Try again...Entitlement -VS- Generosity

[drben]

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👎 Okay, I'll try to post this again since my computer ate it the first time...

The one thing I have learned in private practice is that people sense of entitlement WILL exceed your ability to be generous...

Example: A GP friend of mine called and said that he had a young, attractive, single mother that was trying to make something out of her life but had a socially debilitating malocclusion. He asked if I would consider doing the case for free, or at a significantly reduced fee. I met with the patient and agreed that she had a severe TSALD (crowding) that would require premolar extraction and comprhensive orthodontic treatment. The GP (Dr. U.) extracted the teeth for her for free and orthodontic appliance were placed. I asked the patient to pay $50 a month during the duration of her treatment ($1200 -VS- $6000...I would LOOSE about $1800 treating the patient).

Well, about a week after I placed her braces my TC gets a phone call from this patient's boyfriend saying that he would like to come in for an orthodontic evaluation. He then proceeded to tell my TC that he heard I was giving killer deals to patient's of Dr. U and that Dr. X was really his dentist but he wanted Dr. U listed as his dentist to get the same deal as his girl friend. 😡

The question is what would you guys do with respect to the patient (who incidentally has not paid me a dime) and what would you say to her boyfriend when he came into the exam?

The reason I'm even writing this is to inform those who think it's all warm and fuzzies doing "charity work" that sometimes "charity work" leads to cynicism, and regret. 👎

Ben

 

[drhobie7]

👎 Okay, I'll try to post this again since my computer ate it the first time...

The one thing I have learned in private practice is that people sense of entitlement WILL exceed your ability to be generous...

Example: A GP friend of mine called and said that he had a young, attractive, single mother that was trying to make something out of her life but had a socially debilitating malocclusion. He asked if I would consider doing the case for free, or at a significantly reduced fee. I met with the patient and agreed that she had a severe TSALD (crowding) that would require premolar extraction and comprhensive orthodontic treatment. The GP (Dr. U.) extracted the teeth for her for free and orthodontic appliance were placed. I asked the patient to pay $50 a month during the duration of her treatment ($1200 -VS- $6000...I would LOOSE about $1800 treating the patient).

Well, about a week after I placed her braces my TC gets a phone call from this patient's boyfriend saying that he would like to come in for an orthodontic evaluation. He then proceeded to tell my TC that he heard I was giving killer deals to patient's of Dr. U and that Dr. X was really his dentist but he wanted Dr. U listed as his dentist to get the same deal as his girl friend. 😡

The question is what would you guys do with respect to the patient (who incidentally has not paid me a dime) and what would you say to her boyfriend when he came into the exam?

The reason I'm even writing this is to inform those who think it's all warm and fuzzies doing "charity work" that sometimes "charity work" leads to cynicism, and regret. 👎

Ben

What a great lesson. And even more than that, you are still open to LAWSUITS when you do free work. Meaning that you need to cover your ass by documenting everything, even if you're just doing a sealant on your niece.

Getting back to the matter at hand... I would explain to the BF (and patient again) that occasionally very special patients are given the opportunity to receive care for a reduced cost, and that his GF was fortunate to be the recipient of this. I would further explain that these situations become the financial liability of the doctor and therefore can only be done in rare instances. You could explain to him that you'd be happy to evaluate his orthodontic needs but his costs would be the same as any other patient receiving that treatment. If his finances are tight you could refer him to one of dozens of financing services.

Regarding the actual patient who's not paying the $50/month. You could reiterate your expectation that she pays that amount and that it is a GREATLY reduced cost. If she says she's having a hard time meeting that expectation, you could tell her she can get independent financing for the $1200, alleviating your office of being a collections agent.

(Philosophically, I don't believe in dental offices providing their own payment plans or financing to patients. I think the risk outweighs the benefit, it adds stress & paperwork and threatens to compromise treatment and erode the doctor-patient relationship)

If she has a problem with meeting your expectation you can tell her you're unable to continute treating her. Now that's tricky because I don't know if you're legally bound to the patient through some law against abandonment. Perhaps you have to finish the treatment? I don't know. There are some crazy laws out there. But I see several possible outcomes: she doesn't pay the $1200 and you continue treating her, she doesn't pay the $1200 and you stop treating her, she pays the $1200 either through independent financing or through your office on a monthly basis. My gut tells me I would ask her to get financing for the $1200 so I could continue treating her.

Good luck and thanks for the posting.

 

[J2AZ]

I think it is great that your friend has a big heart was willing to give this woman an incredible discount. However, it seems that the woman was did not fully understand the special circumstances surrounding her treatment. This case illustrates the problem with charity work. The best way to approch such a situation is to 1)not do charity work, 2)only participate in charity work if it is done through an established organization (doctors without borders, flying samaritans, etc.) 3) make sure your patient has a vested interest in his/her dental care and work before begining the treatment.

Many nongovermental organizations now approach third world development like option #3. They make sure the development is what the community wants not what they, the organization want by setting up guidelines and requirements the the community must meet before any work is done. If the community chooses not to participate the NGO moves on to another community.

