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Soon most every dentist will need to post his or her fees for regular public consumption. When is soon? That I do not know. But the Internet predicts it (many prices are already compared there) and the American consumers will begin to demand it. Dentists need to find a way to do it (or not do it) effectively and consumers will need to know how to navigate pricing. For example, when are high fees better than low fees?

The consumer will demand to know dental fees because they will be forced - as the global economy flexes - to fit the square peg of their incomes into the deep round hole of what they need and want. This is also being talked about in other medical circles along with the need to know who is doing things right.

As reported in the news the last few years, nearly 100,000 people die from medical mistakes each year, but we know little about who is actually making those mistakes. Is it my doctor or your doctor? Is it my hospital or your hospital? And when is it us? As soon as the government or consumer groups start to monitor this in a way we can digest on a regular basis (like online), dental quality and fee scrutiny will ratchet up too.

Determining Correct Fees

As reported in the news the last few years, nearly 100,000 people die from medical mistakes each year, but we know little about who is actually making those mistakes. Is it my doctor or your doctor? Is it my hospital or your hospital? And when is it us? As soon as the government or consumer groups start to monitor this in a way we can digest on a regular basis (like online), dental quality and fee scrutiny will ratchet up too.

Medical Errors

While most dentists that I work with would rather not compete on price, they often ask me to submit my prices before they consider my services. Soon their customers will want the same level of scrutiny before they decide which dentist they will choose.

Besides budget worries, consumers are also time conscious. As the consumer needs to make better decisions about what is worth their time, they will want more information about its value. Not knowing upfront what their dental care could cost and whether it is as valuable as the fee suggests means they might just pass on it altogether.

Research

Spending three hours doing "research" at the dental office - could be stopping many from even trying. Think of how many people avoided or put off car buying before the Internet just because they did not really know the "real" cost and did trust the sales process.

Calling various dentists to find out fees - creates a "confrontation" that few engage in - and that still does nothing to help understand how their fees match their quality. At least as far as I know, there is no independent third party rating dentists that easily accessible to the novice consumer (more than licensing issues or medical-legal claims). Contact DentalBlogger.com if you know different.

And because a large percentage of dentists are in private practice (one to three dentists), there is no umbrella group that directly manages them and would be forced by public opinion to offer quality information. A large health management group with hundreds of doctors - can "point fingers" about quality much easier than if the dentist had to point a finger at him or herself or their partners.

Unfortunately, this initial price scrutiny might create some serious financial problems for some good, but higher priced dentists. The lower cost dentists might get the bulk of the new business - but of course, at some point they will need to off load their excess business on someone else. Some will ramp up by hiring other dentists to take over their excess business. Maybe these will be "well-trained" dentists, maybe not.

High Fee Vs. Low

The dental patient with insurance might be more focused on quality than price. But higher prices for any procedure outside the realm of insurance will catch their eye and maybe deter them from proceeding.

At first glance dentists might have a big problem with publicizing fees or requests for quality data, but the consumer does have a basic need to request this data. Customers want control - like the car buying example above. Pricing gives them more control over the decision process. Of course, it could just confuse some even more.

If the dentist requires the patient make all their decisions in-house (no prior knowledge of what could happen) and how that compares to other dentists, they create a very volatile situation. For example, "I believe I did not need what the dentist was recommending and the fee seemed extreme. Thousands of dollars and very little of it would be covered by my insurance." Maybe this person is right, maybe they are just not educated on overall value.

I am not sure how all this will play out, but at some point as other professional organizations go through this evidentiary process, dentistry will need to follow suit. Of course, from the dentist's point of view there are issues that are not quantifiable in a fee statement. Like every dental patient has different needs, no mouth is the same, some problems are complex, others are not, and finally, fees only tell part of the value story.

For example, a patient might think they have one problem, but the dentist might legitimately diagnose 10 problems and that could cost thousands of dollars. Then imagine if the patient has not been to the dentist in years - the price would throw them even more.

Fees Come From

There are three basic places where fee levels originate: business structure, experience and expertise.

Business structure: This equates to how the practice is set up from a business standpoint.

Large companies can often hold fees down costs because they hire younger, less experienced dentists. Dentists with more experience that don't want to run their own business can also be part of the team. They can hire more of those dentists because of the advantage of scale/efficiency. For example, they buy 20 dental chairs for thirty percent off - rather than 2 at full price. They can get these discounts from every entity they buy from: their lab, the business supply store, etc.

Smaller practices of one or two dentists are in tougher position to find savings in this way. However, they can be more flexible than a larger group and spend less in some years to hold fees down. Then again, both types of structures can buy too big of a building, spend too much on advertising, implement a bad compensation plan or buy too much technology too quickly causing a rise in fees.

Experience: It is very hard to gauge when experience is more valuable than talent, but having someone who has worked on 100 patients versus 1,000 patients, work on you, might give you pause, especially if you feel the fee is substantial.

Whether someone has a part-time job or has a career that required many years of post-secondary training, people expect to be paid more as their tenure increases. Of course, at some point without building specific skills that warrant an upgrade in pay, experience starts to loose its value. While there are many talented newcomers with updated skills, paying more for experience alone is probably valuable in the first 5 to 10 years or so. After that expertise takes over (and/or those who are constantly updating their education).

Expertise: This can be achieved through enhancements "beyond" direct patient treatment experience.

These are dentists who have connections and interactions with various organizations and/or have regular postgraduate, continuing education experiences. Of course, if they join the American Academy of Cosmetic Dentistry or study at the Las Vegas Institute for Advanced Dental Studies, do they have the same or nearly the same level of expertise as someone else who promotes these affiliations? They can go to one class at LVI or join the AACD (pay some dues) and promote it and not have noticeable competency improvements over dentists who might avoid joining groups or doing "advanced" training.

Of course, there are all kinds of unethical reasons for high fees, plus over-diagnosis and plain old greed that could jack up your final price.

Is Knowing Prices Good?

Price "knowledge" pressure often has many benefits - bringing more good things to the masses. But Wal-mart type strategies can also drain the quality from the product and how that quality is backed up along with lowering the service/knowledge level surrounding the "buying" encounter. Who will know more about your electronics purchase, the Wal-mart or Best Buy salesperson?

Some dental examples: Does the dental restoration last as long as you expected and/or need? Does your smile look as good as it should? Do you have time to "really talk" to your dentist? This list goes on and on.

And in the end, is the lowest-end strategy something you want connected with your teeth, which can determine how long and well you live!

I went for many years (in my 20s) went without seeing a dentist as I worked in various radio stations, which had no dental insurance plan and paid very little. If I had continued this for another 5 or 10 years, where would I be with no teeth? Maybe I would be in a less fulfilling job because of my embarrassment and/or reduced confidence? Perhaps periodontal disease induced heart disease would shortened my life.

Conclusion

Maybe your dentist might avoid presenting fees online for a while, even for many years - in some cases and/or for some services that might make sense. I recently heard that a hospital could legitimately have nearly 100,000 procedures and services in their fee repertoire.

If true, it would take a dozen mathematicians stacked on top of each other to decide what is the valid amount for each one. So blaming the dentist for not posting prices tomorrow might be premature, but the day will come. And hopefully we will have a good system for stacking mathematicians by then.

Determining which direction fees should take you is not a simple one. However, the basic price of taking the wrong course is explicit, damaged health, diminished confidence and reduced longevity. Let fees be a guide not a constantly constricting noose, preventing optimum health.