Hate For Corporate/DSO Dentistry Misguided

2TH MVR

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    When I graduated in 1993 and moved to a large urban city .... ask me how many jobs were available back then. ZERO. There were no Corp/DSO companies back then. I literally went to lunch with an established Ortho and bought myself a job. He wasn't even looking to sell that practice. He had two. Now ...recent grads have many Corp jobs as their disposal. Nice safety net if you ask me.

    Corp/DSO quality of dentistry poor? Well .... who is doing most of the work? New grads. Not their fault, but a new grad hardly has the experience, speed to treat dental issues. I see it with the recently graduated orthos in my Corp gig. They're new. It's obvious to me since we work on the same patients and I see their decisions and treatment .... that they do not have experience. Not their fault. Being a good, experienced dent/ortho/etc. takes TIME and PRACTICE.

    Is Corp/DSO responsible for the large student debts? No
    How about the saturation in the cities? No.
    Are they a cancer that is spreading? No. What's the difference between a private practice that opens next to you vs a Corp office? At one time ....the nearest Ortho was 3-4 miles away. Now I am surrounded with Orthos, GPs doing ortho, Corp/DSO, etc. etc.

    Would I recommend staying with a Corp/DSO as a career? Absolutely not. But it is an option for those recent grads looking for a paycheck and us old farts looking to slow down a little.

    So, as I listen to all the doom and gloom about dentistry economics today .... in some ways .... new grads have it better than I did. Plenty of jobs.
     
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    Vicviper

    Michael De Coro, DMD - AKA Steve McAwesome
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      My first job right out of residency was for a Corp, one the bigger and fancier ones on the west coast, at one of their biggest and busiest practices. After 2-3 months, I was stressed and frustrated, and I hated going into work. I kept feeling significant peer pressure to make ethically gray or compromising decisions or statements to patients - I felt like a used car salesman. I kept seeing things I didn't agree with, but hey, I was the new guy, and these other dentists have been doing it for a long time and they're making a lot of sense. We literally had a huddle every morning with the entire office staff to go over each providers production numbers from the day before where you would get shamed or praised based on how much you did.

      We had about 40% HMO patients, which many times translates to, you don't get any money for seeing them unless you upsell them onto something else that isn't a covered benefit. One time I did 9 fillings on a patient, and since she was HMO, and the fillings were a covered benefit, I only got about $250 in production credit (meaning my take home value - 22% of that - was only $55 ). I kept being pressured to sell things like laser gum treatments and "antimicrobial irrigation" for 45-60 bucks a quad which is actually just ten seconds of Chlorhexidine irrigation, which I was always taught was a part of SRP anyways. They actively discouraged us from doing fillings - saying that we needed to do more inlays and onlays as they were really a more "permanent treatment." On your stats you actually had a number tracking your direct to indirect restorations - (fillings compared to crowns), and they stressed that you wanted your filling number to be as low as possible compared to crowns.

      I will be the first to acknowledge that not every Corp Practice is created equal, and some are much better than others. Also, I was new, slow, and impressionable, which contributed to the friction and animosity from and towards me. The dentist that eventually became my mentor, and helped me become the much more confident and skilled dentist that I am today, eventually went on to buy into a practice for the same company I worked for previously. Now I don't think he suddenly changed his core beliefs and practice philosophy, and so I don't think his practice is like the one I was at. I also know there are much worse places than where I worked - one company that has a name like a Compass Direction in particular - one of the dentists at the health center I'm now at used to work there, and his wife still did, he told me that one day, they had his 7 Month Pregnant wife see 45 patients. As a GP, I find it difficult to see how that allows for proper patient care and education.

      I'm sorry for the Rant and the long post, this is just one of those topics for me. I worked at that corp practice for 4 months, and we parted ways - I couldn't take it anymore, and they didn't want me anymore anyways. Leaving there, and finding a place that was a better fit let me love dentistry again, and made a huge impact on my life.

      Unfortunately, you're totally correct in that there aren't many good private practice jobs for new dentists in major cities today, and that is why so many end up in corporate for at least a year or two before they're able to move on. I do think that under the right circumstances you can get the experience you need to get your foot in the door, but you need to be careful to not to fall into bad habits, and don't let peer pressure effect you to lead you to do ethically gray things. I would recommend that new grads look to community health centers as a viable option for right out of school - now there is a fair share of bad ones of those as well, don't get me wrong - but I found a great place, and I love going into work every day - part of the reason I wanted to become a dentist in the first place.
       
