DrJeff, What will Dentistry be like in 15 years??

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DrJeff,

First off I just wanted to thank you for your contributions to this forum. You have given everyone sound advice and I always look forward to reading your posts.

I have a question for you. I am applying to Dental School this year. I was wondering what you thought dentistry will look like in 15 years. Do you think managed care will continue to grow in Dentistry like it has in medicine? Obviously, this is a concern to all of us, both pre dents and practicing dentists, but will probably have more impact on us future dentists.

What is being done to stop managed care from taking over Dentistry? And, so far has it been effective?

Also, how do you feel in general about managed care? Do you think it is something I should even worry about? I shadowed a physician for a long time during my undergrad and saw all the s*@t that had to be dealt with when working with HMO's/managed care. It was awful. I mean, essentially they are trying to practice medicine without a licence!!! Who are they to say what or how a patient should be treated. I mean doctors don't go to school 8+ years just to get out and have someone behind a desk tell him/her how to run his/her practice and how to treat his or her patients. I just think managed care cause, or at least promote, healthcare providers to compromise their own "gut feelings" or even ethics on how a patient should be treated in order to ensure quality healthcare to the patient. Isn't that what its all about!!?? Shouldn't the patient's health/wants/needs come first.

Anyway, I just feel very strongly about this. I even took a Law and Medicine class in undergrad, so I have been exposed to some severe cases involving managed care, and it aint pretty.
 
The reason why managed care hasn't penetrated dentistry as much as medicine is because dental cases rarely if ever involve life or death situations. This is not an attack on dentistry. We do provide a service that the public needs. However, I am pointing to the reality of the situation that many dental procedures are not immediately threatening one's life such as a bone marrow transplant or certain antibiotics etc. Also, medicine essentially allowed managed care to infiltrate them. Dentistry has learned the lessons from medicine's battle with managed care and will not allow such penetration from them.
 
Dentoman, interesting read. Well... parts of it. A lot of it bored me to death. :laugh: According to that, though, things are looking up for those interested in perio. I'll have to keep that in mind until I get some actual dental experience under my belt and start thinking about what direction I want to take my career. 😉

Dentalvibe, I also agree that dentistry needs to keep a close eye on how deeply the insurance companies get entrenched. Insurance isn't entirely a bad thing. I'd actually argue that insurance and government programs are the very thing that allowed doctor's salaries to get so outrageously high in the first place. A lot of people would simply not have sought medical services if they had to pay the doctor's fees with their "own" money. But because all of a sudden it was "already payed for", they decided to go ahead and see the doc. The doctors were free to raise their prices without fear of losing business as consumer's were no longer conscious of the costs. It was "already payed for."

It's only now when the 3rd party payers (insurers and government) are trying to get costs down to a more reasonable level that the docs are crying foul. And because dentistry has been out of the loop for all these years, we don't have the bargaining room (already exorbitant fees) that medicine does. The insurance companies are at war with the MDs and dentists are in the perfect position to be the innocent civilian causalties if we're not careful.

BUT... I think even scarier than that is the possibility of socialized healthcare. You'd have a lot of dentists opting to follow their newly found desires to teach highschool - cause it'd probably pay more. 😱 :laugh:
 
Originally posted by Supernumerary
I think even scarier than that is the possibility of socialized healthcare. You'd have a lot of dentists opting to follow their newly found desires to teach highschool - cause it'd probably pay more. 😱 :laugh:
Click to expand...

Canada has socialized medical (not dental) care, and rest assured, physicians and surgeons in this country make a lot more money than teachers and dentists (and remember, the dentists here are ca$h and carry, just like in the US).

It all depends on how the system is set up.
 
I don't see medicine nor dentistry being socialized in this country because it's lobby is too strong. They are already in the works to limit punitive damages on malpractice suits to 500K which would not only lower the cost of health insurance, it would lower the cost of malpractice insurance. This law is already instituted in California and premiums have actually fallen since its inception.

Also consider the legal industry. There have been cries for tort reform for years. If you took public opinion poles, they are heavily skewed toward tort reform. However, there hasn't been limits to lawsuits and other forms of legal abuse in this country like there is in Europe. Why you may ask? Simple, it's because the legal industry's lobbying power on Capitol Hill is incredibly powerfull.

