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 in Biological Chemistry 
 
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THE BUSINESS PROBLEMS 
 OF A PROFESSION 
 
THE BUSINESS PROBLEMS 
 OF A PROFESSION 
 
 BY 
 
 FREDERICK CROSBY BRUSH, D.D.S, 
 
 FOUNDER AND FELLOW OF THE NEW YORK INSTITUTE 
 OF DENTAL TECHNIQUE ; MEMBER OF THE NATIONAL 
 DENTAL ASSOCIATION, THE FIRST DISTRICT DEN- 
 TAL SOCIETY, STATE OF NEW YORK, THE NEW 
 YORK ODONTOLOGICAL SOCIETY, THE NEW 
 YORK INSTITUTE OF STOMATOLOGY, 
 PSI OMEGA FRATERNITY, ETC. 
 
 NEW YORK, N. Y. 
 
 THE PRESS OF THE DENTAL DIGEST 
 
 1911 
 
1^ I / .-'J? 
 
 Copyright, 1911, by 
 FREDERICK CROSBY BRUSH, D.D.S. 
 
\^ 
 
 CONTENTS. 
 
 CHAPTER PAGE 
 
 I. — Commencement ..... i 
 
 II. — Location 7 
 
 III. — Offices 14 
 
 IV. — Office Arrangement . . . . 18 
 
 V. — Signs 21 
 
 VI. — Stationery 27 
 
 VII. — ^Advertising 30 
 
 VIII. — Attendant 37 
 
 IX. — Fees 40 
 
 X. — Estimating the Cost .... 46 
 
 XI. — ^TiME 53 
 
 XII.— The Hour Fee 58 
 
 XIII. — ^Appointments 60 
 
 XIV. — Reception of Patients ... 63 
 
 XV. — Records of Operations . . . 66 
 
 XVI. — ^Journal and Ledger Records . . 69 
 
 XVII. — Credits and Collections • • • 75 
 
 XVIII. — General Application of the Hour 
 
 Charge 82 
 
 XIX. — Increasing the Fees .... 84 
 
 XX.— Notes 87 
 
 V 
 
PREFACE. 
 
 This little book is the outgrowth of numerous 
 short articles written for dental journals and ad- 
 dresses delivered before societies. If it proves of 
 assistance to brother practitioners in solving some 
 of their business problems, its purpose will be 
 served. 
 
 Twenty years of varied experiences in the prac- 
 tice of dentistry together with extensive acquaint- 
 ance among the practitioners of our chosen pro- 
 fession, have afforded the writer unusual oppor- 
 tunities for observing the conditions that prevail. 
 He is convinced that the reason that some have 
 not succeeded as they anticipated, has not been due 
 to their lack of professional ability so much as to 
 their lack of business ability and a knowledge of 
 the business principles that are involved in all 
 transactions. 
 
 It is the object of this book to supply informa- 
 tion on this subject. 
 
 Although this work enters a field which is an 
 essential element of a profession, but which has 
 been quite universally ignored, it is not the writer's 
 purpose to lay claim to any originality for the 
 
 vii 
 
Preface. 
 
 methods or their application as outlined in the text. 
 He aims merely to present a general plan which 
 may be a guide for those about to begin the prac- 
 tice of dentistry, one that is also adaptable to 
 an established practice and which is being used 
 successfully. 
 
 F. C. B. 
 
 viu 
 
THE BUSINESS PROBLEMS OF A 
 PROFESSION. 
 
 CHAPTER I. 
 
 " COMMENCEMENT." 
 
 When a young man leaves the hall after the 
 college " commencement " exercises are over, he 
 feels that a successful life lies before him and that 
 all he need do is to engage an office, put up a sign, 
 and patients will flock to his door. Some days 
 afterwards he awakens from his dream to find that 
 the key that unlocks the door of business success 
 is not an elaborately engrossed diploma but that 
 it must be slowly forged by hard, steady work 
 guided by a fixed purpose. 
 
 As he looks about him and ponders, he begins 
 to realize that the privilege of adding the few let- 
 ters of a degree to his name has not changed the 
 conditions of life very much for him; and that 
 there are still many battles to be fought and won 
 before he will be counted as an important link in 
 the economic chain. However, he is anxious to 
 begin at once to hew his way toward that success 
 of which he has dreamed ; but he finds confronting 
 
 I 
 
The Business Problems of a Profession, 
 
 him several problems that must be solved before 
 he can make even a fair start on his chosen career. 
 
 One of his first decisions must be whether he 
 shall at once begin to establish a practice for him- 
 self or seek a position as assistant in some well- 
 established practice, where he will be afforded op- 
 portunities to gain much needed experience, and a 
 degree of self-confidence that will enable him to 
 cope with any emergency that may arise. 
 
 A philosopher has said that a young man begin- 
 ning practice for himself immediately upon leav- 
 ing college, will make more mistakes that will 
 injure his chances of success, during the first year 
 in practice, than he will be able to overcome in the 
 succeeding five years. This Is undoubtedly true 
 and, being the case, it will, In the long run, be of 
 incalculable benefit to a young man to secure all 
 the practical experience possible before beginning 
 practice for himself, and thus escape what is other- 
 wise a very considerable handicap. 
 
 The time devoted to gaining experience Is well 
 spent and two years Is little enough, while three or 
 four years is none too much. How to get a posi- 
 tion without having had experience and how to get 
 this experience without a position may seem a for- 
 midable problem, and yet it should not be hard 
 to solve for an ambitious young man who has a 
 good moral character and plenty of grit and deter- 
 mination. There are several ways of accomplish- 
 
 2 
 
'' Commencement/* 
 
 mg the purpose; the most desirable one Is to 
 become associated with some well-established prac- 
 titioner of good repute. Many young men have 
 preceptors either before or during their college 
 course, and will be able to continue on with them 
 after graduation. To those who have no such 
 affiliations the following suggestions are offered : 
 
 In the cities where the colleges are located there 
 are usually one or more professional organizations 
 which hold meetings once a month. Many of these 
 societies welcome senior students and permit them 
 to attend meetings without any charge for dues or 
 assessments. At these meetings the young man 
 will have opportunity to make many valuable ac- 
 quaintances, and the chances will be good for him 
 to effect some arrangement whereby he can become 
 associated with one of these men. The terms 
 and agreements in connection with such an associa- 
 tion will depend so largely upon the individuals 
 and general conditions, that it is not feasible to 
 offer advice concerning them. Suffice It to say, 
 that If an opportunity offers to become associated 
 with a progressive and aggressive man it will be 
 well to take advantage of It on the best terms that 
 can be made. It will, however, behoove the young 
 man to bear In mind that the practitioner who 
 takes an Inexperienced man Into his office assumes 
 a great moral and legal responsibility, and must 
 give up much valuable time to the proper instruc- 
 
 3 
 
The Business Problems of a Profession, 
 
 tlon of such a man. So the young man should not 
 allow his ideas of his own ability and importance 
 to stand in the way of effecting a desirable con- 
 nection. 
 
 Another way to get an opportunity to become 
 associated with some good man is to keep in touch 
 with the dental depots; for there is usually some 
 one there who is a veritable information bureau 
 regarding such things, and very likely would be 
 able to place a man in a very desirable position. 
 If the young graduate does not care for a city con- 
 nection, then it will be well for him to make the 
 acquaintance of the traveling salesmen visiting the 
 territory within which he wishes to locate. When 
 seeking the assistance of these men he should be 
 perfectly frank with them regarding his qualifica- 
 tions, what he is willing to do, and the terms he 
 will accept, but be chary of estimating the value 
 of his practical ability. 
 
 It will also be well to watch the advertisements 
 for assistants that appear in the various dental 
 journals. When direct communication is finally 
 effected with some practitioner who desires an as- 
 sistant the young man should be sure to state all 
 the facts regarding his experience. It means much 
 inconvenience and disappointment to a busy man 
 to find that the assistant from whom he expected 
 immediate help, must be taught those things which 
 will make his services of value. 
 
 4 
 
<< 
 
 Commencement.'^ 
 
 There Is still another avenue leading to experi- 
 ence that Is always open — the advertising dental 
 office. Mention of this has been left until the last 
 for many reasons; one is that the moral pitfalls 
 and temptations In an advertising practice are 
 many and cannot be discussed here. Unless a 
 young man has a strong moral character and com- 
 plete mastery over himself and his passions, I 
 should advise him to avoid seeking experience 
 through this channel. If he is of the stuff that 
 men are made of, however, a couple of years' ex- 
 perience In various offices may be of considerable 
 value to him. 
 
 The young man who seeks a position as an as- 
 sistant with the Idea of obtaining as wide an expe- 
 rience as possible before engaging In practice for 
 himself, will do well not to remain too long In one 
 place. A good plan to pursue will be : first get a 
 place where all kinds of work may be done; after 
 a good idea has been obtained of the general con- 
 duct of a practice, seek another place where special 
 work can be done. For instance, first get a good 
 idea of general practice; then take up extracting; 
 follow this by doing all kinds of gold work; spend 
 some time doing general prosthetic work, and wind 
 up with general operating and prophylaxis work. 
 The man who will devote two or three years to the 
 carrying out of such a program will have obtained 
 in return the best post-graduate course in dentistry 
 
 5 
 
The Business Problems of a Profession. 
 
 that it IS possible under present conditions to re- 
 ceive. Do not think that such a plan is a mere 
 theory that could not be carried out, for it has been 
 done in a number of instances and can be again by 
 any man who has the moral courage to undertake 
 it and the grit to see it through. 
 
CHAPTER II. 
 
 LOCATION. 
 
 Where to locate is probably the most impor- 
 tant question that a young man will have to deal 
 with during his entire professional career. Whether 
 the future shall bring success or failure may de- 
 pend very largely upon the decision at this time. 
 Some men seem able to move along the line of 
 least resistance and find good fortune always await- 
 ing them; but there are other poor mortals who 
 find It necessary to ponder carefully over every 
 new move and situation, and to exercise matured 
 judgment in order to avert a catastrophe. 
 
 This is a subject about which it is hard to offer 
 advice; men differ so widely in temperament, In- 
 dividuality, and inclinations that it is difficult to 
 foresee what conditions will have to be met. There 
 are, however, some major things that should be 
 given consideration when a man is selecting a lo- 
 cation for his future activities. 
 
 The first of these is the question of health. 
 Some men are so constituted that they are greatly 
 affected by climatic conditions. When a man Is 
 sensitive to such Influences, he should be partlcu- 
 
 7 
 
The Business Problems of a Profession. 
 
 larly careful not to plunge into some place because 
 there seems to be a good opportunity for immedi- 
 ate business. He should study all the conditions 
 thoroughly; for health is one of the greatest busi- 
 ness assets a man can have. If climatic conditions 
 are such that health cannot be maintained, he will 
 be most seriously handicapped at a time when it 
 will seem too late to begin all over again in some 
 place where the climate is more favorable. 
 
 To an ambitious young man a large city will 
 seem to present unlimited possibilities. There will 
 be opportunities to affiliate with large professional 
 organizations, to meet and become acquainted 
 with men of note in the profession, to build a large 
 practice and receive high fees, and to pursue his 
 own course through life uninterrupted by the petty 
 criticisms that are coincident with life in many 
 small communities. But life in a large city is not 
 all smooth sailing. It means heavy expenses that 
 seem to be ever increasing, meager opportunities 
 for making social acquaintances that are worth 
 while, inadequate means of becoming profession- 
 ally known to the public, and the long heart- 
 breaking struggle to gain a practice that yields a 
 sufficient income to enable one to enjoy the real 
 pleasures of a city life. 
 
 A suburban community adjacent to some large 
 city will present opportunities that will appeal to 
 many. In such a place the practice will be a family 
 
 8 
 
Location, 
 
 one, and the clientele principally women and chil- 
 dren. Fees may not be as high but the expenses 
 will be materially less. 
 
