Can You Raise Fees and Retain Patients?

Intro: This is The Thriving Dentist Show with Gary Takacs, where we help you develop your ideal dental practice—one that provides personal, professional, and financial satisfaction.

Gary Takacs: Welcome to another episode of The Thriving Dentist Show. I’m Gary Takacs, your podcast co-host. The title of this episode is Can You Raise Fees and Retain Patients? I think you’re really gonna get a lot of value out of this episode. It’s a, uh, topic that’s important to every one of our listeners. Uh, fees and how you set your fees have a lot to do, um, with the financial, uh, performance of your practice. I think we’re gonna share some very useful information for you.

Hey, before we get to that episode, uh, first of all, I’d like to, uh, make an announcement about our upcoming Thriving Dentist Live event. Uh, this is happening on August 6th at, uh, 7:00 PM Eastern Time. It’s a one-hour live event, and it’s going to be a panel discussion. We’ve invited, uh, some of our colleagues and friends in dentistry, uh, and this panel is gonna talk all about emerging technologies and their impact on dentistry.

So they’re gonna share some of the latest technologies that are emerging and happening, and, uh, how they could positively, uh, impact your practice. Um, we’re offering this at no tuition, uh, in appreciation for your listenership. Uh, you do have to register for that event, uh, and to register, go to thrivingdentist.com/events,  uh, and grab your seat. Again, that’s happening August 6th, 7:00 PM Eastern Time. Uh, that’ll be 6:00 PM Central Time, 5:00 PM Mountain Time, and 4:00 PM, uh, Pacific Time. Uh, come join us.

The second announcement that I have is, uh, Naren is going to share another Thriving Dentist Marketing Tip with you. And this tip he’s gonna talk about Google SEO versus social media. Uh, he’ll share some perspective on, uh, on, on the two, and, uh, give you some thoughts about, uh, how to use that information to, uh, help you attract more patients to your practice.

With no further ado, um, here’s Naren and that marketing tip: Google SEO vs. Social Media.

Naren Arulrajah: Welcome to the Thriving Dentist Marketing Tip, and, uh, I’m Naren, the co-host of the Thriving Dentist Podcast. And the tip that I’ll be addressing today—it’s a question that I get a lot: Should I focus on Google SEO, or should I focus on social media? And I think, uh, one-line answer is, it’s about knowing oneself, right?

There is 1% of my clients who excel with social media. They’re who I call influencers, right? Who is an influencer? An influencer is someone who’s spending 15 to 20 hours a week creating tons of video content—video specifically, right? Not written content—and they’re putting themselves out there. Why?

You know what Instagram and TikTok did? Is it—it kind of democratized becoming a celebrity or an influencer. In the old days, you needed a TV show like Oprah to be a celebrity. Now, anyone who’s willing to put the time in and get to a hundred thousand followers is an influencer—i.e., celebrity.

So, you can do it. But what I noticed is, most doctors who go into medicine are not interested in being celebrities. They like taking care of patients. They like the science of medicine. So they’re not necessarily, you know, excited about, you know, becoming celebrities.

So, um, if you’re in that 1%, you love the camera, you are willing to put 15 to 20 hours, and you are willing to wait till you get to, you know, tens of thousands of followers—ideally a hundred thousand—then this is a wonderful way to grow your business. Now, if you’re in that category, lean in.

But the only thing is, no company can do this for you. No employee can do this for you. Why? Because the celebrity walks away. At the end of the day, people don’t trust the business. They trust the human being—the celebrity.

So, if you hire a consultant or an employee, and they leave, now the celebrity’s gone with them. So pretty much you are just wasting your money. And the reason a company cannot do this is—remember, celebrity is linked to a human being. So without you, the human being, they really can’t do much. So they can obviously take your money—that’s easy for anybody to do—but when it comes to meaningful results, it won’t really make a difference unless you personally are doing it.

So, if you’re in that 1%, I would say lean into social media.

So, who is Google SEO for? Google SEO is for those who don’t want to spend a lot of time on marketing, but they want superior results. And what do I mean by that?

Yes, you can buy Google Ads, but they are five to ten times more expensive. So Google SEO—that catches. It’ll take at least a year for you to rank for a hundred or more keywords. That’s what we tell our clients. But once you’re ranking for a hundred or more keywords, you get 95% of the free recommendations and traffic from Google that the top 5% get.

Remember, if you’re ranking for a hundred or more keywords, you are in the top 5%. So it becomes a really, really, really powerful way for you to get traffic through marketing.

So, uh, if you want a done-for-you method, and you are willing to kind of give it a year, and you want to have an unfair advantage where your cost of a new patient is, you know, one-tenth the cost of a new patient for those who are using ads, then I would say Google SEO.

Now, it takes time, and you also have to be involved. Like, for example, you have to tell the marketing team what keywords you care about. Like in our case, we would send you original content. You have to look at that and make sure we can publish it. So there are things you have to do. But typically, think of it like 5% of the work will be done by you, and then 95% can be done by a team.

