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Value Your Skills – How to Stop Underselling Yourself – AJ006

Because You’re Worth It – this episode is your L’Oréal moment 😉

How to take pride in what you charge.

Watch AJ006 on Youtube

Stop Diagnosing wallets and giving discounts, these negative practices hurt our business and highlight a mindset issue.

In this ‘Ask Jaz’ episode I discussed all the reasons why you need to STOP underselling yourself, starting from a lesson me and my wife learned in Singapore. 

I explored common reasons behind this trend, such as fear of rejection and a lack of confidence, particularly among new practitioners. I shared my perspective, emphasizing the importance of building confidence through continual learning and practical experience.

I also discussed the concept of ‘neuro-fiscal drag’ – the phenomenon where a figure in your mind gets substantially reduced by the time it comes out of your mouth. This mindset often leads to dentists undercharging for their services. It’s crucial for dental professionals to take pride in their work and understand the value they bring to their patients. After all, we’re not just providing a dental service; we’re restoring confidence and quality of life.

Remember, valuing your work appropriately is not just about financial gain; it’s about respecting the skill, effort, and care you put into each procedure.

Need to Read it? Check out the Full Episode Transcript below!

Highlights of the Episode:
0:00 Opening Snippet
0:52 Experience in Singapore
4:24 The Late Night Emergency
5:37 Don’t apologize for your fee
6:32 Introduction
10:24 Neuro-fiscal Drag
11:38 Why NOT to give Discounts
13:37 Don’t diagnose wallets
15:03 Gaining Confidence 
23:35 When a patient laughed at the fee!
32:42 Protrusive Guidance

If you liked this episode, you will also like Think Comprehensive – Communication Gems with Zak Kara – PDP010

Did you know? Whilst this episode is not eligible for COD, you can get over 220 hours of CPD from the Web App or Phone App and watch premium clinical videos, for less than a tax deductible Nando’s per month!

Click below for full episode transcript:

Jaz's Introduction: You know, remakes aren't fun anyway, but trust me, remakes, when you've undercharged in the first place, are the worst. So I guess, make sure when you're charging to factor in that there's a degree of fudge factor. And by adding in this fudge factor, you're not going to have anxiety about doing the remakes, about the financial aspect of it as well. So the lesson there is, even if you're doing like a review appointment, make sure you charge for a review appointment. Because if it's your opinion, and your expertise that the patient's paying for, and the overheads of the building, that is really important to consider.

[Jaz]
I’m going to start this episode with a little story, a personal story, actually.Me and my wife used to live in Singapore. You guys might know this already if you’ve been a listener for a long time. We moved to the UK, to Singapore, to practice dentistry, but also travel and stuff, which was, which is great. And dentistry in Singapore was a nice chapter that we look back at when we reflect on our time there.

It was a beautiful time. And of course, the very first episode of Protrusive was all about our time in Singapore. But while we were there, Sim, my wife is a practicing dentist and me and her, we worked. In the same corporate, so shout out to Q&M and the kind of working hours we had there was strange.

It’s like nine to nine. That’s right. It was 9:00 AM to 9:00 PM. But in some countries this, like in the Western countries, like to have that kind of a working schedule sounds absolutely insane, but hear me out, right? Because we didn’t have kids and the pace of work wasn’t crazy. Like I’d see a patient.

I’d have a coffee, I’d see a patient, I’d have some noodles. I’d see a patient, I’d have some dimsum, couple hours of a break kind of thing. Have a siesta, it was a chilled way of working. And an interesting cultural thing about working in Singapore was that I’d, I’d go into work and my day list would have just two patients the whole day, but at the end of the day, I would’ve seen like 11 patients because there’s a whole walk-in culture in Singapore.

At least it was pre covid at the time when I was there. Anyway, so one of these days, I think I finished at 6pm my shift that day and my wife was working until 9pm. So, I had some dinner and then from the apartment I walked to Sim’s practice where she was working and I was waiting for her to finish so we can walk back home and catch up.

But an interesting thing happened. See, I was in the waiting room and I kind of overheard that something Interesting was going on and basically she then says to her patient. Okay. My husband’s a dentist. He’s here Let me just bring him in for a second or a third opinion You’ll see why it’s a third opinion in a moment. So I walk in and I introduce myself to the patient and so basically this pleasant gentleman pleasant, young man had a lateral incisor crown.

