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Why Dentistry Is Separate from Medicine

theatlantic.com

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Re: Why Dentistry Is Separate from Medicine

#101

Post by AnthonyMouse »

maxerickson wrote: post #96
AnthonyMouse wrote: post #92

Earlier quoted context omitted.

The true problem you're identifying is poverty. Dental care isn't outrageously expensive. It doesn't have huge margins or vast inefficiency. The reason people can't afford it is because they're poor . No bureaucratic solution involving government-subsidized dental services is going to produce a better outcome than taking the same money and giving it to those people in cash.

The margins are healthy enough that many dentists work 4 days a week while earning a fantastic living.

Salary isn't margin, it's cost. You have to pay the market rate to convince your dentist to be a dentist instead of a psychiatrist or lawyer or bank manager.

What are you proposing, price controls? Then what do you do when your dentist quits to become a real estate broker?

Re: Why Dentistry Is Separate from Medicine

#102

Post by maxerickson »

AnthonyMouse wrote: post #101
maxerickson wrote: post #96

Earlier quoted context omitted.

The margins are healthy enough that many dentists work 4 days a week while earning a fantastic living.

Salary isn't margin, it's cost. You have to pay the market rate to convince your dentist to be a dentist instead of a psychiatrist or lawyer or bank manager. What are you proposing, price controls? Then what do you do when your dentist quits to become a real estate broker?

I'm not proposing anything. Just stating that dentists make good money on nice hours.

If I was proposing anything, it'd be to make it easier to become a dentist.

Re: Why Dentistry Is Separate from Medicine

#103

Post by LyndsySimon »

PeterisP wrote: post #51
mtdewcmu wrote: post #35

The real question is not why is dentistry kept separate from medicine. The real question is why dental insurance is treated like a luxury, compared to regular health insurance. The problem is that so many people are unable to afford dentistry, because of poor or no coverage.

If you have a type of expense that's (a) unpredictable, and (b) rare, then it's a good fit for insurance. Car crashes are unpredictable and rare, so it makes sense to insure them. Regular car maintenance is predictable and tends to happen in (almost?) every insurance period, so it's not - some payment plan or bundling may be an option, but insurance makes no sense, it would only be more expensive than paying directly…

> If you have a type of expense that's (a) unpredictable, and (b) rare, then it's a good fit for insurance.

That fits fine for things like cleanings, cavities, and implants - but what about impacted wisdom teeth and resultant issues? Broken teeth due to impact injuries? Even people with excellent dental hygiene have a decent chance of chipping a tooth, and even those types of things aren't covered under medical insurance.

Re: Why Dentistry Is Separate from Medicine

#104

Post by AnthonyMouse »

maxerickson wrote: post #102
AnthonyMouse wrote: post #101

Earlier quoted context omitted.

Salary isn't margin, it's cost. You have to pay the market rate to convince your dentist to be a dentist instead of a psychiatrist or lawyer or bank manager. What are you proposing, price controls? Then what do you do when your dentist quits to become a real estate broker?

I'm not proposing anything. Just stating that dentists make good money on nice hours. If I was proposing anything, it'd be to make it easier to become a dentist.

That would certainly make more sense than any kind of public dentistry service, though it's not clear there is a lot of room for improvement there. What makes becoming a dentist hard is, basically, medical school. It's possible there is some low hanging fruit there, but a lot of that hardness is intrinsic.

Re: Why Dentistry Is Separate from Medicine

#105

Post by maxerickson »

AnthonyMouse wrote: post #104
maxerickson wrote: post #102

Earlier quoted context omitted.

I'm not proposing anything. Just stating that dentists make good money on nice hours. If I was proposing anything, it'd be to make it easier to become a dentist.

That would certainly make more sense than any kind of public dentistry service, though it's not clear there is a lot of room for improvement there. What makes becoming a dentist hard is, basically, medical school. It's possible there is some low hanging fruit there, but a lot of that hardness is intrinsic.

In the US dentistry is a separate track.

Many more people would like to become dentists than are accepted into dental schools.

http://www.adea.org/publications/Pages/2009-Applicants-and-E...

Of course having standards is good for patient outcomes. That said, I bet lots and lots (and lots and lots) of the rejected applicants would be fine dentists.

Re: Why Dentistry Is Separate from Medicine

#106

Post by ghaff »

AnthonyMouse wrote: post #92
mtdewcmu wrote: post #88

Earlier quoted context omitted.

It's a market failure if people are suffering due to being unable to afford proper care. It's possible that the blame lies elsewhere than the insurers themselves. Maybe dentists charge too much. But the market isn't providing what people need. The ideal solution would be single-payer, but expanding Obamacare and Medicaid to cover adequate dental services would be a big leap forward.

