Food For Thought On How the State of Medical and Dental Care Is Changing

At one point, many of us in the dental and medical care fields decided to sacrifice a lot of time, effort, finances and energy to go to school so we can learn to help others – and not just in any way, mind you. We did so to help others get closer to and possibly help maintain and create a state of health. 

When we decided to do this, we didn’t do it because we wanted to do the bare minimum to help others or simply be an “average” kind of professional. In fact, I don’t find or see many “average” people involved with dentistry or medicine, because:

1. It takes more than “average” to have gone to school and achieved a degree on this level. 

2. We are driven individuals that don’t settle for average and we want to give our best to our patients and our profession!

One of the things that I strive to do, like many of you, for all of my patients in my practice but also for any other person I interact with (including so many professionals), is give my very best. Whether it is the kind of service I provide, or an attempt to help someone outside of work with a project or help another professional with a patient I have never seen or met, I try to give my best and help in the very best way I can. When I am not seeing patients, I am interacting with other professionals as well as reading research papers online or taking continuing education courses. 

The list goes on and on. Why? Because, like so many dentists and healthcare professionals, we want to give our very best care and services to our patients, and because we CARE about our patients. 

That all sounds great with the intentions of every patient coming in to our offices and asking for our very best in care and services. And it would only seem to be a natural selection process for a patient that wants to find a dentist that wants to do his or her best. Right?

Well, they do come in and ask for your very best, and then it happens; the word “but” is interjected into the middle of you wanting to present or give your very best. “But”...what? Well, often times it is one of many “buts” that comes up when discussing care: “But is it covered by insurance?” “But are you in network?”  “But why is this not covered?”  “But why...” and the list goes on. 

As dentistry and healthcare as a whole continue to be marketed as a commodity rather than a service, patients begin to lose sight of the simple fact that cheaper is not better (and we are not talking about widgets here)!

Messaging about cost of dental treatment

Patients and consumers are being bombarded with marketing and advertising about getting cheap dental care and if that is not enough, insurance companies are quick to show their “UCR” (Usual Customary Rate) as compared to the “provider fee,” which is often times higher than the “UCR” fee. 

This can indirectly send the message to current or possible patients that your fee is too high. Add in things like, “all crowns are $X” and, “implants for $X dollars” as dentists ramp up marketing efforts to try and compete for new patients in some areas, and patients begin to forget that you are not buying or paying for just a “crown” or “implant.” 

Unfortunately, patients DO want your best, but sometimes they don’t understand that getting the very best in dentistry and/or healthcare requires you, the provider, to charge a fair fee for the service you are providing. They also may not understand that sometimes it is more because we are not simply providing a crown, we are providing a service that includes care, skills and judgement. 

Care, skill and judgement didn’t come with the degree alone and certainly did not come with being “average.”  For example, how does a patient get a “unit” or the “regular” crown or “cap”?

Well, it is not simply by walking in the office, asking the dentist if they have them and how much and when will it be done. It involves a detailed process that requires skill to do the crown at a very high level of precision; the judgement of how to manage the patient along with how the crown is prepared, design and delivered; and the care or the desire to do nothing but the best for their patient.

That sounds different than simply getting a crown, doesn’t it? 

To make matters even worse in this ever-confusing, information-overloaded world, some health insurance companies are beginning to market what they term as a “treatment cost estimator.” This tool allows a patient to go online and “shop” for prices and fees for a particular surgical procedure as well as short term feedback on procedures. Wow! Is dentistry next?

Stay tuned, but I would not be surprised if we don’t see something like this, where Mrs. Smith can “shop” online for her dental care and find the cheapest and “best” care around! 

Prioritizing care over costs

When it comes to wanting our best, patients don’t always understand that many of us, myself included, go way above and beyond continuing education requirements to maintain our license. 

For example, North Carolina only requires 15 hours of continuing education a year to maintain your license along with your CPR certification. On average, I may take 120 to 150 hours of continuing education in one year! 

Yes, I take enough continuing education in one year to maintain my license for 10 years! Why? Simple: I want to be the best dentist I can be and provide the very best of care for my patients. I have learned how to treat my patients on a higher level using the newest and latest materials along with a multitude of other things. 

It’s hard for dental (or any) professionals to be asked by their patients to give their best when the patient simply wants to pay you (or have you accept their insurance) at the “usual customary fee” like everyone else. If you don’t, then the patient is upset, resentful, and in some cases, will simply leave your practice for someone who is “in-network.”

So, let me ask you a question: If you worked really hard to do the very best job at what you did for a living and your boss or customer came to you and simply told you, “I will pay you what I pay everyone else, no matter how well you do your job,” would you keep doing it better than everyone else? Would you go the extra mile? Spend thousands of dollars on self-improvement and work toward being the best? Buy the very best products and use the best materials when someone else is getting paid the exact same amount for generic material? 

My guess is like all humans, there comes a point of diminishing returns when we determine that the effort is not worth the outcome. This is what we are starting to see in healthcare, and medicine is the first victim – providers are getting burned out from seeing too many patients because they have no time to spend with them due to costs and fee reductions from insurance companies. Patients are beginning to see the ill effects of it with mistakes and lack of care, compassion and time spent with them. Many times I have patients tell me that I spend more time reviewing their medical history than their doctors.

The list goes on and on. In fact, errors in medicine are leading to an increase in deaths associated with those mistakes, and recent studies show that this could be the third leading cause of death in the United States.

It is these factors that are now driving doctors to either join large medical/hospital-based practices, go out and develop a “boutique” practice so they can take time with patients or, in some cases, quit altogether. 

Dentistry, do we want to follow in the same footsteps as medicine?

And for you patients out there: Do you really want the very best care, or do you want the very best VALUE? 

I think when we really ask ourselves what it is that we really want, no one wants or desires the cheapest, worse care that they can find. I think they are seeking the very best VALUE. By “value,” I mean simply that they are getting the gain, worth and/or benefit from something that it is exchanged for it (and in many cases, the exchange is monetary in nature).  

So I think patients do want our best care at the very best value, but like so many things in life, there is a point of diminishing returns where you simply can’t have great care, skill and judgment and cheapest cost. 

So what can we learn from this?  If we want the most well-trained, highly educated doctor, dentist or healthcare provider, then we can’t simply force them to work the same and be paid the same as someone who is less trained, less educated and who is not as motivated to provide the very best to their patients. As professionals, we have to elevate our care as a whole by supporting and growing other professionals.

We also should elevate our patients’ understanding of what it is we are providing for them instead of devaluing our care, skill and judgement for short-term gains to get patients in the door. 

I think as insurance companies continue to attempt to drive down costs and, in return, increase their profit, we must stand together to combat what has been happening in medicine. 

Jeff Lineberry, DDS, FAGD, FICOI, Accredited Member, AACD and Visiting Faculty and Contributing Author, Spear Education.  www.cccdds.com