Quantity over quality: The trend 1 endodontist fears most

An increased emphasis on quantity of treatments has one endodontist concerned about the quality of patient care.

Christopher Carrington, DDS, is the owner of Care Endodontics in Hartford, Conn. He recently spoke with Becker's about the dental industry trend he is most afraid of.

Editor's note: The response was lightly edited for clarity and length.

Question: What trends in the dental industry are you most afraid of?

Dr. Christopher Carrington: The most significant trend in the dental industry I am most afraid of is how dental providers have been following the medical model for patient care, whereby dentists are increasingly working for institutions or corporate entities in a group practice with multiple providers in a large office. This invariably has caused the emphasis on dental treatment to be driven by quantity of treatments rendered rather than quality of patient care to ensure maximum profitability of the dental practices.

When I was in dental school 40 years ago, dental offices consisted of single provider dental practices, providing fee-for-service patient care. Medical offices at that time were mostly insurance-based practices in a group setting. A practicing dentist would be known for the quality of dental treatment provided in that office. Ten years later, many dental offices started accepting dental insurance payments for patient care, and some were also accepting capitation dental insurance plans (HMOs, DMOs, PPOs, etc.) to attract new patients. Ten years beyond that, in the 2000s, corporate DSOs expanded and began competing with private practices. The DSO dental offices promoted a quantity of dental treatment by delivering complete and total dental treatment to their patients. This was done in part by offering their patients extended hours and available days of the dental provider(s) to provide not only dental treatment but urgent care and dental emergencies.

As a dental specialist who receives many referrals, I have heard from my patients about their experiences in many different dental practices, including some of the DSOs in New England. A common report from patients was that their treatment plans were excessive and/or too costly. And this caused many patients to seek a less expensive dental provider, or one who accepted their dental insurance as part of the insurance network. As a clinical professor who teaches dental students and residents, I have seen how most of the debt-laden dental graduates no longer want to own their own dental practices. Instead, they preferred to work a few years for a senior associate dentist or a DSO so their debt load could be reduced, rather than increased by owning a dental practice.

I consider my dental practice to be driven by quality and excellence in dental patient care. I am very concerned that dental care today is driven by quantity, with the emphasis on maximizing profits for the organization or entity providing the dental treatment.

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