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Second Opinion: The Dilemma of Dental Aid Therapists Fred Joyal

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The Dilemma of Dental Aid Therapists
by by Fred Joyal
There is an ever-increasing amount of buzz about dental aid therapists, especially in light of the recent Frontline coverage on access to care and corporate dentistry. I’m going to try to distill this down to its essentials.

Practice Shoppers in the Old World
At the beginning of managing our practice, two kinds of patients caused me to be tongue-tied on the telephone. The first caller group wanted to know the doctor’s age and where he went to school. The first part of the question was hard to handle because you never knew what the caller was looking for! Fifty percent of callers wanted a young dentist. They connected youth with recently graduated from dental school and upto- date equipment and techniques. The other 50 percent wanted age, experience and gray hair! I learned if I had handled the call correctly when the caller either hung up or stayed on the line to make an appointment! Today, your Web site gives your community this data.

The second caller group thought it was their given right to schedule an interview appointment with the doctor, after which they would then decide if they would schedule a new patient examination. These tough patients certainly made me appreciate the referred patient who had bought doctor and practice before they made that first call!

First, let me say that this is an issue dentists need to confront head-on; otherwise government is going to feel the pressure to solve the access to care issue for you. As you might know, there are several states that are training dental aid therapists already (DATs, as I will call them), and more are considering it.

The issue as I see it has five different interrelated elements. They are:
  1. Access to affordable dental care for about onethird of the population;

  2. Lack of basic understanding of oral health in about two-thirds of the population;

  3. The rising cost of dental school and subsequent student debt;

  4. Ignorance of the total economic impact of the dental health crisis;

  5. The scarcity mindset of many dentists.
Access to Care
This is both a geographic and economic problem. Many people cannot afford even basic dentistry. They are unlikely to have any dental “insurance,” and if gasoline goes up 50 cents, every bit of their discretionary income disappears, if they had any to start. I know that they might still spend money unwisely – on tattoos, cigarettes and things like that – but you won’t change that about people. I believe in focusing on what realistically can be changed, rather than pointlessly pontificating about what people should do.

Access to care is also tied directly to the next two elements.

Dental Health Education
People are woefully ignorant of how and why to take care of their teeth. At the lower income levels people are also often misinformed, believing, for example, that since deciduous teeth are going to fall out anyway, there is no need to take care of them. But it is not just the lower class. At every income stratum millions of people do not appreciate the essential nature of oral health. This will not be solved by some educational program or ad program. It would take hundreds of millions of dollars and a really effective campaign. Who is going to do that? The ADA? Not a chance. They’d have to increase dues by $1,000 a year. 1- 800-DENTIST, a large voice to consumers, already spends $50 million a year, and it’s a blip on the screen in terms of changing awareness.

Dental School Tuition
The average cost of dental school, including tuition and living expenses, now exceeds $100,000 per year. Students typically graduate with debt in excess of $250,000, and the interest rate for graduate student loans is double what it is for undergrads. The money that was once used to buy a practice is now used to service that debt. And directly related to access to care is the fact that a new dentist is not going to practice in an underserved area like rural Tennessee for two reasons: one, she doesn’t want to make $70,000 a year and only do extractions, and two, she doesn’t want to live there. When I talk to dental students, they all want to practice within 10 miles of where they would like to live. They give almost no consideration to how many other dentists are already there, which is why we have such a wide disparity across the country in providers per capita.

Economic Impact
States and counties are just starting to realize that when they cut state aid for dentistry the problem and cost doesn’t go away (shocking!), but the burden is shifted to ERs, where treatment costs an average of 10 times as much, virtually all of it paid by the county. The exponential savings of preventive care is never more evident than in dentistry, but few legislatures get this. And even fewer are calculating the impact on absenteeism and productivity of employees with dental pain. And even worse is the downward spiral created in children’s lives when tooth pain keeps them out of school, affecting their learning, and inevitable tooth loss limits their job opportunities.