I think it was maybe an emax that broke. So he had a fractured emax crown and he had a flight to Australia the next day and this was like an important business thing. So he needed his tooth back, which is absolutely fair. Now, moments before I came in, my wife, Sim, the patient’s dentist, was facetiming the patient’s sister because it was actually the patient’s sister in Australia who did the crown.

And so the patient was like, look, you need to speak to my sister before you do anything to my tooth. You need to speak to my sister. So maybe, protrusive is quite big in Australia. So a shout out to my Aussie fans. And so maybe that dentist from, I don’t know, eight years ago that is maybe listening to this now.

Maybe you remember that evening in Singapore when this happened to your brother. Obviously I’m keeping everything confidential here. So the patient’s sister, the dentist, was just giving my wife some advice, okay, so use this and make this kind of temporary and I’ll take over and I’ll fix it good when the patient’s back in Australia.

The reason I came in is because Sim just wanted some advice, right, so we were both young dentists at the time and I had an interest in restorative. And she’d just done a year of MaxFacs so she was like kind of like doubting herself or it was a bit rusty in her restorative skills so she just wanted some hot hand holding basically she was she wanted me to hold her hand basically so I was there as support kind of like nursing for her in this clinic in the suburbs of Singapore.

Now long story short she was able to deliver a nice new temporary crown for this patient. So the patient was in the waiting room, everything went well, well done Sim. Now the patient was in the waiting room and then Sim was kind of doing her notes and then now it came. to the bit where she had to charge some money.

You see, everything happened so quickly and she kind of got distracted with the facetiming, the patient’s sister, and then me coming in and she just wanted to fix the tooth that she forgot to have that money conversation with the patient. And so she looks at me and says, I don’t know what to charge. Now I’m thinking back and I don’t really remember what we used to charge for a standard emergency but this kind of emergency was like a big thing.

I think it took her 45 minutes from the history, the radiograph, actually building up the temporary and making it look nice and make sure it satisfies the patient and of course the patient’s sister in the future. So, it was a job well done and also this was like 9, 9.15 at nighttime so he was super grateful to have this tooth sorted before his flight the next day.

Now, Sim being Sim, she put a very low number. Like, she completely undersold herself and she was about to charge the patient a very low amount of money. So low that I think the patient’s sister, the Australian dentist, would have just actually spat her coffee out and laughed at Sim’s like, wait, like, that is way too cheap.

And I said, Sim, why? Why are you doing this? It’s 9. 15pm, you have just done a wonderful job, 45, 50 minutes with the patient, even agreed to speak to a sister. You need to charge more. And I finally moved her up to about 250 Singapore dollars. Now, when we start talking numbers and currencies, in some countries that’s, whoa, that’s crazy.

That’s a crazy amount of money. In other countries, that’s like, really? You just charged 250 to do a brand new de novo temporary crown, rescuing someone at that time of night. That’s a bargain. So, I can see both viewpoints, but it’s not so much about the number because number could vary from country to country.

It’s more about what happened afterwards. You see. She went into the waiting room, and this is what she said to the patient. She said, look, I’m really sorry, but actually the emergency fee for this kind of what we just did now is 250 dollars. Okay. And that’s generally how she said, she was like, I was listening from the surgery, and she was in the waiting room telling him the fee.

And I was in surgery. It was, bless her, bless my wife. It was cringeworthy. It was like, oh my God, why she apologizes so profusely that she’s just done this amazing service for this patient. And you know how the patient responded? He literally, because I came out and I saw this. He literally just shrugged his shoulders like okay, okay, and he went, and he paid and he said thank you so much for helping me. And then we never heard again, right?

So I’m assuming that his sister it sorted out the definitive crown and everything went happily ever after. Now fast forward many years. Sim, my wife, is a community dentist in the NHS.

So she doesn’t have to deal with numbers It’s like public health dentistry. She doesn’t have to worry about talking about numbers and money and that kind of stuff. That was never her forte, but she does a great job with children and adults and children with disabilities. And that’s really her passion.

And she’s doing a master’s in pediatric dentistry. And so that’s what she does now. But at the time she was really underselling herself. Now, is that something that perhaps, you might have done as well? I’ve certainly done it. And so this episode, I just want to pass on some of my reflections and advice to make sure that we stop underselling ourselves.

Hello, Protruserati. I’m Jaz Gulati and welcome to AskJaz 006. If you’re new to the podcast, this is the arm of the podcast, whereby we kind of collect all the DMs and the emails we get. And then we choose episodes based on that to make sure we serve you the best. So you’ve picked a pretty good episode to join us.

