Dr. McBride talks about the different “Tiers” within the dental profession

(continued) “Tiers” within the dental profession:

And so, it has come to a point where a dental practice is defined based upon how it chooses to deal with these realities. Let me offer you these definitions. We now see the development of three definite modes, or “tiers” within the dental profession, which exist based upon the viewpoint of the dentist and his/her basic values

Tier 1 – This is the dentist who is basically “putting out fires,” seeing patients who just want to get out of pain through having teeth removed, or basic “patch and repair.” These dental practices are heavily based upon insurance company policy, and the patient may be treated by several dentists who have little time for interaction or teaching. I would say that I practiced this type of dentistry in the earliest stages of my career after I graduated from dental school

Tier 2 – This type of dentist is also very common. This is the dentist who primarily is a “fixer,” perhaps even touting “cosmetic dentistry” to attract new patients. They may educate the value of having good dental repair, having teeth cleanings regularly, and a “perfect smile,” but don’t take it much further, as they are also influenced by insurance company policy that has more to do with its bottom line than the health of its enrollees (patients). I confess that I passed through this mode of dentistry as well. Within this mode I discovered that there was little time to teach and provide high quality services, as the insurance companies were in essence dictating how much time I should spend with my patients. I eventually had to get out of that mode, as I felt that the regulation of my dental practice based on insurance company policy was a disservice to my patients and conflicted with my sense of ethics.

Tier 3 – This is the dentist who practices “Health-Centered Dentistry,” to which I aspire. It views dentistry from wellness and learning rather than just treating the results of disease. I made a decision in the years after dental school to search for more educational experiences that looked at the “bigger picture” of the connection between dental health and general health. During this learning evolution, it became more and more apparent that each patient is unique, with individual needs. A health-centered approach was what naturally followed this ongoing learning process. I now take the time with each patient to delve further into diagnosing their dental needs, and thus provide a wider range of preventive and treatment services. This interactive process is very important because it facilitates the development of trust. As indicated, trust is of paramount importance in the healing professions, especially dentistry. Many patients who have described past negative dental experiences to me say that the dentist spent little or no time with them from the beginning, which resulted in rushed diagnosis and uncomfortable and/or poor treatment. Trust was not given a chance to develop, so the patient eventually learned to avoid going to the dentist altogether, until their pain finally outweighed their fear. This negative experience is completely avoidable, and I have learned that the uniqueness of each person demands that they cannot just be put into “time slots” to fill appointment times on my schedule. Excellent dental service can only occur where quality becomes the constant, and time the variable, not the other way around.

I have noticed that only a few of the dentists out there have “taken the leap” and moved on to the Tier 3, health-centered mode. This is probably due to a combination of the above-mentioned factors. The tough question for me was, “How can I exist and be nurtured through really helping people if they only relate dental fees to things being “fixed?” Will they pay for relationship building time, data collection and diagnostic procedures not covered by dental insurance?” It was difficult and risky for me to all of a sudden change my office, staff and systems into a Tier 3 practice, so I tried to ease into a Tier 3 mode while still practicing Tier 2. The question then became, “How would I manage in one facility, two distinctly different modes of dentistry?” I discovered the futility in attempting to “serve two masters” by providing both Tier 2 and Tier 3 care under the same roof. I tried for some time to “dance to two tunes,” but discovered that it didn’t work. I have seen other dentists try this and fail. I still don’t know of any dental practice in which these two tiers co-exist successfully. I have discovered that if I wanted my patients to benefit as I have through the knowledge I have gained, I must cherish, and therefore allot the time necessary for my patients to realize these benefits. I must “assume the full mantle” of Tier 3, so to speak, rather than tiptoeing back and forth between the two, no matter what the risks.