Medicine and health care will never be socialized because their lobby is too powerfull and too influential. Many politicians subside on their influence. That's why I laugh when these fears of socialized medicine arise. Physicians are actually earning higher salaries than they once did. Physician salaries have numerically risen. However, when adjusted for inflation combined with the rising cost of malpractice and paperwork, physician income has actually fallen. But still, people act like doctors who were once earning 200k are now earning 100K. It's more like those physicians were once earning 200K are earinng 220K except they work more hours and do more paperwork for essentially the same salary.
 
There's an exceptional article in <i>Time</i> this week about the healthcare crisis America's weathering right now. I highly recommend it if you can find a copy.

I also happen to agree that dentistry is inherently a lot less vulnerable to managed care than medicine was, and it's largely thanks to the nature of the work. Basically, no medical specialty exists in which irreparable damage can't be relatively easily done. An acquired disability doesn't have to be severe; civil juries hear "irreversible" and start considering how many billions to award the plaintiff. In order to counteract that, insurers have to raise premiums across the board; in effect, the majority of competent physicians are being run out of business by the comparatively few inept ones.

In dentistry, on the other hand, it's harder to do damage that can't be repaired, and adversely impacts quality of life. Miss decay, and you can do a root canal. If you ruin a filling, you can put on a crown. Screw up the crown or root canal, you can extract and do a bridge. Obviously none of those is ideal except for doing the job right the first time, but the point is that it's possible to employ substitute measures. We can do fake teeth; cauterizing someone's gallbladder into charcoal is rather more problematic. Vive la dentistry! :clap:
 
WOW!!

Great replies everyone. And thanks for the link Dentoman.

I am understanding what all of you are saying, and I hope everyone is right. But, how do you explain the infestation of managed care in California and what will keep all the states from becoming like this? Also, I understand that Dentists in private practice can lobby together and all decide not to sign on with managed care companies like Delta Dental (for example). But what keeps these HMO/PPO's from just bypassing dentist all together and opening up their own establishments, hiring their own dentists and staff? If this happened in large # it would definelty be hard for a small private practice to effectively compete with a large, national chain of managed care dental establishments. Right?
 
Right, except...who's going to work for them? Nobody's going to leave private practice without a hell of a motivating influence, and as enticing as managed care salaries and bureaucracy sound...I think I'll stick with running my own office once I'm out 😉
 
Yes aphitis I agree....

But, the problem is effectively competing with managed care once they start acquiring a "monopoly" so to speak with the national customer base. Corporations who sign on with these managed care companies provide their employees with dental coverage granted they choose a member dentist. This is essentially what happened to medicine and I still don't see how we can stop it from happening to dentistry. Yes, I understand dentistry and medicine are different in the sense that dentistry is primarily elective healthcare, but I still worry about the future of managed care in dentistry

Is there anyone out there that can shine a light on this subject? Anyone work with dental managed care on a daily basis?
 
The company that I work for offers two dental plans. One is the traditional "choose your own dentist" with built in incentives to use "preferred providers" and the other is an HMO type. The HMO offers real bargains on some procedures such as orthodontic services, but the vast majority of employees still opt for the traditional plan. Some of the concerns I have heard expressed by those who tried the HMO plan but returned to the traditional plan are: 1: There seems to be a high turnover of staff dentists who tend to be young and apparently soon choose to move on to other opportunites. 2: The dentists often express frustration to their assistants about the lack of optimal equipment and materials when performing certain procedures. 3: A factory atmosphere (glorified dental school clinic).

So, it would seem to me that most people still find significant value in the intangibles that are offered by private practitioners. While on the other hand some folks (a small minority at this point in time ) are content to go where they can get the work done for what they project to be the best price (dental school clinics do have long term patients who are not financially stressed for example).
 
Yes aphitis I agree....

But, the problem is effectively competing with managed care once they start acquiring a "monopoly" so to speak with the national customer base. Corporations who sign on with these managed care companies provide their employees with dental coverage granted they choose a member dentist. This is essentially what happened to medicine and I still don't see how we can stop it from happening to dentistry. Yes, I understand dentistry and medicine are different in the sense that dentistry is primarily elective healthcare, but I still worry about the future of managed care in dentistry

Is there anyone out there that can shine a light on this subject? Anyone work with dental managed care on a daily basis?
Click to expand...

