Really curious about your thoughts on this. In your opinion why should people rethink dentistry because of COVID-19? I get that practically all dentists are out of work right now, but what reasons besides this are you thinking of?
I am a general dentist, and I
really (emphasize really) hope I am wrong about this, but here it goes...
I think our workflow is going to permanently change due to new infection control requirements that would prohibit dentists from seeing multiple patients at the same time if aerosol generating procedures are being completed during the appointment. Like almost every general dentist I know, I work out of multiple rooms and see multiple patients at the same time. If donning and doffing PPE as they like to call it is going to prohibit us from practicing this way, my daily production will probably be cut in half...it may be cut by more, and it will absolutely be cut by more than 50% if you include hygiene production because we’ll lose out on the exams that day.
Maybe, some of the production will be made up for it by working more hours or additional days, but labor laws make that challenging without adding more staff and that might just increase your overhead as a percentage of collections to a point where it’s not worth the extra work...I don’t know, but I can say I am very concerned, and if I was an applicant this cycle, I would wait 12 months and see what happens before moving forward.
Beyond this will be a bit of a rant...
There are many things that may be required that are not currently in place in most offices - like closed/sealed operatories, additional PPE requirements, modifications to HVAC etc. Hopefully we are not told we need negative pressure ops but PA (for whatever reason) originally required that when they rolled out their guidelines for ER treatment last month...they eventually rolled it back but that might be a sign of things to come. AAE also posted their guidelines for treating patients suspected to have COVID that included negative pressure environments too. I do not think negative pressure operatories are going to become a standard requirement, but when you think about practice ownership, any time we get more regulations our costs go up, and they just keep going up. Our overheads are already much higher as a percentage of our production than previous generations of dentists, and insurance shows no signs of increasing reimbursement (in fact, it’s going down). Delta CA recently announced they were decreasing their reimbursement to specialists by 20% in California. These cuts were supposed to go into effect on July 1 2020 if I remember correctly. Since COVID, Delta of CA has graciously decided to delay the cuts until Jan. 1st 2021....They’re not going to magically increase reimbursement for dentists. There are strong deflationary forces in our profession and we’ve lost control of our own fees. As we dig into this recession (it may be a depression) we’re probably going to see more cuts to reimbursement rates from multiple carriers, and our newly unemployed or underemployed patients are going to rely on the discount to get the work done.
Dental care is purchased with discretionary income, and you can see right now how many Americans live month-to-month. More than 30 percent of people didn’t have the money to pay April’s rent, finding an extra grand to buy a crown is going to be a difficult sell.
Without an increase in fees, we’re basically holding our breath hoping the ADA can actually lobby for a separate billable procedure for infection control that at least covers the cost of the equipment and the lost provider time used to put it on and take it off between patients. But it won’t be enough to make up for the lost production of working out of 2 or 3 columns.
Important for students to note - this would be anyone graduating in the next 1-4 years, maybe even 5 years...every associate dentist I know has either been furloughed or fired. The job market after this event is going to be terrible for dentists over the next 12-24 months, and some dentists who are current owners will go under.
Running through an example of why some will be forced to close - one of my previous coworkers (he was 70 years old at the time) was a dentist in Virginia. The town’s economy he practice in was built around coal mining...coal mining fell out of favor, town went bust and practice dried up. He sold the practice for nothing...it was basically worthless. He moved to CA and became an associate dentist never looking back. 2020 - substitute coal mining for tourism/conferences both domestic and international. Many getaway towns or travel heavy cities (like Orlando) are going to be absolutely crushed and those dentists will close and move to urban centers where there’s opportunity...some people will say go rural - when you get burned this badly by relying on a town with a heavy reliance on 1 industry or 1 employer, those I’ve met who have experience this have advised me they’ll never repeat that mistake because the trauma from losing everything is too significant so they practice in areas with a more diversified economy despite the increase in competition.
It is already difficult to find a good job as an associate, and it’s even more difficult to find a good job as an inexperienced associate. When I’m looking at this situation, I am guessing we will see both a decrease in the number of jobs available and we are going to see an increase in the number of experienced dentists looking for associateships for at least a few years. For those that want to own soon, we’ll have to see how banks will evaluate financing dentists in the near term (long term, it will be fine, but over the next 1-3 years we may see banks less eager to lend to young dentists without significant cash savings). So with that, I’m guessing these young grads in the next few years are going to have a very, very difficult time...
. I've been browsing the pre-dental forums lately and there's no mention about deferring acceptance or re-thinking this profession due to COVID-19 which absolutely blows me away.
