I recently attended the convocation at UNLV SDM and it brought me back to the day I walked across that stage. I couldn’t wait to get into the “real world.” My friends and I would fantasize and tell stories about all the fun and freedom that was to come. Finally, after a lifetime in school, staying late and working hard, we would have the opportunity to help people and let the entrepreneurial side shine. The sky was the limit, the sun upon our faces and the wind to our backs.
As the first six months to a year passed, the same friends and I would catch up at conferences and Sunday calls discussing private practice. We always agreed that life was different than we expected, more difficult. Our DDS degrees weren’t exactly the keys to the kingdom so to speak. We were exhausted, scared and frustrated. When we would bring the reality to the attention and question those more experienced than us, we would not get optimism. We would look at each other puzzled as if to think, “what did we get ourselves into?” and “why are we just now finding out?” In school, our peers were excited and bright eyed during the four years we spent together. We all felt privileged to be one of the 100 or so chosen out of 2,400 applicants to take this journey. But the journey seemed to lead to a profession of empty promises.
If we analyzed our practices and lives critically to determine our source of despair, we consented that we felt controlled by outside influences. Many of us chose the profession with an understanding that it would provide us freedom…financial freedom, time freedom, relationship freedom, and personal freedom. Freedom to choose when we were going to work and how we were going to work. Freedom of choice as to who we will work on and our patient’s choice as to who will work on them. The personal freedom that comes with the security of knowing that you will not be tied to the chair later in life. These are the very reasons we chose the profession in the first place. The opportunity to have the freedom to do what we want in our lives is the American dream.
In the early years, and sometimes much longer, dentists find themselves in the survival stage of dentistry. Your life is in distress as you feel a constant urgency to figure out how to pay the bills and how to get new patients in the door. You feel anxious and insecure as if you don’t have any control. You take one day at a time and just try to make it through the week. You feel as if you are always reacting to what is thrown at you as compared to creating an environment with structure. What ultimately happens in this stage is you develop behaviors and belief systems that are very hard to let go of for the rest of your career. As a means of attracting new patients and keeping a healthy flow, dentists sign on to managed care plans.
Managed plans have dramatically changed since their inception in 1971 and dentists have been losing control and giving up their freedom. In 1959, an average ADA dentist had a gross income of $60,000 and net income of $30,000. Adjusting for inflation, today $60,000 equals $1,171,000 in gross revenue and $597,000 in net income.
The biggest change is the 50% overhead that now averages upward of 80 to 85% as a result of managed care write-offs. In 1971, the $1000 dental co-pay benefit would be equivalent to $6,704.20 in 2015. Patient care times will continue to deteriorate as dentists attempt to out produce the increasing overhead which leads deeper into a vicious cycle of moving faster and faster. A negative outlook ensues and sometimes even hopelessness.
Two years ago, I was curious as to how my contract had changed over a five year period from 2008 to 2013 as far as reimbursement compared to overhead increase. My overhead was increasing at an average rate around 3% per year but my reimbursement was increasing by .6% per year. In that five-year period, my overhead had increased by 15% and my reimburse- ment by just 5%. My overhead was increasing by 10% every five years. If I did the same amount of dentistry on managed care patients, my net income would be decreasing 20% every decade of practice.
Dentists try to combat this by speeding up and adding different procedures to their armamentarium.
When volume goes up, quality relation- ships and treatment acceptance go down. Dentists then build a practice model which operates so fast that they are caught in the single tooth trap and an “I’ll do whatever the insurance will pay for mentality,” regardless of what a patient really needs. Precisely where insurance corporations want you to be.
This reality has happened slowly over the years and is referred to as the boiling frog dilemma. If you put a frog into a boiling pot of water, the frog will jump out. However, if you put a frog into a room temperature pot of water, and very slowing increase the temperature, the frog will unknowingly cook. Dentists are the frogs, the pot of water is our practices that we built, and slowly managed care has increased the heat. And we as dentists have let them. There is an inability or unwillingness of people to react to threats that occur gradually.
Organized dentistry is one of the only platforms to combat the outside force, nationally. It starts with education and camaraderie. Taking a good hard look and honest approach about the current state of our profession, and knowing that if we don’t act, the heat will increase. I feel many in our profession have turned their back to organized dentistry out of frustration of past efforts and the current state.
My “Call to Action” for each one of us is to support organized dentistry and make information into transformation. Both as professionals and personally, we need to educate our friends, family, team members and patients that health care and managed care is really disease care. To achieve optimum wellness and health, our patients need to take responsibility for their own health and we need to be their role models leading the way. We need to get healthy ourselves. Take the time to better develop our relationships with our patients and ask them if they would like to get healthier. For those that say “yes,” help them. Over time, more and more of your patients will get healthier and so will you, your practice and dentistry as a whole.
We owe it to the dentists who just walked across that stage, and to the ones who will walk across it in future generations, to have a profession where they can have their freedom. ■
Source: SNDS President’s Message NDA Journal Volume 17, ISSue 2