Experienced Dentists: Does it get easier over time???

[monkeykey]

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People say that dentistry is extremely stressful but you can find people saying that about virtual anything. My question is for experienced dentists (10+ years) does it ever get so easy you don’t even think about what you’re doing? Perhaps like driving a car?

Ideal scenario:
Come into work. Do filling. Easy AF. Make BS small talk with patient. Easy AF. Perform non wisdom tooth extraction on healthy patient. Easy AF. Perform root canal on maxillary canine tooth. Easy AF. Place decently good veneer. Moderately easy.

The point is do you ever get to the point as a dentist where you are extremely confident in yourself and don’t get uncomfortable? Or are you always thinking you might be on the borderline of screwing up?

I’d like to have a career where I can work my way into feeling extremely confident everyday and feel like a boss with the quality of my dental work. Does this happen in dentistry as with other careers? Thanks

 

[TanMan]

People say that dentistry is extremely stressful but you can find people saying that about virtual anything. My question is for experienced dentists (10+ years) does it ever get so easy you don’t even think about what you’re doing? Perhaps like driving a car?

Ideal scenario:
Come into work. Do filling. Easy AF. Make BS small talk with patient. Easy AF. Perform non wisdom tooth extraction on healthy patient. Easy AF. Perform root canal on maxillary canine tooth. Easy AF. Place decently good veneer. Moderately easy.

The point is do you ever get to the point as a dentist where you are extremely confident in yourself and don’t get uncomfortable? Or are you always thinking you might be on the borderline of screwing up?

I’d like to have a career where I can work my way into feeling extremely confident everyday and feel like a boss with the quality of my dental work. Does this happen in dentistry as with other careers? Thanks

I'm not in the 10+ year mark, but it does get repetitive over time. Dentistry isn't the stressful part. It's the people.However, over time, you learn to weed out the BS that some patients tend to dish out on you... such as I hate the dentist (response: don't we all) or how much is this going to cost me, in a sarcastic tone, etc... I refer to what you're thinking of as "autopilot". You just perform dentistry instinctively.

I don't get uncomfortable, I get annoyed. It's not the difficulty of the case that I'm assessing. It's whether the case is worth my time.

Your ideal scenario can fall apart in many ways (problems in parenthesis):

Come to work (some equipment broke)
Do filling (patient can only open 1 inch, treats its own saliva like it's toxic, needs suction every 10 seconds)
Perform non-wisdom tooth extraction on healthy patient (has phobia, thinks pressure is pain, lots of time wasted, crying because they can't fathom the thought of extracting the tooth, end up doing the tooth as surgical extraction because they can't handle forcep pressure.)
Perform root canal on maxillary canine tooth (31mm file not long enough, two roots, hypo accident, patient refuses rct because they believe in holistic dentistry, etc...)
Veneer (patient complains about something after approving try-in, post-cementation)

If this was my first hour schedule, you have to anticipate "loading time - anesthetic time, procedural time, patient factors/difficulty, how many can I finish as fast as I can in the shortest period of time, who came first, and which procedure(s) require initial intervention to get the ball rolling). By developing a queuing system in which you take these factors into consideration, then you can be efficient and reduce the snowballing effects of a difficult patient.

Thankfully, when you get these types of patients and they aren't happy s/p procedure, they don't come back most of the time.

On being the boss of the quality of your dental work, it all depends on how anal you are. If you are strictly anal/diva about everything, you'll never be happy and you'll be miserable in your existence in dentistry. If your goal is to make the patient happy and deliver clinically acceptable work, then you'll feel confident and like a boss everyday. It's not hard to deliver clinically acceptable work and make the patient happy. I find it the most satisfying part of our profession.

 

[monkeykey]

How good are you referring when you say “clinically acceptable”?Like government defined minimum standards, because that’s not saying very much. I can get a government drivers license but that doesn’t mean I won’t be a trash driver.

I want to be able to feel that I’m selling the patient a quality product when I do procedures. It by no means has to be the best but I don’t want it to be Walmart quality either. Perhaps Macy’s ‍♂️

 

[TanMan]

How good are you referring when you say “clinically acceptable”?Like government defined minimum standards, because that’s not saying very much. I can get a government drivers license but that doesn’t mean I won’t be a trash driver.

