Unless you are just coming out of a coma, you are acutely aware that the economic situation is pretty bleak. Those of us living in the United States have seen the biggest financial set back, probably in our lifetimes. The effects have rippled throughout the global economy, driving markets down to levels not seen in more than a decade. Most in my age group have seen their investment portfolios set back as least ten years. For many of us retirement now seems like a far away fantasy.
Fortunately most of you, like me, love our chosen field and will probably never completely retire. Although dismayed and (let’s be perfectly honest) outraged by the actions of many of our incompetent, self-serving elected officials, unscrupulous financiers and a significant segment of the populous who feel that they are owed something for nothing, we will continue to move on and take care of the people who have entrusted their healthcare to us.
Those of us involved with the treatment of Craniofacial Pain often work with patients who must pay “out of pocket” for their care. All too often, reimbursement is negligible to non-existent because of profit-driven health insurance providers who are concerned less for their client’s health than their own bottom line.
While wandering the halls of academia most of us were taught that profit (if it was even mentioned at all) was a concept not to be discussed. As doctors, we were taught to focus first and foremost on the care of our patients. Indeed, this is our chief and primary concern, but after being set loose in the real world most of us learned - all too quickly - that in addition to being doctors, we also had to be savvy small business owners. We learned that we had to run a storefront – just like any other - whether we liked it or not. Our staffs expect a salary, our suppliers demand to be paid and our labs do not care if the patient skipped out on their bill. And hanging like the Sword of Damocles over all of our practices, a government that demands an ever increasing piece of the action to enrich their constituencies, i.e., pay for their pet programs, the merits of which are dubious at best. Compound all of these burdens (of which you are all keenly aware) and it’s a small miracle that any of us have enough left over to pay the bills at home.
Since the economic downturn, many practices–particularly those where the care is based on discretionary income–have seen a decrease in patient flow and/or case acceptance. People are pulling in their spending horns and circling the wagons, so to speak. So, how do we stay productive and continue to survive and profit in these uncertain times?
Well, there are really only two avenues: cut costs or increase production (and, oh by the way, if there’s a magic spell or formula out there that I have missed please pass it along). Obviously we’d all like to increase production and cost cutting is difficult unless you are prepared to cut staff. The remaining overhead (equipment, materials, etc.) are, by and large, fixed.
As I contemplated this apparently insoluble conundrum, I came up with a third solution: how about putting unproductive doctor and staff time to productive use? How, you ask? How about increasing in office services by incorporating services either not offered or referred elsewhere?
Much of what we deal with in our practices is of musculoskeletal focus. We deal with inflamed and painful TMJ’s, sore and painful muscles and maxillomandibular malrelationships. Do you make orthotics? If yes, who makes them, you or your lab? Existing staff can easily be trained, in relatively short time, to do the laboratory portion of appliance fabrication.
Do you offer physical medicine modalities in your practice? No? Why not? Modality therapy greatly decreases treatment time, provides for more rapid symptom relief and leads to a superior therapeutic outcome than orthotic therapy alone. Physical medicine modalities are non-invasive and avoid virtually all of the undesirable and sometimes dangerous side effects of pharmacological agents.
Modalities such as ultrasound, phonophoresis, electrical muscle stimulation, iontophoreisis, TENS and manipulative therapy such as spray and stretch are a main stays in my practice. These instruments are cost effective and usually pay for themselves in very short order. Once these techniques and technologies are fully integrated and become just another part of your treatment, they quickly evolve into real profit centers for the practice. But even more importantly, they enhance the level of care and help patients get better quicker. If you are not offering these services or are referring patients to someone else, you are not exploring all of the profit centers available to a pain practice.
The training in the use of these modalities is readily available and the enhanced level of patient care, as well increased profitability, will astound you. In addition there are training vehicles to learn basic manipulative therapy. Did you know that in the 1997 revised parameters of care for Temporomandibular Disorders of the American Dental Association1 they state: “The dentist may prescribe or administer physical medicine (therapy) modalities.”
Do you provide sleep appliances for snoring and obstructive sleep apnea? These are a fantastic service for patients who suffer from these problems. Do they work? You bet they do! I should know: I wear one. How many of you know that in the most recent guidelines of the American Academy of Sleep Medicine,2 oral appliance are recognized treatments for mild to moderate sleep apnea and as a treatment for severe apnea for CPAP intolerant patients (which by the way, after two years is about 75% of them)? And you know what? They are classified as durable medical devices and may be covered by the patient’s health insurance company.
And, how about you younger docs out there? Wouldn’t it be great to be as productive as you can be now so that by age 45 or maybe 50 you could retire if you wanted to? If you love doing this stuff as much as I do, you probably won’t retire early. But consider getting up in the morning and going to your office, not because you have to, but because you want to continue to serve people and improve the quality of their lives.
I am not embarrassed nor do I feel timid about discussing profit, not just surviving but THRIVING in hard economic times. We have all invested a great deal of time and money in our education and practices. We work in a demanding and stressful arena. If we are following the rules and practicing in an honest, ethical, and professional manner, we deserve to be successful–not because some government program bequeathed it to us in an entitlement program, but because we work hard for a living, providing an invaluable service to our patients.
Gerald J. Murphy, D.D.S.
Grand Island, Nebraska
Note: Have faith! The United States of America is the greatest nation in the course of human history. We have the highest quality of life and more opportunities available to us than anywhere else on the planet. This should be apparent considering how many people still wish to come to the United States and be a part of the American Experiment. Though many of us bristle at the numbers of people who would try to cut in line and sneak into the U.S., we can also take pride in knowing that no (honest, hard working) person has ever had to sneak out. We have been through tough times before, far worse than this, and prevailed. This current situation is no different. And as the United States recovers from its wounds, once again all the peoples of the world will benefit. Study history and remember the principles of our founding fathers. There are many in our government and in the private sector, who have forgotten or obscured their original intentions. But remember, WE are the small business owners that everyone talks about, and we are the engine that drives this country.
References
1. http://www.ada.org/ prof/prac/tools/parameters/tmd.asp.
2. Kushida C, Morgenthaler T, Littner M, Alessi C, Bailey D, Coleman J, Friedman L, Hirshkowitz M, Kapen S, Kramer M, Lee-Chiong T, Owens J, Pancer J. Practice parameters for oral appliances - AASM practice parameters. Sleep, 2006; 29( 2):240-243.
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