Scarcity
Despite the fact that 30 to 50 percent of the population doesn’t see a dentist regularly, many dentists complain that there isn’t enough opportunity, and worry that dental aid therapists will take away even more income from them than the recession has. I believe that dentistry is the most abundant profession in the country, but that requires adaptability. We need to evolve how our services are delivered.

I sincerely believe that dental aid therapists have the potential to address all these issues. Before you fetch the pitchforks, hear me out.

First, it is never going to be feasible for most dentists to treat the underserved segment of the population. We are coming up on a shortage of dentists as it is, due to population growth outpacing graduates – by some estimate a shortfall of 35,000 dentists by 2025. And few of you can treat patients for 25 percent of your normal fees without eventually closing your doors.

Second, the only way people learn anything is when they are listening. When it comes to taking care of their teeth, this happens when they are in a dental office. DATs will bring millions more people into dental care, and begin this education process. Furthermore, and this is no small point, many people with dental issues put off seeing a dentist precisely because they know that the diagnosis will be serious, as will the cost. It’s human nature. Many will believe that going to a DAT will be safer, because she won’t be able to do the whole treatment. And gradually they will be drawn into preventive care.

Which leads to my third point: The more people visiting someone about their teeth, the more dentistry will be diagnosed and treated, especially if they are also being educated. I believe billions more in dentistry will be done. What this is called in marketing terms is “broadening the category.” Just as Invisalign did not destroy orthodontics, but instead created millions more cases with patients who would never have put brackets on their teeth, and whitening vastly expanded the cosmetic veneer market, this can happen in all of dentistry, if the proper gateway is created.

DATs will tend to be smaller, storefront-type facilities, which will also create greater awareness. They will work hours that are more convenient to the lower classes.

Governments will see the real economic benefit of this at some point, and start to support it more intelligently. (OK, I’m a wide-eyed optimist on this one.)

We will never get all dentists to agree on this. And societies see their primary job as preserving dentists’ income, so they will not get behind it. But it’s coming. And it will not destroy dentistry. (They’ve had DATs in New Zealand for 90 years – no disaster yet.) So you can fight it, or see it as an opportunity.

I know the argument is that people will not be getting good, professional dentistry. But they already aren’t. Just as supervised neglect is better than unsupervised neglect, infrequent treatment is better than none. And pretending that the problem will solve itself with proper education is a pipe dream.

Here’s my recommendation: Embrace this, and as a dentist, create three or four dental aid therapist clinics in your area that essentially feed you cases as they arise from patients who cannot be treated by the DAT. (OK, maybe start with just one!)

This is also what we call “a technology play” in business. These clinics will often be one or two person operations, where appointing, billing and record management could be a challenge. With the right technology you can manage them centrally. Your current PMS and phone system will handle it, most likely. Beyond that, you can also do remote diagnosis with each of those facilities – the technology is already there, with intra-oral cameras, digital radiography and Skype.

Lastly, instead of fighting it, get involved in the training and regulation of DATs, so that states are not just making up rules that could botch the whole process.

There are four stages of societal change: ignorance, denial, violent resistance and finally acceptance. The sooner we get to acceptance, the sooner this crisis abates, and the faster the dental category broadens. If I’m wrong, tell me why. I’m all ears. Feel free to write me at fred@1800dentist.com.
Author's Bio
Fred Joyal co-founded 1-800-DENTIST in 1986. As the company’s CEO, he has written more than 200 television and radio commercials and interacted with thousands of the most successful dentists across the country. Under Fred’s leadership,
1-800-DENTIST has matched millions of consumers with the right dentist, giving him unique insight into the mindset of the modern dental patient. Fred launched GoAskFred.com, a free online marketing resource, to share his expertise. He is also the author of Everything is Marketing: The Ultimate Strategy for Dental Practice Growth, which is available at GoAskFred.com. You can reach Fred at fred@1800dentist.com.
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