Although I agree with majority of what you mentioned, there are actually corporations out there who do not allow the new grad docs to do their own dx and tx planning. I interviewed for a job that flat out told me I wouldn't be able to do my own tx planning... that they would "over see me, and guide me, and do a lot of the treatment planning, especially at the beginning." Screw that. Needless to say I did not even consider that place. Some corporations tell you what to do even if you don't agree, and if you don't do it, they get rid of you and find someone who will... I hear of this mainly with pediatric corporate mills, but it does happen in other corporate offices/big group practices. And as far as over-diagnosing... it happens everywhere... probably a bit more in corporate than private practice. I'll give an example... the hygienists do majority of the perio charting... I do it though if I get the chance because I know that they will have 5 mm pockets when in fact they are 3 mm because they are hard pressed for diagnosing SRP because corporate wants them to be doing SRP. I had a 22 year old come in the other day who had a history of SRP. I had never seen this patient before. It was clear to me that this patient did not need SRP. They had 2 isolated 4mm pockets at their last exam and recommended local SRP 1-3 teeth. No associated bone loss whatsoever, no calculus... mild inflammation... pseudo pocket, due to residual cement from a crown that was done. Anyways, the patient didn't need SRP or maintenance and the front office tries to tell me the patient has a history of SRP so they have to be maintenance. Not if I don't think they do. They don't like my answers all the time, but it's not their license. If you are a new grad and go into corporate, you really have to hold your ground and not cave in to what big money corporate CEOs want you to do. No one can ever fault you for doing what you think is right because it is your license on the line, and if they do, you don't want to work for them anyway. And as far as the money is concerned... in corporate you have to work your tail off to make what your daily guarantee was for 3 months or whatever the agreement is. I go home exhausted on days where I did a ton of work, but because many patients are HMO, I will do $6000 (FFS) and produce maybe $2000 (HMO) and get 27-29% of that. Money is important, but it isn't everything. For me, it has been the experience... getting my speed and efficiency up, doing tougher extractions I might not have done otherwise, but we have an in-house oral surgeon who can bail me out if it needed. Fortunately, I've only had to be bailed once. I've learned a ton of ortho tx planning by chatting with our in-house orthodontist over lunch... lots things I wouldn't have had the opportunity to do. And I am getting to see a ton of kids because many general dentists with the corporation I work for won't see them because they are HMO. I do $500 FFS tx and get maybe $100 production if I'm lucky. But for me, I'm getting to work on kids that no one else will see. And when days are slow, $100 is better than $0. I still refer out when necessary, but I get the experience of doing lots of SSC/pulps, extractions, and space maintainers. Anyways, I understand that as long as people like me keep working for these big companies, they will still be around. Are they bad for dentistry as a whole? Yes. But I wouldn't have a job to pay the bills otherwise right now. So until there are private practice jobs available, practices for sale, loans to be given to start your own practice, corporate dentistry will still be around.
It's easy for the predents and dental students to say bad things about corporate offices when they haven't had to deal with the reality of paying back the student loans and supporting the family. Good dentistry depends on the doctor's hand skills, clinical judgement and his/her ethical standard, not on where he/she works. I've seen bad dentistry and over-diagnosed tx plans that come from many private practices as well.