And of course, if you’re a veteran Protruserati, thank you so much for coming back again. Now for every PDP episode, I give you a Protrusive Dental Pearl. Now this is an Ask Jazz episode, but I’m going to introduce a new thing for AJ episodes, right? I’m going to play some voice notes from the Protruserati.

I appreciate you as a community so, so much, and I’ve kind of been collecting and hoarding all these lovely messages and voice notes for too long. And I thought, okay, let’s share the love, right? So I’m going to play you a voice note from Dr. Saranga Yapa, who is literally one of the biggest Protruserati I know.

He’s been there since like episode three of the podcast all those years ago. I just want to give a massive shout out to Saranga for always supporting Protrusive. So I’m just going to play this and then we’ll continue the main episode.

Saranga:
Hey there, dude, I just wanted to give you a massive, massive, massive thank you. Just for the last three years I’ve learned so much from you, and the knowledge acquisition that’s happened has allowed me to help my patients so much with so many different areas of dentistry, and I just wanted to just say thanks man, and I know, obviously none of the courses were free and everything, but they were just so worthwhile and all the discussions you’ve had with all the different people you’ve had on your podcast.

I’ve learned so much. I mean today we did a like I’ve done so many of these different bridges now, and I really like doing it now and yeah, I just really enjoy dentistry. I like doing new things. I like new trying new types of treatment to help people in different ways and it genuinely has meant that my income levels has gone up so much because of the things that you’ve helped me learn about. Really practical stuff and stuff that’s actually well within my ability and parameters to help people with and yeah, I just wanted to say massive thank you.

And if I don’t hear from you for a while then I just hope you have a great new year. I’m really looking forward to more of your content, especially on verti preps I want to integrate that into my practice completely. Just so that the whole pretty much prosth is down, fixed prosht is down. So yeah, just thanks again, man.

[Jaz]
Dr. Saranga Yapa, thank you so much for all those nice words. And so if you guys want to get featured on Protrusive, send me a voice note, right? I’d love that. Send us a voice note about what impact Protrusive Podcast has made on you and your career. And you might get featured in one of these episodes.

Now, what I love about you guys and Saranga included is like, you could be listening to a lot of other different types of podcasts or watching this on YouTube or the app, for example, like there are so many dental business and explore your patient growth and masters of business and dentistry and that kind of stuff.

And they all have a place because we’re all practice owners and we need to make sure we actually thrive as businesses in dentistry. And that’s totally cool. But you guys come back to protrusive as something that will, I think improve your bottom line. I do think that people who listen to every single episode of Protrusive will end up making less mistakes, doing better work, feeling more confident about certain things.

And we’ll talk about all those factors, but that’s a secondary benefit. The increased income is a secondary benefit. The primary reason you’d come back to a podcast like this is because either you love clinical dentistry or you want to love clinical dentistry. Or you just need your protrusive fix to get that fire in your belly before work.

What I’m trying to get to is you don’t watch or listen to this podcast for any financial benefit. That’s a secondary outcome, as I said. Now, I’m hoping that what’s discussed on this episode, for those who need it, is going to massively shift your mindset. If ever you had this issue, which I used to have a lot, which is what one of my old mentors, Dr. Raj Ratan, he used to call this a neuro-fiscal drag, i. e. you have a number in your head, but by the time it goes, travels from your brain into your voice and comes out your mouth, that number has reduced substantially.

And so what’s up with that? Why does that happen? I think that’s a mindset issue and I want you to start taking pride in what you charge and take a pride in your dentistry in general and know what your worth is.

And I’m going to elaborate on that. I’ll start by saying that if you are underselling yourself or you have this neuro-fiscal drag, like I did as well, then you are having a massive negative impact on your business. But if you’re an associate, like you’re really undercutting and underselling your principal or your corporate that you work for.

Now, I’m no business guru or anything. I’m not a sales guru. I’m nothing like that. I’m just a humble general dentist who is very geeky and I love the clinical dentistry. I love learning. I love sharing. So that’s my angle. But somewhere along the way, I attended some business lectures and communication lectures.

I think we all do once in a while, right? So I think it’s important to not neglect that area. And remember, this lecturer said that 10 percent discount that you give to a patient, the amount of impact that has on your bottom line is way more than 10%. Interestingly, conversely, by increasing your fees by 10%, you actually have a huge effect on your profit.

So be very careful about giving these little harmless discounts, whether you do own your own business, whether you’re a principal or an associate, it is definitely hurting business far more than what you think. You know why? Because you’ve given a discount and the overheads don’t change, right?

