Friday, July 03, 2009

Why are dentists such a pain in the wallet?

I_hate_dentists Deborah Hill Cone asks an obvious question in this morning’s Business Herald: Why are dentists so gosh-darned expensive?

I see a lovely dentist who “cares for cowards,” plays hot jazz and gives me nitrous oxide – it’s fabulous, like going to a pleasant nightclub where you can’t talk or dance because someone is fiddling with your mouth.  Until you get the bill.  Open wide, wallet. Last time it cost $3300 for a crown and a filling.

Ouch! 

I have tried and tried but I don’t understand why dentists are so expensive.  If I go privately to see another sort of medical specialist who has trained for a squillion years – a neurologist or a dermatologist, say – they are likely to charge me about $400 an hour.  Even factoring in the fact that the dentist has an assistant, a whizzy chair and more technology the, difference in fees seems startling.

Yes, it does – especially to one whose profession would kill to charge $400 an hour!

And dentists only have to tell people to floss, not that they have a brain tumour.

True. 

web Now, I have a confession to make. I’m a coward when it comes to dentists too – I blame a bad experience back at the school murder house many years ago at the hands of one of its badly-trained institutional torturers – and the twin pains of drill and wallet-ectomy have made me a very reluctant visitor to dentist’s offices since.  I’m sure I’m not the only one.

So here’s your chance to talk up your own favourite angel of dentistry: who can you recommend to readers like me who need their fangs fixed, but are reluctant to pay through the nose for another pain in the mouth?

And feel free to explain why all the others are so gosh-darned expensive.

33 Comments:

Blogger Mark Hubbard said...

Why are dentists so gosh-darned expensive?

I've been too long on the Internet this morning, so I'll keep this brief. By anecdote, I can have a shot at both giving a dentistry nightmare story, as well as an explanation of why dentists are so expensive.

A client, qualified dentist in his home country, immigrated to NZ seven years ago with his wife and young family (lovely family by the way).

He went through all the immigration process, had the appropriate points, etc, no problem welcome to the country.

Set up with another local dentist in practice.

Then, raided by Internal Affairs (or some such government department, can't exactly remember which), because NZ's governing regulatory - note that word - dentistry body did not recognise his foreign qualifications, even though he basically had the equivalent of a PHD!, and no one, throughout the entire immigration process, told him that this would be a problem. No one tapping him on the shoulder and say you realise you won't be able to practice your profession here.

That regulatory body has now, over seven years, made this man almost completely resit his qualifications through our tertiary sector.

Over this seven years when he has been studying and sitting exams, he has funded his family, and study, through odd jobs where he was able and had the time, but mainly via Student Allowance, the old Family Support, and latterly, the obscene Working for Families. That is, because of the monopoly power of a dentistry body - who surely face a conflict of interest, because the more they can limit the supply of foreign dentists, the more they can charge in their own practices - the NZ taxpayer has had to pay for this man to unnecessarily (matter of opinion, I know) resit qualifications he already had from his home country, and feed and fund his family over a seven year period.

The great news is, he is finally practicing.

Thusly, I contend, this nightmare - and it was for him and his family (put yourself in his and his wife's shoes - points to the excessive cost of my, and your, dentistry bills :)

7/03/2009 12:04:00 pm  
Blogger Richard McGrath said...

If you don't like the prices here, do what I did - book in at a clinic in Bangkok for your dental work. The savings on the cost (50%) I estimate would have covered my air fare over there (I was on my way to Hong Kong anyway). Check out silomdental.com.

If your budget is really limited, do a search on 'Indian street dentist' and watch the video clip that lasts 2 min 5 sec for a cheap alternative...

7/03/2009 12:09:00 pm  
Blogger Blair said...

Try this fellow.

Cheapest dentist in town. Will not rip you off. I wouldn't use anybody else.

7/03/2009 12:15:00 pm  
Anonymous matt b said...

I haven't read the other comments, which look interesting, but here's my guess: Deborah is on the wrong end of some price discrimination.

Dentists have large fixed costs to recover and they want to recover those fixed costs from those clients most willing to pay.

Those clients are the ones who are desperate to avoid being awake for, well, anything. So charge a lot for the NO2.

I doubt marginal cost has much to do with the prices being charged. That doesn't certainly mean its anti-competitive - cinemas do the same thing. But didn't the Commerce Commission say something recent-ish about dentists not being competitive? Whether entry into the market is free might be a good place to start looking.

7/03/2009 12:21:00 pm  
Anonymous Terry said...

Why are dentists so gosh-darned expensive?

Dentist A: does the job in half the time of Dentist B. Both do equally good jobs. Dentist A is $400 per hour, Dentist B is $200 per hour. I know which one I would choose.

7/03/2009 12:30:00 pm  
Anonymous Falafulu Fisi said...

