Strip Mall Dentists...

[aphistis]

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Has anyone else noticed both of this thread's major antagonists have "predent" as part of their usernames? Maybe it's just me, but I think that says a lot about their credibility to talk about how dentistry really works. 😉

 

[DDSSlave]

Has anyone else noticed both of this thread's major antagonists have "predent" as part of their usernames? Maybe it's just me, but I think that says a lot about their credibility to talk about how dentistry really works. 😉

😀 This is at it's core a predent argument.

 

[Midoc]

Midoc

Let's be a little more genuine about this. The general public for whatever reason does not provide the same level of respect to dentists as it applies to physicians. And dentists rightfully expect this same level of respect due their training which is why this "not as much respect" bothers some dentists. It doens't help that Readers Digest has articles telling consumers to be weary of unethical dentists or the fact that shows like 20/20 and Dateline have tried to expose unethical dentists. And let's also not deny that we know dentists who overdiagnose and gut patients for money. It's sad that these dentists exist but they do. Patients are aware of these dentists too much like car mechanics who overcharge of unnecessary procedures. These are issues that I will have no control over and I'm okay with this. Many patients will love and respect the work I do and others won't regardless of how well I treat them. I'm okay with all of this because dentistry has so many positive attributes that outweigh the negative.

I just wish more people in the dental field could be more candid about the drawbacks of dentistry instead of trying to rationalize them or deny them altogether. It's sad that everyone gets so defensive when one lists a few drawbacks to dentistry.

I completely agree with this post and I think it is much better written than your first post.

It appears that maybe your original post was meant to be a "wakeup call" and was purposely more negative than reality. I was in turn trying to say its not as bad as you make it out to be. In some areas new dentists might be forced to start up in a strip mall but not in all areas. Some patients may hate your guts but not all of them will.

 

[honestpredent]

Lastly, the happiest dentists are those that love their job and lifestyle period. There's no qualification or distinction of how you compare to a physician in the real world. You have your responsibilities as a dentist to your patient (cosmetic & disease, surgical & medical, etc), which you will learn when you start going through dental school. That is what you'll care about. To accept or not to accept the fact that you're not a physician is what makes predents happy or unhappy, not dentists. Dentists and dental students don't even consider the question.

Actually, this is also a generalization. Some dentists and dental students do consider the question as some choose not to practice dentistry and enter other fields. To deny that there aren't a signficant number of dissatisfied dentists is misleading. There are many dentists who hate being a dentist. Let's not deny this. And the reason why they are unhappy is because they entered the field with pre-existing notions of what a dentist is. And many believe that they will receive the same level of respect as physicians due to their training.

I'm making statements like these because students need to consider these issues before deciding to enter dentistry. I'm sick of giving up spots in dental school to people who quit after a year or two or wish they never went into dentistry. All dentists should take this responsibility upon themselves. The last thing you want are unhappy dentists in the field regardless if 85% of dentists are happy. That 15% is still a large number.

I agree that I have made generalizations. At the same time, let's acknowledge that there is truth to the statements I have made.

 

[honestpredent]

Has anyone else noticed both of this thread's major antagonists have "predent" as part of their usernames? Maybe it's just me, but I think that says a lot about their credibility to talk about how dentistry really works. 😉

You aren't exactly in private practice either. I have been admitted to a dental school and am going with full faith. Like others, I have shadowed and worked in a dental office. I have networked with plenty of dentists and heard various opinons from many different dentists. They aren't all happy and cheerfull. It was interesting to hear from those unhappy dentists and what about dentistry drove them away or made it unappealing. And even the happy dentists could acknowledge many of those drawbacks. The difference is that the happy dentists didn't feel that those drawbacks were significant or mattered much to them.

I just think people considering dentistry should hear about the drawbacks. It's sad that I'm getting flamed for listing a few drawbacks. Why is it that people in the medical forums have no trouble being candid about their negative aspects while people on the dental forum get childishly defensive.

 

[DDSSlave]

Actually, this is also a generalization. Some dentists and dental students do consider the question as some choose not to practice dentistry and enter other fields. To deny that there aren't a signficant number of dissatisfied dentists is misleading. There are many dentists who hate being a dentist. Let's not deny this. And the reason why they are unhappy is because they entered the field with pre-existing notions of what a dentist is. And many believe that they will receive the same level of respect as physicians due to their training.

I'm making statements like these because students need to consider these issues before deciding to enter dentistry. I'm sick of giving up spots in dental school to people who quit after a year or two or wish they never went into dentistry. All dentists should take this responsibility upon themselves. The last thing you want are unhappy dentists in the field regardless if 85% of dentists are happy. That 15% is still a large number.

I agree that I have made generalizations. At the same time, let's acknowledge that there is truth to the statements I have made.

Allow me to give you another generalization. By the time you actually put some effort into dental school, you and the majority of your classmates won't think (let alone care) about "Oh, I could have had more respect as a physician." This is a predental concern, that very seldom pops up in dental school or the profession. I do agree that if you have a subconcious desire to be a physician than dentistry will always be second place to you. However, the vast majority of your classmates won't fit into this catagory. Also, as an anecdote, my school has the lowest dropout rate of any professional school in the city - med, law or otherwise. I imagine this holds true for most dental schools. Lastly, ask around to why MOST students drop out. As you say, it's because they don't have a clear idea of what dental school/dentistry is (and neither do you at this point), but it's not because they wished that they were in med school or had a different level of respect. That is chiefly a predental concern.

 

[DDSSlave]

Why is it that people in the medical forums have no trouble being candid about their negative aspects while people on the dental forum get childishly defensive.

There are many drawbacks and it's a good idea of yours to try to point those out. But, imo the drawbacks you have chosen are largely flawed or not common.

 

[honestpredent]

I completely agree with this post and I think it is much better written than your first post.

It appears that maybe your original post was meant to be a "wakeup call" and was purposely more negative than reality. I was in turn trying to say its not as bad as you make it out to be. In some areas new dentists might be forced to start up in a strip mall but not in all areas. Some patients may hate your guts but not all of them will.

Midoc

I'm sorry we got into a spat. I have always respected your threads. The OP's post about better offices just gave me the impression that she was trying to emulate a physician. I for one expect to work in a strip mall as most dentists in my area work in strip malls. I have never once thought twice about working in a strip mall or setting up a nice offer near other shopping areas. To me, if setting up an office in a strip mall bothers you, there are a lot of other cheesy aspects of dentistry that aren't so "white" collar. There are tradeoffs. Medicine may have the respect factor and a little more of that white collar atmosphere, but they endure a lot of stress, malpractice costs, poor reimbursement, lifestyle issues etc. I still think dentistry lacks some of that posh white collar atmosphere that is associated with physicians. Personally, I don't have a problem with because I'm very laid back. But I have heard from dissatisfied dentists who dislike the laid back nature of dentistry. The reality is most dentists will usually end up practicing in a strip mall because it's cheaper and more visible. It's usually those hole in the wall offices on the street that gross the most money.

 

[honestpredent]

But, imo the drawbacks you have chosen are largely flawed or not common.

IMO, that is your opinion. I have spoken to enough dentists who would disagree with you.

 

[honestpredent]

Allow me to give you another generalization. By the time you actually put some effort into dental school, you and the majority of your classmates won't think (let alone care) about "Oh, I could have had more respect as a physician." This is a predental concern, that very seldom pops up in dental school or the profession. I do agree that if you have a subconcious desire to be a physician than dentistry will always be second place to you. However, the vast majority of your classmates won't fit into this catagory. Also, as an anecdote, my school has the lowest dropout rate of any professional school in the city - med, law or otherwise. I imagine this holds true for most dental schools. Lastly, ask around to why MOST students drop out. As you say, it's because they don't have a clear idea of what dental school/dentistry is (and neither do you at this point), but it's not because they wished that they were in med school or had a different level of respect. That is chiefly a predental concern.

First, let's get beyond dental school since that's not even the issue right now. Again, you are making generalizations as I have spoken to dentists who have just spent two years as assocates who hate it. They aren't senior dental students who assume they know what it's like to practice. I'm not taking about dropouts. I'm talking about practicing associates. These aren't dental students but actual dentists. These dentists are friends who graduated together. These dissatisfied associates are friends with several dentists in the area who love dentistry. When we get together, it's interesting to listen to the various opinions. When asked why they hate dentistry, these associates provided the reasons that I listed. When you actually practice dentistry, you might have a different opinion. Those guys did

 

[drat]

Huh. I would like to make an observation, with the hope that honestpredent doesn't see it as a personal attack.

