I remember 20 some odd years ago, when they put dental offices in Sears stores. Some would have had us believe the sky was falling back then. “Corporate dentistry will shut down private practice as we know it.” It didn’t happen. Today, we have a number of “chain” dental offices across the country like Monarch, Aspen, Gentle Dental, Towncare, and others. Yet, private solo practices persist and continue to make dentistry a “cottage industry.”
Can you compete?
So, it seems dental offices are coming to Walmart. I say so what? I posted about this on Facebook, and some have suggested that dentists in towns where Walmart is opening a dental office might have to compete on price. I believe that would be suicide. Many much larger corporations with much smarter business minds have tried to beat Walmart at that game and 100% of them have lost. I believe it would be folly for a dentist to try to compete on price with Walmart.
However, a dentist certainly could compete on SERVICE. In fact, that’s the only way I think a dentist could survive against Walmart dentistry. Of course, some patients will get it. Some won’t. But, if you compete on price, you WILL lose. Walmart can survive a race to the bottom. A private practice dentist cannot.
We can edumacate them to appreciate fine dentistry, right?
Another dentist suggested that educating patients would be the way to keep them (from going over to Walmart). While I’m certainly an advocate of patient education, I don’t think this is a winning strategy, either… at least not by itself. A dentist could wax philosophic for hours about marginal integrity, lab quality, materials, anatomy, esthetics, etc., and it will be to little or no avail. That’s focusing on features which patients simply cannot appreciate in most cases.
Personalized service, on the other hand, is something patients can immediately appreciate. And, consumers in general are willing to pay more for better service. Remember that… They’ll pay more for better SERVICE, not better margins. Only dentists can appreciate technical quality like closed margins. We have to put ourselves in our patients’ shoes and focus on what they appreciate.
One Dentist. One Smile.
I can fill that tooth from 300 meters!
Maybe we should think of ourselves (solo practitioners) as “Sniper Dentists.” “One dentist, one smile.” (Borrowing loosely from the sniper motto of “one shot, one kill.”) It surely fits into the Dental Warrior meme!
A smart Dental Warrior facing down the Goliath Walmart will simply “hit’em where they ain’t.”
UPDATE 3/1/20: Walmart Health Clinic opened… to include $25 “cleanings.”
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appreciate find dentistry?
Yeah… already caught that. Typing very quickly! I whipped this up between the last patient and lunch. 🙂 But, I’m glad you’re paying attention! But, you’re OK with “edumacate,” right?? 😉
Good blog, Mike. I agree that Walmart, DDS shouldn’t affect most of us. Patients expect quality work, and if they have to pay more to see a private dentist, they’ll do it.
Ed
Well said.
I come from a “slightly” different background than most newly graduated dentists. I’m a good bit older (38) and I’ve done a handful of different things between high school and dental school (owing my own remodeling business, working as a drill hand, raising a family… ect) , so perhaps my take on this is somewhat different than that of my fellow new grads or perhaps even those who have been in practice for a number of years but haven’t had my experiences.
In a nut shell I think that most dentists try to sell their services as if they are selling to other dentists. (yes I used that dirty word “sell”) Frankly our patients don’t know a hill of beans about dentistry or medicine in general. They know about the seat they put their butt in when they are waiting for our services, the chair they lay in when they are receiving our services, and the way that they are treated in between.
I believe that practicing good dentistry with sound treatment planning is for us… not for the patient. Personally, I want to be able to sleep at night and so my treatment motto is, “what would I do in my own or my mother or father’s mouths?” Patients though, care more about how you relate to them. they don’t give a thought to your ability to capture the margin on a crown prep when taking an impression. Expertise is assumed until there is a disagreement about price 🙂 Patients want you to call them after a treatment and ask how they are doing. Patients want you to ask about their son’s soccer/baseball/football games. They want you to know what they do for a living. They want you to talk to them about their interests outside of dentistry… because GASP… they aren’t dentists… Any private practice dentist that masters the ability to communicate to and relate with his or her patients doesn’t have to fear “Walmart” dentistry. Only you can loose your own patients. … Just my Two Cents.
C.S.Hoffpauir DDS
Great post. I agree with you that most dentists market themselves as if it was for other dentists. Crazy. Thanks for your comments!
Great post Dr Hoffpauir!
Establishing rapport and “laymans terms” are key.
Love that you worked as a “drill hand”! Just smaller tools now?
Rob Cookson BDS LDSRCS
Good post per usual Mike. I agree that most of us won’t be affected too much by this as people will always seek out quality. For those who see dentistry purely as a commodity or practice that way already then sure, a Walmart could make an impact on them. It would seem that for now…corporation dentistry is here to stay. Will it surpass the old Sears model?…Probably. The problem for younger dentists that I see is that there is (again) a strong movement to make dentistry a commodity just beginning in this country. It’s happened before but with the current economic factors involved it seems to have more momentum and backing this time around. I guess we’ll see if it takes over as some predict?
