Asking to be switched from base to % production/collection

[Drfunnyteeth]

Hello all!

I'm a new dentist that has been out of my GPR for over a year. I started practicing in two practices in NYC in Sept. 2020. I recently asked to set up a meeting to discuss switching from the $500 base per day to a % of production/collection at one of the offices. It has been almost a year and I know that while my production isn't stellar, I would have been netting more than my base pay each day for at least 5 months now. So, there is no benefit for me to be on the base. If I net less one day, than it is more motivation to make it up another.

The owner would like me to set goals (of 3 or 6 months - she said whatever I want) or how much I aim to produce each day and I guess each month, and how I could reach that. She also wants me to understand what my day should look like to reach those goals and the breakdown from each procedure, whether it is reimbursed through insurance or out-of-pocket. I also need to figure out what portion of Invisalign case production should go to me.
I agree that I should know all of these aspects of where my pay comes from, but I'm not sure the best way to understand exactly how much I make on average right now. I have my day sheets, but don't know which numbers to pay attention to. Are the charges just co-pay or also what we expect to get from insurance? How do I know how much I was actually reimbursed for a procedure?
I didn't like that the owner said that if they switch my pay they would essentially stop "going easy on me." I never compromised how much effort I put into the practice just because I was on base, and I really doubt that the office manager did either. I said that to the owner, along with the fact that I clearly have been making efforts to expand what procedures I can do to increase my production (via endo, Invisalign and improving on my crown preps)

For context: It is a PPO/FFS office and there is no hygienist at the office, so for the most part it is one column with some side books. I am the only one seeing exams and most treatment. The owner focuses on TMJ/airway management. It is a relatively low caries population, but we see a lot of fractures and wear and do a lot of pre-restorative ortho via Invisalign. I don't work up the cases, but I do all the chair treatment (attachment placement, removal, IPR, etc) and am usually the one who gets the patient to agree to start treatment.
The goal they want producing $500 per hour or $5k a day. I feel like I'm limited in reaching that without a hygienist (apparently there aren't any that want to work in Brooklyn). But, of course, there is also the question of - do I have enough treatment to still be busy if I'm not doing all the hygiene? I think if I could see NPs more quickly, then that would lead to more procedures, but right now they sometimes have to schedule a few weeks out since my schedule can be so busy.

Essentially, I'm looking for some guidance on how to best understand how much I'm producing, how much I'm actually being reimbursed from insurance, and what are realistic goals based on the type of practice it is and that there is no hygienist.

Any help is appreciated! Thanks in advance!

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[allDAT]

Do you have access to production reports (daily, weekly, monthly, quarterly, and annually)? You should be able to pull these from your PMS.

Do you have access to collection reports? It’s much easier to calculate adjusted production as an associate than collections because it’s unlikely you have unrestricted access to the accounts receivable. To calculate your adjusted production, you need to see where in the PMS the practice is calcuating the insurance adjustment and that depends on the practice. Some people put UCR in as the full fee for everything and adjust elsewhere, other’s put in the insurance fee as the full fee. Monitoring this is actually one of the biggest problems for associates - so easy to steal from them.

I don’t know why the owner would “take it easy” or not take it easy on you either way. The owner should want the maximum amount of output from you during the workday as possible.

Averaging 5k a day and doing your own hygiene is likely an unrealistic goal If you’re only running 1 column and there is no hygienist in the office because you’ll always be bogged down doing some % of hygiene In your day.

At 5k a day though, you should net 3x what you’re currently paid based on your daily rate.

I would ask that the daily base continue and that a bonus structure as a percentage of adjusted production be implemented where you are paid the greater of your current daily base or x% of adjusted production on a monthly basis.

When the owner tells you that you can’t have both, ask why not? Your daily base in Brooklyn is already low at just $62.50 an hour. A hygienist in the area is probably asking for $55/hr - you’re not at the minimum brining in an extra $20/hr in additional value to the practice? I would find that hard to believe.

Always be prepared to leave if the negotiations turn sour though. Dentists are a sensitive bunch.

 

[rippedbx]

Don't plan to get off a $500 daily. Do it now. Like today!
30% of collections or 28% of production is pretty average (You'll find some people up to 40%) if no lab bills taken out.
Look at the schedule and find out where the time is being spent and where the money's coming from. (Time typically is spent on exams and cleanings and sometimes single surface fillings, and money comes from crowns and build ups, extractions etc).
If you're 3 weeks out, the office has to get more efficient (hire another assistant, hire a hygienist, general efficiency, maybe you need to be more efficient, etc). If you're busy all day you should be making $1400/day at least.

Edit: Post a picture of your schedule for a couple days and have people give advice

 

[Rambunctious]

Hello all!

I'm a new dentist that has been out of my GPR for over a year. I started practicing in two practices in NYC in Sept. 2020. I recently asked to set up a meeting to discuss switching from the $500 base per day to a % of production/collection at one of the offices. It has been almost a year and I know that while my production isn't stellar, I would have been netting more than my base pay each day for at least 5 months now. So, there is no benefit for me to be on the base. If I net less one day, than it is more motivation to make it up another.