I want to be able to feel that I’m selling the patient a quality product when I do procedures. It by no means has to be the best but I don’t want it to be Walmart quality either. Perhaps Macy’s ‍♂

Clinically acceptable refers to a few perspectives. From the patient perspective, it should look good, not fall apart, not hurt. From a clinician's perspective, it means meeting the minimum standard in order to deliver a good product/service. Depends on the procedure, i.e a filling should have caries removed, unsupported enamel removed, good bonding, flush margins, tight contacts, not hyperoccluded, good patient perspectives, etc... the criterias of a good filling from your perspective and patient perspective. I can go on about each procedure. Now, what's beyond clinically acceptable for a filling? Tertiary anatomy, staining/grooves, gold study club style of preps, super high gloss finish, etc... Doing something at a minimum clinical standard is still a pretty high standard. Everything else is superfluous.

Macy's is like a Wal-mart, but with much higher markup. Maybe you're thinking of Neiman Marcus?

 

[beannaithe]

The description from @TanMan is dead-on for how dentistry gets the longer you do it. I'm not quite at 10 years, but I've been doing it long enough. It gets clinically easier the longer you do it. For me, it was around year 5 where I figured out my comfort zone, got good with the bread and butter dentistry and decided what I should refer out. I tend to get annoyed at certain things too because sometimes, whatever you've done is good and the patient is the issue.

A lot of days for me are show up, do a bunch of fillings and some crowns, and see a bunch of hygiene patients. Then I leave.

Then there's the days where an assistant is out sick and now, I've got 4 columns while being short-staffed. I get walk-in emergencies that don't understand why I can't see them right this second. A patient calls to complain to me about how the insurance didn't pay for something. I have to do an MODBL on a wisdom tooth. I have to do an MODBL on a second molar. I have an easy extraction and break off a root tip. I'm doing a molar endo and suddenly, there's 5 hygiene checks. My MILF filling on #9 is perfect, but the patient hates it and I can't tell what's wrong with it. Patients get mad because I tell them they have cavities and they don't floss.

I'm pretty confident because I know what I'm doing and how to handle most situations. But patients are people and can be extremely unpredictable. For me, I'm at the point in my career where the procedures are relatively easy, some patients are not.

 

[TanMan]

How good are you referring when you say “clinically acceptable”?Like government defined minimum standards, because that’s not saying very much. I can get a government drivers license but that doesn’t mean I won’t be a trash driver.

I want to be able to feel that I’m selling the patient a quality product when I do procedures. It by no means has to be the best but I don’t want it to be Walmart quality either. Perhaps Macy’s ‍♂

I have a feeling that you may struggle with self-satisfaction when you start out and managing your expectations of ppo/hmo patients along with striving for Macy's quality. Trying to deliver a Macy's product for dollar tree prices will eventually get to you, especially if you cannot deliver a Macy's product in a timely manner. Now, if you were to practice to be able to deliver a Macy's style product in a few minutes, then dollar tree prices wouldn't be so bad. However, it is this learning curve that would be your primary source of frustration... especially if you're taking 30 mins for an interprox and getting paid 100USD.

There’s annoying crap that will always come up. Anyone that tells you otherwise is lying.

- dealing with staff drama
- gaggers
- labwork when they hire a new guy
- rude patients
- postoperative sensitivity
- numbing lower molars
- lower dentures

These are just a few.

If you want to cruise as a gp, buy a medium hygiene based practice in a unsaturated market and keep the referral pad close. Do a couple crown preps and several fillings a day. Minimal ppo involvement. You can do surprisingly well like that

Lower dentures... If you do lower dentures, make sure to throw in a few implants in there too. Otherwise, good luck with a world of adjustments and miserable patients. Numbing lower molars can be difficult if you're not doing an endo. I found that IA septo takes care of most of issues with lower molars, but for hot teeth, intrapulpal may be the only option. At least it's a one and done deal though.

The description from @TanMan is dead-on for how dentistry gets the longer you do it. I'm not quite at 10 years, but I've been doing it long enough. It gets clinically easier the longer you do it. For me, it was around year 5 where I figured out my comfort zone, got good with the bread and butter dentistry and decided what I should refer out. I tend to get annoyed at certain things too because sometimes, whatever you've done is good and the patient is the issue.

A lot of days for me are show up, do a bunch of fillings and some crowns, and see a bunch of hygiene patients. Then I leave.

