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By Benjamin Burris, DDS, DrBicuspid.com contributing writer

March 30, 2016 -- Can you believe that greedy corporate interests have subdued the medical profession and forced them to rely on and work for large corporate health conglomerates? Wouldn't it be better if none of the medical doctors took jobs or paychecks from nonphysician-owned corporate medical companies? Shouldn't doctors do their surgeries and other tasks in independently owned, standalone offices? Wouldn't it make more sense to have a cardiologist, an urologist, and a cardiothoracic surgeon on every corner where they own their own shop and do everything in house with their own equipment? Isn't that better for patients?

No.

Benjamin Burris, DDS
Benjamin Burris, DDS.

Corporate medicine and hospitals evolved, not out of thin air, but out of need. Medicine has become so advanced in this country that few, if any, standalone specialists or surgeons could ever afford to have what they need outside of a hospital. Access to medical care has grown through an ever-increasing number of medical school graduates (more than 18,000 in 2015 according to the Association of American Medical Colleges).

This market saturation, though good for the public, makes it difficult for a new graduate to hang a shingle. What choice do they have but to work for "corporate medicine"? Many see this as a bad thing, but if you think about it, what would happen if direct ownership by nonphysicians was not allowed? What would happen if these corporations were not there to offer jobs to the grads, build them offices and hospitals to work in, or buy the necessary equipment? Sounds to me like corporate medicine fills a vital role that traditional practitioners are not willing to address.

What's that you say? Medicine is broken and not to be emulated? We should shut down medical schools to stop the excess supply of doctors and lower pay for doctors?

I know that's the feeling among doctors who don't want to share the marketplace or feel the effects of competition, but having more doctors is in the interest of the public good. Furthermore, if medicine in this country is so bad, then why do so many people travel from so far to have procedures done here? No, medicine in this country is not perfect, but it has become what it is because of the political, social, moral, legal, and financial forces at work in this marketplace. Corporate medicine is the only player who can make the system work and deliver care.

"I'm a dentist, why should I care about this? What are you getting at?" I can hear you saying. Well I'm glad you asked because I said all that to say this ...

Corporate dentistry is good for patients and good for dentistry.

I know you disagree, but allow me to share my reasoning:

More dental schools are opening all the time. More dentists in circulation are beneficial to the public because of the resulting increase in access to care. Trying to shut down dental schools is wholly unrealistic and protectionist. You say you love the profession and want it to carry on after you retire, so why do you want to stop others from doing what you do? Why would you want to limit the public's access to dentists? Don't you want dentists who follow you to do well? How do you expect them to make a living when the cost of doing business and technology are constantly increasing while fees remain flat or decrease? Who is going to provide jobs to all these dentists graduating with nothing but a degree and a ton of student debt?

Corporate dentistry, that's who.

“Just like nurse practitioners, midlevel providers will be a reality everywhere eventually.”

Just like nurse practitioners, midlevel providers (MLPs) will be a reality everywhere eventually. Again, this will be beneficial for the public. Trying to block MLPs individually or via organized dentistry is contrary to the public good and bad for the public image of the profession.

I know you don't like it, but that doesn't matter. I know you want to defend your turf, but that's irrelevant and protectionist. This is healthcare and more access to care is better, because we have a duty to the patients. Who is going to employ these MLPs and expand the reach of affordable dentistry into less desirable markets and small towns that can't support a dentist?

Corporate dentistry, that's who.

"But corporate dentistry is bad! They are ruining the profession! They do terrible work and they cut corners!"

I can hear you screaming at your computer. On what do you base these "facts"? That case you saw that one time? The fact that you and your buddies all agree it is so? Because "they don't do things the right way"?

