Sigh… another “exposé” on the shortcomings of the “dental care system” in our country. This one is nearly an hour long, done by PBS. I’m not going to write a long post about this program, however. I’ll try to get to my points efficiently and then let you come to your own conclusions after you’ve watched the video. And, if you’re a dentist, you should watch the whole thing. It’s long. Just take the time and watch it. See video and commentary after the jump.
The show is divided up into segments about the various avenues by which a patient “in trouble” may obtain low cost dentistry.
Don’t Drink the Medicaid
They first talk about Medicaid and lament that so few dentists will accept it. They do mention the extremely low compensation offered by most Medicaid fee schedules. It comes to about 20 cents on the dollar. The reality is that represents a net LOSS for virtually any private dental practice. A BIG net loss.
Another significant issue (that they did not mention) with Medicaid is the tremendous risks it presents to any dentist who signs up (contractually). When you get in bed with the Federal Government, you are on the hook in ways you rarely hear about. If you are even suspected of fraud (say a disgruntled ex-employee files a report), you are GUILTY until proven innocent. They can padlock your front door. They can seize your records and computers. They can freeze assets and bank accounts. And, they can do all that BEFORE you go to trial. In other words, they can ruin your life irreparably while you wait YEARS to clear your name (assuming you are innocent).
Personally, I would not sign up for Medicaid if they paid me DOUBLE my private fees. I honestly wouldn’t. I’m not willing to surrender my Constitutional rights for any amount of money. I’d be doubly-crazy to do it for pennies on the dollar. If I’m going to work on certain patients for a loss (aka charity), I’m doing it on MY terms.
Organized Dentistry Does Not Represent Me (as usual)!
The clowns they had speaking on behalf of “organized dentistry” were an embarrassment. Once again, they’ve convinced me to not rejoin the ADA. I understand these hack journalists edit interviews to suit their own agenda, and they can make even the most polished spokesman look like a fool. But, I dare say these “leaders” of dentistry needed no help in that department.
Dental Mills – It’s Not What’s for Breakfast
This PBS program also brings up the corporate dental mills that “specialize” in working with Medicaid. Seeing some of the kids suffering was heart-wrenching. To consider that some of my colleagues may be “gaming the system” at the expense of these kids is unconscionable.
One thing that bothered me is that there is no mention at all of the PARENTS’ responsibility and accountability for the NEGLECT of their own children. My kids don’t have a mouthful of cavities. It’s not because they have “access to care.” It’s because they have access to a toothbrush and floss. And, it’s because they DON’T have access to an unlimited amount of Coca-Cola and Sour Patch Kids candy.
They say they can’t afford to go to a “regular” dentist. Yet, I’d be willing to bet most of them have an iPhone with a $100 / month data plan.
Rocky Mountain Low
The segment on Aspen Dental was sickening to me. The presentation of denture options to the patient came across like buying carpeting for your house. The dentist says, “What we will do is do an upper denture. There’s no way around it.” He then quite literally whips out a brochure and says, “Here we go. We make a number of different dentures, which is really complicated.” REALLY? Complicated? After insulting the patient’s intelligence, he goes on, “We organize them based on the type of warranty.” Warranty?? Are these car tires? Gosh, maybe I slept through that class, but I am not aware of dentures being distinguished by “warranty types.”
The office manager presented various “packages” with distinct “warranties.” These clinics are touted as being a more affordable alternative to private offices. Yet, the denture “package” being pushed on this patient was about $6,800. Now, my fees are fairly high. And, I’ll just say this: This patient isn’t saving a whole lot by going to the “affordable” dental clinic.
We Just Need Some Dental Therapy
I’m adding this commentary after my friend, Dawn, mentioned this part of the program in the comments below. In my haste to get my thoughts written, I skipped this section. So, now I’m adding it.
The concept of a “dental therapist” (DT) or “mid-level provider” has gained traction in some parts of the country. The idea is that a lesser-trained individual could deliver basic care at lower costs to those who don’t have much money to spend or to provide care in “under-served” communities… where dentists won’t go.
