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Stresses in the practice of dentistry caused by current economic and social shifts and their effects

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farmerjeanh

Former Member
Stresses in the practice of dentistry caused by current economic and social shifts and their effects

I have a theory (with a long footnote, see below) that some of the current increase in dental phobia may be down to dentists in the US being forced to lie to patients constantly in order to make as much money as possible, and this deceit being perceived on a conscious or subconscious level by the patient. Dental professionals are under great stress, is that stress being transmitted to the patient? Are we "barking up the wrong tree" here:

Economic models of dental services and pricing are based on supply and demand curves. The demand curve is based on the common sense law of demand. This states that, all else being equal, as price falls the quantity demanded rises and conversely as price rises the quantity demanded falls. In simple terms, if something is too expensive you buy less of it, and if its cheap people buy more. The demand curve is thus a downward curving graph of quantity (horizontal axis) versus price (vertical axis). The supply curve shows the various amounts of a product or service that producers or providers are willing and able to make available at each of a series of prices over a specific time period. The supply curve is based on the law of supply which states that as selling prices rise, that is the price consumers are willing and able to pay for products or services rises, the quantity of product or service a supplier will make available will rise. In other words if people are paying more for your product you will want to sell more of it, and if the people aren't willing to pay so much you will have to drop your prices to get people buying again. Thus the supply curve is an upward curving graph of price (vertical axis) versus quantity. The optimal price, that is the price at which all products offered are consumed is determined by the intersection of these two graphs. As time goes on, the prices consumers will pay and the prices suppliers charge oscillates around this optimal, equilibrium price. Also the quantity on offer as well as the amount people will buy oscillates around the same point.

The basic determinants of consumer demand are consumer tastes, the number of consumers in the market, consumer's income, the prices of related goods, and consumer expectations. These will shift the demand curve right or left. For example if consumer income goes up, demand tends to increase, and the demand curve shifts right. Conversely decreasing income decreases demand, shifting the curve left. The net effect of a right shift is an increase in the optimum price for the product or service in question, and the net effect of a leftward shift in the demand curve is a reduction in the optimum price.

The basic determinants of supply are: resource prices, technology, taxes and subsidies, prices of other goods, producer expectations, and the number of sellers in the market. Changes in these factors shift the supply curve left or right, thus decreasing or increasing the optimum price.

All the factors influencing shifts in supply and demand have varying degrees of independence and interaction, so predicting these movements is complicated. When employment and incomes are high people may be more concerned about getting the best product or service and not care so much about what it costs. Or they may feel more comfortable indulging changing tastes and fashions than worrying about getting the most for their money. When money is tight it's a different story.

Income is a major factor for most people. If you are rich it might be nothing for you to spend $30,000 to $40,000 for a full set of top of the line implant anchored dentures. If you are poor you will have to settle for cheap plastic dentures or more likely no teeth at all. Obviously, during economic downturns people have less money to spend and are going to see where they can get by spending less, thus reducing the demand for dental procedures. This reduction should induce practitioners to lower their prices. continuing the denture example, new or alternative technologies providing cheaper means to get the same quality at lower prices may arise. These days one can buy denture making kits and create dentures without going to a denturist or prosthodontist. If practitioners start using these lower cost technologies they could offer more services to more people, thus reducing the demand for more expensive procedures and therefore reducing the overall cost of dental procedures. If do it yourself technologies become easy enough to use and if people develop a taste for these technologies, denture prices would plummet.

Increasing diversification of the dental profession results in different tiers of dental workers with different degrees of training and more of less limited areas of practice. For example, denturists just make dentures whereas prosthodontists make dentures, do implants and all sorts of restorative work. This increases the number of suppliers and the number of alternative goods and thus decreases the prices of relevant dental procedures.

Sociological and psychological factors can complicate this picture. If a practitioner views his occupation as high status he may feel entitled to a high price for his service and be reluctant to lower it. Or he/she may have gotten used to a high income and incurred a lot of debt. Servicing this debt requires one to maintain high prices as long as possible to maintain the lifestyle.

Dental insurance greatly affects how much and how quickly prices respond to these factors. Obviously if one has 100% coverage then individuals don't much care what the procedures cost, since the insurance pays it all. This called elasticity of demand. This also provides an incentive for the practitioner to raise prices because he knows the insurance will cover most of the costs to the consumer. As coverage decreases price becomes more of an issue. Also if the insurance industry changes radically confusion about regulations and coverage can result in increased difficulties in knowing how to price services as well as require much additional time and effort to understand the changing insurance procedures and requirements. This is time that is taken away form performing the services and from leisure time as well. this can also lead to misunderstandings by consumers, more uncertainty about costs and even reluctance to get procedures

Did you ever feel you were being railroaded into an unwanted procedure because it was the most expensive option? Could this increasingly common practivce lead to a universal loss of trust in the profession?
 
Re: Stresses in the practice of dentistry caused by current economic and social shifts and their eff

Interesting thought.

