It's because there is a slavery mindset among dentists. No offense to real horrible historic slavery, but I'm going to use the analogy so if you get offended then stop reading.
When I went into dental school I figured it would be a ticket to an upper middle class lifestyle and I guess technically it is, but just barely. This is all due to dentists decision to participate with insurance long ago. Period. Insurance is the biggest problem, by far, in dentistry. Every other problem is related to this: student loan debt, staff issues, wages, access to care BS, DSOs, back and neck injuries (to an extent). If dentists made more money all those "problems" would go away.
The reason dentists can't break the chains of insurance is fear. They have been conditioned by a multimillion dollar industry that they have to be in-network which evolved into the painful propaganda of do you "take insurance." Their first associateship was probably a PPO practice. They are terrified that if they drop Delta (see delta patients at out of network fees (OON) ) they will lose those patients. Delta even threatens to send the check to the patient as punishment for leaving. See, there are threats to leaving... "the patient will get your check, doctor." They are shamed by patients "you won't take my insurance?" The more indebted they are, the less likely they are to drop Delta so each year they accept a loss 12k per year in profit hoping that the big bad insurance company won't cut anymore. But they always do. Because of insurance participation, dentistry has gone from an awesome best kept secret to another almost mediocre primary care profession.
As insurance cuts crown fees another hundred dollars and drives fillings under $100, you have two choices, do more fillings or cut staff and wages or lastly... and this is what most do... they accept a personal pay cut. This is why dentists' earnings including that of practice owners has been on the decline for years. We say we just cut costs, but that's not true, otherwise we'd lower costs, but incomes would have stayed the same. We tell ourselves it's not so bad.
I do ok and only work in my own practice, and I employ associates, but I'm feeling the squeeze of inflation and fee cuts. Dentistry is a middle class sub 120k job in 10 years if this continues. The asset values of practices will dry up. It won't be too long from now until most of solo practice sells to private equity. A lot of us practice owners are absolutely exhausted with PPO dentistry- we're on rollerskates trying to see so many patients for less and less each year. If this continues it will be a terrible profession. The ADA cannot help--too small. You'd have to begin to get favorable laws passed at the state legislature level and insurance companies own the legislatures. Rarely will they ever pass better laws like assignment of benefits or a rule that OON benefits must be the same as in network benefits like Texas has. My advice is plan to not participate with insurance, take insurance, but don't participate. Don't ever let the slavery mindset into your head. The only thing that can save you is you. You not participating-that is. Unfortunately, it's not a group project. We have tried for years. BTW, if you organize to drop an insurance that's against the law. I have literally brought it up in a room full of dentists at a state association meeting and had the executive director interrupt and say "Now, now, we can't talk about that!"
If you take a step back and carefully and dispassionately analyze what dentists say about insurance, they basically have no answer. They get uncomfortable. We mumble something about cutting costs and getting more efficient or learning a new procedure. Why? Why do the some of the smartest, highest achieving people have no answer? Think about that for a minute... like they should... they are winners in every aspect, but they have no constructive answer. My answer first is to understand that they/we have been mentally beaten down and they don't believe they can escape the insurance plantation so it's just better to accept their fate. It's easier this way. This is the slavery mindset. They have accepted cuts to their income for years and worse given up the right to ever raise prices no matter the economic condition or the increasing clinical value they bring.
It's not just dentistry. Quick story: I don't have medical insurance. A few months ago I went to a group practice to pay cash for a doctor's exam and saw a specialist. She was excellent. She spent 45 mins with me listening, examining me and answering questions. When it was over, I went up front and checked out with the FD. "No insurance?" she said. "No" I said. "Nothing?" She said. The insurance interrogation of patients I call it. The front desk office manager presented the bill to me: $350. She winced as she gingerly put the bill down in front of me, apologizing with her facial expression. She said "I'm sorry, maybe I can discount it for you?" As if I even asked for a discount. This is the slavery mindset of doctors and their team members. I didn't want a discount. I didn't ask for it and paid $350. I was grateful and thinking about what a good experience it was that I got 45 mins with a specialist that is helping heal my body and here she is trying to destroy the value of that. On the way out, I passed by a sign at the front desk that said "If you can't be respectful to our front desk staff, we'll be glad to transfer your records to another office." Don't you just know they had some terrible insurance patient curse out the FD over a $30 copay and now everyone knows about it. Yep, I was on the insurance plantation.
I am slowly dropping insurance in my practice. I don't care that 95% of my fellow dentists won't do this. I'm doing something about it. I'd rather take a risk and do something than watch my quality, health and happiness decline. I believe that I will be sucessful in rebuilding a practice with out of network patients. I'm confident, but If you're just starting out, really try to go OON.
ps. Go OON before they implement EPN.