Personally, I don’t see how they will provide similar (even basic) services as dentists at a lower cost. Will their overhead magically be less than ours? Where will they get funding to build their offices? And, how will they repay it?
The PBS program implied that the DTs were similarly trained. However, it is my understanding that their education is simply 18 – 24 months of vocational training. They don’t go to college first. They don’t get a Bachelor degree first. They just need a high school diploma or equivalent and a six-week online anatomy and physiology course.
Holy SHIT! It seems I wasted FOUR YEARS getting an undergrad degree. I took 2 semesters of General Chemistry, 2 semesters of Organic Chemistry (TOUGH!), 2 semesters of Physics along with full semester courses in Genetics, Anatomy, Physiology, and other courses totaling 124 semester hours. THEN, I spent four AGONIZING years in Dental School. But, yeah… the “dental therapist” has the “same training” as me… just fewer procedures.
Yet, the shit-for-brains ADA president could not effectively articulate the difference between my education and the high school graduate with 6 weeks of an ONLINE anatomy course who then was taught in 18 months how to “drill and fill” teeth. Thanks a lot President Shit-for-Brains!
(Deep breath)… OK… You know what? If people are willing to let these high school graduate, tooth-carpenter “dental therapists” perform surgical procedures on them, then HAVE AT IT! Best of luck! Seriously. The lawyers will have a freakin’ field day. They lawyers will be so busy with these folks, they won’t have time to pay any attention to the real dentists.
It’s All Our Fault
OK… the program didn’t quite put all the blame on dentists. But, the general tone was that dentists were uncaring, profiteering predators. Ironically, the show began and ended with examples of charitable deeds by dentists. That’s not enough, of course! However, the overall implication was that Dentistry had not come up with solutions for those who don’t have “insurance” or can’t “afford” dental care.
Of course, all of us in dentistry know that dental “insurance” isn’t insurance at all. It’s a pre-paid dental benefit. My dentist friend and fellow blogger, Dr. Alan Mead, aptly refers to it as a “gift card from a control freak.” And, the maximum annual benefit is the same as it was in 1965… about $1,000. Back then a patient could get a lot of treatment for $1,000 in a year. Now, we call it the “tooth of the year club.” It’s a joke.
Consider that the maximum annual benefit from any dental plan would not cover the yearly average “uninsured” patient’s iPhone bill. But, yeah… they “need” dental insurance in order to have “access” to preventive and restorative dental care.
I’ve done my fair share of charity treatment right in my office with no fanfare. It doesn’t get reported or tracked by any entity. I just do it. Most of us just do it. We do what we can.
Sadly, the notion of self-reliance and accountability is all but extinct in America. We are a nation of parents who indulge their children at every opportunity. Worse yet, many believe they are entitled to health care (among other things). Nothing was said about dental disease being nearly 100% preventable with little more than some personal effort at the bathroom sink every morning and every night. Two minutes!
You Don’t Have to Be Rich, to Be Cavity-free.
I physically helped my kids brush their teeth every day until about age 6. No dental degree needed. No money or “insurance” needed. All you need is to CARE as a PARENT. We brushed and we flossed. My kids learned to love it. Now they brush and floss on their own. My son even uses a floss-threader around his fixed orthodontic retainer. Neither have had any cavities.
Ultimately, I found the program to be rather depressing. It’s depressing because I recognize there is a dearth of public awareness when it comes to oral health. Dental CARE is not expensive. Repairing dental NEGLECT can be rather expensive. I find the notion of lumping the blame for poor oral health on the profession of Dentistry as an overt display of abject and willful ignorance at best… and contemptuous at worst.
No Man Owns the Talents of Another
I won’t hold my breath waiting for the ADA to make any positive contribution to the discussion. But, if we don’t raise our voices in some way, we can expect the current nanny-state trend to infect Dentistry. And, if the day ever comes that my licensure is made contingent on working in any sort of federal entitlement program, I will drop the keys to my office on the front desk and walk out the door. I will not be an indentured servant (no pun intended) while I incur all the financial and legal risks.
Crap… it ended up being a long post! That’s all I’m going to say for now. OK… chime in with comments below!