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Sun Feb 10, 2013, 01:14 PM

Sunday Dental Thread: Treating the Wealthy Edition

For purposes of this thread, I will stipulate that the term "wealthy" applies to those worth, in my estimation, over three million dollars. In fact, compared with many of my clientele, these individuals would be considered middle-class a la McCainesque classification, but we know better.

Now of course, this applies only to dentistry, since I don't practice medicine, but it may be a bellwether of behaviors practiced elsewhere. I have discerned these tends over 35 years of practice and I want to state for the record that they are generalities only and not applicable to many, and all of these generalities in toto apply to almost no one individually, although there are about three people who fit the profile entirely.

1. There is an implicit statement at the outset of the therapeutic relationship that the practitioner needs to understand that it an "honor" to be selected to treat the individual. Chosen out of hundreds of others, the doctor is the Chosen One. The upside is that it is seemingly flattering. The downsides are legion: that one can be fired at any moment, that every movement is watched, that every syllable is analyzed, and that every appointment is critical to success, to efficiency, and to professionalism.

2. There is an implicit statement that if the case works out well (read: perfectly) other extremely wealthy and influential people will be referred. The upside is that it's flattering and theoretically munificent (more on that later)', the downsides involve more pitfalls than a trip to the Inferno. What that means is that every nut case, psychiatric, obsessive, and quite possibly insane character within the rich person's purview will be referred and the worst part is: they will come. They will come because they are afraid of the rich person casting aspersions upon them if they don't come, to wit, "I told her to see you but she's still seeing that other dentist who is ruining her mouth. Plus which, he's really expensive." Which brings us to...

3. These people attempt to not pay and it is a magnificently honed skill set. Since they have millions, there exists an assumption that they'll pay the going rate in a timely fashion. Wrong on both counts. They pay pittances during the treatment and imply that they'll await the result before paying the complete bill. Yes yes, I know, the practitioner needs to be firm. These people or their spouses negotiate billion dollar deals and know exactly how to push all the right buttons at the right time. In addition, they all have dental insurance which requires the explanation that there is an annual maximum almost universally (BTW, Philadelphia schoolteachers have no annual maximum, the only indemnified group in the city where that is the case to my knowledge) and they don't generally buy the concept of a maximum. Of course it is bad enough that we have to lower our fees to the allowable charges, but those are the rules, and Lord knows, we follow the rules, especially for the wealthy, since they know every rule which is to their advantage and conveniently forget those which are not. They are particularly adept at the escape via the bathroom routine. When completed, they walk to the front desk and immediately ask for the bathroom key, they return it quietly, say that they'll call for the next appointment and walk out the door, usually when the staff member is occupied with someone else. It is clever technique because you can't stop someone who needs to run to a rest room, and you can't insist upon giving an appointment to someone who preempts you by stating that they cannot make the appointment without his or her secretary or aide de camp. And these folk move fast, I mean like The Flash fast. I called one guy Barry Allen and he actually got it and changed his behavior...miraculously, since he's famous for ducking bills all over town.

4. Wealthy people referred by other wealthy people are often troublesome. One has to figure that by the age of 65, living in the same place for decades, an individual would have finally found someone who fits their profile and their needs. There are many reasons why that wouldn't be the case, such as dentist retiring or getting weird with the patient, which happens a lot. The are many stories which would be great for another thread or my book in progress, but you can only imagine. Psychodramas are de riguer and the complexities of their lives are beyond comprehension unless one has a net worth of eight figures. The worries involving their eighty-seven foot boats and crews are incomprehensible to me, and the amazing aspect of all this is that they speak of this in the same breath as their complaints regarding the cost of groceries when their children visit the Homestead, or as I like to call it, Versailles. I actually say these things and they laugh, because we have come to an understanding that they can say what they want, but they aren't fooling me. They are rich beyond comprehension and that is that. One guy whose name is plastered on buildings all over Philadelphia told me that he was on a "fixed income". I asked him if his previous dentist had known this, and he said that she had. I asked him if he'd ever seen The Godfather Part II, and since he had, I reminded him of the Meyer Lansky character who said that he was a retired pensioner with a fixed income, even though he had made millions at the pinnacle of his organized crime empire. We were off to a good start. I didn't do the case, the guy who did got stiffed big time, as your former VP would say. I know this because I had to send the radiographs to his office and ran into him in the elevator a few months later. His buddy who had sent him to me told me later that the guy was well-known for stiffing practitioners and I asked him quite frankly why he would foist this guy on me. He just laughed that dismissive laugh they have an waved me away, so to speak.

