In this seminar transcript, Rick Kushner outlines a controversial philosophy for running a dental practice. He argues that >99% of dental services are elective, meaning patients can choose whether to receive them, and therefore dentists should base treatment decisions on a patient’s willingness to pay rather than an assumed ability to pay. He defines non‑elective services narrowly as (1) temporary relief of acute pain or infection, (2) temporary relief of a cosmetic embarrassment (e.g., a fallen crown), and (3) treatment of an accident, noting these account for less than 1% of practice revenue. Diagnostics are also treated as elective, with no upfront cost discussion. Kushner stresses the importance of securing financial commitments for elective care, maintaining a friendly yet business‑focused patient relationship, and prioritizing the financial security of the dentist’s family over professional or ethical pressures to provide unpaid care. He critiques the dental profession’s “high‑road” attitude, likening it to physicians who make life‑or‑death decisions, and promotes a pragmatic, cost‑efficient approach that treats dentistry as a means to personal freedom and profit rather than an end in itself. He also challenges common industry advice—such as limiting services and raising fees or focusing solely on quality—advocating instead for expanding service offerings, avoiding elite‑only market targeting, and adopting a “Lena Mean” philosophy of relentless practicality and efficiency.
Topics
Elective vs. Non‑Elective Dental Services: A Strict Definition
Kushner delineates elective services (the vast majority) from three narrowly defined non‑elective categories: acute pain/infection relief, temporary cosmetic emergency relief, and accident treatment.
Willingness to Pay vs. Ability to Pay: Financial Philosophy
He distinguishes ‘willingness to pay’ (the patient’s choice) from ‘ability to pay’ (theoretical access via insurance or programs), arguing dentists should base treatment on the former.
Financial Commitment and Collection Policy for Elective Care
Kushner emphasizes discussing costs upfront, securing patient commitment, and adhering strictly to that commitment, while treating non‑elective cases without price discussion.
Patient Relationship Model: Friend‑to‑Friend vs. Authoritative Doctor
He advocates a friendly, relationship‑focused approach with patients while maintaining firm business boundaries regarding elective services.
Critique of Conventional Dental Advice and Elite‑Only Strategies
He challenges common industry counsel—limiting services, raising fees, focusing solely on quality, and targeting elite markets—arguing these are misguided for the majority of practitioners.
Lena Mean Philosophy: Relentless Practicality and Cost Efficiency
Kushner introduces the ‘Lena Mean’ concept, urging dentists to continuously seek the most practical, sensible, and cost‑efficient ways to deliver quality care.
Strategic Expansion of Services Over High‑Fee Niche
He advises expanding the range of services offered rather than restricting to high‑fee, low‑volume models, positioning this as essential for long‑term prosperity.