problems with producing at work

[mrlantern]

---

Members don't see this ad.

About two months ago I accepted a part-time GP position. The salary was 30% of production with a $330 daily guarantee. Being it rare that a nyc-based clinic would offer guarantees, I steadfastedly took the offer.

Now two months down the road, I am having problems with productions. To break even with my daily guarantee, I would have to produce a minimum of $1100 per day.

The problems is, it's hard to produce even $900 per day. The clinic has skank assistants that talk behind my back, old equipment and lackadaisical supplies, 75% no shows ( at the same time, spontaneous new patients that suddenly arrive in the same hour and you HAVE to treat them in multiple operatories ), contracts with crappy dental labs, strange patients, and very low union insurance reimbursements that the office heavily relies on.

For example, just yesterday, I did 15 composite fillings, two molar exos, delivered full upper and lower dentures, 12 quads of scaling, and 3 new patient exams. I did as much as I could. At the end of the day, my day production was scored as $750 only. I have one colleague dentist who works besides me and somehow he produces $1500-$2000/day regularly and loves being there for the money. I don't know how he does it but he always ends up doing twice as much as I do.

My boss isn't accepting any of my excuses for my production. He's not ( yet? ) threatening to fire me but he always nags me on production, which I am acutely aware of but don't know what to do. I also feel guilty about days when I received the $330 daily guarantees but produced even less than $600 on some days.

Please help. Is there a trick that I don't know about when working in this type of practice culture?

 

[K2 Dental]

First off... I think this would better serve you being posted on either Dentaltown or Newdocs.com.

You stated that you did multiple fillings, Root planing and exts. How does this only equal $750? Are you working at a PPO/HMO office?

$350/day minimum is very low. But to be fare... you are not producing. How is your diagnosing? How are your treatment planning/presentation skills. Are you too conservative? How are your chairside manners? How is your speed? These are all things that I would look at first. It may just be the clinic you are in. More info is needed.

 

[mrlantern]

First off... I think this would better serve you being posted on either Dentaltown or Newdocs.com.

You stated that you did multiple fillings, Root planing and exts. How does this only equal $750? Are you working at a PPO/HMO office?

$350/day minimum is very low. But to be fare... you are not producing. How is your diagnosing? How are your treatment planning/presentation skills. Are you too conservative? How are your chairside manners? How is your speed? These are all things that I would look at first. It may just be the clinic you are in. More info is needed.

I don't know how they equal $750 in total but one thing for sure is that all of clinic's patients have union insurances and the dental reimbursements are very low. And I have the same production problems daily.

As for diagnosing and treatment planning, I generally find many reasons to do an exo, filling, or an rct/crown. Getting the patients' consent usually isn't the problem since their plans provide most dental coverage. The problem is that patients don't ever want to return for treatment. They want everything done on the same day, and they don't like waiting for an extra hour or two. There is also no concept of time in the clinic. The clinic wants dentists to treat multiple patients simultaneously. ( can you imagine rushing through an emergency molar endo because there's a second patient that's been waiting at least 40 minutes for an exo and a third patient who is pissed because he was waiting for 30 minutes for a full exam and cleaning ? )

Like I said, there's another dentist working there who produces $1500-$2000 daily with this fee schedule. So apparently my employer isn't buying any of my excuses. I really don't know how much faster I can get with doing dentistry. My hands and back are always aching when I get back home from this clinic and I'm at a loss on what I should do because I find that even crappy dentistry takes time to do.

 

[NAVY DDS 2010]

If you are telling the truth and are stating all the facts, then there is only one thing that we can say - you are getting screwed!!!! There is no way that the numbers you claim you performed the other day only amount to $750. If you are given a report stating these values, then keep them because one day you will probably be able to get a nice settlement from the company you are working for when you slap a lawsuit on them for cheating you. Keep track of EVERY procedure you perform and get a price list the clinics charges for the various procedures performed. from that proce list you can determine how much you actually produced and can see the difference from what they are claiming you produced.

About two months ago I accepted a part-time GP position. The salary was 30% of production with a $330 daily guarantee. Being it rare that a nyc-based clinic would offer guarantees, I steadfastedly took the offer.