Now, it’s not an easy marketing. No, SEO is no longer easy. So we have, for example, 200 employees broken into 14 teams. Nine of them are exclusively focused on doing things that Google cares about. The other five are focused on influencing people online.

So, create—partner with someone if, um, you know, um, uh, if you want SEO. Or become a celebrity, if that’s who you are.

So, those are—those are kind of my tips. So I don’t think there’s a one-size-fits-all, or there’s only one solution. There are two solutions. You decide.

If you want to learn more about SEO, or see how well you are doing with SEO, or even get a plan that you can implement, book a Marketing Strategy Meeting. It’s ekwa.com/td.  Uh, it’s a 60-minute call. We spend hours and hours prior to that. Uh, it’s a $900 value. So, ekwa.com/td.  You would really learn a lot about your practice and how to take it to the next level.

Naren Arulrajah: Welcome back to the Thriving Dentist Coaching in Action Segment. This is Naren, your co-host. Hope you enjoyed that tip that I shared with you about SEO versus social media. If you want to do a deep dive, request what we call a Marketing Strategy Meeting. The link is ekwa.com/msm,  so we can give you a very specific action plan to meet your specific needs.

Gary, I’m really, really excited about today’s topic because this is a topic that, if my memory serves me right, we have not covered at all. Uh, we have, uh, done 700 episodes. We are the longest, um, the oldest podcast that has not missed a single week in dentistry, period. You are known as…

Gary Takacs: The one continually running podcast, uh, since we founded it in 2011.

Naren Arulrajah: Exactly. You are known as the podfather for that very same reason, you know, of dentistry. Um, so it’s kind of interesting to be able to talk about a topic that, you know, at least from our memories, we—we haven’t, we don’t remember talking about, you know, at all.

Gary Takacs: Yeah, we haven’t covered this one since, uh—and, uh, as we were doing our, our podcast episode planning—yeah, we thought it is long past due for us to cover this topic, so we’re doing it now.

Naren Arulrajah: Yeah, exactly. And the topic is: Can You Raise Fees and Retain Patients? It’s an excellent topic, and, um, I think you are probably the best person to talk about it because you have made it your work—your coaching work—where every single year, you help your clients, you know, recalibrate their fees so they are not leaving any money on the table, nor are they charging too much and turning off patients.

So you’ve figured out this methodology of, like, you know, setting the fees the right way. And, um, I know when you first started doing it, one of the things I remember you telling me is that almost 95% of doctors are not doing it, and that means an extra $50,000, extra $100,000 in revenue just from this single exercise alone that you’re able to now bring to their practice. Literally—like literally—it’s just a few hours and that’s it. It’s all done.

And of course, there are a lot of details which you work with your clients on, but it’s not complicated compared to the benefit you get from it. The benefit is huge.

Gary Takacs: Yeah. You’re a business owner.

Naren Arulrajah: Yeah.

Gary Takacs: How—how much, um, if—if you raise your fees, right—um, you know, dentists will—we’ll use our audience—if a dentist raises their fees, how much do expenses go up?

Naren Arulrajah: Zero.

Gary Takacs: So the fee increase goes straight to the bottom line.

Naren Arulrajah: Exactly.

Gary Takacs: Um, no, no—expenses have gone up. Um, and, you know, we’re not suggesting gouging by any means. Yeah. And we’re not suggesting, uh, you know, taking advantage of patients, but it’s the idea of setting your fees appropriately.

Naren Arulrajah: Yeah. I mean, there’s lots of ways to think about this. For example, I remember McDonald’s burgers that used to be like, you know, $2. Today, you know, to have a decent meal, you’re looking at $10. I mean, can you blame McDonald’s for increasing the fees to keep up with the cost of everything, which continues to go up? I don’t think any person with logic would blame McDonald’s, because McDonald’s would be out of business if they still kept charging $2 for something they need to charge $10 for, right?

So I do think people understand that. People get it. Uh, and I think almost—it has the counterintuitive effect. If you don’t do it, you become that, you know, dirty, you know, coffee shop or the dirty, you know, restaurant with broken chairs and broken stools, and almost like people won’t come to you because you’re charging too little. And, um, you know, so it’s kind of a…

Gary Takacs: I don’t think most dentists—certainly not our listeners—want to be, uh, you know, the, uh, the cheapest fees.

Naren Arulrajah: Exactly. Imagine…

Gary Takacs: …taking out a billboard saying—

Naren Arulrajah: “Don’t go to Mexico. Come to me!”

Gary Takacs: Yeah. “We have cheap dental fees,” you know?

Naren Arulrajah: Yeah, exactly.

Gary Takacs: That isn’t the reputation… I think a commonality across our listeners at the Thriving Dentist Show is that our listeners invest a massive amount of time and resources in continued education to keep getting better. Our listeners are not the ones that take the minimal amount of CE just to keep their license.

Naren Arulrajah: Exactly.

Gary Takacs: That’s not the case. And, you know, that’s an expense—not only expense for the tuition, but the travel and the investment of your time, all of that. And our listeners also pride themselves on keeping up on all the latest technology and making sure they have the things in their office that allow them to enjoy dentistry more on their part but get better results with their patients.

