Dr. Alan Paradis: David, you mentioned that dentists were no longer willing to pay a high fee for good quality laboratory work and I have to say that I believe that the dentists over the years have been put under a great deal of pressure to deliver dental care at lower and lower fees, based on dictations from the insurance plans that they had to sign up for now. Why would a dentist have to sign up for an insurance plan? Well this goes back to there being too many dentists so if they’re given number of dentists and only a set number of patients, these dentists are competing with each other for patients, so many of them feel that if they sign up for certain insurance plans which then agreed to put them on a list and send patients to their practice, that would be a good way to develop an adequate number of patients. Well that may look good on paper but the insurance company makes the dentist sign an agreement where he’s going to deliver dental care except for a certain price and this is where the pressure comes in. So dentist ‘A’ wants to have a number of patients delivered to his practice, he agrees to do the dental treatment at a lower fee. Well it’s really hard to do dental treatment and to do it fast is even harder, to do it fast and well, it’s starting to get very difficult and to do it fast well and cheap, now you’re in the level of impossibility. So one of the first thoughts the dentist has when he looks down his balance sheet is that his lab bill is a real high percentage of what he’s collecting from his patients was pretty easy to think I’m just going to pay less for my laboratory work so he contracts with a laboratory to do his crowns for a little bit less so he can deliver his crowns for a little bit less to his patients. Well this is the beginning of a clear spiral downward, so the next dentist has to do the same thing except a little bit less and after 30 years of insurance dictating fees to dentists, well, there’s a very very large industry, a very very cheap laboratory work and in fact im sure people have heard the stories about large volumes of dental crown restoration being sent to china to be made. This became a big big news story when they found out that the metals that were being used in these crowns were mined in china somewhere.
Dr. David McFadden: But here we go back to the corporate model, so all these downward pressures on price in dentistry create a market for corporate industry where they can appeal to all the patients having dental insurance. Typically, when patients come to me for a second opinion with their treatment plan from one of these office, what I find is that their procedure by procedure or product by product price is lower than ours but you’ve got a laundry list of other needs that the patient has, typically add up to our entire treatment cost. So I find it comical and sad at the same time that the idea of saving money on a crown entices people to go to these lower quality clinics but when you look at the overall treatment and the overall cost of treatment ends up being virtually the same as is what we talk about in our treatment plans and our total cost. So the general dental corporate model is very insurance dependent, they want to bring in people with insurances, it’s easier to get them in the front door but you contrast that with the lark that the largest dental implant corporation in America, they don’t take any insurance at all and the problem we see with them is they offer one treatment. SO imagine that every consumer through the front door is offered the same treatment, we won’t go into the details of that but that’s how that system works. The investors and the original founders of this implant company founding way to streamline their treatment down to one basic treatment and the whole operation is set up around that one procedure.
