Trying hard to figure it out

[klobird]

OK, so I just looked up average orthodontic salary in our city and it's $206,500....

Orthos win!!

[ArchWired28]

Well... I was under impression that physicians make more than that... At least those whom I know live well beyond 100K per year. I know Tampa is not expensive, but still.
I kind of guessed that an ortho whom I see makes around 250K per year. Maybe it was about right. He's one of the best known orthos in the area though, and the competition is high. Just thinking... How many new patients should he see a year to afford all that? I mean, he has two fully-equipped offices in the different parts of Tampa, employs at least 5 secretaries/office managers, and at least 5 (probably closer to 10) technicians. He advertises, too. Oh, and he has his fellowship for high-school students. So, how many petients per year has he start to afford all that? I would imagine, closer to 150 at least... However, every time I come in, they have at least 3 "braces on" persons. So, let's assume - 2 people per day, 4 days a week (since they dont do new patients on Fridays). Let's assume there are 46 weeks (minus his vacation time and holidays), so: 46*4*2 = 368 patients per year.
Let's narrow it down to 350 an at the rate of 5k per patient, gives us $1750000!
Well, sounds kind of reasonable. But, one has to work really hard to get to that point. Probably, 50 patients does seem like a reasonable etimate for someone who is new...

[secretsmile]

Such an interesting topic.

In regards to how often people see their ortho's, I know everyone's case's are somewhat different but i'm surprised by how often my appointments are. Tomorrow is 3 months for me and my 3rd adjustment! Including initial consulation I have now seen the ortho - 6 times - not including tomorrow. I'm classified as a complex case, but am paying around what you guys are paying $5750 and was quoted 2 - 2 and a half years, plus I think there's a year of retainer check appointments. I'm sure he's still doing fine money wise but likely not making as much on me than on the patients with 3 month apt. gaps.

[Huggypillow]

Hey Kolbird,

i guess from where i live i find it hard to compare $$$ as so much in our country is paid for by our government, except orthodontics theres about a 4-5 year wait on the public system for that.

But i am actually coming to America for a holiday to stay with friends and the story about the ER experience has made me double read my travel insurance fine print.

inteesting though when i went to get my braces my ortho said i could have clear or metal at the same price as he doesn't charge extra for clear, infact he said that clear brackets actually cost the same if not a bit less than metal brackets, So i agree with you if he was honest enough to tell me that then why charge people an extra $400-500 for 6 brackets.

Then Dr's could say " do you want a long needle or for extra $50 i can give you a smaller less painful needle. I know it's a stupid comparassion but yes we dont force them to go to expensive uni's.

there is so much i still dont understand, i mean i'm still recovering from trying to get my head around tipping when i go on my holiday. ( im glad i dont have to tip my orthodontist on top of the fees)

[ArchWired28]

But i am actually coming to America for a holiday to stay with friends and the story about the ER experience has made me double read my travel insurance fine print.

Oh yes, and be sure that it is not a "pay now and get reimbursed later" insurance, because the doctors here will likely treat you as a self-pay. And self-pay patients usually do end up with higher prices (of course, they will give you a 20 or even 30% dsicounted price, but consider that it will be 20% off the $3600 and insurance will pay $300 for the same thing), and that is money you will have to pay out of pocket right now and waaaaaaaiiiittttt to get reimbursed later.
ER is different though, if you ever have to go, just tell them to bill you later (since they don't know the price anyway, it takes time to calculate it). It is another story what to do with that bill, though But I am sure you will be able to submit it to your insurance and not pay thousands of $$$ out of pocket.
In general, try to stay away from the ERs, they are not the most pleasant place in the world to be

inteesting though when i went to get my braces my ortho said i could have clear or metal at the same price as he doesn't charge extra for clear, infact he said that clear brackets actually cost the same if not a bit less than metal brackets, So i agree with you if he was honest enough to tell me that then why charge people an extra $400-500 for 6 brackets.

That is what I was told too, that clear braces cost the same and there is no addl charge for them. I was surprised to learn that other people pay more for it.

[methoddan]

My clear uppers (In-Ovation C) were an extra $300. I'm not complaining though because my dental insurance paid for half of my treatment. I also paid for everything up front, which saved me 5% off the total.