And furthermore, I believe that our listeners want to be able to pay their team members well so that they can attract and keep quality team members. And all of that, in kind of a back way, relates to our fees, because all of those things go into your cost structure.

Naren Arulrajah: Absolutely.

Gary Takacs: Yeah. Um, well, let’s dive into this: Can you raise fees and retain patients? Well, first of all, this is something that we’ve incorporated into our coaching—into Thriving Dentist Coaching—because it’s such an important part. And there is not a generic fee schedule that every practice should use, by any means. There’s a lot of different variables involved. But it’s something we do annually.

And we cannot set your fees. You have to set those yourself. But we can provide some information that would help you set your fees at what you would feel would be an appropriate level.

Naren Arulrajah: I think what I like about this, Gary, is you make it so easy for your clients. As long as they follow what you tell them to, you literally tell them, you know, this is your new fee for this particular code. You know…

Gary Takacs: Well, they—they determine that, Naren, right? They do. We can’t. Uh, we cannot. We provide a spreadsheet, right, with information that allows them to then determine where they’d like their fees to be set.

Naren Arulrajah: So depending on how high, how low, they can pick the right level. And then automatically, the system will tell them, this is how much you need to adjust.

Gary Takacs: And it’s done in a scientific way. Yeah. Very useful. And, uh, one thing—as we started doing this—the part that really surprised me, Naren, was something we started a while back. And what really surprised me is how few offices had their fees set appropriately.

Naren Arulrajah: Meaning they forgot to adjust their fees for, like, years and years and years.

Gary Takacs: Correct. Uh, or, you know, had random adjustments that weren’t really tied to anything. It was just, “Well, it’s been a while. Let’s raise the fees.” Um, it wasn’t tied to anything. It wasn’t indexed.

Naren Arulrajah: There was no science behind it. It was just—

Gary Takacs: And there was no calibration. One of the things we found with our clients is that sometimes individual fees were set very high, and then other individual fees were set ridiculously low. And then in between, it was just a hodgepodge. There was no calibration of the fees.

And because of that, they really weren’t accurate. And from a business perspective, they weren’t accurate. But I’d like to start by talking about something that is fundamentally important here—that if you’re a PPO provider, you’re not setting your fees.

Naren Arulrajah: True.

Gary Takacs: Who’s setting—if you, if you are a Delta participating provider, whether it be Premier status—which, by the way, is grossly misnamed—you know, there’s two fee schedules within Delta: there’s PPO, and then there’s Premier.

Premier would imply—what does “Premier” mean to you? What does that word mean to you?

Naren Arulrajah: I mean, it means to me, like, high-end. At least, you know, something very—

Gary Takacs: Exceptional.

Naren Arulrajah: Yeah, exactly.

Gary Takacs: If you tell me you went to a premier restaurant, I have an idea of what—

Naren Arulrajah: That is. Premier school, premier restaurant, premier, you know, whatever. Right?

Gary Takacs: Their fee schedule—their Premier fee schedule—is not that at all. It’s slightly better than PPO.

Naren Arulrajah: That’s about it. Slightly better than the worst fee you could ever charge.

Gary Takacs: It’s slightly better than the, than the lesser PPO, right? Um, but in reality, if you’re a PPO provider, you’re not setting your fees. The PPO plan is.

Naren Arulrajah: Yeah. It’s kind of like you’re a commodity. Like, you know, they don’t— I had a crazy question, Gary. You know a lot about PPO practices. Do they look at the doctor’s qualifications in determining what fee they let you set?

Gary Takacs: The only thing they look at is whether there’s been any board or legal action against them. And if there has been a significant number of board complaints or legal action, they may not let a doctor become a preferred provider. So all they’re looking at is, you know…

Naren Arulrajah: Wow. The bottom of the barrel in terms of—so as long as you have a breath, that’s all they want. Like, you know, and then you have the DDS license to practice.

Gary Takacs: That’s it. DDS or DMD, then you’re in.

Naren Arulrajah: You’re in. So it doesn’t matter you have 20 years of experience—you don’t get any different treatment.

Gary Takacs: And by the way, when they give you that letter—"Congratulations, you’ve been accepted!"—that’s really not any honor at all. Because they accept everything.

You know, the biggest complaint that I have with PPO plans is they commoditize dentistry. Right? To them, a crown is a crown is a crown is a crown, right? You know, fillings are fillings are fillings. Doesn’t matter. Whatever you plug in—any service that you do—it’s a commodity. Doesn’t matter where you go, because they pay you all the same.

And that simply isn’t true. We know better. We know—there’s vast differences in quality of clinical care, but also in quality of patient experience.

I’d like to think that our listeners strive for two things: they always want to deliver the highest quality care they’re capable of delivering, and secondly, they want to make every visit a positive experience for their patients.

Gary Takacs: I think that would be a truth across our listener base. And I’m imagining thousands of heads nodding right now, saying, “Yeah, that’s what we want to do.” Yeah, you bet.

