Discussion in 'Dental' started by Noble6, 07.01.11.
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I knew it was coming. I spoke of this in 2006 during my undergrad. Corporate Dentistry is on its ways.
Sears and Montgomery Ward tried to do this in the late 1970's, and by 1988 most of the dental "franchises" were out of business or filing for bankruptcy. People won't trust Walmart for their dental needs, and I seriously doubt they can make enough money off of it to justify the expense of expanding this program.
The one thing that Wal-Mart will have going for it is its enormous buying power will allow their dental office to have a lower overhead and I'm guessing Wal-Mart will have "dental insurance" through only these dental practices. Will this mean the end for dentistry as we know it? Probably not. It might effect the other corporate dental offices but overall I doubt that it will have that huge of an effect
It will probably function similar to the optometry and pharmacy offices in Wal-mart, Target, etc. I would say that the pharmacy aspect offered is a big success for the stores, but I cannot imagine the optometry departments are as successful as other optometry offices. The over-head associated with owning an office may make it difficult to maintain with a low patient pool. Getting glasses from wal-mart is one thing, gettin a rx filled is normalized, but getting a restoration? I cannot see that catching on. Even a poorer population (which I would assume to be the target of these clinics) still wants good dental care, albeit at low cost, and I cannot see wal-mart filling that reputation.
On the other hand, if this makes people more likely to see a dentist, get routine cleanings, and prevent oral diseases (like having the dentists/hygienists there preform oral cancer screenings), then more power to them. I cannot ethically/morally be against promoting better access to care.
If they run this like a denture mill, this will pay faster than an atm. Make hours 2P-9p mon- sat and you you'll need an armored truck to carry your money to the bank.
I think if you could get over the stigma of working at a corporate office located inside of a Walmart, that this idea might work for a lot of people.
Try telling this to all the mom and pop pharmacies and optometrists these days.
The poorer populations don't care about getting dental work period. A majority will go only when something bothers them. They need an incentive to go to the dentist. Why not just drop your kid off for free medicaid dental work while they shop? Or Walmart could offer plenty of incentives/discounts for getting work done.
For the past 10 years, corporate dentistry has made huge strides in how patient care is administered. You can bet that with the bigger companies (Walmart) getting into the picture, there will be plenty of changes to come.
Walmart dentistry is not going to fly.
i'm not immediate to put this down but things will get interesting.
is there a consensus that large factory-like dental franchises provide less quality than smaller private dental practices?
Normally I'd agree but Wal-Mart has ENORMOUS buying power. With that alone they probably can reduce their overhead to 50% while still having the lowest fees in town. Like I said overall I don't think it will have that great an impact on most private practices unless they are denture mills for bottom feeders.
Why do you think they won't fly?
I wouldn't sleep on Wal-Mart. They have the ability to put virtually every medicaid accepting dentist out of business. When new graduates find their dream California job market completely saturated they are still going to need to pay off those loans. Wal-Mart is the 800lb gorilla who has cannibalized pharmacy and optometry practices. There is no reason to believe they can't succeed in dentistry. I doubt medicaid patients would really care that their dentist is located in a Wal-Mart, especially if they can get that crown for $100 cheaper. Wal-Mart can control the means of production from chairside to dental lab, has an enormous patient pool, and has incredible political clout.
Dentistry has strict city and state compliance codes... Radiation, infection control, hippa, to name a few. Who is going to pickup a gallon of milk, a roll of toilet paper and see their dentist across the isle?
Btw, walmart just came out with their own cell phone plan, so this may actually fly!
Hahaha - They have their own word spelled wrong on the homepage ... "Sensilbe Dental" lmao....I tried writing them an email on their "Contact Us" form, however, that failed to work too! Seems fishy!
Man I hate corporate america. I hope the ADA will set up policies to end this type of set up. If that does not happen maybe the tanking economy will take them out - as the poor are most effected and will eliminate their buying power.