 Such communities generally present many social 
 opportunities and advantages, and a young man 
 with a pleasing personality should be able to make 
 acquaintances rapidly. By exercising judgment in 
 the making of Intimate friends and by avoiding as- 
 sociation with any particular clique, he will soon 
 be able to determine what people are worth know- 
 ing and whose patronage he will desire. It will be 
 well to become associated with the civic organiza- 
 tions and take an active part in any movement for 
 the betterment of the place, but as far as possible 
 avoid being mixed up in what Is generally called 
 " local politics." This advice will hold good for 
 larger communities, for it has been observed that 
 when a member of the medical profession succeeds 
 in politics or becomes a politician, it is usually at 
 the expense of professional success. 
 
 A good suburban town usually presents many 
 almost ideal advantages. In such a place one can 
 enjoy the pleasures of a real home with its lawn 
 and garden, its flowers and trees and the accom- 
 panying incidentals that help to make life worth 
 living. It is also possible to reach the city easily, 
 which gives a progressive man an opportunity to 
 attend and take part in the meetings of profes- 
 sional organizations and thus keep in touch with 
 
 9 
 
The Business Problems of a Profession, 
 
 advanced theories and methods. These are ad- 
 vantages not to be thought lightly of when a choice 
 Is being made of a place wherein one Is likely to 
 spend the greater part of a lifetime. 
 
 A manufacturing city or town presents some- 
 what different conditions for consideration. Local 
 business Is dependent upon trade conditions and 
 the steady employment of wage earners. When 
 the country Is prosperous and there Is a good de- 
 mand for manufactured products, the people will 
 be employed, money will circulate freely, and all 
 will be well. But In case of a financial panic or a 
 general trade depression. Industrial centers are usu- 
 ally the first to feel the effects, and a money strin- 
 gency follows. 
 
 As the care of the teeth and mouth Is still looked 
 upon as somewhat of a luxury by the wage-earning 
 class, the dentist will be the first whose business 
 will be affected, and Instead of receiving cash he 
 will have to give credit. He will be the one whose 
 lost time and opportunities are the hardest to make 
 up. If the bulk of one's practice consists of wage 
 earners or their dependents, it will be necessary to 
 be continually on the alert In order to be prepared 
 to meet and go safely through these periods of 
 business depression. In such places the amount of 
 business that a dentist can do, together with the 
 kind of operations and the fees that can be charged, 
 will depend very largely upon the class of people 
 
 10 
 
Location, 
 
 employed and the wages they receive. If a town 
 has Industries of many different kinds, trade con- 
 ditions are not likely to become as acute as they 
 would If but one industry was depended upon. A 
 town dependent upon one kind of Industry for Its 
 prosperity should not be looked upon favorably 
 as a place In which to locate, unless the opening 
 seems an unusually good one. 
 
 A country town or village with a tributary 
 farming population may possess attractions to one 
 who will be content to lead an uneventful existence. 
 The social requirements and activities of such 
 places are usually decidedly limited. Any especial 
 stimulus for mental exertion will be lacking, and 
 he win be an unusual man Indeed that does not 
 get Into a rut and drift along from day to day, 
 following the lines of least resistance. General 
 expenses may not be as great as In larger commu- 
 nities, but It will be found here as elsewhere that 
 all things are relative and that the expense account 
 will be In about the same ratio to the amount of 
 business that can be done, as In other places. The 
 gross annual practice In such communities averages 
 about $2,500. Many credit accounts have to be 
 carried, and collections are slow and In small 
 amounts. Money can be earned and by close 
 economy It may be saved In these communities, but 
 very seldom Is money made In the sense that the 
 term is generally used In the business world, 
 
 II 
 
The Business Problems of a Profession, 
 
 Business Openings. 
 
 It has been said in a general way regarding the 
 population of communities that, iive hundred peo- 
 ple will support a physician, while at least one 
 thousand will be required to support a dentist. 
 
 In the large cities the proportion of dentists to 
 the population need scarcely be considered, as such 
 places are continually growing, and there are al- 
 ways opportunities for aggressive and progressive 
 men to gain a following. The same may be said 
 of the immediate suburbs of the largest cities. 
 
 When a manufacturing city or town is being con- 
 sidered, a much more liberal numerical allowance 
 should be made, for in these places the quality of 
 the people will be of far more importance than the 
 quantity. It will be well to inquire into the gen- 
 eral characteristics and nationality of the wage 
 earners, the average weekly wage received, whether 
 continuously employed throughout the year or 
 only during trade seasons; the average yearly in- 
 come of the different classes of people comprising 
 the population, and whether the people are thrifty 
 and spend money judiciously, or support a large 
 number of saloons and catch-penny stores and 
 amusement places; for the general business condi- 
 tions of the place will be very largely governed by 
 these things. 
 
 The possibilities of building up a paying prac- 
 
 12 
 
Location. 
 
 tice In a country community will depend very 
 largely upon the productivity of the surrounding 
 country; if it is a farming or fruit-growing center 
 and modern methods are employed so that large 
 returns are yielded, then the chances will be much 
 better than they would be in a place where the soil 
 is barren or worked out and the people only grub 
 out a bare living, with little left to supply the 
 needs for physical comfort. 
 
 Mention is made of these matters for the pur- 
 pose of giving a general idea of some of the things 
 worth considering when seeking a place wherein 
 a practice may be established that will yield a 
 suitable income. 
 
 13 
 
CHAPTER III. 
 
 OFFICES. 
 
 After a decision has been reached regarding a 
 place in which to locate, the next thing will be to 
 seek a suitable office. In the larger cities the tend- 
 ency at present is to have an office in one of the 
 modern office buildings or In some building occu- 
 pied exclusively by medical specialists. Such a 
 situation is desirable from many standpoints, but 
 is more suitable for a man with an established 
 practice than for one just beginning; the expenses 
 connected with such an office are usually high, and 
 the opportunities of securing chance or transient 
 patients are reduced to the minimum. 
 
 A second choice might be the securing of accom- 
 modations in a private house or an apartment. 
 This will have the advantage of bringing one in 
 contact with a family neighborhood, but it also 
 has its disadvantages, especially If one resides In 
 the house; for then it will be difficult to establish 
 and maintain suitable office hours, something which 
 in the long run is almost imperative from a good 
 business standpoint. 
 
 Another possible location would be in rooms 
 
 14 
 
Offices. 
 
 over a store on some business street or avenue. In 
 making such a selection care should be exercised 
 regarding the general character of the building 
 and its tenants, the class and kind of stores, and 
 the accessibility, care, and condition of the entrance 
 hall. 
 
 In a suburban place the best location is generally 
 in a private house on the main street or in close 
 proximity to the business center. If this is not ob- 
 tainable, the next best place will be in some bank 
 building or over the leading drug store. If possi- 
 ble, avoid locating over notion shops, grocery 
 stores, or markets of any kind. 
 
 In small cities or towns it is customary to find 
 dental offices located in business buildings on the 
 main thoroughfares, but It will be found that here, 
 as in suburban towns, an office In a well-situated 
 private house will be most desirable. Above all 
 things, avoid having an office located over a saloon 
 or a cigar store, or in any building whose entrance 
 or approach is a congregating place for men and 
 street gossips. Be sure that there is nothing about 
 the building or entrance that will deter ladies or 
 children from feeling free to come and go at all 
 times. These points are pertinent to any place. 
 
 When locating in a business building be sure 
 that the entrance to the office is direct, easy of ac- 
 cess, and that the hallways and stairs are light and 
 kept clean. These conditions are all too frequently 
 
 15 
 
The Business Problems of a Profession. 
 
 disregarded, and are noted and commented upon 
 by patients more often than we would like to be- 
 lieve. First impressions are usually lasting, and . 
 it has often happened that prospective patients 
 have turned away and gone elsewhere, when con- 
 fronted by a crowded entrance or a dirty stairway 
 leading to a dingy, unkept hallway. One would 
 not expect to find a neat, wholesome gentleman 
 and a sanitary office awaiting them in the midst of 
 such surroundings. 
 
 In selecting an office, light and ventilation are 
 two essentials that must be given the greatest con- 
 sideration. It is a generally accepted theory that 
 a north light is the best for operating purposes, 
 but from having worked all around the compass it 
 is the writer's conclusion that a southwest light 
 presents the most advantages. From this point 
 direct light will be obtained for the longest time 
 during the day throughout the year ; the lights and 
 shadows from sun rays and passing clouds will 
 cause less eye strain and fatigue than will the 
 steady reflected light from the north. It is un- 
 healthy to spend the greater part of the day — day 
 in and day out — In a room into which the sun's 
 rays do not enter. Such a condition is a greater 
 cause of eye strain and nervous irritability than is 
 generally realized. 
 
 Note also the toilet accommodations; for a 
 clean, well-appointed toilet room is an important 
 
 i6 
 
Offices. 
 
 adjunct to a professional office and a convenience 
 that will be greatly appreciated by patients. 
 
 Look carefully Into the heating and plumbing 
 arrangements and see that they are adequate. A 
 city man who failed to give these things careful 
 consideration had a rather unpleasant experience. 
 He found an office that seemed to suit his require- 
 ments, and, after signing a lease for a term of 
 years, moved in; when about to set up the foun- 
 tain cuspidor It was discovered that the water out- 
 let was some thirty feet away from where the oper- 
 ating chair must stand and that the floor was con- 
 structed of railroad Iron and filled In with concrete 
 and ashes and then covered with the usual hard- 
 wood flooring. It cost a pretty penny to overcome 
 the difficulty. 
 
 17 
 
CHAPTER IV. 
 
 OFFICE ARRANGEMENT. 
 
 The arrangement of an office or suite of rooms 
 will depend so much on circumstances and indi- 
 vidual taste, that it is not practicable to do more 
 than offer a few suggestions. 
 
 The simplest plan is to divide the room or 
 rooms so as to present a reception room, an oper- 
 ating room, a dressing room, and a laboratory. 
 
 The reception room need not be large, but it 
 should be so situated that it will be well lighted 
 and easily ventilated. The furniture should be 
 plain and good, and should exhibit taste rather 
 than ornate display. Do not overcrowd the room 
 with furniture; a few comfortable chairs and a 
 center table are worth more than a truck load of 
 junk. A few carefully selected high-class pictures 
 are always desirable, but above all things avoid 
 cluttering up the walls with cheap prints, so-called 
 " art " calendars, amateur photographs, class pic- 
 tures or diplomas, and last, but worst of all, any 
 colored or carbon enlargements of photographs of 
 yourself or members of your family. 
 
 Keep the table well supplied with current maga- 
 zines, a few books of short stories, some well- 
 
 i8 
 
Office Arrangement. 
 
 selected children's books, and a dally newspaper. 
 Don't waste money on sets of subscription books 
 to repose peacefully (and dustily) In a case In the 
 reception room. This refers to books containing 
 copies of the world's famous paintings, speeches of 
 great orators, selected poetry and choice literature, 
 and the usual run of such things that are offered to 
 professional men; you will never read them nor 
 will anyone else be likely to do so. When ready to 
 buy books, get the standard authors and miscel- 
 laneous books on subjects that are worth while — 
 the kind that you would really like to read. 
 
 If a separate room Is not available for a dress- 
 ing room, sufficient space should be partitioned or 
 screened off from the reception room to contain a 
 coat tree, a dressing table, mirror, etc. This is a 
 convenience that will be greatly appreciated, for 
 few people like to leave their coats and bonnets 
 scattered about on chairs; and ladles do not care 
 to be compelled to arrange their hair and prepare 
 for the street In the presence of strangers. 
 
 The operating room should have ample space 
 for the chair, cabinets, and other necessary equip- 
 ment, and also for a desk, safe, etc.; for this is the 
 proper place for all that pertains to the business 
 side of a practice. Some very good-looking work 
 benches are made that may be placed In the oper- 
 ating room if one desires; but as the public has 
 been accustomed to look upon the profession of 
 
 19 
 
The Business Problems of a Profession, 
 
 dentistry as so largely mechanical, it would seem 
 that if we hope to successfully combat this idea, it 
 would be better to relegate such evidences of our 
 mechanics to a less conspicuous place. 
 