I agree that the commoditization (if that’s a word) of health care is most likely an intentional effort by certain powers that be. We’ll be seeing the importation of foreign doctors who are willing to work for much less.
“Will be seeing the the “importation”? Honey, it’s been here for several years. Have you checked the dental mill employee lists lately?
http://www.scribd.com/doc/93364256/Church-Street-Health-Management-Rule-2004-Examination-and-Document-Request-Names-of-Dentists-319-2
True. My brother, a neurosurgery resident, tells me that nearly 100% of internal medicine and family practice residents are foreign.
The foreign dentists that come and find a job here are doing exactly what your father or grandfather did some decades or centuries ago.
Why should this be a problem as long as they train in US schools and achieve the same qualifications and attain same skills as locals?
They are also coming to the states legally, and follow all the rules set by the schools, profession, and country.
A private office do not hire them due to extra costs and haggles of the immigration. So they have not choice but work for these leaches. FYI hope you can do some digging and find who are the benefeciaries of these corporations. For instance some american teacher pensions plan owns shares in Aspen.
Most of these cheap foreign doctors eventually get their citizenship, again legally, and start their practices and create jobs.
Some people are merely lucky to born with citizenship, and some work very hard to achieve this.
Sid,
Did I say, or imply, that it’s a “problem?”
I’m simply pointing out a fact… an observation.
When we took my daughter in for chemotherapy, there wasn’t a single American doctor there. Again, I’m not suggesting it’s a “problem.” If I thought it was a problem, I wouldn’t have taken my daughter there, eh? 🙂
It’s simply reality. Not a “problem”… Just reality. Becoming a doctor is becoming less attractive to Americans, as a profession, because the ROI just isn’t what it used to be.
Mike,
As always you are spot on.
Dentists in general are “chicken littles.” Come on, give yourselves more credit than that! You guys and gals change people’s lives daily.
Wal Mart (nor anyone else) is going to put you out of business. In fact, the Wal Marts of the world could just possibly increase your business.
Howie
Have you seen the actual Wal-Mart set up and business plan? Its a disaster when the comes to the actual health of the patients.
Don’t forget, dentistry is medical treatment. It’s a shame so many of your colleges, such as, Chris Comfort have sold their souls to Wal-Mart executive and giving the finger to their patients well being. It’s further disturbing you make so light of a serious situation.
I can see patients health is not exactly at the top of the list is it? Not much different that the non dentist Wal-Mart executives. Just saying…
Hi Debbie,
Thanks for your comments. I’m certainly not defending “Walmart Dentistry.” Of course, it’s really nothing new… just a new location.
I’m not making light of a serious situation. I don’t agree that it’s “serious,” as Americans still have a CHOICE. They can CHOOSE to not go to clinics that don’t treat them right or well. But, yeah… I am making fun of Walmart and the notion of obtaining healthcare at a Walmart. What’s next? Bypass surgery at Walmart?
My understanding is that these clinics located in Walmart are not owned nor run by Walmart. Most states require dental offices to be owned by a dentist. I believe Walmart is simply renting space to these dental offices (just like they do for other businesses like McDonalds, Subway, etc.)
When the government starts mandating which doctors you can see or which treatment you can receive, THEN IT’S SERIOUS.
This is just market segmentation, and consumers continue to have a choice. Of course, those who think they’ll get the best service and treatment at the lowest prices are just fooling themselves.
The type of people that would be attracted to a Walmart dentist are not going to be swayed by service. They are going because that is all they can afford. Since regular health insurance still excludes your teeth (and eyes!) for some strange reason, many do not have dental insurance to pay for the private practice dentist. This is why you have millions of people who have not seen a dentist in 20+ years. This is why millions of people only show up in your office when in extreme pain. This is why a walmart dentist will be successful.
As for price, you are correct. You can not argue with Walmart on that. However, when it comes to those with insurance, you can continue to charge your normal rate. Those with insurance are actually going to care about service and quality…well, the others care, they just can’t afford service and quality.
I enjoyed your article, but feel time would be better spent educating lawmakers and insurance companies that teeth are, in fact, part of the human body….as well as those things we use to look around.
Thanks for your thoughts, Jess. I’m guessing you’re not a dentist. 🙂
Put quite simply, dentistry is not “insurable.” That’s why there’s no such thing as real dental insurance. There are dental benefit plans that amount to little more than a “gift card from a control freak.”
Dental plans were invented in the mid-60s. The maximum benefit back then was $1000. Today, 50 years later, it’s STILL $1000. Most people spend more than that on their iPhone data plan in a year’s time. But, they don’t demand “data plan” insurance.
Dental care is not insurable because it can’t be indemnified like expensive medical care or your house burning down. Insurance actuaries can calculate the probabilities of a 45 year old non-smoker of having a heart attack and needing bypass surgery. The actuaries can also calculate the chances of your house being blown away by a hurricane. They can apply mathematical formulas to those events. Those same actuaries cannot calculate the chances of you needing a root canal and crown. Dentistry doesn’t work that way.