In this same way your friend could have waited before starting treatment. He could have set up rules and guidelines for the treatment that involved the patient demonstrating interest in maintaing good oral hygiene (regular 6 month recall for a year) and paying a percentage of the treatment costs over the course of 6mths prior to treatment.

Now that your friend has started treatment and the patient has not paid, his best course of action is do nothing more until she starts paying. Many ortho offices refuse to adjust or remove wires and brackets unless the pt pays. I suggest he do like wise.

 

[groundhog]

Reminds me of a time many years ago when I was washing dishes at a cafeteria on the night shift while going to college and supporting a wife and new baby. One warm evening I stepped outside into the alley to take my break. I spotted an old tramp going through the dumpster trying to round himself up a meal. I told him to go through the line in the cafeteria and I'd spot him a meal. Well the guy really loaded up his tray. The manager told me never to do that again even though I had paid for the meal. I soon found out why. The word must have spread like wildfire because for the rest of that evening I had an endless stream of homeless types coming into my work area via the alley door in order to hit me up for money and or a meal. Learned a lesson that night.

 

[DDSSlave]

I'd try to find out what the financial situation is. Explain the possibility of stopping treatment if an agreement cannot be reached. If she simply refuses to pay or ever pay after several letters, I'd debond. I doubt there is any legal obligation to follow treatment through, but I'm not an orthodontist either. That's frustrating about the boyfriend's presumptive attitude and lack of appreciation on the part of the girlfriend.

Some people on this board (mostly predents it seems) have an overly idealistic view of charity work. From my very limited experience, patients by and large value your hard work about as much as they have to pay for it. That may seem cynical, but that's my experience. I hope in time to be proven wrong.

As a future orthodontist (hopefully) I think my charity cases will fall into one of two categories. 1) completely pro-bono cases for extremely needy children (whose parents understand the opportunity I'm giving them) and 2) reduced fee cases where I will ask the patient to simply write a check the directly to the AAOF.

 

[DDSSlave]

Many ortho offices refuse to adjust or remove wires and brackets unless the pt pays. I suggest he do like wise.

I would think keeping the patient in braces indefinitely without treatment would be a lawsuit waiting to happen.

 

[UConn_SDM]

I would think keeping the patient in braces indefinitely without treatment would be a lawsuit waiting to happen.

You write her a certified letter asking her come in so you can remove the braces due to nonpayment - if she does come in great as lack of payment is grounds to terminate the relationship - if she doesn't, document the certified letter and that the patient refused to come in.

That seems like you made a reasonable attempt to end treatment without causing the patient harm. I don't think you have to sit there and change wires every 3 weeks for someone who is not paying you.

 

[DDSSlave]

You write her a certified letter asking her come in so you can remove the braces due to nonpayment - if she does come in great as lack of payment is grounds to terminate the relationship - if she doesn't, document the certified letter and that the patient refused to come in.

Agreed.

 

[Biogirl361]

Some people on this board (mostly predents it seems) have an overly idealistic view of charity work.

i agree with your point, but the general condecending attitude of everyone towards predents on the dental board is frusterating 😡

 

[DDSSlave]

i agree with your point, but the general condecending attitude of everyone towards predents on the dental board is frusterating

I understand your frustration and hope I didn't add to it. I'm thrilled about the enthusiasm of predents around here and the one's I meet visiting my school. It's just difficult establishing well founded opinions regarding clinic and clinical dentistry (including charity, an important topic) without experiencing it first. Admittedly, I don't have much experience myself having only been treating patients in school for a little over a year and a half. The only predents I get frustrated with are those on the never-ending quest for the best dental school or the dental school that will land them a residency spot in ortho or OMFS.

Edit: sorry about the tangent; back on topic...

 

[UConn_SDM]

i agree with your point, but the general condecending attitude of everyone towards predents on the dental board is frusterating 😡

I agree but can understand where some of this comes from. Questions or comments that may seem "naive" to 3rd or 4th year dental student or a practicing dentist need to be viewed in light of who's asking/commenting. I think even recently we have had a couple of good discussions here between predents and dental students - I think these posts were beneficial.

But, taking a quick look at the predental board I also think there are questions that shouldn't be asked as they can easily be found in AADSAS booklet, on school websites, are common sense, or more importantly already on these boards - the search function is everyones friend.

First lesion for dental school is there are such things as stupid questions. These include questions you should be able to find on your own, have already been answered 50 times in the last 3 mo on these baords, etc. Questions asked here should mainly be things people already looked for but couldn't find or opinion questions with no correct answer.

It's frustrating to see predental students who are already applying who have obviously done zero reading/preparation before posting. Sometimes it feels like people want someone else to do their homework for them.

The bad posts I think are greatly outweighed by the good posts - and the predental/dental boards are a great asset for the predental/dental students.