Unfortunately corporate dentistry is alive and well because of several reasons.
#1 - economy is still perceived as depressed. People want cheap services and some will try to get at any cost. Hence Aspen/Walmart style dentistry.
#2 - new grads are socked with 150-350k+ in student loan debt and HAVE to have a HIGH paying job day 1 out of dental school. Why work for Dr. Smith down the street who cannot guarantee a base salary when Aspen can promise you $130 + % of collections? Some dental students graduate with like 4 kids on top of this debt. I can't blame them for wanting these jobs.
#3 - the ADA is in bed with Delta Dental. Delta Dental wants to increase it's % in the marketplace by raising services with lowering payouts to providers. Corporate practices tend to have much lower fees than private offices and can lower the UCR in the areas, thus tend to be looked favorably upon by Delta. The ADA also feels pressured to expand Medicaid provider numbers which corporate groups like Western/Aspen also tend to participate in. The ADA is in bed with Delta, Delta is in bed with Aspen/Western/Gentle etc and the corporate groups, so indirectly, the ADA is in bed with corporate dentistry. So therefore, the ADA has a vested interest in not fighting the rise of corporate dentistry, although many individuals and members within organized dentistry do not like corporate practices.
It's much more complicated than many think.
Until you work in corporate offices you really can't say much. Was the worst experiences of my professional career but sure, I did make a very good salary.
In his magnificent and thought-provoking The Long Tail and Free: The Future of a Radical Price, Chris Anderson shows how someone can always do it cheaper or faster or even better than you, so if you're concerned with those things, there will be a "race to the bottom", especially in terms of cost. Ie., you can't out-Walmart Walmart.
"So, in 1883, another French mathematician, Joseph Bertrand, decided to give Recherches a proper review. He hated it. As the Wikipedia entry on Cournot puts it, "Bertrand argued that Cournot had reached the wrong conclusion on practically everything." Indeed, Bertrand thought that Cournot's use of production volume as the key unit of competition was so arbitrary that he, half-jokingly, reworked Cournot's model with prices, not output, as the key variable. Oddly, in doing so he found a model that was just as neat, if not neater. Bertrand concluded that rather than limit output to raise prices and increase profits, companies would more likely lower prices to gain market share. Indeed, they would attempt to undercut each other until the price was just above the cost of production, which is called "marginal cost pricing." And if the lower prices encouraged greater demand, so much the better. Bertrand Competition can be shorthanded like this: In a competitive market, price falls to the marginal cost."
"The other thing about Bertrand Competition is that it applies mostly to products that are similar. But if one product is vastly superior to another for your purposes the primary determinant of price is not marginal cost but "marginal utility"—what it's worth to you."
Now hang in with me here, because Seth Godin takes it a step further in Linchpin:
"We can't profitably get more average. We can't get more homogenized, more obedient, or cheaper. We can't get faster, either. We've gone against our true nature and corporatized, anonymized, and dehumanized as many of our systems as we possibly can. Even health care is a system now, not a human interaction. We could probably go even further, actually, but I'm betting it won't be a fun or profitable journey. If all mortgages are the same, of course they can be chopped up and remixed and resold. But that means all bankers and all homes are the same, and so are all homeowners. Which means the cheap ones or the profitable ones are all that matter. If all online products at all online stores are the same, then of course I'll use a price-shopping Web site to find the cheapest product. If all employees are nothing but a résumé, and résumés can be scanned, then why are we surprised that our computers end up finding us anonymous average people to fill our anonymous average jobs? If every restaurant on the highway will give me precisely the same cheery service from the same robotic staff, at the same prices, then why does it matter where I stop? Do we need to be flatter and smaller? It's our desire to be treated like individuals that will end this cycle. Our passion for contribution and possibility, the passion we've drowned out in school and in the corporate world—that's the only way out. Every successful organization is built around people. Humans who do art. People who interact with other people. Men and women who don't merely shuffle money, but interact, give gifts, and connect. All these interactions are art. Art isn't only a painting; it's anything that changes someone for the better, any nonanonymous interaction that leads to a human (not simply a commercial) conclusion."
