The following premise is one that comes up often when discussing managed care in dentistry:
The practice of dentistry and dental pathology are fundamentally different from their counterparts in medicine.
This is how the argument typically goes:
Dentistry is a fundamentally preventive profession. We have already achieved the success in positively affecting the epidemiology of our most common diagnoses. Dental disease, by its nature, is seldom catastrophic, is generally preventable and easily palliated, and is orders of magnitude less expensive than medical care. Dentistry is already outpatient-based, and thus is an example of the cost-containment that medicine is trying to achieve. The ratio of generalists to specialists in dentistry is already what the medical profession is evolving to achieve. Therefore, dentistry does not need managed care, nor is it attractive to managed care companies, because the major cost containment is already done.
There is one basic counter-argument to this premise. No one ever said that the managed care organizations are altruistically evolving health care for the good of the masses. They are doing what any reasonable corporation does: making profit. Profit for the corporation, profit for the stockholders, and (in case you haven’t read a financial magazine in the last five years) incredible annual bonuses, often in the tens of millions of dollars, to their top management and officers. This profit is the reason for existence of any major corporation. It’s what they are supposed to do. They do not have fundamental fiduciary responsibility to the patient. The patient is a part of the “product”, grist for the mill.
Dentistry is a thirty seven billion dollar a year industry that third parties used to accept risk on. Dentistry is, in its essence, a cottage industry of competitive individuals with no idea of corporate mindset, no big picture, and no sense of modern organizational theory. It has never marketed its basic product. The public has a love/hate relationship with the profession that is almost genetic. More than fifty percent of its “prospects” don’t avail themselves to dentistry’s product. More than twenty five percent of active dentists don’t belong to its national organization. History has shown that, like medicine, you can find a dentist in any community who will sign any contract, no matter how bad or under what potential liability, and accepting of any amount of potential ethical dilemmas toward patient care. Imagine this narrative presented at a managed care organization board meeting:
“Let’s look carefully at this situation. Here is an industry in which the competitive nature of the providers can be turned against themselves. Plant some seeds, give a few doctors in each community special deals to get our panel started, give significant savings on annual dental premiums to industries which are strapped, like education, airlines, municipal workers, and hospitals. Start discussions about panels closing. Create a need to belong. As we already know from our medical experience, we can truly create a self-fulfilling prophecy in such an industry. The numbers are great. Wouldn’t our stockholders love to get 20-25% of 37 billion flowing through our hands? We can easily swing the public by marketing. We know how to do that well; our return on investment will be high. The dentists will never respond. Maybe someone will give dentistry some bad press that we can take advantage of. Here is an industry, ladies and gentlemen, here is an industry that is ripe for the picking.”
Our foremost premise in dealing with today’s health care climate must be to focus on what we are doing, not the third party payers. That starts with offering exceptional dental care, just like this cosmetic dentist in Mobile does. But at the same time we also need to understand the real world like the big boys do. We need to understand consumerism, mass psychology, marketing, and modern organizational theory. Effective change can be accomplished in dentistry, to the benefit of dentists and patients, without mentioning the words “managed care”. Let’s learn about and focus on today’s patient, from a sociological and behavioral basis. Let’s see how good dentists and Optimal Care™ can effect the marketplace. Once we understand, then we can build a new world for dentistry in which we are still included and wanted—by the patients!