PBS Frontline: "Dollars and Dentists"
http://www.pbs.org/wgbh/pages/frontline/dollars-and-dentists/
PBS recently aired a special about access to care for Medicaid patients and how corporate dental companies have stepped in to try and make a difference. However, this special focused on fraud and abuse of the system by these corporate dental offices.
The main issue was that these corporations are offering production bonuses for their dentists and staff and as a result patients are being over-treated. Unfortunately, while probably not the intent, this special seemed to portray dentists as not caring about those in need, only caring about money, not performing quality work for medicaid patients, and wanting to shutout possible answers to the access to care problem (such as non-profit dental corporations and dental "therapists" providing dental treatment).
I have never worked or been a patient at a corporate dental office so it's not my place to critique or criticize. However, bonuses can work two ways: 1) to motivate people to work hard as a team player and care about the company 2) cause people to do unnecessary work to achieve bonus goals. How does it play out where you work? Yes, I think a quantity over quality issue can occur. I don't think there is a profession out there where every individual is selfless and true...yes, some dentists do poor quality work, I have seen it. But I also do not know the circumstances that occurred...was the child kicking crying and screaming and that was the best they could do?
I think we will continue to see the growth of corporate dental practices for a few reasons: 1) Students are coming out of school with so much debt that they are unable to jump into private practice 2) my generation (in general) is lazier, we want to see results asap, we value an 8-5 job and benefits such as vacation days because technology has evolved to provide us a lifestyle where friends, family, and fun can be had with a few taps on device we carry in our pocket. It is tough to invest time and money into private practice opportunities (that typically don't work out) while our classmates are getting loans repaid and enjoying a social life after 5pm and every weekend. I think previous generations were more willing to make sacrifices now for future payoffs, whereas the recent generations (who have benefited from the sacrifices of past generations) feel that we could die tomorrow so we should enjoy life while we can. 3) more female dentists/double professional families = easier on family life, more mobility, corporate with more resources, perceived shelter from a lawsuit crazy society, easier to takeoff from work to travel, benefits....
I do not know anything about the new dental therapist position in Minnesota other than it is a 3.33 year bachelor degree or a 2.33 year Master's degree (5.66 years total) . Compared to 7-8 years for a dental degree. If dental therapists are not associated with the ADA and do not affect malpractice insurance I think it's highly commendable that individuals feel comfortable providing dental care with that experience level. This position opens up the door for more corporate opportunities in my opinion...
There is no one individual who should be blamed and asked to fix the system: politicians, dentists, dental supply companies, education costs, patients, parents...everything and everyone is so intertwined it will take a complete effort. People are trying - dentists volunteer at events such as Give Kids A Smile, TeamSmile, and numerous health fairs, public health clinic, and dental residency programs. Supply companies do their best to donate as much supplies as possible. Politicians are trying with new Medicaid reimbursement schedules and increased capabilities of dental assistants. We can start with something simple: brush twice a day, floss once a day, limit sugar intake, and do not go to sleep right after drinking soda or eating sugary snacks...brush first! Cost of this solution? $10 for a brush, toothpaste, and floss for 6 minutes a day? With no politicians involved? Sign me up! Heck I just gave out almost 200 toothbrushes and floss at my dental booth at a soccer tournament, and our office gives a free toothbrush, toothpaste, and floss out after every cleaning.
And two personal stories for some insights about dentists:
In college, before I could join the premed club to see what life in medicine was about, I had to take a test, be accepted, then go through initiation. Competitive, elite, arrogant. The president of the predental club personally invited me to attend a meeting and then join the predental club if I felt it was a career possibility. Camaraderie, sharing, open. Dentists are not bad people.
One more:
My grandparents wanted to take me to Japan and said 10-14 days minimum, even though I have a continuing education trip planned for 5 days in the same month. I told them 7 days max, and they said there's no sense in going unless we go for 10 days, and my aunty echoed their point. They even offered to pay for me. I explained to them that I would be gone for almost a whole month, who would take care of my patients? I then said that even if you pay for my trip, I still need to pay rent and my staff, some of which may live paycheck to paycheck so I can't just not pay them for 3 weeks out of a month...so even if you are paying for my trip, that two week Japan trip will cost me thousands of dollars in overhead and lost income. I also have no employer like the State of Hawaii who withholds my taxes and saves for my retirement...all that money is on me to set aside, so I am sorry but I cannot afford a two week trip to Japan. My own family had no idea about these limitations. My own family thought money and taking vacation was not a big deal for a dentist.