Dentistry will never be insurable. The math doesn’t work. So, it is the public that needs to be educated. The insurance companies already know the math. Even the government lackeys know the math doesn’t work. It boils down to priorities… data plan… or teeth. 🙂
Dental neglect can be expensive. But, nearly 100% of dental disease is preventable.
Ultimately, if some folks want discount dentistry at Walmart, that’s just fine, of course. 🙂
All of a sudden the dental profession in Minnesota finds its voice?
http://www.startribune.com/lifestyle/health/197905961.html
All well and good, but why do I get the sneaking suspicion that small-town dentists treating Medical Assistance patients at a loss are not really the sudden focus of everyone’s concern?
After driving most of the small practitioners out of business the non-profits, and the private practices that have shunned MA patients, are now ready to throw their weight behind higher reimbursement rates?
Or maybe the idea of Walmart Dental is not as farfetched as we originally thought?
It’s blinding to not recognize my own analogy here: dentists frustratingly compete with corporate dental groups the same way distributor reps compete with dentists bullying us on price to match catalog companies.
Some dentists appreciate good service from reps and others don’t–just like your patients who don’t understand why you can’t come down $350 on your crown price to match Wal-mart’s.
You have to constantly remind your patents what differentiates you from the cheapos down the street. I must do the same with my clients. Amazing how quickly they forget the case of free bleach I gave the, last month.
I will bend over backwards, forwards, drop everything to run cement/bond/impression material/etc to a good, loyal client. If I cannot do that for my dentists, then it means rescheduling the patient, lost chair time, lost production. How much did I just save my doc by running that product to her? Depends. Hundreds, maybe even over a thousand dollars. (Not to mention ALL of the free product I give away to my loyal clients.)
How much does Darby really save you? Pearson? Safeco? Net32?
If I cannot sell myself on service to those younger, newer dentists who see little to no value in a distributor rep, then they receive ZERO service from me.
Unfortunately, it takes them finding themselves between a rock and a hard place before they realize what a local rep can do versus a catalog company.
However, it is tough to not pass up a glimmer of a new business opportunity. So, chances are, I will try my luck, help that doc out, save him rescheduling that patient, and PRAY s/he now understands and sees the service and value I provide.
Some dentists get it; some don’t. Some patients get it; some don’t.
Very good point Mike. Unfortunately a lot of patients do not appreciate the quality of work we provide neither do they appreciate the personalized services. I believe those patients are better served at a walmart/corporate type of setting. On the other hand, many more patients are interested in a dental office that provides good service and one dentist that follows them throughout their lives.
Twenty years ago pharmacy was a cottage industry similar to dentistry today, yet today all the mom & pop pharmacies are gone, replaced by CVS, Walmart, Costco, etc….
We as dentists are kidding ourselves if we think this isn’t going to happen to our industry too. The box stores have the money to pump out T.V. adds claiming personalized service at discount prices, and all but a few hold-out consumers will buy into it. The result will be that all but a few hold-out private practices will go the way of the mom & pop pharmacy.
Twenty years from now the applicant pool to dental schools will not be the high quality applicants that exist today because the high quality applicants that exist today aren’t as good as what existed 20 years before that! Our profession has, undeniably, over the last 20+ years, been taken over by the insurance companies to the detriment of the dentist’s income. As a result there has been a massive shift in the demographics of dental school applicants. Twenty years from now you won’t be able to find a dentist who’s name you can pronounce, or who’s accent you can understand, and you probably would have trouble pointing out his home country on a world map. They’ll work for a big box company, not give their customers the personalized service they get today or in the past, and sadly…..the majority of consumers will simply accept it, just like they did when it happened to the pharmacists.
Thanks for your thoughtful comment, John. I disagree that the truly cottage profession of dentistry is doomed to the same fate as pharmacy. For the reasons why, please check out my latest article in Dentaltown Magazine, available to read online:
Click here to read the article(s), End of the Solo Era? on Dentaltown.com! I got the lead article!
I do agree with you that the brightest and best will not be applying to dental school. The ROI isn’t there. My brother, a newly-minted Harvard brain surgeon, will likely only practice for 3 – 4 years before bailing out. It won’t be worth staying in it. He told me that 100% (ONE HUNDRED PERCENT) of the Internal Medicine residents were foreign.
Where is the dental office? Who is the dentist?
Beware Being in Dental management for many years, there are business plans that can make WalMart dental offices very successful.
Sure, they can be “successful.” I wasn’t debating that. My point is that competing with them on price will spell the doom of any private practice. A private practice CAN still thrive with a Wallyworld dentist in town. You’ve just gotta “hit’em where they ain’t.”
I do believe if this happen in Walmart then doctors will be probably loose their patients.
I hope the outrageous prices are lowered to a sanity level,consultation fees can be a set fee and can give more opportunity to get more then 1 quote..if hesitant! They also need better time lines when teeth need temporary replacement from extractions to be able to function when things happen. Alot need to be held to a higher level rather then allowing poor workmanship without strick consequences..Its actually the biggest rip off for many unless you have a thick wallet!