[kennyandrew85]

I would be very annoyed if an assistant was doing the work I paid a specialist for. In the UK people can get heavily reduced costs if a trainee/assistant is doing most of the work in any medical procedure as they need to learn somehow.

Also the health insurance thing, I love America (i've only been to new york and las vegas) but how is it fair for anyone who can't afford to pay for their own insurance, they are just allowed to go without care unless they can pay the bill?

The NHS is expensive for us all, but I'm quite happy some of my salary goes towards helping everyone in the country get help if they need it, and if I lost my job I could get the medical care I needed without a massive bill at the end. One of the richest countries in the world should be able to support it's citizens with any emergency.

My clear ceramic tops and metal bottoms cost a total of £2700.00 to be paid in 12 monthly payments 0% interest.

[ArchWired28]

I would be very annoyed if an assistant was doing the work I paid a specialist for. In the UK people can get heavily reduced costs if a trainee/assistant is doing most of the work in any medical procedure as they need to learn somehow.

Assistant is NOT equal to trainee. In this case, assistant is a specially trained technician to do technical work with braces, i.e. put them in, change wires etc. Technicians do what the orthodontist is telling them to do, so they don't take any treatment decisions.

There are places where trainees are doing the work, usually at med schools, and the fees are usually heavily discounted there. But, I personally would be highly hesitant to be treated orthodontically at such place...

[ArchWired28]

...how is it fair for anyone who can't afford to pay for their own insurance, they are just allowed to go without care unless they can pay the bill?

The NHS is expensive for us all, but I'm quite happy some of my salary goes towards helping everyone in the country get help if they need it, and if I lost my job I could get the medical care I needed without a massive bill at the end. One of the richest countries in the world should be able to support it's citizens with any emergency.

Well, there are ways to get medical care if you are uninsured and cannot afford to pay. Here in FL there are clinics where you go and they will let you see a specialist free. But you have to be eligible, i.e. be a sitizen on the first place, and have an income under certain amount. There's the catch, I believe right now this is 100% of poverty level or about 20K yearly in FL, so if you make let's say 21K - you are not eligible. BUT, you still cannot afford medical care with this income. And non-sitizens are not eligible either. So, one is forced to go to the emergency room where nobody could be denied care, and later they get a crazy 5-digits bill which they never pay. This accumulates as a bad debt and keeps growing, putting extra pressure on those who pay and pushing hospitals to raise the fees...
This system is messed up, and therefore the health care reform is needed badly. I work in health disparities in cancer, so well - everybody is "surprised" why poorer people have poorer outcomes... That's like... DA!!! If you have no insurance, no chemo for you - I am NOT kidding.

[klobird]

Wow, that is cutthroat--no chemo. It's really sad...that a life is based soley on money. But we see it in our clinic too.
People won't get the care they need because their insurance is so bad, or they won't go to a specialist we want them to
see because their insurance won't cover it at all. And most people can't afford any care beyond a regular physician. We do cut our charges drastically for private paying patients.

Even with that, the economy has been so bad that about 1/2 of our patients have not paid on their bills for 60-90 days+.
We're pretty lenient, but still we have to survive, or no one gets care at all because we won't be able to afford to exist.
We're having a hard enough time keeping our clinic afloat as it is because of the trickle down ramifications of a poor economy.

Ya, we do need some kind of change....I would personally like to see private insurance companies (like Blue Cross/Blue Shield) be paid by the government to handle some kind of mass insurance coverage. The reason I don't want it all running through the government is because there is a much higher likelihood that we will never be paid, because of all of their red tape and requirements. We see that with Medicaid (government insurance for the very poor who qualify). They will pay us $39 out of $105 charge for an office visit. We have to right the rest off. The rub is--they never seem to pay us at all!!! Because we didn't dot our "i"s and cross our "t"s correctly. They have 500 page books on how to do just one little thing correctly.

In our region, we are one of the few clinics that even sees Medicaid patients anymore. Most doctors have opted out, and are starting to opt out of Medicare also (insurance for the 65+), for a lot of the same reasons--government run and impossible to deal with. We could NEVER survive seeing only Medicaid and Medicare patients. That is the fear with a nationwide insurance plan in this country.

