specialist get the authority to dictate
when a referral should be made? They are well within their right to dictate the
standard of care to which all doctors who perform specialty procedures should adhere, but specifically stating conditions where patients should be referred to periodontists is inappropriate, unprofessional, and amounts to an unabashed attempt to forcibly bolster their patient pools.
TOOFACHE32, you're missing an important point. Have you not heard the phrase "chair time" used before? Your time is meaningless (as is mine), because what dictates the pace of our practice is
chair time and
staff time, i.e. the amount of time a chair and staff is unavailable to another patient. It is impossible to
properly set-up, treat, recover, and discharge a 3rds/sedation case in less than an hour. And that's not just an hour that
a chair is used, it's also an hour that your staff is used--assuming you don't leave the patient unattended while you go do the 3rds case in the next room.
I've taken out sets of full-bonies in as little as 15 minutes (albeit rarely)....
without sedation--and even without sedation, the patient spends an hour in the chair. We doctors are rarely the limiting factor in terms of actual productivity. It's usually everything else around us.
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