Before reading an article entitled, Drilling Down on Rent Seeking Dentists, I had no idea what “rent seeking” meant. Jeff Steir, a senior fellow at The National Center for Public Policy Research, a non-partisan, free-market, independent think-tank, crafted the article. What I discovered in this piece was an interesting definition for a political technique that has been used recently by ‘old guard dentists’ and organized dentistry. “Rent seeking” is defined in the Concise Encyclopedia of Economics as the act of people, companies, or organizations attempting to gain benefit through the political process. Simply put, “rent seeking” describes people’s lobbying of government to give them special privileges. A more suitable term may be “privilege seeking.”
There are currently “rent seeking” efforts in dentistry that are impacting access to care and freedom of choice. I am not against regulation if it protects patients and provides better patient care, however I am against anti-competitive actions that reduce access and make false claims. Examining the most current attempts at “rent seeking” in the dental industry, we find a common theme that highlights contempt for change and access to dental services by established dentists and organized dentistry.
Steir’s piece highlights two specific areas where organized dentistry and traditional solo practitioners have lobbied against progressive changes that provide much needed access to care. Firstly, Steir makes mention of mid-level providers in dentistry and organized dentistry’s overwhelming opposition to these newer mid-level options, such as dental hygiene practitioners and dental therapists. While many in the dental industry think these mid-level providers would help ease the demand for dentists in remote, rural areas, others feel that with the addition of more dental schools there will not be a shortage of dentists, and therefore no need for these mid-level providers. However, there is no guarantee that these graduating dentists will want to practice in rural and underserved areas.
Secondly, Steir focuses on dental service organizations and traditional dentists’ opposition to these business entities. As stated several times by others on Group Dentistry Now, organized dentistry for the most part has vilified what they call “corporate dentistry.” There have also been recent efforts to limit or block dental support organizations in states such as Texas, Washington, Wisconsin and North Carolina by dental state boards soley run by traditional, old school, solo dental practitioners. Their faulty argument tends to focus on a DSO’s pressure and influence on dentist’s clinical decisions. DSO structures are specifically set up to support dentists, while leaving them to focus on clinical responsibilities and clinical autonomy. The clinical entity exists as a separate professional corporation with its own responsibility for prioritizing patient care. Opponents also point to DSO member dental practices trying to generate income for the practice by performing unnecessary procedures. Steir points to research done by Dobson / DaVanzo and Lafler Associates that show the efficiencies, economies of scale and cost savings provided by DSOs translate into lower costs for Medicaid. This research appears to debunk the notion that dental groups perform unnecessary procedures in order to increase profits.
Expect to see more of these attempts at the state level to limit or restrict dental service organizations in 2017. Also watch for organizations such as the Association of Dental Support Organizations as they attempt to educate the states on the value of DSOs.
Beth Miller, Contributing Editor, GDN