Your thoughts?

[Destiny11]

So many rich, spoiled kids that do not care about the social issues in the world that are in dental school. The poor and the underserved have no chance with these future dentists.

Do you have similar views?

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[ROFL A PIGGY]

Not everyone has to have the same views as you do. Obviously it would be nice of a person to do charity work for the underserved or in poor countries, but as long as they are doing their main job as a dentist they are still helping people every single day with their oral health.

And there are always bad people in this world, there's no way around it. You just have to live by your morals and teach your kids to do the same and keep company of good people.

Don't let these negative thoughts get to you! Otherwise you'll never stop thinking about the bad and you'll forget about the good in this world.

 

[Koalafied]

So many rich, spoiled kids that do not care about the social issues in the world that are in dental school. The poor and the underserved have no chance with these future dentists.

Do you have similar views?

So many rich, spoiled kids that do not care about the social issues in the world that are in dental school. The poor and the underserved have no chance with these future dentists.

Do you have similar views?

I think 'entitled' is more inclusive.

What are these social issues in the world that are in dental school you speak of? (e.g. cliques, partying, wet Wednesdays, etc.)

Your statement in bold is an ad dictum simpliciter; care to elaborate/explain?

 

[coolslugs]

Not everyone has to have the same views as you do. Obviously it would be nice of a person to do charity work for the underserved or in poor countries, but as long as they are doing their main job as a dentist they are still helping people every single day with their oral health.

And there are always bad people in this world, there's no way around it. You just have to live by your morals and teach your kids to do the same and keep company of good people.

Don't let these negative thoughts get to you! Otherwise you'll never stop thinking about the bad and you'll forget about the good in this world.

I agree and very good points! Although entitled people tend go to towards Cosmetic/Orthodontics. I am not sure how those practices will help people that really need dental care.

 

[Destiny11]

I think 'entitled' is more inclusive.

What are these social issues in the world that are in dental school you speak of? (e.g. cliques, partying, wet Wednesdays, etc.)

Your statement in bold is an ad dictum simpliciter; care to elaborate/explain?

I think you are right. I am thinking of lack of awareness of the world outside of his/her social bubble. I am thinking of a dental student/future dentist unaware of dental issues such as access to care (doesn't insurance cover it all), student debt (bec parents paid for it all). I am thinking of students who see dentistry only as a way to get rich, and are already saying along the lines of practicing in rich areas (or taking over a family practice) and only accept patients who can afford their expensive fees. I am thinking people who would choose a party over a MOM event 9/10 times (in fear of getting his/her hands dirty).

 

[Koalafied]

I think you are right. I am thinking of lack of awareness of the world outside of his/her social bubble. I am thinking of a dental student/future dentist unaware of dental issues such as access to care (doesn't insurance cover it all), student debt (bec parents paid for it all). I am thinking of students who see dentistry only as a way to get rich, and are already saying along the lines of practicing in rich areas (or taking over a family practice) and only accept patients who can afford their expensive fees. I am thinking people who would choose a party over a MOM event 9/10 times (in fear of getting his/her hands dirty).

Here, critically observe this clip: http://www.youtube.com/watch?v=P6iw1y-Z1r4

 

[johnho771]

someone who works his butt of in dental school and wants to be rightfully compensated for his service is not necessarily rich or spoiled in my opinion.

 

[diasIItema]

These are my observations:

The majority of individuals drawn to dentistry are so for two principal reasons: 1) Familial history of dentists 2) Social perceptions of an autonomous, 35 hour work week with excellent compensation.

I'm entering my second year of dental school and almost every single student, minus the internationals, come from middle class, upper middle class, and wealthy families. Not a single student comes from the handful of most rural, most underserved counties in my state.

When we discussed the Affordable Care Act in class earlier this year, I was shocked. Having been a public health major, I was very well informed on the history of health care in our country and contemporary reform. Not so with the rest of the students in the class. People were absolutely oblivious and thought their "get rich quick scheme" was ruined. FB statuses exploded like, "I knew I should have gone to vet school" or "I'm going to quit dental school and become a nomad." Really stupid crap that made no sense.

Anyway, discussions followed and one thing led to another that gradually revealed the chief objective of the vast majority of my peers: making money, with little or no consideration of patients or improving oral health care. Additionally, I've found that most dental students are exceptionally ignorant of social issues. They know their biology, but have very little insight into politics, philosophy, current events, etc. I had one student tell me, "Black people are mainly poor because they're the inferior race." Another, "You have to admit they're better off here than they would be in Africa." Another, "Anybody in the world can be rich if they just try hard enough."

Future doctors, ladies and gentlemen.

I don't fault the students on all counts. The system is set up to basically enroll the privileged, myself being one of them. Society expresses a narrative of dentistry as a business moreso than a service. It will take dental schools actively changing the philosophy of their curricula and enrolling more professionally-minded students to alter the current status quo.

The American College of Dentists and the Student Professionalism and Ethics Association in Dentistry (SPEA) are hoping to do that. SPEA is a very new dental student organization geared towards promoting professionalism and ethics in dentistry. Because at least for this guy, my dental school has done NOTHING to discuss professionalism: what it is, what is expected of me, etc.

Dentistry is a learned profession, meaning the chief objective of the professional is public service, regardless of personal gain. That's straight from the ACD and ADA.

But as long as dental schools push public health and ethics courses to the margins of the curriculum in place of basic science, and as long as students are apathetic about professional conduct and advocacy, then yes, the poor will continue to be "screwed" while 55% of Americans continue to not see a dentist annually and 20% visit only once a decade. And I didn't even learn those figures in dental school; had to research them myself.

It's all about the Benjamins, my friend. Join SPEA perhaps. Keep doing your research. Hold your peers accountable. It only takes one leader in a class to alter perceptions and change culture.

 

[Ferneezy]

Here, critically observe this clip: http://www.youtube.com/watch?v=P6iw1y-Z1r4

i'm struggling to find the relevance of that clip to this discussion, well, beyond the fact chappelle is beast. genuine concern.

I had one student tell me, "Black people are mainly poor because they're the inferior race." Another, "You have to admit they're better off here than they would be in Africa."

what in the actual ****?

 

[Koalafied]

i'm struggling to find the relevance of that clip to this discussion, well, beyond the fact chappelle is beast. genuine concern.



what in the actual ****?

finis coronat opus

 

[coolslugs]

These are my observations:

The majority of individuals drawn to dentistry are so for two principal reasons: 1) Familial history of dentists 2) Social perceptions of an autonomous, 35 hour work week with excellent compensation.

I'm entering my second year of dental school and almost every single student, minus the internationals, come from middle class, upper middle class, and wealthy families. Not a single student comes from the handful of most rural, most underserved counties in my state.

When we discussed the Affordable Care Act in class earlier this year, I was shocked. Having been a public health major, I was very well informed on the history of health care in our country and contemporary reform. Not so with the rest of the students in the class. People were absolutely oblivious and thought their "get rich quick scheme" was ruined. FB statuses exploded like, "I knew I should have gone to vet school" or "I'm going to quit dental school and become a nomad." Really stupid crap that made no sense.

Anyway, discussions followed and one thing led to another that gradually revealed the chief objective of the vast majority of my peers: making money, with little or no consideration of patients or improving oral health care. Additionally, I've found that most dental students are exceptionally ignorant of social issues. They know their biology, but have very little insight into politics, philosophy, current events, etc. I had one student tell me, "Black people are mainly poor because they're the inferior race." Another, "You have to admit they're better off here than they would be in Africa." Another, "Anybody in the world can be rich if they just try hard enough."

Future doctors, ladies and gentlemen.

I don't fault the students on all counts. The system is set up to basically enroll the privileged, myself being one of them. Society expresses a narrative of dentistry as a business moreso than a service. It will take dental schools actively changing the philosophy of their curricula and enrolling more professionally-minded students to alter the current status quo.

The American College of Dentists and the Student Professionalism and Ethics Association in Dentistry (SPEA) are hoping to do that. SPEA is a very new dental student organization geared towards promoting professionalism and ethics in dentistry. Because at least for this guy, my dental school has done NOTHING to discuss professionalism: what it is, what is expected of me, etc.

Dentistry is a learned profession, meaning the chief objective of the professional is public service, regardless of personal gain. That's straight from the ACD and ADA.

