The rising costs in oral healthcare – Time to reboot & reset clinics for economics (Part 5)
COVID-19 is having an unprecedented impact on the global economy, including that of the dental industry. Most dental clinics are shut and a few are offering only the emergency services. Dr Bhavdeep Ahuja will analyse "the rising costs in the oral health care services and how to reboot and restart the dental clinics" in his 5 part series. "Life is a Business that doesn’t cover the Costs" - is the fifth article of the series.
(Author Disclaimer: This article of mine is targeted at small to medium level dental practitioners and new practitioners who deal in a limited level OPD and have small to medium-sized premises. No disrespect, whatsoever to those who are having big spacious interiors, jam-packed OPD’s and big numbers (financial) associated with their name. I would like to re-iterate here that the distinguishing factor is the number of patients and size of the practice and not the skill set of any individual which can be highly inequitable. The only reason for dishing out this disclaimer is that highly successful running dental clinics won’t find the content of the article identifiable and suitable for adaptation in their enormous practices, but, if willing to, can read on and send your feedback to me)
The most prudent upcoming challenge in the post-COVID-19 era is the increase in the cost of oral health services which can limit the patient access to health care as limited resources lead to rationing and delaying and denial of care to people in need. We are in the Lockdown almost all over the world due to a pandemic called ‘Coronavirus’ aka the COVID-19. Of course, the human race has been known to overcome all such challenges in the past. One aspect is, however, getting absolutely clear; practising Dentistry in future (Post-COVID-19 era) is never going to be the same as the Pre-COVID-19 era. Dentistry was already cited as one of the costliest professions in India, by most of the ‘poor’ (and also by some rich, as well) Indian patients; believe me, this bar is all set to go higher and further milestones are going to be breached in near future as and when we resume the regular operations of dentistry, anytime 1-3 months from now. The rampant exploitation of natural resources brought us face to face with animals that harbour these novel viruses (in this case, presumably, a bat). Eminent public health researcher Dr Peter Daszak and his team have estimated that there are as many as 5,000 coronavirus strains globally waiting to be discovered in bats. We may possibly be looking at a future where pandemics and epidemics become a part of life and health takes the centre stage in public policy and even, election campaigning, dare I say that. We will have to learn to live with the virus is the new eternal but bitter truth. I might be sounding silly here, but, health care would finally seem to take precedence over all other key issues and is slowly but surely and steadily going to get its legitimate due, very soon. As dentists and more importantly, as health care professionals we have to play our part in preparing our patients for this new reality. It was said a few years back that the World War III will not be fought with weapons; isn’t that ‘prophecy’ coming true in this COVID-19 era when thousands (rather, lacs) of people all over the world are dying for without any fault of theirs.
Part 5 begins...
Back to Basics
Remember, the cost of storage, cost of shelf life and the cost of money along with a risk of expiry are often ignored costs when we indulge in bulk buying. Even currently, dentists are on buying spree for PPE kits and pre-booking spree for Hepa Filters, Extraoral Suctions, Negative ion generators, fumigators, UV light systems and whatnot, as if they are going to work on with full spree from next day onwards. It is good to be planned and prepared but not impulsive and impatient. There has been a sudden barging in of guidelines from every association like DCI, IDA and individual State Dental Councils along with all individual speciality dentistry associations like IPS, IES and so on. The 70-80% content of these guidelines might be common but it is the remaining 20-30% which makes the difference. Remember these are just guidelines and we have to specifically use our own intelligence, wit and wisdom to make a final discretion for which to follow finally. However, finer set of guidelines, we get, but how strictly we adhere to them is the most important aspect. We are not really sure at the moment as to whether we are doing enough or are we overdoing them (by following the guidelines).
For me, another point of contention (I might sound finicky here) as to what portion of these guidelines is evidence-based?
We all are living in the world of borrowed knowledge about that invisible ‘enemy’ and dare I say that even WHO (World Health Organization) doesn’t have full answers to every question till now. The above aspect holds true for most of the gadgets in line for buying for dentists. Burning a straight hole into your pocket right away when some of them are struggling to make ends meet (shocking for me anyway) to realize later that these gadgets weren’t required in the first place.
The problem gets compounded further when many of the star luminaries have diverging views on so many aspects and who should the average Indian dentist listen to, is the million-dollar question?
Where would the buck finally stop on, no one really can predict that?
I strongly believe it is the time to hold your horses, get mentally ready, plan out but don’t splurge as of now on these gadgets. While investing in your practice is smart, wasting money is not. Impulsiveness might force us to jump on to the bandwagon in a FOMO approach only to realize 2 months down the line that many of these things were quite unnecessary and they will be occupying the shelf in our already space-starved dental clinics to join the illustrious category of those wannabes which we had earlier bought but rarely used. In this way, many of our earnings are buried in our cupboards in unproductive and seemingly, dead investments.