But after reading this thread, I am amazed by the profound emphasis you place on the MD vs. DDS community respect issue. Perhaps you can answer a few of my questions to help me understand this (you) better. . .

1.) Why do you care if a community as a whole respects dentists as a whole? In my opinion, respect cannot be earned based solely on your profession. Rather, it seems more like something that is achieved by an individual. I'm not going to respect a physician just because he or she is a doctor. I'm going to respect them for the quality of work they do. I would think that the only respect you should care about is having the respect of your patients.

2.) Can you fix your car? Did you build your house? Do you haul your own trash to the landfill? Do you cut your own hair? Your posts give the impression that you believe respect is directly related to the number of years you devote to school and is correlated to your annual salary. Maybe I'm a dreamer, but I think people in the community earn respect for doing their trade/job well. I certainly respect my mechanic and my hair stylist. I don't know how to do those things. I think you will find that dentists have a unique ability, too, that is certainly respected by people who need their help.

Enough from me.
drat!

 

[toothcaries]

No, I just wrote it. You never made any judgements, you just implied them by asking for stats on topics that you knew didn't exist.

???

dude what the heck are trying to argue?
i'm trying...but there just isnt anything in this post for me to reply to..

ok,
i asked for u to PROVE your "realities".
u painted a picture of my profession.
i may or not agree with you...that is not important.
...the fact is u made the statements..and i wanted u to disclose your how u came about those conclusions so that i may one day be able to come to those same conclusion.
in my little word...this is basic.

YOU are not an authority.
i'm sorry.
u have to be able to back yourself up when u make strongly worded statements.
(which, btw u never bothered to do...unless u count calling someone an ass)

where are u getting your info?
...are u just making things up?
i mean...why is explaining your statements so difficult?
...to put it blundly, so much crap is coming from you i'm begining to doubt that there is a difference between what come out of your mouth and what comes out the other end..

I shouldn't have to provide financial figures to support the idea that rent in a more professional office complex setting will generally have higher rent.

do u serious believe u dont need to support what u write or say?

Do I really need to provide financial stats to prove that real estate in Beverly Hills is expensive. No, I don't because that information is rather intuitive.

again, i'm trying to not make any pointed statements about YOU... and i am trying to not split hairs..but it's like u put a bunch of words together...and then throw it out as a fact...and then hope no one notices.

yes, BH is expensive...but what if i grew up in midtown manhattan?
is beverly hills still expensive?
so your example is not intuitive. your example DOES required thinking. it does require analyzing.
geti it?

It's quite an expenditure to start your own practice from scratch by locating in an expensive office setting. Again, do you really need statistics for you to accept any of this? No, you don't and you were just being an ass.

of COURSE i want every figure i can get my hands on.
call it due process or whatever.


again, dont take offence...
..but only a simpleton thinks like that....
...the basic question is WHY?
to me...it is common sense to ask "why?".
why is it expensive?
the office setting would not be my largest expense. more than likely that would be my staff. stafff is around 25-30%.
generally u'd pay 50-60% of gross if u buy a practice...big part of that cost is "goodwill" and the charts...not the "expensive location"

...the equipment cost is the monster in a start-up...
"expensive office settings" become more significant when we start looking at actually buying our example office setting's building.

so yes, if i'm buying a practice, i wanna know why it is "expensive".

Did your accountant also guarantee that your practice would gross a particular figure? Does your accountant also know that you are going to be leasing an expensive office in addition to paying for all of your other expenses like say...employees...equipment....you know that type of stuff. Tell your accountant that and he will probably say you need to take out a bigger loan, a much bigger loan. Taking out a 300K loan and purchasing a swanky office with high rent doesn't mean you will be able to generate enough money to pay off that rent.

oh lawd..
somebody help this kid.
alright..
i've got nothing to say..
being the predent that u are..u obviously know more about practice transitions than consultants with 20+ years of experience.
🙄

i only hope that my future paid professional advisors can be as forward thinking as yourself

again,
you made a bunch of statements.
..and...u are unable to back up those statements...and..i am an ass for daring to ask that u back up...those strongle worded statements which we are now calling your opinion...or reality.
is that an accurate summary of this discussion?

 

[toothcaries]

It doens't help that Readers Digest has articles telling consumers to be weary of unethical dentists or the fact that shows like 20/20 and Dateline have tried to expose unethical dentists.

did anyone bother to ask who provided the funding for those expos?s on 20/20 and reader's digest?

 

[predentchick]

Has anyone else noticed both of this thread's major antagonists have "predent" as part of their usernames? Maybe it's just me, but I think that says a lot about their credibility to talk about how dentistry really works. 😉

I am willing to bet I have just as much exposure to dentistry as you. Don't just randomly attack our character/credibility. Besides, this isn't about being in school. This was a thread based upon what the general public thinks. Not students. Please! 👎

 

[ItsGavinC]

Most physicians now-a-days give dentists tons of props, even if the general public doesn't.

 

[Dr.SpongeBobDDS]

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[aphistis]

I just think people considering dentistry should hear about the drawbacks. It's sad that I'm getting flamed for listing a few drawbacks. Why is it that people in the medical forums have no trouble being candid about their negative aspects while people on the dental forum get childishly defensive.

If you think my post was flaming, defensive, OR childish, you haven't spent much time on SDN.

In fact, I think I'm going to call you on this one. I want to hear exactly how my post was a flame, and how it was "childishly defensive." If you choose not to respond, I'll cheerfully accept that as a concession of defeat. Have fun.

 

[Lila08]

Midoc

I'm sorry we got into a spat. I have always respected your threads. The OP's post about better offices just gave me the impression that she was trying to emulate a physician. I for one expect to work in a strip mall as most dentists in my area work in strip malls. I have never once thought twice about working in a strip mall or setting up a nice offer near other shopping areas. To me, if setting up an office in a strip mall bothers you, there are a lot of other cheesy aspects of dentistry that aren't so "white" collar. There are tradeoffs. Medicine may have the respect factor and a little more of that white collar atmosphere, but they endure a lot of stress, malpractice costs, poor reimbursement, lifestyle issues etc. I still think dentistry lacks some of that posh white collar atmosphere that is associated with physicians. Personally, I don't have a problem with because I'm very laid back. But I have heard from dissatisfied dentists who dislike the laid back nature of dentistry. The reality is most dentists will usually end up practicing in a strip mall because it's cheaper and more visible. It's usually those hole in the wall offices on the street that gross the most money.

"dentistry" and "laid back"...hmm...I thought that was an oxymoron 😀

 

[honestpredent]

did anyone bother to ask who provided the funding for those expos?s on 20/20 and reader's digest?

Yes, they are called advertisers and subscribers, maybe you have heard of them? But if it makes you feel better, I'm certain Budweiser and McDonalds are conspiring against dentists.

???...the fact is u made the statements..and i wanted u to disclose your how u came about those conclusions so that i may one day be able to come to those same conclusion.
in my little word...this is basic.

So you ask for stats and URL's every time someone makes a statement. Somehow I doubt that. Some things are intuitive ie...common sense. You were simply trying to belittle what I was saying by asking for something that you knew I couldn't provide.

YOU are not an authority.
i'm sorry.
u have to be able to back yourself up when u make strongly worded statements.

I never claimed I was.

where are u getting your info?
...are u just making things up?

Like I said, do I need to explain even basic things that you already understand but are simply using old school debate tricks by requiring stats all of sudden.

i mean...why is explaining your statements so difficult?

I did explain it. I just didn't explain what you wanted to hear.

...to put it blundly, so much crap is coming from you i'm begining to doubt that there is a difference between what come out of your mouth and what comes out the other end..

Now that's funny because earlier you claimed that you were not "judging" me. You already had your mind made up about my intial comments, but you can continue the charade if you like.

do u serious believe u dont need to support what u write or say?

No, I don't feel the need to support issues that are already well accepted with stats and URL's. If I said that clouds exist, do I need to provide a URL from the NOVA website? It's fairly obvious to all but you that the general public does not view dentists with the same regard as they do physicians. Some dentists do in fact find this to be a drawback to the profession. I'm sorry that you require stats to understand something as basic as this. But then again, I think you do understand this a little too well.

again, i'm trying to not make any pointed statements about YOU

...

Really, you could have fooled me with the: "so much crap is coming from you i'm begining to doubt that there is a difference between what come out of your mouth and what comes out the other end.. But go on with the charade because it's fun to watch you slip out of character.

yes, BH is expensive...but what if i grew up in midtown manhattan?
is beverly hills still expensive?
so your example is not intuitive. your example DOES required thinking. it does require analyzing.

