What exactly is wrong with corporate dental?

[Flipps]

Are they all dental mills that churn out crappy work?


Anyone here with firsthand experience working for places like Heartland/Castle/Monarch/Southern etc. etc.?

---

Members don't see this ad.

 

[Yellow Snow]

I talked at length during a job fair with one of the large dental company reps and what I found out was a bit scary. This particular company has two levels of dentists, "owners" and non-owners. Everyone is required to come in as a non-owner dentist. They get a percentage of their production. You only become an "owner" when you are invited by corporate to do so. The people in charge of extending this invitation are corporate managers, they aren't dentists. The major criteria used in deciding if a dentist is ready to join the "owner" class is "leadership skills". As an owner you can buy up to 49% interest in a practice, corporate always retains 51% interest. The more interest in the practice you own the more % of all dentists production you make, plus a percentage of your own income. So you get that passive income by having dentists working under you in your semi-owned practice as moneys being siphoned off by corporate. And the corporate "trainers" are stopping by every now and then to teach you "leadership skills". And then each year they have Diamond producers, Silver, Gold, etc based on how much money you brought in....and then, after talking to this guy for like an hour I was like, "HOLY S**T, this is a multi level marketing scheme!". Your "leadership skills" consist of making the lower rung dentists hungry for more of the pie so you can string em out for a few years of production.

That is scary enough but also in the pamphlet they gave me a line read, "We practice ethical dentistry based on moral principals as described in the Bible". WTF???

My overall read was some MBAs were trying to utilize dental licenses to make money by controlling the dentists. All upward movement in the company is determined by non-dentists? What they hell are they practicing?

 

[jmill0]

I've worked for Heartland Dental Care for the past five years. There are just as many crappy dentists in corporate practices as there are in private practice. Some corporate practices seem to monitor them though whereas private practice docs don't have anyone looking at their work.

What do you want to know? I can't speak on other corporate practices as I have never worked for them and so for me to generalize about the practices and policies that go on there would be ignorant of me.

 

[Flipps]

I've worked for Heartland Dental Care for the past five years. There are just as many crappy dentists in corporate practices as there are in private practice. Some corporate practices seem to monitor them though whereas private practice docs don't have anyone looking at their work.

What do you want to know? I can't speak on other corporate practices as I have never worked for them and so for me to generalize about the practices and policies that go on there would be ignorant of me.

Do you have quotas at heartland? Does a non-dentist ever assist in treatment planning? Are you pushed into doing certain types of work?

 

[jmill0]

Quotas - No. Never had a quota. Then again, I do fairly well for them and it has never been an issue. Now if I wasn't profitable, that might be a problem after a while. No one can stay in business very long if the don't make a profit. Doesn't matter if it is corporate or private practice.

I do all the treatment planning. No one else. Does my team talk about veneers or invisalign or whather or not that broken off tooth might need a crown, sure! But I do the definitive treatment. After all, it's MY license, not theirs.

I don't do any work that I don't feel comfortable with. If a doc in our company is not comfortable with a procedure, we don't "make" them do it. One question to ask is if they WANT to learn how to do it. If they do, then we try to get them some help so they are comfortable. Now if they sit around all day doing nothing because they refer simple extractions and all endo out the door, that might raise an eyebrow. If they are truly busy and don't have time for it because they are doing lots of crown and bridge, then there's no problem sending them out.

Make sense?

JKM

 

[DrJeff]

1 word - autonomy

 

[jmill0]

1 word - autonomy

1 word - Ignorance

 

[aphistis]

1 word - Ignorance

1 word - elaborate?

 

[jmill0]

1 word - elaborate?

I guess what I want to know is what is meant by autonomy.

I just opened a new "corporate" practice. I picked the location, approved the building plans as well as made necessary changes that were included. I picked out all my equipment to build out 6 chairs... top of the line stuff too! I picked out the decor and have a hand in everything that was done to get it finished.

I consulted on the marketing designs, the logo, and what advertising we did to start out with.

