After a busy day at the office, you finally find the chance to review your e-mails. The first message is from your college-aged son. He has forwarded an advertisement from a neighboring orthodontist who has enrolled in a group coupon plan. Among the offers of discounted massages, pedicures, and mushroom pizzas is an advertisement for esthetic orthodontic aligners at a 52% discount. There is only 1 condition: the potential patient must bring the coupon to the office. Simple enough. You feel your heart rate flutter, shake your head in amazement, and turn off your laptop. You’ve had enough of the Internet for one evening.
Unfortunately, this is an authentic case scenario. The 1975 Supreme Court ruling accepting the Federal Trade Commission’s proposal to legalize advertising by health care professionals ended decades of self-regulation in dentistry, medicine, and allied services. The change was predicated on the premise that the previous regulations, which limited advertisements to signage of modest letter height and conservatively printed announcements, deprived consumers of pertinent information about their options in choosing a health care provider. Opponents of the ruling voiced concern that some practitioners would abuse the privilege of advertising and thereby reduce the professional image into that of a commercial entity.
Many ethicists and established practitioners still maintain that competitive advertising is denigrating to our image because it communicates the priority of financial gain over quality care. Welie et al wrote:
Advertising is morally problematic because it assumes a commercial rather than a professional mode of dentistry. The client seeking the best bargain knows he must beware; he knows the seller will try to maximize her own profits. This is part of the game of free market trading. Advertising is one of the tricks used by sellers to lure buyers… away from other sellers. Advertising by dentists likewise fosters competition among dentists rather than a sense of joint responsibility for the quality of professional care.
One might ask whether the 1975 ruling fulfilled its objective of enhancing patient welfare by encouraging free competition and promoting knowledge of available services. Has the liberty afforded to advertising professionals paved the way for a new image of profit that transcends that of a genuine and altruistic caregiver? If all advertisers used discretion in their marketing campaigns, this ruling might be beneficial. But values and judgment vary among people, including health care professionals, and the line between professionalism and commercialism can become thin.
The orthodontist’s involvement with the group-discount advertising is not only detrimental to our specialty’s image, but also might be injurious to the participating orthodontist because he or she forfeits the ability to choose which patients to treat. Although the ethical concept of autonomy includes the patient’s right to freely choose alternative treatment options, it also allows the orthodontist to determine which patients to accept. The participant in a group discount plan relinquishes that freedom of choice because any respondents to the offer are entitled to acceptance by that practice.
By contractual agreement with the “merchant” (the orthodontist), the group coupon administrators maintain the right to control the requisites of the plan, including the percentage of the treatment fee collected. This constitutes “fee splitting” or rebates, which is not only unethical, but illegal.
As gaudy and deprecating advertising becomes more prevalent, one wonders whether future professionals will infer that such is the norm rather than the exception. Do today’s residents appreciate the high level of dignity and trust that our esteemed predecessors have established?
It has taken a century to elevate dentistry and orthodontics to a distinguished status, involving some of the brightest, most trusted, and compassionate providers in all of the health professions. We must be ever vigilant among our own ranks and within ourselves to prevent our profession from regressing to that of a trade.