Corporate dentistry,Obamacare, and Midlevel providers/dental therapists

Nov 5, 2011
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I've asked multiple panels of different dentists about these topics, and no one has ever given me a clear answer, though I'm getting pretty strong hints these are all bad things. Can anyone edify me on the subject please?

Also, any other controversies in dentistry that I'm not aware of?!
 
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Jun 15, 2011
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I've asked multiple panels of different dentists about these topics, and no one has ever given me a clear answer, though I'm getting pretty strong hints these are all bad things. Can anyone edify me on the subject please?

Also, any other controversies in dentistry that I'm not aware of?!
Dental therapists:

Any arguments against 'dental' therapists are as good as dead in the water because anyone who argues against them is going to be accused of 'racism', 'elitism', etc.

And because the contemporary american culture is now steeped in ignorance regarding the proper roles and responsibilities the first world has in maintaining its status (including in order to provide first world service to the third world)...its now a losing battle on all fronts to maintain the highest standards and quality of care.

Research into the topic here on this forum. Type dental therapists in to the search function. There is at least one really, really informative thread which has been recently getting bumped (in the dental forum-> dental section)
 

yappy

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This guy has a point, heh. Some CT physician assistant killed a pt today at the hospital I work at... blatant ignorance per the attending physician.

It's true that today in society we like to pretend that everyone has around the same level of knowledge or abilities despite education, worth ethic, or skill. It's sad. I am confident; though, that the pendulum will swing back in time.

"The age of philosophy has passed...that of utility has commenced..." ~Yale Orator 1884

Dental therapists:

Any arguments against 'dental' therapists are as good as dead in the water because anyone who argues against them is going to be accused of 'racism', 'elitism', etc.

And because the contemporary american culture is now steeped in ignorance regarding the proper roles and responsibilities the first world has in maintaining its status (including in order to provide first world service to the third world)...its now a losing battle on all fronts to maintain the highest standards and quality of care.

Research into the topic here on this forum. Type dental therapists in to the search function. There is at least one really, really informative thread which has been recently getting bumped (in the dental forum-> dental section)
 
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DentinBond

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I've asked multiple panels of different dentists about these topics, and no one has ever given me a clear answer, though I'm getting pretty strong hints these are all bad things. Can anyone edify me on the subject please?
Corporate dentistry

Corporate dentistry is doomed to be relegated to a small slice of the pie in the U.S.

Corporations-- and the many small businesses that foolishly strive to emulate them-- have treated people as interchangeable, temporary and disposable for a very long time now. By this I mean both employees and customers. As the Internet creates the connection economy, and as other social changes continue to upend our culture, people are looking for something more than average products and services. We wish to be delighted. We want our problems solved. And we are looking for certainty in our business dealings and, above all else. for simple human connection.

Seth Godin explains eloquently:
http://sethgodin.typepad.com/seths_blog/2013/02/scarcity-and-abundance-in-the-digital-age.html

Corporations are legal instruments that are designed for one overriding purpose-- to maximize profits for their shareholders. Everything else is secondary, and they are forced to remain singlemindedly, in fact, pathologically, focused on this goal. For example, if a CEO of a major oil company decided not to drill in a part of Alaska because drilling for oil would destroy the local environment and would wreck the lives and culture of indigenous people, well then that CEO would be summarily fired and they'd find someone else to drill. Corporate dental practices "race to the bottom" on cost. They often over-treat (we hear so many stories of unnecessary endodontics, more than anything else!), they skimp on labs and materials, and they fire doctors who don't meet performance metrics that have everything to do with production and nothing to do with solving problems for real human beings.

An excellent resource on understanding corporations is Joel Bakan's The Corporation.

Yet I'm exceedingly glad we have corporations, and don't mean to sound anti-corporate. They are the only way (so far) to amass enough human and financial capital to build roads and hospitals and airports and create complex new technology. Most of our dental equipment, instruments, and materials are created and produced by corporations. Medical devices and pharmaceuticals created by corporations have saved my life twice and my sight once. They just have flaws, and unless or until those flaws are corrected by reforms, we can know they will behave in a certain way.

And the bottom line is, dental practice corporations do not understand, are not interested in, and at any rate cannot afford to provide certainty and human connection to their patients. They're too busy being involved in a race to the bottom on cost to do these things. (And as you can imagine, the problem with a race to the bottom is that you might win.)

Well-- you must not go bottom-racing. You can provide connection and certainty for your patients. And thus you can race to the top. This is how we in the profession of dentistry will win out over the corporate practice model.

Some readers will say oh no, there are people going to these commodity practices in droves. They choose based on cost and that's it.

