On January 21, 2005 at 10:07:50 AM 'sfjdds' posted....
Jawbreaker,
Mauty may be a great guy, I've never met him, but I judge him based on what he writes. Let me tell you a little story so you know where I'm coming from.
When I graduated in 2000 I went to Phoenix to work for one of the big HMO dental companies. I was wet behind the ears and niave to the ways of the real world outside of school. I held dentists and dentistry in high reguard. My instructors in school where mostly ex-military and were top notch honest guys. So I go to AZ and enter a whole different world. In a little over a year I worked in 7 offices. (Sometimes I was a temp for someone on vacation). So I saw a lot and met a lot of dentists. I also had 3 friends from school who were doing basically the same thing I was so I heard their experiences to. HMO dentistry was extremely aggressive and dishonest. Yes it is true that SOME of the patients who have HMO dental insurance would not be able to afford standard UCR fees. The problem is that we had numerous, in fact I would say the majority of our patients could have afforded UCR fees. My first office was in Scottsdale. There's a bit of money there! The main problem I have with HMOs is that in the minds of patients they don't know that there is a huge difference from traditional or even PPO plans. And they don't know that the type of care that is economically feasible in these systems is radically different from traditional plans. THE PATIENTS DON'T KNOW WHAT THEY ARE GETTING! It's sold to them by their employers as "Insurance". Let me give you some examples of what I saw. A few of the dentists I met had a no 3 surface filling rule. If it went to 3 surfaces it was a crown. I learned the terms "prophylactically crowned or root canaled tooth". And that was said with a wink and a grin. I listed to dentists brag about how many crowns they cut. I saw competitions between 2 dentists at one office to see who could cut the most crowns in a month. Most guys were paid of percentage of production. So if you were going to get 30% of $38 for a 3 surface filling, or 30% of a $380 crown and $40 BU.............well now that's a tough one????? Did the patient get his/her tooth fixed....yep..... did they generally get the best care....... no........... did they know what was going on........HELL NO! They still trust us! What idiots! I knew of guys right out of school making $200K + their first year in these systems. They were crowning more teeth than you can possibly imagine. I remember temping at a office and sat down with this old guy to crown #13. It had a MO amalgam in it that looked to have been placed withing the last 5yrs. TX plan. BU and crown. I asked the guy if this tooth had been bothering him.....no....."Dr. so and so said I need a crown" . No decay. No fracture. No pain. Slow day.....crown it! It made me sick. Now if your thinking I'm exaggerating....I'm only giving you the tip.
Then there is the speed factor. I have never claimed to be fast at dentistry.... infact I'm probably on the slow side. But it gets to a point in which quality suffers as speed increases. Most of these offices had me and my friends seeing 40 to 50 people a day. One of my bosses gave me a time alotment for procedures. 5 min for a prophy. 15 min for a crown. 30 min for RCT. Ect ect..... You were done when the clock told you you were done. Quality, details, who cares! (I have read Mauty post that "we need to stop worrying about the little details that slow us down") I had a flash back to the type of dentistry I was seeing.....short fill endos, sloppy crown preps with undetectable sub g feather edge 2 second margins, overhangs all over the place. I not saying that my dentistry is perfect. It can happen to anyone. But under this system..... it's too frequent and people don't care. I didn't fit in and finally found a little office run by a great family in which I treated kids who were in shelters and care of the state. They let me run at my own pace and I loved it there.
What upsets me is that I believe that ADA knows what is going on and yet they do nothing about it. See HMOs cut fees so low that dentists are forced to be super aggressive in order to make money. So when I hear Mauty talk about how much he makes I know what is going on.... I've been there. The ADA can't come out and say what really happens in HMO offices because that will impugn the dentists that work there and give the profession a black eye. I would have no problem with HMO dentistry if it was only sold for what it is and that patients knew that the type of treatment that is available to them is different from other patients. In our offices we knew if someone wasn't an HMO patient and treatment changed accordingly.
I do have some funny HMO stories like the lady that was left waiting in a chair for over 3 hrs. They forgot about her and were getting ready to leave until they heard her call out as they turned the lights off! Could that ever happen in your office??
I come from a lower to middle class family and I know how expensive dentistry can be. I have a Cerec but my fees compared to a recent national poll were in the low 25%. My Cerec has sat dormant for the last two weeks. I don't manufacture a need for it. It's used when I think it's appropriate. Yesterday I had one scheduled but after prepping it I felt a PFM would be a better choice. The machine was turned off and out came the impression material. It's calming to cut a crown prep.
Mauty hits a live wire with me. I just don't see the need to bash. Funny is once or twice....but continually.... oh ya.... his view of Cerec brings us all back to proper perspective and makes us realize that we don't need evey gadget to do good dentistry?????
Cerec let's you do things that can't be done in any other way. There is now way to restore severly broken down teeth in a more conservitive manner. Cerec uses know what I'm saying. It's all in the prep. You can do onlays on teeth with big amalgams and you don't have to flare the preps. Even if you used lab fabricated onlays in your practice in many situations you have to cut a lot more tooth structure away. It's a great technology and if it fits your practice style and philosophy then great... it not..... that is great too.
Anyway, I need to go do something with my day off. It's been fun. Mauty....if you're out there.... I hope have a good day too.
An interesting perspective on HMO dentistry and the Cerec 3D. I disagree with him on the fact that the Cerec 3D is a more conservative manner of restoring teeth than laboratory fabricated restorations. Those are simply not the facts and I wish he would support his argument with some evidence based papers.
With regards to the American Dental Association vis a vis dental HMO's they know about this now and so do the patients!
Mauty? He can take care of himself!
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