But when they commoditize—when you let them set your fees—they’re commoditizing it. And that’s my biggest complaint against PPO plans. They’re setting their fees in a way that benefits them, not you. You’re outside of the contract. The dentist is outside of the contract. The contract is between the employer and the insurance company. The dentist is outside of the contract.

So it really—I want you to think about this, because why in the world would you let any third party set your fees when they have no idea what your costs are, what your—um—the way you’ve made decisions that relate to the quality of your care?

For example, if you’re using an outside lab, you may choose to use an exceptional dental lab because you know how important that is. Or conversely, if you’re choosing to use CAD/CAM or a mill, you’ve invested a great deal of money in being able to provide that in your office. And that’s not reflected in those fees.

They’re only reflected in, you know, the amount of profit that Delta wants to make. And because of that, that’s why fees are going down. But why would you let a third party set your fees?

I like to use this example: Imagine that you owned a restaurant. And imagine there was some kind of restaurant board that you had to run your menu prices by before you could establish menu prices. Do you think any restaurant would participate with that plan?

Naren Arulrajah: No. Gary?

Gary Takacs: No. Because why in the world? Because let’s say—let’s say you’re a restaurant that strives for quality and you invest in, uh, grass-fed beef, um, you invest in, uh, organic produce—you know, farm-to-table or organic produce—maybe, uh, some of your menu items include seafood, and you invest in, uh, wild-caught salmon.

You know that the cost structure for that’s gonna be higher than lesser-quality variations of those examples. And consequently, your menu prices are going to be higher. So, in reality…

This happened to me yesterday, Naren. Just yesterday, I did a CSM—Coaching Strategy Meeting—where a doctor reached out to me, and, uh, his main reason for reaching out was that he’d like to reduce his insurance dependence.

And I said, “Well, why don’t we start at the top? What percent of your patients have PPO plans?” And he said, “Well, I probably could never do this, because 82% of my patients have PPO plans.”

So in this practice, 82% of the time, he wasn’t setting the fee. Right? It was being set by the PPO plans. Only 18% of the time—those are people that don’t have insurance—that’s the only time where his UCR fee schedule came into play.

And one of the reasons why doctors don’t raise their fees on a regular basis is because I believe most dentists to be inherently fair. That’s certainly been my experience—really quality people that are inherently fair. And I think in some cases, they’re thinking, “Well, only 18% of my patients don’t have insurance, and is it fair for me to raise their fees to subsidize the other 82%?”

Think about that, Naren. You know, at a very, um, personal level, can you imagine that coming into play for a lot of dentists? They might think, “Well, it’s not fair to ask that small group—the 18%—to subsidize the fees on the other 82%.”

Naren Arulrajah: I think that’s a great question, Gary. But I think—let me ask you the counter-question: What’s the price you and your team are paying? Because, you know, both that 82% and the 18% are paying 40% less than what they should be paying. You know, is that worth it? Is that worth it on your team? On you?

Gary Takacs: Yeah—45 to 50%, right? In today’s dollars. And if you actually could do the cost accounting in hygiene today—I’m using hygiene in particular, right? Because of the really rapid, escalating hygiene wages—if you could do cost accounting and determine what it costs you to provide a hygiene appointment…

And it’s not just your hygienist’s salary or hourly rate, but it’s the room, the equipment, the infection control procedures, the admin time and experience to put butts in the seat in hygiene—you put all that together, you might discover that it’s actually costing you money to provide those hygiene appointments. It’s costing you—like, out of pocket—it’s costing you money to provide them.

Naren Arulrajah: It’s like—not having that patient, you would’ve made more money than having that patient.

Gary Takacs: I’ve had doctors ask me, you know, in light of the really rapidly rising hygiene wages, does it even make sense to have a hygiene department?

And my answer is—absolutely it makes sense to have a hygiene department. Because hygiene is the backbone of a successful practice. It’s what keeps us connected to our patient base. It’s what allows us to help our patients achieve better health.

You just have to have a better cost structure—you know, a better fee schedule—so that you can afford to have a hygiene department.

You know, we’re looking for—ideally—one-third of total office production should come from hygiene. I can’t imagine any argument that would say, “Don’t do hygiene anymore. Cut that third out of your practice.”

Could you imagine that, Naren? Would that make any sense?

Naren Arulrajah: Yes.

Gary Takacs: Would that make any sense?

Naren Arulrajah: No, Gary, it doesn’t.

Gary Takacs: None.

Naren Arulrajah: Absolutely not.

Gary Takacs: Uh, because much of your treatment comes out of hygiene through the exams. So, really, you should be solving the problem a different way—by coming up with an appropriate fee schedule that allows you to be profitable in everything you do, including hygiene, which represents a third of total practice revenue.

So, to answer the question: Can you raise your fees and retain patients? Yes.

Naren, what do you think the fee that most of the public is most sensitive to is? What’s the fee that the general public is most sensitive to?

Naren Arulrajah: Uh, the hygiene copay.

Gary Takacs: The hygiene appointment fee. Yeah, hygiene appointment fee. Because that’s what they experience most commonly, right? That’s what they experience.