You still didn't understand what aphitis was trying to say. Managed care does not operate independently of dentists. How is managed care going to acquire a monopoly if dentists refuse to work for them? Before managed care can establish a monopoly, they need to be able to hire a plethora of dentists who will offer their services.

You see with managed care in medicine, physicians and hospitals gladly signed up to work with them. In principal the idea was great. Back in the day, managed care was ideal because it allowed more people access to care. From a financial situation, doctors were thrilled with the idea of managed care because it meant they could enlarge their patient base. What ended up happening is that managed care started dictating how physicians should practice medicine. They started setting limits etc. You know the rest of the story.

As others have indicated, dentists have been exposed to the predicament resulting from manged care. Unlike physicians, they had the luxury of observing the long term effects of managed care. Thus, they are not going to allow themselves to taken over as easily.
 
Another major reason that dental managed care hasn't been as popular is the economics of it. HMOs represent a very large savings to corporations when instituted across all of their employees. As we all know, companies love to do anything they can to cut the costs of labor. Thus, they enroll their workforces in cut rate HMO programs that basically practice medicine without a license. Patients are happy (or at least THINK they are) because they are paying less. Many do not realize the substandard care that they receive until they really need to rely on it. A HMO may save someone a ton of money over an indemnity plan, and they are willing to make the sacrifice of quality care and freedom of choice for this savings.

Dental benefits, on the other hand, simply do not cost enough money to make it be worth it to scrimp. Even the most cut-rate DMO may only save a company or employee a few bucks a month, and this just isn't worth the hassle of actually finding a dentist who will see you sometime in the next 8-10 months when you have a toothache. For companies, it is a much cheaper concession to unions and employees than an indemnity medical plan. For individuals, many have a heck of a time just finding time with a dentist on a cash basis, let alone with a shady DMO. Relative to medical insurance, going all out on a top-notch dental plan is chicken feed.

Not only that, but dentistry is centralized, in that the ADA is one of the most powerful professional organizations in America, and it is also decentralized, because most are sole proprietors. This makes it difficult to reign in. The elective nature of many procedures also makes dental insurance a monster hassle for companies who don't want to haggle over what is "necessary" and what isn't.
 
If you don't think the managed care gonna be a threat to the near future of dentistry then you should think again. Many dentists try to move out of California, Florida, Washington State, and etc. to avoid the managed care. But it's gonna be out of luck. Because the managed care is rampant everywhere. Only a few places that the managed care is still under control. But it's NOT gonna be long as more dentists tend to move to those areas. Consequently, competency starts arising in those places. Soon the managed care will rise and dominate those few good ones. And the history will repeat itself. As a result, anyone of us may sooner or later have to face with the managed care. Believe it or not.

One of the major causes that allows the managed care to spread quickly is the expanding of the big dental corporations. Those corporations clinics wherever they go, they open a huge clinics in the areas and takes all kinds of dental managed cares. And they steal away lots of patients from the local private pratices. Soon the local private practices will start taking the managed care because of lacking patients.

Another factor of causing the managed care to dominate is the managed care's AGGRESSIVENESS. Most of the insurance nowadays offers both dental fees for services and the managed care plans to business corporations employees. Employee pays pretty much the same insurance premium. However they tend to pick the managed care plan. Why? Because, the managed care plan allows insurance companies to pay dentists less. So they're able get more profits as the employes pay similar premium regardless of what plans. Because of profits driven, insurance company sends lots of marketing presentatives, sales persons to the company to sell the managed care plans to the employee but not the fee for service plans. And private dentists lose patients. The profits shifts to insurance companies and we, the dentists, work hard for nothings.

What are we going to do stop the managed care? That's not very easy.
 
Exactly the point that I was trying to make LateComer! Eloquently stated.

I love a good debate and everyone has made very informed and intelligent posts. This is a very serious issue and one that we should all think about a great deal. Managed care is changing the Healthcare industry and changing it fast. Those of us going into dentisry and those already in the field need to quit being so naive. I like to be as optimistic as the next guy, but being naive will make us vulnerable. I think manged care has its positives, but the negatives far outweigh them for both the healthcare provider and the patient. Managed Care Corps are in a win-win situation, and are in perfiect position to capitalize. Unless future dentists and current dentists are educated about the threat and network together, there is a good chance managed care will TRY to take over dentistry like they did medicine. Then, all the comforts of being a dentist (autonomy, flexible schedules, attractive income) will be stripped away.

