Parallax View is an editorial series presented for educational and discussion purposes only.

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When New Trends Conflict

With Old Values

 

The latest 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 most of us. 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 in our practices we 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 our practices unique, what makes them ours. These decisions are often made with the patient sitting in the chair; whether we take that extra panorex, whether we use the nickel titanium wire, whether we bond that recently erupted second molar, whether we need another six months to really finish the case even though it is paid for, and on and on.

These decisions should not be made with the economics as the prime consideration. If my office overhead goes up 2% but my quality of care goes up as a result, that is in my mind 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. I'm convinced that these two perspectives will have to eventually battle for control of patient care, and if an individual has forfeited -or sold- his or her autonomy that battle will be a short one.

An equal concern that I have about 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 I referred to earlier be even more likely decided by accountants? Will the patients be better off under such a system?

I am also very worried about 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 XYZ Company which is subsequently bought out by the ABC Company. Does the orthodontist have any guarantee that the rules are going to remain the same? Suppose in an even worse case scenario, the ABC Company is subject to a stock takeover by Prudential or Delta Dental. Can the doctor seek an annulment?

I am not at all convinced that these entrepreneurs, both DDS and MBA, are altruistic in their motivation. I think that 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, the day to day details of running a 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.

I feel that 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.

To threaten, for those added dollars, the future of the profession that has served them so well is a travesty. I would emplore those of my generation to look beyond the end of their noses and study carefully whether they are serving their patients well before they "sign on" with one of these companies. It may indeed be true that everyone has his price. Only time will tell.

 

Russell Boyd, DDS
The American Independent Dentist’s Association
336 Alhambra Circle
Coral Gables, FL 33134
E-Mail feeforserv@aol.com
February 15, 1998

© Russell Boyd, DDS, 1998

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8American Independent Dentist's Association
Last update 02/15/98