Then there's the days where an assistant is out sick and now, I've got 4 columns while being short-staffed. I get walk-in emergencies that don't understand why I can't see them right this second. A patient calls to complain to me about how the insurance didn't pay for something. I have to do an MODBL on a wisdom tooth. I have to do an MODBL on a second molar. I have an easy extraction and break off a root tip. I'm doing a molar endo and suddenly, there's 5 hygiene checks. My MILF filling on #9 is perfect, but the patient hates it and I can't tell what's wrong with it. Patients get mad because I tell them they have cavities and they don't floss.

I'm pretty confident because I know what I'm doing and how to handle most situations. But patients are people and can be extremely unpredictable. For me, I'm at the point in my career where the procedures are relatively easy, some patients are not.

Are you having to field patient complaints about financials? Also, MODBL? Shouldn't that automatically become a crown? Sounds like a difficult office population/procedure mix if you have to do MODBL's and field insurance complaints. Only time I end up a 5 surface is is on the anterior and they don't want to get crowns/veneers. However, I make it a point to say it's a temporary fix.

The one thing that has kept my sanity in check is to not care more than the patients. If the patient doesn't care, then why should I? If the patient cares about their oral health, then I'm all for helping them. If not, the appointment is resolved in a few words: let me know when you're ready, we'll get you back on the right track. Those that don't heed the advice usually end up needing an rct, ext, and/or I&D.

 

[Saddleshoes]

does it ever get so easy you don’t even think about what you’re doing? Perhaps like driving a car?

Yes! Yes, it does for most of us with "hands".
However, there are a few of us that seem to be all "thumbs". The "thumbs" folks seem to get more dangerous as they move forward.

The point is do you ever get to the point as a dentist where you are extremely confident in yourself and don’t get uncomfortable

Read Malcolm Gladwell's book Outliers. He talks about this issue. He comes up with the 10,000 hour rule. (That would be 5 years of practice.) He says it takes 10,000 hours for practicing your craft to gain mastery of your craft. I think he is on to something with that 10,000 hour thing.

 

[monkeykey]

I have a feeling that you may struggle with self-satisfaction when you start out and managing your expectations of ppo/hmo patients along with striving for Macy's quality. Trying to deliver a Macy's product for dollar tree prices will eventually get to you, especially if you cannot deliver a Macy's product in a timely manner. Now, if you were to practice to be able to deliver a Macy's style product in a few minutes, then dollar tree prices wouldn't be so bad. However, it is this learning curve that would be your primary source of frustration... especially if you're taking 30 mins for an interprox and getting paid 100USD.

Are you looking at this from a revenue perspective? Otherwise I'm not sure I am understanding what you are trying to say because it seems like the same sentence twice to me. The Dollar Tree and Macy's part. Are you saying you can't delivery something good for a low price or that it will take too much time starting out to do higher quality work?

On an unrelated note, do you have any kind of business background or did you just seek all of the knowledge out yourself and try to see what works and what doesn't, in regards to running a practice?

 

[beannaithe]

Are you having to field patient complaints about financials? Also, MODBL? Shouldn't that automatically become a crown? Sounds like a difficult office population/procedure mix if you have to do MODBL's and field insurance complaints. Only time I end up a 5 surface is is on the anterior and they don't want to get crowns/veneers. However, I make it a point to say it's a temporary fix.

Haha, it's not that bad. I exaggerated a bit. MODBLs are almost always crowns unless the patient maxed their insurance. Then, it's a build-up, which is just really an MODBL, until the insurance turns over. PPO insurance doesn't go far. Usually, a crown, an endo and 2-3 fillings. I do a few MODBLs this time of year (and same day when I don't have time) and then, the patients finish up their crowns in January/February. The MODBL on a wisdom tooth is usually once a year, but it's enough to complain about forever.

I've been fielding more insurance questions from my patients because the front desk in my office is short staffed. So I deal with sone patients who want to know why an insurance company told them that their treatment wasn't "medically necessary." My theory is the quicker we get the pre-d's back, the quicker I do the work, the quicker I get paid.

 

[deleted721052]

The MODBL on a wisdom tooth is usually once a year, but it's enough to complain about forever.

serious question from a clueless D4: why would a MODBL be done on a 3rd molar? shouldn't we just extract it a this point? i can't even imagining having to do this, sounds like torture haha

 

[monkeykey]

What is a MODBL?

 

[TanMan]

Are you looking at this from a revenue perspective? Otherwise I'm not sure I am understanding what you are trying to say because it seems like the same sentence twice to me. The Dollar Tree and Macy's part. Are you saying you can't delivery something good for a low price or that it will take too much time starting out to do higher quality work?

