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Most common procedures seen in private practice?

Discussion in 'Dental' started by fug, Jul 21, 2011.

  1. fug

    fug
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    What are the most common procedures general dentists perform during an average day in private practice?

    I've been thinking a lot lately about the push in many states to create programs to train "advanced dental hygiene practitioners" and what effect that may have on the productivity of dentists. Obviously this is not at the point where a hygienist would be able to independently open up shop next to a dentist and start filling cavities at half price, but I see it becoming a very real possibility down the road.

    How much of a general dentist's working day could be just as easily performed by someone with only a few years of additional training after high school? I realize that there are bound to be cases that are simply beyond the scope of a hygienist's training, but are they common enough to keep a general dentist financially afloat?

    Thanks.
     
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  3. mike3kgt

    mike3kgt Hopefully scuba diving
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    Personally, the most common procedure I do is exercising my muscles of masti-cation.

    Yup. I have a low fee for this procedure as well so I am able to increase my volume in this subject matter. Greatly improved my lifestyle :)
     
  4. SeattleRDH

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    First off, ADHPs would have a masters degree so "only a few years additional training after high school" is a gross understatement.

    Second, no mid-level provider can be sustainable working independently. The cost of running an office is too great without high production procedures such as crown and bridge.

    Third, the ADA and state dental organizations have exponentially more lobbying power than the ADHA and state hygiene organizations.

    As to the original question, common procedures are:

    Dr's column:
    Fillings $150-400 depending on size
    Crowns $800-1200
    Bridges $2000-2500
    Endo $800-1000
    Extractions $150-200
    Xrays each $15-30

    Hyg's column:
    Prophies $90-110
    SRP (deep cleaning) $180-220 per quadrant
    Sealants $40-50
    Xray series $60-90
    These are just ballpark figures but you can see that it would take a hygienist a whole day of prophies to equal one crown.
     
  5. fug

    fug
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    Are you licensed to masticate?

    From what I understand, hygienists currently only need to complete a 2-year program after high school to work in a dental office. Although the curriculum that is being proposed to train advanced dental hygiene practitioners (ADHPs) is being touted as a Master's program, applicants don't need to have earned a Bachelor's degree before enrolling.

    Thanks for the info, but I was asking about the frequency of these procedures, not their cost.

    Also, under some of the proposals that are popping up in various states, ADHPs would be able to perform fillings and simple extractions, so those should be included in the Hygienist's column as well.

    True, but your average ADHP isn't going to be graduating with >$300,000 in debt, so he/she will likely be able to afford to offer these procedures at a discounted rate.
     
  6. DrJeff

    DrJeff Senior Member
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    Nope, the average ADHP is projected to have somewhere around 100-125k in debt. Given what an "average" hygienist makes, it is also theorized that the ADHP will have an "expected" earnings of about 100k a year, which would allow them to be able to repay their loan obligations, and live a "normal" lifestyle. From a practice management standpoint with what overhead typically runs, that ADHP will need to produce 200k (very low end number, very low overhead) to 300k+ to make him/her self sufficient and not have to rely on government aid to remain open.

    As for him/her being able to "afford" to offer procedures at a discounted rate, maybe they'll choose to, maybe they won't?? That's the autonomy of a dental practice, you can choose what you want to charge (of course things like market demand will influence things).

    The biggest issue that I personally have with any mid level provider concept out there right now, isn't about some new level of practitioner and their ability to perform a procedure in a safe and quality way, but with the grandiose idea that many a legislator and backer of whatever midlevel provider model you want seems to have that a midlevel provier will suddenly cure the access problem (if there is indeed actually an access problem). No matter how hard any legislator tries, short of them declaring martial law and instituting dental care in the style the the military currently does where going to the dentist is mandatory, not a choice, there will never be 100% of the population receiving dental care, even if it is totally free to them. This concept seems lost on those trying to institute a 100% access plan, that UTILIZATION of care won't be 100%!

    If people trying to improve access to care would be realistic and say that if we could get utilization to be say 60-65% (even for the "free" medicaid population its still below (and often well below) 50% nationwide) that would actually have them focusing on using the LIMITED pool of resources (read a $$ to provide care) on actualy providing care, rather than planning on ways to try and get that 1/3rd of the population that just won't seek out care no mattter what! Take that money and put it towards making the fees that medicaid reimburses providers be a realistic fee (in many cases that means raising the fees to the point where it actually covers the overhead the provider incurs for that procedure/visit). This was done in my home state of CT about 3 years ago, and suddenly the number of medicaid provider dentists statewide went from less than 100 to over 1200, and for medicaid kids (age 21 and under in CT) multiple research firms and the state department of health have determined that at just under 50% utilization rate, that we have one of the top 3 utilization rates in the country and that there is no longer an access "problem" in CT.

    Any rational midlevel discussion HAS to include this concept of UTILIZATION of care, not just "access" to care.
     
  7. mike3kgt

    mike3kgt Hopefully scuba diving
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    A+ Jeff as always.

    Don't forget about reduction of medicaid 'hassle'. Make the system better, more profitable for the dentist, less costly to the taxpayer, and ultimately more efficient for the recipient. It's possible!
     
  8. SeattleRDH

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    As far as the frequencies of procedures it depends on the office and patient base. I'm sure every dentist would love to have back to back crowns but that is not realistic. Diagnosing can vary from dentist to dentist (sometimes drastically) and where one office averages 80/20 fillings to crowns, another might be 50/50.

    The education and licensing of dental hygienists differs by state. I can only speak to my experience here in Washington where we are all licensed and trained in anesthetic and restorative:
    It took a year to complete the prerequisites to be able to apply to hygiene school. The program was 7 quarters of clinical and didactic courses (7:30am to 4:30pm M-F). The only way to be a competitive applicant was to either have completed a bachelors degree or have a minimum of 2 years working as a dental assistant. The youngest person in my class was 21. I went $80,000 in debt just for my prereqs and hygiene school (luckily my dad payed for my prior bachelors).

    My understanding of the ADHP as it has been discussed at WSDHA (Washington state dental hygiene association) meetings is that one would need to do a degree completion program to attain a bachelors prior to applying to an ADHP program. As it stands now, there is a Masters in Dental Hygiene program at UW that is designed for dental hygiene educators. All of the students in that program had to complete a bachelors. The ADHP would be the same only with advanced clinical aspects.

    But, really, I don't think a midlevel provider is sustainable as an independent practitioner. The biggest way that they can threaten a private practice is by working in a dental chain/managed care type of setting where there is one dentist and many midlevels. This already exists to some degree with expanded functions hygienist like here in Washington.

    The successful private practices in the Seattle area utilize restorative hygienists and compete effectively with those 'undercutting' corporate chains. All offices really are going to have to at this point because WDS insurance just cut reimbursements by 15%. The way it works in our office is my Boss's column mostly has high production items like crowns, bridges, and implants. There is me and one other hygienist who do traditional hygiene and most of the fillings (Dr. drills of course). The 2 assistants help out in all procedures and also have a chair for Zoom whitening and child prophies. We have almost 2000 active patients which would usually warrant hiring an associate, but our office is such a well-oiled machine in utilizing expanded functions support staff that it's not needed. Staff salary overhead is 25%. My boss makes good money.

    Now I wonder, why are there no restorative hygienists in most of the US? It seems like a better solution than independently practicing midlevels.
     

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