5. Lastly, rich people are powerful and dangerous when maddened. Yeah, you can crow all you want about your lawyers, the judicial system, and your influence, but all these guys have to do is make one phone call and your life may never be the same. Professional Review Boards, newspapers, local politicos, national politicos, all are beholden to the power of certain individuals and sometimes you deal with these people. You had best better ensure that they have no axe to grind, or believe me, your life can be a living hell. I won't be too specific, but a dentist in town here thought he could milk this one case for a lot of money over about nine years. The lady, a wife of a very influential and extremely wealthy man, came to me and I completed the case in six weeks. This other dentist was verbally attacked unmercifully by both she and her husband for years since they lived in the same building in Rittenhouse Square, and what they would do, is if there we a social occasion, invariably the topic would turn to where the other person was getting their full mouth reconstruction completed, and they would both go off on how this other dentist was a bastard, and worse. It was embarrassing because they would use my name and the dentist thought that I had something to do with it. He actually stuck his fat finger in my chest. I offered to break it if he didn't take it off my chest. Things actually escalated from there. He's dead now, in case you're interested, from a massive stroke, not from anything weird or unholy.

So when I read here about how the rich just walk into hospitals and don't have a concern about the bill or the administration of medical care, think again. They are involved to the umpteenth level and do not miss a trick. The fact that they can afford health insurance and deductibles and private care and experimental drugs and techniques places them at a level where we cannot even begin to fathom the potential. But in fact, they have their ways around much of what you and I expect that they would "have" to do as "paying patients". As my father of blessed memory used to say, "they have more tricks that you have hair on your head."

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Arrow 21 replies Author Time Post
Reply Sunday Dental Thread: Treating the Wealthy Edition (Original post)
PCIntern Feb 2013 OP
hedgehog Feb 2013 #1
PCIntern Feb 2013 #2
Duer 157099 Feb 2013 #3
libtodeath Feb 2013 #4
PCIntern Feb 2013 #5
Nye Bevan Feb 2013 #6
Wednesdays Feb 2013 #8
Nye Bevan Feb 2013 #9
PCIntern Feb 2013 #10
PCIntern Feb 2013 #13
Nye Bevan Feb 2013 #14
annabanana Feb 2013 #16
Nye Bevan Feb 2013 #18
mainer Feb 2013 #19
mainer Feb 2013 #17
Wednesdays Feb 2013 #7
PCIntern Feb 2013 #11
gtar100 Feb 2013 #12
mainer Feb 2013 #15
PCIntern Feb 2013 #20
malaise Feb 2013 #21

Response to PCIntern (Original post)

Sun Feb 10, 2013, 01:17 PM

1. " They are rich beyond comprehension and that is that"

I think many (most?) of the well off have no idea that they are well off.

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Response to hedgehog (Reply #1)

Sun Feb 10, 2013, 01:19 PM

2. Wrong, maestro...

They know...believe me. They just pretend they're regular folk. They know...how do you think they got so rich? As the old ad used to say...

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Response to PCIntern (Original post)

Sun Feb 10, 2013, 01:20 PM

3. Thank you. You confirm exactly what I suspected.

Also, it's nice to get your perspective on this.

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Response to PCIntern (Original post)

Sun Feb 10, 2013, 01:25 PM

4. No matter the howling the rw does about the poor the only entitled feeling I have met are the rich.

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Response to libtodeath (Reply #4)

Sun Feb 10, 2013, 01:31 PM

5. Right u are!

It's that RW projection theme they're so good at executing...

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Response to PCIntern (Original post)

Sun Feb 10, 2013, 02:10 PM

6. How would a dentist have any idea what the net worth of a patient is?

My dentist never asked to see my bank or brokerage account statements.

