The Problem with Chain "Dental Service Organizations"

Everyone knows that insurers are decreasing benefits, increasing rates, and limiting practice options.  I recently terminated my participating provider status with a dental insurance company that wanted to change my relationships and treatment options with my patients (they'll still reimburse for your work, but I am outside their printed network of dentists, who have agreed to their new orders).

But there is also an increasing trend toward expansion and consolidation in many industries, from cell phone carriers and cable companies to banks and mortgage companies. The dental industry is no different and corporate-owned dental practices are slowly spreading.  Many outlets have reported that Dental Service Organizations (sometimes called Dental Support Organizations, or DSOs), dentistry chain organizations run by corporations, are growing at a faster rate than private practices, and may become the future of dental care in America.  I'm sure you've heard ads for them on the radio or seen them on TV, usually with professional actors and jingles.

Dollars vs. Dentistry

In its 2012 story, “Corporate dental chains see big profits in adults who can’t afford care,” the Center for Public Integrity catalogues the variety of ways companies motivated by profit over patients are operating. These corporate chains often consolidate the supportive services needed to run a dental practice – from clerical services to equipment leases.  No one disputes that doctors and dentists are subject to competitive pressures when it comes to the business side of their practices. But shareholder-owned corporate entities can tip the equation – at times, with disastrous effect – toward return on investment and away from quality patient care. 

You see, first and foremost, a DSO is a business corporation.  According to widely circulated reports from insiders, they set daily goals—for instance, if the goal is to make $15,000 in a day, the office simply had to sell $15,000 of dental treatments that day, or they’d be replaced that staff who would.  Trying new materials and technology only happened when the powers that be decided it was good for the bottom line, not when they are good for the patient.

The Lack of Accountability

As you can tell, at the core of the issue is a simple truth: the oath dentists take as health care providers binds them to the best interests of patient health and well-being. This promise is a far cry from the drive to make a buck that motivates some investors in corporate dentistry. Of equal concern is that in situations when outside influence leads to poor quality care, there is no remedy.

Connecticut’s health care disciplinary process relies on the license of the practitioner. If there is no license to sanction, patients have little recourse for substandard care they may have received when it was influenced by non-licensed individuals.

My Vision as Your Dentist

In my opinion, dentistry is unique in that we are physicians, contractors and artists at the same time. We engineer and build things, alter appearances and make changes to the human body. It’s built into our genes that we will create and do it our way. This kind of fierce independence won’t stop any time soon and it could be the reason that there is reportedly a fairly high turnover of dentists in DSOs. Many of us still want autonomy and the ability to just do it the way we think benefits the patient the most, not the way the big corporations tells us we have to do it. 

I see my dental offices, in West Hartford and New Britain, as a respite for people from the new order we see in medicine which is turning more and more depersonalized.   Patients tell me all the time they would never ever go to a DSO office and will always be a part of an independent practice where they are treated well and don’t feel like a number. DSOs are here to stay and will continue to grow over the coming years but the warning that they will take over dentistry as we know it just doesn’t fit in with I see.

That’s why my practice will always be in a small practice where patient care comes first.

Keep Smiling,
 
Dr. Elzbieta W. Basil, DMD is a private practice dentist with offices in West Hartford Center and Downtown New Britain, Connecticut.  She is a Clinical Instructor at the UConn School of Dental Medicine, and has won several awards naming her regional “Best Dentist” and “Top Dentist.” She is an active member of the Connecticut State Dental Association and the American Dental Association. Tel: 860-561-2121