Clinically, I decide all treatment and what is done on whom. No one comes in to tell me to do a crown when a 3 surface restoration will suffice. No one tells me to do a restoration when a crown would be better. I choose to do all my own endo, extractions and pros and refer out when appropriate. I pick all my own materials and labs that I use. I was involved in the hiring of all my team and had the final say on it as well. I was involved in deciding all of their salaries.

I choose what hours I work, when the practice is open and when I go on vacation (granted, I could use a little more of this!).

I am fully involved in my profit and loss statement and know what is spent on each line. (By the way, my team knows all of this as well!)

Here's what I don't do, but let the "corporate" guys do for me: Negotiate higher reimbursement on PPO fees than my collegues down the street. Negotiate substantially lower costs on all my equipment, labs, clinical supplies and office supplies. Take care of payroll and all other accounts payable (I just send them the statement and they write the checks....). I don't take all this junk home with me at night or stay at the office a couple of hours afterwards doing all the above listed stuff.

To be honest, I don't know how much more "autonomous" I can be. I guess I could be in possesion of the checkbook, but that's about it. Anyone who blankets a "corporate" practice with not being autonomous without knowing anything about it is showing "ignorance" in my opinion....

Just my two cents.....

JKM

 

[SoCalDent]

I guess what I want to know is what is meant by autonomy.

I just opened a new "corporate" practice. I picked the location, approved the building plans as well as made necessary changes that were included. I picked out all my equipment to build out 6 chairs... top of the line stuff too! I picked out the decor and have a hand in everything that was done to get it finished.

I consulted on the marketing designs, the logo, and what advertising we did to start out with.

Clinically, I decide all treatment and what is done on whom. No one comes in to tell me to do a crown when a 3 surface restoration will suffice. No one tells me to do a restoration when a crown would be better. I choose to do all my own endo, extractions and pros and refer out when appropriate. I pick all my own materials and labs that I use. I was involved in the hiring of all my team and had the final say on it as well. I was involved in deciding all of their salaries.

I choose what hours I work, when the practice is open and when I go on vacation (granted, I could use a little more of this!).

I am fully involved in my profit and loss statement and know what is spent on each line. (By the way, my team knows all of this as well!)

Here's what I don't do, but let the "corporate" guys do for me: Negotiate higher reimbursement on PPO fees than my collegues down the street. Negotiate substantially lower costs on all my equipment, labs, clinical supplies and office supplies. Take care of payroll and all other accounts payable (I just send them the statement and they write the checks....). I don't take all this junk home with me at night or stay at the office a couple of hours afterwards doing all the above listed stuff.

To be honest, I don't know how much more "autonomous" I can be. I guess I could be in possesion of the checkbook, but that's about it. Anyone who blankets a "corporate" practice with not being autonomous without knowing anything about it is showing "ignorance" in my opinion....

Just my two cents.....

JKM

There must be a couple negatives to it. (otherwise everyone would do it)

 

[SuperC]

.... based on moral principals as described in the Bible". WTF???

HAAAAAAAAAA HA AHA AHAHAHAH HAHHHAHHAHAHHAHH HAHAH ROFL!!!!!!!!!

 

[stdmufin27]

There must be a couple negatives to it. (otherwise everyone would do it)

When it comes down to it you aren't the boss. I'm not saying that dentistry is only worth it in those situations, being numero uno, but I feel that's why there is such a disdain for corporate dentistry in this forum. Nuff' said.

 

[jmill0]

There must be a couple negatives to it. (otherwise everyone would do it)

Sure there are. I can't shut down the practice for a month if I want to travel to Europe for that long. I mean, I don't get unlimited time off if I want to.... someone has to be there to operate the practice.

I'm the boss at the office, but not of the company. If my practice fails to be profitable on a continuous basis, I could be fired and replaced. (Although if i did that in private practice, I'd just be declaring bankruptcy and still be out of a job!)

100% of the profits do not go to me. Half does. The rest of it is distrubuted to all the corporate employees in terms of stock in the company. I also receive stock based on the profitability of the other 200+ offices as well.

I don't get everything handed to me as well. It took five years of doing well for them to build me the office I wanted. I originally came into an existing practice and started working with what was there. I guess if I wanted a CERAC machine, that probably wouldn't be approved either due to the enormous expense. Never really asked though.

