A New Non-Precious Commodity?
Finding dentistry’s voice to confide in.
Dentistry has certainly changed over the past decade, and some would say, not for the better. That might be true, depending on which side of the fence one is standing. Less clear is why. Offshoring has been a major competitive concern for midsize and smaller laboratory owners. To be sure, the national expansion of branded dental offices and privately owned laboratory chains have also had a negative impact. On the other side of the fence are those directing change. Large laboratory owners and private equity companies have brought new technologies into their laboratory holdings to create greater productivity and profit margins. On the clinical side, nationally and regionally branded dental offices continue to expand, driving lower costs to create greater profits and additional opportunities for expansion.
If ever there was credence to the old English proverb, “One man’s fortune is another man’s folly,” it is found in today’s dental industry. Yet, while the shift in fortunes seems obvious, the forces behind these changes are less so.
The Pressure Point
One thing we know for certain is that dental benefits, dentist fees, and dental laboratory fees have remained mostly flat for the past 10 years, while some expenses have risen. One could conclude that because the income of general dentists has dropped by about 25% since 2001, the financial pressures being felt by dental laboratories comes less from offshore pricing structures than from insurance companies in our own backyard. A great resource for an education on insurance trends can be found at the National Association of Dental Plans’ website (www.nadp.org).
The Fault Line
Despite the excellent leadership that exists within our industry, there is no dental industry-wide leadership offering a single vision with a unified voice. This has left our most important constituents—our patients—with little dental industry representation.
Because it is much easier to conquer the divided than to divide and conquer, the insurance industry has had an easy time weakening our industry and de-branding dental care. They have convinced many consumers that all dentists are the same, and that it is they, the insurance companies, that must protect patients through their oversight of quality and credentialing. Meanwhile, our disparate industry has had no voice to counterbalance. We have in effect, abdicated the higher purpose that we should all be sharing with consumers. As a result, consumers now look to the insurance industry for guidance and find their dentists on insurance company websites where PPO (preferred provider organization) dental offices exist on a list, indistinguishable from one another. In effect, much of our industry has contracted to serve an entirely separate industry that has no hand in care, and is doing it on their own terms.
Current and Future State of Affairs
Industry changes over the past couple of decades have had mixed reviews. While we have all benefited from amazing advances in technology, our reputation has not remained stellar. Dentists used to be among the most trusted professional healthcare providers. Gallup (www.gallup.com), an online news source, had dentists’ trustworthiness listed as third in 1995, and by 2009, they found that only 57% of dentists were highly or very highly trusted. The unanswered questions are: Are these downward trends due to the upward trend in restrictive PPOs and managed care? Are they due to a societal shift? Or is it a combination of both? No matter the answer, our reputation is in need of repair, and dentistry’s future lies in large measure in the hands of outside forces. If this is allowed to continue, there is a real risk that dental care itself will undergo changes similar to those in medicine.
Some changes are close at hand. The University of Washington and the University of Minnesota have both instituted dental aid therapist programs to train students with nothing more than a high school education to deliver dental care in under-served areas. This 2-year program adds $65,000 to $85,000 per student in additional revenue to university coffers. Its graduates are permitted to provide multiple dental procedures under the supervision of a licensed dentist, whose only requirement is to be accessible by phone or internet. It has been reported that the average salary for therapists in the University of Washington program operating in Alaska is $33,000.
Today, dental therapists are restricted to underserved areas. Tomorrow, that might not be the case. As insurance companies continue to pressure fees downward, it is conceivable that corporate dental offices will replace licensed dentists with dental therapists to substantially reduce costs. Insurance companies would support this change and partner with corporate dental care companies to underwrite program development and tuition to help more schools graduate more therapists. While we cannot predict the level of care these changes might bring, many dentists could be forced to close their practices and recent graduates might find fewer opportunities. This might reduce dental school enrollment, with more laboratory work going offshore. Domestic dental laboratories of all sizes would have their ranks thinned, as a greater percentage of laboratory work would also move offshore. Manufacturers and distributors would have their profit margins further eroded by the expansion of corporate dentistry that would also buy direct or establish its own distribution chains.
There Is Hope In Us
The changes at our doorsteps are not the results of an evil invasion. In fact, the activities are being driven by very bright business people who are providing us with a unique opportunity to learn how to better compete. Consequently, today, we find our industry at a crossroads. Do nothing, and nothing will remain the same. Alternatively, we can use proven business methods to help restructure our industry and re-educate consumers about the true value of personal and private dental care. Incumbent upon us is to establish an industry leadership with one vision and one voice that addresses the common good. We need to define [for consumers] the proper perspective with regard to dental insurance and its value in the context of their care. We need to help independent businesses within the dental profession establish more efficient business models in order to contain costs without sacrificing quality. And finally, we need to commit to a message for all to hear that dentistry is owned by us to benefit patients, a responsibility that no other industry has the legitimate right to claim.
Today, there is only one voice speaking to consumers, and it doesn’t come from dentistry. The only remaining question is this: Will our industry find its voice and rise to the challenge?
About the Author
Dean Mersky, DDS, is the founder of OPT-In Dental Laboratory Cooperative, and the president of Opt-In Management, LLC, in Doylestown, Pennsylvania. Dean can be reached at dean@optindentallab.com.
