Charging by time

There are some dentists who like to charge patients by the time taken.I always knew that this was the case but had not met the phenomenon prior to working in a practice recently.The owner of the practice, according to his own staff, worked very slowly and "uses up every minute of the appointment".For a routine check up he allowed 45 minutes and was told by his nurse that he would spend the whole time picking and prodding and chatting.That made me think: "Are we, as dentists, paid for time or paid for what we achieve?"In my opinion it has to be both. Please let me explain.Charging solely by time is wrong.It removes any incentive to get better or faster at what you do. When I worked in this practice my fee per item was heavily discounted because I finished in half the time.Even though the results of my treatment were excellent and the patients were happy I was being paid less because I work efficiently. Had I worked slower I would have earned more.Imagine the carnage that would occur in the economy generally if everyone was paid more the slower they worked!I was being de-incentivised, demotivated and dragged back to average.On the other hand I think that charging solely by item is wrong.Every dentist knows that some 1-surface fillings can be done very fast but some take ages. Also, some patients are easy to work on but some slow you down to an incredible degree. You know the ones - they have to rinse every 30 seconds, or they have restricted opening, or they won't let you lean the chair back and so on.So, my suggestion is to use a hybrid system.Have a base rate for items and do not go below it. And, feel free to adjust the fee upward should the situation or the patient be particularly difficult.