How concerned are you about corporate dentistry?

[fantasy football pro]

Do you fear things going the way of optometry and pharmacy?

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[fa_tth]

In the area of the US I'm in, its not really an issue so I'm not too worried about it personally. I do feel like its starting to go the way pharmacy and optometry but it will take a long time to get there.

 

[WheatLom]

Not at all.

 

[Kahr]

Quite to the contrary. For one, it's not going anywhere and there isn't a whole lot you can do about it, so don't worry about it. More importantly I think it's a fantastic way for many new graduates to get their feet wet. With the rising cost of tuition (read: debt incurred), and the cost of opening your own practice, corporate practice is one of the most accessible avenues for employment and has very little risk. Many graduates from my class took an initial contract in a corporate practice, and they got pretty darn good contracts in my opinion.

 

[Hannah Banana]

Do you fear things going the way of optometry and pharmacy?

6 out of 10, abrupt onset, come and go, duration is a couple hours or a few days, frequency is a few times a month, started 1st year of dental school, symptoms are relieved by hearing bad reviews and complaints from patients.

 

[DreamChaser01]

Nope

 

[Cold Front]

Most corporate dentists have 1-2 years contracts. They can leave any time if they are working at offices in "at will" states and open an office across the street (or 5-10 miles if they had non-compete clause in their contracts within the same city).

That's the big difference between pharmacy and optometry corporate offices, pharmacists and optometrists can't compete with large chains due to perks offered by the chains (free antibiotics, reward systems, etc). Also, large pharmacy chains will buy out all local independent small pharmacies (including their customer records) for a fee and make them sign 10 miles non compete for 5 years or more. This actually happened to a pharmacist friend of mine. It would never happen in dentistry, because some patients are loyal to their doctors and may follow him to the other side of the city.

 

[Axiomatician]

This is going to be a little extreme...

I could talk for ages on this. Very interested to see people's opinions.

I hate the idea of corporate dentistry. There, I said it. Absolutely hate it. It puts my stomach in knots.

Am I afraid of it, though? No, not necessarily.

What I am afraid of is this: As dental schools get more and more competitive because of the attractiveness of dentistry as a career prospect, it is going to get harder and harder to get in. I have a feeling that the more academically focused dental schools become, the less common sense-oriented graduating dentists will be. While they will probably be much smarter than graduating dentists of the past, I feel more and more of them will be less inclined to want to run their own business. Also, and I am NOT being sexist, but I feel like a larger percent of newly graduating female dentists compared to their male counterparts will be more likely to be happy working for a corporation. Combine this with massive amounts of debt, and you have a recipe to turn dentistry into a corporation that cares more about profit than patients.

Corporate dentistry, I feel, needs to be fought by dentists. We do not need to let dentistry go where pharmacy and optometry are now.

An already mentioned point of contention is this, though: Compared to pharmacy and Optometry, dentistry is EXTREMELY INTIMATE. It may not matter than the pharmacist at Walgreens is a jerk who hates his job. You hardly ever even talk to a pharmacist when getting medication. You talk to the pharmacy technician, they run your insurance, charge you, and usually give you a cheaper price than traditional pharmacies. Dentistry is not this way. Dentists do much more than count pills. Not only do you have to be intimate with patients, and thus be a people person, but you also have a trade and acquired set of physical skills that can't be standardized the way counting is, or reading is. You ARE a surgeon of teeth, that simple. Pharmacy and optometry can't compare to that.

 

[Polkadotfan]

While they will probably be much smarter than graduating dentists of the past, I feel more and more of them will be less inclined to want to run their own business. Also, and I am NOT being sexist, but I feel like a larger percent of newly graduating female dentists compared to their male counterparts will be more likely to be happy working for a corporation. Combine this with massive amounts of debt, and you have a recipe to turn dentistry into a corporation that cares more about profit than patients.

Can I ask what makes you come to this conclusion? I'm a woman who has worked for a corporation (different field, but included high sales, high pressure, threat of job loss, ect ect that comes with the general atmosphere of many corporations) and have no plans on going back. I'm in no ways trying to attack, but I'm just curious. I keep hearing how "women are more likely to work part time" and things along similar lines, but this is the first time I've heard we're going to be more happy at a corporation.

