Dentists

             The healthcare profession has benefited both financially and emotionally during the past 30 years. With the possible exception of the depressed economy during the last four years of the 1980s, dentists have enjoyed an exponential growth in business and income at your expense. They learned well how to maximize your insurance benefits. They learned well how to maximize your Medicaid benefits. They learned well how to restore, rebuild, and cosmeticize deteriorated or aged mouths. What they have not learned well, or at least chose not to practice well, is how to prevent the deterioration of our mouths . Why? Neither insurance companies, Medicaid, nor you, want to pay for prevention. But, as your parents always told you, an ounce of prevention …

            With fee-for-service dentistry, dentists are paid by the hour or by the piece, service, or procedure. That is, a percentage of their gross production or by some combination of the two: such as a guarantee plus a percentage. The critical canon here is fee-for-service. The more procedures performed, the more money made by the performer.

            Dentists that work on commission or a percentage of their production, obviously have more motivation to do more dentistry. You are at the mercy of that dentist's ambivalent feelings between doing what is best for you and doing what is best for them. Don't bet your mouth and wallet on a stranger's integrity or credit standing.

            Traditional fee-for-service has been a boon and remains the solid core foundation of the health professions. It is what the AMA and the ADA fight so hard to protect and perpetuate in medicine and dentistry. The more we treat, the more we bill. It's as simple as that. And, it is now the cause of a louder hue and cry from you, the long suffering public. It is now finding critics, changers and compromisers. It is what sends health care costs spiraling into the stratosphere. It has finally reached the too often closed ears and minds of our elected officials.

            The aggressive dentist says every defect in the enamel of the tooth, every catch with his explorer on the tooth's surface must be treated as decay, and filled. Even if it is only incipient. The conservative dentist looks at the whole mouth and the patient as a living, breathing person. If teeth are clean and the patient shows a caring attitude and has few fillings, then enamel defects and catches with the explorer can be monitored. Decay can even be arrested. No crime committed here. Not booked, fingerprinted, and indicted. Merely stopped.

            Ever wonder why your dental insurance premiums increase annually or your coverage decreases to compensate for those increased costs? Forever increasing dental procedures billed by your dentist, will consume your annual benefits, and then some, in far less time than the calendar year of coverage. Ever wonder why employers now demand that their employees pay an increased share of their insurance costs? The employers can no longer cover those increasing costs of dental insurance benefits provided for their employees. Insurance companies now look more closely at dental claims and employers now ask their employees to co-pay even more for their dental coverage.

            The predatory entrepreneurial dentists can be found in the inner cities preying upon the poor, under educated and recent immigrants. They are also found in fancy, high rise office buildings victimizing the low income, inadequately insured white collar office workers. Also look for them outside the factory gates, catering to the equally susceptible blue collar workers. No matter the guise or disguise, they, like the notorious bank robber, Willie Sutton, go where the money is. And today, the deepest pockets are worn by Uncle Sam's Medicaid, union health plans, and the major insurance companies.     

Dentists make an excellent living. And why shouldn't they? They can and should do it honestly and with integrity. When their success results in more patients than they can properly treat and they then hire other dentists to work with or for them, that's to be applauded. That's the American way! What concerns me is the dentist who crosses the line of quality care and turns dentistry into a cash cow to be milked until dry. And the patients receive what the cow leaves behind on the ground.