Dental offices in Walmart

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What's interesting is that I have a patient I am treating who is a big-wig in Walmart in our area and is rising through the rank and file of the company about the topics presented in this thread.

He told me that Walmart would "absolutely be interested" in expanding to provide dental services. I asked him about the blood and people in the look of pain and he shrugged it off and told me that corporate is not worried about it and is actively working to find a way to make it work. He told me that there is no difference between dentistry and optometry in regards to corporate philosophy.

Unfortunately, this idea might go through. It depends on the states and what they allow mid-levels to provide.

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Come on, y'all, enough of this defeatist talk!!! Read back to my prior posts. Read the excerpt from Seth Godin's Linchpin that I quoted. And Anderson's take on Bertrand Competition; Here it is again, consider carefully what it means:

"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

Let corporate race to the bottom. Let a percentage of patients go there. They'll be back. Corporations have spent well over 100 years trying to stamp us into anonymous, interchangeable, disposable, obedient drones. Whether as employees or as customers, it's all the same.

Do you really think that this is what people want now?

Now that the Internet allows us to connect, and to readily create rather than just consume, and to evaluate businesses through organic online reviews rather than only via what some gatekeeper of information tells us, or through some stupid ad- we all know that there's more than bland anonymous corporate experiences now. There's more available in every aspect of our lives now, we can readily find it ("Google it"), and when we can afford it, we will. That's what it's like now for us as consumers.

Our mission as dentists now is to restore teeth, yes, but it is also to delight people, to provide amazing experiences in our offices that buck the trend of the terrible impersonal machine that is the modern American health care system, to wow them by treating them as valued individual human beings (which they are not getting from corporations); our mission is to become an indispensable Linchpin in the lives of our patients, our employees, and our community.

Race to the top. For frak's sakes, race to the top and be confident.
 
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I blame the meatheads who run non-ppo practices and charge ridiculous prices for services. Additionally you have the cockroaches who "game" the PPO and DMO or Medicaid plans and up charge patients for bogus ancillary services so they can "make up the difference" in their fees. I was sitting at a table of doctors during a recent CE conference who were talking about how to squeeze every last penny out of a tooth. They tried to disguise their greed by saying it was in the best interest of the patients by making some pretty lame assumptions about patient behavior. Disgusting.

People bad mouth wal-mart, but then they refuse to go practice in the inner city or out in the rural small towns. Everyone wants to practice in the same upper middle class neighborhoods with offices full of all the dental toys and newest equipment.

They have to charge ridiculous prices for simple procedures so they can afford it all. Example: in-office whitening for $450. Hear about it all the time. Absolute scam when you consider that 99.9% of patients will not detect a difference in shade after a one hour session. But the staff and dentist all gather around the patient and exclaim how "amazing" the teeth now look. Shameless liars.

We, the dentists, need to create some organic supply or else the government and corporate dental offices will create it for us. Example: most dentists in private practice work a reduced week with banker hours, because they deserve a long weekend and time to sleep in. Problem: less hours to see patients or emergencies. Solution: corporations open clinics 7 days a week with expanded hours.

Stupid should hurt.
 
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I blame the meatheads who run non-ppo practices and charge ridiculous prices for services. Additionally you have the cockroaches who "game" the PPO and DMO or Medicaid plans and up charge patients for bogus ancillary services so they can "make up the difference" in their fees. I was sitting at a table of doctors during a recent CE conference who were talking about how to squeeze every last penny out of a tooth. They tried to disguise their greed by saying it was in the best interest of the patients by making some pretty lame assumptions about patient behavior. Disgusting.

People bad mouth wal-mart, but then they refuse to go practice in the inner city or out in the rural small towns. Everyone wants to practice in the same upper middle class neighborhoods with offices full of all the dental toys and newest equipment.

They have to charge ridiculous prices for simple procedures so they can afford it all. Example: in-office whitening for $450. Hear about it all the time. Absolute scam when you consider that 99.9% of patients will not detect a difference in shade after a one hour session. But the staff and dentist all gather around the patient and exclaim how "amazing" the teeth now look. Shameless liars.

We, the dentists, need to create some organic supply or else the government and corporate dental offices will create it for us. Example: most dentists in private practice work a reduced week with banker hours, because they deserve a long weekend and time to sleep in. Problem: less hours to see patients or emergencies. Solution: corporations open clinics 7 days a week with expanded hours.

Stupid should hurt.

Some truth in this statement for sure.

But here's another angle to consider, especially with reguards to the likely need of a midlevel in the Walmart-dental scheme of things. Do potential patients of "Walmart Dental" and the likely midlevels they would employee, really want to be treated by a midlevel, a provider who may be trained to do things tecnhically, but isn't a dentist? Is this an answer for the "underserved" or will this be a case where advocates for the underserved will cry out that the underserved are receivin "2nd class care" and therefore are being treated like "2nd class citizens"???? Nobody has done a survey to check this out.

