Mapping dental establishments in New York State just before the recession.

Census Bureau data indicate a continuing increase in the number and size of dental establishments in the period just prior the recent recession. During this same period, the combination of a relatively limited increase of the population in New York State and increasing numbers of dentists and dental establishments resulted in decreases in population ratios, particularly in New York City. The usual favorable expectations of an economic upswing after a recession for dental establishments may need to be tempered given these developments.

Determinants of general dentists' decisions to accept capitation payment: a conceptual model and empirical estimates.

BACKGROUND: Shifts in payment options for dental care over several decades have resulted in more dental expenditures being paid through health maintenance organizations (HMOs), preferred provider organizations (PPOs), and capitation arrangements. Patients' and employers' choices to participate in these arrangements is determined in part by dentists' willingness to participate in plans, and plan choices may be influenced by patient satisfaction, self-reported oral health, and/or quality or cost of care. OBJECTIVES: This study examined determinants of dentists' decisions to accept capitation payment for services. RESEARCH DESIGN: Cross-sectional mail survey in December 2006. SUBJECTS: 1605 general dentists in Oregon. MEASURES: Questions addressed dentists' perceptions of the importance of control over various practice parameters, willingness to accept capitation payment, employment or ownership status within the practice, and practice characteristics. RESULTS: Capitation was accepted by 22.6% of the respondent dentists (n = 729). Reported average fees (2007 dollars) ranged from $60 (initial oral examination) to approximately $800 (porcelain crowns). The likelihood of accepting capitation payment was related to the number of dentists in the practice, but surprisingly owner-dentists were no less likely than employee-dentists (associates) to accept capitation. As expected, dentists' usual and customary fees were negatively associated with accepting capitation. In contrast, measures of dentists' importance of control were not related to decisions about capitation. Longer average appointment delays were related to acceptance of capitation, but the effects were small. CONCLUSIONS: Dentists' behavior regarding payment acceptance is generally consistent with microeconomic theory of provider behavior. Study findings should inform practitioners, plan managers, and researchers in examining dentist payment decisions.

Evaluating a dental practice for purchase or associateship.

Private dental practice can be achieved through either outright ownership or an associateship in conjunction with senior dentists; the decision depends on personal and professional objectives and goals. Once a decision is made, the time and effort required to identify an appropriate practice, negotiate the terms of purchase or associateship, and transition to the new practice can be daunting. This article reviews the process and provides an overview of the general steps involved in the evaluation of a dental practice for purchase or associateship. With appropriate knowledge and preparation, due diligence, and ethical and sensitive behavior, transitioning to private practice can be successful and lead to professional and personal fulfillment.

How to plan a successful associateship and practice transition.

Once doctors decide to plan and form an associateship, the general process of advertising, recruiting, interviewing, and accepting an associate is important. Here we illustrate the process in three phases. We concluded that not only must the doctors be willing to devote a great deal of time and effort to building the practice but even greater time and effort into building and nurturing the associateship.

Commercialization of dental education: have we gone too far?

Early U.S. dental training involved a closer relationship between commercialism and education, which was strongly counteracted by university affiliations at the beginning of the twentieth century. With recent decreases in public support for higher education, schools have become increasingly dependent on private revenue sources, including corporate support. There are ethical risks as well as benefits from dental schools establishing business partnerships with corporations. In 2002, a private, for-profit company was responsible for the inception and direct funding of an orthodontic postgraduate program at a private U.S. university. In the last four years, this company has begun funding two additional orthodontic programs, both associated with U.S. public dental schools. Such partnerships with academic institutions represent unique corporate relationships with dental education that are fraught with ethical risks. The dental profession needs to preserve the appropriate autonomy of dental education from commercial influences in order to prevent erosion of academic and ethical standards that are critical to professional integrity and public trust.

Sharing the burden.

Expense sharing arrangements are extremely beneficial to dentists and not just in a financial sense. They can be easy to organise and administer, but must be based on a proper written legal agreement.

Negotiating a fair compensation package.

At the end of the day, compensation packages must be fair for both you and your employer. Employers should conduct an economic analysis to determine what they can afford to offer and calculate the economic return that they should rightfully receive. Understanding the employer's side of the equation is equally important in developing a win/win compensation package for yourself.