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Response to Nye Bevan (Reply #6)

Sun Feb 10, 2013, 02:15 PM

8. I'll bet the rich patients

make it obvious, if not come right out and say it. I've seen it. It's a power thing..."what good is having all that money if you can't lord it over everybody else?"

In the OP, PC told us some of the clues his patients said to him. Middle-class people down own huge yachts with crews on them, and ordinary people don't have their "names plastered all over Philadelphia."

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Response to Wednesdays (Reply #8)

Sun Feb 10, 2013, 02:27 PM

9. So it is more a complaint about "ostentatious" people as opposed to "rich" people.

I know millionaires who drive Hondas and Toyotas, don't own yachts and don't flaunt their wealth. And I'm pretty sure that they quietly pay their dental bills on time, in full.

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Response to Nye Bevan (Reply #9)

Sun Feb 10, 2013, 02:32 PM

10. Believe me,

I know who they are...

Do not make the mistake of assuming that after 35 years of practicing in the same location and being invested in the various communities, business, professional, charitable, and religious, that I don't know what is going on.

Just because I'm a dentist does not mean that I'm ignorant, a moron, or unaware.

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Response to Nye Bevan (Reply #9)

Sun Feb 10, 2013, 02:38 PM

13. If you read my intro, what I said was

That I was generalizing and ...well, maybe you should read it again....my point was made clearly IMO that the extreme wealth which is proffered in DU as "they get the healthcare they want" is more complex than a simple statement of so-called fact. There are many sides to this...

And lemme tell you, people worth 8 and 9 figures generally do not drive Toyotas...sorry to burst your bubble. I live near Gladwyne,PA , and the only Toyotas, besides my Camry, are those pulling up to service the DryCleaning or messengers.

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Response to PCIntern (Reply #13)

Sun Feb 10, 2013, 03:08 PM

14. Toyota is the number one make of car purchased by millionaires.

The Toyota Millionaire

Toyota is popular among millionaires. Indeed, Toyota was the number-one make selected among millionaires surveyed (market share of 10.9 percent). You may ask yourself: why Toyota? According to marketing consultant, Gorden Wangers, Toyota is “…the ultimate vanilla automobile…it has a silly name. The styling is invisible. It does not give you bragging rights at the valet, to put it mildly.”

.....


All this points to a simple fact, if you breakdown the most recently acquired cars by millionaires, you will find that most of them are not luxury vehicles (those with a sticker price of $42,000 or more). Most luxury car purchasers are aspirational, people lacking a high net worth but want to perceived as wealthy and enjoy the “nice things.” Personally, unless I know that a person is wealthy, I instinctively think the opposite. When I see someone driving luxury cars, I typically feel bad for them because all I see are payments (not status). I instantly believe them to be the Phony Rich leasing these vehicles (94% of millionaires do not lease) hoping that someone is impressed.


http://www.roshawnwatson.com/toyota-millionaires-vs-mercedes/

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Response to Nye Bevan (Reply #14)

Sun Feb 10, 2013, 03:19 PM

16. you sound a tad defensive. .

So what're ya doin' Friday Night?

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Response to annabanana (Reply #16)

Sun Feb 10, 2013, 03:23 PM

18. LOL

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Response to annabanana (Reply #16)

Sun Feb 10, 2013, 03:23 PM

19. It's not at all surprising that they drive Toyotas

Most millionaires are pretty thrifty -- and that's how they got that way.

"Millionaire Next Door" details how commonly they spend beneath their means:

PORTRAIT Of A MILLIONAIRE

Who is the prototypical American millionaire? What would he tell you about himself?(*)

* I am a fifty-seven-year-old male, married with three children. About 70 percent of us earn 80 percent or more of our household's income.

* About one in five of us is retired. About two-thirds of us who are working are self-employed. Interestingly, self-employed people make up less than 20 percent of the workers in America but account for two-thirds of the millionaires. Also, three out of four of us who are self-employed consider ourselves to be entrepreneurs. Most of the others are self-employed professionals, such as doctors and accountants.

* Many of the types of businesses we are in could be classified as dullnormal. We are welding contractors, auctioneers, rice farmers, owners of mobile-home parks, pest controllers, coin and stamp dealers, and paving contractors.

