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This Thing Called Dental Economics
T H IS T H IN G CALLED D EN TA L ECONOM ICS By HAROLD J. NOYES, B.S., D.D.S., Chicago, 111. H E dental profession has decided to take the skeleton of dental econo mics from the closet. T h e emphasis which falls on this subject as it ap proaches professional consciousness might lead one to think it new and unique, but if we consider more carefully, it becomes evident that the basic problems date from the first man who received compensation for rendering a dental service. As long as men and women have been able to obtain a more or less adequate income by the practice of dentistry, it has been of concern to them individually. T h e unique aspect of the present in terest lies not so much in the economics of the individual dentist as in the econ omics of dentists collectively. T his rec ognition of the subject as a m atter for the consideration of the profession as a whole through its rather complicated me chanism of professional societies and or ganizations is a step along a hazardous path, and unless the journey is directed by men of honesty and integrity (of which there are few either in or out of the den tal profession), there is grave danger of serious complications. In this age when all phases of our life are open to critical analysis, there is no reason for excluding a scientific study of the economic aspect of dental practice. T his same type of scrutiny into the me chanical and biologic problems of den tistry has resulted in the grow th in dental knowledge of the past fifty years and, of more importance, the tremendous im
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Jo u r. A . D . A ., M a y , 1930
provement in rendering dental service to the public. T h ere is no reason to believe that a similar m utual benefit may not arise from the application of the same type of study to the economic side of dental practice. I t must be comprehen sive, thorough and honest and not another crime committed in the name of science. N either the profession nor the public can or w ill benefit permanently at the ex pense of the other. T h e opposition to a collective attack on the problem or its recognition by den tal societies has, until very recently, been successfully maintained by leaders within the dental profession, falling roughly into two classifications. One is comprised prin cipally of men who conscientiously feel that any recognition of this phase of dental practice would only serve to em phasize the growing commercialism w ith in the profession. T h eir attitude is one of apprehension. For every one who has maintained his ideal in spite of his school training or caught a spark from which to light it while an undergraduate, they see a score of young men ground out of our dental school mills w ith no more scien tific approach to their problems than the graduate from the schools of mechanical dentistry. N or is their apprehension w ithout grounds. T h e realism of the picture be comes clearer if we compare the present condition w ith th at of fifty years ago. A t that time, dentistry was not a par ticularly alluring field. T h e surface of
894
Noyes— T his T h in g Called D ental Economics its scientific problems had hardly been scratched. T h e public had just begun to be aware of the relation of oral condi tions to general health and were, conse quently, unw illing to pay more than very moderate fees or to seek the aid of the dentist except in extensive loss of func tion or severe pain. Preventive measures had scarcely dawned on the consciousness of the general public; and the social posi tion of the dentist was not enviable. As a consequence, men entered the field for neither m onetary rew ard nor social prestige, but rather because they saw an opportunity to relieve suffering and to advance human knowledge in a direction which had been sadly neglected. T h e leaders of this time worked de votedly, many w ith little or no previous training. T h e fru it of their labors js gloriously shown by the present position of the profession. Few of these men be came wealthy through their practice. T hey paved the way for higher fees and multiplied the num ber of operations by demonstrating the need for dental serv ices and the value of such service, not only through greater comfort to the individual but also by increasing his effi ciency. I t then became profitable to per form dental operations. And w ith the advance in economic status of the dentist and progress in scientific training, there came a heightened social position. A t this point, dentistry began to attract men ambitious of attaining both these ends and not particularly concerned w ith either the advancement of knowledge or the relief of suffering. I t is at this time that we find our den tal schools flooded w ith a very undesir able type of student: one who would tolerate all the scientific training de signed to better fit him to serve his patients in order that he might, on graduation, enjoy greater economic and
895
social prominence. These men are much interested in dental economics. I t is for this reason, I say, there is ground for apprehension. M en who have labored honestly and earnestly to build the pres ent structure of dentistry are reluctant to add another wing which they feel will do much to legitimatize an attitude with which they are not in sympathy. T here are others falling in the second group, more subtle and less honest in their position, who oppose the recognition of dental economics either openly or adroitly. T hey have realized that there was greater return in cloaking their ambition for pro fessional, social and economic prestige in the vestments of science and ethics. As long as dental societies confine their attention to matters concerned w ith the mechanical, biologic and chemical aspects of the profession, it remains bad form to scrutinize too carefully the economic practices of its members. Thus, it becomes possible, through participation in the activities of dental societies, to gain professional eminence w ithout reference to economic practices which may be of questionable benefit to the profession as a whole and to the pub lic. These men are loud in their clamor over dental ethics as long as dental ethics remains the intangible phantom which it now is, and they are even more emphatic in their cries against dental economics which, as they see it, may throw too analytic a searchlight on the conduct of the business side of dental practice. I t must be remembered that the fore going is not an attem pt to classify the entire profession w ith regard to its stand on the m atter of dental economics, but only to point out two attitudes which have appeared to stand out sufficiently to m erit consideration. W e might similarly classify those on the affirmative side of this question roughly into the following
