You need money to run your business. But your patients should always come first! To help you strike the balance of affordability, profitability, and quality care, Kirk Behrendt brings back Dr. Marco Brindis, chairman of the Prosthodontics Department of Louisiana State University, to share his insight into a successful treatment planning process. Don't be a dentist just for the money! To learn the best ways to help patients while still making money, listen to Episode 715 of The Best Practices Show!
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Main Takeaways:
Quotes:
“A friend of mine, Dr. Cinco Feuille, is a periodontist in El Paso. He’s a great friend of mine. He said, ‘If your reason to be here is for money, you're in the wrong business. This is not a good business to make money. Really, go do an MBA. Do other stuff. Do business somewhere else because dentistry is not for that. You can make a good living, for sure — there's no doubt. But your heart has to be in the right place.’” (3:08—3:41)
“How do I deal with a situation where we're talking a lot of money? We're talking a mortgage. We're talking a lot of money to invest in your mouth. And they know that they need it because they have been looking for a dentist for many years. They know. It's not that you have to create the necessity. They have the need. It's just, how are we going to help them? So, I had to come up with a solution to help the patient, at the same time make it affordable for them, at the same time make it profitable for the practice so everybody wins. But at the end, we have to always keep in mind that the patient comes first.” (5:52—6:37)
“When you turn a patient into an edentulous patient — you extract teeth — then the options are so broad. So, you start from a denture all the way to an implant-supported crown and bridge. There's a range of somewhere in between $10,000 and $100,000 that you have there. So, what's the best solution for the patient? On top of everything, would you recommend to a patient as a final treatment plan to wear dentures? And the answer, it's a difficult answer and it’s a very controversial answer because many dentists would tell you, ‘Of course! Of course it's a great treatment.’ And it depends on the area that you're practicing in. It depends on the country that you're practicing in. It depends a lot on the social economic situation of the area that you're working in.” (8:29—9:32)
“This patient is about 70 years old. So, they're retired people. The wife is right there to support the husband. The wife said, ‘Okay. So, what are we going to do?’ And she said, ‘You know something, Doctor? Don't try to do too much. He's old, so he's not going to last too much longer.’ She said exactly those words. I said, ‘What?’ It’s like, ‘No, no, no, no, no.’ I immediately stopped her and said, ‘You don't discriminate against people because of their age. That is age discrimination. Just because you're older, you don't deserve to have quality of life today? It doesn't make any sense.’ So, even to my students, I asked them once, ‘Would you place implants on a 90-year-old patient, two locators to improve the retention of a lower denture?’ And everybody raised their hand, ‘Of course not.’ ‘Why not?’ ‘Because he's 90.’ ‘What? No, no, no, no, no, no. You don't understand. It's exactly when they need them most. There are very few things in life that you enjoy at that age, and one of those is to eat well and to have quality of life.’ So, if you think like, ‘He's going to have less time in this world,’ well, let's give him the best possible time for whatever years he's going to get to live.” (11:16—12:47)
“The oldest patient that I myself placed implants was 90 years old. I placed two implants. The patient lived until 96. And when he was 92 years old, he was the happiest man in the world because he could eat steak again with his lower denture with two locators. Two years later, he had an accident in a car. He was in an emergency room — the driver died — and he was in a coma for a couple of weeks. When he woke up, the first thing that he asked was, ‘Are my teeth okay?’ It was that important for him.” (12:49—13:28)
“We cannot use [age] as a reason to decide what's best for your patient. The best for your patient is the best, whether you're 10 years old or 90 years old.” (13:43—13:52)