Sure midlevels may be working in RURAL Alaska where the villages that they'e working in are accessible often only by float plane or snowmobile and the nearest "real" dentist can be 100's of miles away, and thats fine. But what about the person who lives in a major metropolitan area where there's 100's of licensed dentists nearby?? Will they be fine with that?? Nobody knows.

Alot of time, and $$ is being current put into research of what type of midlevel provider may be the best solution for the access to care problem (and one can debate in many areas of the country if there really is an access problem vs. an access "inconvienence").

One of the key problems that many in the dental community seem to be forgetting, is to critically think about and evaluate the problem presented infront of us BEFORE acting on it. That's how we're tought in dental school with diagnosis and treatment planning: Step #1 - figure out what the problem(s) are Step #2 - devise plans for dealing with the problems (and sometiems we forget that doing nothing is a very viable option) step #3 - present the findings and plans for "treating" them and then step #4 - begin to implement the decided upon plan in a logical manor. It is seeming by many in our profession that we're forgetting these key tennets of critical thinking and how it relates to problem solving and just trying to solve the problem and then think about what worked (or didn't) later and then adapt from there. We need to let the facts and the science speak for themselves and NOT get all caught up in the emotional response that this topic can produce
 
But here's another angle to consider, especially with reguards to the likely need of a midlevel in the Walmart-dental scheme of things. Do potential patients of "Walmart Dental" and the likely midlevels they would employee, really want to be treated by a midlevel, a provider who may be trained to do things tecnhically, but isn't a dentist? Is this an answer for the "underserved" or will this be a case where advocates for the underserved will cry out that the underserved are receivin "2nd class care" and therefore are being treated like "2nd class citizens"???? Nobody has done a survey to check this out.

I generally agree that not enough research has been devoted to finding out if mid-level providers are really wanted by the demographic everyone assumes would utilize said providers. My gut feeling is that mid-level providers wouldn't want to work in wal-mart anymore than top-level providers want to work in wal-mart, the inner city or rural america. Just look at mid-level providers in medicine. They are all clamoring to work in middle income suburbs.

I for one don't really believe there is a shortage of dentists. Nor do I believe there will be a shortage of dentists as all of the baby boomers start to supposedly retire during the next 10 years. There are plenty of dentists who have excess capacity and could soak up the current demand. I haven't spoken with too many dentists who say they are too busy or too rich. In fact most of the dentists I know are wondering if their schedule next week will fill completely.
 
And, for the record, I think a dentist who leased space in a wal-mart but retained complete control of the practice and profits would do very well.
 
I generally agree that not enough research has been devoted to finding out if mid-level providers are really wanted by the demographic everyone assumes would utilize said providers. My gut feeling is that mid-level providers wouldn't want to work in wal-mart anymore than top-level providers want to work in wal-mart, the inner city or rural america. Just look at mid-level providers in medicine. They are all clamoring to work in middle income suburbs.

I for one don't really believe there is a shortage of dentists. Nor do I believe there will be a shortage of dentists as all of the baby boomers start to supposedly retire during the next 10 years. There are plenty of dentists who have excess capacity and could soak up the current demand. I haven't spoken with too many dentists who say they are too busy or too rich. In fact most of the dentists I know are wondering if their schedule next week will fill completely.

And, for the record, I think a dentist who leased space in a wal-mart but retained complete control of the practice and profits would do very well.

Let's think about this from the Walmart perspective, where they use their massive "muscles" to acquire their merchandise for the bare minimum from their suppliers. Using their model and applying it to dental care. It won't take long until Walmart will be doing everything in their power to hire as many mid-levels as possible to drive down THEIR costs and drive up their profits through bulk. Heck, in one sense, given that many of Walmart's Associates rely on medicaid for their medical and dental services already, they've got a patient base in their stores already. Almost makes me wonder if Walmart might actull see an INCREASE in THEIR dental care costs fo its employees if they end up having to subsidize "Walmart Dental" to the real extent that it might need to be done to make it affordable for their employees and (atleast from my personal experience treating many (currently on medicaid) Walmart Associates, their extensive dental needs??)
 