Interesting. I know you already know about corporate dentistry, but let me share a few things that you might not have considered:

  1. Licensed dentists are the only people to render and oversee treatment that necessitates a licensed dentist in corporate dental practices -- dentists who were trained at accredited dental schools, taught by licensed dentists, passed national boards and regional boards, and got a license from your state dental board. Also, despite what you think you know, these "corporate dentists" are seldom actually employed by "corporate dentistry" but rather by a private corporation (PC) that is owned by a dentist and one that usually has signed a contract to provide a suite of nonclinical services to the PC and its offices. So, if corporate practices "do terrible work" as you are so fond of saying, isn't that an incitement of our profession and dentists, rather than of corporate dentistry?
  2. I know you're fond of saying: "The dentists are forced to do bad work by the corporation." Aren't we, as licensed dentists, obligated to look after the patient no matter what? If a dentist is willing to do bad work at the behest of an "evil corporate dental chain" just to get a paycheck, what does that make him or her? "I was just doing what I was told" is not a valid defense for doing the indefensible. It is the dentist's responsibility to render the best possible care. Period. All else is noise. Not to mention, doing bad work is bad for business and I'll venture a guess that most dental service organizations (DSOs) are far more business savvy than the average dentist. It's not in their interests to encourage dentists to do anything other than what is best for patients.
  3. No traditional practice is under the scrutiny from federal, state, and local authorities or from traditional dentists that corporate dental offices are. I hate to tell you this but, just as an example, our little "corporate" dental office that is wholly owned by me and my partner (both of us dentists) does everything by the book for two reasons:
    • Because it's the right thing to do
    • Because there is always someone looking to nail us for doing something wrong

    It's even more so for the big boys. I'm betting that if your awesome, traditional office got half the scrutiny that a corporate office gets, you'd be in deep my friend.

  4. You're not perfect. You have bad cases, failures, and upset patients. No matter how small your practice or how hands on you are, we all have mess-ups, mistakes, bad cases, and failures. These failures may be our fault, the patient's fault, no one's fault, or just bad luck, but no matter the reason, stuff happens. They call it practicing for a reason. Be careful throwing stones when you live in a glass house.
  5. The cost of education and of doing business will continue to rise. Technology will continue to improve, evolve, and become more essential. It will also increase the capacity of the average dentist. Dentists will work longer instead of retiring in their 60s. More dental schools will be built, and they will have ever-larger classes. More competition will lead to lower fees and, thus, lower pay for dentists. It's just the way of the free market that you love so much -- the free market you love everywhere but in your sandbox. And it's good for patients.
  6. Having a job with regular hours, great pay, low stress, and no human resources, billing, marketing, or management responsibilities isn't a bad gig at all. If the job options that are available today were on the table back when I graduated, I could have avoided a lot of heartache, afforded to start a family much sooner, and might even still have my hair.
  7. Corporate dentistry is the future. Dentistry is becoming part of medicine for a litany of reasons, and as this transition happens we will become part of the bigger machine; our delivery systems will look more like theirs. Just look at what happened in medicine over the last 30 to 40 years if you want a preview, but don't fool yourself into thinking it will take nearly as long for dentistry to transform. Dentistry is a tiny industry by comparison, and there is already a proven model.

It's funny to me that we dentists so desperately want to be considered "real doctors," but we also want to be special and outside of medicine. We constantly complain about how things are but refuse to change.

We can't have it both ways.

We can't stop the future from happening any more than we can hold back high tide or the sunrise. Change is coming and we only have two choices: Deny it or embrace it. If we were smart and if state lawmakers understood the present and future of dentistry, we would push to legalize direct ownership of dental practices in all 50 states in order to facilitate dentistry's move toward the medical model and increase the access and affordability of dental care. This would benefit patients and dentistry in the long run, plus we could fulfill the dream of being considered "real doctors."

I hear you and all your "reasons" why I'm wrong, crazy, and a traitor to dentistry; I've heard it all before and I still don't understand you, because my duty -- our duty -- is to all patients.

Ben Burris, DDS, is an orthodontist, writer, speaker, philanthropist, activist, and patient advocate. He can be contacted at OrthoPundit.com.

The comments and observations expressed herein do not necessarily reflect the opinions of DrBicuspid.com, nor should they be construed as an endorsement or admonishment of any particular idea, vendor, or organization.

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Last Updated te 3/30/2016 7:43:18 AM

16 comments so far ...
3/30/2016 10:47:37 AM
MWDavisDDS
One might assume I'd be overjoyed w/ Dr Burris' perspectives. My private practice is SWAMPED w/ new patient refugees from corporate clinics. Redos of 1/2-baked dentistry is FAR more lucrative to me, than initially doing things right. These corporate bait-&-switch mills keep me "making bank". Oh, & that's not the best part.
 