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      2TH MVR

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        I completely understand. It's a lot easier to "sell, promote, whatever" orthodontics than soft and hard tissue needs and treatment. In orthodontics .... it is obvious to the patient that they "want" braces. The only thing that is "sold" is whether the patient wants the pricier gold or ceramic braces. One set of braces. 18-24 months of treatment. Retainers. Done. Part of the issue with General procedures is you guys have ALL THOSE different levels of restorations. One is free or cheap for the patient and you/Corp makes nothing or you upsell to BETTER restorations that will last longer but will cost more. Same with prophys/perio. Patients always want the "free" cleaning as opposed to the necessary (hopefully) S&RP.

        I had a 45 yr old female come in for a consult yesterday at my Corp job. She is currently a general patient at the same office. She wanted braces and the need was obvious. I pulled up some recent PA's from the general side and saw that she had active perio. In my private practice ... I wouldn't have ready access to these PA's ( nice plus at the Corp/group, whatever). I persuaded her to continue her perio tx and once I get the green light from her PCD ..... we can place the braces.

        In a perfect world ... new grads should find employment with an older, experienced, ethical dentist to learn HOW to treat patients properly, but you may need the Corp job on the side if you require additional salary. It's just a job.
         
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        braineddetermined

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          I completely understand. It's a lot easier to "sell, promote, whatever" orthodontics than soft and hard tissue needs and treatment. In orthodontics .... it is obvious to the patient that they "want" braces. The only thing that is "sold" is whether the patient wants the pricier gold or ceramic braces. One set of braces. 18-24 months of treatment. Retainers. Done. Part of the issue with General procedures is you guys have ALL THOSE different levels of restorations. One is free or cheap for the patient and you/Corp makes nothing or you upsell to BETTER restorations that will last longer but will cost more. Same with prophys/perio. Patients always want the "free" cleaning as opposed to the necessary (hopefully) S&RP.

          I had a 45 yr old female come in for a consult yesterday at my Corp job. She is currently a general patient at the same office. She wanted braces and the need was obvious. I pulled up some recent PA's from the general side and saw that she had active perio. In my private practice ... I wouldn't have ready access to these PA's ( nice plus at the Corp/group, whatever). I persuaded her to continue her perio tx and once I get the green light from her PCD ..... we can place the braces.

          In a perfect world ... new grads should find employment with an older, experienced, ethical dentist to learn HOW to treat patients properly, but you may need the Corp job on the side if you require additional salary. It's just a job.

          Thank you so much for your insight! I've been also reading your other posts which helped me have a better understanding of the real situation in this field. Also, I want to ask : is it really compulsory to buy a practice in the future in order to boost the income and have all the other advantages or am I doomed if I only want to work as an associate ? I've thought about it a lot and the general consensus ( at least on this forum )is to go for ownership, but what about people who don't want to become owners? What options do they have?
           

          Vicviper

          Michael De Coro, DMD - AKA Steve McAwesome
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            Ultimately corporations have an obligation not to their patients, but to their share holders - this is a legal obligation that must do things in the best interest of their shareholders. That said, my hope is that the original DSO's had the philosophy of "doing good for our patient will do good for our shareholders." I do think many chains (and even private practice dentists) are much more aggressive than they need to be - I had multiple dentists at the one I worked at tell me that they really don't do fillings anymore - something I consider unethical. I've seen treatment plans patients bring me, and its a joke some of the stuff that is on there. Getting a patient to understand why a crown would be better than a very big filling is something dentists deal with every day, that is normal, and a service to a patient. What I don't like seeing is up selling patients on all sorts of extras that they many times don't need - laser perio treatment, bone grafting when removing a gingiva retained root tip, telling the patient how "terrible" amalgam is and why all of their perfectly fine amalgams should be replaced, etc. Many times it isn't even the dentists doing this, but the "treatment coordinators" who end up doing a hard sell on patients, and get them into a cycle of debt they can't afford.

            But anyways, back to your original topic - I do think some of the hate to DSO's is misguided, but I do think a good part of the animosity is correctly placed. There are some DSO's that are much worse than others that you hear many of these horror stories from - and I think that is where most of the distrust and dislike comes from - that said each office, and each dentist is different. I think it's just easy to fall into bad habits if everyone around you is doing them, and there is a very slippery slope.
             
