Dental Serfdom?

According to the dictionary a serf is "a servant or laborer of olden times who was treated as part of the land worked on and went along with the land if it was sold" and now a days it seems that healthcare workers are being bought and sold by large corporations and this analogy seems more and more apropos.

I read an article today in the Wall Street Journal about CVS negotiating buying a chain of Doctor clinics from Oak Street Health. It should be noted that CVS acquired the Aetna Medical insurer in 2018. According to the article:

"CVS's deal would be the latest in a series of moves by a range of players, including health insurers to acquire clinics and doctors focused on primary care. Of special interest to the buyers are clinics that manage and treat patients with chronic health conditions such as diabetes, whose care can be costly if not managed closely"

It is clear that the hope is that through "greater efficiency" managing and preventing worsening conditions money will be saved and lead to greater profits for the owners of medical clinics.  That being said, I hope that it doesn't  mean that these cooperate entities would pressure their employee doctors to withhold treatments to patients under their care. Many of these clinics will be participating with Medicare Advantage insurance plans, that accept payments from the federal government, and will maximize their profits by minimizing the dollars spent on treating the patients under their care. 

It is my fear that these trends are affecting dentists as well since more and more, younger dentists will be joining cooperate dental delivery systems that are run by MBA's, whose primary mission is to maximize "efficiency" and profits. The problem to my mind is not all great dentistry is efficient and highly profitable but in my experience in private practice, dentist/owners of smaller practices feel an obligation to their loyal patients. 

My patients are like family to me and my primary responsibility is to help preserve the health of their mouths over their lifetimes. Some procedures are just more profitable than others, but a good dentist needs to take care of their patients needs, even when doing so is not terribly efficient or profitable. 

Spending an hour carefully excavating a tooth with a large carious lesion so as to avoid the need of a root canal or an extraction is never as profitable as having a patient undergo a root canal treatment, post and a crown but our patients place their trust in us to do the right thing, even when its not highly efficient or profitable. 

At the end of the day, the real joy in being a dentist should be exercising out skills for the real benefit of our patients and not the corporate entity managing our practices.  Unfortunately, sometimes it seems that cooperate investors, dental insurance companies and even our own government is not really terribly supportive of ideal dentistry but instead seems to be pushing ever greater money savings through greater "efficiencies" in dental care.