HERE are some websites that I found that might be interesting to read for some.

HERE is an article that trys to explain the economic trends behind the growth of Managed Dental Care

HERE a webpage form a dentist's website trying to explain to his patients why he doesn't accept managed care.

Website that explains the different types of practices/philosophies in regards to managed care.
 
While there is no direct solution to stop the managed care, especially the Dental Health Management Organization (DHMO), any effort from each of us, our colleagues, and associates can make a difference to prevent the managed care from taking over the dentistry as it did in medicine.

At the political organization level, ADA and State Dental Associatons need our supports through the memberships so that they can work for us to lobby against any aggressive legislation proposals from insurance companies and big dental corporations. Additionally, we need them standing for us to take actions to file legal suites against any insurance company that is ripping us off with fee manipulation, under payments, delayed payments, and denied payments. They also help in influencing the federal and state legislators to reserve sufficient annual budgets for the medicaid programs for the poor and underrepresentatives that seek dental cares.

At the local community level, we make all efforts to establish a network of local dentists to drop any insurance company that imposes ridiculous low fees and payments. Stop working for the dental corporation clinics that take all DHMOs, i.e. managed care plans, and provide low standard services to local people. Educate your patients as much as you could before they switching to DHMO coverages. Let the patient knows that they will end up with poor services and substandard cares in corporate clinics because DHMO plans provide no or less reimbursements for them.

Best if we can actually get involved in the ADA or State Dental Associations so that we can directly protect the quality of the dentistry profession from the DHMOs expansion. We want the ADA and the State Dental Associations (SDAs) to launch marketing and advertising ads to educate patients about the naked truth of the low quality dental care of the DHMO plans so that the dental health consumers have a better choice of picking the good plans not the DHMOs plan promoted by the insurance company. Last but not least, we want ADA and SDAs to have state legislators to reevaluate the accreditation of non-US dental schools. Make sure the accredited non-US dental schools provide the equivalent time of training and competency.

As part of being or going to be dentists, if we don't take efforts to stop the aggressions of the managed care, sooner or later, we, and our dentistry profession alike, are becoming the suffering part of it -- the victim of the managed care.
 
While there has been good discussion here, you're all missing the 'pernt'.

It's simply a matter of supply and demand. For example, where do many people dream of going? That's right, California, Florida, etc. So guess what? We have way TOO many dentists in many areas. This is where managed care has a field day.

Here's how it works -- you have too many dentists, so the competition is horrible. You've got dentists with expensive offices and way TOO much time drinking coffee. They're having trouble paying the bills, both at home and at the office.

So this guy from a managed care company knocks on their door. This guy tells the doc, "I can send you a lot of patients, but the fee you'll get will be less than your regular fee". The doc calculates the fee and finds that it might be even less than his calculated overhead, and the doc says, "What, are you crazy?! It would COST me money to see those patients. You've offering me 50 cents on the dollar, but my overhead is 85%. So it would actually COST me money to see these people".

But this slick managed care guy says, "No doc. You don't understand. You are ALREADY paying your overhead, so ANYTHING you bring in is gravy. And don't forget, these people will also refer other patients who are full fee patients -- you'll make a LOT more money."

Well, that seems to make sense to the dentist. So this dentist signs up. This dentist figures that he/she'll spend a lot of time on the regular patients, and move VERY quickly on the managed care patients. No. It just doesn't work that way. The managed care patients start coming in more and more. This dentist starts moving quicker and quicker. The regular patients start to notice the haste of the doc, and they start to find new dentists. So this doc starts to depend more and more on the managed care patients.

Because this geographic area is saturated with dentists, the majority of dentists find themselves needing to join to keep their practices afloat. Then, because of all these dentists participating, the insurance companies are able to sign up more and more patients.

If you think that dentistry will EVER ban together to fight this, no way. Dentists don't see the benefit in that. What they see is late notices from their mortgage company. They see paychecks due that they don't have enough money in the bank to pay. You REALLY think they're gonna ban together against the big bad insurance company?

So this is why California is the hotbead of managed care.

But no, in many, many other areas of the country, there are not enough dentists. So these dentists are booked up for months. Yes, this is true. So why in the world would ANY dentist in these areas sign up for managed care. Those areas are safe for now.