But as long as dental schools push public health and ethics courses to the margins of the curriculum in place of basic science, and as long as students are apathetic about professional conduct and advocacy, then yes, the poor will continue to be "screwed" while 55% of Americans continue to not see a dentist annually and 20% visit only once a decade. And I didn't even learn those figures in dental school; had to research them myself.

It's all about the Benjamins, my friend. Join SPEA perhaps. Keep doing your research. Hold your peers accountable. It only takes one leader in a class to alter perceptions and change culture.

 

[Ferneezy]

finis coronat opus

obfuscating. while it's cute to pull out latin proverbs on a forum arguably full of smart people, it doesn't help move the conversation forward for simple minded folk like me.

i just want to go to the skool that teaches me to use the whirry tools to clean the stains off people's teeth.

 

[wtang567]

These are my observations:

The majority of individuals drawn to dentistry are so for two principal reasons: 1) Familial history of dentists 2) Social perceptions of an autonomous, 35 hour work week with excellent compensation.

I'm entering my second year of dental school and almost every single student, minus the internationals, come from middle class, upper middle class, and wealthy families. Not a single student comes from the handful of most rural, most underserved counties in my state.

When we discussed the Affordable Care Act in class earlier this year, I was shocked. Having been a public health major, I was very well informed on the history of health care in our country and contemporary reform. Not so with the rest of the students in the class. People were absolutely oblivious and thought their "get rich quick scheme" was ruined. FB statuses exploded like, "I knew I should have gone to vet school" or "I'm going to quit dental school and become a nomad." Really stupid crap that made no sense.

Anyway, discussions followed and one thing led to another that gradually revealed the chief objective of the vast majority of my peers: making money, with little or no consideration of patients or improving oral health care. Additionally, I've found that most dental students are exceptionally ignorant of social issues. They know their biology, but have very little insight into politics, philosophy, current events, etc. I had one student tell me, "Black people are mainly poor because they're the inferior race." Another, "You have to admit they're better off here than they would be in Africa." Another, "Anybody in the world can be rich if they just try hard enough."

Future doctors, ladies and gentlemen.

I don't fault the students on all counts. The system is set up to basically enroll the privileged, myself being one of them. Society expresses a narrative of dentistry as a business moreso than a service. It will take dental schools actively changing the philosophy of their curricula and enrolling more professionally-minded students to alter the current status quo.

The American College of Dentists and the Student Professionalism and Ethics Association in Dentistry (SPEA) are hoping to do that. SPEA is a very new dental student organization geared towards promoting professionalism and ethics in dentistry. Because at least for this guy, my dental school has done NOTHING to discuss professionalism: what it is, what is expected of me, etc.

Dentistry is a learned profession, meaning the chief objective of the professional is public service, regardless of personal gain. That's straight from the ACD and ADA.

But as long as dental schools push public health and ethics courses to the margins of the curriculum in place of basic science, and as long as students are apathetic about professional conduct and advocacy, then yes, the poor will continue to be "screwed" while 55% of Americans continue to not see a dentist annually and 20% visit only once a decade. And I didn't even learn those figures in dental school; had to research them myself.

It's all about the Benjamins, my friend. Join SPEA perhaps. Keep doing your research. Hold your peers accountable. It only takes one leader in a class to alter perceptions and change culture.

A majority of these kids have never worked a day in their life. When they get into the real world they will see how hard it is. I agree with you that most of them are exceptionally ignorant about many important things in life.

I feel like you are making dentistry out to be some cakewalk profession that requires little effort but gets a lot of money. That may have been like that in the past, but it most certainly is NOT the case anymore. It is much more difficult to make it in dentistry today, than it was in the past. Most of these kids are in for a huge surprise once they see how difficult it is to make a business actually run and produce profit.

There is nothing wrong with people entering dentistry for financial security. If they do not want to help the underserved, it does not mean they are selfish or a bad person.

As for professional conduct/ethics, no school/organization can teach that. Ethics/morals must be taught by that person's family members or self-taught. SPEA will do nothing.

 

[dantemac]

I think while care for the underserved and being savvy on current events is critical, I believe some dentists just want to keep family tradition, join the military, own their own business, have a stable career to raise a family, etc. I don't think bridging the access to care gap is the only noble thing you can do with dental careers, although it gets a lot of press.

 

[DentinBond]

The world has changed and churned and re-aligned, and all in the blink of an eye.

There is now a well-drawn dichotomy. You either:
-Engage in the relentless pursuit of More for its own sake, or,
-Focus on delighting your patients and solving their (interesting) problems.

I put that word in parentheses because the more interesting the problem, the better. Think of physical pain, esthetic pain, that sort of thing.

And not only is this dichotomy more starkly drawn than ever before-- patients can tell the difference now.

And I should think that, looking at all the changes in technology and the ability of people to connect now-- that the online review alone is enough to cause dentists to wake up and take notice of social issues, at least local ones. Those who do not, who focus exclusively on selfish goals, are starting to get hammered because of it. By the connected community around them. The connected economy around them. And it's easier than ever to connect with people who need you.

Volunteer dentistry, if that's part of what you mean by "social issues," takes no more effort than what we do every day in our careers, and it can lead to practice growth as well. If you help someone through a financially difficult time, unless they move away, who do you think they'll seek care from when they land that new job? And an excellent reputation in your community is supremely valuable.

Lastly, as one who is out there in practice, let me say this: be optimistic about our profession. I know so many dentists, hygienists and other staff who have made a difference in their community and the world around them that my pride in our profession is at its highest point ever. By and large, we are good people. Who do good things.

 

[yappy]

Whoa, I almost threw up reading this thread. People who go into dentistry can do what ever they want with their own license. Having a practice that services patients who pay for said services provides jobs and adds to their local economy.

I'm so sick of hearing people talk about "access to care" in the manner done on this thread. It's so naive it makes me wonder if you've ever spent any time in a free, sliding scale, or public health clinic before. Your views are completely devoid of reality and your rhetoric lacks critical thinking.

I'm one of those students who doesn't plan on doing much for the poor until I'm firmly established. However, I've volunteered hundreds of hours before school. I think that's okay; and, just as honorable as the person who works in a public health clinic SUPPORTED BY TAX PAYERS. It is my first responsibility to take care of my family and achieve my professional goals; and, taking care of people who didn't do the same (for a host of reasons) is secondary.

People who do that should be celebrated and not shamed.

 

[DentinBond]

I should clarify: when we delight our patients and solve their interesting problems, that's the surest way to achieve More. And as Yappy suggests, achieving More allows us to create jobs, buy new technology that serves our (paying) patients, support the local and general economy, and so much more.

It's just that-- no messenger-shooting now-- if you aim directly at More...your mileage may vary. Because consumers are smart and connected now, and they will know that's your primary focus.

 

[Koalafied]

So far, I agree with just this:

People who go into dentistry can do what ever they want with their own license.

It's called free will with accountability.


However:

Whoa, I almost threw up reading this thread. People who go into dentistry can do what ever they want with their own license. Having a practice that services patients who pay for said services provides jobs and adds to their local economy.

I'm so sick of hearing people talk about "access to care" in the manner done on this thread. It's so naive it makes me wonder if you've ever spent any time in a free, sliding scale, or public health clinic before. Your views are completely devoid of reality and your rhetoric lacks critical thinking.

I'm one of those students who doesn't plan on doing much for the poor until I'm firmly established. However, I've volunteered hundreds of hours before school. I think that's okay; and, just as honorable as the person who works in a public health clinic SUPPORTED BY TAX PAYERS. It is my first responsibility to take care of my family and achieve my professional goals; and, taking care of people who didn't do the same (for a host of reasons) is secondary.

People who do that should be celebrated and not shamed.