The practice overheads are still there. And so this is an important lesson that principles pass on that, we should really be charging what we’re worth and not giving these so called harmless discounts here and there. They really are hurting business. The funny thing about giving discounts to patients also is a lot of times the patient doesn’t even know you gave a discount.

Like, imagine something is worth 500 pounds of 500, right? This could be, I don’t know what’s worth 500, right? Cause it’s so subjective, but let’s say something is 500 dollars, right? And you decide that, you know what? You want to be really nice to your patient. You’re going to give your patient a 20 percent discount because you love your patient.

And maybe you think that, oh, they might not be able to afford it, or they might say no if I don’t, and therefore I’m going to say to the patient, hey, you know what? We’re going to do this procedure and it’s going to be 400. Like your brain wants to say 500, what it should be, but by the time it came out your mouth, it was 400.

And the patient says, oh, okay, that’s really expensive, but ends up begrudgingly booking the appointment. You see, most dentists probably don’t say to the patient, hey, you know what? It’s usually 500, but because of X, Y, and Z, you will get a discount for this reason, right? And most patients, most dentists don’t actually do this.

Right? So your patient actually walks out thinking, oh man, I have to pay 400 for this. They don’t even know they got a discount. So what was the point of even giving that discount? Like if you’re going to give a discount, first, you don’t give a discount. And that’s kind of the theme of this episode. But if you are, please can you make sure your patient understands and realizes that this is a discount?

Otherwise, there really was no point. So back to why do we actually undersell ourselves? So why did Sim do that at the time all those years ago? Why did she apologize and felt bad about charging? Well, she undervalued what she was doing for sure. But the actual reasons for that could be fear of rejection.

Sometimes we might feel that, oh, you know, if I give this figure, then the patient might reject it. Well, what you’ve just done there is potentially diagnose someone’s wallet. Right. That’s not something that we need to do. We need to know what a fair exchange is. What’s a fair fee for what we’re doing and present that confidently and not try and second guess a patient like, oh, you know what?

If I go in at this number, then the patient might reject it. That’s not a good way to do business. We are not here to diagnose wallets. And I think you would have heard that one before. The other big reason why some dentists may undercharge or undervalue is a lack of confidence. Like maybe if you’re a new dentist and you haven’t seen your work come back, you kind of doubt, hey, is my work even worth that much?

Or maybe you start getting some negative thoughts like, oh, what if this breaks in like six months? Or what if something bad happens? What if some post op sensitivity happens? The patient doesn’t like what I’ve done. All these kinds of things that show that you’re fearful or you lack confidence.

And I think when I was a new grad, I think definitely this was a factor for me. I would have perhaps undersold myself because I didn’t have confidence at that point because quite naturally there was a lack of experience. So how can you actually gain more confidence so you can actually charge the right amount?

This is not like everyone makes you charge probably so we can get rich and buy Lamborghinis. It’s not about this, right? This is to make sure that there is a fair exchange between you and the patient. Low confidence and fear is because you are not sure of the outcome because you haven’t seen what your work looks like in two year’s time in five year’s time in 10 year’s time.

You therefore have this inner doubt, deep within you have this doubt and that could be a key factor. So what I found is by going on courses, I know it’s a cliche, but going on courses, I was able to self-validate my own compass that, you know what, I am doing everything to gold standard, just like I was taught on the course by this awesome dentist and the awesome dentist said to do this and I do exactly that.

And I follow all the protocols that Mr. and Mrs. Awesome Dentist taught me and therefore this gives me a degree of predictability. Sometimes just having that confidence or validation from a course that you are doing things properly. can be enough for some people to start charging what they are truly worth and stop the whole discounting or charging too low because they’re afraid that their techniques won’t work or that they’re not worthy of charging an appropriate hourly fee.

Another mindset issue is a limiting belief that you might have absorbed from somewhere in dentistry. Like there is this belief that whatever your lab fee is, you multiply it by three or four or five and that should be what you charge the patient. This is just like a rule that you pick up somehow magically the first day as a real dentist from out of dental school.

And you take this formula and you start applying it. And you know what? Sometimes it actually works. It actually works out to a fair fee. Other times you are massively underselling yourself. Let me give you an example, right? Resin bonded bridges, right? You guys know, I have an online course on this and I’ve got a dental update paper, which I’ll link below that you can read for free.

I’m very passionate about resin bound bridges in appropriate cases so that you get a predictable, long-lasting result to replace a missing tooth. Now let’s say that the laboratory fee, and just work with me here because I have done this before, whereby I’ve seen a laboratory fee was 100 for a resin bonded bridge, for example.