Science and Engineering are more expensive to be trained compared to accountants, lawyers, arts, commerce and may be architecture.

The reason is that science and engineering training's involve expensive materials. The engineering school at Auckland bought a super-computer worth over 3 millions. The Physics/Chemistry/Bio-engineering bought a scanning tunneling microscopy to share which costs more than 2 millions. The Chemistry department had to keep up to date with the latest in chemical spectrum analyzers (not one but a few) which are very expensive. They also have to keep up the supply of chemicals for students , where some are quite expensive per milli-gram, etc,... When I was doing Chemistry stage 2 paper, we were told that the stuff covered in lectures can't be done in the lab, since that chemical is very expensive to buy per milligram (that chemical was Palladium). Palladium was reserved to be used in final year and post-grad lab classes only but not in year 1 & 2, because of the costs. The lecturer said, that Palladium is used by stage 1 students all the way upto post-grad by majority of Universities in the US, because they can afford them. The same thing goes to biological science & medical science. So, science & engineering should be the most expensive to be trained because it involves expensive materials & equipments to do the training.

From other departments, the only obvious costs is , umm! the A4 sheet of paper that printed the lecture notes for that day.

7/03/2009 12:34:00 pm  
Blogger PC said...

Thanks for the recommendations so far. And so far, Blair's looks better than Bangkok. :-)

FF: "Science and Engineering are more expensive to be trained compared to accountants, lawyers, arts, commerce and may be architecture."

You really should have followed that link above, FF. I made it open for you in a new tab and everything:

"Documents released by the UK Cabinet Office’s panel for Fair Access to the Professions show it costs more to qualify as an architect — over £60,000 — than any other profession."

I don't imagine it would be any different here, sadly.

7/03/2009 12:39:00 pm  
Anonymous El said...

Dentists huh. I have had far far more than my fair share of appointments in my life due to a very unfortunate accident when I was young. Could have broken an arm or something, but no, I had to damage the teeth instead at a cost of thousands and many months fixing the damage, once, and then corrective work again (many more months). I'm used to it now. Wallet has still not recovered from it. I do see a very good dentist though. Yes, it is expensive in NZ, no doubt that the 'red tape' is to blame to some degree. I have been told it is cheaper overseas etc. Thing is, I can't be arsed travelling to another country. If the work done is questionable, then at least it is someone local, and easier to make accountable. Well most of the time.

7/03/2009 12:50:00 pm  
Anonymous Sean Fitzpatrick said...

My dentist is a recent migrant from the US. She brilliant and not at all expensive.

Two interesting stories:

a) she has a doctorate in dentistry - thats a few years study over and above the standard dentist - however she has been told by the NZ dentists council she is not allowed to refer to herself in any of her advertising as Dr So-and-so. Why? because it might make other dentists look not as qualified as she and give her unfair marketing advantage.

b) she herself is amazed how expensive dentistry is in NZ compared to the US.

There are numerous reasons for this - just a few include the fact that health insurance in NZ does not usually cover dentistry (in the US it does). Also the tariffs on importing dental equipment into NZ is massive - a second hand chair imported costs about the same as a brand new one in the US.

Also it is much more standard practice in the US for dentists to take preventative and investigative measures such as x-rays to head off the need for more serious and expensive future intervention.

No need to mention what the presence of state provided school dental clinics do to the market.

c) also she is qualified to use the new invisalign technology on uneven teeth - an alternative to old fashioned braces. However this is a threat to orthadontists who generally see that as THEIR area so expect to see some running to Nanny to get the big stick out so their vested interest can be protected sometime soon.

7/03/2009 01:37:00 pm  
Anonymous frank cobain said...

@Sean Fitzpatrick.
Any chance of getting an address/contact details?

7/03/2009 01:48:00 pm  
Blogger Dinther said...

I'm did what Richard did, You get a better health service anywhere in Asia compared to most if not all Western countries. A few years ago I needed dental work. $10.000 was the estimate. The work involved replacing fillings, pulling some wisdom teeth and a bridge.

In Thailand they have ultra modern facilities with well trained staff. I first went to a local butcher to get photo's made and a detailed quote on what work was required. Cost $250. Make sure to tell them up front you want all the photos and data. My dentist wondered why I wanted it and I told him because I pay for it.

With these details I started emailing various reputable clinics in Thailand. The cost quoted for the entire job was $2000

Throw in $1200 for the airfare (I fly el cheapo) a few hundred for accommodation and food and a couple a grand on lost income for the 10 days I was going to be there and the cost was still much less.

Like Peter I had bad experiences with dentists in my school years so I was stressed to the max but these people were fantastic. Never a hint of pain, no oops or mishaps. Appointments accurate to the minute and besides having to deal with rice loving this new found hole where a wisdom tooth used to be there were no issues.