By which connotation of family are you referring to?​

 

[Ferneezy]

eh, if this goes according to plan, dentistry will be career number three. previously i was in the financial services industry where you lived and died by the level of service you provided and the "price" of your services were completely transparent as mandated by law. some newer associates had reaches that well exceeded their grasp and found themselves floundering much, much longer than they needed to.

as dentin alluded to above, even the 'unwashed masses' can smell the bs on you if you're trying to shake them down for crowns just to make next month's rent or payment on that shiny new AMG; and with today's tech they are able to broadcast your motivations more efficiently and effectively than ever before.

yappy, you're a level-headed poster and i've agreed with you more than i've disagreed over the months. however, i'm confused about your statement regarding the rhetoric ITT and one's personal experience in a community clinic. i've spent boatloads of time in one of those clinics and i can say with great certainty that the vast majority of patients are those with the very jobs that allow local economies to exist. i'm talking about laborers, janitors, food service workers. the spanish speaking populace that do the things many entitled americans feel they're above.

what i'm trying to say is: just because someone works a menial/low class/blue collar job and therefore doesn't have the income or insurance (double whammy, that) to support PP dentistry doesn't mean they aren't supporting their families or meeting their professional goals, such as they are.

somehow i get the feeling that most people do not wish to practice public dentistry not for some notion of lost potential income, but that they simply don't want to deal with 'those kind of people'. i have absolutely no problem with that, as i used to be an elitist snob of the highest degree and i surely can't judge, but eventually i got over myself and realized i'm just a man. i could get snuffed by a bus tomorrow and the world won't feel it in the slightest. reason i say that is i know a GP that schedules medicaid patients for two full days of his five and a half day week and clears $350k+ in a saturated, major east coast city. anecdotal, i know, but somewhat illustrative of the fact you can provide for your family while providing for some of the less fortunate members of your community.

bottom line: yes, with your dental license in hand you can throw on a pink tutu and dance a jig on jerry springer, just don't be a douche and try do right by the patients that sit in your chair. or, if you're going to be a douche, be a good actor so they don't notice.

that sounded better in my head...

 

[Koalafied]

eh, if this goes according to plan, dentistry will be career number three. previously i was in the financial services industry where you lived and died by the level of service you provided and the "price" of your services were completely transparent as mandated by law. some newer associates had reaches that well exceeded their grasp and found themselves floundering much, much longer than they needed to.

as dentin alluded to above, even the 'unwashed masses' can smell the bs on you if you're trying to shake them down for crowns just to make next month's rent or payment on that shiny new AMG; and with today's tech they are able to broadcast your motivations more efficiently and effectively than ever before.

yappy, you're a level-headed poster and i've agreed with you more than i've disagreed over the months. however, i'm confused about your statement regarding the rhetoric ITT and one's personal experience in a community clinic. i've spent boatloads of time in one of those clinics and i can say with great certainty that the vast majority of patients are those with the very jobs that allow local economies to exist. i'm talking about laborers, janitors, food service workers. the spanish speaking populace that do the things many entitled americans feel they're above.

what i'm trying to say is: just because someone works a menial/low class/blue collar job and therefore doesn't have the income or insurance (double whammy, that) to support PP dentistry doesn't mean they aren't supporting their families or meeting their professional goals, such as they are.

somehow i get the feeling that most people do not wish to practice public dentistry not for some notion of lost potential income, but that they simply don't want to deal with 'those kind of people'. i have absolutely no problem with that, as i used to be an elitist snob of the highest degree and i surely can't judge, but eventually i got over myself and realized i'm just a man. i could get snuffed by a bus tomorrow and the world won't feel it in the slightest. reason i say that is i know a GP that schedules medicaid patients for two full days of his five and a half day week and clears $350k+ in a saturated, major east coast city. anecdotal, i know, but somewhat illustrative of the fact you can provide for your family while providing for some of the less fortunate members of your community.

bottom line: yes, with your dental license in hand you can throw on a pink tutu and dance a jig on jerry springer, just don't be a douche and try do right by the patients that sit in your chair. or, if you're going to be a douche, be a good actor so they don't notice.

that sounded better in my head...

And above all, that simple visit to the dentist may be the first time that patient is informed that he/she may have other non-oral-related-health problems/deficiencies. (e.g. hypertension, diabetes, osteoporosis, HIV, breast cancer, depression and/or etc.)

Isn't dentistry just a wonderful profession to be apart of?

 

[diasIItema]

There is nothing wrong with people entering dentistry for financial security. If they do not want to help the underserved, it does not mean they are selfish or a bad person.

As for professional conduct/ethics, no school/organization can teach that. Ethics/morals must be taught by that person's family members or self-taught. SPEA will do nothing.

1) There is certainly nothing wrong with people entering the profession for financial security. But as you said, dentistry is a profession, and the principal aim of a profession, as defined by the ACD and ADA, is service to the public "regardless of personal gain." If they do not want to help the underserved, it doesn't make them a bad person. But it's not a very tenable argument to say they aren't being selfish or unprofessional.

2) Um, your second statement is entirely ignorant. People receive philosophy degrees with emphases in ethics all the time. I've learned more about ethics, morality and professionalism from higher education than my parents ever taught me. In fact, my parents and family are very ignorant regarding ethics and morals. How is it a tenable argument than only a family or individual can teach his/herself ethics and not other learned people in a structured setting? There is ZERO rationale for that statement. Using that same logic, only my family or I can teach myself dentistry. Seriously?

Dental schools can teach ethics and professionalism, and they can do it well.

As for SPEA, the parent organization of SPEA is the American College of Dentists, the most auspicious fraternity of dentists in the nation. And since SPEA is only 2 years old, I think it's a bit early to make a call on that one, chief.

Appreciate the support though.

 

[diasIItema]

Whoa, I almost threw up reading this thread. People who go into dentistry can do what ever they want with their own license. Having a practice that services patients who pay for said services provides jobs and adds to their local economy.

I'm so sick of hearing people talk about "access to care" in the manner done on this thread. It's so naive it makes me wonder if you've ever spent any time in a free, sliding scale, or public health clinic before. Your views are completely devoid of reality and your rhetoric lacks critical thinking.

I'm one of those students who doesn't plan on doing much for the poor until I'm firmly established. However, I've volunteered hundreds of hours before school. I think that's okay; and, just as honorable as the person who works in a public health clinic SUPPORTED BY TAX PAYERS. It is my first responsibility to take care of my family and achieve my professional goals; and, taking care of people who didn't do the same (for a host of reasons) is secondary.

People who do that should be celebrated and not shamed.

I worked several hundred in hours in two separate public health clinics. Therefore my views are based entirely in reality and my rhetoric reflects not only critical thought but pragmatic observation.

As for responsibility, your PROFESSIONAL responsibility is first and foremost to the public, and then to your personal financial circumstance. You can choose to operate outside the guidelines of the profession, but that effectively makes you a neo-liberal charlatan, not a professional.

However, pretty much all of your inflammatory comments on every thread are devoid of any tenable rationale for said statements and only seek to further perpetuate your outlandish self-indulgent and narcissistic ideologies.

And if you ever get into dental school, you'll learn about G.V. Black, the father of operative dentistry, who said:

"Persons who enter upon a profession as their life’s work are supposed to devote themselves to the welfare of man and to the communities in which they live. The professional man sells no goods. In general terms, his equipment is his mental endowment supplemented by his training, which has become an integral part of himself. The professional man doesn’t advertise or sell; he serves: he uses his mental endowment and special training to relieve the difficulties and distress of men, and for the benefit of society or of the state."

So yeah, you basically stand against everything the ADA, ACD, and the father of dentistry profess about the profession. Good luck with that.

 

[wtang567]

I worked several hundred in hours in two separate public health clinics. Therefore my views are based entirely in reality and my rhetoric reflects not only critical thought but pragmatic observation.

As for responsibility, your PROFESSIONAL responsibility is first and foremost to the public, and then to your personal financial circumstance. You can choose to operate outside the guidelines of the profession, but that effectively makes you a neo-liberal charlatan, not a professional.

However, pretty much all of your inflammatory comments on every thread are devoid of any tenable rationale for said statements and only seek to further perpetuate your outlandish self-indulgent and narcissistic ideologies.

And if you ever get into dental school, you'll learn about G.V. Black, the father of operative dentistry, who said:

"Persons who enter upon a profession as their life's work are supposed to devote themselves to the welfare of man and to the communities in which they live. The professional man sells no goods. In general terms, his equipment is his mental endowment supplemented by his training, which has become an integral part of himself. The professional man doesn't advertise or sell; he serves: he uses his mental endowment and special training to relieve the difficulties and distress of men, and for the benefit of society or of the state."

