Why the Cost of Dentistry is so Expensive: “The rise of the machines” (I know I used this chapter title in the previous article, but it is perfect for the next segment)

As a society we are now dependent on technology and the machines that it has given rise to. We love our technology so much so that people who may not have money to spend on things necessary will spend money on the newest cell phone, iPad etc… But technology is not free, the latest profit making business models are all based on selling a product, then selling the services associated with it. The services are the hidden money makers for these technologies. So much so, manufactures will sell the product (hardware) for cheap or often give it away.         

The cell phone is the classic example, money is made on the phone itself, but the apps you purchase, the service plans, and all the accessories are the hidden costs. If you compare the expenses of a typical family in 1970   to a modern typical family you will see how the small but ubiquitous charges for a technology have raised the cost of living. The following is a off the cuff list of things we need to pay for yearly or monthly in our personal lives that the previous generation did not:

                Service or Revolving Monthly or Yearly Expenses

Cable

                                Internet Access

                                Cell phone

                                Netflix

                                Anti Virus plans

                                SiriusXM

               

                               

                Products that require constant upgrades and replacement to keep up with changes

                                Cell phones

                                Video Games

                                iPad, iPod

                                Computers, lap tops, wifi,

                                Software, upgrades (some require yearly contracts such as Quicken)

                               

 

Back to the cost of Dentistry…

 

                Even more so than in our personal lives, technology brings many added expenses to a dental practice. And, furthermore, unlike personal items where you can make a choice to indulge or not, in our field if you don’t keep up with technology you are considered (and probably so) an out-of-date dentist, and who wants to go to a dentist who is still practicing like it is 1970. Lets touch on some of the larger technology expense categories, keep in mind, I love most of these new products and what they can do, but I am demonstrating in this article why the cost of delivering dentistry (or medicine) has become so inflated in recent years.

                Digital X-rays:  a tremendous technology that improves diagnostic capabilities while reducing radiation exposure. We were one of the first practices to go completely paperless and digital x-rays were the icing on the cake. But the salesman marketed it as a cost saver when compared to traditional film x-rays. The argument was you didn’t have buy film x-rays, and the cost of developing them was gone. I’ve crunched the numbers and that just isn’t factual. First of all, the initial cost of a digital x-ray system includes upgrading your current computer system and expanding it to include coverage in each operatory that x-rays are needed. Then the costs of the sensors are about $6,000 each and they break occasionally. Of course there is a monthly service contract needed in case something goes wrong, because there is no way you can repair or figure out anything yourself on these products.   Digital x-rays take up a ton of memory so you need to large capacity servers to house all the files. And lastly they all need to be backed up, and when the backup file is so large you have to use an offsite back up company to ensure all your records are safe.$$$

Why the cost of Dentisty is so expensive: Chapter One “In Quest of Knowing”

               Humans want to know. Whatever the topic, we want more and more knowledge of it. This has been from the beginning of our time. The satisfaction of answering a question leads to an insatiable desire for more questions and answers. It feels good to learn. If you have young children in your house, the never ending “why, why, why..?” will usually result in the highly irritated response of “because it is” by the beleaguered parent. This is our nature.

              

In medicine and dentistry alike (you thought I may have forgotten the topic of this diatribe) the quest of knowing is no different and, in fact, its ostensibly moral and benevolent nature in seeking this information for the good of mankind does provide ample motivation for its continuance. In the hunt for cures and treatments to limit the suffering and death of our fellow men, we must make sure we leave no stone unturned and realize the potential of our intellect and abilities to solve the mysteries of biology, disease and health.

 

To start this journey sometime, during high school, someone with aspirations of becoming a doctor (from  here out I will focus on dentistry since that is the path I know well, but it is a similar one for a physician and other healthcare providers as well)  must start considering colleges. In order to get into a good dental school it helps to go to a good college, usually with a strong science curriculum.  All colleges are expensive and the better ones even more so. $$$ (every time you see  dollar signs I am trying to indicate without being overly repetitive the impact on the eventual cost on health care delivery our current system).

 

Ok, you are in your undergraduate school of choice and with the help of mom and dad, uncle Sam, banks, and loans $$$ you spend four years hard at work studying and graduate with excellent grades. Then you start looking into applying to dental schools. There are applications, entrance tests, visiting schools, buying a suit and going on interviews. $.