 The laboratory should be so situated as to be 
 of easy access from the operating room, but should 
 be separate and distinct, so that it may be closed 
 off tightly to prevent noise and odors from reach- 
 ing the other rooms. 
 
 A better idea of the equipment necessary to meet 
 one's requirements can be gained from the cata- 
 logs of supply houses than from anything that 
 might be written in a book of this nature. 
 
 For decorations, plain soft colors are more 
 pleasing than are the gaudy, flower-bedecked wall 
 papers often used. The soft grays, greens, or 
 browns are desirable, but red is an excitant and 
 should not be used. In the operating room a soft 
 gray or green will be preferable to a dead white, 
 for that is apt to produce a glare and cause an un- 
 necessary strain on the eyes. For the operating 
 room, white enameled cabinets, etc., are having 
 quite a vogue, presumably because white is the em- 
 blem of cleanliness; but white enamel can be about 
 the dirtiest of things, for it does not show dust 
 which is consequently very often overlooked, and 
 when the enamel finally becomes stained it is most 
 unsightly. Cleanliness should be a matter of prin- 
 ciple rather than of color in an operating room. 
 
 20 
 
CHAPTER V. 
 
 SIGNS. 
 
 The question of signs will merit consideration 
 after an office has been secured and equipped. 
 The purpose of a sign is to furnish information 
 and guidance. The purpose of a professional 
 man's sign is to inform the public that a certain 
 person is practising a certain profession in a cer- 
 tain place, and to serve as a guide whereby his 
 office may be readily located. It would seem to 
 follow that any sign that fulfilled this purpose 
 would be proper, but this is not wholly so, for ap- 
 propriateness and good taste must be considered. 
 
 A big, flaring sign with striking colors that at- 
 tracts attention from a considerable distance is, in- 
 deed, a sign; but as it is an offense to the eye and 
 indicates a lack of taste and professional dignity on 
 the part of the one by whom it is used, it is Inap- 
 propriate for anyone who wishes to attract the 
 patronage of refined people. 
 
 On the other hand, there is the sign which is so 
 small and indistinct and placed in such an obscure 
 position that it can only be found and read after 
 a most diligent search. Two such cases come read- 
 
 21 
 
The Business Problems of a Profession. 
 
 Ily to my mind: one Is on a residence street in 
 New York City, and the man's name is so lightly 
 traced in the corner of the parlor window that it 
 can be seen from the street (ten feet away) only 
 when the light or the position of the observer is 
 just right. In this case the number of the house Is 
 also hidden from view, so that any stranger look- 
 ing for this man's office is practically compelled to 
 seek the assistance of the neighbors or the numbers 
 on their houses. The other case is in a country 
 town and the office is located on the main street. 
 I was seeking this particular man and upon inquiry 
 was not told the house number but that his office 
 was on a certain block. I passed along three times 
 without locating him, and, finally, inquired again 
 and was assured that I was on the right block. 
 Once more I went along, peering carefully into 
 each hallway and finally behind a half-closed outer 
 door found his name in tiny letters upon an Inner 
 door that could not be seen from the street under 
 ordinary conditions. 
 
 Neither extreme serves the real purpose of a 
 good sign, for one keeps desirable patients away 
 by offending their sense of good taste, while the 
 other exhausts their patience. 
 
 Some vulgar men have gone to such an extreme 
 In flaunting flaring signs that ultra-ethical men 
 propose going to the other extreme and advocating 
 the doing away altogether with signs of any de- 
 
 22 
 
Signs, 
 
 scrlptlon. Both attitudes are unwise and unde- 
 sirable. 
 
 If the office selected be in a private house situ- 
 ated close to the street, a sign might be placed in 
 a front window where it can be readily seen by the 
 passer-by. In this case it should be of modest size 
 and of the nature of those generally used by medi- 
 cal men; it may include with the name, the letters 
 of the professional degrees or the words dentist or 
 dental specialist, in order not to be mistaken for a 
 physician. If the house be well back from the 
 street, so that a sign in the window would not be 
 desirable, it can be placed on the porch railing or 
 steps at the entrance but so situated as to be plainly 
 visible. 
 
 When an office is situated on an upper floor of 
 a business building, it is well to have a small sign 
 or tablet placed in the entry with the number of the 
 floor or room, together with the name upon it to 
 serve as a guide for finding the office. If in this 
 case the office windows can be readily seen from 
 the street, the name and specialty can be placed in 
 one of them with modest-sized plain gold letters. 
 
 Any of the so-called decorative or plain wood 
 signs attached to the outside of a building are usu- 
 ally objectionable and in poor taste. It seems un- 
 necessary to comment on poster signs, announcing 
 special kinds of work, price, etc., that remind one 
 of a fire sale in a shoddy clothing store. 
 
 23 
 
The Business Problems of a Profession, 
 
 In selecting the lettering for a sign, avoid all 
 attempts at ornate display, and fancy letters of all 
 kinds — stick to the plain, quiet dignity of the sim- 
 ple Roman letter which can be read at a glance. 
 
 One of the antiquated and illogical notions of 
 the medical professions regarding signs is, that it 
 is not strictly proper for a specialist to announce his 
 specialty upon his sign. This may be all right 
 from the ultra-conservative standpoint from which 
 they argue, but it does not seem to take into con- 
 sideration the convenience of one of the most in- 
 terested parties — the public. The medical man 
 needs the public (patients) quite as much or more 
 than the public needs him, and yet if he adheres 
 strictly to the code laid down for his guidance he 
 must not do anything that will enable the general 
 public to know that he is in business and desires 
 their patronage, or that he has any especial fitness 
 for special work and desires to practise that exclu- 
 sively. 
 
 From the standpoint of the public, consider how 
 difficult it is to locate and determine anything 
 about some individual practitioner, to learn some- 
 thing of his habits, his character, temperament, 
 individuality, etc. It would seem as though the 
 public was expected, when in need of medical serv- 
 ices, to walk down some street, or streets, until a 
 sign could be found, use second sight to determine 
 whether it is the office of an oculist, aurist, dentist, 
 
 24 
 
Signs. 
 
 surgeon, or general practitioner, and then walk In 
 and unburden Itself to whatever sort of man hap- 
 pened to be behind the sign. 
 
 Or else the seeker Is expected to Inquire of some 
 friend. In whose advice and judgment he has no 
 great amount of confidence and who, perhaps, in 
 turn Is not wholly satisfied and would like to make 
 a change of dentist if It were not too much like 
 making a leap In the dark. 
 
 Consider how disquieting It Is to one's peace of 
 mind, when, In an emergency, one tries to locate 
 a physician and In desperation calls up someone at 
 random only to find that It Is a dentist or an oculist 
 or some specialist other than Is needed, and that 
 valuable time has been lost. 
 
 Does It not seem reasonable that if we desire 
 the good will and patronage of the public, we 
 should show consideration enough to designate on 
 our signs or cards the special branch of the profes- 
 sion that we desire to pursue, in order to spare 
 their time and patience? 
 
 The medical profession has made great strides 
 and kept pace with the times In nearly everything 
 except its code — but with that, If some man dare 
 differ with the literal precepts, although not the 
 spirit, he is frowned upon as a heretic (but some- 
 times secretly commended for his courage). 
 
 The objection to a man announcing himself as 
 a specialist originated at a time when speclaliza- 
 
 25 
 
The Business Problems of a Profession. 
 
 tion, as it is practised to-day, was literally un- 
 known. The position taken at that time may have 
 been justified, but it seems as though it is now time 
 for a liberal profession to take more liberal views 
 and meet present-day problems in a logical way. 
 
 26 
 
CHAPTER VI. 
 
 STATIONERY. 
 
 A PROFESSIONAL man's stationery Is his envoy 
 to people whom he cannot at the time meet per- 
 sonally. It represents him, and by it he is fre- 
 quently judged. This being the case, it behooves 
 the dentist to spare no expense, but to have all sta- 
 tionery of the best quality and in good taste, so 
 that the impression conveyed may be favorable. 
 The printing on the business cards and letter-heads 
 used by some dentists, to say nothing of the qual- 
 ity of the paper, resembles that used by emigrant 
 sign painters and Polack tailors. Their visible 
 cheapness stamps the user as cheap also. They 
 contain much information that is nonessential, un- 
 necessary, and out of place. If one wishes to ad- 
 vertise, it is better to do it deliberately than to have 
 what should be a professional card look like a 
 handbill. 
 
 A professional card should be engraved — that Is 
 essential. The lettering should be plain and clear 
 — that is good taste. The card should be small in 
 size and contain the name and full address (street, 
 number, and town). It should designate that one 
 
 27 
 
The Business Problems of a Profession, 
 
 IS a dentist, by the use of the letters of the profes- 
 sional degree after the name, or the words dentist 
 or dental surgeon in small letters underneath the 
 name. If it is to be the card of a specialist then 
 the name of the specialty should be placed in the 
 lower left corner. It is permissible to mention the 
 telephone number and the office hours if one de- 
 sires to do so, but as these are usually understood 
 and only tend to detract from the neatness and 
 dignity of the card, it is generally well to leave 
 them off. 
 
 Letter-paper should be of the very best quality 
 and of the standard sizes only — the small double 
 sheet for notes and the medium size, square, two- 
 fold sheet for letters, with envelopes to match. 
 
 The letter-head should consist of the name and 
 full address and should be embossed; if this is not 
 obtainable the printing should resemble engraving 
 as closely as possible. The style of lettering 
 should be the same as that used on the professional 
 card. The imprint should be in the center near 
 the upper border or in the upper left corner. 
 
 It is now customary, and requested by the Post 
 Office Department, that the name and address be 
 placed upon envelopes to facilitate the prompt 
 return of undelivered mail. For professional sta- 
 tionery the imprint should be upon the flap of the 
 envelope and of the same character, either em- 
 bossed or printed, as that used for the letter-head. 
 
 28 
 
Stationery. 
 
 The stamped envelopes issued by the Post Office 
 Department are not good form for professional 
 use. 
 
 Never use for correspondence the ruled sheets 
 that come put up in blocks and pads. It seems 
 hardly necessary to mention these matters, but 
 from an extensive acquaintance with the corre- 
 spondence of professional men it appears that these 
 points are not generally known or at least not 
 observed. 
 
 29 
 
CHAPTER VII. 
 
 ADVERTISING. 
 
 The subject of advertising has been a stumbling 
 block in the minds of professional men for many^ 
 many years, and even now, when the subject is 
 casually mentioned, some one is pretty sure to fig- 
 uratively throw up his hands and exclaim that to 
 advertise is not " ethical." Such a sweeping state- 
 ment indicates sheer thoughtlessness or else a lack 
 of sufficient information on the subject. 
 
 The real purpose of advertising is " to inform 
 the public concerning " some definite thing. This 
 certainly is neither morally nor ethically wrong. 
 If there is anything amiss, then it must be the kind 
 of advertising used or the way in which it is em- 
 ployed, for there are about as many ways of adver- 
 tising as there are leaves on a full-grown tree. 
 
 There was a time, it is true, when advertising 
 was employed almost exclusively for the purpose 
 of deceiving and decoying gullible people; and con- 
 sisted principally of extravagant, untruthful or 
 deceitful statements, usually blazoned forth in a 
 vulgar manner. This sort of thing has been as 
 universally condemned by honest commercial men 
 
 30 
 
Advertjshig. 
 
 as by members of the professions. To-day the 
 men engaged In preparing advertisements have as 
 high Ideals, are as respected and as well paid as any 
 class of men engaged In earning a livelihood. 
 
