If you are a dentist who never participated with dental plans and live in a geographic area that has been hit hard by the recession, and if you are like me, then the thought of participating has probably crossed your mind a few times over the last couple of years.

Last week I heard a veteran dental consultant admit they she changed her tune.  In the past she advised dentists not to participate but lately found herself advising her clients to selectively participate.

I have thought long and hard on this issue…even about the future of fee for service dentistry as a continuing viable model.  The gut reaction is that fee for service has seen its last days, and the more plans you affiliate with, the better prepared you will be.

Readers of this blog know that I am a big fan of thinking…thinking critically, rather than reacting to my gut.

I live in Jersey, a highly competitive area for dentists.  Geography is important when looking at this issue.  For example, if I lived in a town where 75% of the population was covered by insurance, that would be a major factor in my decision-making process.

But I live in Jersey…lots of people…lots of dentists.  A level, competitive market.

Looking at the stats, probably only 47% of the population has dental insurance.  Fifty three percent do not.  I can live with that.  What do those 53% of patients have in common?  If you said that they have to pay for dentistry, you would be right.

And the 47%…well, they each have different ideas about who pays for their dentistry.  No two people think alike.  We can’t generalize about values.  I hear a lot of talk these days about entitlement issues, but let’s not get political.  In better economic times people have a less difficult time paying “out of pocket.”  But let’s not kid ourselves —out of pocket expenses are the issue…they always have been, and always will be.  Whether insurance is a factor or not…values trump everything.

The biggest difference is the size of the pockets.

I heard a statistic once that claimed that 95% of dental benefits are left on the table each year because people don’t want to pay after they reach their limit.  Hmm!  That bothered me on many levels.  The effect of dental insurance on actual treatment seems to be less than what most people believe.

So why does the insurance question cloud our thinking…and I mean everyone’s thinking…doctors, patients, businessmen and politicians?

Why do dentists allow this illusion to interfere with their life’s work?  By participating the dentist will certainly get an increase in patients.  They will come from that 47%…and bring with them the questions about who pays what and what gets covered, and what is excluded, and when they can do it and, and, and…

Those that don’t participate, only have to deal with one patient at a time, one case at a time.  By not participating the dentist maintains his autonomy (freedom to make all decisions), his ability to create meaningful dentistry on people who value the dentistry (they pay for it) and his level of competence by doing procedures that may not be covered by insurance companies…ever!

When I look at it like that, I feel better, knowing I am doing the right thing.  Economies change…but people remain constant…people want to keep their teeth.  When our culture finally wakes up to realize that it’s the dental profession that wears the white hats…not the insurance companies, then we may put insurance into the proper perspective.

Just my thoughts.