Let's think about this from the Walmart perspective, where they use their massive "muscles" to acquire their merchandise for the bare minimum from their suppliers.
And because of these huge savings, big corporations like Walmart have no problem spending big bucks to hire the brightest, fastest, and most efficient managing dentists (and office managers) to help manage the dental offices for them. These managing dentists are capable of handling a variety of procedures quickly and, at the same time, avoid getting a lot of complaints from the patients. These managing dentists usually get paid 2-3 times more than the regular associate dentists. There is no reason for Walmart to hire midlevel providers and risk getting a lot of malpractice lawsuits due to substandard of care…or risk losing $$$ from having to redo/repair a lot of bad jobs. Big corporations don’t like lawsuits.
 
sears already has dental offices owned and run by sears. sears and kmart are owned by the same owner. it seems easier for kmart to do this than walmart.
http://www.dentalworks.com/
 
I blame the meatheads who run non-ppo practices and charge ridiculous prices for services. Additionally you have the cockroaches who "game" the PPO and DMO or Medicaid plans and up charge patients for bogus ancillary services so they can "make up the difference" in their fees. I was sitting at a table of doctors during a recent CE conference who were talking about how to squeeze every last penny out of a tooth. They tried to disguise their greed by saying it was in the best interest of the patients by making some pretty lame assumptions about patient behavior. Disgusting.

People bad mouth wal-mart, but then they refuse to go practice in the inner city or out in the rural small towns. Everyone wants to practice in the same upper middle class neighborhoods with offices full of all the dental toys and newest equipment.

They have to charge ridiculous prices for simple procedures so they can afford it all. Example: in-office whitening for $450. Hear about it all the time. Absolute scam when you consider that 99.9% of patients will not detect a difference in shade after a one hour session. But the staff and dentist all gather around the patient and exclaim how "amazing" the teeth now look. Shameless liars.

We, the dentists, need to create some organic supply or else the government and corporate dental offices will create it for us. Example: most dentists in private practice work a reduced week with banker hours, because they deserve a long weekend and time to sleep in. Problem: less hours to see patients or emergencies. Solution: corporations open clinics 7 days a week with expanded hours.

Stupid should hurt.

THIS GUY nails it right on the point..greedy doctors are what turned medicine from an amazing profession to one riddled with so many problems

i hope greedy dentists dont do the same to dentistry
 
THIS GUY nails it right on the point..greedy doctors are what turned medicine from an amazing profession to one riddled with so many problems

i hope greedy dentists dont do the same to dentistry

Greed is relative. Some people think it's egregious to spend $1000 on a tooth when others just view it as a valuable service. What I have found in practice is that no matter what you charge, people think it's too much. $100 to "pull a tooth" man that's expensive, don't you just "grab and 'yank"?

Just think about the poor schleps who graduate with 300k+ in debt, married with 4+ kids. You bet they need to be "greedy" and make 150k+ a year to service their debt and support their families. So when you're new, look like your 16 years old and trying to convince people to sit in your chair it's a real challenge.

Signing up for PPOs, DHMOs, contracts for corporate groups guaranteeing 150k all look pretty tempting. You most certainly can't blame them unless you've been in a similar situation. Hence the problem with politicians.
 
Greed is relative. Some people think it's egregious to spend $1000 on a tooth when others just view it as a valuable service. What I have found in practice is that no matter what you charge, people think it's too much. $100 to "pull a tooth" man that's expensive, don't you just "grab and 'yank"?

Just think about the poor schleps who graduate with 300k+ in debt, married with 4+ kids. You bet they need to be "greedy" and make 150k+ a year to service their debt and support their families. So when you're new, look like your 16 years old and trying to convince people to sit in your chair it's a real challenge.

Signing up for PPOs, DHMOs, contracts for corporate groups guaranteeing 150k all look pretty tempting. You most certainly can't blame them unless you've been in a similar situation. Hence the problem with politicians.

The basic ability to be "greedy" (i.e. set your own prices based on what YOU feel is appropriate for your time and services) IMHO is much better than NOT having the ability to charge what you feel is appropriate for your time and services! Just ask a large swath of our medical colleagues how they feel about the like of pricing autonomy that they have
 
I still see a fair amount of fear in this thread; fear of what "they" are going to inevitably do to "us". It's not that way anymore, not at all. There is cause for dentists to be supremely confident, and not to give in to any outside forces! And yes legislation and litigation have their role, but the main thing is what we do ourelves, in our own practices. Drip, drip, drip- after a time, you have an ocean. I'm reposting here from my blog:


Things Have Changed: Connection Trumps Advertising

We've done some advertising... and much of it fails. Some works, much fails. That's how the world has changed, and really it's probably a good thing. As Seth Godin points out in several of his books, particularly in The Purple Cow and Tribes, media has exploded and consumers have never been more distracted, overloaded, selfish and less inclined to look at ads of any sort. The effect is compounded by the fact that, as advertising becomes less effective all the time, many marketers feel it necessary to yell at us louder and louder in more and more intrusive ways until we break.

Except we won't.