 The ever-changing economic conditions, the cen- 
 tralization and congestion of population. Improved 
 transit facilities, and the migratory habits of well- 
 to-do people have served to make advertising al- 
 most a necessity for the carrying on of a successful 
 business. This condition Is recognized and taken 
 advantage of by men engaged In every kind of 
 business except the professions. Professional men 
 have made progress In every branch of their work 
 except along purely business lines. Instead of giv- 
 ing the business side of their practice the consid- 
 eration that It deserves, they have been content to 
 adhere to precedents that were established to meet 
 economic conditions existing fifty or more years 
 ago. Precedent Is nearly always a brake on 
 progress. 
 
 In formulating the Code of Ethics of the Na- 
 tional Dental Association, It has been recognized 
 that advertising w^Ill, whether or no, enter Into the 
 business conduct of a professional practice ; and an 
 effort was made to define the methods of advertis- 
 ing that are objectionable, and also to state what 
 will be considered acceptable and ethical. Note 
 very carefully the wording of the paragraph that 
 refers to this subject. 
 
 31 
 
The Business Problems of a Profession, 
 
 Article II. Section 2. 
 
 "It is unprofessional to resort to public adver- 
 tisement, cards, handbills, posters, or signs, call- 
 ing attention to peculiar styles of work, lowness of 
 prices, special modes of operating, or to claim supe- 
 riority over neighboring practitioners; to publish 
 reports of cases or certificates in the public prints, 
 to circulate or recommend nostrums, or to perform 
 any similar acts. But nothing in this section shall 
 be so constructed as to imply that it is unprofes- 
 sional for dentists to announce in the public prints, 
 or by cards, simply their names, occupation, and 
 place of business, or in the same manner to an- 
 nounce their removal, absence from, or return to 
 business, or to issue to their patients appointment 
 cards having a fee bill for professional services 
 thereon." 
 
 The wording of this paragraph is somewhat 
 ambiguous and has been generally interpreted to 
 mean a wholesale condemnation of all advertising; 
 but a careful perusal will show that it aims to con- 
 demn all advertising that could be considered in 
 any way offensive, vulgar or even undignified, and 
 mentions specifically certain kinds of advertising 
 that are considered in this category. 
 
 It would apparently seem unnecessary to insert 
 such a clause in a code intended for the guidance 
 
 32 
 
Advertising, 
 
 of professional men, but the fact Is that profes- 
 sional men in general have such a limited knowl- 
 edge of good business methods that when some of 
 them find the need of an Increasing income in order 
 to keep going, Instead of carefully studying the 
 situation, they jump to the conclusion that adver- 
 tising will solve the problem; and then instead of 
 seeking the advice of an experienced advertising 
 man, they employ some cheap printer or sign 
 painter and use copy and devices that any compe- 
 tent advertising or commercial man would be 
 ashamed of. 
 
 It Is quite evident that professional services can- 
 not be properly advertised by the same methods 
 as are used for the sale of merchandise, but there 
 are many ways by which a professional man may 
 become known in a community without resorting 
 to vulgar advertising or even to the subterfuges 
 that are so often employed. How easy It is to re- 
 call Incidences of young doctors attending church 
 and occupying a prominent seat only to be called 
 out In the midst of the services, by prearrange- 
 ment; or again of their dashing out of their offices 
 and driving furiously down the street only to Idle 
 away some time in an unfrequented place and then 
 driving rapidly back again; and the dentist who 
 makes It a point to get a drop of creosote or some 
 other vile-smelling drug upon his clothes just be- 
 fore attending some function, or else carries a 
 
 33 
 
The Business Problems of a Profession. 
 
 mouth mirror conspicuously displayed In one of his 
 pockets. 
 
 This reminds me of an Incident that occurred at 
 a dental convention recently, when a prominent 
 lecturer at a leading Eastern dental college turned 
 and asked If I happened to have a mouth mirror 
 In my pocket, as he had forgotten his. My reply 
 was that I did not consider a man's pocket a very 
 sanitary place to carry surgical Instruments. Again 
 there are the subterfuges employed to get one's 
 name Into the news columns of local papers and to 
 have press notices printed — gratis. These at- 
 tempts are made so often that It Is no wonder that 
 newspaper men are disgusted when they hear pro- 
 fessional men talk about Its being unethical to ad- 
 vertise. It certainly is unethical for a man to try 
 to get something without paying for it. 
 
 The code states suitable ways for professional 
 men to use newspaper advertising, and for which 
 regular advertising rates should be paid; but, 
 strange to say, these methods are not generally em- 
 ployed except In communities where it would seem 
 unnecessary from an advertising standpoint. It 
 Is not at all uncommon to find in the local papers 
 of small communities a space devoted to the busi- 
 ness cards of professional men. 
 
 It Is hardly possible for a professional man who 
 has ambition and energy, to be located In a town of 
 fifteen thousand or less, more than two weeks, 
 
 34 
 
Advertising. 
 
 without being quite generally talked about and the 
 observed of all observers. This being the case, it 
 would seem hardly necessary to resort to news- 
 paper advertising in such communities. In the 
 largest cities, however, where it is next to impos- 
 sible for a man to become known outside of a very 
 limited circle, these methods are not employed, in 
 fact are frowned upon by the dental societies, and 
 the newspaper field is left entirely to the men who 
 disgrace their calling by their vulgar methods and 
 untruthful statements. In these cities are large 
 numbers of people who come, go, and move about 
 and who have become accustomed to turning to 
 the advertising columns of the daily papers to find 
 the places that will supply their needs. In doing 
 this they naturally see and are influenced by these 
 vulgar dental advertisements and soon come to 
 judge dentistry and dentists in general, by these 
 standards. The general public does not know and 
 cares less about the codes and so-called " ethics " 
 of professional men. It does know that reliable 
 and successful commercial men advertise and state 
 frankly what they have to offer, and that they may 
 be depended upon; and naturally they think the 
 same must be true of dental establishments, and 
 that those who advertise are the ones that have 
 built up a large business from the same causes. 
 
 Every little while there Is talk among dental 
 society members about the need of putting the 
 
 35 
 
The Business Problems of a Profession, 
 
 " Dental Parlors " out of business, but a way to 
 do it is not often suggested. Newspaper men, who 
 are close observers of the situation, claim that if 
 the good men in the profession would publish their 
 cards and other necessary information so that the 
 general public could note the difference and be able 
 to pick and choose, it would not be long before 
 the present vulgar advertising matter would be re- 
 fused or withdrawn and the " Dental Parlors " 
 forced into the background. 
 
 This seems logical, and if carried out should 
 work to the advantage of the public as well as to 
 the profession. Such a course is fully sanctioned 
 by the code and therefore " ethical." 
 
 36 
 
CHAPTER VIII. 
 
 ATTENDANT. 
 
 From a business standpoint a young woman at- 
 tendant Is an essential element of a well-organized 
 office. In the care of the reception and dressing 
 rooms there are many things that will need the 
 touch of a woman's hands In order to keep them 
 looking neat and attractive. In the operating 
 room the sterlHzatlon and general care of the In- 
 struments and cabinets can best be done by a well- 
 trained young woman. 
 
 Time is a professional man's chief asset, and he 
 should never use It for doing minor things that can 
 be relegated to an assistant whose services are 
 worth but a nominal sum. In other words — if a 
 man's time is worth five dollars an hour he cannot 
 afford to spend it doing the things that he can get 
 another to do for about five dollars a week. It is 
 unreasonable to expect patients to be willing to 
 pay several dollars an hour for professional services 
 when a large part of that time includes the doing 
 of petty things that are merely incidental to the 
 operation. This is a point that is frequently over- 
 looked by young practitioners, and in a spirit of 
 
 37 
 
The Business Problems of a Profession. 
 
 economy they waste many minutes of a patient's 
 time and hours of their own in doing trivial things. 
 This is not only being " penny wise," but it is 
 poor business management and tends to lengthen 
 a man's working hours into the time when he 
 should be getting rest and recreation to keep him- 
 self up to the highest standard of efficiency. When 
 a man is not actually engaged In operating or 
 doing those things which other hands cannot do 
 for him, he should be free to employ his mind in 
 working out professional and business details that 
 will tend toward the betterment of his practice. 
 
 The attendant should be trained to assume the 
 responsibility of the general care of the offices; to 
 receive patients and look after their comfort; to 
 answer the telephone and make appointments; 
 take charge of the supplies, and keep plenty always 
 on hand; look after the laundry and see that the 
 chair is always dressed with clean linen; sterilize 
 and polish instruments; assist during the various 
 operations; open and close the office, and, in fact, 
 do everything possible that will tend to leave the 
 operator's hands and mind free to attend to the 
 details of the case before him. 
 
 In some cases the keeping of the books and rec- 
 ords can be turned over to her, but unless she is to 
 be a permanent fixture, is close-mouthed and thor- 
 oughly trustworthy, it is not well to do this ; for it 
 is not nice to have one's business affairs, the amount 
 
 38 
 
Attendant. 
 
 of the business and one's income and the financial 
 relations with patients the subject of gossip among 
 a girl's family or friends. The keeping of the 
 books and records can be so simplified as to require 
 but a few minutes' time each day and a professional 
 man can better afford to keep the knowledge of 
 these matters to himself. 
 
 Another point of great importance is that the 
 right sort of an attendant will be an effectual check 
 against unseemly conversation on the part of in- 
 discreet patients ; be a protection against blackmail 
 and an important witness in case of suits for mal- 
 practice. It is extremely unwise and hazardous 
 for a man to perform any operation for a stranger, 
 particularly a woman, without an attendant being 
 present. The administration of an anesthetic 
 should never be made except In the presence of a 
 third party, and if the patient happens to be a 
 young girl or a neurotic woman It will be still bet- 
 ter to have a fourth party present — one of them to 
 be a friend of the patient. Too great stress cannot 
 be laid on the importance of these points. Many 
 men have been fortunate enough to go through 
 their professional careers without any unpleasant 
 incidents; but one such is enough to wreck a man's 
 reputation and cling to him for life. 
 
 39 
 
CHAPTER IX. 
 
 FEES. 
 
 The fee problem is the most Important of any 
 that a dentist has to solve, yet it has received the 
 least practical consideration. 
 
 The plan of having a fixed price per filling, 
 crown, etc., according to the material used, origi- 
 nated in the days when dentistry was little more 
 than a special trade and has been handed down 
 from preceptor to student ever since. It is an- 
 other of the things that has become so firmly estab- 
 lished through custom and precedent, that it has 
 been almost exempt from discussion by profes- 
 sional societies, and yet, from a truly professional 
 and business standpoint, the method is unreason- 
 able and unjust to all parties concerned. 
 
 According to this way of basing fees, the value 
 of the materials used is considered of more impor- 
 tance than the services rendered. The method Is 
 not elastic, for no allowance is made for the kind 
 or position of the cavity, the difficulties of accurate 
 preparation, the time involved, the temperament 
 of the patient, the equipment required, lost time 
 from broken appointments or any of the many de- 
 
 40 
 
Fees. 
 
 tails that are Involved in various operations. It 
 resolves Itself into purely a matter of how many 
 fillings at a definite price per filling. 
 
 The establishing of such a method will, In the 
 long run, prove to be a considerable disadvantage. 
 Let us follow the workings of the system and see 
 how this may be. 
 
