Upskilling for the good times
In poor economic times, when discretionary spending is reduced, entrepreneurial dentists take the opportunity to upskill and diversify. If you believe the marketing, courses to get up to speed on orthodontic or prosthodontic skills, such as installing crowns, bridges, implants and braces, can take just a few days.
Meanwhile, referrals to specialist prosthodontists are drying up, with general dentists taking on more of this work, as well as difficult extractions they may have referred on. By and large, general dentists do a good job and many dentists will recognise when a job’s beyond them. But when it goes pear-shaped, specialists – who undertake three years’ further training – are left to fix up any problems that arise.
Other popular courses teach how to improve their profitability – in part by making clients say “yes” more often. In recognising that people resist sales pressure, these courses help dentists phrase their treatment proposals in such a way that patients view their condition as one that must be treated rather than simply could be treated.
One of the initial questionnaires a dentist asked our shadow shopper to fill in had multiple-choice questions such as: “When would you like the treatment to be done? Before problems arise; when it’s worsening; or, after the problem occurs.” And, “How healthy would you like your teeth be? As healthy as they can be; as healthy as they can be; or, as healthy as they can be.”
This line of questioning helps shape expectations, perhaps making you more responsive to suggested treatment plans – which are supposedly in the best interests of your health. The same dentist charged $240 for the consultation with X-rays and recommended more than $1000 of treatment considered unnecessary by our independent experts.
Feeding from the government honey pot
Poor oral health is often a manifestation of deeper health issues, and vice versa. So dentists will usually try to get a complete medical history from patients to determine underlying concerns or conditions.
Under current Medicare arrangements, patients with certain chronic medical conditions, including asthma, cancer, diabetes, cardiovascular disease, mental illness and arthritis, can claim up to $4250 of Medicare-funded dental treatment, including fillings, crowns, bridges and dentures.
However, there have been reports of dentists giving eligible patients substandard work, or treating easily fixed problems instead of more urgent but difficult ones. There are also reports of patients who aren't eligible receiving Medicare-funded treatment. So we became suspicious when one of our shadow shop dentists spent an inordinate amount of time extracting an extremely detailed medical history from her.
The interview asked about family history of heart disease and whether any relatives – parents, aunts and uncles – had missing teeth, and if so which teeth. He asked if she slept well, and when she admitted sometimes waking up tired after having children, he suggested she might have sleep apnoea and he'd recommend a specialist. And so on. Was there an ulterior motive to this intense questioning? We can’t say, but patients should certainly be alert to potential abuse of the system.