Oh, now that is priceless. The conspiracy of the malicious funders of the 20/20 expose was pretty bad but now this. You should be embarassed that you are resorting to such a pathetic argument. What percentage of dental students do you think grew up in Midtown Manhattan so that they could turn their nose up at Beverly Hills? The fact that Beverly Hills is expensive is in fact intuitive. And do you really think that someone like Paris Hilton who grew up in midtown Manhattan doesn't know that Beverly Hills is expensive. It's amazing how low some people will stoop to save face.

of COURSE i want every figure i can get my hands on.
call it due process or whatever.
again, dont take offence...
..but only a simpleton thinks like that....
...the basic question is WHY?
to me...it is common sense to ask "why?".
why is it expensive?

You need financial figures to understand that nice office complexes occupied by physicians and other professionals is more expensive than your standard strip mall? Thank you for making me feel like Donald Trump. I guess this information really isn't that intuitive as I thought. Maybe, I'm just a real estate genius?

the office setting would not be my largest expense. more than likely that would be my staff. stafff is around 25-30%.generally u'd pay 50-60% of gross if u buy a practice...big part of that cost is "goodwill" and the charts...not the "expensive location"

Well, you would have a point if I actually claimed the office setting would be your largest expense. Even if it is 10% of your expense, an expensive setting can affect your practice. I know you have a difficult time with logic but please fake it this time and listen:If you are paying 7 K more in rent per month, that amounts to 84 K more per year in rent. Please tell us that 84K is insignificant? This is a major reason why dentists choose to practice in strip malls and areas with lower rent. They don't do it because they love being next to the Jiffy Lube.

...the equipment cost is the monster in a start-up...
"expensive office settings" become more significant when we start looking at actually buying our example office setting's building.

I'm aware of the equipment bearing the burden of the initial cost. What you fail to acknowledge is the fact that location significantly influences your expenses as well should you choose to practice in a location with high rent or lease. If that wasn't an issue, then every dentist would set up their practice wherever they chose. The rent or lease of an office can significantly vary in regards to location. Just because a bank will cut you a check for 300K, they aren't telling you that you can set up your office on Rodeo drive.

so yes, if i'm buying a practice, i wanna know why it is "expensive".

That's fine when you are with your attorney and accountants peering over your contracts. But when we are ona student forum, I don't feel the need to provide you with financial statements.

i've got nothing to say..
being the predent that u are..u obviously know more about practice transitions than consultants with 20+ years of experience.

(sigh)I was criticizing you, not your consultants. Just because you can acquire a 300K loan doesn't mean you can pay back your loan if your expenses exceed their expected levels. Your expenses can significantly be raised by paying higher costs in rent per month as I have already proven. And 7k more in rent is conservative estimate. You can easily pay more than 10K per month in rent depending upon your location. That would exceed over 100K per year just in rent. Apparently a 100K is a meaningless figure to you. Also, keep in mind that you are starting from scratch. You will need to build your clientele which could take months if not a year.

again,
you made a bunch of statements.
..and...u are unable to back up those statements...and..i am an ass for daring to ask that u back up...those strongle worded statements which we are now calling your opinion...or reality.is that an accurate summary of this discussion?

No, I wasn't able to tell you what you wanted to hear so you felt the need to discredit me. What this comes down to is you pulling an old debate trick by asking for statistical numbers on issues that don't require stats or URL's. You knew very well that I didn't have them and felt that you simply made your point by requesting them. What you were not expecting was someone who would call you on your little games. Now I'm certain, you will respond with some impressive diatribe of your own so you can have the last word because I'm done. Talking to a brick wall is amusing for only so long.

 

[honestpredent]

Huh. I would like to make an observation, with the hope that honestpredent doesn't see it as a personal attack.

But after reading this thread, I am amazed by the profound emphasis you place on the MD vs. DDS community respect issue. Perhaps you can answer a few of my questions to help me understand this (you) better. . .

1.) Why do you care if a community as a whole respects dentists as a whole? In my opinion, respect cannot be earned based solely on your profession. Rather, it seems more like something that is achieved by an individual. I'm not going to respect a physician just because he or she is a doctor. I'm going to respect them for the quality of work they do. I would think that the only respect you should care about is having the respect of your patients.

2.) Can you fix your car? Did you build your house? Do you haul your own trash to the landfill? Do you cut your own hair? Your posts give the impression that you believe respect is directly related to the number of years you devote to school and is correlated to your annual salary. Maybe I'm a dreamer, but I think people in the community earn respect for doing their trade/job well. I certainly respect my mechanic and my hair stylist. I don't know how to do those things. I think you will find that dentists have a unique ability, too, that is certainly respected by people who need their help.

Enough from me.
drat!

I compare dentists to physicians for a couple of reasons. First, we endure a significant number of years of training. Second, we are responsible for the health of our patients. And third, many people were intelligent enough in undergrad to enter either field but chose dentistry over medicine. So yes, most dental students do go in expecting many of the same rewards afforded to physicians. Respect is one of those rewards. And yes, it is a drawback to not gain the same level of respect as physicians. That doesn't mean I want to be a physician. It just means I want to be appreciated for my efforts considering the amount of training I have undergone much like a physician. What dentist let alone professional wouldn't want the same level of respect that is afforded to physicians? Now some of you can say that it doesn't matter to you or that this issue is a pre-dent issue blah blah but you are full of it because no human being likes to be underappreciated for their efforts. I'm sorry for being honest. That doesn't mean, I don't want to be a dentist. I wouldn't pay 200K to pursue a path I'm not passionate about. But with any profession, there are drawbacks that none of us like. Likewise, what physician wouldn't want the low malpractice coverage that dentists pay? Does that mean a medical student wants to be a dentist if she can admit that dentists pay less in insurance premiums or works less hours per week? No, but it is a drawback to medicine that they can admit. Likewise, this is a drawback to being a dentist that I can be candid about. Sure, I don't like it but it's not going to prevent me from being a dentist much like a harsh lifestyle isn't going to prevent an aspiring surgeon from become one. We don't get the respect we deserve and that's the truth. I'm secure enough with being a dentist that I don't take offense to this fact like all of you have done. If it makes all of you feel better by trying to belittle me and accuse me of wanting to be a physician, so be it. I suppose I should apologize for being honest.

 

[Dr.SpongeBobDDS]

Come one, come all. Defend your fragile ego in a 20,000 word essay.

 

[Tony.]

Huh. I would like to make an observation, with the hope that honestpredent doesn't see it as a personal attack.

But after reading this thread, I am amazed by the profound emphasis you place on the MD vs. DDS community respect issue. Perhaps you can answer a few of my questions to help me understand this (you) better. . .

1.) Why do you care if a community as a whole respects dentists as a whole? In my opinion, respect cannot be earned based solely on your profession. Rather, it seems more like something that is achieved by an individual. I'm not going to respect a physician just because he or she is a doctor. I'm going to respect them for the quality of work they do. I would think that the only respect you should care about is having the respect of your patients.

2.) Can you fix your car? Did you build your house? Do you haul your own trash to the landfill? Do you cut your own hair? Your posts give the impression that you believe respect is directly related to the number of years you devote to school and is correlated to your annual salary. Maybe I'm a dreamer, but I think people in the community earn respect for doing their trade/job well. I certainly respect my mechanic and my hair stylist. I don't know how to do those things. I think you will find that dentists have a unique ability, too, that is certainly respected by people who need their help.

Enough from me.
drat!

Im always on the Optometry forum, and sometimes i read other posts from different professions.

I really like what I read above. Good job and well stated, whoever you are... 👍

 

[DrTacoElf]

Personally i have to agree with predentchick. I think most consumers would agree as well. A nicer office does make you feel as though you are getting better care to a degree. Clearly this is only perceived quality. I think each neighborhood has an optimal practice type. If you are a strip mall dentists the risks you run are 1) customers think you are cheesy 2) nothing else. If you are a medical complex dentist the risks you run are 1) cost 2) lack of advertising.



In the end there will be dentists for each type. Personally i'm leaning towards a medical complex but hell i have no idea where i'm gonna end up. i would have no same working in a strip mall if it came to it although i believe i've always deisred to be in a complex. The key is to find a comlplex that isn't hidden where you can have a decent sign, advertise properly (not just tons of flyers) and to the right people. Different areas of town will provide different patients (FFS, HMO, medicare) research and go after what you want. Then setup your practice.