Man, I bet I've read that passage a hundred times.
See? There will always be cheapest/fastest/mass market, all those things. But now more than ever, consumers are tired of that vibe and its relentless, escalating in-your-face advertising. We're bombarded everywhere by ads that promise an amazing experience and then experiences that don't live up to the expectations. Yet if we go the other way...
Mall dentistry (while not necessarily intrinsically "bad", btw) and corporate chains will stay around. But we can beat them easily by providing amazing experiences for our patients. In fact, yesterday I ran into a former student (saw his office in my doctor's building). His story is inspirational for new grads.
After being treated terribly as an associate by an owner doctor, he set out on his own and bought a practice. He knew that the previoius owners were slimy and that they would hide things. He paid an appropriate price though and found that only 100 patients were left- far less than he was told, even than he expected. By providing remarkable patient experiences, though, he's gained many of them back; he also gained 200 new patients in a short time from internal referrals, and things are going well.
Students and recent grads, pay attention: You can race to the bottom, or you can race to the top. The only thing that really prevents you is your Limiting Beliefs about yourself.
Try not to have any.
A+. Your post is by far one of the best I have ever read on this forum.
It's a breath of fresh air to know that there are like-minded people throughout this profession.
Competition on price alone - you will lose in the long-run. We provide services, not marginalized products.
Keep up the good word...
Amen sir. Dentistry is different than shoes, magazines, and electronics sales- there is ALWAYS a human element and, in this case, the human element controls EVERY aspect of the quality of the product placed in your mouth. Before I started dental school, a family friend said that I was going to get "a license to steal", and I didn't understand what he meant when he said that. After a few years of dental school, I completely understand. You can go out there and put crap in people's mouths- open margins, leaving decay, selling crowns when fillings would work, etc...and no one will know except you. Other dentists can't criticize because they don't know how the patient has treated their own mouth, which is a huge variable, but you know if the crown margin was wide open when you seated it. There are plenty of unscrupulous people out there, it's up to you and I to make the right decisions when it comes to patient outcomes.
This means that patient communication and rapport is even more important; let patients know you will do your best, they might understand when the crown the lab sends you is horrible and you have to retemporize and send it back. Let the patient know what your limits are, and let them know expected outcomes. Sure, you may not grow your practice in numbers [$] right away, but it is my firm belief that you'll grow your practice in patients [#'s] in the long term. Call me naive if you like, but that's what I think...
Gosh, thanks! Here's who to read for more, plus Derek Siver's new book Anything You Want:
Oh, heck, and maybe this:
"Edgecraft" is perhaps the most under-exposed and under-rated of Seth Godin's concepts. And my friend, the one with the 100 patients, is doing it instinctively, just because he's such an amazing human being. He's patient, and it's bringing good things to him AND his lucky patients.
Oh, and Mike3kgt, I meant to say- I got a lot out of your comments about ADA/Delta Dental, etc. above. Thank you, very insightful. I guess it goes like this: while we'd all rather see the ADA fight corporate dentistry, if they're not going to- WE can! As long as there are enough of us, we certainly can.
Man, that "human element" quote is the basis for, idk, a book or maybe, even better, a mandatory semester-long course in dental school. In ALL of them! Nice bit of writing there!
And "In the long term" is the key thing in many ways. Much of the unethical behavior that we see in dentistry is due in part to short-term thinking, coupled of course wth seriously flawed ethical maps to begin with. You guys see, though, that patient building of affinities with patients (nice word-bracketing there, eh?) will bring long-term success.
wont work sears has done this with mixed reviews. because they draw mostly people just out of school and little experience, they have to deal with people screamibg, in pain and bloody not a good image. the eye doctor works bc its a "clean" "painless" field... not so with dentistry, last thing they want are complaints...
exactly. the overhead generated by their dental services will only be a drop in the bucket.
exactly - they can operate their dental chain at a loss in some regions just to gain their position in the market. This is what they have done with pharmacy. We in America have to destroy places like walmart!