Naren Arulrajah: Yeah. It’s kind of like, you know, if you are thinking of a car—yes, once in a while they’ll spend $5,000, $3,000 on a major repair. But if you charge $500 for your oil change, they’ll be like, “Okay, I’m not really sure if I want to take it there,” because just—yeah—because they do it frequently, and that jumps out at them.

Gary Takacs: The oil change is what’s probably most… except for Tesla drivers.

Naren Arulrajah: Tesla. Oh! But I’ll tell you the other side—we don’t change the oil. Like, there’s no oil to change. There’s zero maintenance. You don’t change the brakes. It just is like—it keeps going. It’s like that Energizer Bunny commercial. It never stops.

Gary Takacs: Naren, you can talk till you’re blue in the face, and I’m not gonna drive a toaster until I have to.

Naren Arulrajah: I think that might happen one day when AI will be safer than humans, I guess.

Gary Takacs: Maybe. But yeah, so it’s that hygiene appointment. I mean, how often does someone get a crown, Naren?

Naren Arulrajah: Um, someone gets a crown—you know, I think it depends on the patient, of course. Maybe once a year, maybe like every five years. Depends, of course, right?

Gary Takacs: Depends on their home care, depends on their condition.

Naren Arulrajah: Exactly.

Gary Takacs: But the point is, it’s not very regular.

Naren Arulrajah: Yeah. So they don’t notice it. So I think what you’re saying is, when you’re setting fees, those other things they don’t notice—but the hygiene appointment, they do notice. Is that what I’m hearing from you, Gary?

Gary Takacs: Well, that’s the one they’re most… it’s the one they purchase most commonly. So it’s the one that’s most familiar to them. Right?

To prove that point, I had a wonderful discussion with one of our clients recently. We were on a Zoom call, and he said, “Yeah, Gary, I did a crown the other day on our oldest patient in the practice.” This is a relatively new practice owner—he purchased his practice about eight months ago.

And he said, “I did a crown on the oldest patient in our practice.” I said, “Oh? How old was he?” And he said, “Ninety-seven.”

And he said, “He drives himself in, he doesn’t use a walker or a cane, he walks briskly—he walks like he’s 50. He’s sharp as a tack, no glasses, has perfect eyesight. Just a delightful man.”

And he said, “I presented this crown fee to him, and the patient said, ‘Yeah, when I had my first crown, I traded two chickens for it.’”

Gary Takacs: And my client has a good sense of humor—he’s quite witty—and he said, “Hey, do you still have those chickens? Because if you do, it might be worth me trading some. With the price of eggs today, it might be worth it.”

Naren Arulrajah: The price of eggs! 

Gary Takacs: And the guy laughed. He goes, “No, I’m past my chicken-raising days. But given the price of eggs, that could be a good deal for both of us, couldn’t it?”

I thought that was a funny interaction.

But yeah—and I’m not suggesting, you know, we hide our fees from your patients—but they don’t know what they are. And so, you should set your fees at a level that allows you to be profitable. I mean, unless you’re a nonprofit.

Sadly, some dentists are nonprofits—but not by choice. You’re not an actual nonprofit—you’re just… “non profit”.

Naren Arulrajah: Or a loss-making business.

Gary Takacs: In your operations, you’re “non profit”… Right?

But, you know, we’ve come up with a really good way to do this in a way that’s fair for you and fair for your patients.

Naren Arulrajah: Can I recommend they book a Coaching Strategy Meeting, Gary, in case they haven’t done this and they really want to get started?

So, for those of you who don’t know, most of Gary’s clients are coming there to drop PPO plans and/or help their practice grow—

Gary Takacs: It’s really to optimize their practice.

Naren Arulrajah: Exactly. Yeah, exactly. And in order to work less. So those are the three things that drive, you know, the clients.

And I think adding—increasing your fees every single year—and of course, if you haven’t done it for a long time, getting it to the right level automatically adds money to the bottom line. Like an extra $50,000, an extra $100,000.

I know many of your clients—just that one exercise you do for them every single year—pays for your coaching.

Gary Takacs: Actually, many times over.

Naren Arulrajah: Many times over. Exactly.

Gary Takacs: And now it’s done scientifically. It’s done with data. It’s done with respect to your quality of care, and it’s done in a way that really allows you to know that that part of your business is buttoned down. Right?

If you’d like to schedule that, just go to thrivingdentist.com/csm —that stands for Coaching Strategy Meeting.

Naren, let’s hit pause here on the Coaching in Action segment. We’ve got some great questions that will allow us to add some color to this and to go into more detail about fees. So coming up next is our Thriving Dentist Q&A.

Naren Arulrajah: Welcome back to the Thriving Dentist Q&A segment. Gary, this topic is a really important topic, and I think this just is a huge ROI topic in my mind. Can you raise fees and retain patients? And the answer is absolutely. You have done this with your clients, and, you know, the only thing it did is just added an extra $50,000 to $100,000 to their bottom line every year.

