Editor's note: This article originally appeared as a letter to the editor in the November-December 2015 issue of Apex360. Click here to access the digital edition.
October 1, 2015
Dear Mr. Kulsrud:
I have just read Mr. Shea's article on corporate dentistry ("Corporate dentistry—Is this really what we want?", September-October Apex360) and feel qualified to respond as I am now a "corporate dentist." My experience is far different than what Mr. Shea describes. I will respond specifically to his assertions. I would also like to provide some perspective, the perspective of someone who has been in practice for 33 years, 30 years of which were prior to my affiliation with a corporation.
As someone who has been in practice before, during, and after the onslaught of DMOs (dental maintenance organizations) and PPOs (preferred provider organizations), I have witnessed the changes that have occurred in dentistry, particularly in remuneration. I could bore you with the details, but suffice to say the new economic model of medicine has more than arrived. While the fee-for-service model is alive and well in dentistry, that fee is determined predominantly by insurance companies. Furthermore, that fee tends to be stagnant over several years. All the while, costs increase. Therefore, cost containment becomes paramount. For my practice, despite my best efforts, costs continued to rise as a single practice only has so much buying power, whether that is for supplies or lab expenses. The same is true for practically all expenses. Larger entities can buy for less, simple as that. Meanwhile, insurance patients, PPO patients in particular, have grown exponentially, taking over the patient populations of most practices. The net result is flattening revenues, increasing costs, and reduced net profit. Less money becomes available for continuing education, purchasing new equipment, and marketing. Thus it becomes more difficult to innovate and maintain the doctor's income.
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I affiliated with Heartland three years ago, and I can honestly say none of Mr. Shea's complaints are remotely applicable.
Fact: I sold my practice for more than I would have received from a potential buyer and was paid in cash! I did not finance any of the sale price. As I did not desire to retire, I have continued to work in my practice. Yes, I said "my practice," because it is my practice with my team-the team I have worked with for many years seeing my patients in my office.
Fact: I am not paid less. I just do less. Now the overwhelming majority of my time is spent with patients. Do I have some management responsibilities? Yes, I do. But it is mostly responsibility any supervisor of people would have. I don't pay bills, deal with IT issues, or manage payroll, benefits, or human resource issues. I used to spend probably between eight and 15 hours per week dealing with non-patient-related issues. That is no longer true. The fact is, my income has not suffered. Of course, I no longer have the tax perks of private practice, but I don't have the stress either. To me, that is worth more than money.
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Fact: I have not lost control of my practice. No one tells me how to practice, but I do avail myself of training, marketing, and a great and powerful company that is able to control expenses at levels no individual practice can possibly dream of obtaining. Consequently, we are busier, more productive, and more profitable than ever before.
Fact: To Mr. Shea, I would say this is American free enterprise. The simple truth is that the smaller you are, the more likely you will be trampled by the assembly of governmental regulation, insurance headaches, and the daily grind that comes with being a small business owner. I did not affiliate lightly; I looked at the landscape of dentistry and my own life, and I made my decision with open eyes. It has been three years since that decision, and I am going nowhere. In short, I do not regret or have second thoughts about affiliating with Heartland. Perhaps Mr. Shea is correct about other companies and how they interact with the doctors and practices they acquire, but that simply is not my experience.
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One last point: Dentists are coming out of dental school with debts of $200,000, $300,000, or more. It takes that much or more to purchase a practice. Where and how are these graduates going to obtain the funds to pay their debts, much less purchase a practice or build one from scratch? Heartland provides a welcome home for those graduates, providing support and training and, most importantly, an income to allow them to live and grow without the expense of setting up their own practices.
Having been on both sides, I can honestly say, at least for me and my experience at Heartland, Mr. Shea's claims are factually untrue. It serves no one's interest to paint a segment of our industry with the same brush. Furthermore, facts are stubborn things. The fact is, practicing today is harder than it was 25 years ago, and I see no signs of any return to the "good old days." For most of us, those good old days when we could charge what we wanted are over. Frankly, Heartland represents the future, and Mr. Shea speaks of a system that either no longer exists or is much smaller than it once was.
Sincerely,
Richard J. Reinitz, DDS, MBA, FAGD
Pearland, Texas