Let’s say a lower incisor, 100. Now, some people will say, whoa, that’s too much. That’s too little, whatever. Let’s just go with these 100 units of currency, right? So 100 for a Resin Bonded Bridge lab fee. That doesn’t mean that automatically, okay. Yeah. Therefore, I’m going to charge 300 or 400. Okay. There is an element of that and we can use that as a guide.

But let me tell you that Resin Bonded Bridges are massively, massively impacted by this mindset or this limiting belief whereby we really under charge for it. We have to flip it around and think what is the patient getting from this? Okay. Now, whether they’re getting an implant or whether they’re getting a respiratory bridge or they’re getting a denture, what they’re actually getting is not even a tooth replacement.

They’re getting confidence. They’re getting the ability to smile again. All the reasons why they’re actually motivated to replace that missing tooth in the first place. You have to keep thinking about the value of that to a patient. Now, if an implant is 3, 000 units, why, oh, why should a resin bonded bridge be 300 units?

Why is there a 10 times difference, which I’ve seen before? And I just really want to address this, that just because it’s a resin bonded bridge doesn’t mean that it’s an inferior thing, especially if you’re doing the case selection correctly. And we know that if they go on to last four years, they will last eight years.

And there’s about an 80 percent plus success rate of these bridges when there’s appropriate case selection at the 10 year mark. And the interesting thing is that there are some papers whereby they compare implant supported crowns versus resin bonded bridges. And if you include that any complication whatsoever is a failure, actually resin bonded bridges were more successful than implants.

Because implants can have some prosthetic failures, integration failures, surgical failures, a lot more complicated. So whilst I know that implants do command the right fee. Please don’t undersell yourselves with resin bonded bridges. I think resin bonded bridges should be half and if half is too much, then maybe a 40%, a third minimum of the implant fee because yes, the lab fee is lower, but you are giving the patient a tooth replacement.

You’re giving the patient confidence. So please don’t just use the blanket lab fee and multiply it by a number. Do consider what is it that the patient is getting and how is it meeting their objectives and goals? Now, following on from this, when we are charging a fair fee, what happens that time to time, you’ll get failures, right?

We have the composite that fractures or the denture that needs a few more adjustment visits than you anticipated. And hopefully, very rarely will you get a resin bonded bridge, a decementation. Just to bring it back to that previous example, like imagine it de-bonds, right? When those complications happen, because they do happen, right?

When we’re not all perfect, and therefore we will have a certain percentage rate of failures and remakes and re dos. You don’t want to undersell yourself so that when you do have to do something like a remake or do something again or help the patient out, you don’t want to like constantly be thinking, oh man, I wish I charged more for this and this is totally not fair and resent this patient or resent what you’re doing because you didn’t charge correctly in the first place.

You see, when you charge appropriately, you take pride in your work and you do things by the book and you care for it. And in the small percentage of cases that something happens, you will take ownership and you’ll gladly do what’s right by that patient to help them to fix that issue. If of course, it’s something that could have been improved by you.

If it was like an early failure and you feel it’s fair that you should correct it for free, for example, sometimes that happens. But trust me, if you’ve charged the right amount in the first place, then you’ll feel happy to do that. If you gave a massive discount and you undersold it, then it’ll be like something that comes in your day list and it’ll be like, oh no, not that patient, oh no, not this thing again.

Remakes aren’t fun anyway, but trust me, remakes, when you’ve undercharged in the first place, are the worst. So I guess, make sure when you’re charging to factor in that there’s a degree of fudge factor. And by adding in this fudge factor, you’re not going to have anxiety about doing the remakes, about the financial aspect of it as well.

Now, I’ve actually just remembered another story I’m going to tell you. This is me, my first year out of dental school, and I was working in our public health system called the NHS at the time, and a patient walks into reception and says to the receptionist, I have my crown in my hand, I want to know, can I get it glued back in?

And so I had a gap and the receptionist suggested, okay, why don’t you go and see Jaz, and he’ll be able to take a look and tell you if that’s possible. So I greet the patient, I do the whole new patient protocol, medical history, etc. And I take a look at the crown and I think, whoa, that’s not looking good at all, like the entire core was inside it.

I take a look in the mouth, and you guess it, it is completely carious, it’s rotten, there is no way that this could be glued in. And of course, you take a radiograph to validate that and make sure that everything’s medical legally correct. And then I tell the patient, I’m so sorry, this can’t be glued in.

