Dr. Frank Vascimini, Sound Bites, 10/30/12

With the number of corporately owned dental practices on the rise, I thought I would talk a little bit about this trend and share some interesting information with you I have read about in one of my dental journals.

In an article titled, “The Business of Oral Health Care — A Look Into The Corporatization of American Dentistry” in The AGD Impact magazine for the general dentist, the author explores the trend of dentistry toward the world of corporately driven professional services.

According to the article, in 2006, 76 percent of dentists were solo practitioners; that number had fallen to 69 percent by 2010. During the past 10 years, at least 25 dental management service companies have emerged. These companies are bankrolled by private equity firms, some of which contract with dentists, others which hire their own, where local laws permit. These companies are known as dental management organizations  — DMOs — or dental service organizations — DSOs.

According to North Carolina Academy of General Dentistry president, Jerry Caudill, DMD, the corporate view is that dentistry is ripe for takeover. Dr. Caudill calls this corporate trend the “big boxification” of dentistry and observes that these dental corporations move into an area, bombard the consumers with advertising, and reduce their prices on services, driving out the local private practices — and then they raise their fees.

They open multiple offices and hire specialists who rotate among all of the locations and basically eliminate referrals to any outside sources. The dentists in these groups may not have the option of referring to a specialist they think would best serve their patient if that specialist is outside of the group.

The article goes on to say some corporations may put their doctors on production quotas. In doing this, the corporation may be putting pressure on the dentist to produce, thus they may be more apt to prescribe the most expensive options to their patients when it comes to treatment planning.

There may also be the push to up-sell — an example of this is the situation in which the dentist prescribes a filling, but the hygienist or treatment plan coordinator may try to convince the patient to accept a crown instead, so all the employees can get a bonus.

Dr. Caudill goes on to explain these dental management organizations may also have quotas on supplies, as well. If the practice has had a slow month, then the corporation may refuse to send needed supplies the following month when the practice may be busier. In many cases, the practice cannot order again until the next month, which can lead to changes in treatment or delays in treatment — or even worse, compromised or subpar treatment.

Dr. Caudill even cited a situation where the dentist was tempted to use the wrong color composite because that was all he had.
Dr. Caudill also stated he has encountered corner-cutting techniques and postponement of treatment for capitation patients. He states the corporation dentists are often told they could only use labs approved by the corporation, and these labs are usually the lowest bidders and not always of the highest quality. Even if the labs are found to be sub par, the dentists are not allowed to change labs in many cases.

The article continues to say that, while the DSOs may be able to offer lower cost treatment to patients, but they come up short when it comes to other benefits, such as easy-to-understand treatment plans, human connection, trust, stable low-turnover employees and a solid relationship between the patient and the doctor.

According to Academy of General Dentistry Vice President W. Carter Brown, the doctor should be able to inform the patient of his or her needs and present a solution for those needs. After the patient expresses his or her wishes, they should be able to discuss the best way to proceed with the treatment in the patient’s best interest. The patient should be able to trust in the dentist.

Unfortunately, for some corporations, the most important thing is to make a profit.

While some corporations do it right, others will cut everything in order to squeeze out more profit because there are so many layers of people they need to feed — not just employees, but stockholders, as well.

According to the legislative chair of the North Carolina Dental Society, Gary D. Oyster, DDS, “these profit-seeking corporations are not directly required by licensing laws or patient-care interest to meet a dentist’s ethical responsibilities.”

Dr. Brown adds that there is a public health iron triangle that says you cannot have quality care from a committed, caring professional at a fraction of the cost. You cannot minimize cost without negatively affecting care.

The article concludes by saying it is a challenge for the private practitioner to try to compete with these corporations, mainly because they are rich and powerful. It looks like the trend toward corporate dentistry will continue. But it is important to remember that the patient should be the No. 1 priority, and patients have the right to receive the best quality care from a dentist who puts the patient’s needs first, rather than the corporation.

I hope you found this information as interesting as I did.

Dr. Frank Vascimini is a dentist practicing in Homosassa. Send your questions to 4805 S. Suncoast Blvd., Homosassa, FL 34446 or email them to him at info@MasterpieceDentalStudio.com.