Question:
Ask the lab guy for referral to the dentist?
No, I don't think so. I'm against this, except as a very last
resort.
Dentistry is a relationship between doctor and patient. As
with all other relationships, it involves quite a bit of
"trust."
Answer:
When you go to your supermarket you'll pay extra to pick
through the melons and tomatos to pick out exactly what you
want. At the end of the week, there's some stuff that's much
too soft to sell. So the higher price is necessary to offset
the spoilage.
Produce Junction by way of contrast, sells produce quite
reasonably. If you want the tomatos, you tell them how many
bags you want. They hand you the bags. When you get home if
the tomatos are too soft, then you'll remember that for next
time.
But make no mistake. Produce sellers are all competing
against one another for the same customers but using
some very different strategies.
Dental laboratories come in 3 grades: Superb, excellent and
good. In dentistry, there's an increment built in to cover
some remakes, which come out of all 3 laboratories.
Sometimes the denture does not fit exactly as needed or the
crown needs to be recast. This is why prosthetics costs
additional. But, the lower the cost, the more that you must
push through the pipeline.
I submit that you local guys do not even see our best work!
We send that to the more qualified laboratories. Laboratories
where there is a higher degree of excellence.
As with so many things, you kind of get what you pay for.
Sometimes we need a superb lab (big case, maximum
aesthetics), other times we need an excellent or just a good
laboratory. This depends on what we are doing, and what
results we expect to obtain. Kind of like buying tomatos to
make some spaghetti sauce, and buying other tomatos for
salad!
As example, Glidewell Laboratory charges the dentist $229.
for a Vitallium cast mandibular or maxillary partial - Kenson
teeth, acrylic saddles. Pennsylvania Medical Assistance pays
the dentist $217. for the same job. Guess which laboratory is
doing this case?
In the laboratory business, the "Big Boys" do superb work but
it is also expensive work. The small lab owner does what he
can do to "compete" against the big boys. The big boys
including Glidewell, MicroDental Laboratories, Associated
Laboratories, spend hundreds of thousands of dollars on
marketing and advertising. They consistently deliver a
quality product.
The small local laboratory owner's stock in trade is service.
The laboratory owner bends over backwards to get and support
the dentist/customer's business, which is a good thing. They
reciprocate by referring patients back to their own
doctor/customers. This is more about looking out for the
laboratory's own interests rather than referring to "the most
qualified guy" in town. Besides, dentistry is a "people"
business. You, the laboratory owner may not be in a position
to evaluate the most important part of a dentist's skills.
You also might find that the most talented dentists will not
even send any cases to your laboratory at all. In fact, the
"big boys" probably get more work from those excellent
dentists.
Furthermore, while you are evaluating our "manual dexterity
skills" we are doing exactly the same thing with your "manual
dexterity skills" too. Many of the small laboratory owners
save themselves a few dollars by hiring poorly trained and
uncaring technicians who are paid their wages through
piecework. They quite often will not even follow our written
instructions!
Its kind of well known in the dental community that its
almost impossible to get a properly-surveyed Vitallium
casting. Your first case or two is usually quite excellent;
after that -who knows? Too many laboratories are always
jumping after the first-time doctors. Too many laboratories
looking for more business.
But in our case, our evaluation of you is a real distinction
based upon your product, not some subjective one, based upon
the quality of our impression. I doubt that you are in a
position to evaluate how kindly that dentist has treated the
periodontium while preparing that bridge! This most certainly
will affect the life of the bridge just as surely as how
parallel the abutments might be.
My personal view is that this is yet another case of the
"self-styled experts" beating up on the doctors! I find your
statement "manual dexterity is not a pre-requisite for dental
school" to be inaccurate. Absolutely inaccurate! In fact,
dentist-bashing is certainly more in vogue than laboratory-
bashing is. Perhaps this is what I'm hearing. But that's
another post entirely!
And please remember that this is only a small part of our
"dental business."
So you, the laboratory owner are not a "disinterested party"
offering an opinion as to which dentist knows how to "cut the
best crown prep in town." In fact, supporting your customers
is a key element of your business. Who could doubt that the
lab guy picking up the phone and offering this bit of
friendly "referral information" is any more reliable than a
similar referral from a friend?
At least with the friend, your new dentist might extend extra
consideration to you and to that friend too, out of respect
for the referral. If I, the dentist disappoint you the new
patient, I am risking the relationship with two people, and
possibly more. And, I'll do everything possible to prevent
that.
Besides, when our patients refer us their friends, this is
indeed a nice complement. When a laboratory refers me a
patient its usually called "payback" time!
If someone wants a specific referral (who is the best dentist for a crown,
etc.) that is not my area of dentistry, I am honest. I tell them I have no
experience working witht the doctor in that area.
If someone wants a referral to an orthodontist, I always advise them to ask
their general dentist for a referral...I believe that is an important
relationship and it should be respected. I never refer directly to an
orthodontist.
I believe my referrals are honest, objective and good.
Who do you want a person to ask? A dental school? They will be biased
toward their own graduates and instructors. The dental association? They
will be biased toward their members. A referral company? They will be
biased toward their members. A neighbor? What experience or education
makes the average layperson qualified to make a referral?
When I make a referral I take pride to only refer the person to a dentist I
would personally recommend based on his abilities and qualification, not his
contribution to my pocketbook.