There is not even an iota of doubt that the economy will be impacted a great deal. People just won’t be spending money like they have in the past and will be more cautious and conservative. The financial environment may increase savings (as the perennial shift occurs from a want based to a need-based in every significant aspect of life) which might be good for individuals but bad for the economy overall. The pertinent point here is that instead of splurging handsomely now further on making investments in the clinic, we devise ways to economically reduce our input (costs) so that we have a better carry home output (income). One of the practical ways which I have been following even in the pre-COVID-19 era is doing more work in the clinic for one patient in one sitting. Of course, patient comfortability and consent is paramount to that if we plan to give a longer than desired sitting to him/her. This nullifies the aspects of more expenses per patient. As Indian dentists, many colleagues are fond of flaunting and flashing their numbers in their peer groups. A tall claim like a dental OPD of 35-40-50 doesn’t impress me much especially when coming from a standalone dentist.
Can an average dentist actually ‘treat’ more than 8-9 in a day, handsomely?
If No is the answer, who are we showing our numbers to?
In coming times, those numbers will have to be mandatorily shunned away. We might have to learn to live with the virus especially when it seems to have entered our ecosystem and seemingly social-distancing might be the new norm for all of us.
Every small clinic as well would be requiring a bare minimum of two assistants, one inside the operatory and another in the reception/waiting area. The one outside the operatory will assume more importance as he acquires the role of a guardian angel for us from all evil forces (seemingly) in terms of guiding the patients coming in randomly or by appointment. The role reversal trait for each of them will have to be acquired pretty quickly assuming one of them is on leave someday and staff training by us will play a big role in that. The dentist should set aside formal time for staff training, but for that sometimes, being ourselves trained is also needed. Sometimes, we need to spend money to reduce our overhead like becoming accomplished at newer tricks and techniques in practice as the confidence we receive in delivering dental excellence will change the treatment mix in our practice. Our investment will pay for itself and it can reduce our overhead by increasing our production. A dentist won’t have to constantly reinvent the wheel, then. Once these systems are in place, every team member is trained so he/she can perform the task in the appropriate manner and be accountable for the consistent results. By not having systems as mentioned above, one is not able to train an individual to be efficient and effective, so the overhead increases in such a way when mistakes are happening. This is not about understaffing because your team is critical to patient care, patient satisfaction and practice’s success. Most dentists don’t have systems, they don’t train teams and their teams can’t, therefore, be effective and efficient. It is indeed time for some tough love. No one else can save you but yourself. If you don't like what you have, make a better choice and enhance your leadership skills for a different result. We have to draw a line in the sand and then stand firm on it. Dentistry is going to change and our patients will become more sophisticated. So, we have to quit whining about our overhead and do something about it smartly by creating a plan and making the bold decisions, some of them via a tough call.
As long as people have teeth and gums, there will be dental problems on this earth; the priorities might change for people (patients) like ‘this summer vacation I am going to Europe might change to I am going to my dentist’. It is time for clinics to reset and reboot 2.0. It will require a stronger commitment by the dentists themselves to understand economics and a slight tweak by the DCI in their revised guidelines of 2014 vis-à-vis marketing. Also, a strong need for an exclusive Dental Insurance policy in India which is the need of the hour, although it is not in our hand because common sense says, if costs of dentistry go up, Govt. health care services will be seeing a surge in OPD levels but whosoever sees health as a priority, will avoid the Govt. setup and I don’t mean here that they won't upgrade – but the system is slow and takes much more time than us. A common man would be stuck badly, thus, this is the opportune time for Dental Insurance in India which can take care of both of us (patient and dentist). The same can be set up as a PPP model (public-private partnership) for trial purpose. The models of Western countries are before us, so not much of homework would be required but for that, the representation and suggestion have to be made to the Govt. 72,000 (1/4th) members of IDA can't do that but 3 lac plus (total) dentists of India can surely do that because the organization voice works better rather than individual voices. Insurance brings so much parity all around and enhanced standardization in most clinics. We all dentists need to become connoisseurs in matters of teeth and be in an enviable position as far as comparison with other AYUSH colleagues.
Unless the above is done, Dentistry won’t get its legitimate due in coming times.
Dr Bhavdeep Singh Ahuja graduated in 1998 from Punjabi University, Patiala. He has specialized in Implants from BioHorizons Inc. USA in 2004-05 & in Advanced Course from LACE-ICOI, USA in 2006. Apart from Dentistry, he holds a Triple M.B.A. in Hospital Management, Finance/Human Resources (dual) & Marketing from three premier Institutes/Universities of India viz. the IIMM Pune, IGNOU Delhi & Annamalai University, Chennai respectively. He also holds Post Graduate Diploma’s in Medical Law & Ethics (NLSIU - Premier LAW School of India), Clinical Research, Cyber Law, IPR's (Intellectual Property Rights), Disaster Management, Financial Management, Bioinformatics amongst many more from different Universities. He is a Certified Health Care Waste Manager from IGNOU & is qualified in Consumer Law as well. He is an academically oriented dentist & has more than 75 Original Scientific Publications to his credit in many International & National journals. He lectures all over India extensively on the topics of Practice Management, Medical Law, Ethics and Consent and Finance for Dentists and he is writing a series on all these topics in multiple journals simultaneously. He has been the Past Editor-in-Chief, L.E.D. E-Journal & PAGE 3 OLA-D E-Newsletter, the twin Publications of IDA Ludhiana Branch. Presently, he is into his 21st year of Clinical Private Practice in Ludhiana, Punjab.