 

[cooliyak]

This is going to be a little extreme...

I could talk for ages on this. Very interested to see people's opinions.

I hate the idea of corporate dentistry. There, I said it. Absolutely hate it. It puts my stomach in knots.

Am I afraid of it, though? No, not necessarily.

What I am afraid of is this: As dental schools get more and more competitive because of the attractiveness of dentistry as a career prospect, it is going to get harder and harder to get in. I have a feeling that the more academically focused dental schools become, the less common sense-oriented graduating dentists will be. While they will probably be much smarter than graduating dentists of the past, I feel more and more of them will be less inclined to want to run their own business. Also, and I am NOT being sexist, but I feel like a larger percent of newly graduating female dentists compared to their male counterparts will be more likely to be happy working for a corporation. Combine this with massive amounts of debt, and you have a recipe to turn dentistry into a corporation that cares more about profit than patients.

Corporate dentistry, I feel, needs to be fought by dentists. We do not need to let dentistry go where pharmacy and optometry are now.

An already mentioned point of contention is this, though: Compared to pharmacy and Optometry, dentistry is EXTREMELY INTIMATE. It may not matter than the pharmacist at Walgreens is a jerk who hates his job. You hardly ever even talk to a pharmacist when getting medication. You talk to the pharmacy technician, they run your insurance, charge you, and usually give you a cheaper price than traditional pharmacies. Dentistry is not this way. Dentists do much more than count pills. Not only do you have to be intimate with patients, and thus be a people person, but you also have a trade and acquired set of physical skills that can't be standardized the way counting is, or reading is. You ARE a surgeon of teeth, that simple. Pharmacy and optometry can't compare to that.

This is going to be long... sorry.
Although I agree with some of your points, I disagree wholeheartedly that corporate should be fought by dentists because, well, they ARE dentists. If anything, dentists should be working to improve it.
This is a completely different issue than certain models of midlevel providers that are being advocated for where non-dentists do dental procedures (not all midlevel provider models are like this so it is important that I specify and not group them all in one). THAT is what dentists should be fighting against because it can compromise dentistry as a profession and put patients directly in harms way. Unlike corporate where it is actually a dentist that they are seeing and the only thing that can compromise the integrity of dentistry is the compromised integrity of the individual dentist (which is also a completely different issue that I feel dental schools are not only poorly addressing, but also indirectly encouraging unethical behavior).
You are right in saying that less and less dentists will want to be a business owner, but I don't think it is necessarily for the reasons you said. What you said is true, but I think it has more to do with a generational attitude than anything else. Millennials and younger (generation Y and Z specifically) are known to have completely disrupted the status quo in a number of different categories. We are so much less inclined to do certain things just because the older generation did and we question "why" more (which gives the name Generation Y or "Generation Why" a deeper meaning). We won't do anything unless we can see direct benefits which is also why the ADA is having a hard time retaining younger new dentists. They accuse us of not caring about the profession and the rote tradition of joining and we accuse them of being out of touch with our needs and not providing any real/immediate benefits to us. We are also always looking for easier and more efficient ways of doing things (which is partly why the older generations view us as lazy), not for lack of wanting to do things, but so that we can do more things and multitask (we were also raised on technology and can watch Netflix, do homework, text, and eat all at the same time). While there are some who see owning a business as part of their multitasking life, it is becoming more and more common for us to see it as just a traditional model of dentistry that we would rather not deal with. We would rather be traveling or expanding our lives in other areas. We have hundreds of thousands of dollars of debt and see a more immediate benefit in working for corporate office where we can start to make the good money while not having to spend additional effort in learning the business side of things.
You were also right in saying that schools are causing the growth of corporates because of these 2 things: 1) had they added more business classes into the curriculum, newer dentists would have come out feeling ready for all aspects of private practice and 2) had debt not skyrocketed, newer dentists would have been more patient in joining or starting up a practice of their own.
Last thing, you cannot feel disdain for corporate anymore than you can for small groups, public health clinics, hospitals, or any other practice model because it really is just another practice model. Do some of them push for certain treatments or push dentists to do certain things? Probably, but like I said earlier, dentists should be working to improve this. It is the dentist that has the final say because it is their license and their integrity is the only thing that can compromise a treatment plan. If they don't like the pressure or can't stand up to it if they disagree, they should quit. For the most part, it is just simply another practice model that seems to fit a millennial life-style. Most see it as a stepping stone to private practice anyway, but I think it is deeper than that. In fact, I met a dentist this weekend who started in a community health center, moved to private practice and THEN to corporate. He said he just didn't like private practice and agreed more or less with my theory that I have stated above.
Last last thing, if corporate offices really care more about profit than they do about patients, then they wouldn't be doing as well as they are. The free market would have destroyed them. The free market drives quality up and drives costs down. Although I hesitate to use this in my argument because healthcare isn't exactly the free market anymore, patients are viewing it that way and I have read multiple articles about this and even about how malpractice lawsuits are less likely to be filed if the patient feels they are treated fairly and with respect. They are also always looking for cheaper costs and less invasive health care. If they really don't feel they are being treated right, they will not only look up Yelp reviews about the office, but they will google the treatment or go to another office for a second opinion.
This was just my two cents on your comments. I also say all of this having agreed with your point that dentistry will never go completely the way of pharmacy and some others, but my main point is that I don't really see corporate as inherently bad.
Ps. Pharmacists do WAY more than count pills (my wife is one), but yes, they do not provide as intimate of treatments as dentists do and I agree with your reasoning there.

