New Job Offer, low % production being justified with high fees

[Drfunnyteeth]

Hello,

I have been offered a job with a group that does very some niche dentistry with special needs patients, they also see very "healthy, wealthy" patients as well.
The job will include non-service work to help market and grow the group. The job can also be very physically demanding (beyond typical private practice) as some patients are limited in changing positions, so it can be a lot of standing for hours or having to hunch over.

The contract offer is :
Independent contractor
$500/service day or 20% of the fees (They are FFS)
They justify the 20% by saying they have higher fees than other offices
Lab fee: I pay 40% and can choose the lab

Example fees (they do have a sliding fee scale tho):
NP exam is $500
Recall: $400
Fillings (regardless of surface number): $300
4 quads SRP: ~$1000
Simple extraction: $450
Crown is $1800

I am concerned about being labeled as an Independent because I won't be paying rent, the employees, or bringing my own instruments. And I think the compensation is low and the lab fee % too high, but wanted to get feedback from others who may be more familiar with salaries and negotiations.

Thanks for any help!

---

Members don't see this ad.

 

[PerioDont]

That’s an interesting offer. I would look at a typical day schedule. Wonder if they have enough pts for you to see

 

[Drfunnyteeth]

The days we see special needs patients, it may only be 1-4 pts. They are building their in-office presence more though. So, it will be slow to start, which is why some of my work will include marketing the office, going to conferences and events

 

[Rayne1156]

Don’t walk… RUN. YOU ARE BEING CHEATED AND SLAPPED! 20% production!! A joke… and you’re paying 40% lab bill?! Baddd idea. Keep looking.

 

[T00thDr]

The days we see special needs patients, it may only be 1-4 pts. They are building their in-office presence more though. So, it will be slow to start, which is why some of my work will include marketing the office, going to conferences and events

There is a chance that you'll see ONE patient?

If they have sliding scale you can guarantee that you will be the one that gets all of those patients (which will be a majority of the special needs patients as most are already on sliding scale fee programs elsewhere)

Marketing the office?

This offer sound like a living, breathing hell.

You should just plan on getting the $500 per day. If that is the case you can go get a TON of wonderful experience working with special needs patients in a FQHC in your area and make $700 per day. I have four years experience and make $850 per day and work with the exact population you are interested in working with.

Obviously I don't have a ton of wiggle room to move up in pay and you may at a private practice... But, at the point where you feel like you should make more money (and now you have experience) you can just move to another office.

Good luck with the decision.

 

[Screwtape]

There is a chance that you'll see ONE patient?

If they have sliding scale you can guarantee that you will be the one that gets all of those patients (which will be a majority of the special needs patients as most are already on sliding scale fee programs elsewhere)

Marketing the office?

This offer sound like a living, breathing hell.

You should just plan on getting the $500 per day. If that is the case you can go get a TON of wonderful experience working with special needs patients in a FQHC in your area and make $700 per day. I have four years experience and make $850 per day and work with the exact population you are interested in working with.

Obviously I don't have a ton of wiggle room to move up in pay and you may at a private practice... But, at the point where you feel like you should make more money (and now you have experience) you can just move to another office.

Good luck with the decision.

I agree entirely with this. This sounds like a bad deal. Are you having a tough time finding better opportunities? What makes you interested in this one?

 

[nobeldds]

Pretty much nothing about this job sounds good.
Cons:
- really challenging patients
- not enough patients
- very low daily minimum
- ownership doesn’t have any respect for your time (offered you $500/day minimum)
- very low pay %
- very high lab

This job sounds very difficult. If they offered $800/day at 25% of production and no lab bill then it would be worth considering but this is a joke.


High fees are NOT a justification for a low %. There is a reason why a patient would pay that money, and your service is a huge part of that. Also, it would be far better to be paid a high % of low fees than a low % of high fees. This is just a terrible job offer

 

[Drfunnyteeth]

They do house calls. That is a big aspect of it. So, the days that would be 1-4 pts, it is the house call days. It would presumably be closer to 8-12 patients for in-office, but they are just growing that side of the practice now. The house call aspect is really unique and pretty amazing. They only have one other doctor and they only do house calls two days a week. I would be working on different days building my patient base.

It is only for two days a month to start and then adding days as the patient base grows. They have an office in another city that is already built out like this and is actually really busy, and they want to grow this location to that level. I spent a few days at the other office and the employees are happy and the experience would be great, which is why I want to make it work, but I definitely want to negotiate the deal.

I already work at another office and get experience there with digital dentistry, private and medicaid pts. So, I'm not taking it out of necessity.

 

[Torshammer]

20%? I would decline based on principle alone to be honest. That's not fair.

 

[Screwtape]

They do house calls. That is a big aspect of it. So, the days that would be 1-4 pts, it is the house call days. It would presumably be closer to 8-12 patients for in-office, but they are just growing that side of the practice now. The house call aspect is really unique and pretty amazing. They only have one other doctor and they only do house calls two days a week. I would be working on different days building my patient base.

It is only for two days a month to start and then adding days as the patient base grows. They have an office in another city that is already built out like this and is actually really busy, and they want to grow this location to that level. I spent a few days at the other office and the employees are happy and the experience would be great, which is why I want to make it work, but I definitely want to negotiate the deal.