Now two months down the road, I am having problems with productions. To break even with my daily guarantee, I would have to produce a minimum of $1100 per day.

The problems is, it's hard to produce even $900 per day. The clinic has skank assistants that talk behind my back, old equipment and lackadaisical supplies, 75% no shows ( at the same time, spontaneous new patients that suddenly arrive in the same hour and you HAVE to treat them in multiple operatories ), contracts with crappy dental labs, strange patients, and very low union insurance reimbursements that the office heavily relies on.

For example, just yesterday, I did 15 composite fillings, two molar exos, delivered full upper and lower dentures, 12 quads of scaling, and 3 new patient exams. I did as much as I could. At the end of the day, my day production was scored as $750 only. I have one colleague dentist who works besides me and somehow he produces $1500-$2000/day regularly and loves being there for the money. I don't know how he does it but he always ends up doing twice as much as I do.

My boss isn't accepting any of my excuses for my production. He's not ( yet? ) threatening to fire me but he always nags me on production, which I am acutely aware of but don't know what to do. I also feel guilty about days when I received the $330 daily guarantees but produced even less than $600 on some days.

Please help. Is there a trick that I don't know about when working in this type of practice culture?

 

[OceanDMD]

If you are telling the truth and are stating all the facts, then there is only one thing that we can say - you are getting screwed!!!! There is no way that the numbers you claim you performed the other day only amount to $750. If you are given a report stating these values, then keep them because one day you will probably be able to get a nice settlement from the company you are working for when you slap a lawsuit on them for cheating you. Keep track of EVERY procedure you perform and get a price list the clinics charges for the various procedures performed. from that proce list you can determine how much you actually produced and can see the difference from what they are claiming you produced.

Sure there is. Medicaid, Capitation, or HMOs. Poor private insurance or goverment reimbursement.

 

[mike3kgt]

I don't know how they equal $750 in total but one thing for sure is that all of clinic's patients have union insurances and the dental reimbursements are very low. And I have the same production problems daily.

As for diagnosing and treatment planning, I generally find many reasons to do an exo, filling, or an rct/crown. Getting the patients' consent usually isn't the problem since their plans provide most dental coverage. The problem is that patients don't ever want to return for treatment. They want everything done on the same day, and they don't like waiting for an extra hour or two. There is also no concept of time in the clinic. The clinic wants dentists to treat multiple patients simultaneously. ( can you imagine rushing through an emergency molar endo because there's a second patient that's been waiting at least 40 minutes for an exo and a third patient who is pissed because he was waiting for 30 minutes for a full exam and cleaning ? )

Like I said, there's another dentist working there who produces $1500-$2000 daily with this fee schedule. So apparently my employer isn't buying any of my excuses. I really don't know how much faster I can get with doing dentistry. My hands and back are always aching when I get back home from this clinic and I'm at a loss on what I should do because I find that even crappy dentistry takes time to do.

Been there, done that. I sucks and won't get ANY better. This sounds like a medicaid office or heavy HMO. I would run far away from this "practice" and either 1. move out of NYC or 2. tough it out and find a better job (if possible!)

$330 /day guaranteed is very low even for first year out of school, I know NYC is a tough market, but it's quite low.

In terms of production, even in a medicaid office, one can produce big numbers in dentistry, however, I don't know if it's possible in NY. In Ohio, we have EFDAs that can place & adjust restorations. How we made it work here was prepping several teeth (3-20) and letting the EFDA go to town. We had two of them that would work along side of the dentist. I could spend time working on patients, doing RCTs or EXTs while they were restoring. We routinely produced $3,000 - 4,000 a day but 25-50% of the time we could produce 4,000 - 11,000 (my personal best). I was paid on a production bonus, but not 30%... it was quite less.

Knowing what I know about a dental practice now, I would take nothing less than $500 / day and 30% above $1,650. That would be the equivalent salary of $120k a year base with production bonus incentive.

Best place to be right now is in a stable, growing community suburb of a metropolitan area with a good housing market and stable job market. Also you can try rural to gain some practice experience. Good places to work are out there, but I doubt you will find that anywhere between SoHo and the Bronx unless you have a family or close friend that's a dentist.