On an unrelated note, do you have any kind of business background or did you just seek all of the knowledge out yourself and try to see what works and what doesn't, in regards to running a practice?

What I'm saying is that if you are getting reimbursed like a dollar tree, reimbursements makes it hard to deliver a higher quality product/service like Macy's. If your focus is on quality, but you are not able to deliver it in a timely manner required to make a profit when starting out (especially if getting reimbursed at PPO/HMO levels), then as an associate, you might starve, as an owner, you might go broke.

Parents are entrepreneurial/business owners. Somehow, working with them, I learned something from them. From that conceptual framework, I try things that I think should work, and adjust strategy accordingly.

Haha, it's not that bad. I exaggerated a bit. MODBLs are almost always crowns unless the patient maxed their insurance. Then, it's a build-up, which is just really an MODBL, until the insurance turns over. PPO insurance doesn't go far. Usually, a crown, an endo and 2-3 fillings. I do a few MODBLs this time of year (and same day when I don't have time) and then, the patients finish up their crowns in January/February. The MODBL on a wisdom tooth is usually once a year, but it's enough to complain about forever.

I've been fielding more insurance questions from my patients because the front desk in my office is short staffed. So I deal with sone patients who want to know why an insurance company told them that their treatment wasn't "medically necessary." My theory is the quicker we get the pre-d's back, the quicker I do the work, the quicker I get paid.

Ah, that is nice of you to do MODBL's. I refuse to do them since there's an expectation that they are going to hold up. Cheap and picky are the two worst combinations. I think I would go insane with an MODBL on a third molar; the only time I could foresee myself doing an MODBL would be as a same day prep for a crown. Buildup, cure, then prep.

Do you pre-d all of your major procedures? I don't talk to patients about financials at all. If they try to hold me verbally hostage, I say that we'll try and work something out and do a handoff to my staff. I find that procedures that resulted from neglect typically should be done the same day, otherwise, the patient's pattern of non-compliance/behaviors that resulted in required procedures is going to continue until the teeth become hopeless. Namely, perio/rct+crown is where I push for same day, no pre-d's, unless the insurance explicitly requires a pre-d. Otherwise, you will probably not see them for another few years for extractions.

Around this time, we find that the patient is more willing to forgo pre-d's due to the time it takes to receive one. We tell them that it takes weeks to receive them, and if it passes the calendar year, they lose their benefits for the year. That incentivizes them to take the risk of doing procedures that we normally pre-d during the rest of the year. I find that patients who bring up the "medical necessity" argument by the insurance are the ones that tend to try to opt for a "cheaper alternative" and the fact that they bring it up to my staff just shows that they tend to be bargain hunters. I remember yesterday that there was a patient that had the ADA codes that his insurance covered. In my mind, this isn't Mexico where you point at what kind of procedure you want and I'll do it for you. I let him know what he had, what/why he needs it, and if he wants it, get it, if not, good luck. I prefer these kinds of patients compared to cheap+millions of questions, because it's short and simple, and I don't have to waste much time.

serious question from a clueless D4: why would a MODBL be done on a 3rd molar? shouldn't we just extract it a this point? i can't even imagining having to do this, sounds like torture haha

If it's a functional upright molar used for mastication (especially if they are missing a 2nd or 1st molar), then it becomes a bit more valuable to save. You could also extract it, or autotransplant into a failing 1st or 2nd molar site. I'm not a fan of direct restorations on 3rd molars unless there's a functional reason to do so, but you have to explain to the patient the reason that it got caries in the first place. The patient need to clean the area better to prevent recurrent caries, otherwise, you end up extracting in the future.

What is a MODBL?

5 surface direct restoration (a filling that encompasses all 5 surfaces of a tooth).

 

[beannaithe]

serious question from a clueless D4: why would a MODBL be done on a 3rd molar? shouldn't we just extract it a this point? i can't even imagining having to do this, sounds like torture haha

We don't always extract them because the patient might have a medical condition that precludes it (bisphosphonate use is a biggie). That might be the only molar remaining if 1st and 2nd are missing. The patient might already have a big restoration there and need for it to be replaced. Crowning is a nightmare because getting a margin is hard. Then, there's the clinical height issue. If the prep is short to get clearance, it's hard to get the crown to stay predictably. Personally, I usually restore or extract. I crown one every few years and it is literally torture for everyone involved.