 

[Biogirl361]

yeah, i asked my share of questions on the predent board last year, but wow there seem to be an excess of annoying threads this year. which is why i don't visit there anymore. i just wanted to give a shout out that not all of us are completely naive, uninformed etc. 🙂 but i definitly understand where the sentiment comes from.

 

[toofache32]

My dad had similar experiences in his orthodontics practice. He offered free care to teenagers at the local "Boys Home" where kids lived who didn't have parents, or didn't leave with their parents for whatever reason. After a few cases, none of them were getting finished because the kids would suddenly be sent to a foster home in some other state or they would end up in prison. Even the patients he did see regularly had trouble making appointments because the staff at the Home would just bring them in whenever they felt like it, ignoring their appointments.

He finally brought it up with his lawyer who told him he'd better stop doing that because it was such a non-ideal situation.

 

[trypmo]

I shadowed for a short while in a clinic in an underserved urban area where the dentists worked for free and the patients paid only a reduced fee. Some of the dentists (retirees) worked there full-time, but there were several who had regular practices who worked there a couple of days a month in addition. Why not be one of those dentists, working through an established organization and periodically doing work for free, who could say to a charity-case patient, "hey, here's the address of the clinic I work at on X days, here's the reduced fee schedule they have, so let's make an appointment and I'll see you there next Friday (or whatever)"?

Do the more experienced folks here think that this is possibly a workable arrangement? I totally agree with doing one's charity work through established clinics, but I think there can be a place for charity work in anyone's practice if they want it.

Making personal deals with your patients about discounts and such puts you in the position of being the financial enforcer; working at a reduced-fee clinic lets you be the dentist and gives the office managers there the responsibility of collection and all that. The question then becomes whether most cities in fact have such clinics in place, to which I don't know the answer, but it seems that in a big enough city there'd have to be one or two, wouldn't there? 😕

 

[balance]

I shadowed for a short while in a clinic in an underserved urban area where the dentists worked for free and the patients paid only a reduced fee. Some of the dentists (retirees) worked there full-time, but there were several who had regular practices who worked there a couple of days a month in addition. Why not be one of those dentists, working through an established organization and periodically doing work for free, who could say to a charity-case patient, "hey, here's the address of the clinic I work at on X days, here's the reduced fee schedule they have, so let's make an appointment and I'll see you there next Friday (or whatever)"?

Do the more experienced folks here think that this is possibly a workable arrangement? I totally agree with doing one's charity work through established clinics, but I think there can be a place for charity work in anyone's practice if they want it.

Making personal deals with your patients about discounts and such puts you in the position of being the financial enforcer; working at a reduced-fee clinic lets you be the dentist and gives the office managers there the responsibility of collection and all that. The question then becomes whether most cities in fact have such clinics in place, to which I don't know the answer, but it seems that in a big enough city there'd have to be one or two, wouldn't there? 😕

I like. Medical doctors do recommend the county hospitals when their patients are not able to afford their fees.

You got to make money to run a private practice, otherwise, work for the non-profitable organizations or set up one.

 

[grant555]

I agree that you have to make money, but if there was one model for my eventual practice hopes, it would be this one.

http://www.jsonline.com/bym/biz2biz/oct03/178987.asp

Take care and GOD bless.

 

[drben]

I shadowed for a short while in a clinic in an underserved urban area where the dentists worked for free and the patients paid only a reduced fee. Some of the dentists (retirees) worked there full-time, but there were several who had regular practices who worked there a couple of days a month in addition. Why not be one of those dentists, working through an established organization and periodically doing work for free, who could say to a charity-case patient, "hey, here's the address of the clinic I work at on X days, here's the reduced fee schedule they have, so let's make an appointment and I'll see you there next Friday (or whatever)"?

Do the more experienced folks here think that this is possibly a workable arrangement? I totally agree with doing one's charity work through established clinics, but I think there can be a place for charity work in anyone's practice if they want it.

Making personal deals with your patients about discounts and such puts you in the position of being the financial enforcer; working at a reduced-fee clinic lets you be the dentist and gives the office managers there the responsibility of collection and all that. The question then becomes whether most cities in fact have such clinics in place, to which I don't know the answer, but it seems that in a big enough city there'd have to be one or two, wouldn't there? 😕

Honestly, it's easier for me to see patients out of my own office because I have all of the materials I use regularly and things just "flow" better. Trust me you guys will agree when you get out and get into a "groove"

The question isn't whether to do charity or not...I feel that as someone in the top 5% of income earners I can afford to do a little charity. I'm just saying don't plan on getting off doing "charity" because people will try to take advantage of your generosity. Seriously, it happens just about EVERY DAY. I got off the phone an hour ago with someone who "had to talk about an emergency with Dr. Ben" the emergency..."My daughter had her retainer in a secure location and it got stolen and my family is on a single income and blah, blah, blah (Come on, who the f*** steals a retainer anyway?) and can we get a new retainer for free or at a reduced cost?"

Again, all I can say is be careful because people's sense of entitlement will exceed your ability to be generous