An article in this month’s Journal of the
American Dental Association says the number of dentists in “very small”
practices is down 9% over the last 20 years, with that 9% being evenly
distributed between dental practices deemed “small” “medium” and “large.”
As a patient, one might ask: Is bigger better? Should I be a patient of a larger
group? The truth is that bigger might seem better at first glance. But
look deeper by reviewing all the advantages and disadvantages.
Certainly, a bigger practice has more dentists,
and other staff. That means more
available appointment times, and more physical locations. For the owners of the practice, it probably
also means more money, as there is a profit margin on the work of every
employee.
Despite this attraction for dentists like me, I
will always be in a “very small” practice, and here’s why:
1. Bigger doesn’t always mean more efficient. One
of the primary selling points for large dental groups is that they create
greater efficiencies. But bigger sometimes simply means more administrative
overhead, more time spent in meetings, more office politics, and less time
devoted to actual patient care. It also
means you might not get the same dentist or hygienist twice, and of course,
some employees are better than others, and some care more than others. It’s random.
2. Not all
dentists will share the group’s philosophy. One of the biggest complaints many doctors
have after joining larger systems is that they lose control over what they
believe is the best way to care for patients. Even something as basic as specialist referrals may no longer be at
the doctor’s sole discretion. In many large groups, referrals aren’t made to
the best provider in the area. Instead, referrals
must be made within the group or a designated network of
one-hand-washing-the-other providers.
This is not in the best interest of the patient.
3. There
may be more pressure on the dentist. Many dentists, especially
those in solo practice, are simply tired of uncertainty and having to work
harder just to stay afloat. Often,
joining a large system seems like a way to get off this proverbial treadmill
and have more time for family and other interests. Large groups do have
administrators and support staff who run some of the business aspects of the
practice. However, there are often new
administrative demands placed on dentists in large groups—profit, profit,
profit. And, regardless of size, all
groups face demands to increase productivity, in part because salary and
bonuses (and perhaps penalties) are tied directly to productivity.
4. The
closeness of attention is simply lost.
You know that gingival pocket I might be watching? Or the beginning of a small cavity I've been tracking? Or your daughter's wedding that we've been getting you ready for? In a large practice, you might
not get a dentist for your appointment who had time to read the note—or if they
did, could accurately compare the condition with what you presented on your
last visit.
In fact, while it isn’t an exact correlation,
recently Cornell University did a study of small versus large group medical
practices, and found that patient care was much
better in small practices, with an astounding 33% fewer preventable hospital
admissions! I remember when I was first
married, my husband and I had a large HMO for our medical coverage. Every time we had to go to the doctor, we had
to educate them on the history of the reason of the visit, because every time
we had a different doctor treating us.
And rarely did we think we had one who cared, or was very good.
I will never have that kind of practice, and I
will never be in that kind of practice.
I want my patients to know everyone in my practice, and I want everyone
in my practice to know my patients.
And because of that, my promise to you is I will always be “very small”—the best kind.
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