And @TanMan , that's the breaks of being an associate unfortunately. Gotta follow the treatment planning philosophy of the office that you work for. We've always waited for pred's/done build-ups at the end of the year. You can't be more aggressive than the owner because then, patients think you're greedy. So I tend to wait a little more/treatment plan slower.

 

[TanMan]

We don't always extract them because the patient might have a medical condition that precludes it (bisphosphonate use is a biggie). That might be the only molar remaining if 1st and 2nd are missing. The patient might already have a big restoration there and need for it to be replaced. Crowning is a nightmare because getting a margin is hard. Then, there's the clinical height issue. If the prep is short to get clearance, it's hard to get the crown to stay predictably. Personally, I usually restore or extract. I crown one every few years and it is literally torture for everyone involved.

And @TanMan , that's the breaks of being an associate unfortunately. Gotta follow the treatment planning philosophy of the office that you work for. We've always waited for pred's/done build-ups at the end of the year. You can't be more aggressive than the owner because then, patients think you're greedy. So I tend to wait a little more/treatment plan slower.

Yes, I suppose that is true as an associate, especially if the patient you're treating has a preexisting relationship with the owner, and the owner has defined their relationship in that manner. It's unfortunate that some clients we inherit from other offices expect their relationship to be the same, especially when said offices have coddled or babied them too much. Goes back to high maintenance, low pay type of client. I've been getting a lot of that lately and it can be quite aggrevating when they are venting about how much they paid to that other high maintenance office and how they don't have any money to proceed further, but expect me to continue their treatment for almost free. This type of behavior seems more prevalent during the holiday season, as people seem to scramble for funds.

I think the important lesson for future practice owners would be to define the relationship between your patient early on and don't let the patient step over you unless that's what you want.

 

[2TH MVR]

>26 years of practice. Yes. It does get easier. Everything does once you are experienced. I have literally seen just about everything regarding orthodontic Dx and Tp. With experience comes confidence. Same with dealing with patients. Treating teeth is easy. Treating patients is another issue altogether. Early on .... most of us will try to please every patient. With time .... you'll realize this is not possible. Your life will be substantially better once you learn to not let that patient's poor behavior affect your attitude for that day and when you come home to the family. What is poor behavior? For myself it is the patient that questions everything you do (lack of respect) and tries to dictate treatment (they're not the dr. .... they are the patient). I've refined my patient behavior technique over the years. It's almost a game to me now.

Re: the MODBL on the 3rd molar. Someone made the comment that it is just a 3rd molar. Let's just extract it. You have to change your thinking from being a single tooth fixer to enhancing a patient's overall occlusion, facial esthetics, masticatory function, TMJ health, etc. etc. One example of when you want to save a wisdom tooth is if that patient had upper 1st bicuspids extracted for ortho reasons. I PREFER to maintain the upper 3rds and have the lower 3rds extracted assuming that the upper 3rds are viable. 4 bicuspids extracted for ortho .... let the 3rds erupt and see how they function. But remember .... teeth like opposing contacts.

 

[Saddleshoes]

>26 years of practice. Yes. It does get easier. Everything does once you are experienced. I have literally seen just about everything regarding orthodontic Dx and Tp. With experience comes confidence. Same with dealing with patients. Treating teeth is easy. Treating patients is another issue altogether. Early on .... most of us will try to please every patient. With time .... you'll realize this is not possible. Your life will be substantially better once you learn to not let that patient's poor behavior affect your attitude for that day and when you come home to the family. What is poor behavior? For myself it is the patient that questions everything you do (lack of respect) and tries to dictate treatment (they're not the dr. .... they are the patient). I've refined my patient behavior technique over the years. It's almost a game to me now.

Truth!!!!
---After a few years the patient behavior game is the most fun part of the day.

 

[TanMan]

>26 years of practice. Yes. It does get easier. Everything does once you are experienced. I have literally seen just about everything regarding orthodontic Dx and Tp. With experience comes confidence. Same with dealing with patients. Treating teeth is easy. Treating patients is another issue altogether. Early on .... most of us will try to please every patient. With time .... you'll realize this is not possible. Your life will be substantially better once you learn to not let that patient's poor behavior affect your attitude for that day and when you come home to the family. What is poor behavior? For myself it is the patient that questions everything you do (lack of respect) and tries to dictate treatment (they're not the dr. .... they are the patient). I've refined my patient behavior technique over the years. It's almost a game to me now.