Of course there are such people. See my profile pic here? It's the Diffusion of Innovations curve. This is a huge and immensely useful body of research that goes back to at least the 1940's. Everett Rogers is the icon of the field. There's a brief intro here for those who are interested:
http://www.stanford.edu/class/symbsys205/Diffusion%20of%20Innovations.htm

Generally speaking, the patients who choose corporate dental practices, and who choose on cost alone, are the Late Majority and Laggards.

At this point in the trajectory of our culture, Innovators and Early Adopters have long since decided that they want to be treated right, that they deserve to be delighted in their business experiences and they most certainly want their problems solved. And, students and young dentists, you want to reach the large meaty slice that is the Early Majority, yes. They are a larger group than the Early Adopters by far. But you don't even have to reach them directly. They are looking for affirmation in their decisions from the Early Adopters. All you have to do is reach a number of Innovators and Early Adopters and the notion of your practice as a great place to come to will spread. Focus your efforts on the Early Adopters and Innovators.

Furthermore, we live in a wondrous time. Nowadays, even the Late Majority (and, gasp, some Laggards!) get sick and tired of being abused by uncaring businesses and decide they want the best for themselves. They often decide to come to you-- eventually. You have to be patient!

We've also been trained by corporate advertising that all we need to do is advertise and people will buy from us right away. That's not true anymore. Sorry, but I didn't make the rules. Here's what's changed-- success will come to you from sustained effort, and emotional labor is more important than media spend.

I thnk that's an excellent thing, but it doesn't matter what I think because that's just the way it is now. You'd better get used to it.

So that's how we fight corporate dentistry. By providing the two things that corporate can never ever provide-- connection and certainty. And by building trust over time and by respecting the (finite) attention of our patients.

Some further thoughts here. I hope this lights a few fires. Dentistry will go all corporate if enough people in our field fail to understand these issues. We need you. We need you to be strong.

http://rickwilsondmd.typepad.com/rick_wilson_dmds_blog/2012/12/a-bespoke-business.html

http://rickwilsondmd.typepad.com/rick_wilson_dmds_blog/2012/09/the-race-to-the-top.html

http://rickwilsondmd.typepad.com/rick_wilson_dmds_blog/2012/07/corporate-dentistry.html
 
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+1 :thumbup: A very interesting post. Let me sum up my response with I WISH (the majority would get what you are saying).

Corporate dentistry

Corporate dentistry is doomed to be relegated to a small slice of the pie in the U.S.

Corporations-- and the many small businesses that foolishly strive to emulate them-- have treated people as interchangeable, temporary and disposable for a very long time now. By this I mean both employees and customers. As the Internet creates the connection economy, and as other social changes continue to upend our culture, people are looking for something more than average products and services. We wish to be delighted. We want our problems solved. And we are looking for certainty in our business dealings and, above all else. for simple human connection...

...And the bottom line is, dental practice corporations do not understand, are not interested in, and at any rate cannot afford to provide certainty and human connection to their patients. They're too busy being involved in a race to the bottom on cost to do these things. (And as you can imagine, the problem with a race to the bottom is that you might win.)...

...So that's how we fight corporate dentistry. By providing the two things that corporate can never ever provide-- connection and certainty. And by building trust over time and by respecting the (finite) attention of our patients..."
^^ Personally, the way the moral wind is blowing (immoral that is) I'm not going to hold my breath for the average person to figure this out (dentist or layman). I would've liked to have hoped to several years ago. Unfortunately the movie Idiocracy has proved far too prescient in regards to the average joe's mindest these days. We are living in an increasingly Lord of the Flies like milieu.

Based on trajectories the 'race to the bottom' will merely increase in speed. The whole thing has got to crash and burn so that the average person will figure it out. Human nature is really weird that way. Most people are going to wait until its too late and it will be too late at that point.

The good news is that the sooner the whole race to the bottom thing collapses in on itself the quicker the rest of us can rebuild from the ashes. Thus, I am wishing for total implosion sooner rather than later. Probably won't be in any of our lifetimes though.

Far too many obama voters for any viable hope at this point. *shakes head and walks away*
 
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DentinBond

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Well, Bobby Fischer, you describe the Late Majority and Laggards beautifully. ;}

But there's so much more. Even right now.

I suggest you all read, during the clinical years of the second half of dental school:
Seth Godin: Linchpin and/or his new The Icarus Deception, and perhaps Tribes
Tribes is a really cool book for a dentist to read and apply to her practice.
Chris Anderson: The Long Tail
Joel Bakan: The Corporation

And Seth's blog is:
http://sethgodin.typepad.com/
If you read it for a time, not just for a day or two but read each day for a few months, it will empower you.