“Patients are very concerned because they come here like, ‘We want to see your doctor,’ and start kind of talking in an aggressive way, saying like, ‘It's insane what they're trying to charge us. It's an abuse, and it's a lot of money.’ It's like, ‘I completely understand it's a lot of money. It doesn't mean that it's the wrong thing. It’s a lot of money, and I understand. Not all of us have that amount of money. Now, it's an investment. However, if you don't have it, you don't have it. But I'm here for you. So, here's the plan. The plan is this. Understand that my premium plan, which is an implant-supported, full-arch prosthesis, upper and lower — so, extractions, grafting, implants, and implant-supported, possibly with immediate loading protocol — all that is going to be this amount of money. Now, remember I told you that one of the treatment plan options was a denture.’ And as soon as I mention denture, they start [shaking their heads]. ‘No, no, no, no. Hear me out. Hear me out. I'm not proposing the treatment plan to be dentures. However, for me to get from A to Z, Z being the implant-supported prosthesis, the first step that I have to do is to make a denture. That's the first step. So, here's the thing. Why don't you go one step at a time?’ So, the advice here to you is, how do you charge in these cases? How do you help the patient to make the right decision? What is what they absolutely need? Do they have to go all the way to $100,000 to make them happy, or is $20,000 going to be enough to make them happy? We cannot know that 100%. We can't until they try it.” (14:08—16:11)
“My advice to other prosthodontists or other restorative dentists that are doing these extensive treatments is that you make a treatment as a whole. You plan. Remember, you're an architect. So, don't make the plan of, ‘Okay, I'm just going to make a treatment plan for your bathroom or your bedroom or your kitchen. Make the plan for the whole house. And then, you talk to the patient and say like, ‘Do you want to start with the kitchen? Do you want to start with the bathroom?’ But the bathroom is already connected in the plan with the kitchen, with the bedroom, and with the rest of the house. So, you made the plan for the whole house. And when they start doing the bathroom, perhaps they say, ‘That's all we needed. We only needed the bathroom here.’” (16:12—17:05)
“In this particular case, going back to the patient, I told my patient, ‘Listen, you need a denture to start with. And you will be in a denture anyway because we need to wait for some healing before. So, if we do that, test it. Pay for the denture. We do the dentures. Don't pay for the whole treatment plan. Pay for the denture. And guess what? That's a down payment for the premium treatment plan that I presented to you. It's a down payment. It's putting towards your treatment. This is not a separate treatment. It’s putting toward the maximum best treatment that I can present to you. So, do that. Pay only that. Let's try it.’ And you might be surprised. They might say, ‘You know something? I feel very comfortable with the denture.’ And then, ‘Perhaps you have other priorities in life where you can use the rest of the money too. And I completely understand. You're retired. I understand you have to be careful with your money. I understand that.’ And I am very conscious. We all have to be conscious about — they are people. They have families. They have struggles. They have lack of money. They have to really take care of diseases and other stuff. So, it's not only us. We have to be very careful what we ask the patients to pay for.” (17:06—18:33)
“Let's go back to the question, what are the three sections? I plan for the whole thing. I plan even appointments. So, this is the amount of appointments for this stage, for this stage, and for this stage. If you divide it in three, for example, the first step was extractions, bone grafting, and denture. Ask the patient to just pay for that portion. Go for that one, for the cheapest option, which is extraction and dentures. And you're going to have to live with that for four months. After the four months, you can tell me, ‘You know something? I'm okay with it, and I'd rather use my money somewhere else. But I'm fine. My bite is fine now. I can smile. I'm really happy with it, and I'm going to stay with that.’ And perhaps you say, ‘No. I'm miserable with this. I cannot stand the palate. I cannot stand being careful of not dropping these. When I chew, they fall off. I want to have something implant-supported.’ Then, at that point, you can move and start upgrading to that. And that upgrade could be not all the way to implant-supported, but it can be implant-assisted, for example. But you're still planning the full house. You're not planning for just restoring the bathroom. You're still restoring the whole house. So, you plan the whole house. The message here is always plan the full house. And then, you can divide it by rooms. It's fine. But always plan the full house. Don't start fixing rooms without having a plan for the whole house.” (21:35—23:18)