So yeah, you basically stand against everything the ADA, ACD, and the father of dentistry profess about the profession. Good luck with that.

This diasltema guy is a work of art.

 

[Koalafied]

A majority of these kids have never worked a day in their life. When they get into the real world they will see how hard it is. I agree with you that most of them are exceptionally ignorant about many important things in life.

I feel like you are making dentistry out to be some cakewalk profession that requires little effort but gets a lot of money. That may have been like that in the past, but it most certainly is NOT the case anymore. It is much more difficult to make it in dentistry today, than it was in the past. Most of these kids are in for a huge surprise once they see how difficult it is to make a business actually run and produce profit.

There is nothing wrong with people entering dentistry for financial security. If they do not want to help the underserved, it does not mean they are selfish or a bad person.

As for professional conduct/ethics, no school/organization can teach that. Ethics/morals must be taught by that person's family members or self-taught. SPEA will do nothing.

This diasltema guy is a work of art.

[YOUTUBE]S8635VAnOeE[/YOUTUBE]
[YOUTUBE]Y2adQ-5WDPA[/YOUTUBE]

And here's the kicker: Guess what he majored in during undergrad?

Lots and lots of change. It's only a matter of time.​

 

[charlestweed]

I charge low fee and see mostly low income patients simply because I need to survive in the competitive market in SoCal. I admire the doctors who run high end practices and charge fees that are much higher than mine. They must have good people skills and business skill. For me, I choose to do the easy path: low overhead, low fee, less demanding patients. I don’t have to sell. I don’t have to advertise. I don’t need to go to the local churches/schools to advertise my business. Being a likeable person in the community requires a lot of efforts. I am just too lazy to do all these.

I agree with everything that Yappy said. Taking care of your own family should be the #1 priority. You will never make others happy, especially if you are a successful person. If you charge your patients too much and drive a Mercedes Benz, people say you are a greedy doctor who doesn’t care for the poors. If you charge too little, your colleagues will say you are cheapening the profession and doing substandard dentistry

 

[wtang567]

I charge low fee and see mostly low income patients simply because I need to survive in the competitive market in SoCal. I admire the doctors who run high end practices and charge fees that are much higher than mine. They must have good people skills and business skill. For me, I choose to do the easy path: low overhead, low fee, less demanding patients. I don’t have to sell. I don’t have to advertise. I don’t need to go to the local churches/schools to advertise my business. Being a likeable person in the community requires a lot of efforts. I am just too lazy to do all these.

I agree with everything that Yappy said. Taking care of your own family should be the #1 priority. You will never make others happy, especially if you are a successful person. If you charge your patients too much and drive a Mercedes Benz, people say you are a greedy doctor who doesn’t care for the poors. If you charge too little, your colleagues will say you are cheapening the profession and doing substandard dentistry

nice to hear from an actual practicing dentist as opposed to glossy eyed annoyingly idealistic Dental students

 

[Koalafied]

Whoa, I almost threw up reading this thread. People who go into dentistry can do what ever they want with their own license. Having a practice that services patients who pay for said services provides jobs and adds to their local economy.

I'm so sick of hearing people talk about "access to care" in the manner done on this thread. It's so naive it makes me wonder if you've ever spent any time in a free, sliding scale, or public health clinic before. Your views are completely devoid of reality and your rhetoric lacks critical thinking.

I'm one of those students who doesn't plan on doing much for the poor until I'm firmly established. However, I've volunteered hundreds of hours before school. I think that's okay; and, just as honorable as the person who works in a public health clinic SUPPORTED BY TAX PAYERS. It is my first responsibility to take care of my family and achieve my professional goals; and, taking care of people who didn't do the same (for a host of reasons) is secondary.

People who do that should be celebrated and not shamed.

I charge low fee and see mostly low income patients simply because I need to survive in the competitive market in SoCal. I admire the doctors who run high end practices and charge fees that are much higher than mine. They must have good people skills and business skill. For me, I choose to do the easy path: low overhead, low fee, less demanding patients. I don't have to sell. I don't have to advertise. I don't need to go to the local churches/schools to advertise my business. Being a likeable person in the community requires a lot of efforts. I am just too lazy to do all these.

I agree with everything that Yappy said. Taking care of your own family should be the #1 priority. You will never make others happy, especially if you are a successful person. If you charge your patients too much and drive a Mercedes Benz, people say you are a greedy doctor who doesn't care for the poors. If you charge too little, your colleagues will say you are cheapening the profession and doing substandard dentistry

It is my first responsibility to take care of my family and achieve my professional goals; and, taking care of people who didn't do the same (for a host of reasons) is secondary.

I agree with everything that Yappy said. Taking care of your own family should be the #1

What is the connotate of this word 'family?' The flow of this discussion will greatly be enhance, so may I ask you to please kindly elucidate/elaborate? Please.
http://en.wikipedia.org/wiki/Family_(disambiguation)

 

[predent1891]

These are my observations:

The majority of individuals drawn to dentistry are so for two principal reasons: 1) Familial history of dentists 2) Social perceptions of an autonomous, 35 hour work week with excellent compensation.

I'm entering my second year of dental school and almost every single student, minus the internationals, come from middle class, upper middle class, and wealthy families. Not a single student comes from the handful of most rural, most underserved counties in my state.

When we discussed the Affordable Care Act in class earlier this year, I was shocked. Having been a public health major, I was very well informed on the history of health care in our country and contemporary reform. Not so with the rest of the students in the class. People were absolutely oblivious and thought their "get rich quick scheme" was ruined. FB statuses exploded like, "I knew I should have gone to vet school" or "I'm going to quit dental school and become a nomad." Really stupid crap that made no sense.

Anyway, discussions followed and one thing led to another that gradually revealed the chief objective of the vast majority of my peers: making money, with little or no consideration of patients or improving oral health care. Additionally, I've found that most dental students are exceptionally ignorant of social issues. They know their biology, but have very little insight into politics, philosophy, current events, etc. I had one student tell me, "Black people are mainly poor because they're the inferior race." Another, "You have to admit they're better off here than they would be in Africa." Another, "Anybody in the world can be rich if they just try hard enough."

Future doctors, ladies and gentlemen.

I don't fault the students on all counts. The system is set up to basically enroll the privileged, myself being one of them. Society expresses a narrative of dentistry as a business moreso than a service. It will take dental schools actively changing the philosophy of their curricula and enrolling more professionally-minded students to alter the current status quo.

The American College of Dentists and the Student Professionalism and Ethics Association in Dentistry (SPEA) are hoping to do that. SPEA is a very new dental student organization geared towards promoting professionalism and ethics in dentistry. Because at least for this guy, my dental school has done NOTHING to discuss professionalism: what it is, what is expected of me, etc.

Dentistry is a learned profession, meaning the chief objective of the professional is public service, regardless of personal gain. That's straight from the ACD and ADA.

But as long as dental schools push public health and ethics courses to the margins of the curriculum in place of basic science, and as long as students are apathetic about professional conduct and advocacy, then yes, the poor will continue to be "screwed" while 55% of Americans continue to not see a dentist annually and 20% visit only once a decade. And I didn't even learn those figures in dental school; had to research them myself.

It's all about the Benjamins, my friend. Join SPEA perhaps. Keep doing your research. Hold your peers accountable. It only takes one leader in a class to alter perceptions and change culture.

You sir, are narrow-minded. Why does it have to be black or white? Why do you classify people's motives as being EITHER a desire to help others OR being financially stable? Can't it be both? I know that I'm in dentistry for multiple reasons and not just ONE "principle" reason OR the other.

1. What's wrong with wanting to live the "American dream"? I come from a single parent home, family of 5, annual income of $30k. I was never able to claim that I was from a disadvantaged background because I actually lived at the very tip of a moderate neighborhood. So I was on the same playing field as the middle income and high income kids...but I had to work even harder to compensate for the disadvantages. So I don't understand what's wrong with dreaming of becoming financially stable. Its not like I'm robbing a bank, embezzling money, or doing anything dishonest. So whats the shame in working hard to someday have the luxury of being able to take my mom out for a nice dinner, or surprise my family with early Christmas gifts, etc. etc.

