Question:
I see a dentist the Hygienist does all of the work. With the U.S. focus
on health care cost these days, it seems to me there would be great
cost saving for routine dental appointments if there were a dental cleaning
market. Dental Hygienist owning there own practice competing to drive down
the cost dental cleanings.
Just as dentist today recomends periodontist and oral surgens for work they
are not able to do, Dental Hygienist could recommend you see a dentist if
they feel a "stick" or whatever.
I think a dental cleaning would be less expensive and more efficient, don't
have to wait for the dentist to come check you out and then talk about golf
for 5 minutes.
Has this ever been tried in the U.S. Do other countries do this? What percent
of revenue for dentists is Hygiene? Do dentists and hygienists make
proportionately the same amount of money based on revenue generation?
Answer:
Without even beginning to discuss the issue of quality control, let me
address your question-cost. In my dental office, the fees we charge for a
"cleaning" by our hygienest is at cost. In our dental business
literature, it becomes apparent that many dentist provide this service at
little or no profit. In fact, for many dental offices a "cleaning" is a
lost leader. So the issue of having independent hygiene offices really
does not look financial beneficial for the patients.
Colorado has had independent practice for several years and it has not
been terribly successful. As someone else mentioned, cleanings are a
loss leader for many offices. Overall care is delivered more
efficiently in a setting that can deliver the most services in one
location.
Plus, you would have to take off work four times a year to have your
teeth cared for, you would have to pay for x-rays at both locations or
pay to have them duplicated and transferred. Coors changed their
dental plan to deny benefits for services performed in independent
practices because they felt that removing the dentist from the loop
was not in the best interests of the patient and would result in
higher costs.
I have seen your appends to this newsgroup before, so I respect your
opinion very much Dr. Margarit. But, I was under the impression that
Hygiene is usually about 25-30 percent of most dental practices. Is this
not true? Is overhead and direct costs so much as to make this a loss leader.
I find that hard to believe.
Also, your statement that one would have to take off work four times a year
assumes that each time you have your teeth cleaned, you would need dental work
that would require a dentist. Am I the exception or the rule, that usually
when you get your teeth cleaned you need no further dental work such as fillings, crowns, etc. Plus, when I do need a filling I always have to make
a second appointment with the dentist anyways.
As for X-Rays, just another reason for more dental offices to be hooked up
to the information super-highway. The digitizing of radiographs I think will
be a major cost savings to the dental field. From insurance processing to
labwork to storage costs. I would much rather have all my dental records
stored as "ones and zeros" of some sort of electronic media then in some manilla folder. That is a whole other issue.
I just have a gut feel that if Hygienist could own a stake in their practice
the market would help drive down costs. But most state have laws prohibiting
the Hygienist from owning even a percentage of the practice.
