After Darth Vaders raid, we experience the rebirth of private care

Quietly, while we dentists were asleep one night, a dark force we now call managed care stole the volume market share of patients. A new distribution system swept over our universe and the bulk of us woke up one morning to find ourselves enslaved to Darth Vader. Those enlisted now toil in their office ditches, shoveling dental hardware at substandard fees. They are a labor statistic grouped with the secretaries and custodial staff, which is scoffed at by lavishly paid, Power Ranger-type insuranc

Dan Rosen, DDS, CCN

Quietly, while we dentists were asleep one night, a dark force we now call managed care stole the volume market share of patients. A new distribution system swept over our universe and the bulk of us woke up one morning to find ourselves enslaved to Darth Vader. Those enlisted now toil in their office ditches, shoveling dental hardware at substandard fees. They are a labor statistic grouped with the secretaries and custodial staff, which is scoffed at by lavishly paid, Power Ranger-type insurance executives. In the name of cost containment, these executives incessantly look to squeeze this annoying overhead expense, demoralizing the spirits of those overqualified technicians toiling in this servitude.

As a business, dentistry is fundamentally almost too good to be true. It is a 50 percent overhead business, where the technician simply sells himself or herself directly to the customer and does not have to wed a particular product line. However, most of us manage to complicate this business to the 80 percent or higher overhead level. It is no wonder that insurance companies, who aren`t particularly good at relationships themselves, were able to step in and literally mop up overnight.

Dentistry is a relationship business. The better the relationship between you and your patient, the less vulnerable you are to outside interference. Quite honestly, I believe that it is our inability as analytic technicians to fully grasp the nature and depth of human relationships that has caused most dentists to actually welcome dental insurance. It simply is easier to accept payment from an insurance company or sign on with a plan than to painstakingly bond with patients, confront personal issues and talk to them face-to-face about health and money. Receiving payment directly from our patients forces us to create real value in service. Developing these relationship skills certainly is not for the lazy or faint of heart. Our willingness to tackle this difficult personal-growth process provides us with a true measure of our courage, integrity and values.

Our society and culture generally is ridden with narcissism (self-love with little regard for introspection and active listening). This causes dentists and patients alike to fail at establishing meaningful doctor-patient relationships and go for relatively sterile and mechanical insurance-driven health-delivery systems.

Medical doctors fell into the insurance trap first, as their often authoritarian styles left them especially impotent in developing these essential relationship skills. However, even as I sit at a table of dentists, the conversation invariably is about cases, crowns and the technically safe jargon. Rarely do I hear anything said about health, healing and personal growth through relationship.

Dentists and staff have become preoccupied with filing insurance and using computers and have forgotten about relating to their patients at the significant level necessary to maintain private care. Preventive dental services were not reimbursed, so they disappeared. Twenty years later, it is indeed rare to find a new patient who knows how to properly floss and care for his or her mouth. Here again, as the quality of the doctor-patient relationship eroded, so did gross income. At the same time, insurance contracts resulting in increased production and a high volume style of business pushed overhead up.

Health is a function of participation. When you involve yourself in a meaningful relationship with your patients, they will respect you, find improved levels of health and well-being and find great value in what you and your office have to offer. On the other hand, when you minimally develop your own personal growth and introspection, you will have less significant relationships with your patients and they will find their insurance contract of greater value to them than your abilities as a healer and caring human being.

Today, I work a relaxed 10-12 days per month. My office consistently grosses at least twice the national average and we see a modest patient pool of average means. In fact, I`m even hard to find in the phone book. We do not accept one penny from insurance companies and my overhead averages just 52 percent of gross collections.

A growing number of dentists has made the commitment and done the work. They have "the force" behind them and are profitably enjoying the rebirth of private-care dentistry. Would you like to become one of them?

Dr. Dan Rosen has a private, general practitioner in Austin, Tex., since 1980. He has completed a one-year program at Dr. Michael Schuster`s Center for Professional Development, Inc., and is a Certified Clinical Nutritionist. He can be reached at (512) 472-3565 or e-mail rosen-dds@ccsi.com.

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