Stop shopping at walmart!
i thought laws in USA were set where a DENTIST must OWN the practice.
is that not the case?
The website in question is a dental franchise so it would be owned by a dentist but contracted to be in a Walmart.
I would imagine Walmart wants to get into dentistry but is concerned of the look of people in pain sitting around waiting for the dentist to open or people with bloody gauze hanging out of their mouths leaving to go shopping for more gauze.
Key point, if Walmart could put a mid-level provider in the store only doing hygiene and whitening, I promise you they will at the first opportunity. They don't want dentists in there, hygienists and mid-levels, yes. Easy profit margin, cheap labor, and feeding the needs of people who want something to cover up crap (i.e. whitening over decay) is the tenant of that type of model.
Do you know the demographics of the people that shop at walmart?
Initially (especially considering today's economy) it may appear as a threat. However, in the long run I think private practice dentistry will continue to prevail. Dentistry is not equivalent to optometry or pharmacy. Pharmacy--of course I want to go to the place at which I can get the cheapest prescription (who cares if my pharmacist is competent; I know that my medical doctor who called in the prescription request is competent) and the prescription is the same, regardless of the pharmacist verifying it. Optometry--as long as I get prescription glasses that let me read the "yield" sign I'm approaching, are decent looking, and cheap, I'm all for it... Isn't this the thought process of the general public (esp. those that do not have the income to support taking their family to a private optometrist)? If they're getting the same drugs, they'll certainly go to the cheaper pharmacy.
IMO, dentistry has an ethical standard that I belive Walmart just won't be able to stand up to. We are in a field of highly competent and passionate individuals, and we will stop at nothing to make sure it stays that way, including in the low-income communities (especially!). Dentists not only have an obligation to their patients, but also to their community (including those who shop at Walmart, especially b/c those are the patients that can benefit the most from the generosity of dentists).
Patients may at first see this as a positive notion, but I think later will realize the value in going to a private practice that can offer them a welcoming, comfortable, reliable, and relatively inexpensive restoration of their oral health that will, in the end, save them more money due to long-lasting procedures. (I, of course, realize there are an infinite number of variables involved).
In all honesty, I just hope dentistry doesn't come to this--it would be unfortunate.
sorry double post
AZ for example you can apply for a license to operate a dental clinic as a non dentist. This is fairly new in AZ, and came about bc of lobbying by big corporations. The big corporations are "killing" the avg dentist, bc they can undersell the avg dentist and offer payment plans as little as $10 a month. You want to save dentistry join your local dental association and have them reverse the decisions to allow corporations to run dental clinics. IF you think corporations are great then google the corporations and see pages and pages of cpmplaints. Walmart may some pilots but will end the end not proceed with it bc dentistry draws many complaints and it may become a PR issue for them.
google western, dental. koolsmiles, small smiles,
I would agree except that their exist one major problem that in that corporations are becoming smarter and are learning from the mistakes of the main corporations of today. for example Pacific Dental is not using their name, rather they have the clinic use a local name say, the clinic is on sunshine rosa, they will call it sunshine road dental, so that all their clinics appear to be small business locally run family practice, but its not. The only real way is to return to only dentist owning clinics, the way it use to be, corporations lobbied to change the rules and got it. Many also dont realize that corporations lobbied for immunity and got that too. What I mean here is that the coporation and the practice of dentistry are seperate in the eyes of the law so if a complaint by a patient occurs the corp is immune and solely the treating doctor is to blame as it is considered a malpractice issue. I had a friend who worked for a corp, did a partial and it did not fit in the end he offered to redo for free the partial, but the corp refused to allow the patient back bc they had a balance, ultimately the patient sued and the case landed on the doc. lucky for him the patient realized it wasnt the doc fault had it dropped and he just paid for her to have a denture at a different location, but the suit against him still shows up on his record even though it was dismissed. So push your local association to support onlly dentist run dental clinics, not corporate run clinics..
