Kevin Lewis replies to letter

Peter Clark writes to Kevin Lewis about practice expenses and how the contracts may not weigh up.

Dear Kevin,

Methinks you protest to much in focusing on the increased costs to GDP’s of replacing endodontic files and reamers. What worries me is not the mythical future increase in my contract value due to the increased costs of endodontics sundries but the negative payrise we will receive when the effect of the massive reduction in lab bills is factored into the practice expense/ income ratio.

As you rightly point out the information from the suppliers and the dental laboratories all point to a reduction in spending. This can only lead to a reduction in contract values. I would like to bet the labs are not shedding any tears over us!


Hi Peter,

Thanks for your response to my recent leader ‘Once is Enough’.

How very perceptive you are – because of the extended lag in the system in terms of the way in which it responds to practice expenses, this is an area I was planning to flag up a bit nearer the time. As ever, we do have a very selective memory and history repeats itself again and again. The changes in prescribing have been profound, if we are to accept at face value the information which is coming from the limited number of sources that are left available since the end of fee per item.

I am cautious in accepting this information without question, given that the source of the data has a financial interest every bit as vested as the practitioners on the other side of the equation. But there is no getting away from the fact that we seem to be seeing a significant shift in patterns of activity. Many of them reflect little credit upon us as a profession, whether we accept these new levels as just right, and hence the old levels as too high, or vice versa.

My focus upon endo was simply because the recent focus has been on endo, for very obvious reasons. The endo issue has concentrated everyone’s attention upon what I have been banging on about for almost 2 years now – for 50 years we have been preoccupied with gross income (and now UDAs and UDA values, which is the new ‘code’ for gross income), instead of thinking about the costs associated while generating the gross income. UDAs might have an average value (different for each practitioner) but they all attract very different cost levels. 12 UDAs achieved by examining 12 healthy five year olds is a lot more profitable than 12 UDAs achieved in making a set of complete dentures, or chrome dentures, or crown and bridgework.

But I suspect that we share the view that we can’t hold out our hands for extra funding of (for example) single use endo instruments, while expecting to retain the funding we are simultaneously receiving for lab items and complex courses of mutiple-unit treatment that are no longer happening.

I appreciate you taking the time to write in.

Kevin Lewis

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