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Letters: Practice model debate

December 07, 2015

I believe I am uniquely qualified to respond to the letter written by Dr. Gregory Yen (Nov. 16 ADA News) as both someone who practiced in a typical model as described by Dr. Yen for nearly 30 years and as someone who has practiced in the “corporate world” for nearly four years.

First, no one is suggesting that the solo practice is going to disappear. Witness the explosion of concierge medicine practices even in the face of consolidation of medical practices and acquisitions by large groups and hospitals. But to suggest that group practices are an “answer” to difficulties assailing our profession is to miss the point completely. The problem, which shows no signs of going away, is that most fee control has been surrendered to insurance companies. For the vast majority of dental practices, access to patients means passage through the insurance company filter. Patient loyalty, while still present, often only extends as far as the annual insurance contract with employers. Patients can and will leave a practice based on your participation or lack thereof in their insurance network. What that means for most practices is the lack of ability to adjust fees upward as their costs increase and make no mistake, costs continue to increase. An individual solo practice has limited ability to bargain for lower supply and laboratory costs, never mind increases in insurance, utility and other costs. It has become more difficult to not only maintain profitability but to access capital at reasonable rates on reasonable terms, despite years of excellent credit standing and debt repayment.

Let us also not forget the enormous increases in costs for dental education with amounts reaching what I would call mortgage levels of debt in excess of $300,000. This cost translates into an immediate need for sizeable income to service that debt, and may preclude large numbers of dental graduates of either starting their own practices or purchasing existing ones. The combination of increased education costs, loss of fee control and increasing costs means downward pressure on profits. Grouping together, while not a panacea, allows better fees to be negotiated. Perhaps most importantly for new graduates, it means a job and income and for existing practices it means the ability to access capital, maintain personnel, access continuing education and continue in practice until we want to retire or cut back.

I applaud Dr. Yen in initiating his membership program; however, to suggest that 200 patients can be sufficient to maintain his practice is illusory at best. To suggest that this type of program, which by the way is nothing new, can be applied as a solution for all or most dental practices is also fantasy. Most patients are price sensitive and insurance centric, which is true for both medicine and dentistry.

I apologize if my response is too visceral. However, what I hear in Dr. Yen’s letter is the typical organized dentistry response that I have heard over and over again. I have heard that response when dental insurance became prevalent and their resistance to submitting preoperative X-rays. I have heard it again when preferred provider organizations came on the scene and we were also told that they were a fad and all we needed to do was resist participation and they would go away. We need to face the fact that while we all do what we do because we love taking care of patients, the simple fact is that dentistry is a business. That is not a dirty word and neither are things like profit and concerns over costs. Am I saddened by the fact that many dentists coming into our profession will only see dentistry as a job and not the integral part of our patients’ lives that we really are? Certainly. There will still be some who we can train and translate our experience and thus maintain certain traditions, but existence must come first.

There is a saying that the only constant in the universe is change and dentistry is not immune from that constant. It is how we adjust and respond to change to maintain our integrity and standards of care while continuing to remain in practice that will determine the future of our profession.

Richard J. Reinitz, D.D.S.
Pearland, Texas