Corperate Dentistry

Since graduating from UCLA in the mid-70s I found Dentistry going through many transformations as far as its delivery of dental care to our patients. In the 70's there was a fear among all private practitioners that HMO style insurance would take over (similar to Kaiser.) That never occurred.  HMOs are still in the 5-6% range of overall Dental Services in our area, primarily PMI for the state, which is a division of Delta Dental. The current challenge in Dentistry is corporate dentistry or DSO's or Dental Service Organizations. These large corporate practices have huge money backing them up and can provide services at decreased costs, but not without risk. While almost every one of my graduating class dreamed of owning their own practice I do believe that percentage is drastically lower today for a variety of reasons and one of them is corporate dentistry. Many of the corporate players are offering different financial packages and continued education opportunities. They are finding ways to reduce staff and doctor turn overs that plagued the industry in the past and corporate dentistry will continue to grow over the next several years because of what I believe are 3 primary reasons.

11.      Generational differences between myself and the new graduates. There are happy just “working for the man” and getting their paid holidays and benefits. They value their time off and do not dream of creating their own “empires.”

22.      My class only had 3 females out of a class of 106. At UCLA in Dr. Naten's class 3 years ago, it was 60% female. Because of differences between men and women dentists which I have blogged about before, women desire to work part time only, for family reasons compared to male dentists and therefore there is a complication in buying their own practices compared to their male counterpart.

33.     Lastly, the debt load of current graduates can be $300,000.00 compared to the $50,000.00 debt load that I had in the 70s. While this may be consistent with the increased costs of housing in that same time frame it certainly is a daunting factor in setting up your own practice.

These three factors will  undoubtedly help corporate dentistry to continue to grow over the next several years.  Hopeful for all of us at private practices, its growth will be limited, and not affect the way we provide services for our patients.

OPPS!

To all you bloggers!  I just had a patient in today that reminded me why they call my job "Practicing Dentistry".  We did a fairly minor tooth color filling on this patient’s lower right bicuspid to replace an old broken silver filling.  I placed the new filling with no apparent problem but he called up about a month later complaining of recurrent pain with the very same tooth.  He was going to Maui next week and wanted to have it looked at ASAP.  An X-ray quickly showed the problem.  I had a margin problem between the teeth on my brand new tooth colored filling.  Now this reminds me off an old saying of Dr. Jennet's, my operative instructor at UCLA in the early 70's.  One of his favorite sayings was, "The only dentist that never had an overhanging margin, is the dentist that never did a filling."  Much to my dismay, it actually took me 2 additional tries to get the margin down on this extremely interesting situation.  Relying on our radiographs to verify the edges.  And that is indeed why they call my job "Practicing Dentistry."  You never know what is around the next corner or where future surprises may lay.

Dynamic Duo

The other day we had a long time patient “visit” for the prep and impressions of a new crown on a tooth he had broken. He humorously noted that he looked forward to his visit to see how the “dynamic duo” was doing. I rarely have patients come in for treatment with such enthusiasm and friendliness. He obviously made Edison’s and my day. Edison is originally from the Philippines and came to us here in Sacramento after transitioning with his family on Oahu for five years. He then ended up here in Elk Grove. He is actually a dentist in the Philippines and due to the educational cost for retraining here in the states he opted to continue serving the public as an extremely confident RDA in our office for the last 14 years. In a field where most of his contemporaries are female he stands out as an outstanding example of a caring and sympathetic RDA. In fact, in our office of 19 staff members Dr. Naten, Edison and I are the only males which is not typical for most dental offices. However, the way we work together it’s probably the reason for the dynamic duo compliment. We all strive to do the best that we can for our patients and do dentistry to the highest quality standards possible. And with that thought in mind, Edison and I as a "dynamic duo" will go on to service our large family of patients and I do feel that our new name is a compliment of the highest order and we really appreciate it. 

Lifetime member

There are many advantages to getting older.  One of them is my natural parks senior pass (used to be called the Golden Eagle pass which I liked the name of much better) that allows for free access to all natural parks, forts, monuments, etc.  Next is probably all those senior discounts that you see at restaurants, shops and other retail outlets that provide me with anywhere from 10 to 20% discounts on services.  The next in line would have to be my new Medicare card that covers my health insurance costs.  It was something that concerned me quite a bit but my health insurance costs dropped by over 80% by going onto Medicare.  Certainly a nice financial surprise, but the most important asset for getting older for me personally is that I just received the attached letter from the American Dental Association.  It indicates that I have been a member of the Dental Society for 40 years and have turned 65 years old, so therefore I am now “Life Member.”  To put that in perspective, the SDDS, the local component of the ADA has over 1,400 dentists and only about 20 of them are life members.  It says in the letter “when you receive your life member pin please wear it with pride.”  I will definitely do that and the next time I see you at the office I will be wearing my life member pin, as I do believe it reflects my many years of work to prove the dental health of our community. In addition, I no longer have to pay my membership dues which is once again a nice financial advantage for getting older.  See you on my next blog.

