Guest Post by Dr. Alan Stern:

Health care has hit rock bottom. And, we’re still digging.
I spend several weekends a year treating National Guard soldiers. Not having served in the military (and feeling just a bit guilty over it), I have developed a profound respect for people who volunteer their time and risk their own well being so that the rest of us can live our lives in peace.

I jump at the chance to help these great people, and I work with the same enthusiasm and energy as I do in my office and in other aspects of my life. The work is markedly different than what I do in my office, but the National Guard’s dental mission is true to its values and the work is profoundly appreciated by the soldiers and their commanding officers.

I really enjoy the time I spend and the work I do with our heroes!
One of the standard questions on a soldier’s health history form is familiar. “Have you been under a health care provider’s care in the last two years?”

This is , of course, a very appropriate question, but when a  few soldiers checked off “yes” this past weekend  and wrote down the name of an insurance carrier as the explanation to the affirmative answer, I wanted to scream, cry, bang my head against a wall, and chug a bottle of scotch all at once. As an alternative to all the above, I started writing!

The soldiers I encounter are ordinary people doing extraordinary things. If their mindset towards health care is reflective of our nation’s thinking, then we are in BIG trouble.

The medical community has utterly failed to teach the public that an insurance company and the U.S government are not physicians. They have, in many senses, surrendered their role as care givers and have been relegated to technicians and trades people.  It can be argued that the role of today’s physician is to do as he/she is told, fix what the government or the insurance company orders them to fix at whatever rate of reimbursement the third party chooses, fill out the paperwork with appropriate codes or face criminal charges for failure to do so properly…. and move on to the next patient.

The patient, on the other hand, is expecting first class care while their benefactor, the third party payer, is paying third class reimbursement to the repair person whose title remains doctor. The patient is expecting Marcus Welby, MD to watch over their well being while the doctor is legitimately worried about coding, paperwork, productivity (that is, generating enough money to pay a burgeoning overhead and take a  much reduced salary or justifying his or her pay to the corporation to which they have sold their practices and/or with whom they have entered into employment agreements).

The third party payer is worried about earning more than they are spending (just like all of us, by the way), making sure that their premium dollars reflect a perceived value to the customer, and that their policies fall under government guidelines. Yes, they provide some assistance to their members in obtaining their care from their “providers.” (I despise this word.) And, my own encounters with some customer service representatives have been helpful. But, who is my health care (ugh) provider? Is it the insurance company? Is it the physician? Is it an appointment secretary? Is it a nurse practitioner or a physician’s assistant? And, who is accountable to whom, and for what are they accountable?

A few years ago, I had a discussion with a college professor on this very subject. She made the point that health care is the one area in which the entity that is paying for the service has no vested interest in the outcome, the recipient of the service has no financial accountability to the provider of the service, and the provider (God, do I despise that word) of the service has an obligation to someone other than the recipient of the service. This is, in my young adult kid’s vocabulary: “a train wreck if ever there was one!”

In dentistry we are beginning to see the train wreck approaching. Decades ago, people like Avrom King, L.D. Pankey, and others saw this coming. The dental marketplace would be tiered, they said, dividing it into what was then called welfare care (e.g., Medicaid and other government-provided treatment), insurance care subject to the market forces described above, and private care. Well, that day is here, and no dentist and no patient will be exempt from the struggle.

All patients will need to decide what type of care they want and what price they are willing to pay to do so. And, we dentists will need to decide what type of care we want to provide and what price we are willing to pay to do so. More importantly, for those who choose to pursue the private care model, the need to distance ourselves from the typical medical model AND to provide a service that is worth money, both in perception and in reality, is more critical today than ever.

So, the question I have asked myself and now pose to you is “What will YOU do to provide real care, skill, judgment, and service to those who choose you as their health care PRACTITIONER? Do you wish to play the insurance game? (That’s OK, if you’re OK with it.) Do you wish to provide care to the under-served? (That’s OK, too!) Or, do you wish to go the route less traveled?

The one less traveled is a very risky road with no guarantee of outcome. For some of us, though, it’s the only way, because for some of us, climbing is a better route than digging!