Gary Takacs: And maybe, Naren, the broader discussion is: Every successful business has a pricing strategy.

Naren Arulrajah: Right?

Gary Takacs: Every successful business does, right? Outside of dentistry—every one of them.

Naren Arulrajah: Look at Apple, right? They don’t charge the same amount they charged, you know, 10 years ago. No. They just—they have new products, they change their prices, they increase their prices. It’s always… they… it’s a very complicated pricing strategy, for sure.

Gary Takacs: Yeah. And so dentistry is no different.

Naren Arulrajah: Yeah, exactly. And I think what you provide is that methodology where it’s run consistently. It’s not random. This goes up, and that is, you know, above market, and this is below market—and none of that stuff. It’s just all about…

Gary Takacs: Don’t throw a dart at a dartboard.

Naren Arulrajah: So, the questions are really valuable questions, Gary. So I’m gonna ask you four questions.

Question number one is:

In my area, the economy is currently neutral—neither good nor bad. I think a lot of people would, uh, resonate with this kind of an economy right now. How do you feel about raising fees in a “neutral” economy?

Gary Takacs: You know, and I actually think we could answer that question more broadly. We could replace the word neutral with positive economy or negative economy. Yeah. You know, it all relates.

And in reality, when we look at your fees—and once we get them indexed to a certain level—we then look at things like inflation.

I wish there was an actual dental profession inflation index. You know, what is inflation in dentistry? There is no such thing. It’s not that narrow. Economists don’t narrow it down that much.

I wish they could say, “In dental offices, your inflation last year was 8%,” because if inflation was 8%, that might tell us, well, we should raise our fees 8% to make up for our increased cost of doing business.

Gary Takacs: Right? But the best we have is the CPI—Consumer Price Index, right? That Consumer Price Index is so broad, and it eliminates a lot of the… Like for example, what’s really driving hygiene wage inflation in dentistry right now is hygiene wages. And that’s unique to dental.

But yes, you can absolutely raise your fees in a neutral economy. You can raise them if the economy is down. You can raise them if the economy is up.

Remember, when we talk about a down economy, neutral, positive economy—whatever’s happening economically doesn’t affect everybody. You know, Naren, even in a recession, there are people that are not affected economically by the recession.

Naren Arulrajah: A hundred percent, yeah.

Gary Takacs: You know, look at your investments, look at… you know, it’s not universal.

But the answer to that question is yes—you absolutely can raise your fees in a neutral economy. And you need to. Because while the economy may be neutral, your costs aren’t neutral. Your costs are going up.

Naren Arulrajah: I think to be very honest, Gary, if I just flip the whole thing—most people don’t know what your crown fee was two years ago or what it was three years ago. Right?

Of course, hygiene—if you make a big change—they will notice it. I get it. You covered that in your Coaching in Action segment.

But like, you know, I go to a restaurant—do I remember how much I paid for that steak? They have three steak meals… how much I paid for that seven-ounce Angus steak meal? I don’t remember it. It is what it is. They tell me what it is, and I pay it.

You know what I mean? Like, I want it, I’m there. I’m not gonna say, “No, it’s $2 more than last time.” Nobody does that.

So I think sometimes as practice owners, as dentists—and I know you’ve talked about psychology and how you feel about your practice and lots of other things—and maybe you’re having a bad day… We sometimes personalize it. “Oh, this is too high.”

And then that fear of it being too high stops us from realizing—people don’t really pay attention to this. They’ll pay what you tell them to pay. You know, outside of things like hygiene, where you need to be sensitive.

Gary Takacs: Yeah. Well, you bring up a very good point, Naren.

Fee structure has a lot to do with psychology. Yeah. And your own personal psychology—and how you feel.

It actually—it really comes down to self-worth.

Naren Arulrajah: Right?

Gary Takacs: Are you worth it?

Think about the investment that you’ve made. First of all, think about the achievement that you’ve made. You know, not everyone graduates from college. Well, you succeeded—not only graduating from college, but at a high enough academic level to be accepted into a professional graduate school.

You survived four years of dental school. You incurred a massive amount of debt—likely—through dental school education.

You then had to pass the boards. You then, to become a practice owner, had to jump through any number of hoops to get the loan to buy your practice.

You’re worth it. Yeah. And all the while, you’re always improving yourself.

But I think…

Naren Arulrajah: The reason they feel down is like—I know most of your clients, when they start with you, they feel like they’re going to the salt mine every day. So when you’re feeling that way, your self-worth is not that high. You know what I mean? As opposed to…

Gary Takacs: You could be controlled by Delta.

Naren Arulrajah: Exactly.

Gary Takacs: Your self-worth can take a hit. Right? And I think that has a lot to do with how doctors feel about their fees—their own perception of their self-worth.

And I’d like to just go on record as saying: You’re worth it. You’re absolutely worth it.

I’d like to recognize the massive amount of effort and achievement you’ve made to get where you are—and the continuous achievement you make to stay at the top of your game.

You’re worth it. And listen to this part again: You’re worth it.

