When I was a kid, pharmacists had their own pharmacies and optometrists had their
own eye clinics. Now these models have been replaced by Walgreens and CVS, with
EyeMasters and Pearle Vision.
In France they actually have ATM machines for prescriptions. A physician loads the
prescription onto a medical card and a patient can pick it up anywhere there is one of these
machines. The machine dispenses however many pills the electronic script is written for,
puts a sticker on the bottle and drops it into a drawer, the same way you’d grab chips from
a vending machine. Prescriptions are now a commodity.
When we go get glasses, most of us don’t care if we look into a machine to tell us we
have 20/80 vision because that number goes to a lab tech who crafts the lenses. Most of us
are more worried about how the frames look. Glasses are now a commodity.
It’s like “The Jetsons” where a mechanized robot brushes George Jetson’s teeth, shaves
his face and dresses him based on a scanner view of his body. What we once thought was
futuristic and unattainable is here and now!
All this has me thinking about dentistry’s model and how it’s changing. What will the
dental landscape look like in 2050? Will dentistry go the way of Walgreens and
EyeMasters? I asked several of my colleagues this question and they shared their opinions,
which we feature in this issue (page 64).
Let’s talk about the reality. Dentistry’s unique selling proposition is surgery. We work
in an operatory. Our hands and fingers are in someone’s mouth. It’s not the same as a pharmacy
or an eye clinic. It takes human hands and human eyeballs to perform dentistry.
Commodities are things you buy on price. When you buy corn, you don’t care if it’s
from Iowa or Nebraska. The silliest ad campaign I’ve ever seen is the Florida orange juice
one. Have you ever heard anyone at the grocery store asking for Florida oranges because
they don’t want the ones from Arizona?
My practice is 25 years old. I have a lot of contacts from Dentaltown who have significant
roles in the business to consumer (B to C) marketplace, and we all agree: half of
America buys dentistry on price. Some of these people do perceive dentistry as a commodity
and some buy on price simply because they don’t have money. If they have bad dental
insurance and their insurance says they can only go to one doctor in town, they’ll go to
that one doctor in town. This phenomenon is going to be around forever. There are people
who are poor who really do value dentistry and there are rich people who
don’t value it.
The other half of America has strong opinions about who gets to work in
their mouths. The relationship with their provider has a huge impact on their
choice of dentist. Have you ever once based whether you want a prescription
filled at Walgreens on which pharmacist is going to be there? No! You just want
to know when Walgreens is opened and if it has a drive-thru!
The argument is that corporate dentistry fuels the side that says dentistry is
a commodity. These companies are representing a brand instead of an individual
dentist. They’re often marketing on price, rather than procedure or specialty or dentist. So, yes, there are real-live dentists, not robots, performing the procedures, but
it seems to be the beginning of taking the relationship out of the process.
Once you’re 50, you’ve seen everything at least twice, particularly in economics. This
is the second time I’ve seen the idea of corporate dentistry come around. Black Monday in
1987 was just months after I graduated dental school. I was practicing during the stock
market crash in 2000 and Lehman Brothers fall in 2008. When everyone thinks it’s the
end of the world, it’s not. It’s a cycle. We create an economic bubble and then it explodes.
It’s just economics.
Corporate dentistry chains have a good grasp on sophisticated marketing and management.
When I got out of dental school, not a single dentist I knew, including myself, could
use QuickBooks to make payroll. I hadn’t taken one class on management or communication
with staff. For some, the answer is: let someone else do it. So if you hate dealing with
all things social media and Excel, corporate might be the way to go.
For those who would rather learn it for themselves, check out all the practice management
courses on Dentaltown.com. They’re only $18 each. Or, if you want more than a few
hour-long classes, maybe you’re interested in going back to school. I went back to school
in my 40s! I took two business classes each semester. I attended class on Monday and
Wednesday evenings from 6-10 p.m. every week for two years. And I about cried when it
was over because I loved it and learned so much! Another solution is to hire street-smart
staff—an office manager, specifically. Recognize your limits and delegate!
The other advantages to corporate dentistry are better access to capital and better
patient financing. It’s nice not to have to worry about these things. The CAD/CAM unit
and other equipment is part of the package
and there is no third-party when it
comes to financing treatment.
It’s nice to have access to capital and
to have patient financing, but you can
have these things in a group practice, too.
You can split the cost of the rent and the
CAD/CAM and the payroll with other
partners. You can work with CareCredit
for patient financing. So in these ways, I
don’t see how a corporate chain in all 50
states is any more competitive than an
independent group practice.
I’m not opposed to corporate dentistry.
I think it provides needed services
for many Americans who need treatment.
But unless corporate chains can preserve
the one-on-one relationship that a patient
gets when he or she visits her independent
dentist, I don’t see corporate taking over
the dental landscape or dentistry going the
way of Walgreens. I think they’ll always be
a spot in the marketplace for both private
offices and corporate chains.
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