Aspen, Pacific, Metro Dentalcare, Park Dental, or any corporate clinic.

[toyotasupra]

Hi all,

I met with all of the above chains and to be honest, I can’t even make a decision. The vibe I got was production production production. One chain which I will not name, went as far as telling me to survive in this industry I need to upsell and doing more expensive work is better for the patient. Can anyone who works at the above corporate chains share your experience?

I honestly went into dentistry thinking I’d be able to practice veracity, autonomy, justice, nonmalficience, and beneficence — ultimately only treat those who need/want to be treated. But after meeting with several chains and getting “coached” to upsell, told treatment planning outside of dental school is different, and using scare tactics to get patients to agree to treatment... I am sick to my stomach. I feel like a dirty mechanic, used car salesman, or lawyer.

Please share your experiences, hopefully positive ones.

---

Members don't see this ad.

 

[2TH MVR]

1st off .... I'm pretty sure there are plenty of nice privately owned practices that "up sell" also. You do not know what the patient wants until you provide their options. Providing different levels of treatment is the standard. You cannot just offer some treatment you feel is best without making sure the patient has a clear understanding of ALL their options. Kind of like buying a new car. You can buy the stripper model or one loaded with pricey options. Everyone will be different. Nothing unethical here.

But .... if your proposed tx plan doesn't coincide with your Dx ..... not good. i.e patient comes in for routine prophy and is told they need 4 quads of S&RP. Some do. Some are marginal. Some don't.

 

[Vicviper]

**begin rant*

I worked at Pacific, at one of their biggest and busiest offices in the company. Now, I'll start by saying that I came straight out of residency, and so I was slower and more inexperienced being new, but I did not like my time there, and it was just a bad fit. I constantly felt like I was a used car salesman. They didn't like it if I put watches on things, or called things incipient caries - I was told more than once from our treatment coordinator (a non-dentist) that I should just do crowns on some of the ones I was watching. I was told from multiple people that they don't do fillings anymore (just crowns/inlays/onlays), and if I wanted to be successful, I should go that way as well. More than once I had our hygenist "upgrade" with things I would consider ethically grey at best. Every morning we had a huddle with the entire staff where we went over every providers production numbers from the previous day, and people were either praised or shamed in front of the entire office. With that kind of peer pressure, you start to question your diagnosis, and start to think about making ethically grey decisions yourself. I eventually hated going into work every day. Parting ways and working at a community health center was the best decision I've made for my career, and made me start loving dentistry again.

**rant over**

That said... every office is different. A lot of the time it really depends on the owner dentist. My mentor, who I worked under at the community health center, went on to become an owner dentist at a Pacific office, and I don't think he would entirely change his practice and diagnosis philosophy. Bottom line - treatment plan to the patients needs, treatment plan ideal, and give the patient options. Your job as a dentist is to let the patients understand the situation and options, and let them make a decision. You can recommend things, and discuss why something more expensive may be better, and even push for the more expensive option if that is what is in the patient's best interest - there's nothing wrong with that

Also, as 2TH MVR said, corporate does not have the entire market on shady dental practices - private practice has its fair share as well.

 

[Munks]

To echo the above, yes corporate offices tend to be much more forthright (to employees) that they are all about the $$$. But yes it is also true that there are a number of private practice docs that do just the same.. I'm sure you had those one or two (or more) sleazeballs in your dental class.. just imagine those as practice owners.

Like both docs said before me, there is a big difference - one that you will learn in time - between offering the patient multiple treatment plans to fit their goals and budget, verses doing things that are downright overtreatment & unethical (ex: all patients get SRPs, laser tx, arrestin, etc is a very common one). Just personally, I noticed in the years immediately after dental school that lot of the "salesman" feeling comes from dentistry just being plain expensive. For example, even on a patient that really needs a crown, when that crown is $1k+, you have to EDUCATE the patient on why that's the best option and what other options they have... and that EDUCATION conversation can give the feeling of "selling". Kind of hard to describe it in text, but recognizing the difference between these two is something you will learn in practice.

But again to get to your question, yes corporate is all about the $$$, more chance of sleaziness, but if it's your only option then what can ya do. Hope for a good mentor, stay true to your ethics, learn lots, learn the difference between educating & offering options vs upselling, and get what you can out of it.

 

[lemoncurry]

Honestly, you need to think about corporate dentistry as a residency situation where you learn about dentistry in the real world and get faster. You also learn who you are and how much ethically questionable stuff you are willing to put up with. Ultimately, I think most people learn that they don't want to go back to that world once they are done with it (or they are done with you).