“Endonomics” and the Healthy Dental Practice
by Michael D. Goldstein, DDS, FAGD
(Reprint from Dentistry Today and LVI Visions)
After participating in more than forty EndoMagic! Root Camps, I’ve come to appreciate the tremendous benefit and positive impact that efficient and predictable endodontic procedures can have on a practice. In fact, I’ve studied this trend and named it “Endonomics,” and I spend a lot of time analyzing “endonomic” trends as reported by the doctors attending our seminars.
There is no question, that improved endodontic skills can greatly reduce the stress of performing root canals on your patients. In fact, I’ve seen many cases where root canals went from being the most dreaded to the most enjoyable procedure in the practice.
Most dentists understand how improving the efficiency of their endodontic procedures can help their gross production and their profitability. Few dentists fully appreciate the potential for positive economic benefits from their increased skills. In this article, I would like to explore the economic potential of improving the efficiency of your endodontic procedures, and I would like to discuss your fees for performing root canals in your office.
Having majored in math while in college (many decades ago), and genuinely enjoying analyzing numbers and dental practice trends, I decided to put my skills to use to develop some practice information concerning endodontics that was available nowhere else. I wanted to evaluate fees for services, along with efficiency (how long it takes to provide the service) in order to draw conclusions that would be pertinent to the dentists in attendance at our two-day seminars. With that in mind, about three years ago, I began gathering fee and time information from the each dentist in attendance at our Root Camps. After years of analyzing the numbers, I was able to draw certain conclusions concerning the economics of root canal treatment.
One of the most frustrating aspects of my analysis concerned finding the average procedure fees for our dentists to gauge his or her own fee schedule. Unfortunately, all the published fee surveys were either outdated, or from a very different dental population source. I couldn’t find data current enough to be useful. It’s for that reason, I’ve been compiling average fee and time data from the doctors attending our seminars. In fact, the fee data referenced in this article represents the average numbers from the attendees at our previous six seminars. I believe this data is the most accurate and pertinent available to our readers.
The Myth of Crown and Bridge Production
Typically, whenever I’m with a group of dentists discussing office production and income, it seems that the focus is always on crown and bridge procedures. The interesting fact about the crown and bridge is that, according to Gordon Christensen, about 80% of it is single unit. Below, I’ve created a chart showing typical fees and costs for providing a molar root canal compared to a single unit crown.
Of course, your fees and expenses may be different than what’s listed above. We do find, that in most practices, the fees charged and the time needed to provide the two procedures are about equal. You can see from this chart (Figure 1) that due to the lower overhead and the likelihood of having only one treatment visit, the root canal is a more profitable procedure in most offices.
In fact Charles Blair of the Blair, McGill and Hill Group states, “I am convinced that there is no greater potential for increasing your net hourly revenue than by doing your own uncomplicated endodontic procedures efficiently. My analysis has consistently shown endodontics to have the highest dollar-per-hour and highest dollar-per-visit payoff of any procedure we do.”
Charles Blair, DDS, Editor
The Blair/McGill Advisory
Incidentally, Dr. Blair attended Root Camp and has seen the huge potential that most dentists have in their practices to improve their endodontic services to their patients. Through his Revenue Enhancement Program and his Profits Plus Seminar, he has helped many of his clients understand the important roll that Endo should have in improving their bottom line.
In the May issue of his popular newsletter, The Blair/McGill Advisory, Dr. Blair provided financial statistics for general dental and specialty dental practices. These numbers were tabulated from about 400 of his clients from across the country. My most interesting observation was that due to their low overhead (34.7% compared to the G.P. at 62%), the endodontists had the greatest profitability of all the dentists surveyed. Now it doesn’t take an actuary to surmise from this information, that increasing the amount of endodontics a G.P. does should have a very positive effect on their net profit.
Let’s look at this potential by evaluating the typical endodontic fees and hourly production doing endo.
What We’re Charging for Endo
Before we discuss what we’re charging for endo and how much an hour we’re producing, we should look at the typical GP’s overall production.
According to Dr. Blair, the typical G.P. is grossing around $435,000 with $100,000 or so coming from their hygiene production. Working 203 days per year that means they’re grossing $1,650 per day or $206 per hour on average. By comparison, lets look at what the Root Campers who’ve attended our seminar over the past eight months are averaging with their endo:
Now isn’t it interesting, that the more complex the procedure gets, the lower the hourly production. You would think it would be the other way around, but due to the inefficient way most dentists practice endodontics, they loose efficiency when treating multirooted teeth.
Another interesting fee comparison is my survey of the endodontists on the south side of Atlanta, Georgia. Keep in mind that fees on the south side of the city tend to be lower in general than in the “big city” itself.
The Amazing Truth About our Root Canal Fees
On average, the Atlanta south side endodontists’ fees were 45.2% higher than our Root Camp attendees’ fees, and that’s not even considering the retreatment category. The greatest fee differential was the anterior fee. The $680 average endodontist fee is 53.8% greater than the $442 average general dentist fee at our seminars. It seems that the endodontists understand that the typical dental patient is much more motivated to treat an anterior tooth endodontically than a posterior or other non-cosmetically critical tooth. Besides, have you ever noticed that whenever your patients hear the word “root canal,” they think of two things…pain, and the molar root canal fee. Whichever tooth is involved, their perception is that it will cost the same as Aunt Betty’s molar root canal. You may not feel comfortable raising your anterior root canal fee by 53.8% all at once but you may want to consider an immediate 10% to 25% fee increase.
What it takes to increase hourly production by $100 per hour
A fascinating exercise that I do with every seminar group, after we compare their fees and treatment times with the norm, is to calculate how much more efficient they need to be performing molar root canals to increase their hourly production by $100. Keep in mind that this increase in hourly production directly impacts profitability, as there is no increase in overhead. The results consistently demonstrate that an increase in efficiency of only 21-22% accomplishes this goal. That’s an improvement of about 22-23 minutes in a procedure now averaging one hour and 46 minutes.
What is the impact on your practice of performing efficient endodontics?
The most fascinating and exciting statistics I’ve discovered involve the results from our surveys taken at least two months following a dentists participation at one of our technique seminars. On average, we’re seeing an increase of 10% on a doctor’s endodontic fees.
What’s more interesting is the improvement in speed that we consistently see. The chart below compares the average treatment times before and after the Root Camp.
The reporting dentists must be having far less stress than before in their endo treatment, because they reported a perception that they improved their endo efficiency by an average of 51%. In actuality, my numbers indicate an improvement of about 27%. The dentists also reported that on average, their monthly gross income doing endodontics increased by $2,000.
Based on a 10% fee increase and the time improvements noted above, I’ve charted out the average improvement in hourly production seen after learning new techniques.
The perception of the dentist after the root camp was that their hourly production increased by $231 an hour, fairly close to the calculated values on the chart.
The endodontic “goldmine” in your practice
We mentioned earlier that the average GP is personally producing $206 per hour. When you evaluate the dollar-per- hour calculations doing endo, you can see how root canals can easily become the most productive part of your practice. Even the less efficient doctors before taking our seminar were reporting endo hourly production far above the overall average.
When you improve your skills, with or without an increase in your fees, the improvement in hourly production is incredible. Once trained, the doctors perform root canals at an hourly rate, which is 267% greater than the average GP’s hourly production. That’s the difference between $551/hr. and $206/hr. When coupled with decreasing the stress related with treatment, I can think of no more efficient way to boost the net profits in a practice.
