In response to the Viewpoint by Robert Maccario (September issue), I feel that he left out one point in his computations. When you accept a managed care plan, there are going to be existing patients who see that you now participate in this plan. They will be switching from a fee-based patient to a plan participant. He used a 25 percent profit and said managed care is 70 percent of our UCR. By his figures, we are now losing money on our fee-based patients. It will now take more new patients on these plans to make up the loss, depending on how many of our existing patients convert.
We must now take his formula and subtract the income we will lose according to his totals. In addition, when we raise our fees for cost-of-living increases we no longer can include these former fee-for-service patients. I think it is infrequent that we see managed-care plans raise their schedules of payments.
In medicine, there is a trend to pay hospitals to cut the number of specialty positions. This will create more patients for existing specialists or, at least, help maintain their practice levels. Has any one ever thought of cutting dental-school class sizes? Here`s the simple formula: fewer dentists, more patients per dentist.
This is a win-win situation. The only losers are the dental schools, which have fixed expenses and need large classes to balance their budgets. Well, maybe it`s time for them to downsize and make the life of the dentists they produce (who have enormous loans) better. These young dentists will be able to get more and better-paying jobs out of school. With a cavity-free generation approaching, it is going to take more and more patients to fill our practices.
Maybe it`s time to tighten the spigot a bit on the endless flow of new dentists.
Richard Shapiro, DDS