Now, all that took maybe, eight minutes to establish and for me to pass on this information that okay no we can’t actually help you here it can’t be glued in. Now remember I was only one year qualified so when I had to tell the patient that they have to pay something like it was like 18 pounds right that was like roughly the fee that an emergency patient have to pay for like an opinion kind of thing right so it was 18 pounds and I said to the patient look you know you have to pay 18 pounds.

Now this patient was actually upset, it’s like, oh my goodness, you didn’t even do anything, like you didn’t even glue this tooth in, you just told me it can’t be fixed. Why couldn’t you just tell me this outside so I wouldn’t have to come in and, and actually have an official appointment and tell us by his body language.

He was a bit pissed off that he had to pay and he didn’t get his desired result, which is a tooth glued back in. Now, the amount is irrelevant. The amount is actually totally irrelevant because I charge a lot more now to give an opinion like that. But the thing is, the patient didn’t value my expertise and my opinion.

Not one bit, right? Because there was surgery time involved, there was a radiograph, there was a medical history assessment, there was my clinical expertise and opinion. And unfortunately, some patients will not value that. The mistake that happened is that even I, I disrespected it. I didn’t value it. See, at first year out of dental school, you’re kind of like this salaried position kind of thing.

So you’re not really business minded, but it wasn’t nice because I felt as though that day, even I didn’t value the opinion that I gave him. Obviously I value it a lot more now, but back then I think I let myself down. Like, I don’t think I should have argued with him and convinced him that actually you got a really good deal or anything like that’s a waste of time.

That’s a waste of your breath. But, thinking back, I think I was probably a little bit apologetic. Oh, I’m so sorry that you had to pay this and we didn’t glue it in kind of thing. And so I guess I had this like a mindset issue myself. So the lesson there is even if you’re doing like a review appointment, make sure you charge for a review appointment, because if it’s your opinion and your expertise that the patient’s paying for and the overheads of the building, that is really important to consider.

So that’s a common one that I see that dentists may be undercharging. We were not actually doing anything with our hands when we’re working with our minds. You think lawyers are actually great, right? Lawyers are brilliant at this. They’re always working their minds and they kind of start the clock and they stop the clock and they’ll tell you, this will be 5, 000 please or whatever, right?

They are masters of valuing their time. And I think there’s a lot we can learn from lawyers. Now I’m going to play you a little snippet from the archives of protrusive. This is like maybe over a hundred episodes ago with my buddy Zak Kara, who by the way is doing such fantastic communication stuff on Instagram.

And we’re going to the American Equilibration Society to AES in February. And I just kind of convinced him to, to come as well. So me, Mahmoud and Zak will be there. So expect a lot more communication based episodes coming. Zak doesn’t actually know this, that this is happening, but it’s going to happen.

We’re going to bring Zak back. So that’s a really exciting thing to come. So let me just share this interesting snippet about this, the whole mindset thing about undercharging and not valuing yourself. Another thing that I did one year after dental school, which I revealed in that episode.

Have you had a patient laugh at you when you’ve given them price?

[Zak]
No, actually why? So that’s laughed at you.

[Jaz] That’s happened to me during my DF one.

[Zak]
Oh, I want to give you a hug.

[Jaz]
But during DF one, a patient took his tooth out and afterwards, he was a non-English, he was a refugee. We sort of bonded, ’cause I’m also you a refugee. I came to the country when I was six years old and he’s a refugee.

[Zak]
Some story all the time. Jaz, always story.

[Jaz]
I know. What can I say? But yeah. Anyway, so he was a cool guy. But then, look, he was NHS exempt and I took his tooth out. He says, okay, how much do I have an implant? And I said sort of like just over 2, 000 pounds or whatever.

And he actually just started laughing. He was like, wait, wait 2, 000 pounds? He just literally started laughing. And you know what I did?

[Zak]
What?

[Jaz]
I started laughing as well.

[Zak]
It is contagious, isn’t it? It is contagious, isn’t it?

[Jaz]
That’s happened to me. That was a really awakening moment for me. You know what? I need to actually take ownership of what we charge as a profession. Not because I didn’t do implants at the time. I still don’t know what to do. But I need to value the care that you provide so when a patient that kind of patient laughs at you. There’s a they don’t value what you have to offer.

[Zak]
Exactly nail on head They don’t value because they probably don’t understand and one of my favorite questions to ask back to them without being a politician is well what do you understand by a dental implant? Oh, it’s when they’re screwing things. It’s just my car. And then you kind of you basically-

[Jaz]
Get it in India.