The owner would like me to set goals (of 3 or 6 months - she said whatever I want) or how much I aim to produce each day and I guess each month, and how I could reach that. She also wants me to understand what my day should look like to reach those goals and the breakdown from each procedure, whether it is reimbursed through insurance or out-of-pocket. I also need to figure out what portion of Invisalign case production should go to me.
I agree that I should know all of these aspects of where my pay comes from, but I'm not sure the best way to understand exactly how much I make on average right now. I have my day sheets, but don't know which numbers to pay attention to. Are the charges just co-pay or also what we expect to get from insurance? How do I know how much I was actually reimbursed for a procedure?
I didn't like that the owner said that if they switch my pay they would essentially stop "going easy on me." I never compromised how much effort I put into the practice just because I was on base, and I really doubt that the office manager did either. I said that to the owner, along with the fact that I clearly have been making efforts to expand what procedures I can do to increase my production (via endo, Invisalign and improving on my crown preps)

For context: It is a PPO/FFS office and there is no hygienist at the office, so for the most part it is one column with some side books. I am the only one seeing exams and most treatment. The owner focuses on TMJ/airway management. It is a relatively low caries population, but we see a lot of fractures and wear and do a lot of pre-restorative ortho via Invisalign. I don't work up the cases, but I do all the chair treatment (attachment placement, removal, IPR, etc) and am usually the one who gets the patient to agree to start treatment.
The goal they want producing $500 per hour or $5k a day. I feel like I'm limited in reaching that without a hygienist (apparently there aren't any that want to work in Brooklyn). But, of course, there is also the question of - do I have enough treatment to still be busy if I'm not doing all the hygiene? I think if I could see NPs more quickly, then that would lead to more procedures, but right now they sometimes have to schedule a few weeks out since my schedule can be so busy.

Essentially, I'm looking for some guidance on how to best understand how much I'm producing, how much I'm actually being reimbursed from insurance, and what are realistic goals based on the type of practice it is and that there is no hygienist.

Any help is appreciated! Thanks in advance!

OK for this dentist to be telling you what your goal should be is already not setting you up for success. A fair associate pay would be daily minimum or percentage (whichever is higher). For you to just have a daily minimum gives you no incentive to work hard or to produce more and the owner dentist should know that. I believe you should look for other employment as this dentist shouldn't even have said "going easy on you". The way I pay my associates is 26% production or $900 daily minimum. They average $4800-$5800 a day so the daily minimum is just there for the days when everyone cancels. Don't sell yourself short, $500 a day only is robbery especially with our massive dental school debts and i'm just assuming you went to NYU which is already ridiculous.

 

[Drfunnyteeth]

Do you have access to production reports (daily, weekly, monthly, quarterly, and annually)? You should be able to pull these from your PMS.

Do you have access to collection reports? It’s much easier to calculate adjusted production as an associate than collections because it’s unlikely you have unrestricted access to the accounts receivable. To calculate your adjusted production, you need to see where in the PMS the practice is calcuating the insurance adjustment and that depends on the practice. Some people put UCR in as the full fee for everything and adjust elsewhere, other’s put in the insurance fee as the full fee. Monitoring this is actually one of the biggest problems for associates - so easy to steal from them.

I don’t know why the owner would “take it easy” or not take it easy on you either way. The owner should want the maximum amount of output from you during the workday as possible.

Averaging 5k a day and doing your own hygiene is likely an unrealistic goal If you’re only running 1 column and there is no hygienist in the office because you’ll always be bogged down doing some % of hygiene In your day.

At 5k a day though, you should net 3x what you’re currently paid based on your daily rate.

I would ask that the daily base continue and that a bonus structure as a percentage of adjusted production be implemented where you are paid the greater of your current daily base or x% of adjusted production on a monthly basis.

When the owner tells you that you can’t have both, ask why not? Your daily base in Brooklyn is already low at just $62.50 an hour. A hygienist in the area is probably asking for $55/hr - you’re not at the minimum brining in an extra $20/hr in additional value to the practice? I would find that hard to believe.

Always be prepared to leave if the negotiations turn sour though. Dentists are a sensitive bunch.

Thanks for all your replies! I am meeting with the owner tomorrow, but apparently, the office manager will be sitting with us. I'm concerned it is because she is intimidating and they may be able to pressure me more with 2:1. But, I know that as the main producer in the office, they need me. They are going to insist that I should be producing $500 an hour or $4000 a day.

For your questions: We have Dentrix and I get the Daysheet at the end of the day. I'm told that the "payments" number is the production and the "charges" is collection - not sure if that is true. I requested for the month as well. I'm not sure how to find where they are calculating insurance adjustments and you honestly lost me a little with the UCR vs insurance fee. I know that under the fee schedule, it seems that they have a fee schedule for each insurance. How could they steal from the associate in this way? Can they report a lower fee and then not compensate me if they are paid more?

I'm pink in the schedule. They are going to ask me how I can increase my production and what my day should look like to reach that $500 an hour or $4 k a day, but I'm having a hard time figuring that out since we do some much pre-restorative ortho, that delays patient's crowns/onlays and right now the owner is behind on refinements, so patients' treatment is extra delayed. NPs have to wait until November to see me. And the owner made a comment that I need to be able to work multiple chairs (w/o a hygienist) and told the office manager she doesn't want to see me sitting in the back. Mind you, that only happens when I go to get water, a quick bite to eat (or we have a cancellation).

Feedback appreciated!

 

[Drfunnyteeth]

Also, the office manager won't give me access to the Office Manager function of Dentrix, so I have to ask her to print whatever I want from there.

 

[doktorinprogres]

Also, the office manager won't give me access to the Office Manager function of Dentrix, so I have to ask her to print whatever I want from there.

I'm speaking out of turn b/c I'm still a dental student but you're GPR trained and have been out practicing for a year and are having to negotiate with two ppl who seem more interested in playing games and creating hoops than compensating fairly.

Why is someone with your training putting up with doing their own hygiene?

Practice owners can correct me if they'd like but it was my understanding that the minimum a new grad should accept is 500/day. You're not a new grad and I have to assume someone out of a GPR can spin circles around someone who is.

I know it's cliche for someone on a forum to say break up or divorce or in this case leave but man oh man my gut screams leave after reading your situation