Why Solar?

Many of you will have already noticed that we have solar panels on the roof at the office and you might be thinking that I have “Gone Green” despite my previous blogs regarding climate change.  Actually, that would not be correct.  I am a firm non-believer in global warming as I stated before.  I believe there are variations in our climate that are definitely not primarily caused by man/made issues.  Mother nature is the one who controls the planet for us visitors and in 10 million years (a blink of an eye to Mother nature) we will all be gone and she will still be here doing her thing without us.  Instead, the reason for our solar panels is primarily financial.  While most of you that have residential SMUD service you pay between 11 and 12 cents per kilowatt hour our rates can be almost 30 cents a kilowatt hour.  That leaves me with a $1000.00 a month SMUD bill pretty much all year round on a building that is approximately 3500 square feet.  We have already completed many title 24 processes to try to decrease our bills, like our R-58 attic insulation and new HVAC unit.  Therefore, it is now time to hop onto the solar power band wagon to cut our costs. We use the Sacramento county Ygrene program for financing so I can get the tax credits as well as writing off the financing in order to make the project affordable.  I would not say that the process is been devout of challenges.  But I firmly believe that it will pay off for itself in the end. As for those of you that are contemplating solar I do agree with my SMUD advisor that chasing pennies with dollars is not a great idea. Do everything you can to save energy costs prior to attempting solar. You would be surprised how high efficiency appliances or insulation, new HVAC and windows or shade trees, etc. can cut your bills.  But if you do decide that solar is the way to go, shop around there are tons of suppliers and a huge variation in prices and features.

See you at my next blog.

What I Like to Do the Most

It is interesting I oftentimes get asked what procedure in dentistry I like doing the most.  That question reminds me of an old friend and college of mine, Gordon Christensen who practices in Provo, Utah.  He lectures internationally and is very well know among the dental community.  I was at a symposium he was giving several years ago and he was talking about dentists versus physicians.  The average physician/surgeon does approximately 12 different procedures.  And if you think about it for a moment, he is right!  There are no more Orthopedic surgeons anymore.  There are knee doctors, hip doctors and elbow doctors but no people that do all the different orthopedic procedure.  on the other hand, your local primary care physician at Kaiser does not really do a lot of different procedures at all.  Primarily, he or she probably prescribes medication for you if you need it and refers you to a specialist if a specific procedure needs to be done.  That is because in the physician world 95% of the physicians are specialists.  On the other hand, in dentistry, 95% of dentists are in family practice like myself.  The average family practitioner in dentistry does approximately 144 different procedures.  So the question is a reasonable one.  What is the procedure I like doing the most?  I have given it a lot of consideration over the years and actually the better question is what procedure do I like doing the least?  As I thoroughly enjoy all 144 different procedures that I do.  The answer to that question of what I like doing the least the answer is obvious, working on people when they are not numb!

Do I favor Fluoridated Water. Part 2

This is the 2^nd blog on fluoridated water.  Going back to our discussion of fluoridation of public water supplies Elk Grove is special.  When I first began my practice here in the mid-70's we had a population of approximately 3000 and the Elk Grove water district was supplied by 4 to 5 wells depending on the time of the year by a family owned business.  Once Elk Grove grew to its current size of  over 150,000 the family operated business could no longer support the water needs and so the business was taken over by the city.  Still there was not enough water available, especially for the areas in Laguna (attached to this blog you will find the map of our fluoridated water areas).  The problem is that Elk Grove community water district does not fluoridate the water but does not have enough water to supply all of our residences.  Therefore, many times of the year the district purchases water from Sacramento city which is fluoridated.  Therefore, many of our patients are in “partially fluoridated areas” and it is impossible to account for the amount of fluoride being intake through public water use.  That means that if we do have a child that comes in with cavities and they are in a partially fluoridated area it is very difficult for us to prescribe personal systemic fluorides to be I ingested because of the potential for fluorosis, which are white spots that would form on the teeth due to over application of fluoride.  Therefore, it puts the child at risk for additional cavities which is difficult for us to control.  In fact, Kaiser, used to be the largest supplier of prescription fluoride (poly-vi-flor and tri-vi-flor) when I first started practice here and they no longer prescribe it at all because of this issue.  Therefore, in our area I cannot reasonably suggest that fluoridated water is a positive aspect for our community.  I would much rather go back to Dr. Guenette’s comment about giving people cavity medicine when they have cavities on an individual basis. Obviously, as a practitioner in this area for 40 years this is a hot button item for me which apparently has no resolution in our current political climate.  Therefore, the short answer to our patient was, in our area, no.  Hopefully these conflicts can be resolved sometime in the future and we can get on with a reasonable policy that can protect our children and our older adults from the ravages of decay with appropriate use of prescription level fluorides.