 

[DrJeff]

About two months ago I accepted a part-time GP position. The salary was 30% of production with a $330 daily guarantee. Being it rare that a nyc-based clinic would offer guarantees, I steadfastedly took the offer.

Now two months down the road, I am having problems with productions. To break even with my daily guarantee, I would have to produce a minimum of $1100 per day.

The problems is, it's hard to produce even $900 per day. The clinic has skank assistants that talk behind my back, old equipment and lackadaisical supplies, 75% no shows ( at the same time, spontaneous new patients that suddenly arrive in the same hour and you HAVE to treat them in multiple operatories ), contracts with crappy dental labs, strange patients, and very low union insurance reimbursements that the office heavily relies on.

For example, just yesterday, I did 15 composite fillings, two molar exos, delivered full upper and lower dentures, 12 quads of scaling, and 3 new patient exams. I did as much as I could. At the end of the day, my day production was scored as $750 only. I have one colleague dentist who works besides me and somehow he produces $1500-$2000/day regularly and loves being there for the money. I don't know how he does it but he always ends up doing twice as much as I do.

My boss isn't accepting any of my excuses for my production. He's not ( yet? ) threatening to fire me but he always nags me on production, which I am acutely aware of but don't know what to do. I also feel guilty about days when I received the $330 daily guarantees but produced even less than $600 on some days.

Please help. Is there a trick that I don't know about when working in this type of practice culture?

You did 34 procedures by my count and only racked up $750 in production?? Either your getting royally screwed when your production is being entered or those fees are so ridiculously low that you NEED to leave.

15 composite fillings alone, even in a low fee scale should be atleast $1500 in production! 12 quads of scaling once again even with very low fees should be atleast $1200 in production, and if where you work bills for the denture on the insert date (not the start date) at the absolute lowest of low fees that should have been another $1000 in production (more realistically atleast $1500-$2000 and still be on the low side).

Track your production like a hawk and if they won;t show you their records vs. your records, well then that's all you need to know about what they're doing to you!

 

[kiji talons]

i will say what everyone is thinking but will not say. look at their insurance plan before you do the examination. if they definitely need an ext, rct, fill, srp, etc...do it, but we all know there is a gray area for other stuff. if they have bad insurance, diagnose conservatively. if they have good insurance, diagnose more aggresively. also, with those capitation plans, charge out for every single procedure that you do. there are codes for stuff such as pulp vitality tests and desensitization if you line a filling with limelight or place gluma on an area of recession. on limited exams i always take a bw, pa, and most of the time do a pulp vitality test. don't feel bad. your physician or vet doesn't do anything for free. why should you.

 

[OceanDMD]

i will say what everyone is thinking but will not say. look at their insurance plan before you do the examination. if they definitely need an ext, rct, fill, srp, etc...do it, but we all know there is a gray area for other stuff. if they have bad insurance, diagnose conservatively. if they have good insurance, diagnose more aggresively. also, with those capitation plans, charge out for every single procedure that you do. there are codes for stuff such as pulp vitality tests and desensitization if you line a filling with limelight or place gluma on an area of recession. on limited exams i always take a bw, pa, and most of the time do a pulp vitality test. don't feel bad. your physician or vet doesn't do anything for free. why should you.

I completely disagree with you. If you choose to take a plan/hmo/capitation/medicaid, you choose the reimbursement. Regardless, as a dentist you do what is right. Your post has UNETHICAL written all over it. Go back and re-read you post. Reconsider how you approach this profession.

 

[kiji talons]

I completely disagree with you. If you choose to take a plan/hmo/capitation/medicaid, you choose the reimbursement. Regardless, as a dentist you do what is right. Your post has UNETHICAL written all over it. Go back and re-read you post. Reconsider how you approach this profession.

i worked at a corporation for 8 months, and i saw stuff there that was very unethical. the top producing gp in the company would refuse to do fills on hmo patients. he would tell the patient that the only option was a cerec inlay/onlay, and would tell them to go somewhere else if they did not comply. as an associate at these places, you usually get paid on collections. the company gets the hmo check, so you get rocked if you do a bunch of $10, $20, and sometimes free fillings. i did plenty of free/cheap fills, but that is no way to develop job security w/ these mills. the said doctor who would refuse to do fills actually got a promotion. i took over a lot of his patients and had to redo about 80% of his tx plans because he would diagnose inlays even if it was just an occlusal stain or crowns even if a tooth only had craze lines rather than fracture lines. i had to end up telling these patients **** like, "oh, it looks like the tooth healed itself for now" or "we are going to watch that area, so make sure you come in every 6 months so we can monitor it." that crap makes you look stupid sometimes and you don't want to tell the patient that their previous doctor who still works for the company is a scam artist. there are a lot of shady dentists who are crooks out there.

