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Commercialization of Dentistry?

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JackedDiezel

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I was just thinking...If it can happen to optometry and pharmacy, whose to say in 20 years Walmart wouldn't start hiring dentists, and eventually Private Practice Dentistry will disappear. Now only about 25% of Optometrists are in private practice and a good amount pharmacists work in retail. So as a question I ask Can Dentistry be threatened by commercialization?

EDIT: Does anyone know which states have Laws that say only Dentists can only Dental Practices, Texas is one and New York is another. Are there anymore?
 
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The Hammer

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Eventually probably. There are already different "franchise" dental clinics like Monarch, Aspen etc. The reason that dentistry hasn't been done by a big store like Wal-Mart is because at the moment the overhead of a dental office is still too high for them to take much interest in. Even with a company like Wal-Marts buying power the fixed overhead of a clinic would still run 50% or more and a dental clinic is still dentist intensive. What I mean by that is that there are still too many procedures that only a dentist can do (extractions, restoration etc). I have a feeling however that once mid-level providers become more prevalent you will start to see this kind of commercialization of the dental clinics.
 

johncusack

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I was just thinking...If it can happen to optometry and pharmacy, whose to say in 20 years Walmart wouldn't start hiring dentists, and eventually Private Practice Dentistry will disappear. Now only about 25% of Optometrists are in private practice and a good amount pharmacists work in retail. So as a question I ask Can Dentistry be threatened by commercialization?

Another thing to keep in mind is that now you are starting to have parity between men and women in dental school admissions it is only a matter of time before this happens. In general, Women are more likely to want to be an employee than a man (although this too is changing as men do not want added work either because of lifestyle).

When you were until very recently (compared to medicine) a career of all males you had a good chance of holding out. Now the question is, will it be Wal Mart or other local dentists who take advantage of this new flux of people who don't want the extra hours and responsibility of owning a business.
 

The Anhedonia

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I really hate Walmart

it's ironic. i used to be a civil engineer, and my company was a regional designer of walmarts. though it wasn't specifically a reason why i left, it did feel good to say that i no longer worked for "the man" or "the big W".

Now it seems like i can't get away.......
 

JackedDiezel

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I don't want to be the prophet of doom here but....First small businesses, now I feel like Walmart will eventually turn all healthcare from private practices to cooperate ******.
 

The Anhedonia

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??? This is just an article about how to choose a dentist.



exactly. do you go to wal-mart to get medical/dental advice on how to find a practitioner? that's just kind of ...weird to me. why do you think they provide this kind of information? i interpret it as wal-mart trying to broaden it's services. no other grocery chain offers this kind of advice.
 

jay47

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I was just thinking...If it can happen to optometry and pharmacy, whose to say in 20 years Walmart wouldn't start hiring dentists, and eventually Private Practice Dentistry will disappear. Now only about 25% of Optometrists are in private practice and a good amount pharmacists work in retail. So as a question I ask Can Dentistry be threatened by commercialization?

EDIT: Does anyone know which states have Laws that say only Dentists can only Dental Practices, Texas is one and New York is another. Are there anymore?

It doesn't really matter anyways. You can get around this "law" using lucrative business contracts between you and a "dental consultant". I don't see why Wal-Mart would not be able to also take advantage of this loophole.....
In addition, why would WalMart just have to "own" the practice? I mean, cound't they "rent" out offices to dentists within their stores and just charge them fees to run the office?
 

HupHolland

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We learned in our law class that a "corporation" cannot manage a dental practice; only a dentist can. Therefore, wal-mart can't set up a dental practice in its store and hire staff dentists. They would have to find a 3rd party (i.e. a dentist) to rent out space in the store and the run the office. This isn't far fetched, but should calm a few of you down that believe wal-mart has the ability to single handedly set up in store dental operatories.

Hup
 

mike3kgt

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We learned in our law class that a "corporation" cannot manage a dental practice; only a dentist can. Therefore, wal-mart can't set up a dental practice in its store and hire staff dentists. They would have to find a 3rd party (i.e. a dentist) to rent out space in the store and the run the office. This isn't far fetched, but should calm a few of you down that believe wal-mart has the ability to single handedly set up in store dental operatories.

