Barbarians at the Gate?

Dentistry is coming under increasing assault by outside forces of great strength and size. The list of administrative agencies, insurance companies, lawyers, legislators and patient advocacy groups that seek to dictate how we practice is growing at an alarming rate. Most dentists are familiar with the alphabet soup of organizations that are pressuring us--PPOs, HMOs, OSHA, OPD, Esq. and mandatory CE-to name a few. While they all tax our ability to practice with autonomy, coexisting with these

Jul 1st, 1996

Eric J. Ploumis, DMD

Dentistry is coming under increasing assault by outside forces of great strength and size. The list of administrative agencies, insurance companies, lawyers, legislators and patient advocacy groups that seek to dictate how we practice is growing at an alarming rate. Most dentists are familiar with the alphabet soup of organizations that are pressuring us--PPOs, HMOs, OSHA, OPD, Esq. and mandatory CE-to name a few. While they all tax our ability to practice with autonomy, coexisting with these potential antagonists does not mean ceding them the upper hand.

Practitioners of the martial arts are taught to use the superior size and strength of their opponents to their advantage. We must learn to neutralize attacks on our profession and to convert them to our benefit in the same manner. By evaluating our antagonists` weaknesses and strengths, as well as our own, the dental practitioner can thrive because of and in spite of these assaults on our professionalism.

Take OSHA, for example, the epitome of a cumbersome, bureaucratic Leviathan. How on earth can we put a positive spin on onerous OSHA regulations, which are shoved down our throat with virtually no input from the dental community? Flaunt them! View OSHA compliance as a potential practice builder. Comply assiduously with the regulations and show the patients how much we care for their health and well being. Like it or not, the regulations are here to stay. The public has been whipped into a media-induced frenzy about the risk of disease transmission in a health-care setting. Rather than complying with hostility, we should embrace OSHA compliance as a marketing tool and an image burnisher for our own practices and for dentistry as a whole.

The encroachment on our professional independence by PPOs, HMOs, capitation plans and other insurance industry concoctions presents a more daunting, but not insurmountable, challenge. These programs are heavyweights, bent on squeezing all their purported savings out of our wallets. If you join one or more of these plans, make them work for you, not the other way around. Think of plan membership as a marketing tool to attract patients you would have never gained access to. Perhaps, by joining a plan, you can hire an associate or add a staff member to help with the increased patient volume. This may permit the sole practitioner more flexibility in coverage and vacation time. Remodeling or enlarging office space may finally become practicable, or even essential, if a significant volume of new patients is expected. Slow times of the day can be filled in. The key is to make your participation in any plan a positive step that is in your best interest, not a leap that you feel you need to make simply to survive.

On the other hand, perhaps you resent the pressures that plan participation places on your ability to practice independently. In that case, plan an alternative strategy. Look at your decision not to participate in any plan as the opportunity to practice dentistry the way you always have or always wanted to. If patients are leaving your office solely because you are not a plan dentist, don`t get angry. Use your non-participation as a chance to achieve a higher level of patient service. Instead of going the low-fee, high-volume route, do the opposite. Become Nordstrom`s, not Macy`s. You won`t have to do a pin amalgam instead of a crown simply because some administrator says that you must utilize the least costly alternative. You can present the patient with the best possible treatment plan and not worry about being second-guessed by the insurance company. Since you will not be competing for the plan participants, your fees can reflect the true cost of doing the kind of dentistry you choose to provide.

Going exclusively fee-for-service might be the time to remodel the office to provide the ambiance that a fee-for-service patient wants. More time can be scheduled for each patient. There will be less paperwork and frustrating communications with plan overseers. Maybe you can reduce the size of your office or your staff. You can avoid all the uncertainties that come with hiring an associate. A decision not to participate in a plan should be a strategic move based upon an evaluation of the facts and an assessment of one`s best interests.

The threat of a malpractice suit scares all of us. But here again, we shouldn`t let lawyers invade the autonomy of our office or dictate how we should practice dentistry. Keep informed of court decisions on the standards of care and use this free advice to help you practice more comfortably. This may mean tightening up record keeping, becoming better acquainted with the statute of limitations or reviewing your informed-consent procedures. Re-evaluate the terms and limits of your malpractice plan. Use the litigious nature of today`s patient to institute office protocols that lessen the chance of making a silly, lawsuit-provoking blunder. Don`t be intimidated by some ambulance-chasing lawyer. Use the very fact that there is a malpractice crisis to allow you to practice better dentistry.

By now you should get the picture: when life gives you lemons, you make lemonade. Each of the forces being brought to bear on dentistry has the potential to damage us, but none should be viewed solely as an assault on our professionalism. Of course, we should try to prevent harmful outside interference, just as we try to prevent cavities with good preventive care. But once these outside forces insinuate themselves into our profession, we shouldn`t simply rail against the injustice of it all. We should treat these apparent assaults on our professionalism in the same manner as we treat carious lesions, as a problem we can successfully master. And we should master them by adopting whatever course of action best serves not only our patients` needs, but our needs as well.

The author is a practicing orthodontist in New Rochelle, a member of the faculty of NYU College of Dentistry, Department of Orthodontics, and an attorney admitted to practice law in New York State.

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