I got another one of these solicitations for joining a PPO in the mail today.

They only want to cut my fees by about 35-40%. Now, considering that I run at about a 65% overhead, that would just about insure that I couldn't continue to practice my profession.

I'm fortunate. Most of the people in my field in my area are NOT on any PPO's, so I don't have to worry too much about not joining up. My patients won't be flocking to the guy next door, because generally he's not a participating provider either. So I can just garbage can this solicitation without too many fears of lost patients.

But just as a thought experiment, I started trying to work through the numbers. Seriously, if I accepted the fees this network provided, I'd have to take some sort of action to lower my overhead or increase my productivity. I can think of a couple ways to do this. One would be using the cheapest instead of the more expensive (read: higher quality) laboratories. I would have to work faster, do more per appointment, and insist on my hygienist working faster as well. I would probably have to freeze wages and lay off at least one (needed) employee. I'd have to take a serious pay cut.

Or I'd have to change my entire practice model. I would have to move away from providing individual care and from building relationships with patients. I'd have to bring in so-called "cheap" labor (read: recent grads, if I can find any to work). I'd have to run multiple appointments out of the facility. I know you can make a decent living on this model; I've seen a couple people I know do it. But when my patients change to their offices (because the insurance shunts them that way) they return as fast as they can, it seems. So it wouldn't appear that it's a tremendous system from the patients' point of view either.

Anyway, I'll count my lucky stars that I can simply throw this thing in the garbage, after laughing at their fees, and continue to stay about as busy as I want to be, and continue to have long term employees who make decent money and stay because they like it here and don't necessarily need to jump to the other, greener-grass side of the fence. And I can treat patients exactly as I would want to be treated myself (or at least offer that level of treatment/service), and that is what makes it worth my while to stay in this profession.