Let me begin by reminding all of you who read this, that my blog is strictly my own opinion and not necessarily one that is shared by other members.
Hello my friends, the FDC is coming next week and I will be there! I'm reminded of Al Pacino in Godfather 3 (ffwd to 0:59) https://www.youtube.com/watch?v=UneS2Uwc6xw
So, let's talk about the DSO issue, which will be on our agenda as an "ask". DSO's are becoming more and more prevalent in our dental marketplace and will continue to be there, given the realities of how we deliver care, the burdensome debt new dentists graduate with and the fickleness of the public. This is especially true of big metropolitan areas, where most of our dental maldistribution of practitioners occurs. We often hear how the traditional solo practitioner is a dinosaur on its way out and what I jokingly called McDentist (more on that later) among my fellow dentosauruses is the wave of the future, especially for GPs.
Now let's look at why this issue is on our plate. Apparently when our leaders address DSO member dentists who are in the FDA, they're told organized dentistry makes them feel like 2nd class dentists, that we look down at them, don't welcome them, etc. Therefore, we need a dialogue with DSO practitioners to see where we have common ground, how we may be able to help them, make them feel included, etc. There's even commentary that if they hear a term like McDentist they're offended, if we ask them what their long term plans are and they plan on being DSO providers for life, they get offended. If we state the ADA/FDA policy of fee for service or autonomy for the dentist, be it solo or group settings, they take that to mean we see DSOs as inferior and, by default, we see them as inferior. I'll take these points on one at a time, using only GPs as my reference, since they're 80% of our profession and the most impacted by DSOs. I can assure you the young dentists I work with in SF district may or may not be DSO practitioners. I don't know and I really don't care. I treat them all the same, we have mutual respect and the most diverse, dynamic delegation in the state!
DSO providers are in 1 of 2 camps, they either plan to eventually transition into private practice of some sort or they're happy to stay in a DSO for their entire career. If the first group wants us to help them, I believe we can but so must the dental schools. If we in organized dentistry and their schools don't teach them how to network, meet like minded classmates and develop a strategy for working together once they graduate, it will be much more difficult for them to make that transition. Granted, there are millennial dentists who are not in DSOs and have managed to start or buy a private practice, but they're a minority. As for the second group, I don't see where we can help them, aside from negotiating a more favorable contract with the DSO. Keep in mind, the DSO has the lawyers, the size, money and leverage over new grads who they know desperately need work. That numerical reality is made all the worse with the opening of more and more schools.
As for hurt feelings, I can only speak from my own experience. I sit with these young dentists in many MDDS affiliate meetings and other courses. We have spirited and informative conversations. I met a young dental couple in MDDS who both work in DSOs and want to have their own practice. They've come to my office and seen it and my small building. Needless to say, any dentist who asks me to do that would also be given the welcome to visit. I've never used the "McDentist" term in a dental meeting, especially at the mic. I reserve those occasions to trash the DHAT lobby which, thank God, we beat back yet again this session! So, to sum up this factor, if you wanna change your practice model, we can help you but so must dental schools or courses we can offer. Let's be honest, we dentists are a bit OCD about wanting only clinical content in our CE courses. How many young dentists would take these courses if they were about networking, the business end of their profession and offered no CEU? We often find ourselves scheduling events after hours or weekends that are so sparsely attended we've had to stop holding them. Help and problem solving are a 2-way street, what is offered must be accepted. Otherwise, it's all an exercise in futility.
I think there are mitigating factors millennial dentists inflict upon themselves. One of the most obvious is location. If they wanna practice in the big metropolis and its "cool" places, where the clubs and great bistros are, where they can get a latte, go to the art walk, etc. they need to understand so does every other dentist and they'll be new fish in a big, highly competitive pond. When I graduated U.S.C. in 1984, I went to interviews in L.A. and saw several of my classmates who were miserable working in volume practices as associates. So I purposely interviewed for and landed a job in Indio, a small town 2 hours away near Palm Desert, actually a lovely place. It was swim or drown for me, the owner had this satellite MediCal/insurance/private practice and I ran it for him 4.5 days a week. We never saw each other, I saw 30 pts. a day and had 2 assistants, a receptionist, hygienist and Army trained in house denture lab tech. It was great experience and served me well for later in life. Case in point, when I left they had to hire 2 new grads like I'd been to replace me and handle the workload. Young dentists do have a choice where they decide to practice and should consider those factors, something else that can be taught to them. Decisions, like all choices, have consequences.
There's a great solution to at least help some new dentists eliminate loan debt by agreeing to work in low income, low access designated govt. run clinics. It's passed before and been vetoed, or just not finalized. It's not fair to blame the FDA for that, the do nothing FL legislation failed us once again, as always! Last year I addressed the GAC and suggested holding all political $ to those who'd betrayed us and was told that was short sighted and not a good option. Well, this year we got shafted again, we never learn! I wonder what our FDAPAC & FDA's legislative action staff will offer up as the excuse this year, when they ask us to keep the faith and continue following Einstein's Definition of Dental Advocacy?
Lastly, some tough love and what I consider a possible impasse. If I've used the term McDentist, it's because some DSOs seem to operate that way. When you send out mass mailers, loaded with coupons, free this, that & the other, a list of procedures and fees like a menu, it reeks of hucksterism. How about a possible double standard? How many DSO dentists who get offended when their employer is criticized are also totally okay with Smile Direct Club and mall kiosk tooth whitening? I'll bet you a media noche at La Casita it's few or none. I wonder how much of this hurt feelings issue comes from the participation trophy, instant gratification, no judgement generation who comprises part of our dental population? I'm all for getting together with DSO members and discussing any and all factors they feel are pertinent to them. What I'm not willing to do is to see the ADA/FDA lose its way and reject what made us great and the highest standards of how dentistry is delivered. I'm sure I'm not the only dentist who's had a pt. come in for a 2nd opinion after going to a big dental chain and being told they suddenly had 8 cavities, need 2 root canals and crowns. This is nothing new folks. When I practiced in CA I recall the Stein Clinics, Dr. Beauchamp's, etc and the way they cranked out production in mass volume. "60 Minutes" did a segment on them back in the late 80s. Yes, I fully realize we've come a long way and I'm not saying all or even most DSOs are doing that today with no standards or scruples.What I am saying is that if the FDA has to embrace and endorse corporate dentistry to assuage its younger members, they're gonna lose much of their membership and maybe they'll eventually morph into a mostly specialist and DSO member association. I'll be long since retired if and when that occurs but I hope it never does. See you in Orlando next week!