 A young man selects a location and begins prac- 
 tice. He soon learns the scale of fees of his neigh- 
 boring practitioners and adopts It; or, possibly, 
 he may establish a scale that Is somewhat lower, 
 thinking thereby to sooner gain a following. He 
 takes the requisite time to perform each operation 
 to the best of his ability that he may gain a repu- 
 tation for good work and attract more patients. 
 In time he finds that his practice has grown so that 
 he has all that he can comfortably attend to dur- 
 ing reasonable working hours. About this time 
 he is also likely to find that the expenses of main- 
 taining his office and equipment, together with his 
 personal responsibilities and expenses, have in- 
 creased to such an extent that a much larger in- 
 come is needed. If he studies the situation he will 
 find he is not getting any better fees for fillings, 
 crowns, etc., than he did when he first began 
 practice, although he has more experience, better 
 judgment and Increased skill, and has kept pace 
 with the times In methods and Improved equip- 
 ment. So far, the reward for his efforts has been 
 
 41 
 
The Business Problems of a Profession, 
 
 an increase of patronage, but this has brought him 
 to a parting of the ways; he feels that he must, and 
 is entitled to, increase his income, but finds it can 
 only be done at the expense of either his health 
 or his operations. He can increase his working 
 hours and become a veritable slave, toiling days, 
 nights, and Sundays, and be content with having it 
 said that he has such a large practice that he hasn't 
 time for a rest or vacation, and in this way help 
 verify the mortality records which say that the 
 average period of life for a dentist is forty-five 
 years; or else he may cut corners on his work and 
 become a nervous wreck, trying to do two opera- 
 tions in the time which he formerly took for doing 
 one. 
 
 A method which places a man in such a dilemma 
 at the height of his career must surely be faulty. A 
 satisfactory reason has never been given for hav- 
 ing a fixed fee for each filling, crown, etc. It 
 surely is not logical, nor is it based upon any defi- 
 nite idea of covering the cost of the material, the 
 cost of the operation, the maintenance of the office, 
 or of producing a definite income for the operator. 
 The progress that has been made in the methods 
 of operating has called for improved and expensive 
 equipment, the standard of office furnishings has 
 been very materially raised, the general expense of 
 conducting a suitable office is continually increas- 
 ing, the social demands upon professional men 
 
 42 
 
Fees, 
 
 have become greater, but this antiquated method 
 makes no provision for meeting these Increased 
 expenses. Many men who have been years In 
 practice are not able to earn any more In a given 
 time, by this method, than they did twenty years 
 ago, and yet their expenses have been steadily in- 
 creasing. 
 
 About the only purpose that this method has 
 served has been to fix In the public mind the Idea 
 that a filling Is merely a filling, and that It Is the 
 material for which they pay, that the time and skill 
 spent In preliminary treatment do not count; that 
 examinations are to be made and consultations and 
 advice given without charge; that when dentures 
 are to be made the surgical removal of useless 
 teeth is to be done free, and that It Is only when 
 materials are used that a bill should be rendered. 
 In other words. It has served to put dentistry on a 
 plane with the dealers In merchandise — no mate- 
 rials, no charge. The years spent and expenses in- 
 curred In acquiring knowledge and skill count only 
 as a means of getting more trade. The man who 
 keeps abreast of the times, attends professional 
 meetings and clinics, reads the latest professional 
 journals and books and Is continually Improving his 
 technique, Is expected to sell his services for the 
 same price per filling, etc., as does the other kind of 
 man; his reward Is in the possibly increased number 
 of his customers. All of which means that if he 
 
 43 
 
The Business Problems of a Profession, 
 
 wishes to Increase his income so as to be reimbursed 
 for this outlay, he must labor an increased number 
 of hours and thereby wear himself out that much 
 quicker. Ah ! but we must not forget the glory of 
 having such a big practice. But glory is an empty 
 bubble when one is worn out and bills are pressing. 
 
 This method of charging for services is unrea- 
 sonable and unjust to patients in that it makes no 
 distinctions. The patient that aims to take good 
 care of his teeth and visits the dentist frequently, 
 coming with a clean mouth and small cavities, is 
 expected to pay the same price per filling as the 
 one who neglects even the simplest laws of hygiene 
 and appears only after long intervals, with a 
 mouth reeking with filth and with cavities so exten- 
 sive and complicated as to frequently require con- 
 siderable treatment before they are in a condition 
 to be properly filled. Under these same conditions 
 a crown is considered as merely a crown, and no 
 distinction is made in price between the case where 
 the root merely requires proper shaping to receive 
 the crown and the one where extensive treatment 
 is required, possibly involving the treatment and 
 cure of a chronic alveolar abscess. 
 
 Again, no allowance is made for the difference 
 In the temperament of patients. The patient who 
 Is always prompt in keeping engagements, sits 
 quietly and allows the operator to work quickly 
 and without unnecessary Interruptions, Is expected 
 
 44 
 
Fees. 
 
 to pay as much for each operation as the one who 
 Is generally late in keeping an appointment, restive 
 and fussy, and wastes the operator's time with un- 
 necessary questions, gossip, and general indecision. 
 In fact, the method considers a patient as being 
 merely a patient and a cavity as merely a hole — 
 requiring a filling, at a uniform price, according to 
 the kind of material used. Occasionally a slight 
 difference In price Is made — said to be due to the 
 size of the filling, but It Is more apt to be from a 
 sizing up of the patient. All of which is illogical, 
 unreasonable, and unjust. 
 
 However, there Is a method of basing fees that 
 has none of these objections and which seems to be 
 perfectly logical, reasonable and just to all parties 
 concerned, and that is founded on good business 
 principles. This method will be considered in 
 Chapter X. 
 
 45 
 
CHAPTER X. 
 
 ESTIMATING THE COST. 
 
 Probably no other class of men carrying on 
 business know so little about the general principles 
 underlying business transactions as professional 
 men. 
 
 In all lines of general business It Is considered 
 essential that the cost of the thing to be disposed 
 of shall be known before fixing the selling price, 
 and yet It Is customary for professional men to es- 
 tablish a scale of fees for their services without 
 having any definite Idea about what It actually 
 costs them to render the service, nor Is this scale 
 based upon any plan for producing a definite 
 Income. 
 
 A professional man usually adopts the scale of 
 fees that he finds already established In the com- 
 munity where he begins practice and continues to 
 render his services at the same rate during the rest 
 of his career. This Is particularly true of dentists. 
 Most of them are even now rendering their serv- 
 ices for the same remuneration that was established 
 many, many years ago. This Is In spite of the fact 
 that the cost of obtaining a professional education 
 
 46 
 
Estimating the Cost. 
 
 '^» 
 
 is now ven^ much greater, and the general cost of 
 living and the maintenance of a practice have very 
 materially increased, to say nothing of the progress 
 that has been made In dental science and the In- 
 creased cost of the services rendered. 
 
 The excuse has been that the cost of professional 
 services cannot be estimated as can that of mer- 
 chandise, and so the fee must be based on what the 
 dentist thinks the patient can or will pay. It has 
 been quite the general impression that there was 
 no method by which the cost of dental services 
 could be estimated except by possibly considering 
 the first cost of the materials used. As a conse- 
 quence, many men have labored under the delusion 
 that unless materials were used In connection with 
 an operation there was no direct expense attached; 
 and also that If there was any time during office 
 hours when a dentist was not engaged In earning 
 something, he was not suffering any loss. These 
 Ideas are certainly erroneous, for a dentist Is under 
 a direct expense every minute of his office hours, 
 and besides, there is a method of determining what 
 this expense may be. 
 
 In a commercial business the selling price of an 
 article is fixed with reference to its actual cost to 
 the retailer. This is determined by adding to the 
 first cost of the article a given percentage of the 
 cost of distribution, the interest on the capital in- 
 vested, and a certain allowance for covering profit 
 
 47 
 
The Business Problems of a Profession, 
 
 or loss. The term " cost of distribution " is a gen- 
 eral one and covers the cost of maintaining the 
 necessary establishments, insurance, the salaries of 
 the proprietor and employees, and any and every 
 item that has any bearing upon the cost of conduct- 
 ing the business. 
 
 A similar plan may be used for determining the 
 cost of maintaining a dental practice, and by know- 
 ing the cost it will be possible to formulate a scale 
 of fees that will be equitable. 
 
 In applying this plan the first item to be consid- 
 ered will be the capital invested. The first invest- 
 ment of capital will be for the obtaining of a pro- 
 fessional education. The amount involved may be 
 determined by figuring the cost of college tuition 
 and fees, of books, instruments and supplies re- 
 quired, of board and general living expenses during 
 the college years, and the amount of lost earnings 
 during the period. Five thousand dollars has been 
 considered a fair estimate of the total cost of ob- 
 taining a professional education under present con- 
 ditions, and for the purposes of illustration, this 
 sum will be taken as the amount of capital thus 
 invested. 
 
 The next investment will be for the equipping of 
 a suitable office. The average office having mod- 
 ern furnishings and equipment will probably in- 
 ventory at about $2,000. This gives a total of 
 $7,000 as representing the amount of capital that 
 
 48 
 
Estimating the Cost. 
 
 Is Invested In the business. If this amount of 
 money were Invested In mortgages or In securi- 
 ties It would yield an Income of about six per cent, 
 and It should at least yield the same amount from 
 having been Invested In the dentist's own business. 
 The Interest on the Investment at six per cent 
 should be considered as one of the fixed expenses 
 of the business. 
 
 The next point to be considered In applying this 
 plan will be the estimated expenses of conducting 
 the business per annum. The first Item will be the 
 necessary sum required to cover the depreciation 
 and cost of renewal of the furniture and equip- 
 ment. The serviceable life of such things Is usu- 
 ally considered as being about ten years, and It Is 
 customary to set aside ten per cent of their original 
 cost each year, to cover the expense of their replace- 
 ment. Another Item will be the amount of the 
 premiums on an Insurance policy, taken on the life 
 of the operator and made payable to the business 
 (estate). The amount of the policy should be 
 governed by the amount of business that the oper- 
 ator can produce; that Is to say. If the gross busi- 
 ness amounts to $5,000 then the Insurance may be 
 for a like amount; because this will represent his 
 producing value to the business. This Insurance 
 policy becomes a collateral of the business and will 
 be found particularly valuable In adjusting the af- 
 fairs in case of such an emergency as the sudden 
 
 49 
 
The Business Problems of a Profession. 
 
 death of the operator, and will also be found an 
 advantage in securing or establishing a business 
 credit. 
 
 The next items will be the general expenses con- 
 nected with the carrying on of the business. First 
 of these will be the fire insurance premium, for it 
 is always wise to be protected against loss. Fol- 
 lowing this will come the rent, heat, light, janitor 
 services, telephone, etc. The next in order will be 
 the estimated amount of dental supplies required 
 during the year. After this there will be the yearly 
 salary of the young woman attendant. The next 
 important item to be considered will be the salary 
 for the dentist himself. At this point it may be 
 well to state that there is one important thing that 
 should be fully understood and kept constantly in 
 mind during all business transactions, and that is : 
 In dealing with a practice from a business stand- 
 point the practitioner should consider himself and 
 the practice as two separate and distinct parties, 
 and his personal relation to the business as merely 
 that of an employee. This is one of the essential 
 features of good business management. 
 
 Regarding the amount of salary that the dentist 
 will be entitled to — while this must be governed 
 very largely by the amount of business he can pro- 
 duce, yet it will be necessary for him to look ahead 
 and provide for an income sufficient to cover his 
 personal requirements. A young and inexperi- 
 
 50 
 
Estimating the Cost. 
 
 enced operator will not be able to command as 
 much business as an older practitioner and should 
 not expect to draw as much salary from his busi- 
 ness, but he should try to plan his business affairs 
 so that as his experience and skill Increase, he will 
 be enabled to draw an increased salary each year. 
 
 Still another Important Item will be the Inci- 
 dental expense. This account should cover the 
 cost of all stationery, postage, minor office sup- 
 plies and everything that In any way pertains to the 
 general maintenance of the office or the Improve- 
 ment of the dentist as an operator. By this Is 
 meant all society dues, the expenses connected with 
 the attendance of clinics, study courses, etc., the 
 cost of books, subscriptions to dental journals, 
 books and magazines for the reception-room table, 
 etc. These items are generally overlooked in mak- 
 ing up the expense account and yet they are all 
 legitimate charges, as they are for the betterment 
 of the practice. 
 
