Yeah, I said it. I wrote that title. I stand by it, because it’s true. The corporate interests in Dentistry are a scourge to quality, patient-centered care. When non-dentists are running the show and dictating treatment plans, it’s not a good thing for patients. And, that IS what is happening.
Along came Bobby (not his real name)…
This week, a new patient came to my office. He had a terrible toothache. His partner told me he was up all night curled up in a fetal position. The patient has early-onset dementia, and his partner is his advocate and caretaker. The patient was quite lucid in our conversations, though he’d repeat himself a bit. So, here’s the story…
The patient presented with a number of obvious dental issues. But, he was in severe pain. He had a missing bridge (left it at home), leaving his upper anterior teeth as exposed crown preps. He pointed to the upper right premolars (his most posterior teeth on that side) as the source of pain. I tapped on his teeth, and he winced in pain with all of them in the upper right quadrant all the way to the central incisor (#’s 4 – 8). He explained he was certain that it was #5 by pointing to it. I palpated along the vestibule and the area of the apex of #7 elicited a response. The x-ray confirmed there was a large diffuse lesion over the apex of #7.
While the other teeth MAY be causing problems (see #6, for example), I diagnosed an apical abscess #7 as the culprit for his current pain. After discussing the pros / cons and risks / benefits, the patient agreed to root canal therapy for #7.
I opened the tooth and pus came pouring out steadily. Sorry, I didn’t get a photo of that. I know some of us LOVE seeing that! I admit I do, because I KNOW the patient is going to feel much better. The pus continued to drain for quite a while. I instrumented with hand and rotary files under a rubber dam. I decided to leave it open for 24 hours. We made an appointment for the patient to return the next day to place a temporary restoration in the access. I didn’t want to leave it open over the weekend. The appointment went very well.
I prescribed PenVK 500-mg qid with a 2-gram loading dose, for 10 days.
I went back out to tell his partner how things had gone. I asked about his health history indicating his current meds included Amoxicillin. And, that’s when he told me…
He went to McDentist.
It turns out the day before, the patient had been to a local corporate chain dental office. They had prescribed three days worth of Amoxicillin. Mind you, I understand I’m getting the patient’s side of the story, via his partner. As to protect their identity as much as I can, I won’t say what the partner’s occupation is. But, I will say that he is a credible and qualified witness.
For simplicity and anonymity, I’ll refer to the corporate office as, “McDentist.” At the McDentist office, the patient was told he needed two root canals. The also handed him a treatment plan for additional treatment for $9,000. Presumably, the $9,000 treatment plan was for restorative-prosthetic services. They asked for $1500 right away, and they would refer him to their endodontist…. at another office in a town 31-miles away. The patient’s partner felt uncomfortable with the experience, so they left with only the prescription for 3 days of amoxicillin. He also told me that the root canal part of the treatment plan did not include #7. Again… due to his occupation, his story is credible.
They went home, and his partner went online to search for a dentist. He found my office in a Google search and looked at my reviews and my website. He then made an appointment online for the next day.
I texted the patient that night, and he was doing great. Feeling much better.
He returned the next day, my last day of the week. I irrigated the canal, dried with paper points, and sealed it with a dry cotton pellet and some cavit. He brought his bridge this time to see if I could put it back in.
I couldn’t recement the bridge. But, it occurred to me that I could “tack” it in with some TempBond and take an impression for a provisional to be made later. I can at least give him some teeth to smile with.
The patient will be returning next week to complete the RCT #7 and a comprehensive exam. Then, as I explained to the patient and his partner… I would not have a treatment plan at the time of the exam. I would have to “sit down and review my findings, the x-rays, and photos.” Then I would formulate some treatment options. Perhaps “Plan A” and “Plan B,” and even “Plan C.” Then we would meet and discuss those options. Then we can decide the best course of action for the patient.
They told me on Day 2 that McDentist had called asking if they were coming back for treatment. Ummmm… no.
What’s bothering Dr. MacGyver?
What I find bothersome is that McDentist presented him with a big restorative / pros treatment plan at the emergency visit. It’s not that it was an additional $9,000. The fee isn’t the issue. I expect mine will be higher. I doubt VERY much that they did a comprehensive examination. And, even if they DID (they didn’t), it had to be a harried effort to put it together, considering the extent of the dental issues present. Furthermore, pressuring a patient, who is under duress (PAIN), to accept a large treatment plan at the first emergency visit is ethically dubious at best.
I’ve been told by dentists who have worked at corporate practices, that some of them have big screen monitors in the back that list the dentists and hygienists along with their production for the day. A “scoreboard,” if you will. I’ve also heard from these dentists that the office manager either pressures them with “suggested” treatment plans, or that the manager actually creates the treatment plans.
This patient’s story would reflect those claims. He was in excruciating pain (from ONE tooth) and he was pressured to accept a $9,000 (presumably large restorative) plan. I would loved to have seen the actual treatment plan, but they threw it away.
Hold the pickles, hold the lettuce. Special orders don’t upset us. Have it your way…
No doubt, McDentist is a growing trend. My plan is not to compete with them. I won’t compete with them on their terms, which are: (deceptively) low fees and being on all the “insurance plans.” Rather, I will market myself as the OPPOSITE of McDentist. In my practice, they’ll see the same dentist every time. I will be the only dentist that sees them, and they will be the only patient I’m seeing during their appointment. I don’t chair-hop. Personalized private care. While a lot of people see dentistry as a commodity and seek the lowest cost option… I believe some people still see the value in personalized private care. I hope I’m right!
PS… I get emails from Indeed (jobs website) listing the local dental jobs. Month after month after month, year after year… it’s the SAME corporate clinics perpetually hiring associates. They’re always hiring. Which can only mean dentists are leaving. Patients have told me that they’ve never seen the same dentist twice at these places.
Stay tuned! I’ll update this article as the case progresses! Feel free to add your comments below!