The true problem you're identifying is poverty. Dental care isn't outrageously expensive. It doesn't have huge margins or vast inefficiency. The reason people can't afford it is because they're poor . No bureaucratic solution involving government-subsidized dental services is going to produce a better outcome than taking the same money and giving it to those people in cash.

There are actually already public dental clinics in many cases with reduced fees for people below certain income levels.

Re: Why Dentistry Is Separate from Medicine

#107

Post by chimeracoder »

maxerickson wrote: post #105
AnthonyMouse wrote: post #104

Earlier quoted context omitted.

That would certainly make more sense than any kind of public dentistry service, though it's not clear there is a lot of room for improvement there. What makes becoming a dentist hard is, basically, medical school. It's possible there is some low hanging fruit there, but a lot of that hardness is intrinsic.

In the US dentistry is a separate track. Many more people would like to become dentists than are accepted into dental schools. http://www.adea.org/publications/Pages/2009-Applicants-and-E... Of course having standards is good for patient outcomes. That said, I bet lots and lots (and lots and lots) of the rejected applicants would be fine dentists.

> Of course having standards is good for patient outcomes. That said, I bet lots and lots (and lots and lots) of the rejected applicants would be fine dentists.

Would you bet your root canal on it?

The fact that there are more people who would like to do something than there are people who are capable of meeting the performance qualifications for it isn't an inherent problem. Only 0.6% of Navy recruits end up becoming SEALs despite 50% of recruits expressing interest. I'm sure there are many, many Navy sailors who would be fine SEALs, but that's neither here nor there.

Unless you're referencing specific evidence that the qualifications are systematically too strict[0], then it doesn't mean much to say that there are rejected applicants who would be fine dentists. And to be blunt, I think it'd be easier to make the case that they're not strict enough.

[0] The working hours and revenue of dentistry practices are not evidence of this

Re: Why Dentistry Is Separate from Medicine

#108

Post by maxerickson »

chimeracoder wrote: post #107
maxerickson wrote: post #105

Earlier quoted context omitted.

In the US dentistry is a separate track. Many more people would like to become dentists than are accepted into dental schools. http://www.adea.org/publications/Pages/2009-Applicants-and-E... Of course having standards is good for patient outcomes. That said, I bet lots and lots (and lots and lots) of the rejected applicants would be fine dentists.

> Of course having standards is good for patient outcomes. That said, I bet lots and lots (and lots and lots) of the rejected applicants would be fine dentists. Would you bet your root canal on it? The fact that there are more people who would like to do something than there are people who are capable of meeting the performance qualifications for it isn't an inherent problem. Only 0.6% of Navy recruits end up becomin…

If the marginal applicants rejected from dental school wouldn't make good dentists, then sure, it's likely the case that the marginal graduates aren't good dentists.

It's not really the case that we learn anything about the capabilities of applicants from the rejection, the number of people admitted to dental schools isn't adjusted to account for particularly good or particularly bad applicant classes.

Re: Why Dentistry Is Separate from Medicine

#109

Post by opo »

madengr wrote: post #90
peteretep wrote: post #59

Earlier quoted context omitted.

> Ophthalmologists Doctor > dermatologist Doctor > general practitioner Doctor > optician Not a doctor

You mean physician. An optometrist typically has a Doctor of Optometry degree. One can argue if that's really a Dr. (I'd say it more like an MS), but nonetheless they could be called Dr. They also write prescriptions for lenses. An optician fits the glasses, which is more like the technician.

An optometry program lasts four years, so that is equivalent to the schooling needed for an MD. (After schooling there is a state and national examination in order to get the license.)

Re: Why Dentistry Is Separate from Medicine

#110

Post by deong »

AnthonyMouse wrote: post #92
mtdewcmu wrote: post #88

Earlier quoted context omitted.

It's a market failure if people are suffering due to being unable to afford proper care. It's possible that the blame lies elsewhere than the insurers themselves. Maybe dentists charge too much. But the market isn't providing what people need. The ideal solution would be single-payer, but expanding Obamacare and Medicaid to cover adequate dental services would be a big leap forward.

The true problem you're identifying is poverty. Dental care isn't outrageously expensive. It doesn't have huge margins or vast inefficiency. The reason people can't afford it is because they're poor . No bureaucratic solution involving government-subsidized dental services is going to produce a better outcome than taking the same money and giving it to those people in cash.

The problem is that poor people need cash for lots of things. If you're poor enough that you can't go to the dentist, you're poor enough to be hurting in any number of ways. If we give you $500 and say, "now this is for the dentist -- save it in case you need it", they're quite rightly going to tell you to fuck off and go buy food and gas for the car to get to work. And then when they need a dentist six months later, we're right back where we started, except with the added shittiness of a bunch of upper middle class conservatives preaching about how they "wasted" the money.
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