I have now been in the profession for over thirty years, and have been in practice in three out of the four counties I have worked in. In that time I have owned three practices, including CAP City Dental here in London. Obviously in my case I can only speak from the perspective of fully private practices, as in this country I have only worked within the NHS for a couple of years right at the very beginning of my career.
All these years and in every country I have heard patients complain about the perceived high ( too high?) cost of dentistry. So of course, many of the public think all dentists live in mansions, drive Ferraris and holiday in Caribbean Islands. Most members of my profession have heard jokes many times, along the lines of … ‘ well my crown/ root canal treatment/ fillings etc. are paying for your holiday’.
I don’t want to be an apologist for the standard of living dentists do, hope to or expect to, enjoy as a result of their labours. However, I would like to bring some clarity and transparency to the issue of dental fees.
Dentists are professionals. Like doctors they actually spend five years at University (doctors have one more year than that) and a further two if they specialise. As such it is reasonable that they expect to enjoy a standard of living comparable to their peers of similar standing, training and experience in other self employed professions such as medicine, law, accountancy, architecture, etc. Indeed, on the whole, they do. So why does the public particularly consider that dental fees are so excessive?
The most significant circumstance that makes the practice of self employed dentistry different as a business from the other professions and results in unavoidable high costs of providing dental care is:
Most professionals can set up shop in a room or two. They may need to employ a secretary and may need to invest in one or more computers, books (although less so in today’s world), a desk and some chairs. Doctors may need a couch along with a few examining instruments.
A dentist has to find at least three rooms (surgery, waiting room and sterilizing room) and they must be properly plumbed and compliant (nowadays regulated by the Care Quality Commission). The surgery and sterilizing room, are in effect, a mini hospital. At the very least a compressor, suction motor, sterilizing autoclave machines, motorized electronic treatment couch, surgical light, drill hand-piece delivery unit, X-rays unit, laser unit … are all basic equipment. Many dental practitioners in various specialties also need to invest additionally in surgical microscopes, larger panoral x-ray machines, specialised implant surgery units etc. There are a multitude of instruments and materials needed on a daily basis and special in-surgery storage facilities need to be installed. The equipment needed is very expensive can cost up to a £1,000 a pop and most of us need at least half a dozen of these! The monthly bill just for consumables for a one man or woman dental practice can often reach £ 2,000.
The dentist also needs to pay at least two full time staff (nurse and receptionist) and will also need to pay a professional dental technician for many items of dental restoration (crowns, veneers and dentures etc.).
Any down time that the dentist is not treating a patient, not only does not generate an income but is actually a cost to the business. Dentists do not generate income unless there is a patient in the chair .
High quality dentistry, dentistry that lasts and is aesthetically beautiful, combined with the appropriate level of patient care and attention and true professionalism exhibited by the dentist and his/ her staff cannot be rushed or done quickly. That simply means that there has to be a limit to the number of patients that can be seen reasonably in a normal working day. In reality it can’t be more than about a dozen and often less! The income from those patients on that day needs to pay ALL the overheads, salaries and income for the business owner for that day. That is obvious business common sense.
On top of that, in today’s world, there is a lot of competition out there and the necessary costs of marketing have become a very significant additional expense, that can often run into further thousands of pounds a year.
Many dentists are still one man shows and all these expenses may have to be carried on just one set of shoulders . It may be not that long before the single handed or even small independent dental practice may become nonviable to sustain.
So the next time you hand over that credit card to pay for your dentist’s time care and attention, spare a thought for what it costs to run his or her little mini hospital.
It’s true, most dentists don’t starve and any that do, usually it’s because they have failed to run their practices as effective and profitable businesses. The vast majority of dentists work very hard, carry a lot of responsibility to maintain what is generally a fair and equitable income, and is indeed commensurate with other professionals .