I'm not sure I've ever felt rail roaded into the most expensive solution, although that might be because I knew what I needed done. It was a simple shut and close case. Fillings, root canal what have you. Not really any alternatives.

I have, however, felt like I was being talked into unnecessary treatment or not being told the entire truth. Recently a dentist said to me a tooth she would be filling may or may not need a root canal. I responded, "Well do I need a filling or a root canal, are you saying the filling won't work? Shouldn't I just get a root canal then?" And she went on to say that "answering that question is like trying to predict the weather". Uh, no, I think not. Two very different things!

I have no confidence in her, I don't trust or like her, but unfortunately shes my only option right now since I'm not the one paying and my mom for some reason has faith in her...which to me makes no sense. I feel like I'm being given the run around by the dentist. But hey, I'm not a dentist. If only I was different I would try to become one, but I like neither sharp objects nor the majority of people and my brain can't handle all that information :ROFLMAO:
 
Re: Stresses in the practice of dentistry caused by current economic and social shifts and their eff

Interesting thought.

I'm not sure I've ever felt rail roaded into the most expensive solution, although that might be because I knew what I needed done. It was a simple shut and close case. Fillings, root canal what have you. Not really any alternatives.

I have, however, felt like I was being talked into unnecessary treatment or not being told the entire truth. Recently a dentist said to me a tooth she would be filling may or may not need a root canal. I responded, "Well do I need a filling or a root canal, are you saying the filling won't work? Shouldn't I just get a root canal then?" And she went on to say that "answering that question is like trying to predict the weather". Uh, no, I think not. Two very different things!

I've also felt like I was being ripped off at the dentist's office. In searching for a replacement for my soon-to-be-retired current dentist, Dr. L, I visited a Dr. B, a younger dentist about my age (mid 30s). Dr. B had taken over for my previous dentist who retired early due to health problems. Dr. B was recommended by a couple of friends, one of whom has a dentist for a father.

Dr. B was ok, I guess, but his chairside manner wasn't the best. After looking at my teeth and the xrays from Dr. L, he and his office manager informed me that I was looking at around $7,000 of dental work, including four crowns and three wisdom tooth extractions. The crown thing is what made me really think I was being ripped off.

Dr. L, my current dentist, said I only needed a crown put on an old root-canal tooth. So did another dentist I visited with. Funny thing is, my dentist and the other guy put on temporary crowns and send off an impression of your tooth/teeth to a lab for the final crown, whereas Dr. B has a fancy machine in his office that makes the crown right then and there, making it a same-day appointment. Something told me he was just trying to pad the bill and get his money's worth from the fancy, in-office crown machine. :(
 
Re: Stresses in the practice of dentistry caused by current economic and social shifts and their eff

I have been fortunate to have practiced a long time here in Miami, Fl. I have seen it all during my career. There are some amazingly talented very well educated doctors here while at the same time their are more than a few that seem only interested in your money. In the last 20 years there are more and more dentists that are more money oriented. The economic pressures are greater now as there are too many dentists in most of the USA. Their are more for profit dental schools opening up and all dental schools have very high tuition. 50,000-100,000+/ year x 4 fours plus living expenses and that is after 4+ years of college. There is also set-up costs that if you rent space can vary from 300,000- a lot more.
Now you need patients to treat so along come the DMO which is a type of insurance that the dentists gets paid a small monthly fee to treat all basic need needs whether a patient shows up or not. The problem is the fees are so low that patients are routinely offered treatment that isn't covered so that the dentist can survive.
I regularly see patients for a second opinion that have been presented with some rather unusual tacked on fees.
I also see this as a growing problem with no end.
 
Re: Stresses in the practice of dentistry caused by current economic and social shifts and their eff

Thank you, Doctor-I honestly don't see how many practices are going to stay afloat. Texas' "All Smiles" investigation showed the extent of Medicaid abuse taking place as students are forced to do whatever they can to repay loans-including working for these sleazy operations:


Ellis, a Dallas orthodontist, testified in Congress last month that the “flagrancy of the fraud” she found in audits she performed for Texas Medicaid “is truly unbelievable,” with only 10 percent of the paid claims she reviewed actually qualifying for Medicaid coverage.
Texas “has gained a lot of fraudulent orthodontic providers, including many private equity owned dental clinics engaged in the illegal practice of dentistry,” Ellis told the U.S. House Committee on Oversight and Government Reform.
 
Hi, I'm a senior and seen the changes in price and cost of dental college. It is terrible what students have to pay now for an education.

I feel much of it goes into politics and the high prices colleges pay for political speakers, sometimes a couple hundred thousand for their opinions. Also, everything is higher under the inflation and employees now make a lot of money doing blue-collar jobs, some janitorial service pays in the 6 digits.

I have been to campus dental clinics in the past and the students seem a little stressed more so than normal. Most were very nice and so are their teachers. They seem to still do good work.
 
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