Reality vs. Perception: Doctors (and Dentists) Going Broke?

This article could not appear at a better time...it's perfect. It's the perfect segway into my next blog; the realities vs. the the perception. CNNMoney published a wonderful, controversial, and utterly thought-provoking article a week ago (well, Jan. 6, 2012, to be exact). The title is "Doctors going broke", and the reason it hit me like a sledgehammer is because this is what has been happening to Dentists for about 5 years now, and is coming to a head. In fact, I STILL hear from Dentists how close they are to not being able to pay their bills, or are actually in the hole, financially. I heard it this week, actually. This is one of those embarrassing secrets (like dirty family secrets) that are becoming more common place than we even think. Here is the link, for those that want to read more: http://money.cnn.com/2012/01/05/smallbusiness/doctors_broke/index.htm. Basically, the short version is that the perception of doctors and dentists is that they are all living high on the hog, on our hard earned money (if we can actually pay our copays),  while the rest of America can't afford their over-priced services. Reality Check #1: in many, many cases, this is false. In fact, the dirty secret here is that its the exact opposite. They are going broke (just like us). I know....you're floored. Keep reading, my friends, because this is where I earn my title as The Scary One. All I ask here, is that you keep an open mind and consider all sides, because there are sides here that you are not aware of. Don't formulate a final opinion until all sides are taken into consideration.

Let's broaden your horizons on some things, and give you a real foundation for the numbers before you make a final judgment. Let's start by giving you the facts: when a dentist (for instance), graduates dental school, their debt load is anywhere from $155,000 (for a public university dental program), to $250,000+ (for a private school dental program). That's a mountain-load of debt...but we're not done yet. In fact, we have barely begun. If they want to buy an existing (older) dental practice from a retiring dentist, they take on another (approximately) $250,000 to $500,000 of debt for that purchase. If the practice has been renovated and updated, it could cost more. If that dentist wants to build a practice instead of buying an outdated one (for instance), the cost of building a 6 operatory dental practice runs approximately $600,000 (without the land and inside an existing building). If they need to construct the actual building itself AND purchase the land, it could easily run another few hundreds of thousands of dollars. If you have your calculator handy, that equates to EASILY a half million dollars and up. Any idea how much that monthly payment is?? It's a staggering amount. In fact, before that dentist has filled their first cavity, their monthly debt load is monumentally huge. And, that's without payroll, supplies, utilities, malpractice and insurances, etc., etc., etc..

Now ponder this: the average dentist receives approximately 3 weeks of GENERALIZED business curriculum. That means a cursory amount, at best. So, with little business knowledge, and a mountain of debt, they open their doors. They have very knowledge on running their business, managing debt, estimating the cost of their overhead, staffing their practices with market-value salaries, or forecasting what revenue they need to pay their bills each month. Nothing. They are unaware of marketing, sales, promotion, advertising, negotiating expenses, setting fees; nothing. It's generally not part of their 3 weeks of "practice management" (that's dental talk for business ownership or business management for dentists). They are unaware of how to track reports, track expenses, estimate their overhead, manage and pay off their debt load, or estimate future capital needs and expenditures, retirement planning, employment law compliance; nothing. I know. Its staggering. In fact, its mind boggling, but there it is. That's why, when this article came up in CNNMoney, I jumped on it to illustrate that its not just an issue with medical doctors but has been an issue for dentists (who suffer in silence out of sheer embarrassment alone) for a dog's age. No kidding. THAT's the reality you just don't know about.