896
T he Journal of the American D ental Association
T h ere is some danger of dividing the groups: (1 ) those who hope to justify their materialistic attitude by turning the profession into economic societies and profession economic-minded; (2 ) those scientific societies. A similar condition anxious to obtain some light on a side of prevails in medicine at present. T here their practice which, because of their at are medical societies in some of our larger tention and interest in the purely profes cities which developed principally be sional side of their vocation, has been cause economic and political twaddle con sadly neglected, and (3 ) those who sumed a m ajor part of the time and ab would like to have it studied in a scien sorbed the attention of the larger organi tific frame of mind and stripped of the zation. I t is possible to develop dental glamour of a “get rich quick” method, economics in a spirit of honest research yet clarified and made available as a which is wholly compatible with the high means of eliminating waste and ineffi est ideals of a professional society. But ciency in rendering dental service to a it will be much easier to allow this sub ject to further demoralize the existing public which needs it. Although I appreciate the point of dental societies and, in this manner, lead view of the men who oppose dental eco to the two-society condition which ob nomics because of honest fear for the tains to some extent at least in Europe. T his is unfortunate, for it places too profession, I do not agree w ith them. I cannot but feel that the best way to cope great emphasis on its importance in the with the problem is to throw light and economic societies and falls short of im plenty of light on the m atter. A ttack it partial analysis, which is essential to a in the same manner that we would go scientific attack. As long as men practic about the study of any other problem ing dentistry receive remuneration for associated w ith the practice of dentistry. their service, and as long as the public T he second group of the opposition has pays for such service dental economics is a more accurately analyzed the situation, problem of the profession. I t is not the and their reasons for opposing it are some whole or m ajor factor in the profession of the greatest points in its fa v o r; namely, as long as dentistry remains a profession ; that it would, through im partial analysis it may become so if dentistry chooses to and study, disclose conditions and prac become a trade. W e may study the ap tices of many so-called ethical practition plication of economic principles to the ers that are not to the economic inter practice of dentistry through our existing ests of either the profession as a whole dental societies w ith m utual benefit to the profession and to the public if we or the public. But to consider opposition at all is, preserve an honest, scientific and altru perhaps, beside the point, for one has but istic attitude. A nd by doing so, we may to review programs of dental societies prevent the tail from wagging the dog. W e are approaching the time when which have met w ithin the past few months to realize the extent to which at this thing called dental economics w ill be tention is being given this m atter. T h e squarely before the dental profession. time is not far distant, if indeed it has W hether we make it a factor in the ad not already arrived, when the profession vancement of dental science and public w ill have to face the issue. W ill we run welfare or allow it to become a malicious it as another dental fad and ruin its force with morbid influence is a chal lenge to our integrity. benefits by cultivating its evils ?
T
Jo u r. A . D . A ., M a y , 1930
provement in rendering dental service to the public. T h ere is no reason to believe that a similar m utual benefit may not arise from the application of the same type of study to the economic side of dental practice. I t must be comprehen sive, thorough and honest and not another crime committed in the name of science. N either the profession nor the public can or w ill benefit permanently at the ex pense of the other. T h e opposition to a collective attack on the problem or its recognition by den tal societies has, until very recently, been successfully maintained by leaders within the dental profession, falling roughly into two classifications. One is comprised prin cipally of men who conscientiously feel that any recognition of this phase of dental practice would only serve to em phasize the growing commercialism w ith in the profession. T h eir attitude is one of apprehension. For every one who has maintained his ideal in spite of his school training or caught a spark from which to light it while an undergraduate, they see a score of young men ground out of our dental school mills w ith no more scien tific approach to their problems than the graduate from the schools of mechanical dentistry. N or is their apprehension w ithout grounds. T h e realism of the picture be comes clearer if we compare the present condition w ith th at of fifty years ago. A t that time, dentistry was not a par ticularly alluring field. T h e surface of
894