* About half of our wives do not work outside the home. The number-one occupation for those wives who do work is teacher.

* Our household's total annual realized (taxable) income is $131,000 (median, or 50th percentile), while our average income is $247,000. Note that those of us who have incomes in the $500,000 to $999,999 category (8 percent) and the $1 million or more category (5 percent) skew the average upward.

* We have an average household net worth of $3.7 million. Of course, some of our cohorts have accumulated much more. Nearly 6 percent have a net worth of over $10 million. Again, these people skew our average upward. The typical (median, or 50th percentile) millionaire household has a net worth of $1.6 million.

* On average, our total annual realized income is less than 7 percent of our wealth. In other words, we live on less than 7 percent of our wealth.

* Most of us (97 percent) are homeowners. We live in homes currently valued at an average of $320,000. About half of us have occupied the same home for more than twenty years. Thus, we have enjoyed significant increases in the value of our homes.

* Most of us have never felt at a disadvantage because we did not receive any inheritance. About 80 percent of us are first-generation affluent.

* We live well below our means. We wear inexpensive suits and drive American-made cars. Only a minority of us drive the current-model-year automobile. Only a minority ever lease our motor vehicles.

* Most of our wives are planners and meticulous budgeters. In fact, only 18 percent of us disagreed with the statement "Charity begins at home." Most of us will tell you that our wives are a lot more conservative with money than we are.

* We have a "go-to-hell fund." In other words, we have accumulated enough wealth to live without working for ten or more years. Thus, those of us with a net worth of $1.6 million could live comfortably for more than twelve years. Actually, we could live longer than that, since we save at least 15 percent of our earned income.

* We have more than six and one-half times the level of wealth of our nonmillionaire neighbors, but, in our neighborhood, these nonmillionaires outnumber us better than three to one. Could it be that they have chosen to trade wealth for acquiring high-status material possessions?

* As a group, we are fairly well educated. Only about one in five are not college graduates. Many of us hold advanced degrees. Eighteen percent have master's degrees, 8 percent law degrees, 6 percent medical degrees, and 6 percent Ph.D.s.

http://www.nytimes.com/books/first/s/stanley-millionaire.html

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Response to Nye Bevan (Reply #14)

Sun Feb 10, 2013, 03:21 PM

17. I know quite a few millionaires

and most seem to drive a Prius. So I think this is correct.

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Response to PCIntern (Original post)

Sun Feb 10, 2013, 02:12 PM

7. K&R

Sometimes it works in reverse, too...upper-crust professional people who act like you're being handed a gift from Heaven they're stooping down to accept you as their client.

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Response to Wednesdays (Reply #7)

Sun Feb 10, 2013, 02:33 PM

11. I wasn't discussing that today...

I have, however, discussed that in previous threads.

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Response to PCIntern (Original post)

Sun Feb 10, 2013, 02:33 PM

12. I've gotten the impression that the most expedient way to become rich is to always act in your own

selfish interest. It doesn't surprise me that rich people act so miserly and childishly selfish despite their means. It was precisely that behavior that helped them accumulate their wealth in the first place.

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Response to PCIntern (Original post)

Sun Feb 10, 2013, 03:14 PM

15. Most lawsuits against professionals I know have been by lower income patients

not upper income patients. So no, I don't think rich people are out to ruin dentists or doctors.

And maybe hospitals/doctors/dentists cater to rich people because they pay in full and in cash?

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Response to mainer (Reply #15)

Sun Feb 10, 2013, 03:35 PM

20. Wherein my post did I mention lawsuits...?

I'm not talking about actionable cases, I'm talking about what they consider mistreatment. Or bad result. Big diff.

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Response to PCIntern (Original post)

Sun Feb 10, 2013, 03:35 PM

21. Great post

I was in a high end store with a sibling and this rich elderly white woman walked right up to me, touched my blouse and said it was precisely what she was looking for. I gave her a 'how dare you' and suggested that she fly to Jamaica to find it.
To be fair, she came back and apologized.

Just the bag, shoes, jewelry and attitude told me all I needed to know.

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