Corporate Dentistry

North Carolina's legislature (House and Senate, both unanimously) has passed Bill SB 655 which, as of this writing, awaits signature by the governor. 

What is the intention of this bill? According to Dr. Alec Parker, executive director of the North Carolina Dental Society, as quoted in the July 16 ADA News:

"It provides for adequate patient protection and states in no uncertain terms that only a dentist should be involved in making treatment decisions in consultation with the patient, and not a for-profit corporation whose primary fiduciary responsibility is to its shareholders."

Ah. Now, why did he say that?

Let's look at another quote, this one from Joel Bakan's powerful book The Corporation. In this passage he's talking about how Adam Smith, in his classic The Wealth of Nations, had a concern: since corporations' owners, the shareholders, do not run their own businesses, but rather delegate that responsibility to professional managers, how can those managers be trusted to manage other people's money?

Bakan explains:

"The 'best interests of the corporation' principle, now a fixture in the corporate laws of most countries, addresses Smith's concern by compelling corporate decision makers always to act in the best interests of the corporation, and hence its owners. The law forbids any other motivation for their actions, whether to assist workers, improve the environment, or help consumers save money. They can do these things with their own money, as private citizens. As corporate officials, however, stewards of other people's money, they have no legal authority to pursue such goals as ends in themselves-- only as means to serve the corporation's own interests, which generally means to maximize the wealth of its shareholders."

This is how corporations are structured. They are legal entities that always act in their own best interest, which means to maximize the wealth of their shareholders. Any CEO that tries anything else will be summarily fired, and the next person in line will start maximizing again.

Hey, as a stockholder in terms of our retirement plan, that generally tends to make me rather happy. Howeverrrr....

A corporate-owned or managed dental office thus has an inherent conflict of interest. A dentist may fully diagnose a patient's oral health. She may then ask the patient, respectfully, about esthetic concerns. She may then put it all together in a plan of treatment that brings her patient to optimal oral health and beautiful esthetics. Patient and dentist discuss options, then a financial coordinator (who has investigated dental benefits and other factors on behalf of the patient) helps the patient explore their ability to afford the proposed care, and at some point, final treatment decisions are made. 

Between the dentist and her patient.

But what if a corporation employs everyone in the practice, including the dentists? What if they dictate that the dentist always plan the most expensive treatment? What if they require costly and unnecessary procedures on all patients? What if they cut corners on materials and instruments? (Corporations almost always give in to the temptation to cut costs at some point in their trajectory.)

Allow me to present two examples.

Patients with unchecked periodontal disease desperately need treatment if they are to keep their teeth, not to mention their overall systemic health. Patients who do not have periodontal disease, however, do not need complex gum treatment. It is easy to imagine a dental management corporation going down the slippery slope of stipulating that all new patients complete a 'soft tissue management' program.

Patients who have chipped, stained, worn front teeth can regain a beautiful smile through porcelain veneers. Patients who have even, intact, beautiful teeth where their only concern is that they are too dark can use whitening techniques and all their concerns will be satisfied at a tiny fraction of the cost of veneers. Veneering such teeth is viewed by most as over-treatment. Others push them for inappropriate situations.

Corporations fight laws like SB 655 by claiming they do things like "manage business-related tasks for dental practices, help make dental care more affordable and easier to get for many families across our state."

Of course they would say that.

If you were the CEO, wouldn't you have your staff craft a press release like that?

Comments

[Jali Kyllönen]

That is really a very good thing and very good aim,oral health and dental health for all people is one of their habit or it is common,in Finland country most of the dentist are very professional and they always prescript the best dental care product in Finland.

[Sally Johnson]

I didn't know that dentistry could be so complicated. Interesting article, easy to read. Keep up the good work.