2020 and the sky is falling?

The year 2020 marks my fortieth year as a dentist. During this time there have been gradual changes in dentistry. Things are not quite as easy for us as they were when I started out. Back then, most patients who worked for large companies had dental insurance. Those who worked for most fortune 500 companies had dental plans that paid a high percentage of usual and customary fees for dentistry. If their dentist's fees were not above ninety five percent of the other dentists' fees, insurance would cover a percentage of their fee, as long as the insured hadn't' exceeded their yearly maximum. 

Implants were not that common and when teeth were lost, we would replace them with fixed bridges or partial dentures. There was no digital dentistry and dental overheads were lower (60% was the average) . Paper records were the norm and our recall system was run using a bunch of pink cards kept in a file box. We spent a great deal of time on the phone calling our patients with gentle "It's time to come in “reminders" and they actually answered their phones when we called!

Sometimes when I get together with "senior" dentists and talk about the status of our profession it is a little disheartening. They remind me a little of the parable of "Chicken Little" because of their pessimism. "Dentistry is being ruined!" "It will never be the same!" "Its a race to the bottom!" "Insurance companies are ruining!" Ok, I should add that I have at times thought and possibly said all of the above things, but the truth is more nuanced. Our profession must evolve and must change with the times.

Healthcare is going through a period of consolidation. Many Medical practices have been absorbed by hospitals and large group practices. Solo owner operated pharmacies are really not prevalent in NYC most are owned by CVS, Rite Aid, or Walgreen's (Duane Reade). What makes us dentists think we will not be affected by this trend? The writing is on the wall in big bold letters. Advertising for dentistry is driving people towards large group practices that take many insurance plans.

While insurance companies and large corporate practices are on the ascendency, Fee For Service Dentistry is not dead, but maybe it’s on life support. At a Christmas party this year, I spent time talking with a colleague who reported that while she doesn't participate on any plans, her partner and her just took on an associate, who will also continue doing fee for service as well. I must say that my private reaction was "How does she do it?.  I really don't know what her recipe is , but I must tip my hat to her since she seems to swimming against the stream and apparently still runs a growing dental practice.

So the sky is has not fallen just yet, and our profession will make adjustments as needed. Just how we respond is not clear.  I believe there changes to come and dentistry surely will not remain the same! Not all the changes have been for the worse. Implant and cosmetic dentistry were not popular when I started practicing. Now people are living longer and many of my patients don't want removable dentures to be the solution for their  lost teeth. Also, now many people are receptive to using cosmetic dentistry to enhance worn or discolored teeth. Implant dentistry and cosmetic dentistry have become a more important part of most dental practices and they are not the type of procedures are well compensated for by dental insurance.

When one of my patients is about to lose a tooth we have a discussion about how we will replace the tooth. This is not always the most comfortable discussion, since many patients are stressed about money.  Some are retired, and even younger patients may have children in college that need support.  Since implant replacements are costly compared to more routine dental treatments, it often comes as a shock to patients just how large an expense will be required., A single tooth extraction, implant and restoration can cost between $4000-8,000 dollars depending on the dentists involved, techniques used and the  location in the mouth .

Another development is there are a higher percentage of group practices that hire their own specialists to help treat their patients implant needs. Also there are many continuing education programs that help general dentists master procedures requiring special expertise.

In the future I am sure there will be practices that thrive and some that will not. Clearly standing pat and not responding to trends is never the best strategy but no one has a crystal ball that will allow us to see the future. Young dentists, who have their whole career ahead of them,  must find their best way.

What has worked for me, over the last four decades, is to never stop learning and to keep improving my clinical skills.  I have never intended to have the most exclusive practice, or most beautiful office, but do make sure to place my patients' needs first and to I strive to provide the best dentistry I can offer. This recipe has worked well for will and me likely work well in the future, for others as well. It doesn't guarantee to make a dentist wealthy but should help provide them a comfortable income and patients who return, year after year!