 When this schedule has been put together It will 
 appear somewhat as follows: 
 
 Original Investment. 
 
 Professional education $5,000.00 
 
 Furnishings and equipment 2,000.00 
 
 Total. $7,000.00 
 
 51 
 
The Business Problems of a Profession. 
 
 Estimated Expenses for the Year, 
 
 Interest on investment $420.00 
 
 Depreciation and replacement 200.00 
 
 Life insurance premium 
 
 Fire insurance premium 
 
 Rent 
 
 Heat, light, janitor service 
 
 Telephone, etc 
 
 Dental supplies 
 
 Attendant's salary 
 
 Personal salary 
 
 Incidental expenses 
 
 Total 
 
 In making up the schedule of estimated yearly 
 expense, figures have not been carried out after the 
 various items, for they will vary considerably ac- 
 cording to the community, the kind of practice and 
 conditions generally; but if the practitioner who 
 desires to use this plan will fill in the amounts with 
 his own figures he will be enabled to determine the 
 approximate cost of conducting his practice. 
 
 With the amount of the total yearly expense 
 known, the next problem is to determine how this 
 may be apportioned so that each working day may 
 bear its own quota. 
 
 521 
 
CHAPTER XL 
 
 TIME. 
 
 The practice of dentistry differs from that of 
 other professions In the nature of the work and 
 the way services are rendered. A dentist must 
 have a general knowledge of medical science and 
 be familiar with parts of many of the arts and 
 mechanical trades, yet with all this his earning 
 power depends almost entirely on the exercises of 
 fingercraft. Instrumentation Is a feature of all the 
 operations, and time Is an Important factor In their 
 proper performance. The amount of time re- 
 quired Is governed very largely by the nature of 
 the operation and the general conditions, such as 
 the temperament of the patient, accessibility, etc. 
 
 This being the case. It Is plainly seen that time Is 
 an Important factor In all operations, that It very 
 largely determines the number that may be per- 
 formed and thus has a very material bearing on 
 the earning power of the operator. How much 
 time, then, during the course of a year, will be at 
 the command of a practitioner who desires to re- 
 tain his health and vitality, maintain himself at the 
 highest standard of mental and physical efficiency 
 
 53 
 
The Business Problems of a Profession. 
 
 for his work, and also have time to enjoy the pleas- 
 ures and recreation of cultured people, in which to 
 earn a sufficient amount to cover the yearly expense 
 and make a reasonable profit besides? 
 
 This may be determined by a process of elimina- 
 tion. First to be considered will be the question 
 of working on Sundays and holidays. While there 
 may be good reasons why physicians should be on 
 duty on Sundays and holidays there are practically 
 none why dentists should be. 
 
 Emergencies may arise at such times requiring 
 the services of a dentist in order to relieve suffer- 
 ing, but it certainly is not necessary for the dentist 
 to keep regular office hours on these days in order 
 to meet these emergencies. 
 
 The physician's work differs from that of the 
 dentist in that a large part of it consists of making 
 calls which take him out into the fresh air and sun- 
 shine, where there is an everchanging scene to rest 
 his eyes, mind, and nerves, and thus he is enabled 
 to stand the strain of long hours for a continuous 
 number of days. The work of the dentist necessi- 
 tates his spending his working hours within the 
 confines of a small room, operating by a steady 
 light from which the direct rays of the sun are usu- 
 ally eliminated. The effect of such a condition is 
 a tremendous strain upon the vitality and nervous 
 energy of the one subjected to it. It therefore fol- 
 lows that the dentist of all men is the one who 
 
 54 
 
Time, 
 
 should embrace every opportunity for rest and rec- 
 reation in the fresh air and sunshine. 
 
 The fact probably is that most dentists who 
 have established office hours on Sundays and holi- 
 days do so from a mercenary rather than a hu- 
 manitarian spirit. The old plan of a fixed price 
 for the different kinds of filling, etc., has made it 
 seem necessary to work long hours and on Sun- 
 days, that a dentist may increase his income. It 
 is, however, really unnecessary for a dentist to 
 have office hours on Sundays and holidays, and it 
 is never good business policy. These days should 
 therefore be deducted; thus eliminating sixty days 
 in a year. 
 
 The next to be considered is the question of a 
 vacation. How much time should be taken for a 
 complete change and rest by one who is engaged in 
 such a confining and nerve-exhausting occupation 
 as dentistry? It has been well said by a profes- 
 sional man that he could do twelve months' work in 
 eleven, but that he could not do it in twelve and do 
 it satisfactorily. If a dentist wishes to maintain 
 for a long period a high standard of mental and 
 physical efficiency, then he must take sufficient time, 
 whenever needed, to thoroughly recuperate, and he 
 must also have an opportunity to take an interest 
 in other things, so as not to become narrow-minded 
 and self-centered. 
 
 Four weeks' rest seems little enough for a pro- 
 
 55 
 
The Business Problems of a Profession. 
 
 fessional man. While some men would prefer to 
 take the four weeks consecutively, there will be 
 others who will find it more beneficial or convenient 
 to divide the time. One good plan is to take a 
 week in the spring and another in the autumn, as 
 they will then come at a time when one is working 
 hard and most needs the change. The other two 
 weeks, or more, may be taken in mid-surtimer 
 when business is slack and most people are away. 
 
 Allowing four weeks for a vacation period, there 
 will be practically ninety days, all told, eliminated 
 from the year, leaving two hundred and seventy- 
 five days within which to earn sufficient money to 
 meet all the expenses and provide something for 
 old age and the proverbial " rainy day." 
 
 Next should be determined the available number 
 of working hours in each day. As most dental 
 operations require the undivided attention of the 
 operator for periods of an hour or more, this pro- 
 tracted concentration becomes a very considerable 
 nervous strain and tends to limit the amount of 
 work that can be safely undertaken, if health and 
 vitahty are to be maintained. A business day of 
 six or seven hours is all that a professional man 
 should undertake, and if the office hours are ar- 
 ranged to be from 9 A.M. to 4 or 5 P.M., they will 
 cover the time that is most suitable and the period 
 when the light is the best. It is poor business pol- 
 icy and decidedly unwise from a health standpoint 
 
 56 
 
Time, 
 
 to have evening office hours or to do work by an 
 artificial light, except In cases of emergency. 
 
 If the office hours are arranged to cover a 
 period of seven hours it will be found, owing to 
 interruptions and the time lost while changing pa- 
 tients, that there will be but five, or possibly six, 
 hours that are occupied with work for which a 
 charge can be made. 
 
 Given the total amount of the fixed and esti- 
 mated expenses for the year, together with the 
 number of business days decided upon. It is but a 
 simple matter to determine the proportionate ex- 
 pense for each day. If this amount is again di- 
 vided by the number of actual earning hours it will 
 give the expense per hour. 
 
 Thus it is shown that time is a very Important 
 factor to a dentist, as each hour represents a defi- 
 nite amount of expense that must be met in order 
 to conduct a practice successfully. 
 
 57 
 
CHAPTER XIL 
 
 THE HOUR FEE. 
 
 Having found that It does cost a definite 
 amount per hour to maintain a practice and know- 
 ing what that amount is, the next step is to fix upon 
 a fee that will be sufficient to cover this expense 
 and yield a reasonable profit. Such a procedure is 
 essential for the successful conduct of a business; 
 is perfectly legitimate and fair to all parties con- 
 cerned. 
 
 In determining what this amount (the fee) 
 shall be, it is necessary to take into consideration 
 and make allowances for lost time, uncollectable 
 accounts, etc. As a general proposition twenty-five 
 per cent may be considered a fair amount to repre- 
 sent such losses and another twenty-five per cent 
 may represent a reasonable profit. These percen- 
 tages will vary, however, according to the indi- 
 vidual practice. 
 
 The actual cost plus fifty per cent will represent 
 the amount that must be earned and charged each 
 hour in order to meet expenses, yield an income 
 and profit, and have a successful business. Know- 
 ing now that a definite amount must be charged for 
 
 58 
 
The Hour Fee, 
 
 each hour or fraction thereof, It becomes essential 
 that such a degree of skill and speed In operating 
 be developed as will make It possible to render a 
 fair amount of service In return for this fee. It Is 
 not called for, nor Is It wise, for an operator to 
 work at race-horse speed, but the work should pro- 
 ceed systematically and steadily at a rate that will 
 neither excite nor overtire the patient; and the op- 
 erating equipment should be so arranged that no 
 time need be lost. Sufficient time should be taken 
 to attend to all the details of the case in hand, no 
 matter what it may be, and when it Is finished the 
 amount of the fee will be governed by the amount 
 of time that has been devoted to that patient. 
 
 In this way the patient only pays for what he 
 gets and the operator Is paid for all that he does. 
 
 59 
 
CHAPTER XIII. 
 
 APPOINTMENTS. 
 
 In a practice that is conducted on the time basis 
 it is not desirable to have patients dropping in with 
 the expectation of receiving immediate attention or 
 to have the reception room filled with waiting peo- 
 ple. It is far better to have it understood that all 
 operations are performed by appointment only. 
 One or two hours a day should be set aside for 
 consultations, examinations and emergency work, 
 and, as far as possible, such work should be at- 
 tended to during those hours. When patients are 
 to return for some specific work a definite appoint- 
 ment should be made for a stated time, and it 
 should be thoroughly impressed upon them that a 
 certain amount of time has been reserved for them 
 exclusively and that, if through any unforeseen cir- 
 cumstance they find themselves unable to keep the 
 engagement, suitable notice must be given or else 
 a loss will be entailed for which they will be ex- 
 pected to pay. If a patient makes an engagement 
 under these conditions, it becomes a legal contract 
 and will be held as such if it should become neces- 
 sary to go to court in order to collect an account. 
 
 60 
 
Appointments. 
 
 In making these appointments enough time 
 should be reserved for each one to permit of meet- 
 ing any conditions that may arise and of giving 
 proper attention to all the details of the case. It 
 will be found that, as a rule, about four or five such 
 appointments a day will be all that can be taken 
 care of during suitable office hours. When all the 
 time for one day has been allotted, fill the hours of 
 the next, and the next, and so on, as far ahead as 
 the practice may warrant. Do not increase the 
 working hours of any day or days just because of 
 the number of patients asking for time, but assign 
 them a future hour in the order In which they come. 
 The reason and policy of this will be discussed In 
 Chapter XIX. 
 
 With regard to broken appointments, It is well 
 to have It understood that all lost time will be 
 charged for, but there are times and circumstances 
 when It may not be advisable to adhere too strictly 
 to this rule. Unless some such understanding Is 
 had with patients they will get the idea that an 
 appointment not kept does not entail any loss, and 
 form the habit of needlessly breaking appoint- 
 ments. 
 
 As a general thing the full charge for all time 
 reserved should be made in case of a broken ap- 
 pointment ; but there will be times when It Is advis- 
 able to make only a portion of this charge. The 
 patient should then be given to understand that 
 
 6i 
 
The Business Problems of a Profession. 
 
 this is not the general rule but that an exception 
 has been made in his case. When charging for a 
 broken appointment some allowance should be 
 made if it has been possible to fill the time or some 
 portion of it. 
 
 If a patient comes in five, ten or fifteen minutes 
 late and the operator has been ready and waiting 
 during that time, the charge should be made for 
 the full time just the same. If the patient is a 
 half hour late he should be made to lose the entire 
 engagement and other appointment be given him, 
 and a full charge made for the lost time unless a 
 very satisfactory excuse be given. 
 
 An operator should always try and be as prompt 
 in keeping appointments with his patients as he 
 expects them to be with him. 
 
 62 
 
CHAPTER XIV. 
 
 RECEPTION OF PATIENTS. 
 
 The way a person is received in an office 
 may have considerable bearing upon his decision 
 whether to become or remain a patient or not. 
 
