Fee-for-Service Without Fear with Dr. David Eshom

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In Part 2 of this powerful series, Dr. Melissa Seibert continues her in-depth conversation with cosmetic dentist and AACD leader Dr. David Eshom, exploring the deeper psychological, business, and interpersonal frameworks that underpin a thriving fee-for-service practice. Together, they unpack the realities of transitioning away from insurance dependence, the emotional traps dentists fall into, and the communication strategies that safeguard both the patient relationship and the dentist’s peace of mind.

Dr. Eshom offers decades of wisdom on how to recognize patient readiness, how to present comprehensive treatment without triggering defensiveness, and how to gracefully identify patients who may not be ideal candidates for complex care. He shares the subtle behavioral cues that differentiate collaborative patients from those who may become litigious, overly exacting, or misaligned with your practice philosophy—and how to exit these relationships ethically and respectfully when needed.

The episode also tackles some of the profession’s most pressing realities:

• Why the insurance model forces dentists into ethical and financial corners

• How to communicate a fee-for-service structure without alienating patients

• The psychology behind presenting conditions and consequences—not pressure and sales

• Why slowing down for deeper exams ultimately accelerates practice growth

• How to block your schedule, restructure hygiene exams, and build time for meaningful conversations

• The importance of discernment: knowing when a patient is truly a “yes,” when they’re a “not now,” and when they’re a “no”

Dr. Eshom also walks through his workflow for large aesthetic cases—from shade decisions to motivational mock-ups and trial smiles—while highlighting how these tools improve clarity, set expectations, and reduce risk for both patient and provider.

The conversation concludes with a reflective discussion about building a freedom-based business, attracting aligned patients, and creating a practice model that delivers exceptional dentistry without compromising your wellbeing, your values, or your clinical standards.

If you’ve ever wondered how to elevate your practice beyond the constraints of insurance, identify ideal patients, or cultivate a career defined by autonomy and fulfillment, this episode is a masterclass in sustainable, relationship-driven dentistry.