 

[Axiomatician]

Last thing, you cannot feel disdain for corporate anymore than you can for small groups, public health clinics, hospitals, or any other practice model because it really is just another practice model. Do some of them push for certain treatments or push dentists to do certain things? Probably, but like I said earlier, dentists should be working to improve this. It is the dentist that has the final say because it is their license and their integrity is the only thing that can compromise a treatment plan. If they don't like the pressure or can't stand up to it if they disagree, they should quit. For the most part, it is just simply another practice model that seems to fit a millennial life-style.

This is the one thing you said that I have to disagree with. I don't think you can say what I can and can't have disdain for. Are there corrupt CEOs at the top of hospitals with money signs in their eyes? Yes, definitely. But I don't get sick at the idea of hospitals taking advantage of doctors and patients, because I don't think of hospitals this way.
-Hospitals have their place for both doctors and dentists. The capital required to provide cutting edge healthcare is out of the realm for private practice doctors, and thats why hospitals are so necessary. Not to mention 10,000 other reasons. Oral surgery and hospitals go hand in hand.
-Public health clinics have their place helping people who usually could otherwise not get help.
-Small groups provide a business model where some dentists/owners can focus on business aspects, and others just practice dentistry.

I, personally, would hate to work for corporate if I knew that some businessmen way above me that never went to dental school are making decisions that affect the people's health that I am working on(This is not necessarily the case for all corporate; I know this is a rash generalization). In fact, a personal reason that dentistry attracted me was the ability to be your own boss(A common theme among tons of us on here, I would like to think). And to segway this into an example that sticks out in my mind, Aspen Dental will issue a credit card to someone who can't afford work that they don't need. I have read/heard instances where Aspen dental would push extractions and full dentures rather than a few fillings, just to make sure they would make the money then, not having to worry about patients returning, without the dentist being able to recommend the decisions. If you aren't familiar with this, I could look it up and share with you through PM.

But to even have the idea that the person running a dentistry not being a dentist just gives me chills. It is very easy to make financial decisions when you sit at a desk, only see numbers and profits. I think corporate dentistry should be fought by dentists because of that. Why let someone who never could have made it to dental school make your profession in healthcare their method to get rich? That is NOT what healthcare is about. I guess what I mean is, I do have disdain at the thought of corporate dentistry because it seems so susceptible to corruption.

So why are young dentists still going corporate? I guess because of the ridiculous loans, because of the saturation in "desirable places to live", and because of the stigma/lifestyle that is associated with being a dentist. I feel like some of it is the thinking of our generation, but instead of letting a dental corporation take advantage of the surplus of new graduates in desperate need of money, the problem needs to be fixed before that point. Because if it continues, it could spiral to a point where the corporations have a monopoly over dentistry, and then it will be where pharmacy is now.