In the end i believe success is directly attriubted to you skills and your research of the area you practice in via demographics.

 

[Leukocyte]

Why are you guys comparing Dentists with MDs?

Dentists do not do what MDs do, and MDs do not do what dentists do.

Dentists are the teeth and Gum SPECIALISTS, and no one argues about that.

MD's are not tought tooth and gum pathology/management in Medical School, and Dentists (to my knowledge) do not do clinical rotations in Internal Medicine, Family Practice, OBGYN, Psychiatry, Neurology, Pediatrics, Ophthalmology, and General Surgery.

OUTSIDE THE FIRST 2 YEARS OF MEDICAL AND DENTAL SCHOOL, MEDICINE AND DENTISTRY ARE IN FACT VERY DIFFERENT PROFESSIONS.

Just my 2 cents.

 

[ItsGavinC]

Come one, come all. Defend your fragile ego in a 20,000 word essay.

Why the word limit? I have all the time in the world to read ricidulous arguments on an anonymous forum.

Hell, let's set it at a 20,000 word MINIMUM.

 

[aphistis]

Why the word limit? I have all the time in the world to read ricidulous arguments on an anonymous forum.

Hell, let's set it at a 20,000 word MINIMUM.

You should talk to Lee about upping the maximum character limit in posts, Gavin. We could get some full-length novels going, then. 😀

 

[Zurik5]

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I watch Nip/Tuck and their office is in a strip mall type of area. Thus, strip malls are ok... am I right? Am I right? *high five*

 

[dunson]

Most of the dentists i know practice in a house at either a major intersection or near some major roadway. But perhaps that is the area i live in (cushy Long Island burbs) however, my point is that working from home is the best rent of all! Strip mall dentists are cheesy, usually in ghetto or maybe just more rural(i dont know) areas yet they can still beat me over the head to have them brush my teeth.

 

[Mo007]

Dentists in Malls? - I wouldn't mind ending up in a TARGET/WALMART store.

I thought Pharmacists dominated in that idea. I think it would be very comfortable from a patient's point of view to keep Dentists in a their own private offices.

Also, society is evolving towards being too lazy to do things... I wouldn't be suprised in the future, finding all the healthcare offices in SUPER GROCERY STORES.

Personally, the traffic you can get at a dental office in a mall might be overwhelming... you will just end up being a money-making machine and burn yourself out.

It wouldn't be a bad idea for new graduates for a serious exposure.

 

[aphistis]

Dentists in Malls? - I wouldn't mind ending up in a TARGET/WALMART store.

I thought Pharmacists dominated in that idea. I think it would be very comfortable from a patient's point of view to keep Dentists in a their own private offices.

Also, society is evolving towards being too lazy to do things... I wouldn't be suprised in the future, finding all the healthcare offices in SUPER GROCERY STORES.

Personally, the traffic you can get at a dental office in a mall might be overwhelming... you will just end up being a money-making machine and burn yourself out.

It wouldn't be a bad idea for new graduates for a serious exposure.

It wouldn't be a bad idea if you could work out some sort of mutually beneficial lease agreement with the retailer. But most pharmacists are salaried employees of the retailers they work at, and I'm 0% interested in earning a Wal-Mart salary compared to what private practice gets.

 

[airvent]

I?ve been working as a dental assistant for 3 years as I completed my undergrad. Honestpredent?s first post was right on the money. The Dentist I work for has an office in a business park. There is absolutely no foot traffic. She advertises in the local paper, but She does very well. She maintains a patient bases around 4-5000 patients. She owns the office her self an employs an associate dentist. She is booked for the next month and half. She makes twice what most MDs make. She has great chair side manner and her patients love her. She is very sweet, and she has had the same patients for 15 years now. She has families coming from 2 states away because their children won?t go to anyone else. She has many MD friends who all hold her in high regard.

Those who worry about respect have other personal issues they need to deal with. I find the whole idea of not wanting to work in a strip mall as immature. It?s not about where you practice, but about your professionalism. If you?re worrying about prestige or respect, then you won?t make a good ?anything.? This goes along with all those threads about which school is better.

Looking at dentistry as a good solid career is not a bad thing. Looking at it as a stepping stone to OMFS or some higher status is a mistake. 👎

Okay, The dentist I work for does Crowns, bridges, rootcanals, dentures, implants as well as the general everyday fillings. She does them well, and refers the more complicated procedures. After a while in the community other doctors get to know the quality of work you do. That is how you earn respect. 👍

On another note, she does plenty of fillings, but the big procedures are what pays the bills.

Also I would like to add, many MDs who are in private pratice have strip mall offices. Not all MDs work in a hospital setting. My regular Dr. has an office in a small 3 story office building sandwiched in between a Burger king and a gas station. He charges me $80 for a five minute visit. It seems the most strenuous thing he does all day is write prescriptions. As opposed to my dentist who does several surigical procedures a day.

 

[reccos]

http://www.pollingreport.com/values.htm

http://www.ssmonline.org/News/ViewRelease.asp?ReleaseID=4097

 

[DcS]

I'm sick of giving up spots in dental school to people who quit after a year or two or wish they never went into dentistry. All dentists should take this responsibility upon themselves. The last thing you want are unhappy dentists in the field regardless if 85% of dentists are happy. That 15% is still a large number.

How can you possibly be sick of students going to dschool who didn't want to go in the 1st place? For one thing, you are not even in dental school. Even if you were in dental school, if/when someone does drop out they hardly broadcast to the school why they did. How can you possibly make such a statement without being enrolled in a dental school. Even if you were, you'd be surprised to see how few people drop out in most schools across the country. How do I know this? Because I am in dental school, can tell you the number of people to leave my program and their reasons for the last 3 years, along with numbers from about 10 other schools where I have friends. You have a knack for speaking about things which you have no background on. I would love to hear you asking admissions directors about that too. "Hello Dr. Smith, can you tell me how many students you admitted wrongly, who didn't like dentistry, and took spots up from ambitious students like myself?" 🙄

Someone else also hit the nail on the head. You must have posted at least 5 times about respect. The original post had nothing to do with this, yet you feel you must inform all of us about the perils of thinking a dentist is a respected member of the community. If anything, go to the predent forum and spill your superior knowledge of the profession to the people who have yet to enter it. Me and my colleagues have a better feel about patient respect when we have actually treated a live patient.

You need to understand that the way dentistry is in your area may not necessarily hold true for the rest of the country. I spent 18 years in NJ and now 8 in NC and can tell you that while I do see some strip mall dentists, by far the norm is to have a separate office.

Finally, your last sentence just reiterates your thoughtless statements. Regardless of what the %s are of unhappy practitioners, can you tell me any job profession that has 85% satisfaction? If you could find one that could come close I would be shocked.

 

[toothcaries]

Originally Posted by toothcaries
did anyone bother to ask who provided the funding for those expos?s on 20/20 and reader's digest?

Originally Posted by honestpredent
Yes, they are called advertisers and subscribers, maybe you have heard of them? But if it makes you feel better, I'm certain Budweiser and McDonalds are conspiring against dentists.

just an interpretation...since facts about how the reader's digest conducted their article have never been really made public...
http://www.simpledental.com/articles/?a=rd

Counter-investigation of Readers Digest Article

Mr. Ecenbarger is an investigative journalist who writes for the Readers Digest. He wrote an article published in February's issue of the Readers Digest concerning his investigation of American dentists. The title in big bold letters on the outside of the Reader's Digest read, HOW DENTIST RIP US OFF. He said his findings were disturbing. His implications were, that dentists are dishonest, that they have been trained to sell unnecessary dentistry by using intra-oral cameras, that dentists are trained to be profit minded by management companies, and that a wide range of treatment recommendations by dentists concerning his case can be interpreted as an indication of fraudulent behavior. His ending statement is that he got 50 opinions and that he is not comforted by them.
Readers Digest Feb '97

Read the original article here

Since this link no longer works, the Google cache link is provided.
Google Cache
Since the google cache also no longer works, a local copy is provided - Ed.
local copy

After reading this article I also was disturbed and wondered how, indeed, Mr. Ecenbarger could have received so many diverse opinions. I wondered if any of Mr. Ecenbarger's conclusions and implications could be true. And, I wondered, what steps did the Reader's Digest editorial board take to determine whether Mr. Ecenbarger's article was accurate. At the end of the article was an address for a web page. I typed in the address and was able to see the article, only this time it had pictures of Mr. Ecenbarger's x-rays. It immediately began to become clear to me how varying opinions might have occurred. On these x-rays I saw many crowns. The crowns appeared to have margins that did not fit the teeth well. Without a clinical examination, I could not make a diagnosis but it stimulated me to look further.