And for a while the ADA was doing a great job of limiting the production of new dentists. So the numbers of dentists was actually going down. But there are now some new schools opening or opened. So who knows! The key is to keep the supply of dentists down. Otherwise, competition will kill the profession.

Rod
 
Well, sort of personal experience. I've seen the area that I used to practice in go VERY managed care, and I've seen exactly how it swallows up practices.

It got to the point of, 'if you can't beat 'em, join 'em', so I tried it. I didn't try to get involved in a big way, but I did see how it works. But around the same time, my wife and I decided to open a practice closer to home anyway. We considered moving our home closer to the original office, but decided we wanted to raise our kids here where we are.

But I sorta get around a lot in dentistry, so as far as 'personal experience', yes, I'd call seeing things first hand like I have to be personal experience.

Some dentists can really make it work -- managed care that is. If you ever visit DentalTown, you'll see posts from our very good friend Mauty. Mauty seems to have mastered managed care. He's mastered the techniques of providing high-speed dentistry, being financially successful at it, and not having to resort to ripping off patients to do it.

But I'd say, again from personal experience, at least here in Southern California, that Mauty is not in the majority. We see the typical 'bait 'n switch' all the time. In fact, when a patient comes in, having just dropped their membership in an HMO, and if they complain about it to me, I ask them if a certain scenario happened to them -- and they look at me in amazement, wondering how in the world I knew. There are certain typical things we hear.

Anyway, no, I do not take any PPOs or HMOs in my practice. Instead I've developed a technique of marketing to the type of patients who do NOT want the 'managed care' level of dentistry, and it keeps me very busy.

Dr. Howard Farran (if you've not heard of him....you will) feels that many dentists miss the boat, and want to go to places where they will have a very tough time with competition. He often talks about the fact that there are many, many areas in this country that NEED dentists. These are places where you can have a FULL practice very quickly -- even the existing dentists in the areas are so full, that they refer patients frequently to a new doc.

And in many of these areas that are already underserved by dentists, many of the existing dentists are going to be retiring soon.

Give that some thought. Believe me, it's no fun wondering if you will still have your practice in a year, and worrying if you'll be able to pay your mortgage payment and your payroll. Sure, it's nice to live in the wonderful areas like Southern California -- but there is one heckuva lot to say about financial security also, and not having to worry about the financial future of your family.

By the way, this forum is really fantastic for all you students and new grads. And keep in mind that you will want to transition over to www.DentalTown.com as time goes by. Spending time on these forums can really put you lightyears ahead of the pack.

We 'old timers' never had anything like this. The way we learned was by trial and error -- mostly error. But YOU have this great information ability now. And dentistry is so much fun now that I just love every day of it. In school, you'll learn a lot of 'things', but not as much the 'big picture'. The 'big picture' will fall into place the first couple years you practice.

It's after graduation, when you then have all the basics, that you can go out and start learning some of the incredible new things we now have. I'm very excited for all of you. If you're excited enough to hang out here at this forum, YOU are the type that will do VERY well in practice.

The future is bright -- go grab it. Work hard in dental school. Pay your dues. It will ALL be worth it. I envy all of you.

Rod
 
Rod

I just wanted to say....YOU DA MAN!!! I just recently registered for DentalTOwn and I must say WHAT A GREAT RESOURCE, even for us pre-dents. I believe that SDN, combined with Dental Town's message boards, along with 4 years of dental school under my belt will definetly prepare me for "Real World Dentistry"

Thank you so much for shedding some light on this issue. I think Rod is agreat example of how people in a profession can network together and TRULY help one another.
 
Talking of dental HMO expansion, competition resulting from supply and demand does accelerate the spreading of HMO but it's not the brute force that may drive HMO to take over the dentistry. It's the disguise of the healthcare insurance companies and their policies under the legal support!

If you look back to the history of how HMO has evolved to taking control of the practice of medicine, you will see that nothing may stop it from doing the same thing with dentistry. At first, medical HMO was initiated by the insurance and sponsored by the government as a generous program to provide the healthcare for the poor and the low-income. But as soon as medical HMO gets supports from physicians and all the permission it needs from the legislation, it has compleletly broken its promise. It does not follow anything it is originally intended for. It becomes a legitimate and powerful vehicle for insurance corporation to drive profits away from physicians. As a result, physicians now make in the range of 100K to couple 100K's while HMO insurance CEOs and executives earns millions a year. The insurance industry has successfully turned the medicine into another enterprise such as General Motor Corporation and alike, in which management staffs and executives earn the most income while physicians work for a healthcare industry like any other regular employee of any other industries such as auto industry, high-tech industry, bio-tech industry, and so on.

