I said it. And the marketplace backs me up. We are already seeing the effects of an increased number of dentists graduating, increased capacity per dentist, dentists practicing longer in general, and nondentists performing functions that used to be reserved only for licensed dentists.
Just as one simple example of the market forcing dentists to charge less, let's consider teeth whitening. It used to cost hundreds of dollars to get professional whitening, but products from Crest and other effective alternatives, combined with increased competition and the desire to attract new patients, make whitening very affordable or even free these days. And that's a great thing for patients!
Benjamin Burris, DDS.Think this is an isolated event? Sorry to disappoint you, but this is just the beginning. Wait until you see what companies such as SmileDirectClub do to the market and the profession over the next decade.
This kind of market disruption is small potatoes, however, and the cumulative impact of all of the above will be minor by comparison to what will happen once the state-supported dental cartels are no longer able to maintain their dental monopolies. Federal courts and the Federal Trade Commission will eventually make this a reality if state lawmakers refuse to look after the public good instead of bowing to the powerful dental lobbyists.
What will you do then if you haven't adapted to the new reality, doctor? It's coming whether you like it or not. As access to care increases, the cost of what we do will decrease. Equipment, supplies,and laboratory procedures cost what they cost, so where will the difference in price be made up? It will come out of your salary.
More specifically, it will come in the form of reduced profitability for dental practices and their owners. In the long run, almost all owner-dentists will see profit margins approaching the 10% range. I'm not pulling this number out of thin air.
Corporate dental practices do very well with average margins much closer to 10% than 20%, and everyone else will move in that direction over time for all the reasons listed above. I know you hate it but, once again, more access and affordability are always good things when it comes to healthcare. Dentists will still be able to make a very nice living, but you will have to do more for more people to do so -- dentistry will follow medicine in terms of massively increasing access. This, also, is a good thing for the public.
State boards
Right now most state dental boards, controlled by market participants, do everything in their power to block dentists from entering their market or competing with them. Let's take my home state of Arkansas for example. The Arkansas State Board of Dental Examiners refuses to allow dental specialists to provide even the most basic dental care to suppress supply and keep pricing artificially high. The state board is also moving to limit the number of dentists entering our state by reverting back to requiring licensure exams by the Southern Regional Testing Agency (SRTA) for all applicants starting in 2017.
Apparently, accepting the much more broadly used American Board of Dental Examiners (ADEX) examination as Arkansas does now is "allowing too many dentists" to become licensed in the state. How crazy is that? In Arkansas. Of all the states in the union, one would think that our state would want to improve our citizens' dental health and the state's dental reputation. Only Mississippi has fewer dentists per capita than Arkansas, but the Arkansas dental board still makes it as difficult as possible for dentists to come to the state.
Why would the Arkansas State Dental Association and its board members do such a thing? It's obvious -- self-serving greed and blatant protectionism. There is no way that such actions are in service of the public good.
Arkansas should accept any dentist who graduates from any accredited U.S. dental program and should definitely take anyone who has graduated from an accredited dental school and passed any of the regional dental boards. But the state doesn't.
We should be pushing for midlevel providers (MLPs) in Arkansas to improve access to the most basic dental care and educate Arkansans about maintaining better oral health because of the wide spectrum of benefits that come with prevention. But we won't.
We dentists should recognize that we are part of healthcare and that our duty is to patients -- all patients. And we should keep in mind that more access and affordability are always better. But we can't -- or at least we act like we cannot put the needs of our patients ahead of our own wallets.
Dentists account for a minuscule percentage of the 319 million Americans, but we have total control over a precious resource that is vital to our fellow citizens. We have a tremendous responsibility to leverage our education and skills to help others live better, fuller, happier, and even longer lives. We can do that and make a very good living.
We dentists worked hard to get where we are and achieve our goals. I'm all for each and every one of you earning a great living, but if we don't do a better job of taking care of all our fellow citizens, people well above our pay grade and much higher up on the governmental food chain than state dental boards will decide how things will be for us and the public in the future.
The Federal Trade Commission and the federal courts will eventually use antitrust laws already on the books to put the "free" back in the free market if we don't do a much better job of policing ourselves and serving our fellow citizens. I know you vehemently disagree. Let me know how that works out for you over the next decade.
Ben Burris, DDS, is an orthodontist, writer, speaker, philanthropist, activist, and patient advocate. He can be contacted at OrthoPundit.com.
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