[Zak]
So foreign right now, I love it.

[Jaz]
Okay, that was really cringeworthy, but you know what, I’m happy to openly share the stupid things that I’ve done and I just want to make sure that you guys value what you’re doing, no matter what stage of your career you’re in.

Now on the topic of review appointments and valuing those, the other reminder I want to give you is, remember that little old lady? Who’s denture you did and then it needed about 25 appointments for adjustment, right? Do you remember that lady? Yeah, we all remember that lady, right? So if you calculate your hourly rate, it was probably like your hourly rate You’re probably better off working in a local supermarket stacking shelves, right?

We know you spent so much time trying to please this patient that your hourly rate as a business as a finance really suffered. Now, why am I mentioning this? I’m mentioning this because sometimes The way the economics of it all works out is that you will be doing a service whereby your hourly rate will end up being a little bit more than what you usually get per hour, whatever that is, right?

It’s just because the number of restorations needed, you end up doing it quicker. For example, a quadrant of class fives. And if some practices, the way they do it is a charge per restoration and not by time. And so you might find out that by doing all those restorations, a 45 minute appointment. But you’re getting paid usually what you might get paid, an hour and a half appointment.

So you actually, you’re up. And so the silly thing that I would do at one stage of my career, and I know that some of you do it and that we do this all the time, right? Which is we look at that figure that comes up and says, you know what, let me bring this right down.

So that kind of matches what my normal hourly fee is. And patient’s getting a massive, you know, 40, 50 percent discount here. And so the lesson I want to pass on here is remember, remember that lady and the 25 adjustment appointments, just never forget her because sometimes you’re losing and sometimes you’re winning.

And Dr. Lincoln Harris, one of my mentors, he’s taught me that when you’re winning, you want to win big. And it took me a long time to internalize that. And get over it. Like money is a taboo subject. I felt that as well. To be honest, I felt kind of uncomfortable with that. I did. I did generally feel uncomfortable with charging more than my hourly rate, if you like.

But you have to remember that there are swings and roundabouts. Sometimes you’re winning, sometimes you’re losing, and it should bounce out. If you’re always like in the middle, you’re always like, you know, drawing and then you’re losing. When are you actually winning? So it’s okay to take that win sometimes.

Okay. It’s okay to don’t reject that win. Don’t give your wins away. And sometimes your hourly rate will work out more favorable. Sometimes it’ll work out less favorable. That’s general density for you, but definitely please don’t forget that little old lady and the 25 adjustment appointments for when you are winning, please win with grace, win gracefully.

And I tell you what, your patient will still be very grateful. What I’ve learned is that people value what they pay for. And over the years, as my fees have gone up to reflect my experience and my expertise and my skill, my patients are more grateful. I get more chocolates, more thank you cards than ever before, despite my patients paying more.

So patients really do value what they pay for. Now, in a similar vein, I think this is completely how Perio works, okay? The treatment of periodontal disease works like this, right? You scale the patient to within an inch of their life, right? And you do all the OHI and toothbrushing instructions, and you do all the TPs and stuff, and the patient comes back and they’ve still got perio.

And you’re like, damn, why they still got perio, right? And then you refer them to periodontists, okay? The periodontist does the exact same thing as you, except they paid the periodontist like three times more than what they paid you. And guess what? Suddenly all the pockets are gone, right? Do you feel that way as well?

Because I believe sometimes when you send someone to a specialist and they’re paying a lot of money, they start taking things a little bit more seriously. I think this is true imperio more than anything. If you guys got any other examples, do comment below. Now, the next thing I want to cover is foundation restorations or core restorations.

So what I mean by this for the dental students, maybe, is when you remove the caries and you, let’s say, dismantle a tooth and you move all the amalgam and the pins, before you actually now go ahead and prepare this tooth for a crown or an onlay or whatever, you’ve got to complete the carries removal and do the bonding protocol, rubber dam, et cetera, and build this truth up before you then actually prepare it for whatever it needs preparing for.

Now, you’ve actually spent some time with carries removal, you’ve actually spent some time with the restorative protocol, and you’ve kind of just done a restoration before you now do the indirect part of the procedure. And so sometimes I find that dentists are charging for the crown fee, but they’re not charging for the core fee or the foundation fee.