In fact there was so little discomfort that the much dreaded feeling miserable in a hotel turned into a pleasant 10 day holiday interrupted by a total of 10 hours in a dentist chair.

That was 2 years ago. All the repair work is still in place and I have no problems with my teeth what so ever.

There is no way I will ever see a dentist in NZ again. Just collect the problems and go for a big maintenance session in Asia. You be laughing all the way to the bank.

7/03/2009 01:52:00 pm  
Blogger PJ said...

I have tried dentists in Ireland, London, Hong Kong and NZ....I have to say that my current dentist in Queenstown is both brilliant and reasonable to the wallet.
Try Jamie Hopkirk 03 442 8580
....and, no, this is not his Mum :)

7/03/2009 01:58:00 pm  
Anonymous Marcus said...

Last time I went to a dentist he looked in mouth, picked around with one of those hooks for about 20 seconds and said "Hell your teeth are in good nick, keep doing whatever it is you're doing." That was back in '93, cost me $120,and I haven't bothered going back to a dentist ever since.

Despite the justification that the charges are so high because of training and costs etc, dentists are supposed to have the earliest average retirement age of any profession outside of professional sports.

Though the early retirement maybe because nobody will pay to have some rickety old geezer with shaking hands poking drills around in your mouth.

7/03/2009 02:59:00 pm  
Anonymous Anonymous said...

I remember going to a guy in Auckland called Eicholzt. He reminded of the Lawrence Olivier character in Marathon Man. Haven't been back since. He was very yelly too, as I recall it.

7/03/2009 03:54:00 pm  
Anonymous LGM said...

PC

Why so much to train an architect?

LGM

7/03/2009 04:27:00 pm  
Anonymous the drunken watchman said...

Filling teeth? let's face it, anyone halfway handy could do it themselves if mirror work wasn't so barse ackwards disorienting.

Me, I get my (big) fillings done for $10, a gold crown for around $300. Same skill level, same materials, much prettier attendants.

But you all would have to promise to stop being bigots before I would share my secret with you.

7/03/2009 07:32:00 pm  
Anonymous Sus said...

PC, I know just the chappie.

Recommended to us when we first moved to Auck by someone we knew who supplies all dentists with one particular product. He had no barrow to push whatsoever.

Stay tuned. :)

7/03/2009 08:04:00 pm  
Blogger Andrew B said...

Make sure you're all sitting down before reading the following.

I wholeheartedly agree with Blair.

One of their pre-merger entities was actually related to my family and when I went in there last I found my mate Matt Cho was there to do my teeth.

Makes you more attentive to your fangs when you know your mates are taking an educated look at your teeth.

Good parking too.

7/03/2009 10:05:00 pm  
Anonymous New Graduate Dentist said...

I would love to give Deborah Hill Cone a free filling anytime. I just got out of Dentistry School so I charge cheap price, but for Deborah Hill Cone, I'll do her for free.

7/03/2009 11:21:00 pm  
Anonymous Anonymous said...

Here's the best dentist in town - Steve Martin....

http://www.youtube.com/watch?v=bOtMizMQ6oM

Elliot

7/03/2009 11:50:00 pm  
Anonymous Mark.V. said...

The reason dentists are so expensive is because they are not regulated or subsidised by the government. They charge what the market will bear. As a consequence they earn more than doctors and there is no shortage of dentists. Some dentists, in Wellington, will even meet the market and work nights. If the medical profession was privatised, doctors would charge the way dentists do.

7/04/2009 08:44:00 am  
Anonymous Anonymous said...

There are a myriad of reasons why dentistry in NZ is so expensive compared to other health providers, dont think its one factor only. But please bear in mind that if you have work done in Asia etc there is no system in place to complain or follow up should the work fail. Also, most dental work is not likely to fail in the first few months but rather about a year or two AFTER the treatment - when decay under crowns/implants etc causes them to fail. The problem is that most people judge a dentist by their personality/of they caused pain etc - NOT by the quality of the work - cos basically, a layperson cannot tell if something is clinically perfect or just mediocre. This is a problem when expensive and extensive work is done because it doesnt fail straight away - you think you got a cheap deal and if it didnt cause pain you are happy - but when it fails 12 months later are you going to fly back to Bangkok?? And will anyone there listen or care?? In NZ all dentists are legally obligated to comply to the Health And Disability legislation that includes 'the right to complain' and follow up appropriately.
In simple terms, Bangkok is fine until things fall to pieces - when you are out of pocket, have no recourse and still have to fork out to go back overseas or see a dentist here (which you could have done in the first place!).

Good Dentist I have found: (Caring, careful, explains everything well and suits treatment to your needs not just the most expensive option!) is Dr Krystal Soma at One Health Dental on Remuera Road. They are reasonably priced so dont be fooled by the Remuera address. Ph: 524 8834

7/04/2009 01:40:00 pm  
Anonymous pythonr said...