Hup

Said like a dental student. I have seen (and worked) in places where they had a "dentist owner" who actually was a shareholder and a "name" but the practices were actually owned by non-dentists. Even though at Walmart it says "Dr X, OD", the optometry practice is still owned by Wal-Mart (either directly or indirectly).

While I don't think Walmart will run a "dental practice", I can see them running a "Wal-Mart Dental Hygiene." Independent hygiene and mid-level practitioners will speed this along. If you don't think it's possible (or rapidly on it's way) you are fooling yourself. You can stop and get a cleaning and some whitening while you shop for Totino's pizza-in-a-box and pick up your new set of all-season floor mats. Sounds like the place I'd like to be!

This article just came out today on drbicuspid.com (link):

--------

Dental clinics proposed for large retail outlets
By Laird Harrison
Senior Editor
November 18, 2009

"Honey, I'm headed over to Wal-Mart to get dish detergent and garbage bags -- and have my teeth cleaned."

You're likely to hear remarks like this all the time if the vision of the California HealthCare Foundation comes true. The foundation this month released a study analyzing the feasibility of putting dental clinics, staffed by dental hygienists, in retail stores.

“I think it's a fantastic idea.”
— Lydia Jolie, R.D.H., vice president
of the California Dental Hygienists
Association

Though focused on California, the report suggests the idea might work as well, or better, in other states.

"As we have explored the challenges for many citizens, we thought there might be an interest in retail clinics," said Senior Program Officer Len Finocchio, Dr.P.H.

The report's author, consultant Mary Kate Scott, concluded that the clinics could provide oral care to people not currently getting enough such care, and that the clinics could pay for themselves -- as long as they didn't have to rely on the low reimbursement Medicaid provides for dental services in most states.

But making them work would depend on the support of a dentist, or a change in the scope of practice for hygienists in most states.

Filling a need

The foundation became interested in the idea because so many people in the U.S. are not getting the oral care they need. Scott cited statistics from the Health Resources and Services Administration, which found that 49 million Americans -- one in six -- live in an area lacking adequate dental services.

Even in places with plenty of dentists, some people -- particularly in rural areas -- lack transportation to get to appointments. Others can't afford the cost of dentistry. In California, Scott conducted three surveys with 275-537 respondents and margins of error of 3%-4%. She found that only half of Californians with insurance, and a quarter of those without, had been to the dentist in the past six months.

Retail dental clinics might help address these problems by offering, quick, convenient, inexpensive basic dental care. "At a minimum, clinics would have to offer essential diagnostic and preventive care, including screenings for schoolchildren, oral exams, x-rays, cleaning, polishing, fluoride varnish, and sealants," wrote Scott, adding that they could expand to whitening or straightening if there were sufficient demand. Hygienists staffing the clinics would refer patients to dentists for anything more complex.

To make the idea work in most states, new laws would have to be passed to expand hygienists’ duties and independence. In most states, hygienists aren't allowed to diagnose, Scott found, but Alaska, Colorado, and Maine are exceptions, she wrote.

In California, registered dental hygienists in alternative practice can work autonomously in residences with homebound occupants, schools, residential facilities, hospitals, and dental health professional shortage areas. Lygia Joley, RDH, vice president of the California Dental Hygienists’ Association, said the law would have to be changed to allow hygienists to operate the type of clinic envisioned in the report.

"I think it's a fantastic idea," she said, adding that additional education should be required if hygienists' scope of practice is expanded.

Another potential obstacle are laws in some states that prohibit ownership of a dental practice by anyone other than a dentist.

Asked to comment, an ADA spokesperson said the organization would issue a statement in the future.

Dollars and sense

The inspiration for dental retail clinics comes from existing retail healthcare clinics in drug, grocery, and big box stores. They offer a list of services with fixed prices for patients who pay in cash, and a list of acceptable insurers and related copayments.

