Indemnity Fees Are Rising – But Are We Looking in the Right Place for the Cause?
In recent weeks, I’ve seen countless posts from colleagues bemoaning the rising cost of indemnity. I don’t deny that this is frustrating. At a time when patients are under financial strain and practices are feeling the squeeze, yet another fee increase feels like a kick in the teeth.
But these posts also trouble me. Too often the blame is laid squarely at the door of indemnity providers, with implied accusations of greed. Before we point the finger, perhaps we need to pause, look in the mirror, and consider the part we as a profession have played in driving up the risk — and with it, the cost.
A Changing Profession
When I qualified 35 years ago, dentistry looked very different. Implants were the preserve of a handful of clinicians in a county, trained overseas at great personal expense. Now, almost every practice offers them. That growth is not a problem in itself — but what of the quality, mentoring, and rigour of training that underpins it?
I know of one practice that proudly advertises “the cheapest implants in Europe.” To patients, that might sound appealing. As a professional, I wonder: what compromises are being made in order to deliver dentistry at rock-bottom prices? When it goes wrong what happens to your indemnity fees?
The early 1990s also saw Boots disrupt the industry with whitening at £199, sparking the commercialisation of cosmetic dentistry. Since then, the growth of corporates, shorter appointments, tighter targets, and a relentless focus on financial outcomes have become normalised. But in this race for efficiency, something vital has been lost: the time to build trust, understand expectations, and communicate clearly.
Complaints Are Often About Feelings, Not Fillings
In my work as a coach and trainer, I am called in as often by patients as by practices to mediate disputes. The vast majority of patients do not want to sue. They don’t even want compensation. They simply want to be heard.
Patients forget what we say, forget what we do, and they always remember how we made them feel. Almost without exception complaints arise not from poor clinical outcomes but from unmet expectations and broken communication. The unhappy feelings are wrapped in the language of clinical dissatisfaction.
Take the case of a recent client. Their associate was hit with a complaint after delivering treatment. Only after the complaint was lodged did the practice discover the patient had a “photograph which was shaping their expectations. Had the clinician taken time to ask the right questions, the photograph would have been shared before treatment was started and a conversation would have been had that the expectations could not be achieved with Invisalign. With a little less haste, he issue — and the accompanying stress, anxiety, and risk to indemnity fees — could have been avoided.
Another common situation is instead of inviting the patient to come in for a conversation, to be listened to and fully understood, many practices default to “put it in writing.” What begins as a plea for dialogue and understanding becomes a formal complaint — unnecessarily escalating the problem.
From Collegiality to Competition
Three decades ago, if a case went wrong, colleagues did everything they could to resolve matters informally. We picked up the phone. We had conversations. We minimised blame and sought solutions.
Today, in a hyper-competitive environment driven by marketing, targets, and social media, I see the opposite. Some clinicians actively encourage patients to sue competitors. When colleagues are willing to throw one another under the bus, we all suffer. Apparently, dentist on dentist are bult of referrals to the GDC.
Cheap Dentistry Comes at a High Cost
In the pursuit of being “cheapest,” too many practices strip out the very things that protect patients and clinicians alike.
- Time to train ourselves and our teams.
- Time to plan, explain, and set realistic expectations.
- Time to place treatment in the context of the patient’s whole mouth, health, and lifestyle.
Instead, I see rushed restorations placed in mouths with active disease. Implants placed where a well-executed RCT might have been the better option. I presume this is because clinicians are motivated by the cash going in their pocket and not another clinicians. Work undertaken with no attention to occlusion, no long-term planning, and no space for dialogue.
Are we surprised when these treatments fail, and patients are unhappy? If you were the patient, wouldn’t you expect the work to be put right at no additional expense?
Time to Face the Mirror
Before we criticise indemnity providers for raising fees, perhaps we should acknowledge the uncomfortable truth: we are part of the problem.
- By prioritising sales over listening.
- By cutting appointment times at the expense of relationships.
- By chasing conversions and cheap prices over quality and detail.
- By neglecting to build robust, trust-based communication with patients.
When money becomes more important than the human connection, we are doomed.
Bad dentistry is bad dentistry — even if everyone is doing it. Good dentistry is good dentistry — even if you are the only one providing it.
The Way Forward
If we want indemnity costs to stop spiralling, the solution isn’t outrage at our providers. It’s a recommitment to what makes dentistry a healing profession:
- Clear, compassionate communication.
- Investing in training and mentoring.
- Creating space for trust and understanding.
- Building a culture where quality is valued above speed or price.
The mirror may show us truths we’d rather not see. But only by confronting them can we change the story — for ourselves, our patients, and the future of our profession.
A problem can only be present in the absence of a truth full conversation (spelling error intentional)
I would love your feedback, comments and Insights. Please share publicly or privately If you prefer.