 

               With some luck you get into a great dental school. $$$. Spend four years studying and learning, yada, yada, yada.  You get the idea- education is expensive! But the knowledge our profession (as well as other fields of study i.e. physics, computer science, engineering) has grown to the point where even a four year graduate education is merely scratching the surface of what the collective information there exists. The student has the responsibility of learning and retaining this information to bring into the real world and use it to improve the life of our patients.

              

What a dentist needed to know in 1955 is probably 10 % of what a dentist graduating from dentals school in 2013 must know. For medicine it’s probably even more dramatic. Just think of what is available now just in the small subset of healthcare that is dentistry. Since 1955 we now have implants, cone beam (3D scans), rotary files for root canals, myriad of bonding adhesives, microscopes, cements and composite materials, Cad Cam (milling crowns and inlays by computer), bleaching, veneers, Invisalign, numerous types modern ceramics, computer records, digital x-rays, bone grafting, gum grafting, non surgical periodontal treatments (Arestin), Lasers for surgery, lasers for tooth preparation and periodontal treatment, digital imaging. I could probably fill a full page, so what does this mean? – Specialization $$$, Continuing Education beyond dental school $$$, staff and doctor training to use specialized equipment $$$.

 

Specialization was inevitable when the breadth our knowledge grew. But to be a specialist means additional years of schooling. $$$. When specialists do finally get out, they want to treat patients with all the latest and greatest things that they have learned. $$$. Even general dentists upon graduating are no longer really prepared to practice modern dentistry. What is taught in dental school provides the foundation for practicing dentistry. It is then the responsibility of young graduates to seek out post graduate training to really learn how to do procedures that patients want since they were unable to master in dental school. Implants are the perfect example; in most dental schools undergrads get very little practical experience with implants. Enrolling in an implant course $$, is just the beginning. To fully be proficient you must continually educate yourself and join groups or academies $$ that provide further information and support. The days of a dentist graduating from dental school and “hanging the shingle” are over. In fact now to get your license, graduating from an accredited dental school is not enough you must pass licensing tests and  do a one year post dental school program $$ before you can practice.

              

               All of the progress our profession has made in the advent of new technologies and understanding of pathology and the best ways to treat our patients requires a significant investment in time and money to fully grasp and integrate into our practices.  The end result is extraordinary advances in the profession that have the potential to change people’s lives. If you have ever seen a child with cleft lip, you know there is no way we cannot use every advancement we have to try and correct these malformations.  There are so many ways that all those technologies listed previously have made a difference in our quality of care, and there is no going back. But once again the progress trap comes into play, are we creating doctors that spend so much of their lives educating and training, and mounting huge financial debts, that when they come out to practice, the fees they need to charge for these advanced treatments are out of reach for the average person.  I’ll leave you with a dialogue I had not too long ago:

 

Patient- “you would think by now, you dentists would have come up with a way of giving someone back       their tooth by now”

              

Dentist –“we have – they’re called implants”

 

Patient- “I mean something that I can afford”

Why is Dentistry so Expensive?

“A long, long time ago,
I can still remember how that music used to make me smile.” – D. Mclean

                The first three questions I usually get asked when telling a patient they need some type of treatment or another are in order:

1.       Is it going to hurt?

2.       How much does it cost?

3.       Is it covered by my insurance?

Sometimes in the mix of question and answer is “Why is dentistry so expensive?” My point is - cost isa always a factor (as it should be!). But how did dentistry or healthcare costs, for that matter, rise at such a rate over the latter half of this past century?

                Society may be headed for a progress trap. Our dependence on technology grows at an overwhelming pace and the very benefits we seek from this technology could ultimately be our downfall. Just as a vast supply of inexpensive food made in part abundant by advances in farming, food preservation and mass production has led ironically to many problems they meant to solve those being obesity, nutritional issues and causal links disease related to some of the chemicals used in modern food production. This is just one example of a progress trap. Because the natural tendency to correct a progress is to solve it with more technology and so it goes around and around like the famous Penrose steps illustration.

                What does this have to do with the cost of dentistry? Well healthcare (dentistry included) is falling into a progress trap. The very goals of education, advances in treatment, advances in technology, advances in administration, the development of pharmaceuticals, insuring patients safety, protecting patients against malpractice and third party systems all directed toward improving the health of our patients is actually driving the cost up to such a degree that we can’t afford to be healthy. Hence a progress trap.

               

                In the next series of articles I will attempt to discuss how some of these technologies and progressions in how we administer health and dental care have evolved into the current conditions and the impact these have had on the economics we are now challenged with.