 It should be the duty of the young lady attend- 
 ant to answer the door as promptly as possible, 
 learn the wishes of the caller and make him feel 
 at ease until the operator has an opportunity to 
 speak with him. In the case of agents, traveling 
 salesmen or a patient who merely wishes an ap- 
 pointment, the attendant will probably be able to 
 attend to the business without disturbing the oper- 
 ator; if, however, it should be a patient really de- 
 sirous of speaking with the doctor, or a brother pro- 
 fessional man, he should be announced at once and 
 word returned how soon the operator will be able 
 to speak with him. It will mean a good deal some- 
 times, if the operator will but merely step to the 
 door of the reception room and himself tell the 
 patient how soon he will be at liberty to talk with 
 him. 
 
 It is bad policy to leave anyone to cool their 
 
 63 
 
The Business Problems of a Profession. 
 
 heels in a reception room not knowing whether 
 they are to be kept waiting five minutes or an hour. 
 Their time may be quite as valuable as the doc- 
 tor's, and they might prefer to spend it elsewhere, 
 particularly if their business with him would take 
 but a moment to transact. In the case of a brother 
 professional man, it is but courtesy that he should 
 be seen at the earliest possible moment and not be 
 detained one minute longer than necessary. If it 
 happens that the operator is really engaged upon 
 some work that cannot be left for sometime, it is 
 better that the attendant should, from time to time, 
 speak to the person waiting and inform him of the 
 circumstances and that the doctor regrets keeping 
 him waiting so long and that he will be ready to 
 see him soon. 
 
 Sometimes a professional man gets the idea if 
 he keeps people waiting for a long time before 
 speaking with them, that they will be impressed 
 with the idea that he is an important and a very 
 busy man. Well, it may, but it certainly is not 
 very courteous. 
 
 It may not be amiss to mention one person's ex- 
 perience in two dental offices in the same town. 
 This person had occasion to call upon a dentist and 
 accepted the invitation upon the door to walk in. 
 There was no one in sight to receive him, although 
 a voice could be heard in a distant room. He took 
 a seat and waited — and waited. At the expiration 
 
 64 
 
Reception of Patients. 
 
 of one-half hour he became disgusted and walked 
 out. During the entire time there had been noth- 
 ing to indicate to him that his presence was even 
 known, but being a gentleman he did not feel called 
 upon to make a disturbance in order to attract 
 some one's attention. He went from this office to 
 another, up a flight of stairs Into a hall in the cen- 
 ter of a number of living rooms with the doors all 
 open. While debating which door to enter he no- 
 ticed that he was being observed by a young 
 woman in one of the front rooms, but she gave no 
 sign that she saw him and quickly disappeared be- 
 hind a screen. It was afterwards learned that this 
 was the operating room and that she was the at- 
 tendant. The reception room was finally discov- 
 ered and other people found waiting. When one 
 patient was dismissed another one was signalled to, 
 from a passageway leading through to the oper- 
 ating room, but neither the attendant nor the doc- 
 tor came Into the reception room nor where either 
 could see who was waiting, or speak to them. The 
 doctor's attention was finally attracted by the 
 stranger taking a position directly in front of this 
 passageway so that he had to be seen. 
 
 Not very good business management In either 
 case, was it? 
 
 65 
 
CHAPTER XV. 
 
 RECORDS OF OPERATION. 
 
 It almost goes without saying that a record 
 should be kept of all operations and the details 
 connected therewith — and the more complete they 
 are the better. Many methods have been devised 
 and there are innumerable " card systems " on the 
 market for this purpose. It cannot be rightfully 
 said that any one '' system " is preeminently better 
 than the others, for they all have some good fea- 
 tures, and it is merely a matter of adopting the one 
 that best suits the individual requirements. For 
 general purposes, however, a card system is better 
 than a book record. 
 
 With cards, it is possible to so divide and ar- 
 range them that while any record will be always 
 available only the active ones need be handled 
 and the open accounts can be so segregated as to 
 greatly facilitate the rendering of bills and the 
 keeping track of slow pay accounts. A card that 
 has a space for recording general information re- 
 garding the patient, a good diagram of the sur- 
 faces of the teeth and sufficient space for the 
 charges and credits will serve the purpose very 
 
 66 
 
Records of Operation. 
 
 well — anything more than that adds to the time 
 and labor required to keep up the records. Always 
 have In mind that a good system Is Intended to 
 simplify — not to complicate. 
 
 So many ways have been devised for recording 
 the different operations In connection with the dia- 
 grams that It Is out of the question to give space 
 to a description of them. Any scheme of marks 
 that can be readily understood at a glance will 
 serve the purpose, and such schemes are usually 
 best developed by the individual to suit his own 
 needs. 
 
 As time goes on these records will become the 
 most valuable accessory In the office, for In case of 
 a fire or other accident, practically everything else 
 could be replaced without difficulty; but if these 
 records are destroyed they never could be entirely 
 replaced and this would be a serious handicap when 
 beginning practice again. For this reason the 
 cards should be of such a size and kept in a recep- 
 tacle that will permit of their being quickly re- 
 moved to a place of safety should an emergency 
 arise during the day, and of their being placed In 
 a fireproof safe or vault when not in use. 
 
 The best time for filling out these records is 
 when the patient leaves the chair immediately after 
 the operation. The patient may then be asked to 
 step to the desk in another part of the room (It 
 would be out of place In the reception room), and 
 
 67 
 
The Business Problems of a Profession. 
 
 the entire record made out in his presence; in this 
 way mistakes are likely to be avoided, and the pa- 
 tient will have an opportunity to raise any ques- 
 tions he may desire. This is also the time to dis- 
 cuss charges, terms, payments, etc. More will be 
 said in reference to this particular feature in a sub- 
 sequent chapter. It is important that these records 
 should be made at this time and on the permanent 
 chart, for should it become necessary to bring suit 
 to collect an account, the courts only accept, as 
 good evidence, the original records made at the 
 time of the operation. 
 
 The few minutes required for this work will not 
 be lost even in a busy practice, for while it is being 
 done the attendant should be getting the operating 
 equipment ready for the next patient. Changing 
 the linen on the chair, sterilizing the instruments, 
 and getting everything spick and span in the pres- 
 ence of the retiring patient is a good plan, for it 
 gives that patient an opportunity of seeing the care 
 that is exercised and tends to increase confidence. 
 The succeeding patient should not be allowed to 
 enter the operating room until everything Is In per- 
 fect order. Many a good patient has been lost 
 from having been asked to sit in an untidy chair, 
 with a litter of instruments used in previous oper- 
 ations all about, and by having the operator forget 
 and pick Instruments out of the mess and begin to 
 use them. 
 
 68 
 
CHAPTER XVI. 
 
 JOURNAL AND LEDGER RECORDS. 
 
 It Is essential that a complete record of all 
 transactions be kept, In order that the conditions 
 of the business may be known at any time. A day- 
 book Is the proper place for recording such Items 
 as these. 
 
 In keeping such a record there are four funda- 
 mental accounts, the figures of which should be 
 readily at hand In order to conduct the practice on 
 a sound business basis. These are: i. The amount 
 of business done. 2. The cash received. 3. The 
 expense Incurred. 4. The amount of money with- 
 drawn from the business for personal use. 
 
 A simple method of separating and tabulating 
 these Items Is to use a day-book that Is ruled with 
 four or more columns Instead of the customary 
 two at the right hand side of the page. A column 
 Is reserved for the figures of each of the accounts 
 that It Is desired to keep. As the Items for the 
 day are entered, the figures are placed In the 
 proper columns and the footings carried forward 
 from page to page until the end of the month is 
 
 69 
 
The Business Problems of a Profession. 
 
 reached, when the totals are figured up and bal- 
 anced. These figures may be supplemented by 
 bringing forward the totals of the preceding 
 months, thus giving the amounts for the year up 
 to that date. 
 
 Putting the figures together In this way makes 
 It easy to ascertain the condition of the business at 
 any time ; make comparisons with other years, day 
 by day or month by month; to note how the cash 
 receipts compare with the gross business; how the 
 expense account compares with the net business; 
 the exact amount that Is being withdrawn from 
 the business for personal use, so that one's private 
 affairs may be regulated accordingly; and to know 
 whether the practice is making a fair profit or a 
 business loss. In keeping the expense account It 
 will be found that there will be continual expendi- 
 tures of small amounts for minor supplies, such as 
 postage, etc., and it is unnecessary to write out 
 each of these items In the day-book unless It Is de- 
 sired to have an absolute record of what each 
 penny was spent for; a simpler way is to have a 
 petty cash account from which all such Items are 
 paid, the total to be entered In the day-book at the 
 end of the week under the head of sundries. The 
 salary of the operator should, of course, be 
 charged directly to the expense account each week, 
 but if one prefers, the amounts withdrawn may be 
 entered in the personal column during the month 
 
 70 
 
Journal and Ledger Records. 
 
 and a balance struck, and the amount of the salary 
 be charged to expense at that time. 
 
 Entering the amounts of the " accounts receiv- 
 able " and the " accounts payable " each month, 
 gives a still further insight into the condition of 
 the business. In the business world, a man who 
 does not know exactly " where he is at " is pretty 
 apt to be in an unsafe position. 
 
 By using a card system for keeping the accounts 
 with patients and making the day-book entries as 
 suggested, it becomes practically unneccessary to 
 do any double-entry bookkeeping or to keep a 
 regular ledger. The " accounts payable " will be 
 principally for dental supplies, stationery, etc., and 
 of course some record of them must be kept, but 
 there are several simple ways of doing this. If 
 cash is paid for all supplies at the time of purchase 
 the regular day-book entry will be all that is neces- 
 sary; if a monthly account is run with the supply 
 houses the sales slips should be filed and checked 
 off with the regular statement received each month 
 and a record kept of the total amount. If these 
 accounts are paid in full at the end of the month 
 the following simple plan may suffice; if not, it 
 would be better to keep a regular ledger record of 
 them. 
 
 71 
 
The Business Problems of a Profession, 
 
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 73 
 
The Business Problems of a Profession, 
 
 These suggestions of simple bookkeeping meth- 
 ods are intended principally for the average one- 
 man practice, and with the idea of reducing the 
 amount of labor required to the minimum. In the 
 case of a large practice, where assistant operators 
 and a regular secretary are employed, it may be 
 better to use the regular double-entry system of 
 bookkeeping throughout. 
 
 in 
 
 74 
 
CHAPTER XVII. 
 
 CREDITS AND COLLECTIONS. 
 
 It is not the amount of business or the number 
 of patients that determine the business success or 
 failure of a practice, but whether the cash receipts 
 will equal the amount of the expenses and will 
 show a profit at the end of the year. 
 
 Young men have been told, all too frequently, 
 that they should not think of money in connection 
 with their work, for to do so is sordid and mer- 
 cenary; but they should think only of the beauty 
 and poetry of their operations and the good they 
 may be doing their fellow man. A man who fol- 
 lows these precepts literally will not be fulfilling 
 his whole duty to society, for it demands that a 
 man shall care for his own, and when he fails to 
 do so he adds a burden to others t^ is morally 
 unjust. 
 
 No man is called upon to r<~ ir services that 
 mean an actual expense to him, without some as- 
 surance that they will be paid for. This, of course, 
 does not refer to charity work. A man Is justified 
 in giving as freely to charity as he can afford, but 
 
 75 
 
The Business Problems of a Profession, 
 
 charity should not be extended to " dead beats " or 
 to people who can well afford to pay but who 
 will not. 
 
 There are many men who have sufficient nerve 
 to undertake any kind of an operation, yet lack the 
 moral courage to Insist on being paid for their 
 services. Such a course Is unwise and unjust and 
 leads to business failure. 
 