2. Having many childhood friends in the same financial situation as mine, I know what its like to not have health insurance or dental insurance. Hell, I didn't even really know what it was until I was entering college and I was asked about waiving insurance, getting immunizations, etc. I vaguely remember going to a free clinic for dental care once or twice as a kid. So I feel for people in hard financial situations. I wanted to become a dentist to help out people that are in the same financial situation I am. During undergrad I used to volunteer a day out of my week at the free clinic and I plan to do the same after I graduate in a couple years. But it doesn't mean that I go around acting like I'm the only one in the world that wants to help people. Just because people don't advertise it doesn't mean they aren't in it to help patients. Stop acting so self-righteous. When your classmates say they are in it ONLY for the money, its a joke.

3. I thought we all enter dentistry because we love teeth. Haha. I actually really like dentistry because I like to fiddle with things, design things, build things, etc. I can spend hours sitting down trying to build things which is also the reason why I have loved my time in the preclinics during the first year.

So from your post I can tell that you don't really know your classmates and youre just making generalizations. Go and get to know your classmates. You'll soon learn that people's motives aren't so black and white.

 

[Koalafied]

Paul Graham's Hierarchy of Disagreement

• This is a pre-health professional forum and professional behavior and treatment of other users is expected.

You sir, are narrow-minded. Why does it have to be black or white? Why do you classify people's motives as being EITHER a desire to help others OR being financially stable? Can't it be both? I know that I'm in dentistry for multiple reasons and not just ONE "principle" reason OR the other.

1. What's wrong with wanting to live the "American dream"? I come from a single parent home, family of 5, annual income of $30k. I was never able to claim that I was from a disadvantaged background because I actually lived at the very tip of a moderate neighborhood. So I was on the same playing field as the middle income and high income kids...but I had to work even harder to compensate for the disadvantages. So I don't understand what's wrong with dreaming of becoming financially stable. Its not like I'm robbing a bank, embezzling money, or doing anything dishonest. So whats the shame in working hard to someday have the luxury of being able to take my mom out for a nice dinner, or surprise my family with early Christmas gifts, etc. etc.

2. Having many childhood friends in the same financial situation as mine, I know what its like to not have health insurance or dental insurance. Hell, I didn't even really know what it was until I was entering college and I was asked about waiving insurance, getting immunizations, etc. I vaguely remember going to a free clinic for dental care once or twice as a kid. So I feel for people in hard financial situations. I wanted to become a dentist to help out people that are in the same financial situation I am. During undergrad I used to volunteer a day out of my week at the free clinic and I plan to do the same after I graduate in a couple years. But it doesn't mean that I go around acting like I'm the only one in the world that wants to help people. Just because people don't advertise it doesn't mean they aren't in it to help patients. Stop acting so self-righteous. When your classmates say they are in it ONLY for the money, its a joke.

3. I thought we all enter dentistry because we love teeth. Haha. I actually really like dentistry because I like to fiddle with things, design things, build things, etc. I can spend hours sitting down trying to build things which is also the reason why I have loved my time in the preclinics during the first year.

So from your post I can tell that you don't really know your classmates and youre just making generalizations. Go and get to know your classmates. You'll soon learn that people's motives aren't so black and white.

▲ This is besides the central point, but according to Paul Graham's Hierarchy of Disagreement, so far, much of the rhetoric in the post indicated above is below the yellow.​

Please properly, professionally, respectfully, maturely, rationally, intelligently concede or refute the central point of this discussion/thread. Please, at the very least for the sake of dentistry.

 

[yappy]

I live in the US during the year 2013.

US Census definitions:

A family consists of two or more people (one of whom is the householder) related by birth, marriage, or adoption residing in the same housing unit.

What is the connotate of this word 'family?' The flow of this discussion will greatly be enhance, so may I ask you to please kindly elucidate/elaborate? Please.
http://en.wikipedia.org/wiki/Family_(disambiguation)

Dias, I respect your concern for undeserved communities and hope you get to impact those communities in your career. However, you've got it completely wrong when it comes to people who wish to provide well for their family. To be honest you come off as coercive and hostile.

I disagree because on one hand you condemn people who want to provide for their families; yet, wish to extend help that is paid for by people who provide for their families. All the public clinics in my area are paid for by tax revenues. I too was once excited to work in one and asked my brother to vote to support the clinics, and expand a dental benefit, to which he responded

"Why should I pay for other peoples dental care?"

I didn't know really want to say; because, I didn't have a good answer. He was struggling financially, as most young families do, but made enough money to support them and would be hit by these increased property taxes. He probably doesn't know it but that question, along with studying economics, has completely changed my perspective on politics and what ones responsibility is in society.

My rational is based off of empirical data and personal experiences. Like I said; I have not always thought this way. My views are extremely rational. In time you'll change your perspective too...

 

[yggdrasila]

I live in the US during the year 2013.

US Census definitions:





Dias, I respect your concern for undeserved communities and hope you get to impact those communities in your career. However, you've got it completely wrong when it comes to people who wish to provide well for their family. To be honest you come off as coercive and hostile.

I disagree because on one hand you condemn people who want to provide for their families; yet, wish to extend help that is paid for by people who provide for their families. All the public clinics in my area are paid for by tax revenues. I too was once excited to work in one and asked my brother to vote to support the clinics, and expand a dental benefit, to which he responded

"Why should I pay for other peoples dental care?"

I didn't know really want to say; because, I didn't have a good answer. He was struggling financially, as most young families do, but made enough money to support them and would be hit by these increased property taxes. He probably doesn't know it but that question, along with studying economics, has completely changed my perspective on politics and what ones responsibility is in society.

My rational is based off of empirical data and personal experiences. Like I said; I have not always thought this way. My views are extremely rational. In time you'll change your perspective too...

I don't have a reason as to why your brother should pay for other people's insurance really but at least my family and I should now because when we were poor other people were paying for us.

Actually maybe that's the answer. I didn't have medical insurance for most of my life but I was lucky that I had relatives that were willing to do some check up for a really low cash price also my family was pretty damn healthy. Everything else was from free clinics. We basically just skipped out on seeing the dentist ever but you know what it probably would have been really helpful to the development of my teeth to have seen a dentist more often. No one likes extra taxes and I don't think that those who can't afford it should be taxes more, I have more of a sliding scale mentality but let me stop here because honestly my thoughts on this aren't fully developed.

Anyway there are so many people who don't have access to care that need help sometimes. I was able to get some kind of access out of sheer luck, like I could have developed goiters and be drowning in medical debt rn if I didn't have that one random distant distant family friend/reletive who happened to be a MD.

I feel like sometimes people on this site get financial stability mixed up with financial excess. Yes I also want to take care of whatever family y'all are talking about, I am EXTREMELY filial, but you only need so much to actually do that. I guess my mentality is leaving anyone high and dry when you can afford to help is horse doodoo I pretty much roll my eyes over anyone complaining about netting more than 100k after their loans are paid off. I can sympathize with the people who make less bc even though my family of 4 has lived off way way less I know circumstances can make it difficult.

I think it's naive to think that everyone can survive by sheer hard work. That's way more glossy eyed and annoying idealistic in my opinion. And yes sometimes dental care is a matter of survival. Money is the bottom line but damn doesn't anyone have room for empathy. Whatever poor people suck tho amirite damn the financial burden they cause, upper middle class brofist, I'm part of the club now.

Thanks for helping me free write for a personal statement tho

One more thing I'm glad that a real working dentist is able to verify that running an office while offering prices that widens the range of access is possible in some markets. Thanks Charlestweed. Even if it's not your objective you're still doing the thing and that makes me happy.

 

[NDPitch]

I worked several hundred in hours in two separate public health clinics. Therefore my views are based entirely in reality and my rhetoric reflects not only critical thought but pragmatic observation.

As for responsibility, your PROFESSIONAL responsibility is first and foremost to the public, and then to your personal financial circumstance. You can choose to operate outside the guidelines of the profession, but that effectively makes you a neo-liberal charlatan, not a professional.

However, pretty much all of your inflammatory comments on every thread are devoid of any tenable rationale for said statements and only seek to further perpetuate your outlandish self-indulgent and narcissistic ideologies.

And if you ever get into dental school, you'll learn about G.V. Black, the father of operative dentistry, who said:

"Persons who enter upon a profession as their life’s work are supposed to devote themselves to the welfare of man and to the communities in which they live. The professional man sells no goods. In general terms, his equipment is his mental endowment supplemented by his training, which has become an integral part of himself. The professional man doesn’t advertise or sell; he serves: he uses his mental endowment and special training to relieve the difficulties and distress of men, and for the benefit of society or of the state."

