ECONOMICGeneral economic pressures, many of which have been outlined in the February 2014 Ontario Dentist reported by Rose Abate as well as information in the R.K. House Report, may negatively affect future dental practices bear examination. According to Abate
•Our practices are operating in an uncertain economic environment that seem to put particular pressure on the middle class of our potential patient population, which is probably the backbone of many of our consistent patient base.
• Unfortunately, some of these people have already included dentistry on their list of discretionary expenses.
• Many job opportunities available to new entrants to the work force are not strongly oriented towards providing health benefits in general and dental care in particular.
• Many contemporary remedial dental procedures, by nature of their sophistication and complexity, require financial investments of some thousands of dollars that for many in this economy may be problematic.
• Conducting business in a practice within a typical dental office environment also poses additional financial burdens; for example, the cost of human resources, rental units, energy, increased equipment, and sundry expenses.
These factors put pressure on the office to provide ethical quality dentistry at a fee that allows people who need the health care to be able to access it financially.
With these factors in mind, dentists have a legitimate expectation to be able to earn a living commensurate with the educational and financial investment they made in their practices.
SOCIOLOGICAnother challenge is the sociologic pressure closely intertwined with economic pressure. Notwithstanding those of us who practice in a province that is growing in population, the growth is asymmetric. In other words, most of the growth is concentrated in major urban areas, such as the Greater Toronto Area. Often a significant portion of the increase is due to immigrant population. It is understandable that immigrants take time to integrate into mainstream society, and they are often “potential” patients. Finding a dentist is not the first priority for many who are newly arrived.
This group, therefore, is very important for the future growth and stability of any province. They are, for dentistry, often a “potential resource” to replace patients that have moved on.
Another sociologic factor we have discussed previously is the new consumerism that seems to be the current attitude of our younger patients’ perception of health care. For example, for this demographic, location, hours of operation, and customer service profile seem to have increasingly more sway with them than the reputation for competency. This leads to a propensity to demand appointment hours that fit most easily into their schedules, such as after work, hockey practice, dance, or other personal interests that create high demand for key hours leaving significant schedule openings in the middle of the day.
AETROGENICFinally, self-inflicted aetrogenic factors – those that cause harm – are becoming more apparent. Most recognizable are the following examples:
• Advertising initiatives displaying questionable taste and reduce dental procedures to the status of commodities. Such advertisements do little to enhance the value perception of dental services; for instance, goofy tooth and brush logos tend to infantilize the sophisticated health care facilities that most dental offices represent.
• Featuring Invisalign bracing on the Internet as special purchases on sites such as Dealfind and Living Social.
• Radio and TV spots that offer special reduction for seniors. Based on the assumption that they do not contravene our Royal College of Dental Surgeons’ regulations, they certainly contribute negatively to conflating dentistry with costs leaving out the health benefits dentistry offers.
The concepts of attempting to lure new patients into our premises by any means possible and then attempting to convert them into knowledgeable, appreciative recipients of our care is a bridge too far. One has only to follow the path that retail pharmacy has been on to see professionalism relegated to a small part of a very large entity.
All is not doom and gloom. Identifying the problems leads to possible solutions we will address in a future edition with suggested measures to assist in maintaining dentistry’s well-earned professional profile and allowing more of us to be proud of our achievements and practices.