Surf and turf

The evidence is growing that private dentistry has been bitten by the economic downturn. For the most part it appears to have been a flesh wound, although at one end there are practices who have been hit pretty hard, and at the other practices that are still busier than ever and can’t understand what all the fuss is about.

The natural first reaction is to go in search of new people to whom you can sell your existing product(s). Alongside (or instead of) this is the alternative approach of finding new things to offer existing patients or new things to attract new people. Or both.

We can sometimes forget  how fortunate we are that dentistry remains such a heavily protected activity. Not for us the encroachments that solicitors saw in their once-sacred and lucrative conveyancing market, or their once-exclusive access to the Bar.

Nor the step-change encroachment that opticians experienced in terms of the market for the
provision of spectacles and contact lenses, as a result of which the branded corporate chains are
everywhere and the ‘old-style’ stand-alone dispensing optician has become almost invisible – with or without glasses.

But despite our fortunate and privileged position, dentists still get remarkably cross when they see tooth whitening booths in shopping malls, just as they used to get disproportionately cross with ‘denturists’ before clinical dental technicians became recognised and registered. Some dentists even get cross when they see other members of the dental team empowered
to undertake extended duties or to own and operate practices themselves.

Specialists get cross when they see their ‘turf’ being invaded by general practitioners who (in the view of the specialist) should be doing less themselves and referring more to specialists. Generalists get irritated by specialists who make such suggestions. Some oral surgeons got cross when their specialist list was merged with that for ‘surgical dentistry’, describing this as a dilution of their own speciality. And some of those who had gained entry to a specialist list on the strength of having undertaken many years of recognised, formal specialist training (at considerable personal cost) were more than a bit miffed when they saw others being
grandparented onto the same list(s) without having done so. These two groups may be poles apart, but at least they are united in their displeasure regarding the GDC’s latest proposals for further mediated entry to specialist lists in the future.

Specialists might assume – and not always correctly – that members of the public will appreciate the subtleties and significance of the title. Those who are not specialists will often make a virtue of everything other than being on a specialist list, and therein lies the potential risk – for all concerned.

There has always been a somewhat uneasy interface between oral and maxillo facial surgery and the massed ranks of the facial cosmetic surgeons, and when general dental practitioners started to expand into the dento-facial aesthetics market it really seemed (to some) like a bridge too far – so to speak. And the very thought of tanning studios, beauty salons and tattoo parlours muscling in on the act with Botox, fillers, laser treatments and other forms of beautification, it all turned ugly. Very ugly. Enter IHAS with its plans to regulate this burgeoning market and limit its provision to registered health professionals of various kinds. Cheers of joy from one end of the paddock – hoots of derision and cries of ‘protectionism’ from the other.

The internet has compounded and added a further dimension to all these turf wars because of its capacity to communicate with and influence a much wider (and critically, a less informed) market.

The internet transcends artificial internal boundaries like specialist lists because their significance is far better understood within the profession itself than by the public at large. Spare a thought, therefore for dentists in the Republic of Ireland who, while precluded from advertising themselves, were forced to endure a torrent of advertising from dentists in Northern Ireland reaching patients (and potential patients) south of the border. It was soon very obvious that there is an awful lot of turf on an unlevel playing field.

The term ‘unfair competition’ is often used to describe those moments when we feel our own market being squeezed by others – just as the term ‘free market’ is used to describe those moments when we elect to expand into a market traditionally occupied by others.

In primary healthcare – as in other forms of business – economic downturns can be dangerous times for consumers because things are not always as they seem. All kinds of providers are eyeing them up and trying to sell them their wares. But these are also dangerous times for those providing the service because of the jealousies that exist on crowded turf. I am often saddened to witness the lengths to which some individuals will go in order to defend their own, already highly protected position.

If you are good enough at what you do, if you deliver what people need and want at a price that is perceived as good value, then my own view is that the market gives you all the protection you need.

I am certainly not a fan of over-protected markets because they end up being unfair to consumers and they create the wrong incentives and rewards for those providing the service.
But there is a catch in all of this. The logic is compelling but it falls over if the consumer has no valid means of differentiating quality, safety and value. If the alternatives are actually very different, but they all look pretty much the same, then the consumer’s choice is illusory and rendered more hazardous.

There currently seems to be a preoccupation with those marauders who are parking their tanks on the lawn outside our surgery windows, and with trying to repel these invaders by fair means or foul. I just wonder if we might do better if we turn our attention to ensuring that members of the public have a better understanding of what they are getting for their money. Some of the claims one can find on the web aren’t just pretentious, they are actually disingenuous, unfair and often illegal, because they are clearly designed to mislead. The best restaurants are quietly
confident and unobtrusive; they don’t need flashing lights outside.

Pretending to be something that you are not has always been a fool’s errand and ultimately a recipe for failure. Disappointed customers become angry and driven when they feel that they have been deceived or misled, and although the internet has become the new shop window by means of which businesses seek to entice new customers, it is worth bearing in mind that shop windows have always been at their most effective when they are clear, transparent and up front.

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