Health Care Politics Management

Doom and Gloom ??

The usually effervescent Huge Doherty sent me this article link.

The evident truth is that the world is changing, and changing fast. The number of dentists who are employees versus owners is increasing rapidly. More than 40% of graduating dentists are women, many of whom do not seek nor want ownership. The debt load of graduating dentists is staggering, making the purchase of an existing practice out of reach. Third parties, which cover roughly 57% percent of dental patients seeking treatment in this country

via The Future of the Solo Private Practice.

The author, Marc Cooper, makes a fairly convincing case that private practice is doomed and future dentists will be little more than drones working in corporate clinics.

I might take this more seriously if I hadn’t heard it all before. Thirty-five years ago a guy named Avrom King was predicting pretty much the same thing. At that time the big threat was not Heartland but the Sears Dental Clinics. Didn’t happen.

Third parties pay for a bit over half of dentistry but that means that a bit less than half is fee for service paid by the patient. Dentistry is nowhere near as dependent on third parties as medicine.

On the other hand there is no doubt that economic conditions are tough. Many young graduates are facing way too much debt with limited options.

It is wise to face the future aware of the brutal facts. I am just not convinced that private practice is doomed. New technology, new educational systems and even new business models based on technology have the potential to transform and save private practice.

One reply on “Doom and Gloom ??”

A comment from Dental CPA extraordinaire Rick Willeford:

“Now that “everybody” is pronouncing the impending death of the sole practitioner, I wonder if it is time to question the herd mentality? Some of the forces cited are real indeed. But might some of that primarily affect the masses and leave plenty of prospective patients for solo practitioners?

How about look for some redeeming points in support of the private practitioner? Some might include:
1. A personal relationship with someone who will be spending an hour in your face, up close.
2. Are some patients discerning enough to question the fact that a lot of providers at the big box shops often do not have the old “skill, care and judgment” of the sharper practitioners?
3. One of the reasons cited for going to dental school was that it provided an opportunity to be your own boss. That entrepreneurial drive may mean that such a solo practitioner has a certain edge to him/her. The patient may sense a difference between dealing with an owner vs. an employee.
4. Most of my young clients are working at the big box stores out of short term necessity – and they universally hate it there. They are counting their days until they can leave. That HAS to affect their attitude.
5. I would like to see a stat that shows what percentage of dentists are still working at the big box places, say, 5 years after graduation.
6. Not all of the world sees dentistry as a commodity. (And the solo guy needs to market into that.)
7. Discerning patients may not want to go to a huge clinic where they see a different dentist on every visit.
8. They may not want to go to such a clinic where they realize that the accountants are in charge. (Docs should be playing reruns of the PBS piece about Aspen in their reception room!)
9. A silver lining of the big box issue is that solo practitioners will be forced to get their act together if they are to compete.
10. For many people, the cost of dental care is just not that large. And if they are going to have a 10,000+ case, I assume they will be seeking out someone with a special reputation.

Frankly, my bigger fear is the inexorable rise of low-paying PPOs. We can fight the big box using “mom-and-pop” feel vs. “nameless-corporate” feel. But as larger portions of the population get “insured”, how do you fight that?”

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