January 1, 2014
by Dr. Reza Nouri
It’s a beautiful sunny Sunday afternoon on the Thanksgiving weekend. The crisp, cold air creates an unfiltered view of the colors of autumn. The colors are so pure and versatile on the canvas of the beautiful nature that one cannot deny the deep sense of gratitude within. As I reflect on the significance of the weekend festivities, it only takes seconds before I realize how fortunate I am to be a member of the great profession of dentistry. We are truly blessed as a profession to be self-regulated yet to be viewed by the public with a high level of respect and trust. This gift is the result of years of hard work and ethical practice by generations of dentists before us. This very privilege of self-regulation should not be taken for granted and must be guarded by our entire membership. We must be aware of the many challenges that threaten the professional foundations of dentistry.
The evolving business models in the management of dental offices under the umbrella of corporate dentistry pose a significant threat to our profession. Dentistry has come a long way from the solitary practices of decades ago. Nowadays dentists working together in group practices are common place. There are many advantages in dentists working under the same roof. The benefits of drawing on each other’s experience and knowledge in patient management, clinical practice, and business operations are significant, especially in the lives of new graduates. While dentists coming together and working in a group practice in one or several locations is an acceptable model, having large corporate entities with no ownership by practicing dentists purchasing and managing dental offices poses a great risk to the integrity of our profession. Large for-profit business corporations may shift their focus from ethical patient-centred care to increasing profitability in order to keep their shareholders satisfied. Gradually the integrity of our profession may be questioned and subsequently the right of the dental profession to self-governance may be challenged.
Improper distribution of dental manpower also poses a threat to dentistry’s position in public’s view. Most unfortunately, a large proportion of new graduates settle in large cities immediately after graduation as opposed to moving into suburban areas to service communities in dire need of dental care. This also places further financial burden on new graduates who need to service the student loans they have amassed throughout their education. Compounded by reduced patient load and limited expertise in managing complicated clinical cases, new graduates may fall victim in the hands of large business corporations managing multiple dental offices. Complicating this further, many senior dentists fail to properly plan and execute an exit strategy from clinical practice. This results in lost opportunity for mentoring and engaging recent graduates to take over their practices, a scenario which will be beneficial for all those involved. Dental schools and the entire dental profession should take responsibility for adequately educating dental students and colleagues with respect to best options for entry and exit strategies. There appears to be a tremendous need for more dental business management courses to be incorporated into dental curriculum in most universities.
Increased use of social media is another example of a potential threat to our profession. The culture of social networking amongst dental colleagues spreads its roots during dental school and tends to flourish when in clinical practice. Even the solo practitioner may not feel as isolated anymore. The psychological benefits of such social networking are undeniable. By sharing clinical experience we soon realize that we all deal with the same challenges both in clinical practice and in daily business operations of our dental offices. This culture of digital networking could substantially lessen the psychological burden of dental practice. Nevertheless the same culture could alienate some of our colleagues who do not adopt it, and may push them even further into the isolated world of solitary dental practice. It is therefore incumbent upon each and every one of us to be inviting and supportive of other dental professionals. By offering our knowledge of clinical dentistry, business management, and financial planning we can certainly be more supportive of our colleagues. Furthermore, it is incumbent upon each and every one of us to ensure that our use of social media for promotional activities stays within the boundaries of professional conduct.
Hasty adoption and introduction of modern technology into our clinical practice may also prove harmful in maintaining our professional stature in society. Technological advances in all aspects of dental practice allow us to provide better and more efficient services to our patients. The challenge however, is to what extent should one follow the recommendations of dental manufacturers and marketers? An example of this challenge is the increasing use of Cone Beam CT (CBCT) in clinical dentistry. One should remain cognisant of the added radiation to the patient when such imaging techniques are used. In every potential clinical scenario we should question whether CBCT significantly enhances our diagnostic ability beyond what basic radiographic techniques offer us. Routine use of CBCT imaging in clinical practice in place of panoramic radiographs to assess growth and development, in place of periapical radiographs to assess pulpal and periodontal health, in oral surgery to assess permanent third molars, and similar scenarios are some of the most challenging clinical decisions facing our profession.
We must continue the hard work of our predecessors in order to maintain our professional and ethical status. Unfortunately, at times we find ourselves in difficult situations when the pressure of running a dental business is in conflict with ethical and patient-centred practice of dentistry. This is particularly challenging when business managers and marketing agents become involved in the day to day operations of a dental practice. Some of us fall victim to the belief that such individuals can actually assist us in running better practices to the degree that we allow them to negatively alter the vision for our practices. We must not forget that we are the ones representing our profession; and as such we must exercise all ethical principles in order to provide the best care for our patients. I try to practice dentistry by believing that if I take care of my patients well, my patients will take care of me. I believe that finances will take care of themselves as long as I take care of my patients from the heart. I am thankful for those who instilled that thinking in me. In order to maintain our professional and respected place in society, I am certain the leaders in our profession will take the necessary steps to guide us through the many challenges facing dentistry today. In such challenging times, thankfully we have each other! OH