There were three panelists who were chosen by Mr. Ecenbarger as dentists who had no financial interest in his teeth. He used their diagnosis as a comparison for his findings from other dentists. I called the first dentist, Dr. John Dode of Woodhaven, New York. He is the dental expert for the National Council Against Health Fraud. He wasn't in the office but I was able to speak with his associate. I asked his associate whether Dr. Dode's worked as a consultant for insurance companies. He seemed to stumble in his response and finally said that Dr. Dode's had worked for an insurance company in the past but he wasn't sure whether he currently did. I asked him whether he had ever heard of the National Council Against Health Fraud. He said yes he was a member himself and asked if I would I like to join. I asked what the NCAHF did. He was vague and suggested that I call the NCAHF myself and gave me the phone number.

Dr. Morris/panelist

Next I spoke with the other panelist from Mr. Ecenbarger's list, Dr. Alvin Morris of Pawley's Island, S.C., the former dean of University of Kentucky's College of Dentistry and recipient of the ADA's Distinguished Service Award. He stated that he believed it was too subtle for the lay public to perceive but he believed that the article was an indictment against Direct Reimbursement Insurance. I asked him if he thought Direct reimbursement is bad. He said that Direct Reimbursement's problem was that there was no mechanism for accountability with this type of plan. I asked him if he thought that consultants working for dental insurance companies who had access to x-rays but no clinical view of the patients dental condition could provide proper diagnosis of the patient's dental condition. At the time Dr. Morris would not directly answer this question. During a later conversation he said that insurance company consultants could not diagnose but could legitimately question some treatments based on x-rays. He did reveal that he was a consultant for Met-Life. I asked him how Mr. Ecenbarger chose him to be on his panel. He didn't know. I asked him if he thought after viewing Mr. Ecenbarger's dental condition that there was room for varying opinions concerning Mr. Ecenbarger's treatment recommendations. He said that in Mr. Ecenbarger's case there was room for a wide range of opinions. He said that there needs to be better guidelines for diagnosis. I asked if he could suggest some. He didn't offer any. I pursued this line of questioning and asked him how we would define defective crowns, how thick do the margins need to be? How overhung do the margins need to be? Where's the cut off? How do we measure them? He said there was no simple answer to that question. Precisely, I thought. I asked him whether he thought that the article was accurate, he thought it was. I asked him whether he thought the article distorted the truth. He said he thought it didn't. "So you believe that the majority of dentists are dishonest?" I asked. He said he didn't say that. "How do you draw any other conclusion after reading this article?" I asked. He insisted that I was paranoid and that he didn't believe the public would draw that conclusion after reading the article. I replied, "Dr. Morris, you are going to take the position that I'm paranoid and I am going to take the position that you are blind, why don't we get an unbiased third party to poll fifty people and ask them what they think the article intends? I'll bet whatever you want that they say the author implies that the majority of dentists are dishonest". I told him that I thought the article was deceptive, that it has hurt dentistry and that he had played a hand in it. He was very upset. Dr. Morris suggested to me that it would never be like the golden days of dentistry, that it's a whole new world. I replied that I never practiced during the golden age of dentistry and am not interested in the golden age of dentistry but I am interested that the truth be told about American dentists.

 

[toothcaries]

Dr. John Mayes panelist

Dr. John Mayes returned a call I had made earlier to him so I left my conversation with Dr. Morris. "Do you work for a dental insurance company" I asked. "No", he replied. "What was Mr. Ecenbarger's dental condition like?" I asked. Dr. Mayes stated that with the exception of one or possibly two defective crowns his dental condition was O.K. I asked him if Mr. Ecenbarger's other crowns were defective in any way, were there any overhangs or defective margins. He said there were not. I asked him whether he was aware that some of Mr. Ecenbarger's x-rays were posted on the internet. He said no. I told him that in fact they were posted on the internet, that I had viewed them and that to me they looked like they fit like boots on a rooster (as we say down here in Texas). He admitted that the margins were thick.. I asked him whether he thought there was any room for a variance in interpretation amongst dentists concerning Mr. Ecenbarger's dental condition. He said he could not. I asked him whether he could see how some dentist might take the position that Mr. Ecenbarger's restorations would not be acceptable in their own mouth, that they would not want that level of quality in their mother's mouth, and, furthermore that they certainly wouldn't recommend that level of dentistry in any of their patient's mouth's. He said that he couldn't see the rationale for replacing any of the dental treatment. "So in other words Dr. Mayes," I asked, "There is no room for other opinions in this case, only yours is valid?" He stated that since the patient had undergone full mouth periodontal surgery, the crowns were now all supragingival and that they could be carefully watched. I asked him whether he had ever considered that many dentists and many patients (given the choice) would prefer excellent dentistry with smooth margins that did not require being carefully watched? Dr. Mayes offered that he had informed Mr. Ecenbarger that many dentists would see the need for a full mouth reconstruction given the condition of Mr. Ecenbarger's mouth. "How so?" I asked. "Mr. Ecenbarger has severe occlusal disease." said Dr. Mayes. "However", he continued, "I find it disturbing that Mr. Ecenbarger found such a range of opinions, that's the main point." "Is it reasonable to assume," I asked, "That somewhere between a recommendation of one crown and a full mouth reconstruction, a variety of opinions might lie? One dentist might say, gee, there are a lot of defective crowns here, I think these four are the worst, another might say, I think six should be replaced." I didn't mention it to Dr. Mayes but I found it interesting that a member of Mr. Ecenbarger's own panel had suggested the possibility of full mouth reconstruction and yet no mention of this was found in the article. I asked Dr. Mayes again whether he had ever worked for a dental insurance company. He said at one time he had. I told him that I believed that the article was not objective and that it did much to harm the dental profession. He said that he felt the article was accurate.

Later I found out that Dr. John Mayes father is Dr. Don Mayes. Dr. Don Mayes is a dentist who is evidently a very strong advocate of managed care. In particular, he is an advocate of, capitation. He wrote a book which includes a statement which casts Direct Reimbursement in a negative light. What a coincidence, I thought.

Dr. John Thurmond

Next I was able to reach Dr. John Thurmond. Dr. Thurmond is the chairman of oral diagnosis and radiology at the Creighton University School of Dentistry. Dr. Thurmond stated that Mr. Ecenbarger had presented himself with certain conditions. I asked, "What sort of conditions?" "Well it's sort of difficult to perform extensive dentistry on a patient who lives in Pennsylvania." He replied. "By the way, I mentioned to my colleagues, after Mr. Ecenbarger expressed his intent of writing an article, that this man presents with a case that is open to broad interpretation." Dr. Thurmond stated that a full mouth reconstruction was a viable option for restoring Mr. Ecenbarger's mouth to an ideal state of occlusion. I asked Dr. Thurmond whether he thought that a variety of opinions might be offered by dentists in Mr. Ecenbarger's case. He replied that there was certainly room for different opinions. He said that Mr. Ecenbarger left out important information in his article. Dr. Thurmond had told Mr. Ecenbarger that after Mr. Ecenbarger had been placed in the dental school's periodontal maintenance program and proven to be stable, then he was a candidate for extensive amounts of restorative dentistry. Dr. Thurmond was shocked by the Reader's Digest article. He said that he had been shown a couple of benign paragraphs prior to publication that had not prepared him for the true content. I didn't ask him but I doubt that Dr. Thurmond has ever been employed by a dental insurance company.

Dr. John Dodes/panelist

Dr. John Dodes was contacted on Wednesday January the 29th. I asked him what his activities were concerning dental fraud and he cited two 20/20 appearances that he had made including an article that was published in the JADA. He stated that Mr. Ecenbarger's teeth were in excellent condition, that Mr. Ecenbarger had excellent home care and that his restorations were in excellent shape. He said that Mr. Ecenbarger was a model patient who was a non smoker and just the kind of patient that we would all like to have in our practices. I asked him how Mr. Ecenbarger's gums were. He said that they were excellent and that Mr. Ecenbarger had no periodontal pockets. I asked him if there was any room for variances in opinions concerning Mr. Ecenbarger's treatment recommendations. He said only extremely small variances. I asked him if there were any problems with the existing crowns in Mr. Ecenbarger's mouth such as open margins, overhangs or bulky margins. He said no and besides, the crowns were all supragingival. I asked him if he was aware that Mr. Ecenbarger's x-rays were posted on the internet. He was not. He said he didn't appreciate being interrogated as if I were the Attorney General. I apologized for offending him and said that I ask these questions only in search of an understanding of the article. I asked Dr. Dodes if I could ask him one more question. "Dr. Dodes, do you work for a dental insurance company?" "That is an invasion of my privacy and none of your business!" he snapped. "But Dr. Dodes," I replied, "You were good enough to give me so much other information about yourself, what's so secret about working for a dental insurance company?" As you may have guessed, Dr. Dodes was not going to go down that road. His associate had told me earlier that Dr. Dodes had, in the past, worked for a dental insurance company but was not sure about his current associations.

