Do patients get a fair deal from corporate dentistry? A note for the public!

The next time you step into a plush, well advertised, branded dental clinic that is part of a large chain, remember that you need to be cautious. You are entering a business centre not a health facility! I am not for a second suggesting that traditional dental clinics are altruistic establishments that render free treatment. But there is a vast difference between the ethos practiced in the well advertised branded corporate clinics and the traditional practices that you visited as a child two decades ago.The former is obviously based on questionable business models where success is measured in financial returns whereas the latter is an enduring example of a more flexible system of 'payment for services'. In other words a patient seeking treatment in a branded corporate clinic is not only paying for the dentist's services but also for the huge profits of the corporate company. 

The new genre of clinics may seem to sync with the ambiance of the swanky malls and eateries in metro centers. The question is whether you want to place your health in the hands of a business group that hires and fires it's nameless professionals or with the permanent neighborhood dentist who has serviced your community and who is answerable to his/her clients.

Of significant concern is the fact that these corporate houses peddling treatment with enticing offers, including dinners at the local restaurant, are involved in a practice that is forbidden by law. It is another matter that they are run by powerful businessmen rather than qualified dentists.

A quick glance through the practice guidelines laid down in the Dentist Act of  1948 , section 51 (1), unambiguously states that 'the profession of dentistry shall not be carried out by a company or corporate body'. It makes a small exception in 51(2) which permits a company to practice dentistry provided such company 'carries on no business other than dentistry or some ancillary business.......and if the majority of directors and all operating staffs are registered dentists'. It is obvious from the above statute that the intention of such a clause was to keep out  cloth merchants, goldsmiths and other business speculators from dabbling in health and profiteering from it. 

Ironically this provision has been grossly violated.

Let us take a look at some of the popular corporate houses. One of them runs a chain of medical shops and ophthalmic clinics and has ventured out into the establishment of chain dental clinics . They are explicitly prohibited from doing so because they are not dentists. The majority of directors in these companies are also not dentists as can be gleaned from their memorandum of articles. The irony of the whole business is that the CEO of one such company is a retired dentist who was once the Vice President of the Dental Council of India, the body that framed these rules. A decent retirement job indeed!

Another corporate company that runs tens of dental clinics in Karnataka is the founder chairman of a famous heart hospital that dabbles in chain dental clinics as a side business. The celebrated cardiac surgeon is also touted as the Henry Ford of Indian medicine for having created assembly line treatment ( like cars). I would have cringed at such a sobriquet. Are you happy to be put into an assembly line for your health needs? Both these organizations have been formed illegally and practice unethical methods to entice patients with shameful promises of free dinners and special offers as if your dental health was a packet of soap powder you bought at the local super market- Buy one get one free!The specific violations are section 51 of the Dentist Act and section 6(c), (d), (e), (f) etc of the code of ethics regulation. 

The question now is whether you would be happy to actually submit yourself to an establishment or persons who knowingly violates the law of the land and the ethical standards laid down by the government. What would prevent them from fleecing you. It is good to remember that anyone who offers you more than dental treatment for a fair price has something sinister up their sleeves.  Ingenious advertisement lines like 'we care', crafted by expensive advertisement agencies are only cosmetic and meant to give the impression that the humble private practitioner 'does not care'!

So how is the public affected by this new phenomenon?

1. Direct or surrogate advertisements running into crores of rupees are put out by these corporations, thus creating brand names. Despite being illegal they keep the law at length through their political and financial power. In a highly consumer driven society the patients are fooled by their tall claims. In the absence of a level playing field the traditional private practitioner and the neighborhood family dentist is slowly being wiped out.

2. Corporate dental clinics are run on tight business models and the doctors are under constant pressure to meet financial targets. These are supervised by non medical administrative staff to keep the till ringing all day. If you have wondered why you have been asked to take an OPG (a large full mouth X Ray) even before you mention your problem, remember that it is the first step in springing all kind of surprises on you, including real and fictitious treatment plans that involve eye popping estimates. They have regular meetings to take stock of their incomes and strategies to increase per patient income.

3. Most patients do not realize that in a corporate clinic you are not just paying your dentist for treatment. You are paying for the frills, the advertisements, the salaries of a bevy of non medical public relationship officers, marketing managers and administrative staff and a large profit that the company declares every year.

4.  All this would have been fine if you were getting the best doctors. Have you ever wondered why a dentist would work for a pittance of a salary if he/she was really talented?Except a few good dentists, most of the professionals are raw graduates with little experience, who are biding their time until a better opportunity comes their way. Take a look at the attrition rate in these clinics and you will realize the truth.

So the next time you step into a corporate clinic, remember that you are paying for all that empty glitz and glamour. In fact, you are paying for the reason you are there- clever marketing! Go back to your family dentist to whom you will be paying a fair fee for your services!