 

[mrlantern]

i will say what everyone is thinking but will not say. look at their insurance plan before you do the examination. if they definitely need an ext, rct, fill, srp, etc...do it, but we all know there is a gray area for other stuff. if they have bad insurance, diagnose conservatively. if they have good insurance, diagnose more aggresively. also, with those capitation plans, charge out for every single procedure that you do. there are codes for stuff such as pulp vitality tests and desensitization if you line a filling with limelight or place gluma on an area of recession. on limited exams i always take a bw, pa, and most of the time do a pulp vitality test. don't feel bad. your physician or vet doesn't do anything for free. why should you.

Almost of all this clinic's insurance plans aren't noticeably different from each other, and they all reimburse very low fees. I doubt it will help if I were to single out the "good" and "bad" insurance plans. Like I said, the other associate is producing way more than I am, and thus the employer is not taking any excuses from me. I'm wondering if there are any tips and strategies for producing well in this type of clinic.

 

[DrJeff]

Almost of all this clinic's insurance plans aren't noticeably different from each other, and they all reimburse very low fees. I doubt it will help if I were to single out the "good" and "bad" insurance plans. Like I said, the other associate is producing way more than I am, and thus the employer is not taking any excuses from me. I'm wondering if there are any tips and strategies for producing well in this type of clinic.

There are low fees and then there are low fees. Like I previously posted, based on the # and types of procedures you did that day, your production should have been WAY more than $750(heck 15 fillings alone even at $50 a tooth is $750!). Makes we seriously wonder if you were getting credit for all the work you did. Seriously pay attention and keep track of the procedures you did each day and then double check that against what they bill for you that day. Based on that day you gave the example for, I'd guess, that even with really low fees, you still weren't given production credit for a good portion of what you did.

 

[charlestweed]

i worked at a corporation for 8 months, and i saw stuff there that was very unethical. the top producing gp in the company would refuse to do fills on hmo patients. he would tell the patient that the only option was a cerec inlay/onlay, and would tell them to go somewhere else if they did not comply. as an associate at these places, you usually get paid on collections. the company gets the hmo check, so you get rocked if you do a bunch of $10, $20, and sometimes free fillings. i did plenty of free/cheap fills, but that is no way to develop job security w/ these mills. the said doctor who would refuse to do fills actually got a promotion. i took over a lot of his patients and had to redo about 80% of his tx plans because he would diagnose inlays even if it was just an occlusal stain or crowns even if a tooth only had craze lines rather than fracture lines. i had to end up telling these patients **** like, "oh, it looks like the tooth healed itself for now" or "we are going to watch that area, so make sure you come in every 6 months so we can monitor it." that crap makes you look stupid sometimes and you don't want to tell the patient that their previous doctor who still works for the company is a scam artist. there are a lot of shady dentists who are crooks out there.

This is so true about corporate offices. The managing dentists are always busy doing all the high production (cash and PPO) procedures. And the associate (mostly new grads) dentists do all the $5-10 fillings on HMOs and Medicaid patients

The GPs who work at these mills have to attend tx planning seminars. At these seminars, the GPs will be taught to diagnose and tx plan according the type of insurance that the patients have. There are color stickers on the patient charts (yellow stickers = HMO, green stickers = medicaid etc). Since many HMOs pay zero for amalgam fillings, the GPs have to convince their patients upgrade to composite fillings. The GPs have to upgrade to PFG crown because certain HMO plans only pay $100-150 for a PFM crown.