I want to try and make the case that the market for corporate dentistry exists not because of expansive, multi-million dollar equipment(as in the case of hospitals), or in the lack of will to want to learn about business(there are group practices with dentists who do business work and others who don't), but because of the extreme need of new graduates to start paying off their loans combined with over saturation in desirable areas near dental schools. It seems that dental schools are getting too expensive, and the idea is born that if dental school cost 300k, then I have to make at least 100k per year to stay afloat. This type of thinking will cause a balloon effect and eventually it will burst, just like the housing bubble in 2008.

Also, I don't think the millennial lifestyle is necessarily a good one to have. I, myself, have millennial tendencies - eating while doing 4 other things - looking things up on the internet rather than calling an office or going in person - searching for jobs on the internet rather than by word of mouth. Dentists who are retiring, at least in my area, do not know this millennial way of life. In the future, our generation of dentists will definitely have to learn to market themselves online more than ever before, but on the flip side of that, the way to get in with a practice that has a retiring dentist is not by looking up openings online. It is by word of mouth, "knowing people", networking, however you want to think of it. Just because keen businessmen can do this does not mean that dental graduates can't.

Again, I am not even in dental school yet, but just thinking about the future.

Obviously I am putting a lot of this in an extreme case. I also want to reiterate that I am a dental school applicant, and my opinion probably holds little to no value, and for good reason. I definitely am not wanting to step on toes. I just want to understand the situation that new graduates are entering in to and get people's ideas on them.

 

[cooliyak]

This is the one thing you said that I have to disagree with. I don't think you can say what I can and can't have disdain for. Are there corrupt CEOs at the top of hospitals with money signs in their eyes? Yes, definitely. But I don't get sick at the idea of hospitals taking advantage of doctors and patients, because I don't think of hospitals this way.
-Hospitals have their place for both doctors and dentists. The capital required to provide cutting edge healthcare is out of the realm for private practice doctors, and thats why hospitals are so necessary. Not to mention 10,000 other reasons. Oral surgery and hospitals go hand in hand.
-Public health clinics have their place helping people who usually could otherwise not get help.
-Small groups provide a business model where some dentists/owners can focus on business aspects, and others just practice dentistry.

I, personally, would hate to work for corporate if I knew that some businessmen way above me that never went to dental school are making decisions that affect the people's health that I am working on(This is not necessarily the case for all corporate; I know this is a rash generalization). In fact, a personal reason that dentistry attracted me was the ability to be your own boss(A common theme among tons of us on here, I would like to think). And to segway this into an example that sticks out in my mind, Aspen Dental will issue a credit card to someone who can't afford work that they don't need. I have read/heard instances where Aspen dental would push extractions and full dentures rather than a few fillings, just to make sure they would make the money then, not having to worry about patients returning, without the dentist being able to recommend the decisions. If you aren't familiar with this, I could look it up and share with you through PM.

But to even have the idea that the person running a dentistry not being a dentist just gives me chills. It is very easy to make financial decisions when you sit at a desk, only see numbers and profits. I think corporate dentistry should be fought by dentists because of that. Why let someone who never could have made it to dental school make your profession in healthcare their method to get rich? That is NOT what healthcare is about. I guess what I mean is, I do have disdain at the thought of corporate dentistry because it seems so susceptible to corruption.

So why are young dentists still going corporate? I guess because of the ridiculous loans, because of the saturation in "desirable places to live", and because of the stigma/lifestyle that is associated with being a dentist. I feel like some of it is the thinking of our generation, but instead of letting a dental corporation take advantage of the surplus of new graduates in desperate need of money, the problem needs to be fixed before that point. Because if it continues, it could spiral to a point where the corporations have a monopoly over dentistry, and then it will be where pharmacy is now.

I want to try and make the case that the market for corporate dentistry exists not because of expansive, multi-million dollar equipment(as in the case of hospitals), or in the lack of will to want to learn about business(there are group practices with dentists who do business work and others who don't), but because of the extreme need of new graduates to start paying off their loans combined with over saturation in desirable areas near dental schools. It seems that dental schools are getting too expensive, and the idea is born that if dental school cost 300k, then I have to make at least 100k per year to stay afloat. This type of thinking will cause a balloon effect and eventually it will burst, just like the housing bubble in 2008.