Re: the MODBL on the 3rd molar. Someone made the comment that it is just a 3rd molar. Let's just extract it. You have to change your thinking from being a single tooth fixer to enhancing a patient's overall occlusion, facial esthetics, masticatory function, TMJ health, etc. etc. One example of when you want to save a wisdom tooth is if that patient had upper 1st bicuspids extracted for ortho reasons. I PREFER to maintain the upper 3rds and have the lower 3rds extracted assuming that the upper 3rds are viable. 4 bicuspids extracted for ortho .... let the 3rds erupt and see how they function. But remember .... teeth like opposing contacts.

Do you find that upper 3rds tend to supraerupt and cause issues in terms of cheek biting or oral hygiene issues? I've been seeing my share of cases where I had to extract the upper 3rds when the lowers were removed due to caries/perio/uncomfortable function. What are the benefits of leaving the 3rds when extracting the upper 1st bi's? Will they fall into the slot of the 2nd molars? I'm just curious as it seems like each ortho has their own treatment philosophy, but I usually defer to the orthodontist as the quarterback of the case.

On another note, I find that the patient behavior isn't what ruins the day, it's the time consumed managing that behavior that ends up cascading into other appointments that increase the stress without much considerable production gain. Does that ever stress you out when you got a massive time wasting appointment when you have a lot of other patients to treat?

Truth!!!!
---After a few years the patient behavior game is the most fun part of the day.

Man, I wish I had your mindset of poor patient behavior. It's the most annoying part, especially when I have other things to do besides managing bad behavior. Perhaps I have not practiced long enough to enjoy the game.

 

[2TH MVR]

Do you find that upper 3rds tend to supraerupt and cause issues in terms of cheek biting or oral hygiene issues? I've been seeing my share of cases where I had to extract the upper 3rds when the lowers were removed due to caries/perio/uncomfortable function. What are the benefits of leaving the 3rds when extracting the upper 1st bi's? Will they fall into the slot of the 2nd molars? I'm just curious as it seems like each ortho has their own treatment philosophy, but I usually defer to the orthodontist as the quarterback of the case.

1.If no lower 3rds .... yes ....best to extract upper 3rds because they will supra-erupt without an opposing contact.
2.Ortho extractions #5 and #12 in a young pt with a Class 2 malocclusion. Allow upper 3rds a chance to erupt and slot over the lower 2nd molars. But lower 3rds will require extraction.
3. Ortho extractions #21 and #28 in a young patient with a class 3 malocclusion. I like to wait a little longer to make a decision on the 3rds. In younger pts ... erupting lower 3rds can further complicate the class 3 correction.
4..Ortho extractions 4 bicuspids in a young pt. Allow all 3rds the chance to erupt.
5. Ortho nonextraction cases. Odds are all 4 3rds will require extraction.
6. Orthognathic surgery cases. OMFS usually like all the 3rds removed well before surgery.
You can always extract them later. Why extract them prophylactically just because they are 3rds? No reason. Give them a chance in a young patient. Of course all these rules default to perio, caries, etc.
I usually make a decision on younger pts around age 16-18 to prophylactically remove the 3rds based on the above guidelines.
Again ... these are younger pts. The rules are probably different for the adults.

 

[BingDent]

I am 11 years out.
Good news, everything gets easier over time - from ALL clinical, business skills, patient communication, etc.

BUT never boring, as you are faster, your schedule less time per procedure.

You also assess your skill level better and focus on the procedures you are good at and refer out the ones you are not so good at.

 

[AONLINE]

What is pre-d? Is that the same as pre-authorization with insurance?


Sent from my iPhone using SDN

 

[TanMan]

What is pre-d? Is that the same as pre-authorization with insurance?


Sent from my iPhone using SDN

Yep. Some insurances are notorious in not honoring pre-auths, so it's not the golden gospel/end-all for some insurances. We have a record of what insurances pay w/ or w/o a pre-auth, and adjust risk accordingly. Most will pay for rctbucrown without a preauthorization

 

[gryffindor]

Yes it gets easier. You learn your limits and you learn to not care when the patient doesn't agree with you and leaves your practice.

The part that has yet to get "Easy AF" is managing staff. I can have all the confidence in the world, but I can't stop an employee from leaving tomorrow and the office flow is immediately thrown off. Now I have to spend time and energy hiring someone to keep things rolling smoothly. And when they need to be trained which is most of the staff you will have the luxury to hire, it doesn't roll smoothly for a long while.