Retention Fees: A Modern Invention Creating Old Problems
If you’ve been in dentistry for any length of time, you’ll have likely encountered the phrase “retention fee” – and perhaps even found yourself in the middle of a disagreement about one. As someone who receives regular calls from both principals and associates about disputes over retention fees, I can say with confidence that this issue is widespread, persistent, and emotionally charged.
Scroll through any dental forum or social media group and you’ll quickly see the same theme: confusion, frustration, and resentment surrounding how, when, and why retention fees are used.
The Problem with Retention Fees
Let’s be clear: retention fees are a relatively new phenomenon in dentistry. They are not grounded in long-standing clinical or contractual norms. Their purpose is often framed as a safety net – a buffer in case treatment needs to be redone or if patients come back dissatisfied after an associate has moved on.
But here’s the paradox: by requesting a retention fee, are we not implying that failure is expected?
If the dentistry provided is of a high standard – biologically sound, aesthetically appropriate, and functionally balanced – why would we anticipate needing to redo it?
As clinicians, our goal is to provide dentistry that lasts. I have restorations in my mouth that were placed when I was 12 years old. I have a gold inlay that I placed in my mouth during my vocational training year – restorations in place for half a life-time. Great quality work stands the test of time.
When Retention Fees Reflect Deeper Concerns
Sometimes, retention fees arise because principals are worried about the predictability of short-term aesthetic cases – composite bonding or Invisalign, for example. They fear that a patient will return with movement, wear, or chipping, and they want financial coverage for that possibility.
But isn’t the better approach to understand occlusion, biology, and biomechanics more deeply? Shouldn’t we, as a profession, be placing restorations in harmony with the dynamic function of the TMJ and the musculature – in positions that are maintained and protected by the patient’s natural function?
If the composites are breaking, is that a material failure – or a failure to consider function? If the teeth are moving, is that a relapse – or a sign that the retention plan and patient understanding were inadequate?
If you don’t understand occlusion don’t mess with it.
Retention Fees Damage Relationships
One thing is certain: retention fees cause strife. They often aren’t discussed clearly, agreed upon properly, or managed professionally. As a result, one or both parties walk away feeling short-changed or mistrustful. In a profession where collaboration, integrity, and trust are vital, that’s a high price to pay.
Worse still, disputes over retention fees can undermine what might otherwise have been a healthy, productive working relationship. They leave a bad taste – and they can damage reputations.
A Better Way Forward: Raise Standards, Not Barriers
Instead of relying on retention fees, let’s work as a profession to make them obsolete.
Let’s raise the bar on:
- Quality: Do dentistry that truly lasts – not because you’re trying to avoid complaints, but because it’s the right thing to do.
- Communication: Set realistic expectations with patients from the start. Equip your team with the skills to explain outcomes, risks, and responsibilities clearly.
- Contracts and Clarity: If there must be agreements about follow-up care, make sure they are transparent, agreed by all, and rooted in fairness – not fear.
Ultimately, retention fees are a sticking plaster over a deeper wound – one that speaks to fear, mistrust, and misalignment. Let’s choose instead to lead with confidence, clarity, and quality.
It’s time to raise our standards – not collect retention fees.
