By Dr. Christine L. Kirchner

They may carry cheery names like Gentle Dental and Bright Now, but what actually happens in these corporate dental chains can lead to some very unhappy outcomes for their patients.

Former patients talk of painful care, high staff turnover, inferior treatment that needs to be repaired later, unnecessary procedures, and actual expenses well in excess of the promised fee.
I’m proud of the dental practice I’ve built here in West Seattle over the past 17 years. I recognize that visiting my office is not my patients’ favorite activity, but I also know that when I provide high quality care, I am rewarded with their loyalty. Most importantly, I understand that the best results always come when my patients and I work closely together and communicate honestly in developing a treatment plan that meets their needs.

But corporate chains frequently don’t let that sort of direct doctor-patient collaboration take place. Instead, they inject non-dentist corporate managers into the relationship.

Charged with the responsibility of meeting corporate profit goals, non-dentist managers routinely hire, supervise and evaluate licensed dentists on their ability to meet unrealistic production schedules that track patients like widgets in a factory. They can be responsible for choosing equipment and materials that directly impact dental procedures – and rewarded for cutting costs even if that means reducing quality. They’ve even been known to disregard the professional judgement of – and challenge treatment plans developed by – the licensed dentists working in their offices.

Corporate chain employment contracts, often offered to recent dental school graduates burdened with a heavy student debt load, can include incentives for pushing specific treatments like the indiscriminate prescription of sealants for everyone regardless of need, or referring patients to affiliated specialists without disclosing that relationship. Such incentives aren’t necessarily related to patient needs or the quality of care provided, but are designed to generate revenue and maximize profit – and exert control over the independence of the practicing dentist.

These corporate chains are already operating in our state, but they do so in a grey area. Department of Health oversight is limited to the individual dentists within the clinic, who often have little or no control over decisions directly impacting patient outcomes. The department has no authority to patrol the actions of the clinics themselves.

This current situation is bad enough, but corporate chains are now pushing legislation to give themselves virtually unlimited authority to operate here in Washington, while remaining completely free of regulatory oversight or patient protections.

I think that’s a bad idea, and my colleagues at the Washington State Dental Association agree. The state’s Dental Quality Assurance Commission thinks it’s a bad idea, too, and they’ve shared their concerns about non-dentists gaining influence over dental treatment and adversely impacting patient care. Even a June 2013 U.S. Senate report concluded that “profits are being placed ahead of patient care” in these offices.

So, the current situation is bad and the corporate chains’ proposal is worse. What would be better?

We need strong legislation that provides clear regulatory oversight and common-sense protections for patients. These include: forbidding corporate managers from interfering with a licensed dentist’s independent judgement on patient care; prohibiting corporations from linking dentists’ compensation to volume, revenue generation, referrals to affiliated specialists and other such arrangements currently used to exert control over their decisions; and establishing whistle-blower protections for anyone reporting violations.

There’s room for many different dental practice models. But all dental providers should be playing by a clear, fair and consistent set of rules – ones designed to put patient care in front of corporate profits.
Dr. Christine Kirchner is a licensed dentist who practices in West Seattle and a board member of the Washington State Dental Association, which represents more than 4200 dentists across the state.