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A Letter to Corporate Dentistry


The following is an open letter to dentists who work in large group (“corporate”) practice.  It is not intended for the non-dentist administration, presidents, CEOs, etc.

Hello fellow dentists,

I want to begin with an apology.  Many dentists, young and old, have said some unpleasant things about the kind of practice you have joined.

The fact is that the dental world is scared.  It’s a difficult time to be in private practice.  Offices that were once successful now have more open schedules.  Dental insurance fees can’t keep pace with the rising cost of doing business.  Dentists in the twilight of their careers aren’t retiring, dental schools are expanding their class size, and new dental schools seem to appear out of nowhere; all of which lead to fewer job opportunities.  The opportunities that do exist aren’t always so attractive.  There are offices that are on the slow side of the technology boom that have yet to adapt digital radiographs and other basic tech that patients have come to expect.  Other practices fail to implement basic practice management software to allow us to keep up with the fast pace of business.  And then there’s debt.  More and more graduating student s discuss figures that are well above $200,000.

So it’s not hard to imagine why a young dentist would find the large group practice attractive.  Modern offices offering full schedules and financial reward?  That sounds great!  Those who worry that the quality of patient care might suffer would be given pause when they learn what the corporate structure can offer.  Many of these offices employ multiple specialists to ensure that patients’ needs are met by those have received appropriate post-graduate training.  The highest caliber of continuing education is often provided to employees at little or no cost.

Another concern stems from the reports of employee dentists being pressured to perform unnecessary or aggressive treatment.  However we can argue that kind of distasteful behavior can take place in any practice model.  A solo practice owner can hire an associate and attempt to warp their judgement in exactly the same way.  I’ve posted before about some of the horror stories associate dentists have experienced.

And then there is the sweet promise that we won’t have to worry about the complex world of business.  No after-hours paperwork and the stress of hiring and firing.

Yup, the large group practice seems to alleviate many of the burdens of the young dentist.  But it is that last point that I’d like to address here.

All dentists, no matter what the practice model, should understand the basics of business.  It may take a few years of study, but we must never lose the knowledge and control of our own practices.  When we let someone else run all aspects of our business we lose our independence as health care providers.  Look at our cousins in medicine.  Both physicians and patients are unhappy with how the system has been changed.

Sure, some dentists will prefer to remain employees and that’s fine.  Ownership isn’t for everyone.  But I would be concerned about a growing trend of young dentists who leave all business decisions to a third party.  I would be concerned about the “franchise” approach to our profession for the sole reason that can remove our control of our own way of practice.

So whatever practice model employs you, please continue to ask questions, learn, and assert your opinions on how the office does business.  I think there is a place for the corporate model, but we need to maintain our entrepreneurial spirit if we choose to work at that kind of practice.  No one is better suited to regulate dentistry than dentists.

All the best,

Chris Salierno DDS


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