Doctor Eclectic

Doctor Eclectic
Doctor Eclectic

Wednesday, October 26, 2011

Corporate Dentistry

I just returned from the annual American Dental Association where I had the privilege of being an Alternate Delegate to the House of Delegates, the ruling body of the ADA.  For the last several years the ADA has been hosting an intense discussion group on a topic of the future.  This is attended on a volunteer basis by as many of the 450 delegates and alternates as the room can hold; this year about 250.

The topic was “What will be the dentist of 2034?

Part of the relevance for the subject stems from the fact that the ADA is losing membership; due to age, the economy, and failure to attract the new dentist.  The latter deserves some thought.  The biggest problem is school debt.  In California a recent graduate would begin paying on from $200,000 to $500,000 unless he or she was able somehow to have found a parental way to pay as you go.  The interest on those loans has escalated dramatically in recent years and can now approach 8%.  Do the math and you can see it is a career decider.

So, the new dentist no longer can afford to set up a solo practice and, while independence is one of the great motivators to enter dentistry, most have to work for someone else on some sort of salary, often tied to production.

This concerns the ADA and they have labeled this career choice as becoming a “Corporate Dentist”.  The general opinion is that this dentist has less concern for the ethics of good dentistry, less concern for the needs of the patients, and fails to establish the doctor-patient relationship so important in patient satisfaction for the subjective services of dentistry.

My personal experience is different.  Of course I was a corporate dentist for my entire career: first, as a Navy dentist for 25 years, and subsequently as Dental Director for at least five Health Plans.  In both arenas I witnessed dedicated young dentists who, if anything, were free to practice good dentistry without concerns for who was going to pay for it.

On the other side, especially on the insurance side, I saw patients making bad choices of service and failure to accept responsibility for their own care: quick to blame the dentist for failure of treatment not appropriate to their needs.

One of the speakers in the preliminary presentation to the discussion was Jack Dillenberg, Dean of the Arizona School of Dentistry and Oral Health.  Jack is an evangelist to Public Health and has dramatically incorporated the curriculum of his school to include service to the community, previously underserved.  Of the last class graduated, sixty percent went into Federally Qualified Community Health Centers, a topic I covered in an article titled "Will Change in Dentitry Come from Within?"

Which leads me to a proposal I made to the California Dental Association in a presentation I gave more than ten years ago: Find a way to set a career path for dental graduates that mimics their non-dental peers.  Perhaps a three year obligation in community health or research with an accompanying major forgiveness of their debt, then a three to four year stint in underserved areas with a salary supported by Third-party Payers who have need for dentists in those areas, finally, assistance in setting up a solo or group practice in an area of their choice, supported by loans from the dental materials industry.

They would have had six or seven years of doing needed dentistry without concern for revenue and they might have established the ADA hoped-for ethics by the time they enter general practice.

This solution would work equally as well for specialists, since they are also needed in the areas I mention.

Alternatively, the country might embrace what I observed when we visited Ireland about five years ago: secondary school was free, paid for by the government as long as skill and merit goals were met.  They did this for immigrants as well as naturalized citizens and within 15 years they had a labor force that met the technological needs of the country.  Immigrants to the United States began to return and, if the new middle class had not fallen into the housing trap of the rest of the world, they would probably continue to prosper in the European Community.

In my next post, whether they are ongoing or not, I will give you my take on the OWS movement.  Like it or not.

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