29
Volume1 Issue6
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I
ssues and
P
eople
arrangement. It couldalsobeamanagement contract in
which services areprovidedbasedon fees that arenot linked
to treatment and/or production. Inall cases, theclinical
dentist providing treatment shouldalwayshaveunfettered
decision-makingauthority.
Bad corporatization
Badcorporatizationhasbeen investigatedbyno less than
theUSSenate. Its recent investigation into the impact of
“corporate-backed” dentistryonMedicarebillings exposed
how things cango terriblywrong.
2
In its 2013 report on this
issue it found that under theguiseof amanagement services
contract, dental corporationswereeluding state regulations
wherebyonlyadentist canownadental practice. Aswell, it
outlined thecorporatepolicies that placedprofit over patient
care includingovertreatment of children. The report is a
sobering reviewofwhat cangowrongwhenprofessional
ethics are subservient to thebest interestsof thecorporate
entity.
Could thishappen inBC?
TheCollegeofDental Surgeonsof BC’s
CodeofEthics
and
bylaws areclear onadentist’sprofessional obligationswith
respect topatient care. Further, the
HealthProfessionsAct
,
Section43, 1 (c) states that onlya registrant of theCollege
can legallyownvoting sharesof thecorporationwhile family
members canholdnon-voting shares.
Management arrangements alsoexist, themost basicbeing
aprincipal/associatearrangement. Anyarrangement that
seriouslyaffects adentist’s ability tomeet their professional
responsibilities toapatient is aconcern. Recently, the
Collegeaddressed limitsplacedonassociates that it deems
unacceptable in its 2013complaint summary, noting that:
“Particular problems arose inpracticeswhereassociate
dentists (dentistswhowork in thepracticeas employees)
hadno involvement in feediscussionswithpatients. In
somecases, theassociatedentists said theywere instructed
not todiscuss suchmatterswith their patients. This is
not appropriate: associatedentistsmust haveautonomy
todevelop the treatment plan solelyon thebasisof the
patient’soral healthneeds. Associatedentistshavean
obligation toobtain thepatient’s informedconsent,which
includes anunderstandingof all options and their associated
costs.”
3
While theCollegehas a role in setting the standards for the
profession, the real onus restson individual dentists toact
ethically, irrespectiveofwhether one is, or isn’t, ‘caught’. This
is evenmore important asnewcorporate structures evolve
over time.
Badcorporations cannot establish themselves if individual
dentists areawareof thepotential risks to their practiceas
well as their ethical responsibilities andensure that theyare
able topractisedentistryunencumberedbyundue restric-
tionson their practice. This isbothyour right as aprofession-
al andyour obligation.
a
Theopinionsand/orperspectivesraised inthisarticlearenotanofficialpositionoftheBCDA.
References
1.AcademyofGeneralDentistry,PracticeModelsTaskForce. InvestigativeReportontheCorporatePracticeof
Dentistry;2013[accessed2014Aug1].Available:
2.UnitedStates.CommitteeonFinance,UnitedStatesSenate&CommitteeontheJudiciary,UnitedStates
Senate.JointStaffReportontheCorporatePracticeofDentistry intheMedicaidProgram;2013[accessed
2014Aug5].Available:finance.senate.gov/library/prints/
3.CollegeofDentalSurgeonsofBritishColumbia.ComplaintSummaries,2012/2013[accessed2014Aug5].
Available:
Aversionofthisarticleoriginallyappeared intheJuly2014editionofthebridge—the
memberpublicationoftheBCDA.CDAthankstheBCDA forgrantingpermissionto
re-publishthisarticle.
CDAwould like to includeanumber of articles
in
CDAEssentials
andpostson
OasisDiscussions
about thisbroad topic.Wewant toprovide
unbiased, solidadvice toCanadiandentists
about corporatization, grouppractices and
investor-ownedpractices.
–Haveyouhadanyexperienceworkingaspart
of thesegroups?
–Haveyoubeenapproachedbyan
organization topurchaseyour practice?
–Areyouayoungdentistwhohas started
working inoneof thesegrouppractices?
Wewould like tohear fromyouand learn
of your experiences.Wealsowelcome
anyquestions youmayhaveabout such
arrangements.
Contactusat
or
1-855-716-2747.
Wepromiseyouconfidentiality.