 

[toothcaries]

Dr. Morris revisited

I decided to call back Dr. Morris in South Carolina. He was good enough to talk to me at great length. He was a gentleman of about seventy years old. I wanted to know more about his background. I left our conversation with a better understanding and a measure of respect for this man and I think he understood and respected me. While we both may respect one another we are as opposed as day and night on many issues. Surprisingly, however, we agreed on a few things.

After his dental training, Dr. Morris did an internship in the military. He said he practiced oral medicine there. I didn't know quite what that meant, but he explained that it was examination and treating the soft tissues of the mouth and exodontia. He obtained a Ph.D.. He started a dental school in Kentucky. He was given a generous grant from Kellog. Over the years his studies were funded with two million dollars. His interest was developing a methodology for evaluating the quality of dentistry. He has published six papers on this subject. Met-life insurance company had decided that they were going to approach managed care from a position of quality. They had seen Dr. Morris' work in the literature and hired him as a consultant. He is now chairman of Met-Life's National Dental Advisory Committee. To my knowledge, Dr. Morris never practiced restorative dentistry after leaving his dental training over forty years ago.

In October 1996, as best he can recall, Dr. Morris received a call from Bill Ecenbarger. Mr. Ecenbarger told Dr. Morris what he was doing, that he had seen 50 dentists and got all sorts of opinions, etc. and would Dr. Morris meet with him. Dr. Morris met with him and spoke with him for an hour and a half or so. Dr. Morris examined him at his home. He said he didn't have the advantage of good dental lighting but he did have a dental explorer and was able to adequately evaluate Mr. Ecenbarger's teeth. His conclusions were this. Mr. Ecenbarger's teeth were in essentially good shape. The crowns were of clearly average quality, at best. The margins of the crowns could quite readily be caught by an explorer. Dr. Morris said he had crowns of similar quality in his own mouth. Mr. Ecenbarger was informed by Dr. Morris that his was the type of dentistry that would need to be maintained very well and watched very carefully. Furthermore, Mr. Ecenbarger was informed that his mouth would be a maintenance problem and that every two to three years he would probably need to have a couple of crowns replaced. Dr. Morris said that because of the extensive nature of Mr. Ecenbarger's dental work, "A wide variance of opinions was not surprising". Dr. Morris said that the title of the article How Honest are Dentists was highly inappropriate. "That was the work of Reader's Digest so they could sell more magazines, Mr. Ecenbarger wouldn't have done that". "And," he added. "You can better believe, they are selling a lot of those magazines." Dr. Morris told me to leave this thing alone and let it die. He said that the lay public will never be able to understand the wide variance of opinions. He said that I would be hurting our profession further if I stirred things up. I told him that I vowed never to rest until I found out the truth about Mr. Ecenbarger's mouth and that the public, as well as dentists, needed to know the answers concerning Mr. Ecenbarger's investigation. "Besides," I said, "The public won't have any problem understanding the variance of opinions once the truth is told." "Let me write that down." said Dr. Morris, "I am going to be meeting with Met Life in February and I want to tell them who you are and what you said." "Well while you are up there," I replied, "do me a favor and tell them something else. Tell them I said, that using x-rays alone without a clinical examination to determine the diagnosis of a patient's condition is not only illegal but immoral and unethical. There is no legitimate health professional who would claim otherwise."

"Listen Dr. Perkins," Dr. Morris said, "Dentistry will never go back to the golden years like it was in the 50's and 60's. Those days are gone forever. Managed care is part of dentistry's future. Dentistry is following on the heels of medicine. Dentist should give up trying to promote direct reimbursement. Instead of fighting manage care, you should learn how to influence it in the best interest of the public and the profession." "Why is it that you don't like direct reimbursement," I asked. "Because there is no accountability." "Dr. Morris," I asked, "do you feel that cash or a check is a bad way to pay for dental services?" "No," answered Dr. Morris, "Then how can you say that direct reimbursement is bad? There is no accountability when a patient pays by check or cash, or do you suggest that we refer our cash paying patients to dental consultants who work for managed care programs so that they might have quality second opinions?"

"Let me tell you how it works Dr. Perkins. The dental insurance companies are able to collect data on dentists. They are able to look at statistics which show how many procedures you have performed of a given kind. From this information they can target dentists who are way out of line compared to their peers. Then they can increase the claims reviews on these dentists who deviate. This is one method that can be used to control quality."

"Do you believe that managed care is in the best interest of the public and the profession?" I asked. "Managed care is an inevitable part of the delivery of dental care in this country in the future. The roll of the dental profession should be to influence it's development in ways that will be in the best interest of the public and the profession." He replied. "Dr. Morris," I laughed, "you should have been a politician." My personal opinion is that dentists trying to influence managed care in the best interest of the public and profession is like trying to influence a wolf to value the best interests of sheep.

Dr. Blanck

Dr. Blanck is a general dentist who practices in Vermont. Dr. Blanck is a dentist who examined Mr. Ecenbarger. I had two conversations with Dr. Blanck. During the first conversation, I asked him the standard questions. How were the crowns? Good. Were there overhangs. No. Did you know some of the x-rays were on the internet. He said no. I told him that I had seen them and many of the crowns I saw looked like they had overhangs. "I never saw the x-rays." came the reply. "You never saw the x-rays?" I asked. "No." he said. "So you were not able to perform a complete exam?" I asked. "No," he replied, "I told Mr. Ecenbarger that." "What did you see in Mr. Ecenbarger's mouth?" I asked. "Were the crowns in Mr. Ecenbargers mouth good, average or poor?" I asked. "Average," he answered. "A little above average, a little below average or just average?" I asked. "Average." He said. "This is the way I feel about Mr. Ecenbarger's mouth," he said, "If I had his dentistry in my mouth or my mother's mouth or any other of my family members mouth, I wouldn't replace it." if the dentistry fails, gets recurrent decay, etc., then I replace it. The crown margins were all supragingival and the patient had access to the margins of the crowns." "Would you leave room for any legitimate variance of opinion?" I asked, "For instance, would you agree that for ideal dental health, some dentists might believe that replacing some of the crowns might be legitimate?" "I could agree with that." he said.

I congratulated him performing an oral cancer exam, periodontal exam and request for consult with the periodontist. "Did you take his blood pressure?" I asked. "No." he replied. It also came out in the conversation that he didn't chart the existing restorations and conditions. It was difficult for Dr. Blanck to verify exactly what Mr. Ecenbarger's dental conditions were because he never saw the x-rays and had not charted the existing restorations. "Do you mean to tell me, that Mr. Ecenbarger called you up, asked you whether he could mention your name as a thorough dentist in a magazine which reaches 27 million people in 19 different languages around the world, and you knew full well that you had no access to his x-rays, and therefore had not completed a thorough exam, and you said yes!!??" There was a period of silence on the telephone. I realize that I was being hard on Dr. Blanck and I really do believe he is an honest and conscientious dentist but I was frustrated that he allowed Mr. Ecenbarger to use him in the article when he knew that he didn't have access to the x-rays.

 

[toothcaries]

Dr. Wah

Dr. Wah is a dentist who saw Mr. Ecenbarger in Marion, Arkansas. Dr. Wah can't remember the specifics of Mr. Ecenbarger's dental condition. Like Dr. Blanck, Dr. Wah does not chart the existing conditions of his patient's mouths so he is unable to comment on Mr. Ecenbarger's dental condition with any accuracy. I asked Dr. Wah if he was taught in dental school to chart existing conditions as part of a complete examination. He said he was but he no longer follows that procedure.