Why don’t they quit? They can’t quit because they have student loans to pay back. They can’t move to rural areas because their spouses have good stable jobs in big cities. They can’t find jobs at other non-HMO clinics because these places don’t have enough patients to hire them full time. According to my friend who currently works at Western dental office as an associate orthodontist, the starting salary for a new grad GP is $275-300/day😱.

 

[teeth63a]

i worked at a corporation for 8 months, and i saw stuff there that was very unethical. the top producing gp in the company would refuse to do fills on hmo patients. he would tell the patient that the only option was a cerec inlay/onlay, and would tell them to go somewhere else if they did not comply. as an associate at these places, you usually get paid on collections. the company gets the hmo check, so you get rocked if you do a bunch of $10, $20, and sometimes free fillings. i did plenty of free/cheap fills, but that is no way to develop job security w/ these mills. the said doctor who would refuse to do fills actually got a promotion. i took over a lot of his patients and had to redo about 80% of his tx plans because he would diagnose inlays even if it was just an occlusal stain or crowns even if a tooth only had craze lines rather than fracture lines. i had to end up telling these patients **** like, "oh, it looks like the tooth healed itself for now" or "we are going to watch that area, so make sure you come in every 6 months so we can monitor it." that crap makes you look stupid sometimes and you don't want to tell the patient that their previous doctor who still works for the company is a scam artist. there are a lot of shady dentists who are crooks out there.

I used to work for a place just like that. And you know what I did? I left. I'd rather be unemployed than start playing that game. Ocean's assessment is right: do what is right for the patient, not right for your bottom line. I present all options, tell them what I recommend, then let the patient decide. I don't assume how much they can and cannot afford. In that one doctor's defense, he can make the argument that he practices a "higher" standard of care by providing better quality restorations, even though the rest of us knows that it is overtreatment.

 

[Academic Drone]

Almost of all this clinic's insurance plans aren't noticeably different from each other, and they all reimburse very low fees. I doubt it will help if I were to single out the "good" and "bad" insurance plans. Like I said, the other associate is producing way more than I am, and thus the employer is not taking any excuses from me. I'm wondering if there are any tips and strategies for producing well in this type of clinic.

This is a simple answer and you'll probably come up with some excuse - Why don't you just ask the other associate what he is doing right and what you are doing wrong?

 

[mrlantern]

This is a simple answer and you'll probably come up with some excuse - Why don't you just ask the other associate what he is doing right and what you are doing wrong?

For one thing, he is able to do molar endo in 30 minutes or less. It doesn't take him more than one hour for a molar endo + post and core + crown prep.

As for everything else, the fact of matter is that he's able to do twice as many exams, cleanings, fillings, and exos as I can in the same amount of time. My problem is, what can I do to get myself to be that fast in dentistry?

 

[mrlantern]

There are low fees and then there are low fees. Like I previously posted, based on the # and types of procedures you did that day, your production should have been WAY more than $750(heck 15 fillings alone even at $50 a tooth is $750!). Makes we seriously wonder if you were getting credit for all the work you did. Seriously pay attention and keep track of the procedures you did each day and then double check that against what they bill for you that day. Based on that day you gave the example for, I'd guess, that even with really low fees, you still weren't given production credit for a good portion of what you did.

Many of the accepted insurance plans reimburse less than $50 for a multi-surface filling. Some of these plans don't even reimburse for replacing defective fillings placed within the past year.

I just had a conversation about this with the employer. He told me that I am too slow with fillings. According to him, if I can't produce by doing fillings, I should be more aggressive in trying to dx and plan deep fillings for endo+post+crown. But for me, it takes me anywhere from 1 - 2 hours to finish one molar endo, and maybe 30 min - 1 hr for a single canaled tooth. The reimbursements for endo, posts, crowns happen to correlate with the low fee schedules I described for fillings. Again, to be productive by doing a lot of endo and crowns, I would have to be relatively fast in these procedures. I don't know if this suggestion will work for me.

 

[xhamburgersamx]

Many of the accepted insurance plans reimburse less than $50 for a multi-surface filling. Some of these plans don't even reimburse for replacing defective fillings placed within the past year.