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            2TH MVR

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              Bruce Arians head coach for Arizona has a favorite saying. "No risk it. No bisquit". Private practice/small business ownership is not for everyone. Only you will know the answer to your question. That said .... owning your own practice means ALL OF YOUR HARD WORK will reward you ... not the Corp/DSO, etc owner. There is pride in owning your own practice. You are the boss. You can set your own schedule. The other detail that never gets mentioned is the numerous tax advantages to owning your own practice. I write off as many things as possible through my practice. Leased vehicles. Health insurance (C corp). Personal disability ins. Toilet paper. Light bulbs. Cleaning materials. Computers. Etc. Etc. You get the picture. Having owned my private practices (and still do) has enabled me to enjoy many desirable things in my life and secure a future retirement.

              The flip side is that owning your practice means you spend 50% of your time with patient care and 50% of your time running a small business. With my part time job with Corp .... I spend 100% of my time with patient care. At this point in my life .... 100% patient care is very appealing.
               
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              Vicviper

              Michael De Coro, DMD - AKA Steve McAwesome
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                The flip side is that owning your practice means you spend 50% of your time with patient care and 50% of your time running a small business. With my part time job with Corp .... I spend 100% of my time with patient care. At this point in my life .... 100% patient care is very appealing.

                I totally agree with this, this is the major draw for working for a DSO, health center, or as an associate. I think ownership is the dream for most dentists, but fewer are ending up doing it, and there's not anything necessarily wrong with that. Like 2TH said, you have to find what works for you. Some people LOVE the business side of things, and more power to them. If you can find a good business manager, than that helps run the business side of things, and lets you focus more on the dentistry, but something like 40-50% of business owner dentists end up getting embezzled at some point in their career.
                 

                Str82th

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                May 9, 2017
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                  2TH MVR,

                  You make excellent points. However, you are an orthodontist with great seniority and experience.

                  Your experience with corporate may be different.

                  Can you speak to how the GP associates at the corp are treated and if their choice in care is directed or influenced?

                  I highly doubt your treatment plan as an orthodontist can be as manipulated as one by a GP.

                  Then again, I have no experience as a corporate ortho.

                  TIA
                   

                  2TH MVR

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                    2TH MVR,

                    You make excellent points. However, you are an orthodontist with great seniority and experience.

                    Your experience with corporate may be different.

                    Can you speak to how the GP associates at the corp are treated and if their choice in care is directed or influenced?

                    I highly doubt your treatment plan as an orthodontist can be as manipulated as one by a GP.

                    Then again, I have no experience as a corporate ortho.

                    TIA

                    You are correct that recommending Ortho tx is pretty straightforward for the patient to understand and accept.
                    I cannot comment completely on the GP's. There are three GP's that work in the same facility as myself. When I talk to them .... I never get the sense that they purposely "over-treat" patients. Maybe I live in a bubble. I agree that production is everything, but the same could be said for private practice. The one issue I see is over-booking (mostly general). As an Ortho with 4 assts ... I can breeze through 6-10 patients every 30 minutes. Not sure how GPs can do this and not feel rushed with some of their procedures.

                    I personally am motivated to start as many patients in a given day as is possible. I benefit (financial incentives beyond guaranteed salary). Corp benefits (production on the books) and the patient benefit (they get their braces THAT day). win-win-win. btw: I treat my Corp patients the SAME as my private patients. Bond 2nd molars. Parallel roots. CO=CR. Proper everything. Etc. Etc.

                    Working in Corp is not for the faint of heart. You have to work fast and efficiently. Easy for a seasoned Ortho like myself. Seems like it would be a difficult learning situation for a new grad.
                     

                    ncide

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                      For a few weeks I struggled to find a good paying dental job between undergrad and dental school. I was hired separately by two young private practice dentists who didn't have a full schedule to employ me full time. Found a job opportunity at a corporate specialty office and immediately had a pay raise and a full time job as an ortho assistant.

                      We had numerous specialists working in the same facility, so it was great for the patients and us. Patient needed a TAD placed? The periodontist was across from our ops. If a patient would have an expose and bond procedure done, I'd walk in after the oral surgeon's work was finished to tie the tooth to the archwire. Kid in braces got hit in the face with a bat? Our endodontist would just walk in during their ortho appt to check out the tooth. The prosthodontist and oral surgeon or periodontist would have consults with many of patients with congenitally missing teeth on the same visit. Patient's teeth look due for cleaning? We'd check their general dentists' notes to see when they were last seen and see if we would schedule an appointment for them. All of their information and many of their doctors were right there.

                      Our patients had great care and convenience. As an entry-level assistant, it was also the best opportunity for me. I had a 401k, full benefits, a solid salary, and a lot of patients.
                       
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