 The best time to discuss with a patient the prob- 
 able amount of the fee and the terms of payment 
 Is after the preliminary examination has been made 
 and the appointments are to be arranged for. In 
 large cities where people move about frequently 
 and little Is known of their financial standing, It Is 
 perfectly proper and good business policy to ask 
 that a suitable retainer be paid In advance. This 
 Is the usual course adopted by the members of the 
 legal profession. When this Is not feasible, ar- 
 rangements should be made for payments at the 
 close of the engagement, or at a definite time after 
 the work Is completed. A note should be made 
 upon the chart of the arrangement agreed upon, so 
 that no question will be raised when the bill Is pre- 
 sented. 
 
 When a patient is known to be financially re- 
 sponsible It may be good policy not to ask for a 
 retainer but to send a bill at the completion of the 
 work. It Is advisable, however, to have It gener- 
 ally understood that prompt payment is expected 
 
 76 
 
Credits and Collections, 
 
 when the bill is presented unless some special ar- 
 rangement has been made to the contrary. State- 
 ments should be rendered promptly upon the com- 
 pletion of the work. If a considerable amount of 
 time is allowed to elapse before the statement is re- 
 ceived the patient may forget what was done and 
 think he has been overcharged. 
 
 A good form for a professional statement or 
 bill will be about as follows: 
 
 Mr - ^ 
 
 to 
 D.D.S. 
 
 For professional services rendered 
 
 from 
 
 to 
 
 Received payment 
 
 An itemized statement should not be rendered. 
 If one should be requested, a reply can be made 
 about as follows: '' The bill rendered was for pro- 
 fessional services which cannot be itemized, like so 
 much merchandise; however, by referring to my 
 
 records I find that there were engagements, 
 
 occupying hours, during which time the 
 
 following operations were performed gold 
 
 fillings, amalgam fillings, the surgical 
 
 cleansing of the teeth and roots (or whatever it 
 
 77 
 
The Business Problems of a Profession. 
 
 may have been), my customary fee for the service 
 rendered being the amount stated in the bill. 
 Trusting that this will be satisfactory, Yours, etc.'^ 
 Such a reply usually ends the argument. 
 
 All bills for outstanding accounts should be 
 sent out promptly at the end of each month. As 
 many people pay their monthly bills in the order in 
 which they are received, it is a good plan to send 
 out the bills by the 28th of the month. It is the 
 early bird that frequently catches the worm. In 
 case a remittance is not received, it will be well in 
 many cases to send another bill on the 15th of the 
 following month. If an account is still outstand- 
 ing at the end of the second month a bill should 
 be sent with a request for a remittance written 
 upon it. Should this f ailto bring a response within 
 a reasonable length of time a letter should be writ- 
 ten stating that " professional fees are due upon 
 the completion of the work and that credit had 
 been given only as a matter of courtesy, that the 
 account is overdue and a remittance is expected." 
 Accounts that remain unpaid for three months 
 without some explanation being made should be 
 followed up aggressively. A plan that sometimes 
 works effectively is to have the office attendant call 
 upon the debtor and present the bill with a request 
 for an answer. If this is not expedient or should 
 fail, the account may then be turned over to a 
 regular collector. A professional bill collector 
 
 78 
 
Credits and Collections. 
 
 generally produces better results than do lawyers, 
 who usually confine their efforts to writing letters 
 and making threats that are seldom anything but 
 a bluff. 
 
 In places where there are several dentists who 
 will work together, it would be a good plan for 
 them to agree to employ the same collector. In 
 this way considerable information may be obtain- 
 able regarding the people that are slow pay or 
 that evade payment of their debts. When a per- 
 son is known to be poor pay or a dead beat, a den- 
 tist is entirely justified in declining to render pro- 
 fessional services to him unless payment is made in 
 advance. 
 
 Lawyers will frequently advise bringing suit to 
 collect an account, but it is seldom advisable to 
 actually take a case into court unless the amount 
 involved is sufficient to make it well worth while, 
 for the legal expenses will more than offset any 
 small amount. 
 
 Referring again to the rendering of bills, we 
 sometimes hear of professional men who only send 
 bills to their patients once or twice a year. This 
 may be all right in a few exceptional cases where 
 the patients are more than well-to-do or the 
 amounts involved are small, but in most instances 
 it is bad business policy and is unfair to both par- 
 ties concerned. In the first place, a professional 
 man is entitled to his fee when the service is ren- 
 
 79 
 
The Business Problems of a Profession, 
 
 dered or as soon thereafter as is practicable, for he 
 has expenses which should be met promptly ; again, 
 when a bill is sent to a patient only once or twice 
 a year, they have no means of checking it up to 
 determine if it is correct and must depend entirely 
 on the honesty of the doctor and the assumption 
 that his records are correct beyond question ; then, 
 too, the bill may be for a large amount and reach 
 the patient at such a time as will make it a hard- 
 ship for him to meet it within a reasonable period. 
 With most people it is easier and more convenient 
 to meet small bills frequently than to pay large 
 ones at an unexpected or inconvenient time. When 
 accounts are allowed to run for six months or more, 
 the interest on the amount is either lost or must be 
 charged in the bill ; the first should not be expected 
 of the dentist and the latter is seldom expected by 
 the patient. 
 
 Dentists have been frequently heard to say that 
 they have been too busy to send out any bills for 
 some months ; and yet upon closer questioning they 
 generally admit that they need the money in order 
 to meet their expenses; and it quite often appears 
 that these same men lose from ten to forty per cent 
 of the amount of their gross business through ina- 
 bility to collect. It is very often the case that 
 these same men will continue to work year in and 
 year out for people who seldom or never pay their 
 bills and seem satisfied to delude themselves with, 
 
 80 
 
Credits and Collections, 
 
 and take pride In talking about, the size of their 
 practice. 
 
 Professional men are proverbially poor business 
 men, and in no way do they show it more than in 
 the lax way in which they handle their accounts. 
 
 8i 
 
CHAPTER XVIII. 
 
 GENERAL APPLICATION OF THE HOUR CHARGE. 
 
 It will very often be asked, " Do you charge for 
 examinations or treatments?" The answer is a 
 decided, yes. Why not ? A dentist certainly does 
 not gape into a person's mouth from any pleasure 
 that may be derived from so doing, but because it 
 is a matter of business. Patients do not ask a den- 
 tist to examine their mouths merely to satisfy his 
 supposed curiosity regarding their condition but to 
 satisfy their own and to get some advice. In order 
 that a dentist may be able to make such an exami- 
 nation and give competent advice about the condi- 
 tion found, it is necessary that he should have a 
 professional education, maintain an office and suit- 
 able equipment, and consume time which has a 
 definite value to him. This being the case, he 
 should ask and receive a fee for this service the 
 same as for any other. 
 
 As a general rule, an examination or consulta- 
 tion will occupy about a quarter of an hour, and a 
 regular fee for this service should be established 
 that will represent a fair proportion of the cus- 
 tomary hour charge. If, however, the service re- 
 
 82 
 
General Application of the Hour Charge. 
 
 quires more time than this, the fee should be in- 
 creased accordingly. 
 
 For all general operative work the charge is 
 made according to the amount of time involved. 
 
 In crown work the regular charge is made for 
 the operative time (preparing the root, fitting, set- 
 ting, etc.) plus a laboratory charge which should 
 cover the cost of materials, time, and a fair profit. 
 Bridgework is estimated in the same way — that is, 
 a definite price per tooth as the laboratory charge 
 plus the regular fee for operative time. 
 
 In case of dentures it may seem advisable to 
 have a definite fee for each of the various kinds, 
 but the rate should be as high as possible and be 
 governed largely by the time involved and the ar- 
 tistic ability displayed. 
 
 The extraction of teeth is a major surgical oper- 
 ation that may involve the health and even the life 
 of the patient, and it should always be considered 
 as such, and a suitable fee asked accordingly. No 
 self-respecting professional man should think of 
 performing a surgical operation for what is con- 
 sidered small change or the price of a hair cut; nor 
 should a surgical operation be performed without 
 oharge because a mechanical one is to follow it, as 
 is the case when teeth are extracted free if a den- 
 ture is to be made. If the services of a dental sur- 
 geon are not worthy of a higher rating than this 
 — why be one ? 
 
 83 
 
CHAPTER XIX. 
 
 INCREASING THE FEES. 
 
 The law of supply and demand, which has to 
 do with the regulation of so many things in the 
 business world, may also be utilized for regulating 
 professional fees as well. 
 
 In a previous chapter a method was described 
 whereby a dentist could determine the minimum 
 fee that he could safely afford to charge if some 
 degree of financial success was to be attained. In 
 the chapter on appointments it was suggested that 
 only a limited number of engagements be planned 
 for each day and the days filled as far in advance 
 as possible. 
 
 In applying this aforesaid law, the limited num- 
 ber of hours and a reasonable number of days rep- 
 resents the supply, and the number of appoint- 
 ments that can be made represents the demand. 
 When the number of patients desiring a certain 
 dentist's services becomes so great that his appoint- 
 ments are made weeks in advance and there are 
 still requests for time, then he is justified in raising 
 the amount of his fee per hour. 
 
 84 
 
Increasing the Fees. 
 
 This will tend to decrease the number of pa- 
 tients, but it will also increase the income of the 
 dentist with but the same expenditure of energy 
 on his part. When the demand for his services at 
 the increased rate again exceeds a reasonable limit 
 he is once more in a position to make an increase 
 in his fees. And so it may continue — the limit to 
 which fees may be advanced being only determined 
 by the demand for services. 
 
 In the meantime, there is an incentive for the 
 dentist to render the very best services in his power 
 so that he may attract an increasing number of bet- 
 ter class or wealthier patients. Such a procedure 
 means an everchanging set of patients; but no man 
 need feel compelled to continue to render his serv- 
 ices at five dollars an hour if he is able to obtain 
 ten; and if by this method he is enabled to continu- 
 ally improve the technique and value of his serv- 
 ices, thereby increasing his income, he should be 
 satisfied to lose patients and confine his attention to 
 those who can appreciate and afford them. 
 
 Some may ask, what is to become of the patients 
 that cannot afford to pay these increased fees? 
 They will naturally drift to the younger men 
 whose fees may still be low; and this will be the 
 means of giving some other man a chance to get 
 ahead. It will then work out the same as it does 
 in the commercial world — not everyone can afford 
 to patronize a Tiffany, but there are always shops 
 
 85 
 
The Business Problems of a Profession. 
 
 of all degrees to meet the wants of all purses; nor 
 are these shops really the competitors of a Tiffany, 
 but rather they serve as feeders, for it is but human 
 nature to desire better things as one's income in- 
 creases ; and this trait shows itself in all things. 
 
 The only competition that a professional man 
 need recognize is that which may exist between his 
 desires and his ability. 
 
 The man who tries to work for all the people 
 at any price may be satisfied with his success up to 
 a certain point, but as a rule he is one that is doing 
 but very little to advance the standards of his pro- 
 fession. 
 
 86 
 
CHAPTER XX. 
 
 NOTES. 
 
 A SPECIFIC treatise on any method or its appli- 
 cation is usually limited in its usefulness to the 
 immediate now and the immediate few, while the 
 exposition of a few general principles may be of 
 service for some time to come. Having this in 
 mind no attempt has been made to discuss all the 
 phases of any of the subjects presented, but rather 
 it has been the intention to suggest an idea that 
 might establish a train of thought in the mind of 
 the reader that would enable him to adapt the 
 methods to his own practice, and with the hope of 
 arousing a wider discussion of the general subject 
 so that all may benefit thereby. 
 
 Very little has been said about the technique of 
 operations, for it is taken for granted that every 
 man is striving to attain the highest standards as 
 an operator and to render the best services possible 
 to his patients. 
 
 It would be possible to add several more chap- 
 ters to this book on such subjects as general de- 
 portment, the winning of patients, etc., but these 
 
 87 
 
The Business Problems of a Profession. 
 
 subjects have been handled so admirably by Dr. 
 C. N. Johnson in his treatise " Success in Dental 
 Practice " that the writer prefers to refer his read- 
 ers to that book for the information. 
 
 88 
 
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