So yeah, you basically stand against everything the ADA, ACD, and the father of dentistry profess about the profession. Good luck with that.

 

[Koalafied]

It's all about the Benjamins, my friend. Join SPEA perhaps. Keep doing your research. Hold your peers accountable. It only takes one leader in a class to alter perceptions and change culture.

I agree.

It really, does indeed, takes just that one person.

 

[UCSFx2017]

Sitting behind my classmates during lecture, I see a few of them looking up pictures of luxury cars online. Nothing wrong with that but it shows they hold excessive materialistic values. I'm not saying those values are wrong but other values are more conducive to a less self-serving group of professionals. I'll have my starry-eyed image of my ideal profession and everyone else is equally entitled to his/her own.

 

[TheWeeIceMan]

Just recently met a classmate who blatantly told me that he doesn't plan on accepting Medicare/Medicaid.

A lot of my classmates have farming, rural, lower-middle, or middle-class backgrounds.

Is there something wrong with this in your opinion?

 

[yggdrasila]

Is there something wrong with this in your opinion?

It's lawful sure, dentists have that right I'm sure they fought hard as hell for it but you're planning on not treating someone who can't afford treatment without government insurance. I'm pretty sure the payout, while slow as hell , at least covers costs of materials and the pay for your hygienist or whoever is on staff for that procedure, yet plenty of dentist don't take it because it's not as much as they decided to mark up their services.

Anyway in my pure little glowing heart corner it feels like negligence, in the greedy corner it's simply turning down paid work because you feel entitled to higher pay than other dentists? It's you're not doing it pro bono. Maybe some dentist think it'll lower the prestige of their clientele? In that case they're elitist *******s, not surprising. Other reason is probably they don't think they're being paid enough, whatever at least refer the patient to a dentist that does take medicare/medicaid.

 

[Katzen7]

It's lawful sure, dentists have that right I'm sure they fought hard as hell for it but you're planning on not treating someone who can't afford treatment without government insurance. I'm pretty sure the payout, while slow as hell , at least covers costs of materials and the pay for your hygienist or whoever is on staff for that procedure, yet plenty of dentist don't take it because it's not as much as they decided to mark up their services.

Anyway in my pure little glowing heart corner it feels like negligence, in the greedy corner it's simply turning down paid work because you feel entitled to higher pay than other dentists? It's you're not doing it pro bono. Maybe some dentist think it'll lower the prestige of their clientele? In that case they're elitist *******s, not surprising. Other reason is probably they don't think they're being paid enough, whatever at least refer the patient to a dentist that does take medicare/medicaid.

Actually, there are many states where the cost is not justifiable. You have to remember that when you are running a business you can't just be breaking even, you have to make a profit. Furthermore, you need to account for the risk you take of possible litigation and "just breaking even" doesn't even come close to being worth it.

For a simple extraction in my state, Medicaid pays around the order of $39. After I pay my assistant, the supplies (admittedly not much for an extraction, but there are still some costs), and take into account the fixed costs of any given chair time (electricity, rent, etc.)...I'm sorry, but $39 just doesn't cut it. THIS is why so many dentists won't accept Medicaid.

 

[charlestweed]

Actually, there are many states where the cost is not justifiable. You have to remember that when you are running a business you can't just be breaking even, you have to make a profit. Furthermore, you need to account for the risk you take of possible litigation and "just breaking even" doesn't even come close to being worth it.

For a simple extraction in my state, Medicaid pays around the order of $39. After I pay my assistant, the supplies (admittedly not much for an extraction, but there are still some costs), and take into account the fixed costs of any given chair time (electricity, rent, etc.)...I'm sorry, but $39 just doesn't cut it. THIS is why so many dentists won't accept Medicaid.

You forget to mention about the high no show rate problem in the practices that accept medicaid. To avoid paying the staff for sitting around doing nothing (because of the no shows), the dentist has to overbook his patients.....and this is totally unfair for the patients who regularly show up for their appointments. Like I said before, I accept medicaid not because I am a generous person but because I want to stay competitive in the saturated CA market. I completely understand why many of my colleagues don't accept medicaid.

In my practice, there is a high percentage of the medicaid patients who can afford ortho treatment. Many of them become my cash patient because their malocclusion is not severe enough for the state's medicaid to pay for the ortho treatment. Many of them have better smartphones than mine.

 

[yappy]

These are the problems that I've experienced and have heard many dentists complain about. Anyone who has spent anytime in a sliding-fee, free, or public clinic would quickly identify these problems.

In my area most hygienists make more per hour ($35/hr) than medicaid pays for a prophy. Not only is this a financial loss - many patients on medicaid have extensive periodontal problems that need more than an hour of cleaning. The population is also flighty and difficult to manage. The government will gladly shortchange professionals for their services in order to purchase votes... why would anyone desire to take this "insurance" (read: entitlement)?

You forget to mention about the high no show rate problem in the practices that accept medicaid. To avoid paying the staff for sitting around doing nothing (because of the no shows), the dentist has to overbook his patients.....and this is totally unfair for the patients who regularly show up for their appointments. Like I said before, I accept medicaid not because I am a generous person but because I want to stay competitive in the saturated CA market. I completely understand why many of my colleagues don't accept medicaid.

Actually, there are many states where the cost is not justifiable. You have to remember that when you are running a business you can't just be breaking even, you have to make a profit. Furthermore, you need to account for the risk you take of possible litigation and "just breaking even" doesn't even come close to being worth it.

For a simple extraction in my state, Medicaid pays around the order of $39. After I pay my assistant, the supplies (admittedly not much for an extraction, but there are still some costs), and take into account the fixed costs of any given chair time (electricity, rent, etc.)...I'm sorry, but $39 just doesn't cut it. THIS is why so many dentists won't accept Medicaid.

 

[DentinBond]

I'm pretty sure the payout...at least covers costs of materials and the pay for your hygienist or whoever is on staff for that procedure, yet plenty of dentist don't take it because it's not as much as they decided to mark up their services.

I'd like to pose a question; no editorializing or opinions, just want to put the question out there and get us all thinking about it. (I have some of my own answers but asking first is a lot better than telling.)

Hypothetical situation: A doctor (let's call her Dr. Tand) graduates in several hundred thousand in debt and her monthly loan payments are $2,800 a month over 25 years. She'd like to pay them off in 10 years but that's $4,650 a month and she can't live on that.
She works for a fine and ethical doc who after a few years suddenly decides to retire for health reasons. Dr. Tand decides that even though it's yet more debt, she will purchase this practice since the deal will be fair to both parties and it's a great practice.

Still, once she's an owner our Dr. Tand is under great pressure since her debt is so high. Her financial life is balanced on the point of a knife, and her car isn't really as safe as it should be, but a new one is out of the question. And it's ironic and a little sad that she took more vacations back in dental school than she's able to now... And then in 2008 the whole bloody economy tanks.

All of a sudden, many new and existing patients with Medicare/Medicaid start calling. More than ever before. Dr. Tand's is the only practice in town that accepts patients covered under Medicare/Medicaid. In the fullness of time, the number of such patients grows until, some days, up to 10% of the chairtime with doctor and hygienist is patients with Medicare/Medicaid. Some days, it's even more.

Noting a change in her numbers, Dr. Tand does a detailed, objective analysis. For the first time since purchasing the practice she makes an honest and full assessment of her fixed and variable expenses. The purchase loan, employee salaries, rent, supplies, lab bills, depreciation-- all of it. And then she looks at the collections from patients without insurance, patients with insurance (she participates in three as well as billing to various non-par insurances), and patients with Medicare/Medicaid.

She finds that, on average--regardless of how efficiently she tries to schedule--each and every patient on Medicare/Medicaid who enters her office costs her $250 per visit.

Again: She is paying $250 on average for each time a patient on Medicare/Medicaid enters her office for treatment.

