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Oct 24, 2013, 12:43:58 PM10/24/13
Posted by H. Skip Robinson on behalf of an anonymous author. 
I am an anonymous author that wishes to discuss and provide some of my experiences facing employment and patients in the dental industry. I have been in the  profession since 1971, starting as an orthodontic assistant, then becoming a front desk receptionist/administrator in general dentistry, back in the days when offices ran on the pegboard system. I’ve worked in general and endodontic offices with substantive experience in various software, digital x-ray and overall operations in various fee for service and managed care practices. Additionally, I’ve also worked on several occasions in the medical fields, including dermatology, internal medicine and acupuncture, both front desk and assisting.


I am writing this article because since I began working in the field, I have had some very appalling experiences relating to salaries, working conditions and unscrupulous dentists. Because of what I’ve seen and experienced, I have long wanted to start an Office Workers Union that really focuses primarily on two issues; salaries and working conditions. The predominance of employees in the dental field are female and the Dentists are predominantly male, making office dynamics often very interesting. The few male employees are generally foreign dentists getting experience while trying to meeting US qualifications.     


Verbal abuse, no breaks, twenty (20) minute lunches or even no lunches over a nine (9) hour day is not uncommon in the field. The Dentist may take breaks while assistants and front desk play catch up in check-ins and outs, cleanup, equipment maintenance and office prep between patients. Salaries are actually dropping in my area, while fees are going both up and down based on the typed of office.          


Since the financial crash in 2008, the market appears to be getting worse, based on how Dentists are operating their offices and treating their employees. Overall dental office revenues appear to be down, as are salaries being offered while working extended hours to offer expanded scheduling times to appease the needs of a lower number of clients. Large companies are buying up practices, adding specialists,  hiring the dentists to stay on and offering incentives based on the number of patients; hence a consolidation is occurring in the industry.      


There are basically three (3) types of dental practices primarily based on the socio-economic level of the clients and this appears to play a vital role in both how employees and clients are treated and most practices are limited to one to five dentists. There is the old fashion “fee for service” practice where people still basically pay either cash or through some sort of high quality dental insurance plan. These practices generally pay their employees more, receive higher fees and service clients in the higher socio-economic stratus. How well the employees are treated also plays a role in the different practices. Then there are the Managed Care offices providing clients that have HMO, PPO and Discounted dental plans. The lowest tear of the spectrum are those manage care offices that except Medicaid providing services to the poor and indigent.


Having worked in all three type offices, I’ve seen a lot. For instance in a Medicaid office, one Dentist anesthetized a patient one day that needed about 12- 15 teeth removed. He then left for a prolonged period of time, so long so that the patient wasn’t numb anymore.  I even told the doctor he needed more anesthesia, but he started extracting teeth anyway. The patient was screaming and sweating so much it literally turned my stomach, making me nauseated. Teeth were literally popping out and flying across the room while the patient screamed in agony . This dentist was so bad, in between patients, he spent much of his time texting on his mobile phone. A reminder that in life you really often do really get what you pay for. Under Medicaid, no dental services are provided other than extractions and dentures and people are choosing, because of the existing  pain, to extract teeth that could be repaired but do not have the money to do so. 


One dentist used a practice which I coined “create a crown”.  He would cut the cusps off a perfectly good tooth that really only need filing so he then could take an x-ray, as evidence that a more expensive crown was required. I didn’t stay with him very long because if you say anything you get fired.


One dentist tried to get me to adjust a final crown one day, which only dentist are legally allowed to do. Despite having never done one, because I had primarily worked in higher quality, fee for service offices, he told me to go ahead and do it anyway. I told him what if I were to mess it up. He said, quote “better you than me” and I said quote “no, better you than me”. I was fired within weeks.      


Don’t get me wrong, there are many really great dentists out there but a bunch of them obviously graduated in the lower 50% of the class. It appears that the state licensing and university accreditation system is surely not weeding out either the incompetent or the unethical, but it is driving up patient prices and placing pressure on lower wages.                  


Both Dentists and medical Doctors have long been recognized as poor business people, primarily because they went to school for medicine, not business. There business acumen surely plays a vital role in how they operate their practice but there also appears to be a dynamic amongst the dentists themselves affecting the industry . Endodontists, those who specialize in root canals, for instance, rely on general dentists to get clients via referrals. There are also those that are specialists in procedures such as implants and bone graphs that are really considered surgeries in today’s world which also rely on referrals as a primary source of the client base. In other words, dentists talk amongst themselves because of specialization within the industry and it appears that they have long been price fixing both their fees and employee wages as fees are going up and their employees salaries are going down. The sad part is they do not appear to care one iota, how their employees are supposed to survive with salaries that are not keeping pace with rising prices. None of them even appear to be willing to speak out against what is going on, perhaps for fear of being ridiculed by their pears. This however does not appear to be just a problem within the medical and dental industries, it is being reported throughout our entire socio-economic system. It appears that this is a systemic problem that unless solved is going to create an even deeper divide between the haves and have-nots which will eventually backfire on everyone.                     


Based on personal experiences, dentists appear currently to be trading experience and knowledge for money or should I say paying younger women with little or no experience less money in exchange for having to pay more experienced women more money. A business professional will tell you that in the long run, a more experienced and mature woman provides a higher return, even if you have to pay them more money for their services. Younger women are more subject to both missing more work and stay shorter periods on the job. The old adages relating to this issue are, you get what you pay for and being penny wise and pound foolish. 


Since the crash, all the years of experience, is no longer working in my favor. Prior to that, wages appeared to be barely keeping up with inflation, but they were at least getting higher year after year. Sadly to get raises, you almost had to quit one job and go to another. Apparently in even the good times, dentists do not really seem to value their employees.       


Even though I’m employed, my hours have now been cut. I went to an interview last night and they said they had interviewed 187 people already. They also want to  pay lower wages compared to the norm. I either have to take a huge cut with all my experience or starve. I recently applied online for a job and they wanted my picture and how much I wanted per hour, so…. now we have salary bidding wars!, There not even offering a wage, because they KNOW people are desperate for work and they may be able to get the lowest bidder.


Some people are fighting back. A friend sent his wife to Costa Rica for her dental needs and she came back with praise of both the quality and price. It’s sad to see so many Americans walking around with teeth missing and other needed dental work going undone.


If other countries can provide similar quality dental services at lower prices why can’t the U.S? We have a systemic problem and I believe it relates primarily to overly stringent licensure laws that prohibit both unlicensed practitioners from providing dental services but also requires inordinate amounts of so-called education, costing so much that it minimizes the number of people who can afford the schooling. We’ve made dentistry out to be this highly difficult practice when it is not, made the educational requirement extremely costly, created a costly bureaucracy to oversee the industry and all this has not provided the quality we deserve and it has limited the number of practitioners, causing prices many can't afford. Just like attorneys and doctors and why so many are calling for socialized medicine. You think socialized medicine will cure the many problems of our healthcare system, just go to a dental office that takes Medicaid for your dental needs, for an advance experience.
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