Still, as I frequently interact with young dentists, through teaching in my former residency and other venues, and occasionally check what's going on in an online forum, I see a great deal of concern, bordering on fear, of corporate dentistry. Walmart may even get involved in retail teeth. On another end of the spectrum, some folks are mightily impressed by the dental practice that advertises heavily, and seems to be making a huge gross. That situation is often that one owner doctor has a legion of poorly paid associate dentists and even less compensated staff. It's the factory model of business. And the ad copy almost always reads like this: "Look at me! I do the prettiest veneers in town! You NEED veneers, you know. So lookatme-lookatme-lookatmeeeeeee!"

Is this what the modern consumer wants from a medical experience? Some folks are lagging behind, it's true, but many people have had a long hard look into The Abyss of our highly uncertain economy. We've lost retirement funds, jobs, even houses. To the extent that we have disposable income, we are looking for two vital things: Certainty, and Connection. Simple, honest, true human Connection.

A fun pair of examples happened the other day. One patient, in for his six month recall, told me he had taken a leave of absence from work and was going back to South Africa for a few months, to be with family for a more extended time than usual. Having had a number of professors in school from South Africa, a number of whom are now esteemed colleagues, I've always held an interest in the place. So I asked, "Where?" At the same time, I put up Google Maps on our operatory computer and we chatted briefly about the climate, culture, and food of his homeland. He was so pleased that I took an interest in his background, and I was glad to know more about a place I was always interested in but have never visited.

Just a bit later that day another patient told me how she was going back to Greece "for a month this year; I'm old enough where a week isn't enough anymore!" Oh, man, that was cute. And we looked at maps yet again; she was delighted that I showed her her hometown; we even found her family house! We both remarked how even in small villages, the houses all look new; there must be a lot of new construction even in this most ancient of cultures. I demonstrated how easy it is to find famous buildings like The Parthenon by satellite if you know where to look; I do believe that I've started my patient on a new hobby.

Of course, many of our interactions with patients are far more medically relevant than connecting over hometowns, as fun as that is. Over the years we've frequently noticed something amiss in a patient's health and have pointed many patients towards seeking a medical diagnosis early in the progression of some disease process. At times, this has saved them untold difficulty. We've managed early referral for diabetes diagnosis far more than once, for example. This vigilance leverages the fact that some people come in to us at six month intervals like clockwork, but may not have seen an internal medicine doctor or a dermatologist or an opthamologist in a very long time. It also leverages the fact that many dentists listen to their patients for longer intervals of time than some of the hyper-busy M.D.'s in our health care system do.

And that's an interesting point. I've heard stories and seen stats on how little doctors listen to their patients these days, and how poor a medical visit can be from a "customer service" perspective. Yet in my own recent experiences, as well as those of family, I find the opposite to be true. My internist listens and chats and makes sure that things are going well for me. My dermatologist recently removed something rather dangerous from my skin and explained things beautifully. After a single kidney stone caused me unreasonable pain and trouble two years ago, I see a urologist who helps me prevent such occurrences in future and, again, he and his whole practice make me feel like the most special patient in the world every time I go.

Anyone reading this post has probably had both kinds of medical experiences, the superb and the unsatisfying, if not downright dangerous, ones.

We now live in an era of incredible choice. If there's a job to do, you can always get more than one person to do it for you, in fact there are probably hundreds of choices. There is really no reason to remain with dental or medical practices that treat us poorly when, all across the United States, there are dentists and doctors who care, who listen, and who provide Certainty and Connection for their treasured patients.

Once you meet them, you can tell who they are. And it has nothing to do with those ads. An ad isn't necessarily a sign of trouble, far from it. An ad might point you towards a wonderful practice. It may point out some valuable product or service that will benefit you greatly. We have a current ad that brings attention to our In-House dental insurance program, which is meant to increase affordability of dental care, especially preventive care, in these tough economic times. So far, it has been universally well recieved.

What I wish to say is that an ad backed up by Connection and meaningful interactions when it comes to your health is a valuable arrow that can point you to something beneficial. And an ad that screams "Me! Me! Me!" about the advertiser has very nearly become a signal to stay away from that entity entirely.

I'd like to close with a blog post from Seth Godin; I view it as highly important and thought-provoking:

http://sethgodin.typepad.com/seths_blog/2011/04/why-you-might-be-in-favor-of-transparency.html
 
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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! :)

Commercial optometry is creeping up and is taking over the profession. They offer full time 105k salaries and benefits for us while private practices cannot compete with that. People come in with their shopping carts, get their eyes refracted, get dilated to check for retinal diseases and then the optometrists get yelled at because the patients can't see where they are going and don't buy more things. Also if the patient doesn't buy glasses from the optical dispensary owned by walmart the optometrist is let go. True the optometrist owns the lease but all these doofcakes going into optometry school and coming out with 150k-250k of debt have no other choice but to do commercial.
 
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