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The Pros and Cons of Big Vs. Small Dentistry

If you look at Wal-Mart vs. the little shoe shop on the corner you will begin to understand the Dental-Dentist-RDH-Hygienedifferences between big care and little care.

When I was younger, my parents owned a shoe store. It is where I learned how to treat customers and serve others. During my high school years, the big box stores started to open in our small town. The leveraged pricing abilities of big stores versus little stores made it difficult for the ‘little guys’ to compete, and it still does. My parents ultimately decided to close down their legacy shoe store. People wanted to pay less for their products and were willing to trade personalized attention for a more en masse approach. Things change, and so must we.

Corporate Leverage

I imagine large dental companies  probably drool over the thoughts of selling multiple equipment packages to ‘big’ customers making decisions about several, if not hundreds of practices, rather than laboring over one dentist in one town. Who wouldn’t want to offer these bigger companies larger discounts and special deals on bulk orders? It makes fiscal sense. So, I really can’t blame dental product companies for wanting to make the sale and offer better deals to the corporate dealers in dentistry. Small practices likely will not get as good of a deal and will have to find alternative ways to cover their costs.

In dentistry, I think there is a need for corporate dental offices, just like in any business field. There are financial entry points for each need: typically low, medium, and high entrance points. People need to have options depending on their wages and financial abilities. I believe more corporate dental settings are currently serving the lower and middle level of needs, and that is needed. They are not viewed as boutique or small because of the chain style organizational structure. In the future, they may serve higher end clients as well. No one really knows for sure yet.

Corporate Care

When I worked in a corporate setting in Northern Michigan, I was happy to have the extra day of work, and I was happy to serve a Medicaid population in need of care. I also enjoyed the ease of walking away at night knowing I was not responsible for any management decisions. I had a great dental director, and I believe he really cared about people. Those were the pros. The cons centered around my freedom of choice abilities.

I did not appreciate working with people with different goals and aspirations than mine. I had little control over whom I worked with. I also had little control over the types of materials used or instruments available. Money was always a factor and staying within a budget meant little room for ‘extras’. I even knew I could have asked for some of these things, but the overarching theme of keeping costs down made me try and minimize my own needs. I had a sense of scarcity when I worked there.

Seeing patients in need and doing dentistry within Medicaid reimbursement guidelines made me feel like I was doing ‘the best I could’ with what I had to work with. The patients were gracious, and we did do the best we could for them within their insurance limitations and within our means, but it always felt like it wasn’t enough.

The restrictive nature of these patients’ insurance plans made me feel restricted as well. I did not like telling them there were other options, but their insurance plans would not cover them. These people did not have any other choice; they went with what their insurance plans covered. There was little freedom of choice for them either. Truly, something was better than nothing, and I felt good about being a choice rather than no choice. That part was fulfilling.

Insurance Baggage

When dentists must work within insurance confines, a cost/benefit analysis must be completed. The less reimbursement, the more something has to give. It might be time in the chair for patients, materials used, the number of supporting staff on hand, or financial remuneration.

Many large corporate practices take PPO level reimbursement or Medicaid level reimbursement, so they must work out their cost/benefit situation as well. To be fair, so do some lone-standing dental offices. Dealing with insurance qualifications is not something most boutique types of practices have to consider with such magnitude. And, the less insurance limitations, the less clauses to inspect, and the less worry of the next reimbursement rate decrease, the more freedom dentists have to focus on patient care and skill development.

Whether practicing in a corporate setting or a smaller, boutique setting, it is important to recognize the limiting factors in each type of practice.

Each dentist must decide what is most important when it comes to his or her financial comfort, stress level, well-being, and lifestyle. Big and small dentistry is out there today, and there are big and small patient needs. Dentists and professionals may work in both types of practices during their careers for a variety of reasons that fit their needs at different points in their lives.

My Advice

In both big and small dentistry, I see good and bad outcomes. Having a guide or mentor throughout the process is very helpful. As options change, more perspectives are helpful. Read contracts carefully and have an escape clause in whatever direction your calling takes you. I know a smaller dental practice, like my parents small shoe shop, offers unsurpassed relationship building opportunities; I don’t think all corporate settings offer this yet. Some corporate settings offer more of a business feel versus a ‘mom and pop’ feel. Depending on what you want, the business of dentistry offers more options than ever before. It’s hard to lump all corporate or large group practices into one category just as much as it’s difficult to put all small, solo practices into one category. Each dentist is different and will approach his or her environment differently, be it large or small. Unfortunately, it’s hard to know what you will like or won’t like about a place until you are there for a while. Then it becomes apparent. That’s why you need the escape clause.

Big Greed and Small Greed

Regardless of size, the worst outcomes I have witnessed stem from a dentist’s or corporation’s desire for higher and higher profits with little regard for patient care. If a small practice or a large corporate practice begins to compromise patient care with slick marketing techniques or overly aggressive sales techniques based on bonus after bonus opportunity, it may be time to consider another place to practice before your oath to “do no harm” becomes blurred. When a better financial outcome becomes more important than a better patient outcome, it’s time to re-evaluate your situation. There must be a balance between patient care and the business side of dentistry. And a tie always goes to the patient.


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