A little disclaimer for this blog entry, folks: It may (actually, it does) include some ranting. If you’re OK with that, I think you’ll really enjoy the read. If you need to take a blood pressure pill first, you have 5 minutes and I expect you back in front of your computer. GO…!
Today’s topic is access to care. From the moment we entered dental school, it was stressed upon us that access to care was a critical concern for the field of dentistry in the coming years/decades. We learned that it would quite possibly be the most serious issue we’d ever face in our profession. And it most definitely is.
On one side of the coin, there is a shortage of dentists in this country. According to the Health Resources and Services Administration (HRSA), we had a shortage of 4,000 dentists in 2010, and every year there are more dentists retiring than graduating from dental school (wrap your head around that). On the other side of the coin, 130 million Americans are without dental insurance, including 40 percent of adults in the U.S.
In addition, many government-supported dental plans (i.e., Medicaid) have very low reimbursement rates for the general dentist, and thus very low participation rates among dentists. Add in the lack of dental education among the general public and you get an outrageously large portion of the American population not seeing a dentist regularly.
So they end up in the emergency room, where the scope of treatment options is limited and dental problems often are misdiagnosed and/or incompletely treated. The physician prescribes a pain medication and antibiotic if infection is present and kindly refers the patient to a dentist. Then it’s in the patient’s hands to follow up with the dentist—which often doesn’t happen—and the cycle repeats itself. This whole process costs nearly 10 times what it would be in a dental office!
But for some, it’s the only option—or at least appears to them as such. This is where we as dentists come in. We signed an oath as professionals to treat people—to heal people. With that comes an obligation to the community to help combat this access to care problem. I have worked at free clinics, gone on mission trips, done discount and free dental services—all of which help a lot of people and provide my coworkers and me with wonderful opportunities to treat people who need it most.
But I also run a business that has to support five doctors, 25 staff members, and three offices. As such, we've developed a model of “organized care” in our practice that limits the barriers to entry in coming to see the dentist: namely, taking nearly every major dental insurance plan; offering significantly reduced-cost exam/cleaning/X-ray packages through discount sites like Groupon and LivingSocial; and offering free or reduced cost services when deemed necessary. This allows us to run a business and help people to get the care they need at the same time.
And this, friends, is where my blood pressure rises and my rant begins. At last month’s Virginia Board of Dentistry meeting, the board members voted on and began the process of outlining regulations to outlaw fee-splitting programs, namely Groupon. They seem to be concerned with the ethics of splitting the fee with a marketing company (Groupon) for a “health care service.” But that sounds pretty similar to participating in an insurance program, doesn’t it? Or, maybe they are worried about the fact that it low-balls the fee that other dentists charge in the area for the same exam. Or, possibly, they are worried about the legality of Groupon being liable if something goes horribly wrong during the dental exam. All of these are viable reasons for the board members to vote the way in which they did—even if they’re a bit of a stretch—but my guess is that it’s simply a misunderstanding: They truly just don’t know what Groupon is and how the process works. Nonetheless, let’s look at the facts.
I’ve been participating in these programs for two years now, and we’ve sold 800 of these offerings. Let’s get it straight right off the bat: We don’t make any profit from the Groupon sales; we actually lose money on each one. But we’re OK with that. It’s a form of marketing, and one that breaks down the barriers to entry for many patients. The majority are young adults who are uninsured and haven’t visited a dentist in some time. Many of them have significant dental needs that, maybe without this program, would have resulted in toothaches, trips the emergency room…and the cycle we just talked about.
So what gives? Are we here to continue the status quo, or are we called to improve the landscape of dental health? When I see these adults and children coming to my chair for the first time in years, using their Groupon promotion, I get the opportunity to educate them. We are able to do small-scale preventive dentistry: cheaper, better for the patient, easier for everybody. And we’re seeing a population base that may otherwise not see a dentist. To me, it’s a win-win. I can honestly tell you that it’s reaching a population base that truly needs to be reached. I will continue to offer, promote, and graciously accept these discount dental exam programs for as long as I’m legally able to. It is my pleasure, and my duty.
Donald Murray III, DMD
Donald Murray III, DMD