Dental Hypotheses
Volume:2 Issue: 4, Oct-Dec 2011

The economic environment of dental practices is undergoing rapid change. Franchise and network practices are increasing in number because of many underlying economic factors, including supply and demand for services, banking requirements, student debt, proliferation of managed care plans, and healthcare reform. These franchise practices compete very effectively with traditional solo dental practices, leading to the “Wal-Martization“of dental practice, in which dental services are bought and sold more as a commodity than as an individually unique service. These chains compete with private practices on efficiency, convenience, insurance plan participation, and aggressive marketing. There are advantages and disadvantages for both the patients and dental practitioners for participating in this practice mode. This paper explores the reasons that these entities are growing, and offers suggestions for independent solo practitioners to compete with them.

Recent experiences would suggest that there is a significant discrepancy in the number of doctors retiring and transitioning their practices and the number of younger practitioners wishing to assume ownership and build a career. Peaks and valleys in dental school enrollment over the last forty years should have produced an abundance of retirement aged doctors wishing to place their practices on the market to a smaller pool of buyers. Such is currently not the case. Doctors in their sixties have experienced recent stock market downturns in 2000 and 2008, the “9-11” tragedy and a drop in\ both the value and liquidity of the housing market. The ready access to refinance or second mortgage funds may even find some doctors upside down on personal, vacation and investment real estate. All of this combined has had considerable negative impact on their net worth. Health care costs continue to increase and most dentists are personally responsible for their premiums. Combine all of this with the current low level of secure returns on invested capital along with a significant increase in life expectancy over the last two generations and many decide they are simply unable to retire as planned. The fear of running out of money is stronger than their will to pursue retirement. This article examines in some detail the reasons for this imbalance and the effects they are having on practice transitions, practice values and the market for associate employment. We will also explore what the future may hold for both retiring and new career doctors.

Risk management is the study and practice of how to avoid litigious perils in dental practice. All too often risk management is shunted to a minor role in the frenzy of the today’s dental schools as they strive to graduate capable dentists. A sophisticated office risk management program can boast high rewards while minimizing risks in a dental practice. The genesis of this article is hinged on fifty years of dental practice, fourteen in the specialty of pediatric dentistry and the remainder in a large general practice (34 chairs, 55 employees, ten hygienists and seeing 200 patients daily and 400 new patients monthly). A practitioner can learn many key lessons in risk management when encountering so many patients and staff. What I learned was how to avoid the pitfalls, especially those perils springing from five sources: poorly informed patients, displeased patients, patients who owe you payment, dissatisfied (usually former) staff members and patients whom you have let the settlement scheme drag untowardly. This paper outlines seven specific and proven risk management strategies to minimize these perils.

Staff meetings in general dental practices represent what is believed to be a key management strategy to build teams and to enhance efficiency and effectiveness. However, very little research has been done regarding staff meetings in dental offices. This study examined staff meetings from the viewpoint of dental hygienists who grow in unique careers in that they work largely independently of the dentist and yet typically within a dental practice while providing patient care and education. One-hundred-six dental hygienists completed a survey about staff meetings in dental offices. Key findings include: only approximately 43% of dental offices conduct morning huddles to get the day off to a smooth and organized start, 72% of dental practices conduct longer staff meetings with largely positive outcomes, including increasing practice efficiency and productivity, few practices (12%) hold specific meetings only for the hygiene-department (and probably thereby miss some opportunities for practice improvement), the most important variable by far to hygienist's job satisfaction is respect from the owner-dentist, and there exists an important and synergistic relationship among job satisfaction, relationships with other staff and relationship with the owner-dentist.

Access to care is a major concern for the dental profession and legislators at all levels of government. In recent years, workforce issues have come to dominate debates about improving access to care. One proposed solution to this dilemma is to provide more dental providers in the form of mid-level providers. The success of this new level of provider hinges on whether or not the practicing dentist will embrace the concept of utilizing mid-level providers to treat those who are economically disadvantage and/or reside in remote rural communities. Further, this model of care must be profitable in order for it to be successful. In turn, the Medicaid system must be attractive to dentists. The Pew Foundation has issued a report supporting the mid-level provider model and its potential to be profitable to dentists. Opponents point to issues of level of education, state subsidies, confusing regulation, liability, and financial feasibility as reasons to reject the mid-level provider model. The American Dental Association asserts in its report, “The Role of the Workforce,” that the U.S. dental workforce is adequate for now and for the foreseeable future. The ADA further states that the Pew Foundation’s conclusions about the potential role of mid-level providers are flawed and can lead to erroneous conclusions regarding the contribution midlevel providers would make toward accessing care. An analysis of key variables and financial considerations raises serious concerns and questions about mid-level provider model as a cost effective solution to accessing care.