Also, I don't think the millennial lifestyle is necessarily a good one to have. I, myself, have millennial tendencies - eating while doing 4 other things - looking things up on the internet rather than calling an office or going in person - searching for jobs on the internet rather than by word of mouth. Dentists who are retiring, at least in my area, do not know this millennial way of life. In the future, our generation of dentists will definitely have to learn to market themselves online more than ever before, but on the flip side of that, the way to get in with a practice that has a retiring dentist is not by looking up openings online. It is by word of mouth, "knowing people", networking, however you want to think of it. Just because keen businessmen can do this does not mean that dental graduates can't.

Again, I am not even in dental school yet, but just thinking about the future.

Obviously I am putting a lot of this in an extreme case. I also want to reiterate that I am a dental school applicant, and my opinion probably holds little to no value, and for good reason. I definitely am not wanting to step on toes. I just want to understand the situation that new graduates are entering in to and get people's ideas on them.

Yes, you certainly are putting a lot of this in the extreme case. And you're right, I can't tell you what you can and cannot have disdain for, but what you have disdain for just doesn't make sense to me. It sounds like you have a bias against them for some reason because your logic only works for the extreme cases. It doesn't make sense to hate all dental schools just because some of them are for-profit private schools and you disagree with that. It doesn't make sense to hate organized religion and all Christian churches just because some of them are mega TV churches that make millions and you disagree with that. Those aren't perfect analogies, but you get what I'm saying. Some corporate offices have non-dentists as the owners or CEOs (but not all) and you may disagree with that. So fight that aspect. There are ways. It is illegal for those corporate offices to open up in some states. Advocate for those laws in your own state. Some corporates have credit cards that they use to lure in unsuspecting patients and you may disagree with that. So fight that aspect. But realize that that credit card, if used properly and properly researched by the patient, might be the only way that they are able to receive any treatment at all. Advocate for access to care, raising Medicaid reimbursement rates or increasing funds to loan repayment programs for dentists in underserved areas.
All-in-all, if something unethical is happening, it comes down to the dentist, not the company they work for. Give me the name of a corporate chain that you feel is unethical (don't actually, even tho you already did) and I'll give you the name of 10 unethical dentists who are private practice owners. I'm not saying that there are 10x as many unethical private practice dentists, but just that they exist in both realms. Hate the player, not the game.
As for having a monopoly on the field, I don't think that will ever happen... but then again, I feel like insurances already have a monopoly on it. They restrict how much you get paid for a procedure whether they cover it or not. THAT is something that needs to be fought by dentists because it affects all dentists just the same, private, corporate, etc. In fact, that is exactly what dentists did in Colorado and they won. Colorado just passed a law that stops allowing insurances to dictate fees for services they do not cover and they are working on other ones that will stop insurances from doing many things that it is illegal for dentists to do themselves. Anyway, my point is, you need to have something to fight before you can declare war on a huge subset of dentists. This is what the ADA just realized. You can't go after corporate without going after the dentists that work for them. Their efforts to do anything other than collaborate with corporate has only resulted in dividing the profession.
I have no argument against dental schools becoming too expensive. That is all too apparent and a number of things factor into that as well as result from that, corporate being one of them.
I also agree that certain millennial traits are not good. I agree that networking is the way to go. So is being social... and not just on social media. Interpersonal skills also seem to be lacking with millennials and that is not good for job searches, practicing in general, etc.
I don't discount your opinion just because you aren't a dentist or even a student yet. You can have all the opinions you want, as long as you eventually realize that you are wrong (<-- totally a joke, like 100% kidding haha). But in all seriousness, as long as you are willing to have a conversation and not discount every argument that doesn't agree with your own thoughts (which seems to be the case since you've been pretty open), I'm down to hearing everything you have to say. I don't agree with some of what you say, but I certainly understand your point of view and can see where you are coming from. I'm actually impressed that you can even have these kinds of conversations so early into your career.

 

[Axiomatician]

@cooliyak Lots of good insight, thanks. I'm a lot more open to the idea of them after everything you have had to say. You're right in a lot of cases. I really have tried not to be a fearmongerer, but rather spark discussion for people to read now and in the future.