Why Rural Dentistry?
I got into this a little bit in my previous post in talking about who I am, but I want to delve a little deeper into my motives for staring this blog and into why I feel so passionately about practicing rurally. I didn’t come from a small town. Quite the opposite. I was born and raise in southern California, and not a rural part. I grew up in Orange, CA. I was 15 minutes from Disneyland and 20 minutes from the beach. I lived there until I was 17. I then moved to Phoenix and lived there for 6 years. I served a church mission during those 6 years and lived in the 3rd largest city in South America, Santiago, Chile. I’ve also lived in Richmond, VA, Dallas/Fort Worth, Fort Collins, CO and Raleigh, NC. The smallest of these was Fort Collins which had a population of just under 200,000 if you include the surrounding areas. All of this is to prove that I’m not just trumpeting the rural cause because I grew up rurally and wanted to return to my roots. When I moved to Fort Collins I thought it was small. Both of my practices now combined serve a population of roughly 25k.
So why the drastic change? When I was practicing in Colorado my wife developed dry-eye disease. If any of you have every been to, or lived in Colorado, you know it’s very dry. Her vision was worsening and there wasn’t anything that was going to make it stop. Her cornea specialist recommended that if she wanted to drastically slow down the progression of her condition that she should consider moving somewhere with a more humid climate. When we discussed it I told her that I wasn’t going to do the big-city thing again. I had tried it multiple times and no matter where I practiced I was always running into the same issue. Competition. When there is a dentist on every corner, you have to do something to “stand out.” Patients aren’t loyal in today’s world. They are just fine coming to your office, until their insurance changes and then they “can’t” see you anymore because you’re out of network. The truth is they can still see you, but it might cost them ten’s of dollars to do so, when before it was zero dollars to do so. Guess what? They have 400 other options in town that will take their insurance, so you’re out of luck.
What this creates is a situation where you, as a provider, have to take every insurance under the sun to keep patients coming in. You have to accept the outrageous haircut on your fees that the insurance requires you to take. Then guess what happens? You still haven’t differentiated yourself from the 395 other options that are within a stone’s throw of their house/office. Now what do you do? You start discounting your services to get them through the door. New Patient Special, $19 Exam, Cleaning, and X-rays. What a deal! I’ve seen this scenario in every city that I’ve practiced in. I’ve worked in a setting where we did crowns for $500 and implant/abutment/crown for $1995. You’re scouring each hygiene check looking for any justification to replace a filling or find any reason to recommend a crown on a tooth. This situation leads to over treatment and unnecessary dentistry being done. If anyone tells you this isn’t going on, they are lying to you just like their probably lying to their patients about what treatment they “need.”
Here’s an alternative to the scenario I described above. You come to work everyday with a full schedule. When you go do a hygiene check you ask the patient, “Is anything hurting or bothering you today?” When they answer “No” you’re relieved. You quickly scan the mouth. They have a bunch of old amalgams that have been there for decades. They have some superficial cracks, but nothing’s wrong with them. No decay, no worries. You sit them up and say, “Well, I think everything looks good. If everything is feeling good then that’s a recipe for me to leave it all alone.” The patient leaves happy, because they don’t want to have any dental work done if they don’t have to. The “worst” dentistry to do is the treatment where they weren’t having any issues before. You recommended they “swap out” their old silver fillings because they are old, the patient comes in and has that done, and then they complain about sensitivity for months afterwards and question you as to why you recommend that treatment in the first place. I fell victim to this line of thinking early in my career. I quickly realized that I was doing more harm than good.
Back to my scenario. You don’t have to market because your word of mouth is all you need. You treat people respectfully, you do your best not to hurt anyone, and your phone rings off the hook of people trying to get in. You’re booked out for weeks and you have a waiting list to fill in when people cancel. You are an in-network provider for Dental Dental and that’s all. You don’t take Medicaid and you don’t have to. You work 4 days a week, or 5 if you want to, and you’re not working evenings or Saturdays and you’ll never have to, if you don’t want to. Practices sell for a percentage of what they collect, and it’s not 110% like I’ve seen in other places I’ve lived. To me, it’s how dentistry was practiced 30+ years ago when the vast majority of practices were solo practitioners and corporate dentistry was in it’s infancy.
These opportunities are still out there, and they are more abundant than you think. The catch is, they are in locations off the beaten path. Sellers of these practices are faced with either selling them for a fraction of what they can produce or closing the doors and getting nothing for them. I never thought I would see practices just close without a buyer, but that’s a reality in many rural communities throughout the country. In the coming articles I will delve deeper into some of the tremendous benefits that I couldn’t even imagine when I moved to a more rural setting to practice. The benefits extend well beyond just practicing dentistry. It improves most aspects of your life, not just your working life. I hope you’ll continue to explore this subculture within dentistry with me.