Dentistry as a whole has a history of being undervalued. I’m sure you’ve all been called “just a dentist” in the past, though I’ve never heard a medical doctor referred to as “just a physician.” We’re in a profession where patients are leery of the “need” for treatment, frustrated with the out-of-pocket expenses, all while our cost of treatment is increasing and compensation is proportionately decreasing behind the scenes.

fair compensation and billing in the dental practice

I personally wouldn't want to receive treatment from someone that didn’t feel they were being adequately compensated. I know from personal experience, as much as I try to roll out the red carpet for every patient that walks through our door, that I’m far more likely to feel frustration creeping into my dentistry when it’s a patient that I don’t feel has compensated me adequately for the effort and expertise I’ve given them. My best days are those treating patients that walk through my door because they know I’m different, and they’re willing to pay for that difference.

So how do we find more of those patients and feel good in our own skin charging appropriately? At the end of the day, a crown is not a crown is not a crown, but our patients need to be educated in order to understand that. Here are five tips I implement in my practice today to have more of the good days and less of the bad.

Be comfortable talking about money

I'm not sure where the “dentist shouldn't talk about money” taboo came from, but when I started in private practice I felt like I needed to respond to monetary inquiries from patients with, “I’m not sure, but I can have the office manager give you that information.”

In reality, we all know the cost of our treatment, and though we may not know the exact numbers on everything, ballparks are helpful to the patient and allow us to be more genuine in our interactions. It’s okay to say, “it will cost roughly X” and have the front desk get more specifics if the patient wishes. Saying you don’t know the cost of something discredits your authenticity!

Have a black and white bottom line.

It astounds me how often patients will ask for discounts or a “break.” Unfortunately, our rent, staff costs, lab fees, etc. are fixed costs. The only window of negotiation is our compensation. When we start to cave and offer discounts, we teach the patient that our initial cost was a suggested cost and not the true cost of what they’re getting. They’ll continue to barter their dentistry, and we’ll feel undercompensated.

This will lead to a strained relationship with that patient over time. It’s hard to feel good in our own skin when we’ve been nickel and dimed! It’s easy to want to get the patient back in for treatment to fill the schedule, especially if the week is slow, but stick to the fees you have decided are proper compensation for your procedure. If you’ve had this self-realization before you’re in the hot seat when a patient brings it up, you’ll be better prepared to answer.

I struggle with this daily; I love dentistry, and sometimes I just want to do the dentistry because it will be fun. But it’s not fun at the end of the month when the bills roll in and the cash flow isn’t there, so I hold myself to answering the patient with, “we keep our fees as low as we are able to while still providing you with the level of dentistry that we pride ourselves in. You may be able to get ‘x’ for lower at another office, but for me to use the best labs and materials and continue to spend the amount of time getting things just right, we can’t discount our dentistry.”

Bundle pricing

This one took me a while to figure out, but it has been a game-changer in our practice. Treatment planning larger cases takes a significant amount of time. When you simply itemize each step and charge your normal fee, you end up undercharging for the case.

Completing eight anterior restorations, for example, shouldn’t necessarily be the price of 8 single units. There are extra wax-ups, temporaries, specialist communication, and maintenance appointments that go into larger treatment.

We now have “case fees” for larger cases. Rather than patients getting a “treatment plan” that says “crown #2 with core build up, $X, crown #3 with core build up, $X” with a grand total at the bottom, patients are provided with a “case fee” and then the itemized list gives the specifics as to what is included in the case.

It saves a significant amount of time treatment planning the financial end of things. Now, when a patient asks roughly what their treatment will cost, I know what a full arch, full mouth, 8-unit, etc. case costs in my office so I can give them a pretty accurate estimate.

In addition, the “case fee” is nice because not all patients require the same amount of effort and energy to complete their treatment. If it is a patient that I know I will see for multiple extra appointments to ease concerns or calm fears, or if a patient is phasing treatment, that gets built into the overall fee as well.

Get your team on board

If your team doesn’t know why you are doing things the way you are, they can’t stand behind you. If a patient asks them why you are charging a certain amount in order to reserve a large block of the doctor’s time, you don’t want the answer to be, “because the doctor told me to.” Make sure they grasp why a single unit anterior crown next to highly characterized virgin teeth doesn’t cost the same as two single unit crowns on 8 and 9. If they understand the why, they’ll be your advocates in implementation and execution.

Feel good saying “no”

You need to know what your value is, so that when you are put on the spot, you are okay passing on treatment. You need to role play with your team so that you aren’t blubber-mouthed when someone with a very powerful, intimidating personality words things in a way that is hard to say no to.

If a patient says, “the guy down the street charges X for a crown, I can get it cheaper there,” you don’t want to say, “I can do it for you for at that price too.” That completely discredits why you charge what you do for your work. That response tells the patient that you could be charging less and are choosing not to.

Your response should be something like, “You can get a crown for a number of different prices; our crown fee allows me to provide you with the quality and expertise of the best labs and the best materials. I can’t give you the level of care that we provide for a lower price, but if price is a barrier for you, I’ll understand if you need to make a decision based on cost.”

The reality is that you cannot use a high-quality lab, in a beautiful office, while investing in high-level continuing education doing the work for the same price as an office that is antiquated, using a lab overseas, and taking online bare-minimum continuing education. We need to find value in ourselves first in order to instill it in our patients.

Cost of treatment is a constant struggle for the majority of providers I chat with. It’s a difficult, grey area in our profession. There are industry standards that keep us within a certain range, but where you are in that range should be determined by you.

Don't charge the highest cost in town and use a sub-par lab, because you’ll lose patients over time. Don’t try to be the cheapest office and use the best of everything, because you’ll go out of business! Figure out who you are as a dentist, what value you offer each patient, and what the appropriate compensation is.

Your prices don't need to be based on the guy down the street, they need to be based on what happens within the walls of your practice. As a profession (and if you’re involved with Spear, you are likely at the top of our profession), we need to start valuing our worth so that others will continue to do so. 

(Click this link for more dentistry articles by Dr. Courtney Lavigne.)

Courtney Lavigne, D.M.D., Spear Visiting Faculty and Contributing Author -


Commenter's Profile Image Mark S.
June 4th, 2017
Great article, Courtney!
Commenter's Profile Image Rob R.
June 5th, 2017
Excellent article! I'm using the verbiage you have here. :)