I just had a conversation about this with the employer. He told me that I am too slow with fillings. According to him, if I can't produce by doing fillings, I should be more aggressive in trying to dx and plan deep fillings for endo+post+crown. But for me, it takes me anywhere from 1 - 2 hours to finish one molar endo, and maybe 30 min - 1 hr for a single canaled tooth. The reimbursements for endo, posts, crowns happen to correlate with the low fee schedules I described for fillings. Again, to be productive by doing a lot of endo and crowns, I would have to be relatively fast in these procedures. I don't know if this suggestion will work for me.

YOu just need to get out of your current job and get a new one. When I worked front desk, I billed endo (rct $850 and crown $650) EASY with good insurances paying 90%. Molar endo even had more and a lot of fee schedules included $85 surface composite, $120 1 quad scaling, etc. You would be producing over $2-3k per day easy at the place I used to work out in southern california.

 

[mike3kgt]

This is so true about corporate offices. The managing dentists are always busy doing all the high production (cash and PPO) procedures. And the associate (mostly new grads) dentists do all the $5-10 fillings on HMOs and Medicaid patients

The GPs who work at these mills have to attend tx planning seminars. At these seminars, the GPs will be taught to diagnose and tx plan according the type of insurance that the patients have. There are color stickers on the patient charts (yellow stickers = HMO, green stickers = medicaid etc). Since many HMOs pay zero for amalgam fillings, the GPs have to convince their patients upgrade to composite fillings. The GPs have to upgrade to PFG crown because certain HMO plans only pay $100-150 for a PFM crown.

Why don’t they quit? They can’t quit because they have student loans to pay back. They can’t move to rural areas because their spouses have good stable jobs in big cities. They can’t find jobs at other non-HMO clinics because these places don’t have enough patients to hire them full time. According to my friend who currently works at Western dental office as an associate orthodontist, the starting salary for a new grad GP is $275-300/day😱.

This is absolutely, positively correct, an excellent summary. This is an unfortunate reality of the new grad in the contemporary dental practice. We keep telling ourselves in dental school that there are more retiring dentists than graduating, we will ALL have EXCELLENT jobs as soon as we graduate. Sorry, that is not reality.

It is certainly possible and plausible to graduate and open your own practice or purchase an existing practice and stay away from these places, however, with many dentists graduating with 200k+ in loans, it create a SIGNIFICANT amount of pressure to make serious money right away. What does that mean? Corporate / medicaid / HMO practices.

Why purchase a practice, go into 100-400k more in debt and work at it for 2 years building it up (more $) when you can go work in a corporate office that is promising you $120-150k / year from day 1? Loan payment on a 200k loan at 6.8% w/ a 15 year payment plan is $1,775 / month. That is a TOUGH nut to crack... even at $120k year.

It's very tempting, trust me, I know personally. Salary / Availability is the main reason why so many people go there, especially with the thought of "putting money away" to invest in your own practice after 2 years.

If you have no choice, you have to suck it up and just do it. It is ultimately up to you, however, if you will allow yourself to sink down to the level, ethically, that is required to make money at one of these places you are describing. During the beginning, you will be slow, super-careful, and naive.

I did ALOT of endo at the practice I worked for. I can tell you right now, that if you are a GP doing a molar endo in 30 minutes, you are taking MANY shortcuts. Rubber dam, probably not. Working length x-rays.... maybe. Thermafil... absolutely. Open a case that should be done in stages with CaOH?? nope, you'll just fill it... to finish the case. In 30 min / molar cases, will you accept a cone that doesn't go to the apex (or .5mm short)? You bet.

It would take me 1-1.5 hours to do a molar endo, 45min-1.5 hours to do a premolar, 30min-1 hour to do an anterior (if I can stay with rotary and not have an apex larger than 40... i.e. step-back hand filing). There is just too much that can go wrong with molar endo that I refused to do it. Then again, I had several cases of mandibular bicupids (splits and deltas at apex) that were funny that I had to refer out. 3-canal maxillary bicuspid? Yup, seen it and done it. Endo is hard and should often be left to the experts.

There is nothing wrong with keeping your values and ethics intact... you just may make a little less $$. My rule of thumb is that I perform procedures to the level that allows me to go to sleep at night with a clear conscious... nothing short of that.