Dr. Dodes Again

I called Dr. Dodes one more time and asked him how the crowns were in Mr. Ecenbarger's mouth. With the exception of one or two, "Excellent" was his reply. Dr. Dodes seemed to be in high spirits this time, he had been on a satellite link with Mr. Ecenbarger in front of fifteen news stations the previous week.. Great, I thought. Dr. Dodes said that he had been practicing dentistry for 26 years, that during that time he had seen many cases of over diagnosis. "Dr. Dodes," I said, "26 years is a long time. Certainly over so long a period you might have seen opinions which were more conservative than yours. But what are we talking about here? 10% of dentists over diagnosing, 30%, 50%?" Dr. Dodes said he didn't know, he didn't keep statistics. Dr. Dodes is the only dentist who saw Mr. Ecenbarger's mouth that I have spoken with so far who has described his crowns as excellent. Dr. Morris calls them "a maintenance problem", Dr. Mayes says the margins are "thick", Dr. Blanck says they are "average", Dr. Daugherty says that they are "not pristine, if he were grading them at a dental school, a few would be remakes and most of the rest would be a C or less", not to mention my own opinion, drawn from my view of the crown margins as I viewed them on the internet. I thought many looked over hung. I personally find it very interesting how the man who claims widespread over diagnosis amongst dentists seems to stand alone in his judgment of Mr. Ecenbarger's crown margins.

Dr. Daugherty: Mr. Ecenbarger's dentist for fifteen years

Of all the dentists I spoke with, Dr. Daugherty was the easiest to talk to. He was not offended by any of my questions and answered all of them in a forthright manner. He had taught at the University of Pennsylvania Dental College for eight years. He taught in the crown and bridge department there. Mr. Ecenbarger has been a patient of his for the last fifteen years. "Dr. Daugherty, I am extremely upset about this article and like most of the dentists across this country, I am highly interested in what the truth is concerning Mr. Ecenbarger's dental condition. We don't know who these 50 examining dentists were. We don't know what Mr. Ecenbarger's teeth look like. Would you be good enough to answer some questions for me?" He agreed. I asked Dr. Daugherty about the quality of the existing crowns in Mr. Ecenbarger's mouth. "Not pristine," he replied. "if I were grading those crowns at the dental school, a few would have been remakes and most of the rest would have been a C or less." "Dr. Daugherty? " I asked, "When I looked on the internet, many of Mr. Ecenbarger's crowns looked like they had open and overhanging margins. Did they in your opinion?" "No question about it." came his succinct reply, "Most of those crowns I did not place. I had recommended a full mouth rehabilitation to Mr. Ecenbarger several years ago but he declined the treatment." I did a double take. "What?" I asked, "Do you mean to tell me that you informed Mr. Ecenbarger that a full mouth rehabilitation, in his case, was advisable?" "Yes I did." he answered. I was dumbfounded. Mr. Ecenbarger's own dentist not only agreed that a full mouth reconstruction was a legitimate treatment option but had also recommended that treatment to him. I went back to the Reader's Digest article. When a Salt Lake City dentist informed Mr. Ecenbarger that he needed a full mouth reconstruction and that the cost would be $19,402, Mr. Ecenbarger writes in his article, "Nothing, I thought, could top this." Mr. Ecenbarger leaves the reader with the distinct impression that he's never heard of such a treatment recommendation. Not true Mr. Ecenbarger. Not true.

"Dr. Daugherty?" I asked, "How do you feel about the outside flap of the Reader's Digest which said "HOW DENTISTS RIP US OFF", the h eadline on the front cover which said, "HOW HONEST ARE DENTISTS" and the general message of the article?" "I was shocked by the article. It was a baseless denigration of a fine profession," he answered, "I wish I could have seen the article before it was published, I would have tempered the whole thing, 99% of dentists are honest, conscientious professionals who have their patients best interest at heart."

Dr. Groesnik

Dr. Groesnick was the periodontist who performed Mr. Ecenbarger's periodontal surgery. Dr. Groesnik couldn't say much because he didn't want to violate the Dr./patient relationship. I can respect that. I did broach the idea that Mr. Ecenbarger had allowed some of his x-rays to be posted on the internet, allowed himself to be examined by over fifty dentists and published an article in a national magazine implying dishonesty and fraudulent behavior on the larger portion of this nation's dentists. Not exactly the most secretive guy when it comes to sharing personal dental conditions. Dr. Groesnik was very professional and was quite willing to send me copies of Mr. Ecenbarger's x-rays, provided, of course, that Mr. Ecenbarger agreed. Dr. Groesnik called me back a couple of days later. Guess what? Mr. Ecenbarger refuses to allow Dr. Groesnick release copies of his x-rays or to discuss his case with me. Imagine that. The man who labored so long and diligently, and made use of Reader's Digest's generous contributions to his extensive "journey" in search of the truth about our profession, refuses to allow his treating periodontist to discuss his case. What's the harm in just one more opinion? He said that he got 50 opinions and wasn't comfortable. Perhaps 140,00 opinions would make him feel a little better. Or 140,000 for that matter? G ee whiz you would think that such an honest person would jump at the chance to get the truth out.

 

[azcomdiddy]

In Phoenix, all the general dentists office I see are in strip malls and I see very few docs practicing in a strip malls. And the docs who do practice in strip malls are family practice docs. I think it boils down to competition. There are a ton of general dentists in Phoenix just like there are a ton of family practice docs. You don't see a lot of oral surgeons, pedodontists, and orthodontists practicing in strip malls in Phoenix. Both general dentists and general practioners (family docs) have to separate themselves in some manner due to the competition so they probably set up practice in strip malls for visibility and marketing purposes. What was interesting to me was that those dentists with the shady looking strip mall office were the big producers in the valley. My buddy who is a dentist informed me that one such strip mall dental practice grossed nearly 2 mill. DAMN! It may be different in other cities but it's a fact that dentists in Phoenix are all about strip malls.

 

[toothcaries]

How I interpreted the article.

If a dentist has a humble looking office he must be good. If a dentist has nice carpets, pictures and baroque music, then he must be bad. If you have direct reimbursement insurance, you better look out, dentists will try to rob you. If one dentist has a higher fee than the another dentist then the dentist with the higher fee must be bad guy. If one dentist tells you, you don't have anything wrong with your mouth and another dentist tells you, you do, then the dentist who told you, you need work must be lying. If your dentist took a practice management course then he will try to rob you. If your dentist uses an intraoral camera to look in your mouth then he will try to sell you dentistry that you don't need. Because there are more dentists and less disease, many dentists have become thieves.

People usually find what they are looking for

After reading the article and after numerous conversations with people mentioned in the article a lot of questions were left in my mind. How did Mr. Ecenbarger choose his panel? If a person wanted to "Stack a deck" to get a biased opinion on dental matters, they would have a hard time beating Mr. Ecenbarger's selection. If he wanted a balanced view, why didn't he consult members of our profession known for their excellent clinical knowledge and skills? How about an instructor from the Pankey Institute?

Why did Mr. Ecenbarger leave the impression that he was shocked by recommendations for full mouth reconstruction? His own treating dentist, a man he said he trusted, recommended just such treatment several years ago. Another one of his "panelists" said that for purposes of restoring proper occlusal function that a full mouth reconstruction was a legitimate option.

Even with a biased panel, it's my opinion that Mr. Ecenbarger was given information that would have "desensationalized" the article. Why was this information left out? Certainly this information would have helped provide a balanced view.

"HOW DENTISTS RIP US OFF"

Look up "rip off" in the dictionary, it means stealing and cheating. The headline doesn't say, "HOW SOME DENTISTS RIP US OFF", it doesn't say, "DO DENTISTS RIP US OFF". Instead it says, "HOW DENTISTS RIP US OFF". Maybe Dr. Morris is right, maybe I'm just paranoid. Even so, when I read that headline on the outside flap of Reader's Digest magazine and read the concluding statement, "I got 50 opinions and I'm not comforted.", it sure sounds like a blanket statement to me. I was left with the impression that the title on the outside flap was calling a significant segment of our profession frauds and cheats. This is as opposed to some small percentage of frauds and cheats that might be found in any profession. For example, the profession of journalism.

WHY SO MANY COINCIDENCES?