Dr. Tand grew up in this town. She doesn't want to abandon it, or those citizens who have faced adversity, especially as they may recover with the economy, given time. But she owes $2,800 a month in loans, plus twice that on the practice loan and all her other expenses, and it's a matter of simple mathematics, maybe even a law of physics, that she cannot afford to lose hundreds of dollars a day, not to mention that the scarce and valuable chairtime involved in this loss could be producing income for her practice.

Now. You are Dr. Tand. What would you do?

 

[OceanDMD]

I'd like to pose a question; no editorializing or opinions, just want to put the question out there and get us all thinking about it. (I have some of my own answers but asking first is a lot better than telling.)

Hypothetical situation: A doctor (let's call her Dr. Tand) graduates in several hundred thousand in debt and her monthly loan payments are $2,800 a month over 25 years. She'd like to pay them off in 10 years but that's $4,650 a month and she can't live on that.
She works for a fine and ethical doc who after a few years suddenly decides to retire for health reasons. Dr. Tand decides that even though it's yet more debt, she will purchase this practice since the deal will be fair to both parties and it's a great practice.

Still, once she's an owner our Dr. Tand is under great pressure since her debt is so high. Her financial life is balanced on the point of a knife, and her car isn't really as safe as it should be, but a new one is out of the question. And it's ironic and a little sad that she took more vacations back in dental school than she's able to now... And then in 2008 the whole bloody economy tanks.

All of a sudden, many new and existing patients with Medicare/Medicaid start calling. More than ever before. Dr. Tand's is the only practice in town that accepts patients covered under Medicare/Medicaid. In the fullness of time, the number of such patients grows until, some days, up to 10% of the chairtime with doctor and hygienist is patients with Medicare/Medicaid. Some days, it's even more.

Noting a change in her numbers, Dr. Tand does a detailed, objective analysis. For the first time since purchasing the practice she makes an honest and full assessment of her fixed and variable expenses. The purchase loan, employee salaries, rent, supplies, lab bills, depreciation-- all of it. And then she looks at the collections from patients without insurance, patients with insurance (she participates in three as well as billing to various non-par insurances), and patients with Medicare/Medicaid.

She finds that, on average--regardless of how efficiently she tries to schedule--each and every patient on Medicare/Medicaid who enters her office costs her $250 per visit.

Again: She is paying $250 on average for each time a patient on Medicare/Medicaid enters her office for treatment.

Dr. Tand grew up in this town. She doesn't want to abandon it, or those citizens who have faced adversity, especially as they may recover with the economy, given time. But she owes $2,800 a month in loans, plus twice that on the practice loan and all her other expenses, and it's a matter of simple mathematics, maybe even a law of physics, that she cannot afford to lose hundreds of dollars a day, not to mention that the scarce and valuable chairtime involved in this loss could be producing income for her practice. She is thus actually losing more than $250 per visit; it's probably triple that when lost revenues are considered.

Now. You are Dr. Tand. What would you do?

I would hire Dr. diaslltema as an associate(obviously he/she wants to serve the public with complete disregard to personal income) to work my medicaid farm, and open up another facility to serve better compensating PPOS and non insurance patients. Probably could pay this associate a salary in the range of 50-75k (hes not worried about his income right?), or hell, pay him a flat 35% of his collections on medicaid. Thats would be in the same ballpark anyway.

 

[Koalafied]

I would hire Dr. diaslltema as an associate(obviously he/she wants to serve the public with complete disregard to personal income) to work my medicaid farm, and open up another facility to serve better compensating PPOS and non insurance patients. Probably could pay this associate a salary in the range of 50-75k (hes not worried about his income right?), or hell, pay him a flat 35% of his collections on medicaid. Thats would be in the same ballpark anyway.

Show-off.

 

[wtang567]

I would hire Dr. diaslltema as an associate(obviously he/she wants to serve the public with complete disregard to personal income) to work my medicaid farm, and open up another facility to serve better compensating PPOS and non insurance patients. Probably could pay this associate a salary in the range of 50-75k (hes not worried about his income right?), or hell, pay him a flat 35% of his collections on medicaid. Thats would be in the same ballpark anyway.

You could pay Dr. Diasltema minimum wage and he'd be ok with it. He is like a really noble guy who doesn't even like money. The Gandhi and Nelson Mandela of dentistry, if you ask me.

 

[DentinBond]

Well, but this scenario happens in the real world. A lot. It happens with participating insurance plans in addition to Medicare/Medicaid. This sort of challenge impacts many American dentists. We can learn a lot from each other through the interactions here, so let's truly put ourselves in Dr. Tand's shoes and try to get ourselves out of this mess. We've established that hiring a communist associate is a possible tactic. Moving on-- what else??

 

[yggdrasila]

Now. You are Dr. Tand. What would you do?

Okay for my original post I should clarify that in my city I'm pretty sure it covers the costs and that there are plenty of other dentist that take medicare/medicaid. Also slight over booking isn't the end of the world and doesn't cause that many delays if you're efficient in managing you time and your staff. I feel bored in offices where we're ho humming waiting for the next patient.

That being said I wanna answer the question but there are a few things that don't really match up for me first she wants to pay off the loans at 5000 but can't afford that the next second she's paying like 9000ish for her school loans and the practice. Why wasn't she paying of at a rate of 5000 before when she hadn't purchased the place? 4800 a month comes out to like 57,600 a year unless she was being paid 70,000 by Ocean DMD over here she could have probably afforded it. I'm not saying buying the practice was a bad idea.

Honestly it's a pretty complicated situation. I would probably continue taking medicare medicaid while trying to increase the amount of cash patients/insurance, add some new fancy **** procedure, bleaching or something i dunno. Hire some eager to please pre-dent to sterilize, disinfect room and take x-rays (when they're certified) to skim time off appointments and maximize the time of more more trained staff so I can book more people. Pay them barely more than min wage (sorry man). Pick up part time at a different office to make up for the losses at mine. Extend my hours? It would be pretty hard but I was a junior in high school when I thought I wanted to be a dentist for more free time and good pay. Plus Dr Tand graduated with a couple hundred thousand in debt paying it off at 2800 a month worked for a couple years already has at least 1 of that couple hundred thousand paid off. What's the practice cost? I really don't know is it like 500,000-a mill plus or minus 300K?

Whatever it all is I feel like she could still make it outta debt in like 15 years. Does Dr Tand still have a net profit at the end of the month even when accepting patients? If it's above 90K a year and she has no family she's clear as far as I can tell in like 25 years. If she's really frugal or has a few good years she could even buy a house. 90K a year for someone in the practice a few years, assuming she's a good dentist is pretty low on the scale isn't it. I saw a thread from 2008 where people were netting 350K lets say that's really high even if she's making 150K in 2008 and could probably afford a pretty decent life style.

Anyway I'm not Dr Tand. She's lucky to be able to buy just a few years out of school though, other people sometimes just float around being screwed over by various dentist don't they?

Omg i'm in a different forum and some people only pay their assistants $8 an hour??? God damn that's harsh as hell

 

[DentinBond]

Okay for my original post I should clarify that in my city I'm pretty sure it covers the costs

That being said I wanna answer the question but there are a few things that don't really match up for me

Honestly it's a pretty complicated situation. I would probably continue taking medicare medicaid while trying to increase the amount of cash patients/insurance, add some new fancy **** procedure, bleaching or something i dunno. Hire some eager to please pre-dent to sterilize, disinfect room and take x-rays (when they're certified) to skim time off appointments and maximize the time of more more trained staff so I can book more people. Pay them barely more than min wage (sorry man).

Whatever it all is I feel like she could still make it outta debt in like 15 years. Does Dr Tand still have a net profit at the end of the month even when accepting patients?

Anyway I'm not Dr Tand. She's lucky to be able to buy just a few years out of school though, other people sometimes just float around being screwed over by various dentist don't they?

I wonder if the original poster is following our fascinating conversation?

The fact that "other people sometimes just float around being screwed over by various dentist don't they?" and similar fears appear here often is a harsh indictment of my generation of dentists. Some few do behave in this way to younger colleagues, Yggdrasila, and although I never have, I apologize for their behavior of behalf of our profession anyway.

If I were to write a code of dental ethics, Point The First would be:
"A dentist is never to treat a colleague as interchangeable, temporary and disposable."

Well, it would be more than that, dammit. Point The First would be:
"A dentist is never to treat a patient, colleague or employee as interchangeable, temporary and disposable."