I gain added income ($275/hour) by reviewing the screwed up corporate cases (by far & away, most malpractice I review originates from corporate dentistry). These creeps are gonna make me very wealthy. 
 
Sure I'd like to see our new dental grads working in public health dentistry, the military, or corrections dentistry. I'd like them to learn clinical dentistry in ethical settings. Too often, that's not the case. Too many get corrupted by non-dentist corporate manages, who truly direct dental care (unlicensed & unlawful practice of dentistry- largely unenforced). It gives me a heavy heart... but a fat wallet.
 
Michael W Davis, DDS
Santa Fe, NM
 

3/30/2016 3:53:49 PM
MBornfeld
Granted-- private practice dentistry has done little to solve accessibility issues. But to imply that corporate-run dental practices are any less motivated by profit is just plain ludicrous. Corporate dentistry has evolved out of the same economic pressures that exist throughout health care: the erosion of margins in private practice, the inability to negotiate effectively with 3rd party payors, and economies of scale. This has nothing to do with ethics; it is merely a sign of the economic times. Corporate dentistry is unlikely to make inroads in under-served communities for the same reason private practice dentistry has failed to do so: it is not in its economic interest.

3/30/2016 4:06:57 PM
MWDavisDDS
In reality, corporate clinics & their employee doctors are involved w/ FAR greater percentages of state dental board actions. I did a study of this for DrBicuspid. 
 
In review of Health & Human Services- Office Inspector General (HHS-OIG) reports on Medicaid dental for the four states audited (IN, NY, CA, LA), the "outlier" providers were at 1/3 to 2/3 levels for their employment in corporate dentistry. Not positive.
 
One really can't compare small business dentistry to big business dentistry. Different ethics, different business models.
 
Michael W Davis, DDS
Santa Fe, NM

3/30/2016 4:27:59 PM
DrAlignMine
Ben,  The reason hospitals are a bad idea and the reason corporate dentistry will be a bad idea if it follows the path of medicine is that it's income is based on the performance of procedures.  As such, both industries grow and thrive on the presence of disease and pathology and hence, have become self-perpetuating profit centers at OUR (the public's) expense (both monetary and physical).  The result is that our corporations benefit from the ever growing incidence of chronic disease (which includes caries, malocclusion and sleep apnea, to be specific to our industry), and no one in either corporate structure (medical or dental) has any interest in PREVENTING the incidence of disease, ie: fostering wellness.  
 
Can you imagine a board of directors who are eager to please their shareholders by announcing new protocols that will allow the hospital to do LESS procedures than last year?  Less crowns than last year?  Less braces than last year?  Less MAD's than last year, because, hey, it means we're doing well for the public?
 
Are you telling me that your doctors will spend more time talking to their patients about reducing risk factors for malocclusion or caries than they will meeting production quotas?  Are you training your patients in better nutrition?  better posture?  better breathing?  so they don't have to wear braces?
 
I'm all for change.  I think you're right about mid-level providers and being more efficient at delivering more services to more people.  But hospitals and corporate dental organizations are in the sick-care business and only give lip service to well-care at best.  Maybe they don't have to be.  There could be profit is helping people be well.  I'm all for providing services to children that will help them grow up healthy and keep them out of the hospital.  
 
 
 

3/30/2016 7:16:57 PM
sammysalsausa
Everyone seems to be ignoring the elephant in the room: insurance with their ever loweing reimbursements. As one who has worked for a DSO, I've never had 'corporate' interfere with my treatment. Insurances I'm contracted with, on the other hand, directly or indirectly modified almost every treatment plan for their insured. The problem then gets worse when dental corporations build practice models around insurance reimbursements. Then all you have is a office whose sole purpose is to take insurance benefits and give it to shareholders. Then the dentist there is just a pawn to move money from the insurance to the corporation. But not every corporate model is like that. I know some excellent dentists with good corporations I'd trust me and my family with. Then there are also private dentists nearby I wouldn't send my worst enemy to.

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