Focus on the Innovators and Early Adopters though. The Early Majority turns to them for affirmation and guidance. And the Late Majority waits until most of their peers are doing something before coming aboard with whatever it is. It's inefficient to focus on them as you grow your practice and take a stand against corporate, and it's a waste of effort to worry about the "average person" not getting it. They will. Be patient. And you don't have to single-handedly struggle to convince them. The Early Adopters will do it for you.

Recognize and seek out Opinion Leaders (who tend to be Early Adopters & Early Majority), and then delight them and solve their problems. The more interesting the problem, the better. (Physical pain like endo, esthetic pain like fractured or crowded anterior teeth.) Provide certainty in their dealings with you and your staff, and provide connection. Real connection, nothing systematized or faked.

The whole average-stuff-for-average-people marketing-industrial complex has already been imploding for about a decade. Why do you think the economy really fell apart in 2008?

Ride the wave!
 

yappy

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Bond.

I love most your posts - but I cringe that you mentioned Chris Anderson. Don't you find that he is such a light weight with an obvious agenda (promoting his own financial interests). The reason he's so anti-IP is because he doesn't hold any IP and is not innovative to come up with any.

He's the definition of technologist - a late adapter who stands on the shoulders of real innovators (scientists) and hopes to cash out. That's why he's anti IP and anti science.
 

DentinBond

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Bond.

I love most your posts - but I cringe that you mentioned Chris Anderson. Don't you find that he is such a light weight with an obvious agenda (promoting his own financial interests).
Perhaps so, Yappy. Yet Anderson was (so far as I know; Seth gives him credit for it) the first to elucidate for us the concept of the Long Tail, which is fantastically useful. To dentists, I might add.

Haha you remind me of an argument between two friends, in a bar, back when I was in D-school. My wife and I were at the table and would have happily paid for tickets to this. Friend 1 (a med student) said he couldn't enjoy the music of any musician he didn't like as a person, because he couldn't separate the person from the music. Friend 2 (a superb musician) said that's crazy, we should enjoy the music for what it is.

Methinks it will take yet more beer to solve that particular conundrum...
 
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Seth Godin is awesome.

I average 1 business, marketing, management etc book every 2 weeks. Thank you med school.

Seth's make me the most excited about one day opening my own practice. To create something special for myself, my employees, my patients, and my referrals.
 

goffdent

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^^ Personally, the way the moral wind is blowing (immoral that is) I'm not going to hold my breath for the average person to figure this out (dentist or layman). I would've liked to have hoped to several years ago. Unfortunately the movie Idiocracy has proved far too prescient in regards to the average joe's mindest these days. We are living in an increasingly Lord of the Flies like milieu.

*
BRAWNDO..... It has what your body needs.. It has electrolytes!!
 

DentinBond

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Does anyone yet understand the Affordable Care Act?

There are provisions that should end up being positive, from a consumer standpoint:

A new Patient's Bill of Rights goes into effect, protecting consumers from the worst abuses of the insurance industry.
The law provides for where consumers can compare health insurance coverage options and pick the coverage that works for them.
Prohibiting Denying Coverage of Children Based on Pre-Existing Conditions.
Prohibiting Insurance Companies from Rescinding Coverage.
Providing Small Business Health Insurance Tax Credits.
Cracking Down on Health Care Fraud.
Prohibiting Discrimination Due to Pre-Existing Conditions or Gender.
Increasing the Small Business Tax Credit. The credit is up to 50% of the employer's contribution to provide health insurance for employees.

But then the fines for failing to provide health insurance coverage options for employees are draconian and could cripple a small business like a dental practice.
And that 2.3% excise tax on medical equipment-- it punishes innovation and adoption of high-tech equipment and processes! Plus, while the IRS seems to have ruled that the 2.3% excise tax does not apply to dental lab bills, it does without a doubt apply to the materials that the labs must purchase in order to make a restoration of any kind. And they've already started passing that cost on to us, as expected.
And we all know there will be higher taxes and more paperwork in some way or another. There are always higher taxes and more paperwork when the federal government mandates something big and complex...

The best place I've seen to explore the specific effects of all this on dentistry are the McGill Newsletter:
http://www.mcgillhillgroup.com/newsletter.asp
It's really worth subscribing to.

One succinct place to read the provisions of the Affordable Care Act, some of which are copied above, is here:
http://www.healthcare.gov/law/timeline/full.html

And this law is, as all laws are, intentionally vague. Many specific applications will be decided going forward by IRS cases and the courts.

The Affordable Care Act is rather like a cookie jar that's filled with an equal number of cookies and razor blades. If you stick your hand in, you never know if you're gonna get a treat or...
 
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