Such clinics are becoming more common, Scott writes, with some 1,200 clinics in 36 states visited by almost 3.4 million Americans a year. She cited a previous survey by the foundation that found that the top eight out of the 10 most common medical procedures for which Medicaid pays in California are preventive or diagnositic.

Her own survey found that 44% of Californians would be very likely to use a retail dental clinic, while another 21% were open to the idea, with only 36% rejecting it. Among those with household incomes of less than $35,000, 61% said they would very likely use such a clinic.

The clinics could also succeed financially, according to Scott. She calculated the cost per hour to operate would be $48: $41 in operating expenses and $7 in amortized capital costs. Since the median national reimbursement rate under Medicaid is $22.74, the clinics could not be self-sustaining unless they also attract patients who paid out of pocket or through private insurance. (If you want to play with the figures, you can download her spreadsheet.)

But all this depends on retailers' willingness to provide space. The proposition might only be attractive if they believe they could sell products to the clinic patients, Scott wrote, and selling toothpaste and floss is less lucrative than the prescription drugs that a drugstore can sell to patients at a retail medical clinic.

Still, she concluded, stores might be interested in hosting clinics in areas where dental services are hard to come by and retail customers are relatively few. In these places, every visit by a patient could be valuable to the store.
 

HupHolland

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Mike,

Hence, why I said that it isn't far-fetched.

Hup
 

JackedDiezel

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I don't know whats sadder...The fact that Doctors are being burdened with malpractice, rising costs, competition from mid-level providers, or the fact that corporations are now trying to use healthcare to make big bucks for themselves and turn Dentists into nothing more than employees that can easily be replaced
 

jay47

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"The foundation became interested in the idea because so many people in the U.S. are not getting the oral care they need. Scott cited statistics from the Health Resources and Services Administration, which found that 49 million Americans -- one in six -- live in an area lacking adequate dental services"

I know what I find saddest; it's that no matter what you do, people will still neglect their teeth. It's said that 75% of Americans have gingivitis. I find that completely inexcusable. Spend 10 minutes a day, brushing, flossing and drinking just a little water and 99% of oral healthcare problems will not occur.

I have become disillusioned by universal healthcare. Until Americans start taking better care of themselves, teeth and body included, it is just not possible to fix something that does not want to mend itself. Teeth, more than many other healthcare problems, are easy to take care of and I would encourage everyone to really try to get their patients to have better oral hygeine. Even in clinic, I sit down and talk with the patients about this stuff, and I don't even know what a class "X" prep is half the time. It's really so easy, a child can do it (yes, when taught properly).
 

stdmufin27

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Brother, like 75% of the people you see in clinic have horrible teeth when they come to the school. Go ahead and give those people oral hygiene instruction because for the most part they simply had nothing to do with it for a very long time.
 

mike3kgt

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It's said that 75% of Americans have gingivitis. I find that completely inexcusable. Spend 10 minutes a day, brushing, flossing and drinking just a little water and 99% of oral healthcare problems will not occur.

I am a believer in that 100% of people have some level of gingivitis or higher. The only time you can find no evidence of gingivitis is in a laboratory.

Everybody needs continuous OHI and motivation on a personal level. The problem is not always the knowledge but the ownership of their condition that imparts those to use the knowledge.

Ever get the "wow, nobody has ever told me this before, thanks!" and then next time they come in, their OH is still terrible? It's because they have heard it before but did not listen or simply did not care. The real rewarding scenario happens when you get the "wow, I know I've heard this before but never really thought of the importance of hygiene!" and next time they come in with zero plaque and beautiful tissues.

Sometimes all it takes is a diagnosis of the first carious tooth in an anal-retentive person with a normally perfect mouth or the diagnosis of periodontal disease in somebody who just lost their father to cardiovascular disease to create ownership. Maybe all it takes is, "man that cracked tooth just cost me $1,500, maybe I should really wear that nightguard doc made for me!"

Just knowledge alone is not enough, our patients must take responsibility and be accountable for their oral condition. Without addressing patient accountability or responsibility, any oral healthcare reform will be pointless because it's targeting the doctor/staff/system rather than the patient.
 
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