I don't think any of us wants HMO to do the same thing to dentistry as it has done to medicine. But the question is what we are going to do to stop it if we don't halt it at the first place where insurance corporations start introducing and lobbying the state and the federal legislatures for other new disguising policies that favoring them? The dentistry profession is lucky that it has a chance to witness and learn the lesson from medical HMO. We hope that our leadership in ADA and other State Dental Associations will do anything that is neccessary to preserve the integrity and the dignity of dentistry professions that provide quality dental cares and maintain good patients relationships. We hope that they will stop insurance companies and their network affiliates from turning professional dentistry into another free enterprise industry.

I'm glad that Dr. Rod Kurthy has shared with us one of his past experience with dental HMO. However, that's only the initial picture of dental HMO in the early day. Dental HMO has now been transforming itself into a more sotisphicated form that allows it to continue growing and expanding from one population area to the other. Of course, dentists now see no benefits to ban together to fight HMO at this time because dental HMO is currently still weak. But if dental HMO would ever take control of dentistry like it is in medicine, then dentists might need to get together to fight it as physicians are trying to fight HMO by dropping one specific bad HMO insurance altogether, one by one, day by day.

As Critterbug has mentioned that ignorance will make us vunerable, so if we don't see HMO is a threat to our dental profession and don't forsee any need to fight it, we may one day be. If competition will kill the dental profession, the HMO insurance will enslave it.
 
Originally posted by LateComer
If you look back to the history of how HMO has evolved to taking control of the practice of medicine, you will see that nothing may stop it from doing the same thing with dentistry.
Click to expand...

Nothing could be further from the truth. The ADA is an exceptional governing body, the likes of which don't exist anywhere else in the professional world. Comparing the ADA to the American Medical Association (AMA), we find that roughly 15% of physicians are members of the AMA, whereas 85% of dentists are members of the ADA.

Because dentists are so close-knit, at least through their governing body, they have a somewhat unique barrier which physicians never had.

The ADA has and will continue to take any measures necessary to continue the integrity of the profession, both ethically and financially.
 
Fight the HMO!! With HMOs ruling the dental profession, the autonomy and flexibility to treat patients that inspired our pursuits towards dentistry will be obliterated. The ADA is strong now and needs even more strength as insurance corporations find more ways to usurp the health care industry. As a future dentist I realize that thare are pressures of meeting the need of patients economically without comprimising their health and that is why HMOs need to be checked. As an educated and trained dentist my whole range of expertise and skill should be employed in the treatment plan without many of the constraints of the HMO.

Despite what the HMOs preach about access to care the needs of the patient cannot be adequately met by the current scheme of the HMO. I ask you..... how many physicians do you know that favor HMOs??
 
A plain an simple way to save our profession from the dreaded HMO,..... DON'T sign up as a participating provider for them. If not enougn dentists will treat the patients, then the patients will gripe to their employers, who intern gripe to the insurance companies who have the contractual agreement to provide acces to care for the enrollees. If there aren't dentists to provide care to the patients, then the insurance companies end up abandoning the plans and its back to the tradional PPO and or "classical" plans.

If you are/will be practing in a state where the insurance companies require you to sign up for all plans including HMO's, then get on the phone and talk with your state dental association. Here in CT where I live, the CT state dental association has successfully gone after Blue Cross/Blue Shield for among other things the right for an enrolling dentist to choose what plans they want to participate in. As a quick plug for organized dentistry and if anyone gripes about paying the full ADA fees when your out in practice, just look at how the ADA is going after and successfully winning cases against insurance companies about how they set their fee schedules, amalgam issues, and license reforms. The change alone from the fee schedule settlements in the past year has more then paid for my ADA dues atleast 100 times over in additional revenue.

The dental HMO is a thing that we can prevent from happening, and you definately don't have to participate in one to pay the bills. So lets not let what has happened to our medical colleagues happen to us!
 