Thus, "pay them barely more than minimum wage" makes me uncomfortable. Adopting the factory mindset and hiring interchangeable drones is a common tactic to cut costs. But that's short-term thinking, and it's a zero-sum game. For everything the factory owner gains, the interchangeable drone loses something. If, rather, we elevate our employees, inspire and train them to be their best, everyone gains exponentially, including the employer. In the long term. That's the hard part--human beings generally suck at long-term thinking. But you students are bright and amazing and have all kinds of potential. All you need is someone to point it out to you early and let me tell you, Yggdrasila, I can't wait to see what you all create. Just think long-term, and create some cool stuff, ok?

So, Yggdrasila, your suggestions tend towards cutting costs. This tactic is important and useful. We have to be careful not to take it too far, though. Excess reduction of expenses leads you into a race to the bottom on cost. Bertrand Competition. When it comes to equivalent products and services, assuming geographic availability, people often buy from whoever offers the product or service at lowest cost. Price drives everything for equivalent items.
Therefore: You must NEVER view yourself and what you provide as equivalent. ;}

Think about that for a long time. Explore all its implications; it's vitally important.

And you already hit on two excellent strategies for increasing revenues; in fact, they may be the only two besides adding hours:
-new patients
-new or augmented procedures

When it comes to what's "medically necessary," the definition of which we could argue about for hours, our responsibility is to fully diagnose and then present treatment plans effectively. This means communications skills. It's especially important when patients don't have any more discretionary income than Dr. Tand does. But unscheduled treatment is just the same as undiagnosed treatment in terms of its physical effects on the patient, so we have a responsibility to communicate well.

And when it comes to elective procedures, like bleaching or "fancy" treatments, we need to ask, not tell. One man's despised diastema is another man's mark of individuality. As long as we stay ethical and ask, not force elective treatments on people, we can and should ask every patient we see. With big intraoral photographs on the monitor. Sometimes people are in tears, they've been so upset about an esthetic issue for so long and no dentist ever asked them about it.

So if we then raise revenues ethically and do some reasonable cost reduction without treating anyone as interchangeable, temporary and disposable, we are in better shape but I still challenge the assertion that "in my city I'm pretty sure it covers the costs." Medicaid, Medicare and some PPO insurance plans most assuredly do not cover the true costs of providing dental services. What to do??

Well, some participating insurance plans allow dentists to close the office to new patients. This is an excellent solution--you can continue to see all those patients you already know and really like from down at Consolidated Widgets. You don't have to send a letter to them all, telling them that you no longer participate because the plan pays too little. After all, it's not just them--many of them have referred in their friends and relatives who pay cash. But, if you close to new patients, it limits the impact of reduced fees. You may achieve the ideal which is to fill chairs at downtime, but not get flooded. Some plans don't allow this though.

Here's what I don't know--Can you close your office to new Medicaid/Medicare patients, and still participate? Does anyone know? That allows you to do a level of social good that you can afford. Otherwise, it's all or nothing. And all can break your practice, even with participating plans that pay too little to let take over.

What I'm also looking for with my original question is a Kobayashi Maru solution. You know--alter the conditions of the experiment to avoid a no-win scenario, because you don't believe in no-win scenarios.

The original poster asked about doing something about social issues, I presume in the context of dental care and access to care. Keep in mind that this is not necessarily a zero-sum game. You and your practice can gain tremendously while accomplishing some good for your community or in terms of access to care. Reputation and Attention are worth just as much as cash these days, in many respects. Also keep in mind that we dentists need to work together on this access to care issue, and solve it, before some beastly outside entity like the government does it for us. That's the worst outcome imaginable...

So. Any Kobayashi Maru, outside-the-box ideas about Dr. Tand's financial pressures or access to care/treating the financially challenged, without breaking the practice? And does anyone know about the legality of closing Medicaid to new patients?

 

[yggdrasila]

Yeah paying them barely more than min wage is kinda mean but min wage here is pretty high. Plus if I paid for their certifications, trained them to work in the office from scratch and wrote a kick as LoR I think it would be a pretty sweet looking deal to most pre-dents out there. Some pre-dent's around here get paid about $10 to do full time sterilization in their gap year or post-bacc time. I'm thinking more like more than one person working part time so they can still go to school and doing more than throwing instruments in the bag. If they plan to work with me long term of course there would be raises. I really believe in fostering healthy relationships in the office but pre-dents are students and most students work temp like hours/ may leave after a year so it's a little hard to think of them as permanent. At the same time I don't want the people I work with to constantly fear getting fired. Patients can really tell when the staff get along and I think that relaxes them more than a frigid chop shop where everyone is just there to get the job done.

AHHH I have so many ideas

Also if this were irl and I was in Dr Tand's situation one of my solutions would be, ask my parents to help pay off my loans. Family loans are the lowest interest loans after all. But I don't want to sound spoiled because I'm not but desperate times and all. I was operating under the assumption that most peoples parent's can't afford to even help out because that's more realistic...well maybe some others in dental school could do the same.

 

[UCSFx2017]

Is there something wrong with this in your opinion?

There's nothing wrong with operating a profitable business. What I don't like is the "What's in it for me?" philosophy that we fall back on after we graduate from medical or dental school. I understand that we naturally feel deserving of reward after giving up much of our twenties and hundreds of thousands of dollars in loans. But it is our responsibility as the only members of society capable of healing others to serve everyone in society. Not just those who can afford our services but also the destitutes. We shouldn't treat health as a commodity that's affected by supply-and-demand and made available to only those with the means to afford. Everyone needs it. You can want commodities but you need necessities.

Public necessities like fire department services, public water, clean environment, and especially health are needed by everybody and everyone deserves them, even those who would normally not be able to afford them if these services were privatized. By keeping these services public, maximizing profits is second to ensuring good public health, putting fires out, and maintaining a safe, clean environment.

I think in medical and dental school, we often feel like we're in a rat race, vying for top rank, but in a functional society, I like to think that we're all looking out for each other, even if that means we sacrifice a little on our part without expecting much, if anything, in return.

tl;dr = Being too capitalistic isn't good for anyone

 

[coolslugs]

There's nothing wrong with operating a profitable business. What I don't like is the "What's in it for me?" philosophy that we fall back on after we graduate from medical or dental school. I understand that we naturally feel deserving of reward after giving up much of our twenties and hundreds of thousands of dollars in loans. But it is our responsibility as the only members of society capable of healing others to serve everyone in society. Not just those who can afford our services but also the destitutes. We shouldn't treat health as a commodity that's affected by supply-and-demand and made available to only those with the means to afford. Everyone needs it. You can want commodities but you need necessities.

Public necessities like fire department services, public water, clean environment, and especially health are needed by everybody and everyone deserves them, even those who would normally not be able to afford them if these services were privatized. By keeping these services public, maximizing profits is second to ensuring good public health, putting fires out, and maintaining a safe, clean environment.

I think in medical and dental school, we often feel like we're in a rat race, vying for top rank, but in a functional society, I like to think that we're all looking out for each other, even if that means we sacrifice a little on our part without expecting much, if anything, in return.

tl;dr = Being too capitalistic isn't good for anyone

 

[Koalafied]

There's nothing wrong with operating a profitable business. What I don't like is the "What's in it for me?" philosophy that we fall back on after we graduate from medical or dental school. I understand that we naturally feel deserving of reward after giving up much of our twenties and hundreds of thousands of dollars in loans. But it is our responsibility as the only members of society capable of healing others to serve everyone in society. Not just those who can afford our services but also the destitutes. We shouldn't treat health as a commodity that's affected by supply-and-demand and made available to only those with the means to afford. Everyone needs it. You can want commodities but you need necessities.

Public necessities like fire department services, public water, clean environment, and especially health are needed by everybody and everyone deserves them, even those who would normally not be able to afford them if these services were privatized. By keeping these services public, maximizing profits is second to ensuring good public health, putting fires out, and maintaining a safe, clean environment.

I think in medical and dental school, we often feel like we're in a rat race, vying for top rank, but in a functional society, I like to think that we're all looking out for each other, even if that means we sacrifice a little on our part without expecting much, if anything, in return.

tl;dr = Being too capitalistic isn't good for anyone

But it is our responsibility as the only members of society capable of healing others to serve everyone in society.