Earlier this month, Dr. Richard Chambers received a hand-delivered letter from a representative of the Dental Corporation of Canada, inviting him to chat about future “opportunities” for his family dentistry practice in Victoria.
“I thought, is he trolling me?” Chambers said.
This was the first he’d heard of DCC, but Chambers was very familiar with the company’s brand of corporate dentistry. Operations like this have scooped up hundreds of practices in the U.S. and Australia in recent decades. They work by centralizing clinic management and relying on economy of scale — they’re basically the Walmarts of the dentistry world.
Since its inception in 2011, DCC has become the biggest corporate player in Canada, and it’s still in expansion mode. The company says it runs more than 160 practices across the country, including up to 30 in B.C.
Independent dentists like Chambers worry about whether big dental corporations are putting patient care first.
“I think that dentistry is about more than just about looking at people’s teeth and putting fillings in. You develop relationships with people,” Chambers said.
“It seems that when these corporations take over, the dentist is no more than a cog in the machine.”
Corporate dentistry is a relatively new phenomenon in Canada, although optometry and pharmacy both went down this road long ago. The Canadian Dental Association estimates only two per cent of practices in this country are owned by corporate players.
But that figure is rising, and that’s a big concern for Nadean Burkett, a dental management specialist who started her career nearly 40 years ago as a chair-side assistant.
“Everything that is happening will have some kind of effect on the quality of patient care, access to patient care, and the patient’s right to choose,” she said.
Burkett began looking into the issue when she heard that the Ontario Teachers’ Pension Plan had cashed out its investment in the Toronto Maple Leafs and bought a $1.3-billion controlling share in the U.S. firm Heartland Dental.
Only dentists are allowed to own dental practices in Canada and most parts of the U.S., so Burkett was left scratching her head: How was Heartland allowed to operate 375 American clinics?
“What I learned was … they have what they call nominee dentists, which are registered with the regulatory body as the owner of that practice,” she said.
“They will buy the assets out of a company owned by a dentist, stripping it clean of all of the assets, but the (nominee dentist) still stays registered with the college.”
She was surprised to learn that similar dental corporations were popping up across Canada. DCC had no advertising presence, but she discovered it was an offshoot of the highly successful Dental Corporation of Australia.
Another major company in B.C. is 123Dentist, which markets and manages about 70 practices in the Lower Mainland. However, 123Dentist only has ownership stakes of up to 50 per cent in about half of the practices it works with, according to a company representative.
And 123Dentist is highly visible to the public, through extensive advertising and Facebook giveaway contests.
DCC, on the other hand, doesn’t list any of its locations on its website, and none of its practices display their affiliation in their offices or online.
“From the perspective of the public — to me — this is a huge problem, because I would want to know who is controlling my oral care,” Burkett said.
That lack of marketing is very deliberate decision by the company, according to CEO Graham Rosenberg.
“We demand that our practices maintain their individual brands and the brand equity of the individual practitioners that own them and that work in them,” he said.
It’s company policy to never do interviews with the press, but Rosenberg said he made an exception to address up what he described as the misnomer of corporate dentistry.
“It’s an attempt to miscommunicate what the substance is of what companies like us do, which is to support the growth ambitions of general and specialist dental practitioners across the country, and to do it in a way that allows them to realize the value of their practice while continuing to deliver patient care with complete clinical and day-to-day operating autonomy,” Rosenberg said.
He stressed that his company “partners” with dental practitioners — dentists are still the registered owners of their practices — but declined to go into any detail about DCC’s agreements with those partners.
Dentists who have received offers from DCC describe the proposals as extremely generous. After selling, they become part of a company that can afford all the latest technology, while washing their hands of annoying administrative matters.
“What it does is it gives dentists a choice as to how they want to practise: Do you practise on your own?” Rosenberg said. “Do you want to ultimately sell out to one of your associates as a dentist, or do you want to sell out to a company like us who can continue to support you?”
Still, Burkett believes that the College of Dental Surgeons of B.C. needs to investigate the burgeoning corporate dentistry industry to make sure everything is above board.
“It actually needs to be regulated. That’s what it needs. And it needs to be transparent. You need to know if you’re going to a corporate office,” Burkett said.
Of particular interest is whether any companies are enacting the production quotas that have been reported elsewhere, wherein dentists agree to keep their billing revenue at a certain level or pay a penalty. The worry is that quotas could encourage practitioners to push unnecessary, expensive procedures.
Both DCC and 123Dentist say they do not use quotas, and the college says it hasn’t received any complaints about the practice in B.C.
College registrar Jerome Marburg said that any company found to be using quotas would be censured.
“That has no place in dentistry — absolutely no place in dentistry,” Marburg said.
The college requires an official complaint before it will initiate an investigation into any dentist or corporation, but Marburg stressed that every practice in the province is held to the same standards.
“Every dentist has a professional obligation to put the oral health care needs of their patients first and foremost over other considerations. If they don’t do that, that is an ethical breach,” he said.
Burkett has decided to combat the corporate influence by creating the Doctor Owned & Operated Network, a site where patients can search for independent dentists and practitioners can connect with their peers.
“If there’s not going to be any transparency by the corporates, we’ll have transparency by independent practices,” Burkett said.
