Doctors (and Dentists) Going Broke? Part 2

The article posted a few days ago, and ensuing discussion brought about awareness of an issue crossing over both medical and dental lines; the financial stress and potential viability of independent doctors and dentists to continue practicing. Remembering that among the many reasons they are having financial difficulty are increased costs, decreased reimbursements, patients' inability to meet their financial obligations, and lack of business acumen on the part of the doctors and dentists. So, today's article that I want to share is fascinating (as a Part 2) on a number of different levels, and gives yet another perspective of where some of the issues stem from. Hold on, because you are going to love this! The articles are twofold and are located on the July 5, 2011 and Nov. 21, 2011 postings on the DrBicuspid.com website.

At the end of 2011, the NC Board of Dentistry charged a dentist with violating the Dental Practice Act by selling his dental practice to a large corporate dental management firm. The reasons they became involved revolve around the concept of Dentist controlled ownership and management. You see, Dentists must legally own and have control over the management, financial, administrative, and clinical aspects of the dental practice, along with having control over how care is delivered to patients. The issue here, is that many of these large corporate dental management firms buy the practice but then leave the Dentist on staff as an employee, who does not have final say on the above aspects of the management of the practice or how care is delivered to patients. This is the crux of this problem, and yes, the NC Board of Dentistry issued some severe sanctions on this Dentist, and on the dental management corporation. THIS has raised several red flags....read on...we are about to peel the layers off of this "onion" of a situation...

Issues:

1. Dental management companies must be owned by dentists. Management companies can come in, work FOR the Dentist, and make suggestions on managing the Practice. However, the (a) licensed Dentist must have final say and control of both clinical and many administrative decisions. In fact, the Board is now entertaining the idea of having the final approval on all dental practice sales contracts. A bill for such, has been proposed. This, of course, is controversial.

2. Dentists, as stated in a prior blog, have little or no business knowledge, skills or acumen to successfully and efficiently run their Practices. Opponents of this proposed bill, are stating the Board's decision to approve or disapprove of all dental practice sales contracts as a total intrusion into their practice management and ownership. DENTISTS are opposing this. Yup. I know...bizarre right? They are recognizing their limitations and asking for assistance here because many are not making it financially, on their own (because they have NO business skills).

3. Dental PROponents say that the bill and the Board's decision to intervene is needed because dental management firms are only out for corporate profits and won't put patient needs first. (Did anyone tell them that Dentists need profit just as badly because they have NO business skills to properly manage their OWN overhead expenses and therefore, think the only way to raise revenue is through increasing their fees in their  Practices?)

4. Ironic aspect here: these dental management corporations, have officially purchased hundreds/thousands of dental practices over the last 10 YEARS, all over the USA. They are everywhere......with no one blinking an eye over it!?! Why now, is my question? Did no one notice these "illegalities" before this?? But...I digress.....

So, in my humble estimation, and with all due respect, I will attempt to say this. Dentists are set up to fail. They just are. I know that is direct and blunt, but stay with me here (I'm known for my candor here). This is a continual, vicious cycle of how the SYSTEM of dentistry is set up to fail. The common theme here is that they are LACKING business knowledge/skills/acumen to successfully manage their business, pay off their debt, control their overhead, market themselves, and translate that efficiency into lower fees for patients to pay. If we continue to legally limit Dentists into becoming business owners while providing them with NO knowledge or skills on owning a business, it is no WONDER they want to sell out to anyone who wants to buy the Practice. Because, in all honesty, "Dentists don't know...what Dentists don't know". And, believe me, they don't know A LOT about being business owners. We have an OBLIGATION, in Dentistry, to create a system that is not an automatic set up to fail for Dentists, with a trickle-down failure towards patients, who can't access the care because the fees are high as a result of Dentists not being given the necessary business training to efficiently manage their businesses. We need to address these issues head-on from a systems perspective, not a "blinders on" perspective. Those blinders need to come off with a 60,000 foot panoramic view taken instead.

Surveys of Dentists state that they WISH they learned about dental practice ownership on a much larger scale while in school. Some Dentists state that if they had it to do all over again, they would not go into Dentistry as a result of how much they did NOT learn in school, and the problems it caused when they graduated. I know this, because I have seen it for decades. Dentists will be very honest about this when spoken to one-on-one, and it is a researched and published topic. The solution, as I see it, is to restructure dental education, and provide solid, sound business curriculum into the DMD or DDS degree, so that Dentists have a CHANCE for successful, efficient, effective, financially-sound managing capabilities of their Practices. THEN and ONLY THEN, should we propose a bill that reinforces full control and autonomy of dental practices to Dentists. HOWEVER, until then, Dentists are simply going to remain "gerbils on a wheel", working frantically,and going in circles, with no end in sight. Setting up Dentists to fail, by mandating they are the sole business owners without any business training, in my humble estimation, is a failure of the dental system. It's a colossal breakdown, from a systems perspective. This bill, proposed in NC, is like putting a band-aid on an artery wound, in my opinion. We need to treat the systemic problem, not the symptom.

Let's get back to the drawing board and redesign the dental educational standards to include not just the CLINICAL competencies that Dentists need, but the ADMINISTRATIVE/FINANCIAL/LEGAL/OPERATIONAL competencies that they will need JUST as much (if not more) than their clinical core. After all, without the ability to successfully manage their Practices, they cannot provide clinical services. It's that simple. Honest to God.

Thanks for stopping by and remember, you only have to brush and floss the teeth that you ABSOLUTELY, POSITIVELY want to keep. Nothing more. That's it.
Dr. Driscoll