Wednesday, June 27, 2012
In case you haven’t seen it, Frontline aired an episode on PBS entitled “Dollars and Dentists” on June 26. The investigative reporter Miles O’Brien did a great job of bringing to light the problem our country has with access to care. The first concept is that even if money were no issue, there would not be enough dentists to treat everyone. Second, people do not necessarily have the money to treat the needs of their teeth. This is especially scary considering the amount of children in our country whose families have no way to pay for the care. Third, public programs offering dental care to kids are attempting a risky balance of helping those in need, and running a business for profit. Unlike other articles from the New York Times, the episode is in no way sensational, and gives us a hard look at how difficult it is to provide for every dental need in this country. It is definitely worth your time to watch the entire thing, right up to the end when a young woman has her teeth restored by a charity organization.
My biggest reaction to the quote “Dentistry is a business” was this: Exactly. How do you think the phone bill gets paid? Or the staff salaries? Or the benefits we provide to retain good people? It is a business with overhead, a bottom line, and profit. There is no mystery here. If you don’t bring in enough money, your doors have to close.
This is a very different concept, however, from how that business is run in terms of ethics. Does that patient really need that treatment, or are they being pushed into something they don’t understand and cannot afford. In our office, we put the needs of our patients first, helping them make the right decision for their own oral health. It is why we would never have a bonus structure for our employees. At times, our recommendations mean that we will have no billable production for that person. I look at my business partner who has been in practice for 30 years. He has always put the patient ahead of profit, and his business was still successful. It is still incumbent upon dentists to make the right decisions. As a professor of mine once said, “Practice with integrity, and people will come to you.”
Obviously a report like this only has the time to focus on a few key issues, but there is so much more to this problem than Mr. O’Brien brought up.
Corporations – Mr. O’Brien accurately targets some of the dental corporations for existing solely for profit, giving their doctors bonuses to “sell” more dentistry. But what about the insurance companies? Premiums are on the rise, as are their profits, while reimbursement to dentists is often shrinking. This doesn’t exactly help access to care. And what about companies like Coca-Cola? I cannot find a single good thing about soda’s, and yet they are in every restaurant, school, water park, amusement park, and train station in America. They are dispensing bad oral and systemic health, and no one bats an eye. “A coke and a smile” at the end of the road is really a toothless smile.
The patients – If we are going to blame the soda companies, can we leave the responsibility of patients on the wayside? We do our best to educate our patients on a daily basis with personal discussions and email newsletters. However, does it make sense to anyone that drinking cokes every night before bedtime for a decade might be bad for you? For parents, is it a surprise that the candy you buy at the store eventually rots your kids' teeth at home? Does anyone still not understand you are supposed to brush your teeth every day? We cannot blame dentists for the expense of extensive dental work in these cases any more than we can blame an oncologist for lung cancer in a smoker.
Dentists – In case you missed it, the “Cosmetic” Age of dentistry is gone. It is time to focus on the health of your patients. We need to continually make the right ethical choices for our patients. We need to continually educate on things like brushing and flossing, even if it feels like you said it a hundred times to the same person. We need to remind people of the overwhelming evidence that oral health can affect systemic health. We need to spend more time volunteering for people in need, no matter what reason they ended up in the condition they are in.
Yes, dentistry is a business, but don’t forget to think of yourself as a healthcare provider first.