I have a friend who is attending UOP right now and he tells me that they have classes where they teach you about managed care and not to sign up with them etc. They basically teach you the ins and outs of managed care. To me, this is a huge difference between dentistry and medicine. How often did medical schools prepare their student for the threat of managed care. Dental schools are actively educating its students on not joining up with these companies.
 
mcataz

That is some refreshing news!! I hope all dental schools jump on the bandwagon.

OK guys/gals, I have a question for ya. How many of you plan to work at one of these Dental Chains right out of dental school (Monarch Dental, etc.) that are notorious for accepting all sorts of HMO plans? From what I have read on SDN and on DentalTown, Fresh Fish Dentists tend to flock to these clinics to get more experience, speed, etc. The attrition rate seems to be very high though. Gee, I wonder why!!??
🙄
 
I refuse to work for a chain like that. I would rather take less money and work in a place that I'm happy than work for those guys. My mentor didn't have to work for those chains. I guess it depends on your location but I know guys who work at places like that such as Western Dental and they are miserable. I think one big reason why they flock there is because they don't spend enough time actively searching for opportunities. The job search requires work like anything else, and you have to start early. My mentor said he started searching in the fall of his final year and he said that most dental students wait until after graduation when it's too late.
 
I went to school at the University of Washington. Washington state has little managed care compared to Los Angeles, where I currently live. I knew a guy who was very ouspoken against managed care, said he would never participate, and told stories he had hear from his "mentor" about how dentists were becomming slaves. The deal is that he would probably never have to deal with managed care or clinics. It was pretty easy for him to bash managed care or the dentists who provided for it because it would never effect his ability to put food on his table.

Dentists will never band together to fight managed care. Denists are just too individual. The ADA is just not that strong either. I choose not to participate in any form of managed care (HMO/PPO/Medi-Cal, reduced fees, etc..) Partly because I don't want to work that hard and partly because I bought a practice in an area that I can do this.


HMOs and PPOs are a valid way for people to get dentistry. A family of 5 making 20 grand a year is not going to get 10 grand worth of dentistry. You can hold out all you want, but either some people need to step up to the plate, or a lot of people will be in a lot of pain and lose a lot of teeth due to our arrogance.

You can provide good solid dentistry at reduced fees. You may not be able to spend a lot of quality time talking about the patients grand kids, but you can at least take care of the patients problems. In a perfect world we could all charge $900 for a crown but I am thankfull that there are those that can help these people.

As far as the clinics go, go ahead and hold out for that perfect asoociateship in Beverlyhills. I worked in the clinics, all of my friends or co residents did too. Sometimes its the only game in town to pay the bills. Its not fun, but it will get your speed up and allow you to make some money while you look for your own practice. Also, it will teach you a lot about what you don't want to so or be.

God luck, keep your eyes open.

August
 
Thanks augustdds

It's nice to see some townies over here helping us "Fresh Fish" dentists out!!

How do you feel about new dentists developing bad habits? I understnad that these "Dental Mills" so to speak try to optimize efficiency ANY way they can. Now, I agree that efficiency is a good thing, but when does it start effecting your dental skills/habits in terms of providing the patient with quality dentistry. Most of us dentists coming straight out of school will not be the fastest gun slingers in town, so, how do you maintain the positive equlibrium of quality vs quantity in a fast paced work environment (relatively speaking of course) with little or no experience.

This being said, I don't see anything wrong with finding an associateship in a private practice, and it doesn't have to be Beverly Hills. Different strokes for different folks. Personally, I would take a less paying associateship in a private practice if the senior doc was willing to "take me under his/her wing" and teach me quality dentistry. I feel the speed will come with time. But, developing good habits right off the bat is most important to me.
 
Originally posted by augustdds
The ADA is just not that strong either.
Click to expand...

When compared to what? The mafia?

When viewing professional organization groups, the ADA is a good as they get. As Dr. Jeff pointed out, they have been on the offensive when it comes to fee legislation, etc.

The ADA isn't the end-all-be-all, but it is certainly a more valid dam than the MD/DO community has ever had.
 
Gavin,

I am not anti-ADA, have been a member since dentalschool, they are just wimpy. They have not done any sort of national marketting to promote dentistry, like the dairy farmers. They have recently stood up to some insurance companies, but have caved in the past (no multiple surfaces on anterior teeth for operative, no four surface posterior fillings either.) Even if they grew a bit of a backbone, the inscos have far more money and legal resolve and savvy then they could hope to muster.