Dinther, what will you do if your work ever fails or breaks down?

The NZDA and other legal bodies in NZ will not help you becuase you had the work done overseas.

I have an uncle who had all his work done in Malaysia 2 years ago including implants for $1500 which would have cost $6000 here, but now they are falling out and he has noone to tell and is having to pay to have them extracted in NZ... If he'd done it here he could have at least complained to the dental council about the poor workmanship and got some compensation!
Just a thought...

7/04/2009 01:50:00 pm  
Blogger Sally said...

Mark Hubbard is onto it. Government inept policies.

Found this on reply from another blog which sums up why we are where we are. Frighteneing that the populous in general think that government knows best.

..."Since when has any Govt run thing worked? I mean, they invented the word bureaucracy. The second political reality that I ever learned is this: ...every Govt action always has an unintended result that is the exact opposite to the result intended. I used to think that that was true until I found the one exception, and that is that they always manage to completely fill prison accommodation."

"Certainly efficiency is not their strong point. In the end they always return to more taxes. A blunt instrument, very blunt. It's called writing your own meal ticket. Completely without the market restraints found in normal commercial life."

7/04/2009 05:01:00 pm  
Blogger Binzi said...

After my dentist quoted #13,000 and said "my price is average. Remember I have an office here in (insert expensive suburb here) so my mortgage is high" I decided to go to ChiangMai Thailand for the exact same work, done to a far better standard in more modern surroundings with the latest technology, for around $5,000. With return airfare, 15 nights 4 star hotel, better dental work, and all the authentic Thai food and sightseeing I could get, mt entire dental holiday was under $8,000. So, there is NO reason to pay high dental bills at home!!!

7/04/2009 06:16:00 pm  
Anonymous Anonymous said...

Q: Why are dentists so gosh-darned expensive?

A: Because Ferraris aren't cheap.

7/06/2009 12:25:00 pm  
Blogger The Tomahawk Kid said...

http://www.absolutelythailand.co.nz/dental.html

Go to the link above - he is one of my clients here in Tauranga.

Roy has lived in Thailand, and has a Thai wife. He now lives in Tauranga, but has set up a company organising dental tours to Thailand, and he assures me the quality of treatment is equal and if not superior to here

Roy will organise the entire thing for you, flights, accommodation, and a referral to reputable dental clinil

Tell him I recommended you and you may even get a discount!
Graham Clark

7/06/2009 01:14:00 pm  
Blogger Binzi said...

ABSOLUTELY! Roy at Absolutely Thailand aranged my trip, and it couldn't have been better! Now I'm telling everyone! tell 'em Mike sent you!

7/06/2009 02:43:00 pm  
Anonymous Anonymous said...

he assures me the quality of treatment is equal and if not superior to here

With all due respect, his is not exactly a neutral opinion, is it. If you organise tours like that, you're not going to say that those dental treatments are worse, are you.

7/07/2009 10:52:00 am  
Blogger Binzi said...

...BUT I CAN! Having just returned from having ChiangMai dental work, they are light years ahead of what we have here.I personally can say that the treatment was far better than anything I've had previously. And while there MAY be treayment here that's as good, you'll need to sell your house to afford it. I'll never have dental work done here again.

7/07/2009 11:28:00 am  
Anonymous Anonymous said...

Right, and that's your expert opinion?

If you have just returned, you have no idea how good the treatment was, because dental treatments fail over time. But good for you if it all works out.

7/07/2009 01:31:00 pm  
Blogger Aaron said...

Well I can tell you it is just as bad in Australia.

I have had numerous problems over the years at great cost. I had around 30 appointments when living in the UK and because I was contracting, had to visit different dentists, all of which were incompetant.

All of this work now needs refixing.

I went to a dentist in central Sydney where I work and I was quoted $8,500 for the work (4 crowns, 3 fillings and a root canal).

And to top that all off, just 2 days after this assessment, I lost a top incisor - totally unrelated to the assessment above.

To replace this incisor it will cost me $4,000 (a root treatment + canal).

So in summary, Australia is just as bad as NZ. Implants are around $6k-$7k.

I am very tempted by the SE Asian option as am prepared to take the risk of future problems against the huge financial benefits!

10/20/2009 02:27:00 pm  
Blogger Binzi said...

I'm not challenging the reasons behind the costs here (or in any western country) nor the wide range of competance. I just know that I have spent a lot of money for work that needed to be re-done, and could have spent alot more.

By having it ALL done at once in Chiangmai, I saved years of discomfort, and thousands of dollars. But all wouldn't have been worth it if the experience wasn't so good. The fact is, the facilities were modern beyond anything I'd seen to date, and the team of specialists were craftspeople, taking care and showing politeness that simply isn't in western society.

Plus, I saw Thailand and had an amazing experience in another culture.

10/29/2009 08:34:00 pm  

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