My dental hygienist (a co-worker’s spouse) makes about $200,000 annually, in large part, due to her ability to up-sell products and procedures. Based upon her salary, I’m unsure if there are serious ethical considerations based upon the sales volume required and profit margins.
IMO too many dentist offices have rude, indifferent front desk and administrative people that regardless as to the doctor’s abilities, the support people will ruin the business.
Every business could be different situations. I owned and operated a business for 14 years and never accepted a credit card or debit card. If someone didn’t have cash then there was an ATM on the premises. It made my accounting much simpler.
I could see a business such as a doctors office which makes most of it’s revenue through insurance billing and the small co-pay amounts.
My auto mechanic is cash only as his “credit card machine is broke” for over a year now, but that’s cool with me as he does great work at a reasonable rate.