Agree- that they are killing the average dentist. See my post above- in a race to the bottom, the only logical response is to race to the top. Another Seth Godin quote is apropos, followed by one from my friend Anne McCrossan:
"All we have left to sell is expectation and trust".
"When people and organizations cannot be trusted, we are inclined to give them less attention."
Patients have low expectations from corporate chains in general, and once burned by a chain in a certain industry (like ours) their trust falls off the charts. And in this new economy where Attention, capital 'A', is essentially more valuable than money per se, because money flows from respectful treatment of people's Attention, we can actually thrive more because of the contrast that our practice can provide to the chains that are out there.
Provide your patients with Certainty and Connection, real human non-anonymous Connection, and you will be unstoppable.
Forgive me for intruding on a dental forum but the 'Walmart' post caught my attention. I'm an optometrist and have watched the sell-outs in my profession totally destroy it.
The dental profession has long entertained my envy as you guys have done well to limit supply, limit stupid insurances, limit commercialism and have no "MD" couterpart.
But I do see commercialism encroaching more and more into the dentistry. We have a Dental Works place here and a dental practice in Sears for 20 years or so and recently added a 24/7 (365/days a year) dental practice called 'Night and Day Dentistry' in a Sam's Club parking lot (office hours 8 am to 10 pm). Nice building but not sure how the logistics works on that.
I can see Walmart jumping into the game. Optometrist were sold out many years ago because we made a good % of our income on materials. The corporations saw that and jumped at it like sharks.
But the corps are not who you really have to worry about. It's your colleagues. Unless they are different than ODs, they will be enticed by the 'easy work conditions' of corporate life such as no practice headaches-- walk in, do your work and walk out. The 'sell-outs' will drive your profession down and it will snowball.............just like optometry (and medicine is in the sell-out game too with PAs and NPs in stores now).
Hope it doesn't happen to dentistry.
You get it.
Wal-Mart Dental may create a market, but it shouldn't draw patients from practices that DentinBond describes. Those are two very different markets.
I agree with the two different markets comment. I am not overly worried about corporate dentistry. Sure, it appears to be gaining some market share, but whenever I start to feel uncertainty about the future of dentistry, I think about other industries. Look at banking: big banks certainly service millions of customers, but so do the smaller, local banks and credit unions. They have not been crowded out of the market. Same with retailers: Wal-Mart itself has forced many mom & pop stores to close, but still many thrive. The juggernauts and the mom & pop stores generally serve different populations, just as I believe corporate dentistry may cater to a different market (or more remote markets) than private practice dentists.
What is next? Walmart Health care? Trauma dept next to Walmart tire...operating theater next to Men's fitting room Obgy next to women's fitting room ...oh yeah pediatircs next to kids section
Of course everything is Made-in-china..steam cell organs manufatured some where around shanghai !!!
Super Walmart got food, cloths and now they are in heath care..why don't people just live out of walmart? little cubby hole just for $0.99 (Wal mart Roll back special )
Way to highlight the ridiculousness of this proposition of Walmart taking over. I can't imagine picking up my groceries, foods and veggies, and seeing an extraction taking place not too far from me, that would be so odd. There would be just too much at stake for the company, in my opinion. Dentistry is not always a clean job, can get bloody, what about sanitation control, etc? Yea, no...just don't see it happening..
Yeah, and just keep in mind the essential rubric: Race to the bottom, or race to the top. Low cost being the deciding factor, or Certainty and Connection. It's an impassable dichotomy.
Keep the faith and be confident, because the low-cost model (Bertrand Competition, above) cannot, and I mean violates-the-First-Law-of-Thermodynamics cannot, provide the same kind of real, non-anonymous, human Connection that you can in your private practice.
