Letter to the Editor – AGD Magazine

To my knowledge, this was never published by AGD Magazine. So, I thought I’d submit it here instead.


Dear Editor,

In response to Dr. W. Carter Brown’s guest editorial ‘Dental Care as a Commodity’ I understand the sentiment of a senior dentist (solo practitioner?) observing the challenges of private practice in today’s day and age. The challenges are many: a struggling economy has affected every dentist I know, dental marketing is completely different than 5 years ago – no more yellow pages ads bringing in new patients, now updated websites and social media and loads of hard work are what it takes and we still have openings in our schedules. Couple this with the prospect of health care reform, continuous technology updates and the ongoing challenge of keeping up clinically plus managing staff and the Chinese curse “May you live in interesting times” seems perfectly appropriate.

Perhaps Dr. Brown has had personal experiences with a corporate dental chain and has been disappointed that his well-cared for patients ended up overtreated elsewhere. I understand. As a practicing office manager for 15+ years, I have talked with patients coming to us for a second opinion after first visiting a local corporate dental chain in my area. Patients have given me their original treatment plan and we’ve compared our preventive, conservative, minimally-invasive approach to this local corporate chain option. Usually we save our patients 50% – 70% by reducing treatment and expense.

If ‘commoditization occurs as a goods or services market loses differentiation across its supply base’ (Wikipedia) then now is the time for dentists to make changes in their practices to prevent losing their identity to patients. Look at the huge changes happening around us right now:
• Physicians not only practice in groups, they are ‘owned’ by hospitals
• Insurance companies and government are primary drivers for patient’s health care decisions
• Ranking of hospital and health care providers allows people to choose based on measurable criteria (i.e. number of successful surgeries completed)
• About every 35-40 years dentistry remodels itself. 1880-1924 Pull teeth (as painless as possible), 1925-1955 Fill teeth rather than pull them, 1955 – 1990 Reconstruct occlusion, 1980 – 2015 Cosmetic dentistry and now to total health (diabetes, low birthweight babies, sleep apnea – all are influenced by oral health)
• Nationalized health care will add 100,000’s of people to federal and state government Medicaid programs – with few Medicaid providers to care for the existing population, how will this additional volume be cared for?

As an MBA office manager for a 7 dentist, 20 staff, 18 operatory, privately-owned group practice, I partner with the owner dentist to understand the future of dentistry and position our practice to be ready for the new change about to hit dentistry. We see the future belonging to group practice (as of 2009, 55% of dentists practice in at least a 2 dentist group per ADA statistics) using measurable dental health improvements that can be tracked by third party payers who will then share these results online with those looking for a new dentist. Group practice allows, as Dr. Brown mentioned “efficiency, shared costs and shared facilities” – not as the focus, but merely the starting point for dentists to remain independent – not owned by a hospital-based organization.

In fact, if you see the future of dentistry as helping people to maintain their health (dental disease is a preventable, curable infection) – then you recognize that our current reimbursement approach does not reward dentists for facilitating patients to be healthy. Dental insurance pays the big bucks for fixes (crowns, implants) – and the more you repair and replace natural teeth, the more you earn. On the other hand, if you are successful at preventing dental disease in your patient population, then you will earn far less income. This means you either (or perhaps both) need to drastically increase the number of new patients or you need to decrease your overhead. As the ‘business manager’ of my practice, I am responsible for both of these tasks. The more successful I am at reducing overhead and increasing our new patient volume, the more our dentists can practice preventive, minimally-invasive dentistry.

I am proud to partner with my owner-dentist (an MAGD, by the way) as we have developed a “Dental Home Proposal” for a pilot program here in Ohio that would take our approach to keeping regular recall patients decay-free and treat our local Medicaid population the same way by incentivizing health. Through a combination of my dentist’s understanding of behavioral modification and clinical skills added to my corporate focus on measurable results, we hope to provide a solution to the 700,000 new Medicaid enrollees anticipated in the state of Ohio thanks to healthcare reform. This could result in a win for the patients who can keep their teeth, a win for the state who can afford to care for this group, and a win for dentists who can fill open time in their schedules plus help the poor.

As the Vice President of AGD, perhaps an opportunity exists – not to decry the influence of corporate dentistry, but to actually work with insurance companies (who already have the data on the procedures) to organize this raw data and develop a statistical profile of dentists who are successful at curing dental disease. These profiles should be shared online – so people can choose the dentist that is most successful at maintaining oral health. Then, with the help of the AGD, these insurance companies can change their reimbursement to reward these dentists.

So, are corporate dentists the enemy? No, general dentists (whether solo or coporate), insurance companies and our government aren’t catching up with this new era of dentistry driven by the need for reduced costs to patients by curing dental disease. This puts corporate chains and solo dentists on even ground – with the proper motivation. Office managers with a business manager approach can help their dentists to make this transition successfully. With all of us taking the lead to shape the future of dentistry, we can measurably improve the oral health of the American public.

Jill Nesbitt, MBA

AUTHOR: Jill Nesbitt
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