Luckily, the public views HMOs in a poor light and patients realize that the quality of care that they receive may not be the same as indemnity (be it clinically true or not). Also, the way that dental HMOs are set up and Medical HMOs are very different. The copays on medical HMOs is horrible, but the monthly checks are larger. The docs that are making Cap work rely more on the patient copays then the monthly checks.

Critterbug,


Obviously in the clinics there is going to be pressure to do fast dentistry, its up to you and your licsence to say when is when. I could go fast but when my quality seemed to go is when I started bitching. I am not saying be a career clinic dentist, just use it for what it is, available emplyment to pay the bills while you get experience and your own practice. I was in the clinics for two years as well as some nice practices. I am happy for both experiences. I am faster than most, am frugal in some regards, but can do esthetics and good solid crown and bridge as well.

I think that being new to dentistry, its best to get all the facts, expose yourself to all models of dentistry, and then choose what works for you.

August
 
Good advice August. I'll keep that im mind.....now I just gotta get in!! Then I'll start worrying about all this later. Must focus on the task at hand......the DrEaDeD DAT

Thanks again
 
Hey mcataz,

what happened to your post? I thought you brought up some good points.
 
I deleted it because I was being rude. But to sum up my points, you don't have to work for a "Beverly Hills Associateship" to find a non-chain related associateship that hires fresh grads. Maybe, if you were dead-set upon settling down in LA, SF or some other popular urban city on East or West coast, that might be the case. But in the midwest, Texas, Arizona and Florida, there are plenty of associateships available that are not affiliated with a chain. So, location plays a big part with that.

In addition, your salary demands impact where you work. Some people like myself would be willing to take less if we got the right opportunity. The chains will often guarantee 6 figure salaries if a certain quota is met. I just don't like that factory mentality and I would rather take far less and work in an environment that was less malignant.

In regards to August's post about HMO's etc.
Quote from Augustdds
I choose not to participate in any form of managed care (HMO/PPO/Medi-Cal, reduced fees, etc..) Partly because I don't want to work that hard and partly because I bought a practice in an area that I can do this. You can hold out all you want, but either some people need to step up to the plate, or a lot of people will be in a lot of pain and lose a lot of teeth due to our arrogance.
Click to expand...


I think this is a hypocritical statement. He is essentially saying that it's okay for others to get involved with managed care as long as he doesn't. I don't understand how he feels entitled to make this statement considering his situation. If anything, he just proves my point even further. The one person who advocates participation in managed care is the same person who has nothing to do with it, because "he can"
 
Mcataz,

Yea you did sound rude. I find it dissappointing that a dental student can have such a closed mind. When I went to school, I tried to soak in as much as possible. It seems that you are simply a mouthpiece for your mentor. Get out in the real world and figure stuff out for your self, until then its just regurgitated theory.

But to answer your accusations about hypocrisy, I say that I am not being hypocritical at all. Its real popular to trash talk HMo or clinic dentists. But someone need to serve this population. The nice thing about dentistry is that you can choose what type of dentistry and where you want to do it. I looked at all types of practices prior to purchasing mine. I felt that FFS was more my style, but I would never denigrate my collegues that wish to practice in HMO or clinics. The arrogant ones are those that say no to HMOs and give no solution, just "Don't be a scab"!

As far as the clinics go, if you can find a better deal than take it. If you can't just make the most of it. I got a lot of experience in pros that I did not get in dental school.


So if I could go back and retake dental school (scary), I would go back with an open mind, learn as much as I could, about insurance as well as clinical procedures. In the future, if you want to debate, attack the message, not the messager.


August
 
It's true. I'm a pre-dental so I value your expertise. And who knows, I may change my mind. I value your posts. At the same time, you have to understand your post seemed extremely condescending as well. You can't post in the manner that you did and not expect a similar response. You made it seem like I was only interested in Beverly Hills type of associateships, which is not what I'm about. Like I said, I would be willing to take significantly less to work in a slower environent. I know a lot of dental students who would rather worker in a harsher environment if it meant that they could earn more money. So I hardly think I was asking for something improbable.

Nonetheless, I understand why you chose to practice the type of dentistry you did. And I think you made an excellent point about keeping an open mind. I certainly will look forward to reading any future posts of yours.

I understand about not attacking the messenger, but he doesn't have to deliver the message in a flaming envelope.

Peace!
 
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