Report from CEO Terry McGeeney

A Visit to the Dentist

More than likely many of you have been to the dentist in the past year. I feel a little bit like Andy Rooney as he once said he doesn’t pick subjects but subjects pick him. Much like he would say – I was at the dentist recently and it caused me to think.  Dentistry has figured out much of what has escaped primary care.  Certainly it may be somewhat easier in the dental world without Medicare and other payer challenges. Certainly their ability to "balance bill" is not an insignificant issue.  Recognizing that, however, dental practices have done a very good job learning how to function as a team, delegate work to the appropriate level, incorporate technology and most importantly put the patient first.

A dental practice uses hygienists quite effectively to provide a service that patients need but do not require the skill and training of a dentist to provide. The same certainly holds true in medical practices, but many of us have not learned or recognized that. On a regular basis I have the opportunity to see a hygienist who provides a needed level of care and "dental coaching" while making sure I get the needed regular exams and intervention when it is recommended. I never see the hygienist where the supervising dentist does not come in and shake my hand and ask how things are going. Similarly much of the care requested in a primary care office does not require 4 years of medical school and 3 of residency and could easily be provided by a PA or NP freeing up physicians to do what we are trained to do.

Recently, I needed to see the dentist for a crown. I was given an appointment on the day I requested and was brought back to the "operatory" immediately upon my arrival. An assistant interviewed me right away, entering all information into the electronic record which also held my most recent dental x-rays and a consultation for a dental specialist I recently saw. When that process was completed the dentist entered, reviewed the record, asked if I had questions, placed a small camera in my mouth so he could explain what he was going to do and then asked if I wanted headphones or anything else to make me comfortable. When the dentist completed his work preparing a tooth for a crown, his assistant then quite expertly placed the temporary crown with a final inspection by the dentist. I could hear the dentist in the mean time in the next operatory giving the same level of care to another patient. It struck me at that moment that this is a dental "Medical Home" of sorts. Access, technology, team care, education, preventative care and patient focus were all there. I found myself thinking that patients will probably never go to their local pharmacy to a "minute dentist" to have their teeth cleaned. They’re getting what they need from their dentist.

I remember several years ago when dental offices were as antiquated as many primary care offices of today. Why has dentistry changed and primary care has not? Certainly we could make all of the usual arguments— money, time, complexity, etc, etc. The bottom line is that dentistry did what primary care must do to survive. 

Before I left my visit I asked the dentist where the impetus for change came from.  He immediately said his national and state associations. He said you could never go to a meeting without hearing how dentistry needed to change. He said they not only told him that he needed to change but how to change. He then described how vendors then responded to the market rather than define and create the market.

Family Medicine is several years late, but nonetheless we now have national and state associations saying that primary care must change. We also now have TransforMED telling us how to change. What we still don’t have is motivation at the practice level to change. To continue the Andy Rooney theme, he once said "People will generally accept facts as truth only if the facts agree with what they already believe." Primary Care must believe that change is not an option but a necessity for survival. Many say that change cannot occur until the payment system changes. It is clear that the payment system will not change until primary care changes. If you question your ability to change, I urge you to consider taking a visit to your dentist— they believe.