Now don't get me wrong, I'm not saying that every situation is like this or even that there are a lot of these situations out there. I had to pay my dues to get where I am now and some brand new graduate shouldn't expect everything to be handed to them. They had to make sure I would make a return on their investment.

Not all corporate dental offices are the same just as not all associateships are the same either. Some are good situations and some are not so good. Some encourage you to learn and some don't. A new grad must evaluate the situation proposed to them and go from there. There are some corporations I would never work for as well as there are some private practitioners I would never work for either.

I just hate when people make broad generalities about something they know little to nothing about.

 

[Later2008]

working for someone else!

 

[DrJeff]

Sure there are. I can't shut down the practice for a month if I want to travel to Europe for that long. I mean, I don't get unlimited time off if I want to.... someone has to be there to operate the practice.

I'm the boss at the office, but not of the company. If my practice fails to be profitable on a continuous basis, I could be fired and replaced. (Although if i did that in private practice, I'd just be declaring bankruptcy and still be out of a job!)

100% of the profits do not go to me. Half does. The rest of it is distrubuted to all the corporate employees in terms of stock in the company. I also receive stock based on the profitability of the other 200+ offices as well.

I don't get everything handed to me as well. It took five years of doing well for them to build me the office I wanted. I originally came into an existing practice and started working with what was there. I guess if I wanted a CERAC machine, that probably wouldn't be approved either due to the enormous expense. Never really asked though.

Now don't get me wrong, I'm not saying that every situation is like this or even that there are a lot of these situations out there. I had to pay my dues to get where I am now and some brand new graduate shouldn't expect everything to be handed to them. They had to make sure I would make a return on their investment.

Not all corporate dental offices are the same just as not all associateships are the same either. Some are good situations and some are not so good. Some encourage you to learn and some don't. A new grad must evaluate the situation proposed to them and go from there. There are some corporations I would never work for as well as there are some private practitioners I would never work for either.

I just hate when people make broad generalities about something they know little to nothing about.

Your answers made alot of my autonomy points, thank you.

- I can take whatever time I want off
- My profits stay fully in my office, not having 1/2 of them distributed to others
- I can pick and choose which insurance plans that I want to sign up with (or not) and you might be suprised these days at how easy it is to negotiate fee schedules with insurance companies
- If I want that Cerec machine, well then all I need to do is call up my vendor rep, and say "I want that cerec machine, what will it cost me a month?, and when will it be in my office??" - done - same thing for any other major purchase
- Payroll is very easy too, my office manager just calls in the hours each week to the payroll service company we use(and there's lots of them)

I'm a hands on type of guy when it comes to the dollars and cents of my business, and it just wouldn't sit well with me knowing that if I'm working my butt off to bring home $$ for my family that a bigger chunk of my hard earned profits get sent back to corporate HQ to be divided up amongst other who may very well not be working as hard as I am. That just doesn't sit well with me, and that's why I like my "non corporate" dentistry.

 

[bass for less]

Nice thread. Thanks Dr. Jeff and Jmill0.

My intuition about cooperate dentistry is to stay away from it as much as possible... the image in my head is that someone sitting behind a black leather chair somewhere is trying to control the dentists and having us working to make them rich. While focusing on the bottom line does not necessary mean the patient's best interest must suffer, the "cooperation" just sounds like an extra layer of regulation and rules doctors have to go by.

To one his own... I am sure cooperation would work for some and not others, same thing goes for setting up one's own practice.

 

[lemoncurry]

based on Jmill0's description of the corporate environment he's in, I can see how it would appeal to certain people. Some people are not comfortable being the guy ultimately responsible for everything in the company and prefer to let others handle it. I'm not saying Jmill0 is one of those people, nor do I mean any disrespect, just adding my own observations.

However, many people, especially non-trads like myself, relish the idea of starting our own practice and not answering to stuffed shirts in management. Having done the corporate thing in the IT business for over 7 years, I am glad to be rid of it and look forward to being my own boss and answering to no one but my patients.

Me personally, if I were to let going to leave the company decisions to someone else, I would probably join the health services corps or something, where at least my superior is answerable to someone else, and so on up the ladder, and each rung has set limits.