Townie Debate Of The Month

I'd like to see a good discussion of the access to care issue. Let's start out by trying to identify the problem. What do I mean by "Access"? Actually, 'access' is a term coined by the non-dentist individuals who are defining the oral health problem. They coined the "access to care" phrase as part of their efforts to pin the blame on dentistry and our current delivery system. We all know that dental care doesn't compete with food, shelter and money, but it does dip into the satellite TV and bass boat budget. You can bet your bottom dollar that the same "down on their luck" individuals the "access" crowd claims have "barriers" to dental care, have no such barriers when it comes to satellite TV, deer rifles, and cartons of cigarettes. What is the reason there is an access to care problem?
Jgrammer, Official Townie

Concerning access to care, I agree that while it is often a reason given by the patient for not accepting treatment plans, there is generally not a REAL financial component. I often hear "Gee doc, I'd love that crown, denture, but I simply don't have the money. Funny thing is they always have money for their smokes and beer, and they will drive away in a new vehicle. In life there are needs and there are wants. Some people "need" their wants, and look for others to provide them with their needs.
alaskadoc, Official Townie

Is there REALLY an access to care problem? I do not think there is an "access" problem here, in one of the poorest, rural, communities in California where 80-90% of the population is from Mexico. I am in competition with 10 other dentists in the next town for the same low-income immigrant patients, many of whom are on Medi-Cal. There are SO many programs here to help the poor and their families and a lot of money is spent to make sure the people know about them, and almost all of the dentists in the area accept patients from those programs. There are dentists open evenings, Saturdays and Sundays to serve these patients. In addition, there are government clinics that work on a sliding fee scale. I think you could double the amount of dentists, and the same people would still be complaining that there is no "access." Yet, a lot of patients in this population cannot be bothered to show up on time, or at all, for their appointments. And many of them feel entitled to free Cadillac dentistry. I tell them they are lucky they live in California where at least some of it is covered. I have heard from the Medi-Cal guys that other states don't cover things like RCT's and crowns. Fees around here are pretty low, but none of us can compete on price with the guys doing $100 bridges illegally in their garages, don't pay taxes and are not held to any standard of care.
AbreLaBoca, Official Townie

Creating a better environment for you, your family and your neighbors is the best you can strive for. If you want the real answers read Free To Choose: A Personal Statement by Milton and Rose Friedman. If the Friedmans' book does not make you realize that access to care is not an issue, then re-read the book again.
Howard Farran, Official Townie

Dentistry has many problems. Most of which are over looked by dentists in academia and the lecture circuit. These problems are access to care, lack of basic science training for dentists, isolation of the average dentist, and the proliferation of psuedoscience in the attempt to "sell" more dental treatment by calling it complete dentistry, or whatever moniker one chooses. Demonizing all insurance is foolish and self-serving. First let us stop comparing dentistry to medicine. A better analogy would be to something in the beauty industry. Dentists long ago decided, to our detriment, to isolate ourselves from medicine in particular and healthcare in general. This has left our field in a bad position. The IOM published a report a few years back about how dentistry is too mechanical and needs to be brought more in line with medicine. The report received little coverage, but open any dental magazine and you will see article after article about white fillings, and how your hygiene department can make more money for you. Even so-called peer reviewed journals are suspect.The same topics are covered with virtually nothing changing. We herald every new cement or filling material as some Nobel level achievement. My wish is for a group of educated scientists, academics, and physicians to come in and review the entire dental educational system and make binding changes.
GV, Official Townie

I am sick and tired of hearing ranting from idiots about how 'bad' a position dentistry is in right now. If you want a physician to come in and screw up your practice, fine, but they can keep their grubby hands off of mine.
csmith_dds, Official Townie

We've beat the access question to death. What basic sciences are lacking in the training for dentists? Did they leave one of the basic sciences out in our training? Biochemistry, gross anatomy, head and neck anatomy, physiology, histology, embryology, neuroanatomy, organic chemistry, dental morphology, and pathology. What did I leave out? I think the BASIC sciences were pretty well covered.

How do you determine what constitutes "over charging"? How do you define it? Is it someone who charges more than you? Is it someone who charges more than an insurance company's UCR? Likewise, what is a fair fee for a financial advisor's services? Or an attorney? How much is too much?

Should we be more like medicine? Or should it be more like dentistry? Medicine has a long history of treating disease without any focus, whatsoever, on prevention. Just VERY recently, is medicine starting to consider prevention of disease as within their purview. On the other hand, dentistry has ALWAYS focused on prevention, making us perhaps, the most noble profession of all…seeking to eliminate the need for our services. Of course, human nature is such that bad habits will continue to ensure the need for dental services.
Mike Barr, Official Townie

For what it's worth, here's what I think of the current state of dentistry today:

1. There is no access to care problem in this country. Anyone can get care if they desire it, even if they can't afford it.

2. While the ADA can do more to promote dentistry, we as independent businessmen cannot rely on this organization to increase our incomes. It is our responsibility alone. However, I will continue to join because I feel we need some central organization to take care of our interests in regards to issues like OSHA.
mauty, Official Townie

People don't go to the dentist because teeth are low priority in the grand scale of life. Nobody knows anything about teeth and oral health except dentists and those who work in a dental setting. How many people in your community would seek proper oral care if they only knew 1% of what a dentist knows? The reason insurance companies get away with what they do is public ignorance. Let's face it, dentistry has failed the public on the education issue.
Maclee, Official Townie

Now what about the poor? How do they get treatment? It is not our responsibility. In other countries only the wealthy get care. When I pay 50% in taxes, should I also give out more by reduced or free care? I say lower my taxes to a reasonable rate, and I would serve the poor as well.

If they were so concerned about the unmet needs of certain populations, have the law written that my time could be a tax write off, and I would close one day a week to devote to the poor. Perhaps, we could have a part time public health service with rank and privileges of the active duty.

I do my share of free care or reduced prices for those who truly have a hardship. Last year I screened almost 4,000 kids in my city's school district. I sent home letters to hundreds of the kids' parents explaining the need for urgent dental care. The sad part was that very few of these hundreds ever called a dentist in this town. When I returned for follow-up visits the same children had severe needs and again we notified the parents. Was it financial? Who knows? The parents never tried to get help.
desert rat, Official Townie