One rapidly growing trend in dentistry is the rise of dental “chain” practices (a.k.a. corporate dental offices, franchise dentist offices, or dental “mills”). By the term “chain,” I’m referring to practices that are owned and managed by a large corporation and staffed by employee dentists, assistants, and hygienists. Essentially they are franchise stores like most of the fast food restaurants in existence. There are some obvious benefits to owners of these types of practices, such as shared marketing budgets, and multiple locations to generate revenue, etc. Patients should be wary of them, however, because pressures and protocols established high up in the chain of command can interfere with how dentistry is practiced for individuals. Dentists working for such organizations have pressure from employers to diagnose aggressively, upsell whenever possible, and constantly worry about statistics like production per hour or production per day ratios. In other words, patient care tends to take a back seat to revenue generation in chain dental offices.
One such office, Aspen Dental, which has more than 500 offices nationwide, just got nailed by the New York attorney general and fined $450,000 for their business practices in that state. New York is also requiring Aspen Dental to remove management pressures from clinical decisions, change payment structure, and make it clear to consumers that the corporation itself is not a provider of dental services. This case highlights problems that potentially plague all franchise model practices. Many such corporations respond to criticism of their business model, as Aspen did in this case, by saying that all practices are individually owned and all treatment decisions are all made by individual doctors. According to the New York attorney general’s investigation “Aspen Dental did not merely provide arms-length, back-end business and administrative support to independent practices.” Rather, the corporation was found to be involved in incentivizing and pressuring staff to increase sales of dental services, implementing revenue-oriented scheduling systems, and directly hiring associate dentists and dental staff members.
Utah has a particularly vulnerable situation with its business ownership rules. Most states mandate that the owner of a dental practice must hold a dental degree, but in our state anyone can own a dental practice. Chain practices (that typically bend the rules of ownership in other states to make their business model work) basically have free range in Utah to do whatever they want. If this doesn’t sound like a very negative thing, you’ve probably never experienced this type of dentistry as a patient. Consider a scenario where a dentist is being pressured to maximize profit from each patient they see during the day. That might involve improperly diagnosing some teeth with cavities that don’t actually have cavities, diagnosing small cavities as needing crowns rather than fillings, upselling things like whitening regardless of a patient’s needs, charging fees for anesthetic cartridges, charging fees for seating crowns, charging extra fees for standard crown materials, etc. In my opinion, diagnosis should be entirely based on the needs and wants of each individual patient. To involve a third party inside the doctor-patient relationship that is entirely concerned with maximizing revenue is a poor idea at best, if not a downright dishonest business practice.
Beware of “chain” dental practices!
-Nicolas K. Young, DMD