The first thing I hear when I ask someone when the last time they went to the dentist was, is the common phrase "I can't afford it". "Dentists charge too much", is the second comment I hear. And, as much as I try, in vain, to explain to people how important their oral health is, and how highly linked poor oral health is to almost EVERY chronic disease is, people still state the obvious: "I can't afford their fees". Ok, I get it. I hear you. By the time the decay in your tooth has hit the nerve, it requires both a root canal AND a crown (and possibly a build up under that crown since there is little natural tooth left to "anchor" that crown on to), which can total up to $2000 for ONE tooth. I get it; I really do. I'm not out of touch with the realities of that amount of money. In short, it's what we call a "CRAP ton of money". It's huge. Really, it is. ALMOST as huge as the mountain of debt that dentist has taken on (see above) to SAVE that tooth. Between the cost of the dental degree, the cost of the practice, and the monthly cost to run that practice, and the diminishing amount of insurance payments, LACK of payment from Medicare (they don't pay for dental services, although the elderly SURE do need it, I'm just saying...), and PALTRY amount of reimbursement from Medicaid (which most dentists cannot afford to take because it does not come CLOSE to paying their bills), the out of pocket cost of dentistry falls on the patient. In this economy, where people can't pay their mortgages, don't have jobs, and zero savings, we have hit the nail on the head as to why doctors and dentists are going broke. Like you, they cannot pay their bills. They just cannot. If they were kind enough to let you pay off your services (and God bless those who do), and you simply cannot pay and declare bankruptcy on those dental (or medical) bills after the services have been rendered (as 65% of bankruptcies now consist of), they lose that income and cannot pay their bills either. It's a vicious cycle here. The only difference between you and them is the degree of knowledge and the debt load of that knowledge. Otherwise, we are all the same people.

So, the reality is that with little business knowledge and significant clinical knowledge, they can fix your clinical issue. However, like you, they are struggling with how to pay their bills as they (like you) face diminishing income and expanding expenses. They are not very different from you at all. Like you, they simply don't mention how financially strapped they are. They are struggling with where does that income come from to pay the bills. There was an article in the Academy of General Dentistry journal from 2006 that stated that the majority of dentists were overwhelmed as dental business owners because they lacked the business knowledge and it was a major stressor. Many of them stated if they had it to do all over again, they would not have gone into medicine/dental. Too late. Doctors, as evidenced by the above article, are facing the same thing. Corporations are buying up (failing) dental practices at a high rate. From what I hear, its no wonder; they were not taught the business skills they so desperately needed to move into their careers as practice owners. Shame on us for not teaching them that. $150,000-$250,000+ in education and they are not prepared to become dental practice owners? Wow. How tragic. So, as a result, yes, the prices are high. Yup, they are unrealistic. Yup, its not affordable by the average American. No, they cannot afford to take Medicaid and no, Medicare does not pay for dental services either. SUCH a travesty, isn't it? It is truly a vicious cycle. And, on top of it all, most doctors and dentists are embarrassed by this and don't want us to know since the PERCEPTION is that they should ALL be living high on the hog. After all, isn't that why they spent the ADDITIONAL 4-10 years on an education that the rest of society didn't???

So, the point here, today, is that the article I posted opens up the REALITY of the situation right now with health care. It's a hot mess. It really is. Doctors and dentists (and hospitals) can barely afford to practice and society can barely afford to see them for services. So, what's the solution? MY answer is to redesign the system from the inside out. TEACH them how to be business owners, for heaven's sakes! Start with the education process! Why are we NOT? They should not need the "Secret Squirrel Handshake" to successfully run their businesses with affordable rates that patients can afford to pay.

The only secret here is the embarrassment of the inability to practice medicine or dental medicine as business owners first, and clinicians second. And, if I have my way about it, action will be taken and courses will be created. Saving one tooth should not cost more than, say, a whole living room set. It should not. There are better ways to estimate, and negotiate that cost. There are better ways to control overhead. There are better ways.....BUT patients also need to pull their end of it. Specialized knowledge and skills don't come from volunteers. Dentists and doctors are not volunteers. If you have their services, please remember they did not come free. If you don't plan on working for your employers for FREE for a week, please don't expect them to either. There are TWO sides to every story...well, actually three if you count the objective facts (minus the emotions). Just remember that. Be fair and be open.

Well, that's it for me today. I just wanted to share this and begin your TRUE education on the realities versus the perceptions. This IS, after all, "a thought-provoking dialogue on the legal, ethical, and research aspects of dentistry and oral health", as my description states. Consider this my contribution to continued (realistic) life-education.

You don't have to thank me....I'm happy to help.

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. Carry on.
Dr. Driscoll