Noyes— T his T h in g Called D ental Economics its scientific problems had hardly been scratched. T h e public had just begun to be aware of the relation of oral condi tions to general health and were, conse quently, unw illing to pay more than very moderate fees or to seek the aid of the dentist except in extensive loss of func tion or severe pain. Preventive measures had scarcely dawned on the consciousness of the general public; and the social posi tion of the dentist was not enviable. As a consequence, men entered the field for neither m onetary rew ard nor social prestige, but rather because they saw an opportunity to relieve suffering and to advance human knowledge in a direction which had been sadly neglected. T h e leaders of this time worked de votedly, many w ith little or no previous training. T h e fru it of their labors js gloriously shown by the present position of the profession. Few of these men be came wealthy through their practice. T hey paved the way for higher fees and multiplied the num ber of operations by demonstrating the need for dental serv ices and the value of such service, not only through greater comfort to the individual but also by increasing his effi ciency. I t then became profitable to per form dental operations. And w ith the advance in economic status of the dentist and progress in scientific training, there came a heightened social position. A t this point, dentistry began to attract men ambitious of attaining both these ends and not particularly concerned w ith either the advancement of knowledge or the relief of suffering. I t is at this time that we find our den tal schools flooded w ith a very undesir able type of student: one who would tolerate all the scientific training de signed to better fit him to serve his patients in order that he might, on graduation, enjoy greater economic and
895
social prominence. These men are much interested in dental economics. I t is for this reason, I say, there is ground for apprehension. M en who have labored honestly and earnestly to build the pres ent structure of dentistry are reluctant to add another wing which they feel will do much to legitimatize an attitude with which they are not in sympathy. T here are others falling in the second group, more subtle and less honest in their position, who oppose the recognition of dental economics either openly or adroitly. T hey have realized that there was greater return in cloaking their ambition for pro fessional, social and economic prestige in the vestments of science and ethics. As long as dental societies confine their attention to matters concerned w ith the mechanical, biologic and chemical aspects of the profession, it remains bad form to scrutinize too carefully the economic practices of its members. Thus, it becomes possible, through participation in the activities of dental societies, to gain professional eminence w ithout reference to economic practices which may be of questionable benefit to the profession as a whole and to the pub lic. These men are loud in their clamor over dental ethics as long as dental ethics remains the intangible phantom which it now is, and they are even more emphatic in their cries against dental economics which, as they see it, may throw too analytic a searchlight on the conduct of the business side of dental practice. I t must be remembered that the fore going is not an attem pt to classify the entire profession w ith regard to its stand on the m atter of dental economics, but only to point out two attitudes which have appeared to stand out sufficiently to m erit consideration. W e might similarly classify those on the affirmative side of this question roughly into the following
896
T he Journal of the American D ental Association
T h ere is some danger of dividing the groups: (1 ) those who hope to justify their materialistic attitude by turning the profession into economic societies and profession economic-minded; (2 ) those scientific societies. A similar condition anxious to obtain some light on a side of prevails in medicine at present. T here their practice which, because of their at are medical societies in some of our larger tention and interest in the purely profes cities which developed principally be sional side of their vocation, has been cause economic and political twaddle con sadly neglected, and (3 ) those who sumed a m ajor part of the time and ab would like to have it studied in a scien sorbed the attention of the larger organi tific frame of mind and stripped of the zation. I t is possible to develop dental glamour of a “get rich quick” method, economics in a spirit of honest research yet clarified and made available as a which is wholly compatible with the high means of eliminating waste and ineffi est ideals of a professional society. But ciency in rendering dental service to a it will be much easier to allow this sub ject to further demoralize the existing public which needs it. Although I appreciate the point of dental societies and, in this manner, lead view of the men who oppose dental eco to the two-society condition which ob nomics because of honest fear for the tains to some extent at least in Europe. T his is unfortunate, for it places too profession, I do not agree w ith them. I cannot but feel that the best way to cope great emphasis on its importance in the with the problem is to throw light and economic societies and falls short of im plenty of light on the m atter. A ttack it partial analysis, which is essential to a in the same manner that we would go scientific attack. As long as men practic about the study of any other problem ing dentistry receive remuneration for associated w ith the practice of dentistry. their service, and as long as the public T he second group of the opposition has pays for such service dental economics is a more accurately analyzed the situation, problem of the profession. I t is not the and their reasons for opposing it are some whole or m ajor factor in the profession of the greatest points in its fa v o r; namely, as long as dentistry remains a profession ; that it would, through im partial analysis it may become so if dentistry chooses to and study, disclose conditions and prac become a trade. W e may study the ap tices of many so-called ethical practition plication of economic principles to the ers that are not to the economic inter practice of dentistry through our existing ests of either the profession as a whole dental societies w ith m utual benefit to the profession and to the public if we or the public. But to consider opposition at all is, preserve an honest, scientific and altru perhaps, beside the point, for one has but istic attitude. A nd by doing so, we may to review programs of dental societies prevent the tail from wagging the dog. W e are approaching the time when which have met w ithin the past few months to realize the extent to which at this thing called dental economics w ill be tention is being given this m atter. T h e squarely before the dental profession. time is not far distant, if indeed it has W hether we make it a factor in the ad not already arrived, when the profession vancement of dental science and public w ill have to face the issue. W ill we run welfare or allow it to become a malicious it as another dental fad and ruin its force with morbid influence is a chal lenge to our integrity. benefits by cultivating its evils ?