[ArchWired28]

I agree with you, klobird. The level of care (at the patient's level) in the US is very high, but the overall management of cost and resources is very poor. Right now the healthcare spending is about 17% GDP, but if everything continues as it is now, it will reach 100% by 2020 or 2040? Meaning that everybody will be working in the healthcare
Of course not, but the changes are much needed. I like the quote of one physician that said: now in the US, you get as much medical care as you can afford, regardless of whether you need it or not. However, if you need something you cannot afford - chances are you will not get it.
I work at the big comprehensive Cancer center, and for the last year, our department (research) was the only one that actually ended up with profits. Everything else, including a clinic, was in the negative balance. And I remember how upset everybody here was when the Medicare payments were supposed to be cut 20% (have they ever been)?
I also remember someone telling me that apparently the overall Medicare patients' health is worse than someone having no insurance at all This is kind of funny, but very sad.

As of the orthodontists, I am sure they are also affected by recession, just not that much. Many people will pay the last money to have good-looking teeth. But apparently, they also suffer from non-paying patients, and those that will not pay or be behind of schedule and then go to the other clinic for debanding to avoid paying the debt... Just read about it yeaterday. I like professional ortho forums, kind of gives you their prospective on things

[lilone]

Well, there are ways to get medical care if you are uninsured and cannot afford to pay. Here in FL there are clinics where you go and they will let you see a specialist free. But you have to be eligible, i.e. be a sitizen on the first place, and have an income under certain amount. There's the catch, I believe right now this is 100% of poverty level or about 20K yearly in FL, so if you make let's say 21K - you are not eligible. BUT, you still cannot afford medical care with this income. And non-sitizens are not eligible either. So, one is forced to go to the emergency room where nobody could be denied care, and later they get a crazy 5-digits bill which they never pay. This accumulates as a bad debt and keeps growing, putting extra pressure on those who pay and pushing hospitals to raise the fees...
This system is messed up, and therefore the health care reform is needed badly. I work in health disparities in cancer, so well - everybody is "surprised" why poorer people have poorer outcomes... That's like... DA!!! If you have no insurance, no chemo for you - I am NOT kidding.

That is criminal. I can't believe that someone could actually be denied chemo. Can you imagine being someone who makes that 21 grand/year and being diagnosed with a cancer that has a good survival rate with chemo...and then not being able to get the treatment?! You would instantly be terminal with a stage 1 cancer. Scary. And it sorta seems like a human rights violation...."You can pay to live; you can't. NEXT!"

[klobird]

Hey Arch--I never have looked at a professional ortho forum--but I'm going to--I think it would be very interesting to see their point of view---as for the non-paying patients, you are right!! The ortho has to rely on the patient to make the contract payments, and I can only imagine what a nightmare that must be---patients holding onto their payments until the ortho does some ridiculous thing the patient wants. Or the patient who doesn't pay because they don't like what's happening. And if they have a balance at the end after they get the braces off--why should they pay? People actually think that way---and I just don't get it.....

[ArchWired28]

klobird
according to what I have read, there are many non- or slow- paying ortho patients. This specifically applies to those who elect to do payment plans. Some orthos actually employ the "slow pay - slow treat" technique People would go into appointments without paying, and after accumulating big debt, will go to another clinic for finishing and debanding, claiming that they have moved from another area. Many orthos will not deband such cases for this reason, unless they contact their previous ortho.
Because of this, more and more orthos stop offering payment plans. Which is sad because this might actually prevent honest people from getting treated. But this is life.

lilone
this was my reaction, too when I just learned about it. But the prices for chemo are outrageous, oftentimes in the 6-digit numbers. But here goes the catch, if you were ever diagnosed with cancer, rare insurance will take you (unless this is a group insurance), so one is destined to not get chemo.
But I think, this might be different for an early and late stage patients. The thing is, for the late stage patients, chemo will add several months of life at best, at the 6-digit price. Insurance companies do not seem to think this is a good bang for their buck...

[braces2]

There's a Marketwatch article "Ten most overpaid jobs in the U.S." that talks about orthodontists at #4. I can't post links yet.