Naren Arulrajah: I know. Like, part of what you do with your clients is give them that self-worth, right? For example, “Hey, look at your reviews—people are glowing about you. Look at the technology you have. Why are you charging at the bottom of the market versus where you should be? You should be at this level.” Right? You know, it’s just…

Gary Takacs: It’s—you know, for those of you that are doing high-value services like, say, cosmetic dentistry, or implants, adult ortho—imagine that patient looking in the mirror to see their new smile, tears rolling down their cheeks, and the appreciation they have for how you changed their life.

I mean, the reason I’m so bullish on dentistry is we have the ability to change people’s lives every day. And it could be something we do clinically, or it could be something we do behaviorally.

And frankly, what is that worth to someone? It’s priceless. It’s absolutely priceless.

Naren Arulrajah: Absolutely. Let me go to question number two, Gary.

I have not raised my fees since the COVID pandemic. So that’s, I guess, six years now. Could you suggest a specific percentage fee increase, given the long period of time?

Gary Takacs: Well, you know, that actually is a very common situation. We’ve encountered that many times in our coaching.

And think about it, Naren—going back, I guess it’s five and a half years ago now—and all of a sudden the whole world goes upside down and you’re gonna be shut down for who knows how long, right?

Weren’t you shut down for like five years in Canada?

Gary Takacs:  It was a long time!

But—and I can understand why coming out of that—raising fees was not your priority. Your priority was just getting back in… getting back operational.

Naren Arulrajah: I mean, even like hotels, right? It feels like it’s double now versus pre-pandemic. You know, many things feel like at least 50% higher. In some cases like 60–70%.

Gary Takacs: But then if we continue on—right—2021, offices were still kind of in the muck of recovering. We’re now getting into 2022. And then it becomes, you know, “Let’s just restore our practice, let’s get stabilized.” So, there’s a lot of offices that haven’t done that.

But this is something I deal with with our clients. And by actually going through the data individually, I can share information that would allow them to know what to do.

There isn’t a generic percentage that I would use.

And then the question becomes—I’ve had doctors ask me—“Since it’s been five years, should I raise all my fees at once, or should I raise them incrementally?”

And I say, well, that’s up to you. Think of it a lot like pulling the Band-Aid off your arm. You can rip it off a little bit at a time, a little bit at a time… or you can just rip it off.

Naren Arulrajah: If it’s your practice, what would you do, Gary?

Gary Takacs: Naren, I’m ripping it off. Right? I’m gonna rip it off.

Naren Arulrajah: And can you tell us why you would do that? What’s the science? What’s the reason behind it?

Gary Takacs: Basically because they’ve been mis-set for five and a half years. Right? And now I’m gonna get them in alignment—right—put them in alignment with what they should be.

Naren Arulrajah: Yeah. You’re worth it. Going back to that self-worth.

Gary Takacs: And you’re worth it, yeah.

And think about the impact that you’ve made on patients. And the truth is—you don’t even know the full impact. Because many patients think you’re absolute heroes… and they haven’t shared it with you, you know, but they think that.

But that’s what I would do: I would rip it off.

Naren Arulrajah: Thank you, Gary. What’s the most effective way to encourage my team members to support a fee increase? And again, is this an issue—like getting the team on board—is that important? And if so, how do you get them on board?

Gary Takacs: Well, I absolutely want the team on board behind this, because patients don’t discriminate who they ask their questions to, right? They’re gonna ask their questions to the assistant next to them, the hygienist next to them, the admin team member…

And I would teach them how to present your fees confidently and proudly. How to present them confidently and proudly.

And a simple way to say that—because for almost whatever your crown fee is, there are people who will say, “Oh my gosh, that’s a lot of money.” There’s no reference point to it—they don’t really know.

And how might I respond to that if I were a team member?

I’d want to be supportive. I’d say:

“George, I understand. You know, we’re family people—we understand budgets. But I think if you reflect on this, you’ll find that’s a very fair fee for the quality of care we provide and the quality of experience we provide in our practice. I think you’ll find that’s a very fair fee.”

And say it with compassion:

“We are family people. We do understand budgets. I understand.”

So, show some compassion, show some understanding—but then proudly say:

“I believe that if you were to check around, you’d understand that this is a very fair fee for the quality of care that we provide.”

Naren Arulrajah: Let me ask the elephant in the room, Gary—which is, you have done this with all your clients, or like almost 90% of your clients—and you do this annually.

Have you seen pushback or concerns from patients? Or is it just all imaginary? At least, I’m just saying anecdotal evidence. I know it’s not scientific—you know, you’re not in the practice every day.

Gary Takacs: It absolutely is anecdotal. And, you know, you’re impacted by something—there might be a, you know, a patient that said to you, the doctor, years ago, “Oh my God, it only took you, you know, 30 minutes to do that root canal, and you’re charging me this much?”

And now—what’s the patient equating it to? The amount of time that you spent.