"The other thing about Bertrand Competition is that it applies mostly to products that are similar. But if one product is vastly superior to another for your purposes the primary determinant of price is not marginal cost but "marginal utility"—what it's worth to you." -Chris Anderson in Free
Go ahead. Race to the top and be proud!
I think you're taking things a bit too far. It's not like you're going to see a dentist whipping out molars between the produce and frozen food sections of the store. I suspect the dental practices would be placed in locations that offered their own entrance/exit and perhaps a door leading to/from the rest of the store.
It's already happening. If you look at their site, they have one location open in Louisiana. Another one coming soon... Actually the way I came across them is they had an ad for dentists on craigslist. It looks like they are hiring at a number of locations in TX, Louisiana, and elsewhere.
This model would work great as a denture mill in the strip mall in front of a super-walmart. Go ahead and be a snob. This isn't a bad idea. Like I've always heard-- Why rob a bank? Because it's where the money is.
oh, they will fly alright..
They have beaten every odd for almost 60 years, cant say no to waltmart. Specially with low prices.
People will go down 3 miles to fill up the tank just because it is 1 cent less than the gas station next to their house. What makes us think that people wont go there for $100.0 less?
This is amazing. They took on pharmacy, optometry, and now dentistry. Is medicine next target?
Please, don't hold such Limiting Beliefs. You can do so much more for your patients than the low-price, race-to-the-bottom people can. This is the main source of my essential optimism about dentistry. Race to the top, and let some others race to the bottom, they are two different things. See my post above. And not only don't worry about the practices that race to the bottom- don't worry about the patients that see things that way either. Let 'em go.
They'll be back.
And it bears repetition:
"The other thing about Bertrand Competition is that it applies mostly to products that are similar. But if one product is vastly superior to another for your purposes the primary determinant of price is not marginal cost but "marginal utility"—what it's worth to you." -Chris Anderson in Free
What are we worth to our patients... That's the key.
Medicine is already in place. Many Walmarts already have walk-in clinics operating in store. These are "run" by Nurse practitioners or other mid-levels, law permitting. One can go in for a discounted rate and receive a prescription just like any other Med practice.
I find this to be a very sensible concept, regarding doctors' approach to dentistry and quality dental care. From the above posts, it seems people are arguing that this would be set up similar to an optometry practice, where the OD's work just next door to a bank, nail shop, etc. However, I still stand by the fact that dentistry is not always a clean profession-people bleed, kids may not always be properly controlled behavior-wise-how often do you encounter these same issues in a pharmacy or optometry office? And for the NP-run offices in places like HEB, I still wouldnt equate this to dentistry or medicine. I've witnessed a few of these and they essentially operate on a very simple scale-check your blood pressure, maybe a shot here and there for school-and thats it. These NP's are not performing surgeries next to the nail shop.. This is where dentistry is different. And similar to what DentinBond stated, if this is succesful, it is going to pull a whole different demographic of patients-essentially become a Medicaid Mill, and with the cheap ways of Walmart, I will not be surprised if the work that comes back from their labs are subpar, issues with improperly placed crowns and bridges,etc. If places like Small Smiles can get sued for similar issues, trust me, same thing will happen with Walmart. Bad Press will follow, and they will lose the public's trust in terms of dental care. And people will once again realize, you get what you pay for....
I live in the town in Louisiana where one was opened recently. Personally, I don't agree with it but can't do much about it myself. However, I teach dental assisting and one of my students was offered a job there. She turned it down for two reasons: hours (open 7 days a week, until 9pm. Hours/shift varies) more about money than actual patient care. After seeing how this particular office was being ran, she declined the job offer stating she needed to work somewhere else where the doctors weren't driven my ONLY money. She knew dentistry is a business and there are goals you want to meet, but said something wasn't right about the place. Now, this is coming from someone else so I can't judge to hard, but makes you definitely wonder!
wal-mart will destroy dentistry if they can.... all of corporate america will
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