It's seems very coincidental that one of the panelists is Chairman of the National Dental Advisory Committee for Met-Life's Managed Care Program. It seems very coincidental that such a fact was left out of the distinguished gentleman's impressive list of credentials. It seems very coincidental that another panelist's father wrote a book in which Direct Reimbursement Insurance is cast in an unfavorable light. It seems very coincidental that two of the other panelists have worked as consultants for dental insurance companies. It seems very coincidental that Mr. Ecenbarger chooses Direct Reimbursement as his insurance policy when he does his investigation. I got the distinct impression from one of the panelists that much of the American dental profession were quacks. On the contrary I believe he's on a groundless witch hunt. I find it outrageous that Mr. Ecenbarger acts as if he's never heard of a suggestion of a full mouth reconstruction when the facts show he had. I find it outrageous that one of the panelists is even listed as a panelist, when a comprehensive examination was not performed and the examination did not occur in a dental operatory with good lighting. I find it outrageous that validity was given to another dentist's opinion who never had access to Mr. Ecenbarger's x-rays. I find the headline to be ruiness. I don't understand why Mr. Ecenbarger got on CNN in front of millions of people and said "I got 50 opinions and none of them were the same.", when he clearly stated in his article that twelve of the dentists opinions were essentially that of the panel's. It appears, at least for the present, that Mr. Ecenbarger is refusing the release of copies of his x-rays or additional exams. I believe honest people don't hide facts. Whether he's refusing on his own, or whether someone is directing him to withhold information is an interesting question.

I believe that if Mr. Ecenbarger's x-rays were released, along with high quality 35 mm slides of his mouth, that we would be completely vindicated. I believe that we will see a mouth full of problems. I believe that his mouth lends itself too the broadest of interpretations. As the esteemed, and now deceased, Sumter Arnim has shown, A dentist may remove decay from a tooth and leave a gaping hole, and if the patient is fastidious enough, that hole will not continue to decay. Therefore some dentists believe that, as defective as Mr. Ecenbarger's crowns may be, if he keeps them clean, they will be O.K. But in fact, we dentists, by and large, prefer to fill those gaping holes. Many of us know that patients suffer from recidivism when it comes to oral hygiene and we also know that patients don't always keep their recall appointments. L.D. Pankey, on the other hand, spoke about another type of dentistry. He spoke of concepts such as high quality and comprehensive dental health that would be delivered by dentists who had examined themselves and would deliver this treatment from a standpoint of honesty and integrity. There is little doubt in my mind that Dr. Pankey's treatment recommendations would have been a full mouth reconstruction for long term dental health in Mr. Ecenbarger's case. I rest my case for why Mr. Ecenbarger got such a wide range of opinions.

What can we do?

I think dentists in this country need to ask hard questions about this article. I think it is appropriate to find out the facts about how Mr. Ecenbarger's investigation was conducted. If, after the facts are revealed, we find that we are guilty of these implied accusations, then we need to eat crow and humble pie and make serious changes in the way we conduct ourselves as professionals. If, on the other hand, these accusations are found to be inflammatory and deceptive. Then I think Reader's Digest and Mr. Ecenbarger have some apologies to make and some retractions to print.

As much as I have enjoyed the Reader's Digest, I will be canceling my two subscriptions (one to my office and one to my home) until such time Reader's Digest provides me with sound evidence that their article was fair and accurate. Many people I have talked to were left with the impression that a large segment of American dentists are dishonest after reading this article. Even many dentists felt this way. After speaking with all of the dentists who advised Mr. Ecenbarger, I believe there is good evidence that the article was biased. I believe that before publishing such a headline as "HOW DENTISTS RIP US OFF", whoever did it has a moral, ethical and legal duty to make sure they are completely honest about their investigation. It didn't look to me like the selection of the panel was conducted in a fair way. Perhaps Mr. Ecenbarger would be good enough to reveal the selection process to us. It's very significant that Mr. Ecenbarger didn't' make it clear in his article that members of his own panel questioned the long term stability of his existing dental work.

I am going to continue to request that Mr. Ecenbarger allow copies of his x-rays be released to dentists and to allow himself to be examined by dentists without managed care connections. I find it very difficult to gain closure without this information.

I have always been a dues paying member of organized dentistry but have not participated the way I should. Even though I have enjoyed practicing private care dentistry since 1984, I have never lifted a finger to insure my privilege to continue to do so. This Reader's Digest Article woke me up. I feel like Davy Crockett must have in the Alamo, not ready to surrender. Count me in. I am finally ready to protect my profession from those who would seek to destroy it. I urge you to do the same.

In an attempt to understand the impact this article has had on American dental practices I would ask that any dentist who has read this article and who can document that they have lost a patient as a direct result of this article fax, phone, write or email me at the listed places.

.....

It is quite clear from this article that Mr. Ecenbarger had a preconceived notion from the very beginning as he set out to prove his hypothesis. This leads many of us to question who funded this "research". There appears to be a hidden agenda here, hopefully one unknown to Reader's Digest at the time of publication.

http://www.toothinfo.com/hon.htm

 

[toothcaries]

http://www.pollingreport.com/values.htm

http://www.ssmonline.org/News/ViewRelease.asp?ReleaseID=4097

interesting that psychiatrists ranked so low..

 

[azcomdiddy]

Toothcaries


Stacking the deck happens all the time. On 20/20 this past friday, they implied that docs caused a patient to die. A lady was sufferring from a fibroid tumor. When someone suffers from these tumors, they can undergo several procedures which include a hysterectomy, embollization, myomectomy and endometrial ablation. The lady saw her OB/GYN and he recommended that she have a hysterectomy. 20/20 implied that it was the doc's fault because he didn't strongly endorse embollization as an option. The lady didn't want to undergo a hysterectomy so she stalled in her decisionmaking. Eventually the lady died to due excessive bleeding. What 20/20 didn't tell you was that any lady who is bleeding that much from a fibroid tumor will most likely need a hysterectomy. If she was bleeding to the point that she was going to die very soon then embollization wasn't a legitimate option for her. The physician had a right to recommend what he felt was best. 20/20 tried to spin the issue by accusing the doctor of being greedy. Embollization isn't performed by OB/GYNs. They are performed by interventional radiologists so 20/20 impled the doc was being greedy and purposely prescribed a hysterectomy because he just wanted money instead of doing what was best for the patient. The lady who died was aware of both procedures but her death was due to her stalling and not because of what the doctor prescribed. If she would have undergone the hysterectomy like the doctor first suggested, she would be alive today. It is a tragedy that the woman died but no doctor was to blame for this. It was a story that 20/20 spinned just to get ratings.

 

[toothcaries]

it seems certain members of the media believe their viewers are only interested in conflicts, disharmony or controversy (and celebrities)..

the sad part is they are probably correct.

Toothcaries


Stacking the deck happens all the time. On 20/20 this past friday, they implied that docs caused a patient to die. A lady was sufferring from a fibroid tumor. When someone suffers from these tumors, they can undergo several procedures which include a hysterectomy, embollization, myomectomy and endometrial ablation. The lady saw her OB/GYN and he recommended that she have a hysterectomy. 20/20 implied that it was the doc's fault because he didn't strongly endorse embollization as an option. The lady didn't want to undergo a hysterectomy so she stalled in her decisionmaking. Eventually the lady died to due excessive bleeding. What 20/20 didn't tell you was that any lady who is bleeding that much from a fibroid tumor will most likely need a hysterectomy. If she was bleeding to the point that she was going to die very soon then embollization wasn't a legitimate option for her. The physician had a right to recommend what he felt was best. 20/20 tried to spin the issue by accusing the doctor of being greedy. Embollization isn't performed by OB/GYNs. They are performed by interventional radiologists so 20/20 impled the doc was being greedy and purposely prescribed a hysterectomy because he just wanted money instead of doing what was best for the patient. The lady who died was aware of both procedures but her death was due to her stalling and not because of what the doctor prescribed. If she would have undergone the hysterectomy like the doctor first suggested, she would be alive today. It is a tragedy that the woman died but no doctor was to blame for this. It was a story that 20/20 spinned just to get ratings.

 

[Apoptosis]

Just curious to see some opinions on this board: What do you think of strip mall dental offices? I have come across a lot of people who think negatively of them. They say is says "cheap" and they think the dentist is going to do a cheap job. They say they would go to a Dr. in an office complex only. However, I have heard that strip mall/mall dentists do the best as far as monthly production. Any thoughts?

I think Dental offices in the strip mall used to do well up till now But a time has come that dentist will do better in a a small complex which has a chiro practor and or a optometrist and a podatrist

 

[ItsGavinC]

I think Dental offices in the strip mall used to do well up till now But a time has come that dentist will do better in a a small complex which has a chiro practor and or a optometrist and a podatrist

How do you figure? That only makes sense if a large number of patients are referring themselves after visiting the optometrist or podiatrist. I don't see any constant benefits coming from being near an optometrist or podiatrist.

The BEST referral method is to position your place by an area where homemakers frequent during the day. Typically the mothers make the appointments for themselves, their children, and their husbands, so putting an office by a large grocery store, near the pet store, by the oil change place, or next to all 3 of those is a prime situation.