To Fee, Or Not To Fee…. That Is The Question

I was asked this question by another dentist this week:

“Regarding wisdom teeth extractions – in the event that the extraction ends up being ”simpler” than the dentist had expected, and in the event that the patient was already quoted for a higher fee (and time was allowed in the appointment book for a more difficult procedure) – should the dentist reduce the fee from the original higher fee quoted?”

Here’s my answer:

This question is one where there are answers for a number of scenarios, but ultimately, the answer that a practitioner chooses has to be one that the practitioner is comfortable with.

Firstly, I don’t believe that dentists should “quote” or “do quotes” or “offer quotes”.

Quotes are what tradies do to try to get business, and the word “quote” implies that the price is variable and negotiable, and that when offering a “quote” the tradie is hoping to be the lowest “quote” to get the business.

Alternately, health professionals do procedures for “fees”.

The language used by dentists and team should be:

“And Mrs. Patient, the fee for this procedure will be xxx dollars.”

We do not “quote”.

Now, having framed that up, let’s take a look at setting fees for procedures.

The time taken for some procedures such as crown preps and tooth extractions can be variable, because of circumstances, and degrees of difficulty, and also the level of experience of the operator.

With crowns, let me ask you a question….is your fee for a crown the same for a crown prep on an upper right second molar as it is for a crown prep on a lower left first premolar?

Or should it be more? The upper right second molar has a more difficult access, requires more gingival retraction, and has twice the drilling…surely the fee for a crown on an upper right second molar should be significantly more?

What about the speed of an operator? Surely a proficient dentist who preps a C&B case in less time than a less proficient dentist should charge a lower fee?

With the extraction of a wisdom tooth, sometimes we do not know whether an extraction will be more difficult or less difficult until we are in there doing the extraction?

I have found that with the passing of the years, there have been times where I had wished I had charged more for an extraction that ended up being more difficult than I had estimated, and there were other times where I could also have charged less…. but overall, things tended to balance out.

If you were to ask patients whether they wanted you to take 20 minutes to pull a tooth or 5 minutes to pull a tooth, guess what they would say?

They would say:

“Do it in 5 minutes!!”

every time, before they would even bother to ask whether five minutes would mean a lower fee.

Lastly, sometimes the most innocuous extractions become dry sockets, while some very long surgical procedures end up having zero post-operative issues…

It’s the same with fillings… if you asked a patient whether they wanted you to drill their teeth for 35 minutes or 55 minutes, which do you think they would answer?

Occasionally we may over-estimate the time required to remove wisdom teeth. But you do need to be paid for time that you’ve reserved for difficult procedures.

However, if a dentist repeatedly overestimates the appointment length needed for an extraction, and continually “clips” patients, it might be best for someone to “have a quiet word” with the dentist about this perceived “clipping”.

The other dentist replied, asking:

“Just wondering what the rationale is for the more proficient/experienced dentist charging less than the less proficient dentist? Surely most patients would prefer to see someone who gets things done more efficiently?”

I replied:

There are two schools of thought to consider here for the patient.

One school of thought is “well that didn’t take you long Mr. Service Provider, your fee should be reflective of the time you took”.

The other school of thought is “well, the reason I took less time was because of my knowledge and proficiency that I have developed over the years, therefore my fee is reflective of you purchasing that acquired knowledge and IP”.

In life, there is an argument for both cases.

Service providers need to be assertive as to which of those two schools of thought they decide to operate by.

Once you have chosen your lane, you must commit to your choice, and not waiver.

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