Consumer Focused Health

You couldn’t paint a different picture for primary care providers than what is happening to colleagues on the dental side of the business (see NYTimes article). Trained better on the business front, the dental picture is evolving significantly different than for primary care– fees are rising, work hours are declining, and competition is decreasing as practicing dentist levels are flat despite an increasing population.

Dental fees have risen much faster than inflation. In real dollars, the cost of the average dental procedure rose 25 percent from 1996 to 2004. The average American adult patient now spends roughly $600 annually on dental care, with insurance picking up about half the tab.

Dentists’ incomes have grown faster than that of the typical American and the incomes of medical doctors. Formerly poor relations to physicians, American dentists in general practice made an average salary of $185,000 in 2004, the most recent data available. That figure is similar to what non-specialist doctors make, but dentists work far fewer hours. Dental surgeons and orthodontists average more than $300,000 annually.

As dentists have decided to stop accepting Medicaid, and without a Medicare program, dental fees have risen, and people have been willing to pay. With that increase in fees however, some have been left behind:

Previously unreleased figures from the Centers for Disease Control and Prevention show that in 2003 and 2004, the most recent years with data available, 27 percent of children and 29 percent of adults had cavities going untreated. The level of untreated decay was the highest since the late 1980s and significantly higher than that found in a survey from 1999 to 2002.

Despite the rise in dental problems, state boards of dentists and the American Dental Association, the main lobbying group for dentists, have fought efforts to use dental hygienists and other non-dentists to provide basic care to people who do not have access to dentists.

I take 2 things away from this article:
1) Primary care physicians of this generation (as we have decreased the number of practicioners) will likely start excluding Medicaid and Medicare patients from their panels as private rates and cash payment continue to distance themselves from government reimbursement
2) As dentists leave low income patients behind, lower cost substitutes (analogous to nurse practicioners in retail/convenient care clinics) will move into the void, regardless of what the ADA wants to do to maintain its monopoly status