I’d actually like to be sarcastic and say, “Well, I could have taken an hour and a half. Would you prefer that?” (Don’t do that. That wasn’t part of the script—I should cut that out—but we’ll leave it in. )

But I mean—can you understand that, Naren? Right? It’s like a Picasso painting that took him, you know, 20 minutes to paint. “Oh my God, that painting took him 20 minutes, and I have to pay this much for it?”

Gary Takacs: But yeah. I think it’s always useful to say, “I understand. We’re family people. We understand.”

Naren Arulrajah: But most patients don’t have these conversations, right? They’re fine. They’re—they…

Gary Takacs: They accept. They might grumble. They might grumble as they’re pulling out a credit card: “I wasn’t prepared.”

But really, what they’re more grumbling about is their lack of preparedness to pay for this. Right?

It’s not your fees they’re really grumbling about.

And I think we just look them right in the eyes and say,

“I understand. However, that fee allows me to provide you the quality of care that I would do for any of my family members. And it allows me to sleep at night. It allows me to sleep comfortably, with a clear conscience, knowing that I’m taking care of you just like I would take care of my mother, my brother, or my sister.”

Naren Arulrajah: That’s a brilliant answer, Gary. And I think the people who have gotten to that level of self-worth and confidence—they mean it. And the patients know they mean it. You know?

Naren Arulrajah:Yeah. Let me get to the last question, Gary. Question number four:

We have treatment plans with already quoted fees. So let’s say I change my fees today, but we quoted somebody a fee last week—okay—how would you recommend incorporating a fee increase when case fees have already been communicated?

Gary Takacs: That’s a really, really good question. I appreciate the thought behind that question, and that’s probably true in every practice. We have, um, treatment plans that are outstanding, right? They haven’t been completed, where we’ve come up with a fee. What I would do in that case, um—and this involves more significant treatment, you know, the, the, the bigger treatment that we’ve, you know, treatment planned. It’s not, not just everyday stuff—um, what I would do in that case is, uh, I would individually reach out to each one of those patients, um, and simply let, let them know, you know, uh, due to our rising costs, uh, of doing business, we have recently initiated, uh, a fee increase. However, we’ll be happy to honor, uh, the, the fees that we’ve quoted, uh, provided you get that treatment done within X period of time. And it might be three months, but I wanna caution it might not—it might be longer than that—if your schedule wouldn’t allow you to accommodate them within that time period.

Gary Takacs: Uh, so, uh, just reach out to them individually. Have your, uh, treatment coordinator reach out to him, your financial coordinator, and, and, uh, you know, Linda, um, uh, I’m reaching out to you because we have recently, uh, initiated a fee increase due to our rising costs. Uh, and, uh, we have had a fee increase. However, um, you have a treatment plan with us. We will honor that treatment plan, uh, on the current fees, as long as you get that done by this period of time. I’m reaching out to you to see if you’d like to schedule that. Does that make sense?

Naren Arulrajah: Absolutely. Got it. Thank you so—

Gary Takacs: Much. Can’t be, can’t be any more fair than that. Yes. And that might, that might be motivation to have people get things done, right? Um, you know, absolutely. Uh, and it would be a reasonable—it’s not gonna be forever. It’s gonna be a reasonable period of time. And people understand that, and I think they would feel, um, very appreciative of the fact that that courtesy has been extended to ’em.

Naren Arulrajah: Right? I know you’ve used sometimes the phrase "fee adjustment" and "fee increase." Do you have a preference, or it doesn’t—

Gary Takacs: Either way, right? Yeah. Uh, but I wanna bring this back full circle. Um, if 82% of your, uh, fees are set by Delta, that’s what really needs to change in your practice.

Naren Arulrajah: That’s the elephant in the room problem.

Gary Takacs: That’s the, that, that, that is the 5,000-pound pink elephant in the room. Mm-hmm. Uh, and that’s what really needs to change, uh, because Delta, it doesn’t care, uh, about the quality of care you’re providing, right? It’s, it’s a commodity to them. And if that’s something that’s on your mind, uh—and notice, we call it reducing insurance dependence. We don’t call it going fee-for-service, right? Because you don’t have to go all the way to fee-for-service to significantly improve your practice. Uh, every time you successfully resign from a PPO plan, you’ve strengthened your office.

Gary Takacs: But if your goal is to go fee-for-service, I’ll be your biggest cheerleader, because that’s the way to get the most out of it. If you’d like to find whether this—find out whether this is even in the realm of possibility for you—uh, set up a coaching strategy meeting with me. We can—I’ll, I’ll ask you some information about your practice.

Gary Takacs: We can sort that out together. So go to thrivingdentist.com/csm  and love to talk to you about this, and love to have you in control of, of more of your fee schedule, if not a hundred percent of your fee schedule. Well, this has been a fun episode, Naren. Uh, I wanna take a minute and, uh, thank all of our listeners. We appreciate each and every one of you. I hope you’ve found this useful. Uh, it’s kind of a topic that isn’t brought up much, um, and, uh, very happy that we could hopefully provide some very useful information here.

Gary Takacs: Um, on that note, uh, thank you all for the privilege of your time. Uh, Naren and I look forward to connecting with you on the next Thriving Dentist Show.