You have a noise in your engine. You take the car to the shop to be fixed. You’re told that it is a valve. You have the valve rebuilt for $1000. You pay the money and pick up the car and hear the same noise in the engine. How do you feel about the mechanic?

You have a crack in your driveway.  The concrete contractor assures you that he can fix it and does.  The crack reappears six weeks later. You’re told that now it is a result of a plumbing leak below the surface of the driveway. How do you feel about the concrete contractor?

You have pain in a tooth. Your dentist sends you to endo. You pay $1500 for the endo. The tooth still hurts. You are told that the tooth is cracked and needs to come out. How do you feel about the dentists involved?

What does each situation have in common?  The customer pays a fee for a service. Whether the service results in a solution does not enter into the equation.  

What else does each situation have in common?  Faulty diagnosis.  

What else does each situation have in common?  You’ll probably never use those people again.  And these days, such means more than that as people are only too ready to share their experiences not only with their friends but on line, where millions can see what happened.

I can’t discuss the noise in the engine. I can’t discuss the crack in the driveway. I’m not qualified to do so. But I can sure discuss the dental situation.  So can you.  And the above situation is one common reason a patient leaves a dentist and finds someone else.  How often has misdiagnosis occurred in your existence?  Has it happened to you?  It has to me.  Has it happened with those who referred to you?  Of course it has.

What is the one common factor that could set you apart?  You could take the risk for the patient.  And the patient is more than grateful and not only stays with the practice, he or she brags about what a straight up guy or gal you are.

Let’s assume that the missed diagnosis is yours. You see a patient with a toothache and miss the diagnosis of fracture and send the patient to endo. After all, you’re the periodontist. You’re the diagnostician.  But we all make mistakes. What should we do?  Here’s what I would do. I would credit the cost that the patient paid to the endodontist toward the implant procedure.  I would say, “I guess I missed it. Sorry. Let’s do this. I’ll credit the money that you spent for the root canal toward the implant procedure.” What happens? The patient breathes a sigh of relief.

Risk reversal is part of marketing these days. You commonly see it in ads.  “Try ________ risk free for 30 days. See if it doesn’t give you the best ___________________ of your life. And if it doesn’t, just return it to us. No questions asked.  We’ll even pay for the shipping.”

Can you afford to guarantee your work?  Of course you can.   Why? Because a missed diagnosis doesn’t happen very much in your office, does it?  The three or four times a year that you might have to credit is chickenfeed in comparison to the great Google review that it might produce.  (By the way, the way you get great Google reviews is to ask for them.)

Now what happens when you are not sure of the diagnosis in advance of the procedure? You handle that slightly differently.  You talk to the patient. Advise the patient that you are not sure.  And here’s the expense to find out.  You then ask the patient if he or she is willing to take that risk and expense to make the diagnosis. That is informed consent. The patient can then make an informed decision about taking that risk or not.

The name of this process is Fee for Outcome.  Patients are paying for an outcome, not for a service.  They are happy when they get the outcome that they expect, not for the service that got them to the outcome.

We are periodontists. We are diagnosticians first.  If we wear the diagnostician hat with pride, with communication, both verbal and in writing, to advise the patient of the risk in advance, and to absorb the risk when we fail, the public relations produced by that effort will more than pay for the temporary monetary shortfall that you may have.

As government becomes more and more involved in dental care, fee for outcome will likely become the standard of care.  But why wait?  Fee for outcome is a great business strategy.


(If you like what you just read, please forward this to a periodontist friend.)


The American Association of Independent Periodontists is here to help you reach your goals in periodontal practice. We are here to help you control all the variables of your practice.  Our members’ ages are from the 30’s to 70’s.  They practice in major metropolitan areas and in smaller cities all around the country.  They learn practical business principles that are specifically tailored for the periodontal practice by Dr. Lee Sheldon and Danyel Joyner, periodontist and office manager.  Those same business principles are working for our members as well.  And all, yes all, of our members have referral practices.


Twice a month, we give phone seminars and webinars to teach the very principles that are working for us.  We take questions on the phone and provide unlimited email support.   We send disks of those seminars so that you can train your staff.   Every week, you also receive the AAIP Monday Morning Minute.  A sample is attached. How much does all of this cost? Only $297 a month.


Do we hold meetings? Of course we do. Our next meeting is at our office on Saturday, April 2. It a full day of fun as we share tons of pearls on staff motivation, improving acceptance rate, improving the number of patients arriving in your office, internal marketing and external marketing, and team building. That day also includes workshops for staff on Getting Great Google Reviews and Answering the Phone with the Purpose of Scheduling the New Patient.


You’ve been reading about the AAIP for a long time now.  Isn’t it time for you to grow your practice?  Isn’t it time for you have fun in perio again?


Become a member of the AAIP.  For $297 a month, how can you go wrong?