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    Why organized dentistry needs to change in order to survive

    Big changes are happening in dentistry, and organized dentistry needs to accept the future.


    These forces are becoming more and more potent, growing in strength and exerting a greater impact on dentistry. Using the metaphor of a hurricane, the eye of the hurricane is the profound shift in context - from small business to big business. The surrounding eyewall of the hurricane is the tremendous influx of venture capital and consolidators, pushing forward the exponential growth of DSOs. The rainbands of the hurricane are horizontal integration, vertical integration, artificial intelligence, robotics, cloud computing, Big Data, electronic patient record, and genomics. And, this hurricane is moving from a Category 3 to a Category 4.

    Other rainbands of the hurricane are lack of access to 47 percent of the population, direct connection to systemic diseases, dentistry becoming more and more seen as part of primary care, demand for midlevel providers, dental therapists, and a major shift in reimbursement from the fee-for-service model to the pay-for-performance model.

    The very outer rainbands are the dental lobbyists from organizations such as the ADSO, talking to Congress about dentists in solo practice and their protectorate of organized dentistry. Implicit in the lobbyist's conversation is solo practice as a monopoly in dental practice. The lobbyists will argue that organized dentistry and their members are trying to control dentistry and are therefore preventing better costs and greater access by limiting competition. All this is occurring over the warmer waters of limited access and high costs of health care, creating this Category 4 hurricane.

    More from the author: The one question dentists need to ask about DSOs

    What organized dentistry ought to consider is rather than trying to preserve the past of highly fragmented solo practices, trying to prepare its members for the new future. That future clearly will be managed group practice.

    Complaining, faulting and blaming have no power. Condemning, criticizing and accusing have no power. Wake up organized dentistry — you can’t stop the future. The strategy in your states, trying to stop DSOs from entering your borders, is crumbling. Take a look at what happened in Washington state. Attempting to exert onerous state control over DSOs as a strategy to prevent managed group practices/DSOs from coming into your state will not simply hold up.

    DSOs have the leadership, money and “smarts” to create the conditions that can fully adapt to the changes outside forces are producing, whereas solo practices cannot. The train has left the station. The future is going to happen regardless of how organized dentistry feels about it. The context has shifted.

    My recommendation to organized dentistry is to get on board. Educate your members. Create pathways for them to succeed in this new future. The past is quickly eroding as the new future emerges. If you’re not helping make it right, then stop complaining about it being wrong. If you are refusing to light any candles, don’t complain about being in the dark. If organized dentistry cannot adapt to the changes caused by these continuously increasing forces and assist their members to succeed in this new future, then they will eventually lose power and go out of existence.

    Organizations who stay relevant stay in existence. Organizations that don’t stay relevant go out of existence. What remains relevant is always context dependent. Look what happened to unions when they stopped being relevant for their members. The writing is on the wall for organized dentistry — change or perish.

    Dr. Marc Cooper
    Dr. Cooper's professional career includes private periodontist, academician, researcher, teacher, practice management consultant, ...


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