Now, if it’s your policy in your corporate, the practice that the crown fee will always encompass it, that’s fine. But that’s silly because if a crown is, let’s say, for me, it’s a 90-minute appointment. Okay. I’m slow. Okay. If it’s a 90-minute appointment. Okay. But if I need to do a complete dismantling, caries removal, isolation, Teflon, build it all up and then prep it back. That’s going to take me an additional 20 minutes easily, right? And so why would you not charge for that? So you should totally be charging for what you do. Again, vets are amazing at charging fairly. In fact, they charge a lot of money and you’re good on them, right? Because we always value our pets, our children, our spouse, and then ourselves last, right?

It’s one of those things that we do but remember. to be a little bit more like a lawyer, a little bit more like a vet and make sure that you are charging for what you do. Now what I don’t mean is start charging for local anesthetic and start charging for rubber dam, that that’d be silly, but for the more substantial things like a core or a foundation restoration, I feel that you absolutely should be charging.

So guys, I’m going to wrap up the episode now. I’ve got like a summary for you, but if you enjoyed this episode, let me know because I’ve got so much more communication stuff coming with Zak when we’re in Chicago in February. So I’m going to get you a lot more goodness. Remember that in this episode we covered about not apologizing for delivering a fantastic service.

Don’t do what Sim did. Just remember what Sim did in Singapore. Don’t go above and beyond and deliver a fantastic service and then be apologetic about it. Take pride in charging what you’re worth and think of the great benefit that you gave to your patient. Also on that note, make sure you discuss the fees before you actually do the treatment.

We also said about going on courses to get that internal validation to help you justify your fees or just make sure you’re doing everything by gold standard protocols. I know courses can cost a lot of money, but they are an investment in yourself. And I promise you, I’m a massive course junkie here, right?

But I would not be able to charge what I charge with confidence and predictability. If I hadn’t had all these courses as part of my portfolio, the other thing we touched on was getting rid of any limiting beliefs that a certain procedure should cost a certain amount. Like, you know, like I said, resin bonded bridges, they are delivering a tooth to a patient.

So you need to build that value. And also another one I see massively undercharged. It’s splints like a, oh, here’s a night guard, 200 or whatever. Trust me, if you’re helping a patient in pain and you are confident in what you’re doing and you are protecting them from chewing their teeth up and more expensive problems in the future, then you should be charging way more for occlusal appliances.

If you need help with that, check out splintcourse.com. The other thing was that sometimes you lose. Remember lady in the 25 adjustment appointments, and sometimes you win. So when you win, win gracefully. You deserve that win so that you can take the ying with the yang. The other thing we discussed was your expertise and your opinion has a value.

It has a number to it, right? I’ve been guilty of doing like these free three-month reviews. Like, why would I do that? Am I not valuing my opinion? Either you build it into your fee to make sure you get paid for that time, or you put it down as a consultation fee. Your expertise, your interpretation of radiographs, your interpretation of a clinical scenario is super important and super valuable.

And remember that charging what you are worth will mean that you bring your A game and that your patients will benefit. So, I hope you enjoyed a slightly different episode of protrusive. This Ask Jaz double O six episode, this one was not eligible for CPD, but about 95% of our episodes are eligible for CE or CPD.

For those of you in the States, we are pending approval for pace, so you can start submitting for the AGD PACE kind of credits. I’m still kind figuring out how it works in the States, but the whole, bank of episodes are eligible for CPD are on the app, which is protrusive.app. Now we are having a massive upgrade, right?

If you’re on the current app, like it’s okay. But the new one, and I mean, the content on the app is amazing. I’m always taking pride in that, but actually community features and the ability to search that, to have a search function is going to be amazing because that’s what we’re bringing to the table soon.

It’s going to be called Protrusive Guidance, right? So the new system, it was the website was to be protrusive. app. So depending on when you listen to this, just head to protrusive. app to check it out, but the new platform we call Protrusive Guidance, it’ll be like our very own social network, screw Facebook, there’ll be no ads, there’ll be no distracting stuff on there.

It’ll be all us Protruserati, we have an area for us to, to learn from each other and share and connect and polls and articles and images and videos, and you name it, they’ll all live on Protrusive Guidance. So by the time you’re listening to this, we’re probably about 10 days to two weeks away from migration from what I’m using at the moment to Protrusive Guidance.

So please do keep an eye out on your emails, especially if you’re a premium subscriber. You’ve got something very interesting. Look forward to in your email inboxes soon. Thank you so much for listening all the way to the end. Wherever you’re listening from, make sure you hit that subscribe button. Thank you so much.

Hosted by
Jaz Gulati

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