“I wish money was not in the middle because it changes the way you treatment plan. It changes the way you take care of people because you have to cut corners for the patients to be able to pay for it. So, it is a tough one. That's why it's important, for example, when I'm talking about breaking it down into pieces, I am not sacrificing any quality because all the pieces are going to be 100% of my quality. I never, ever sacrifice quality for money, ever. So, whenever I have a pro bono case, I do exactly the same as a patient that paid me $1 million. If you're going to do it, you're going to do it exactly the same way. And I do it that way. So, when you break it into pieces, it doesn't mean that it's going to be less quality. I'm going to give them the best.” (24:37—25:39)
“I might offer a discount, but I never cut corners to decrease the quality. And I think we all agree on that. That's the least we have to do. The minimum is the best. The minimum you can do for a patient is your best. That doesn't mean that all the treatment is going to be affordable for the patients. There are different levels of dentistry that you can achieve perfection in each level — not perfection, but your best in each level. That's the key.” (26:21—26:54)
“Don't get caught up in just treatment planning for the little [things] because the patient tells you that they don't have money . . . I'm going to tell you the risk of just planning for the most inexpensive treatment. If this patient comes to me, and the wife, the first thing that she says is, ‘Don't spend money on this man because he's going to die,’ in this particular case, I'm not going to jump into just offering a denture because I know they don't have money. No, no, no, no, no. You always have to plan the best you can offer.” (27:16—27:52)
“It's very important to keep in consideration the finances of the patient. I don't want to drain their bank account. I don't want to be that person that takes everything from their retirement — because I can be very convincing. I can. I can be very convincing with my patients and make them push, and make them go for it, and spend extra money that they were not prepared to expend. So, I work with them, and I always tell them, ‘This is not a match between you and I. I'm on the same team as you are. I'm here to protect your health, and that means your mental health as well as your financial health.’” (31:19—31:59)
“It’s the same as the concept of interdisciplinary dentistry versus multidisciplinary dentistry. Multidisciplinary is multiple specialists. Interdisciplinary is multiple specialists but acting as one, as a team. When you're acting as one, as a team, the cost goes down and the results are better. And the same thing goes with this. When you treatment plan globally and then divide it in different sections, if you start with one section, you never know. You might help that person with just that first section. That was enough for that patient for the quality of life that they needed. And then, you set the tone for the rest of the treatments over time to start adding and upgrading as they go.” (32:03—32:52)
Snippets:
0:00 Introduction.
2:55 The dilemma between helping patients and making business out of them.
11:06 Patients deserve the best, no matter their age.
14:07 How to talk to patients about their treatment plan.
18:59 Divide your treatment plan into three.
23:23 Don't sacrifice quality for money.
30:11 Final thoughts.
Dr. Marco Brindis Bio:
Dr. Marco Brindis is the chairman of the Prosthodontics Department of Louisiana State University, where he also maintains an intramural restorative practice devoted to esthetics and implants with an interdisciplinary approach. He earned his DDS from the Universidad Intercontinental in Mexico City in 1998, completed a Preceptorship in Dental Implants at the Universidad Intercontinental in 1999, a Preceptorship in Dental Implants at the Dental School at the UT Health Science Center in San Antonio in 2002, and a Surgical Implant Fellowship at the Biotechnology Institute in Vitoria, Spain, in 2003. He earned his Certificate in Prosthodontics at LSU School of Dentistry in the Department of Prosthodontics in 2007, then completed the Esthetic and Occlusion courses at the Pankey Institute in 2007.
Dr. Brindis is very passionate in the field of interdisciplinary dentistry for full-mouth reconstruction, esthetics, and implant dentistry. He is involved in the development of new implant protocols to treat edentulous patients. He has lectured in the United States, Mexico, Canada, and Spain. He is a member of several organizations, including the Academy of Osseointegration, American Dental Association, American College of Prosthodontists, and the Pierre Fauchard Academy. He is a well-established national and international speaker, having spoken at symposiums such as the AAOMS Dental Implant Conference, International Symposium on Oral Implantology in Spain, Academy of Osseointegration, AAOMS Annual Meeting, and the American Academy of Restorative Dentistry.