JADA welcomes letters from readers on articles that have appeared in The Journal. The Journal reserves the right to edit all communications and requires that all letters be signed. Letters must be no more than 550 words and must cite no more than 5 references. No illustrations or tables will be accepted. A letter concerning a recent JADA article will have the best chance of acceptance if it is received within 2 months of the article’s publication. For instance, a letter about an article that appeared in April JADA usually will be considered for acceptance only until the end of June. Letters regarding articles published online ahead of print will be published after the article appears in print if the letter is selected for publication. You may submit your letter via e-mail in Word format to jadaletters@ada.org; by fax to 1-312-440-3538; or by mail to Letters to the JADA Editor, Publishing Division, American Dental Association, 211 E. Chicago Ave., Chicago, Ill. 60611-2678. By sending a letter to the editor, the author acknowledges and agrees that the letter and all rights of the author in the letter sent become the property of The Journal. Letter writers are asked to disclose any personal or professional affiliations or conflicts of interest that readers may wish to take into consideration in assessing their stated opinions. The views expressed are those of the letter writer and do not necessarily reflect the opinion or official policy of the Association. Brevity is appreciated.
This letter is in response to the May JADA article titled “Dentistry’s Social Contract Is at Risk” (Moeller J, Quiñonez CR. JADA. 2020;151[5]:334-339). I would first like to start with agreeing to disagree with their conclusion that dentistry will lose its existing authority over addressing the oral health needs of society. This response is coming from a dentist who has practiced over 34 years in all practice environments listed in the article with the exception of academia. This, however, is not by my own desires but by the pure political nature involved in obtaining such a position.
The authors fail to address the root of the problem they so adamantly attack: the inequity that exists in all of society. They were correct in stating that the problem is complex and not easily addressed. However, their conclusions making the reader believe that dentistry is at risk of failure from a pure social perspective are wrong. After all who has a “pure” heart?
Maybe they need to be addressing the financial responsibilities of a society that cares more about self than the real needs of others. Especially when students are graduating with a debt of $250,000 on average. How does society expect these young dentists to pay back their debts to society if they do not change the way banks loan money, the cost of higher education, the disparity in insurance reimbursements, the rising cost of office overhead, and the need to stay current in technology? When society addresses these issues properly maybe we all will see real change.
From experience, I can honestly say from a one-on-one experience with my patients from all walks of life it is those with unrealistic expectations that have given me the most grief. Also, it is the unrealistic expectations that insurance carriers have placed on the insured minds. The best form of dentistry ever practiced is “fee for service.” Basically, if I desire to treat you at a lower cost because of your situation in life I will (the human factor overlooked in this article). Allow the fair market to control the cost of doing dentistry and not unrealistic insurance reimbursements.
I have often thought dentist should never know if a person has insurance and should not be even allowed to ask the question. We all have practiced for years with standardized American Dental Association codes and fees schedules based on these codes. So, as walk out statements are given to all patients (typically), itemized treatment codes would be given to each person whom in return is responsible for giving this statement to whomever they claim is responsible for the reimbursement. The burden becomes the responsibility of the patient not the dentist. This simplifies the process of collection and holding down cost for dental care. Societal organizations are in place already to help needy people. So why does this now become “dentistry’s social contract” problem in the authors’ eyes? When the needy can bring a treatment estimate of the care they need to a social service agency. I really think our authors need to report their disclosures as this may give great insight on their personal point of view.
In closing, dentistry’s social contract has been damaged already due to “fake” news as a result of all the confusion placed on our profession due to the COVID-19 pandemic.