A recent innovation to be brought forward by the entrepreneurs in orthodontics is the orthodontic management company “concept”. This entity will buy practices, manage them, advertise them, hire staff and orthodontists as needed to operate them, and take a percentage of the profits for their efforts. This model is already well established in the medical community. In fact, as well as almost ubiquitous in the pharmacy profession, it is active among optometrists, veterinarians, and other professional groups as well. The concept of turning over all of the business of a practice, so that one can concentrate on the patient care aspect is somehow very appealing to many oral health care providers. The only problem is that it won’t work in the long term.
At some point in the future the cost of the care proposed will come to loggerheads with the quality of care desired and quality will lose the battle. Every day dental practices dentists make decisions about procedures, materials, auxiliaries, etc., as to whether the expenditure of funds will be justified by the rendering of a higher quality of service. This is what makes a practice unique, what makes it personal. These decisions are often made with the patient sitting in the chair, as the dentist weighs the best options for the situation at hand.
These decisions should not be made with the economics as the prime consideration. If office overhead goes up 2% but quality of care goes up as a result, to most dentists that is a worthwhile expense. That is a decision that must be made by the individual practitioner. The problem lies in the fact that the assessment of practice worth -not value, but worth- as in the quality of care, the daily environment, the satisfaction level of the patients, etc., can only be made by the practitioner. No outside entity is in a position to quantify these intangibles. Dollars and percentages are much more easily assessed from afar. As a result, these two perspectives will have to eventually battle for control of patient care, and if an individual practitioner has forfeited -or sold- his or her autonomy that battle will be a short one.
An equal concern over this corporate approach to practice is it’s effect upon the next generation of orthodontists. If large numbers of practices are owned by management companies doesn’t that limit the choices of graduating orthodontists? Will the new employees have even less control over how they practice than the established doctor who sold out? Won’t the “bottom line” decisions referred to earlier be even more likely decided by accountants? Will the patients be better off under such a system?
Another worry is the business stability of some of these entities. It is very unlikely that all of those companies presently being formed are going to survive. Suppose an orthodontist signs on -sells his or her practice- to ABC Company which is subsequently bought out by the DEF Company. Does the orthodontist have any guarantee that the rules are going to remain the same? Suppose in an even worse case scenario, the DEF Company is subject to a stock takeover by a larger conglomerate. Can the doctor seek an annulment?
It is evident that many of these entrepreneurs, both DDS and MBA, are altruistic in their motivation. More likely, the potential profits for those “in on the ground floor” are the driving force of this movement, and all of the rhetoric about quality and relief from drudgery is designed to divert attention from the real motivation–money. Certainly not an evil, but also not in this case a positive factor in better patient care. Yes, a dentist has to take steps to succeed as a business, ensure practice search engine visibility (that’s where new patients come from these days), advertise locally, and do all the other things that make good business sense. But when the business of dentistry outweighs the main purpose – providing superior care for the patient – then something needs to change.
Yes, the day to day details of running a dental practice are sometimes a pain. They are sometimes a reward too. To learn from one’s mistakes, and get better at anything, offers a sense of accomplishment. Remember too, that being in charge of the details of a practice is what allows the orthodontist to decide when one works, on whom one works, what one does for a patient, what one does it with, who helps one do it, how much one charges for the service, how long they give the patient to pay for the service, how long they need to provide the service, and all of the many more details that stamp it as theirs. Are we ready to turn these details over to “big brother”? How can we believe that we will only let “big brother” decide those details that we don’t want to decide? How can we believe that our management friends will be content with only those details that we don’t wish to bother with? How can we believe that we can send them 15% to 20% of our office income each month and still have the same net income? That’s naive.
To sacrifice one’s autonomy, to turn a professional practice into one in which the decisions are made by business–not professional-people, to eliminate one’s practice from the buyable pool of practices by entrants into the profession, and to create an entity that is a potential take over target for the insurance industry is selling the future of the profession. If any one who has run a successful practice for 20 years must get that added few dollars when they sell their practice, it is a factor of greed, not of need.