the cost of regular cleaning and deep cleaning seems pretty high, even assuming let’s say $50 per hour wage of the hygienist. So it would appear that the dental office and the presiding dentist are in effect imposing a big “tax” on the sale of these services.
Well, so why don’t we see offices that would seek to undercut the competition on price by lowering this per-patient tax and win out through volume? Let’s say the dentist would figure out what is the maximum allowable number of hygienists that can work at the same time under his supervision, hire a few extra to cover for lunch breaks and rest periods and just have this hygienist “factory” running 14 hours a day with prices set at a level to guarantee sufficient number of incoming patients. Presumably, at some price such an office would monopolize its market niche within the metropolitan area (until similar competitors show up) and hence will have sufficient customers.
So why isn’t something like that actually happening?
I’d have to guess that the amount which a dentist makes on a routine cleaning isn’t that much, and if a dentist is spending all his time supervising his cadre of hygenists who are doing cleanings, he isn’t spending time on other procedures which would make him (and his office) more money, on a per-patient-hour basis.
So, even if he’s cranking through “lots of volume” (relatively speaking), he’s got a very large fixed cost (big office, lots of exam rooms, with equipment such as chairs and tools needed in each and every room), and lots of paperwork (insurance filings, etc.).
In short, I suspect that it’d be a great deal for a patient, but terribly unappealing for the dentist.
from my experience of getting the cleanings, it is not very clear just how much work the “supervision” by the dentist involves. Not sure if the dentist never shows up at all or shows up very briefly. So I guess my impression is that the “dentist shows up” task could be accomplished for multiple concurrent hygienists just via appropriate scheduling, without interfering with the dentist’s primary duties (that is, if this task needs to be done at all - hopefully a dentist can shed light on this). Whereas the “dentist comes running to help in emergency” task would happen rarely regardless of whether there are one or four hygienists at the office.
In terms of office expenses, I think the office itself is a classic case of economy of scale. Bigger offices cost less per square foot than smaller ones. The dental equipment cost does scale linearly, but even there savings might be realized via greater utilization, i.e. by keeping that chair occupied as much time as possible. Of course, this all would be relevant only if the costs of the office and equipment really make a big difference in the price; I guess my OP question is predicated on the assumption that the procedure cost consists mostly from hygienist salary and dentist’s profit / remuneration for “supervision”.
Assuming that a dentist does need to be “checking work” with each patient, your business model would seem to indicate that the dentist would need to be there pretty much all the time, doing nothing but that. You’re positing an office in which:
a) you have a large number of hygenists working simultaneously, up to 14 hours per business day
b) you want to maximize the “up time” (i.e., have every chair filled all the time with a patient)
If that’s the case, the dentist would need to be constantly available, as he’s shuttling back and forth between the treatment rooms. Even if he’s only spending a couple of minutes in each room, I don’t see how he’d be able to use “appropriate scheduling” to do much else but be on call in that office. He’d be needed to check work multiple times per hour, all day long.
(Of course, if he doesn’t have to be there, it’s an entirely different situation.)
I get my teeth cleaned every 3 months, and I usually actually see the dentist during the cleaning only once a year, during the actual checkup. However, the hygienist usually does pop out of the room and tell the dentist what’s going on, and she alerts him if I have anything that needs to be seen soon, or seen that day. So he is available if I need him.
I generally do see him in the hallways when I come in, and we hug. Yes, I hug my dentist, and he appreciates it.
My dentist’s office has two actual dentists, and about eight hygienists. The practice works almost exactly as proposed above – the hygienist sees you and does her stuff for about 30 minutes, and the dentist stops by and takes a quick look to make sure all is well. If the hygienist sees something, she’ll note it for the dentist’s particular attention.
Checking in to mention that I can’t imagine it’d be as profitable as being able to slot out time for more hard-core dental work. I had a root canal a few years back that netted the doctor about $900, not including crown, for just a couple hours of work. Given all the overhead that your business model would entail, I just can’t see it being as profitable without the big-ticket procedures.
It would probably be difficult to insure dental hygenists who work outside of an office with a certified dentist, and the ADA has an unaccountable stranglehold on the industry which may not allow that at all.
Also, dental insurance covers a lot of hygene costs, so the customer doesn’t make the choice with with cost as a major factor.
A large enterprise that does this with a lot of hygenists and one dentist may have trouble getting enough customers because dental hygene is a very personal thing, and many people want all their dental care handled from one office. But this attiitude is probably declining. Vanity is driving people to bleach their teeth to the point they no longer look real. So it might have a future.
But cost is probably not going to become the factor that changes people’s habits in this area.
OP is predicated on assumption that the dentist will keep doing his stuff as usual in a neighboring room, possibly dropping by infrequently if that is required. But the magical grace of his presence shall overflow into the rooms with the hygienists and empower them to do their thing. Well, sort of like it happens now, only with more hygienists per dentist.
Also, note Lynn Bodoni’s claim that even the dropping by is not necessary is not necessary. Apparently, as long as you have a dues paying member of ADA somewhere in the office, the “force” abides with the hygienists.
You also are paying to have the dentist “on call” if there is a problem the hygienist identifies.
I had this happen during a 6th month checkup. The hygienist found a “blush” on my tooth and the dentist came in and identified it as internal resorption. He diagnosed it, x-rayed it, confirmed the diagnosis, recommended an endodontist, and helped me set up the appointment to get it treated ASAP.
He did not charge me any more for the checkup than a normal one(where you see him for 5 minutes).
Huh. I am learning that my experiences at dentists may not reflect those of the majority. I have always had one involved during routine cleanings, but I have awful teeth because of my paralyzing fear of dentists. Since I wasn’t forced to by the parents after about age 14, I didn’t go back until I hit 21, and thankfully only needed a root canal. In the intervening 3 or 4 years, I’ve been back twice. But every time my mouth gets pried open, there’s a dentist there at some point, and i just assumed it was the same universally.
A properly managed dental hygienist is a cash cow for dentists. Also, a lot of the time a dental hygienist is not really an employee of the dentist, like the dental assistants, but is a self employed contractual employee, and as such one hygienist may work for several dentists in the area.
It’s a unique relationship. I really think you do need dentist on hand if the hygienist flags something of concern, and I think a part of what you’re paying for is that potential oversight or “presence”. An office of nothing but hygienists would not be able to do this.