I already work at another office and get experience there with digital dentistry, private and medicaid pts. So, I'm not taking it out of necessity.

If it’s only two days a month and you already have a full time job and this new opportunity is really interesting to you then I guess I would say go for it. I probably would try to negotiate some of those numbers but if this is something you are passionate about and don’t need the money then look at it as more of a high paying hobby?

 

[DrJeff]

They do house calls. That is a big aspect of it. So, the days that would be 1-4 pts, it is the house call days. It would presumably be closer to 8-12 patients for in-office, but they are just growing that side of the practice now. The house call aspect is really unique and pretty amazing. They only have one other doctor and they only do house calls two days a week. I would be working on different days building my patient base.

It is only for two days a month to start and then adding days as the patient base grows. They have an office in another city that is already built out like this and is actually really busy, and they want to grow this location to that level. I spent a few days at the other office and the employees are happy and the experience would be great, which is why I want to make it work, but I definitely want to negotiate the deal.

I already work at another office and get experience there with digital dentistry, private and medicaid pts. So, I'm not taking it out of necessity.

The house calls aspect, especially since it seems like a regular thing, would be a BIG red flag for me personally. Just simply because I don't care how good of a portbale hand piece system/light/x-ray head/suction system/etc you have, it's going to be a step down, and often a significant step down from what you have in your operatory in your practice, and that will affect the quality of care you can given, even if it's just a denture adjustment.

Red flag #2 (and a reality that most anyone who has been in practice for a while and sees special needs patients knows all too well). The majority of special needs patients aren't affulent, and more than likely are on medicare/medicaid, both of which have very limited fees schedules and approved treatments, which will affect what you can collect from those patients and the work you may do on them.

Has that office shown you the actual numbers, especially of those full fee $500 new patient exams, that they have done over the last few years to get some perspective as to how many full fee exams they actually do, verses how many total exams they actually do as well as what the percent collection on those $500 exams is?

 

[PerioDont]

The house calls aspect, especially since it seems like a regular thing, would be a BIG red flag for me personally. Just simply because I don't care how good of a portbale hand piece system/light/x-ray head/suction system/etc you have, it's going to be a step down, and often a significant step down from what you have in your operatory in your practice, and that will affect the quality of care you can given, even if it's just a denture adjustment.

Red flag #2 (and a reality that most anyone who has been in practice for a while and sees special needs patients knows all too well). The majority of special needs patients aren't affulent, and more than likely are on medicare/medicaid, both of which have very limited fees schedules and approved treatments, which will affect what you can collect from those patients and the work you may do on them.

Has that office shown you the actual numbers, especially of those full fee $500 new patient exams, that they have done over the last few years to get some perspective as to how many full fee exams they actually do, verses how many total exams they actually do as well as what the percent collection on those $500 exams is?

Yeah I’m curious about how many 500 dollar exams they are actually collecting as well.

I work with this population with our GPR clinic and there is no way in hell 90% of them are paying these fees.

 

[Saddleshoes]

Look at this place from the patient's prospective...
With fees like that why would anybody chose to go there?
The answer is they have no choice in where they go due to the "life challenges" this patient group is facing.

While it is noble to care for these folks, doing it exclusively is financial suicide.

 

[Drfunnyteeth]

I definitely won't rely on this job for finances. It is just a chance to learn a lot, in terms of patient care, but also for growing an office. So, in that regard, I know it will be slow, which is why I have another office I'm at. I submitted my counter offer in regards to contract clauses and the salary and we will see what happens.

 

[schmoob]

This seems very odd to me. Also, house calls? Even with an $1800 crown you are going to someone’s house (which I wouldn’t feel comfortable with) and prepping a tooth in an uncomfortable environment and hauling around all the equipment and materials, all for $360 BEFORE lab fees? I agree that there are way too many red flags and you WILL run into issues with the owners

 

[dentalfinder]

What is the norm of compensation for a GP in different states around the country? Anyone in Washington state Seattle area? How much is the minimum daily or % of production for associate dentist?

 

[yappy]

The house calls aspect, especially since it seems like a regular thing, would be a BIG red flag for me personally. Just simply because I don't care how good of a portbale hand piece system/light/x-ray head/suction system/etc you have, it's going to be a step down, and often a significant step down from what you have in your operatory in your practice, and that will affect the quality of care you can given, even if it's just a denture adjustment.

Red flag #2 (and a reality that most anyone who has been in practice for a while and sees special needs patients knows all too well). The majority of special needs patients aren't affulent, and more than likely are on medicare/medicaid, both of which have very limited fees schedules and approved treatments, which will affect what you can collect from those patients and the work you may do on them.

Has that office shown you the actual numbers, especially of those full fee $500 new patient exams, that they have done over the last few years to get some perspective as to how many full fee exams they actually do, verses how many total exams they actually do as well as what the percent collection on those $500 exams is?

Seriously. House calls were useful for "talk/rx" physicians when the telephone didn't have video and transportation was difficult. It's a huge step backwards to do it today unless it's via telehealth. As a dentist, you need a well-equipped operatory, that is ergonomic, to do good treatment. I wouldn't even examine a patient without a modern dental chair.