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Letters: Insurance and utilization

April 21, 2014

Bravo, Dr. Kolinski (Letters, March 3, ADA News). His opinions on insurance and utilization are spot on.

Like Dr. Kolinski, I, too, have practiced dentistry for many decades. I remember when fee-for-service with a flexible fee schedule was the model for dental care. The system, while not flawless, worked. Fees were affordable. Patients were not turned away. Those who could afford to pay did. Those who couldn't afford to pay paid what they could. The number of dental graduates largely reflected the demand for care.

Insidiously, the influence of government, third-party payers and increasing numbers of dental school graduates have changed the model for dental care and disrupted a delicate supply/demand balance. And as Dr. Kolinski implies, the voices of the practicing clinical dentists have largely gone unheard. The result has been a re-crafted dental health care system more flawed than ever.

Practicing dentists are burdened with enormous debt in an era of declining patient visits and declining revenues. Dentist incomes are falling. And still new dental schools pop up and existing dental schools increase their graduating class sizes. Am I crazy, or does this just not make any sense?

Government, third party payers and dental schools have agendas that do not necessarily coincide with the best interests of the practicing dentist, our profession or even our patients. They have fostered a change whereby the dentist must be a businessman in order to prosper and survive. While some may say this is a change for the better, I say the change has weakened care, fostered bad actors and could culminate in a sad end to a noble profession.

Anthony R. Silvestri, Jr., D.M.D.
Boston