Chapter
6
Ethics of Professional Group Dental Practice
Tartismayi kazanabilirsin ama arkadasini kaybedebilirsin.
Mind your goal, as you may win or overcome a dispute but may lose a friend.
Whether a dentist works alone or with other dentists, the doctor–patient relationship and the duty of care remains the same. To adhere to the guidelines of ethical practice, dentists are obligated to provide the best oral health care to their patients regardless of their practice setting.
This chapter will focus on the group private practice, although similar principles may apply to community clinics, federally qualified health care organizations, and other group practice models. The dentist in the group practice must usually work more closely with his colleagues than the dentist in a solo practice. Group practices usually share staff, management, marketing, and facilities as well as patient care. Each of these activities carries with it ethical considerations.
Although adherence to ethical principles will facilitate the functioning of a group practice, it is unlikely that there will be complete agreement on all aspects of ethics between any two or more practitioners. It is therefore necessary for dentists who participate in a group practice to, at a minimum, have shared practice philosophy. If the group practice is to be successful there needs to be agreement about the mission of the practice and whether its purpose is to benefit the management company, the senior partner, the individual practitioners, the patients of the practice, and the community. Although it is conceivable that a successful practice may not necessarily adhere to professional ethical principles, it has been the experience of the author that group practices that adhere to these principles are far more likely to remain viable over the long term. Participants should have a similar approach to patient care, work ethic, staff management and financial management.
In 2010, the American Dental Association’s (ADA) Health Policy Resource Center defined a group practice as five or more dentists. The ADA does not yet have statistics focusing specifically on group practices, but the 2009 ADA Survey of Dental Practice shows that 22% of dentists work in a two-dentist practice and 18.2% of dentists work in practices with more than two dentists, which includes group practices.
Traditional group private practices are usually one-office practices that contain four to seven practitioners plus related staff. Additional practice models that include two or more dentists are Dental Service Organizations (DSO), which are companies that offer practice management, marketing, and administrative services to dentists who own practices. DSO may be engaged by either solo or group practices. There are consolidated organizations in which a corporation or central entity owns or partners with a large number of dental offices each of which might have one to three practitioners. There are dental practice management companies that manage practices owned by dentists. In this model, the dentist determines fees, hours, and patient mix and the management company manages around these decisions. In many states laws that limit corporate ownership of dental practices may apply.
One major incentive for dentists to join a group practice is the high cost of establishing a new practice, particularly in the face of accumulated student debt. Additional benefits include shared staff and facility expenses as well as an economy of scale for supply and capital equipment purchases. An important motivating factor is the ability of the dentist in group practice to delegate management and administrative responsibilities and concentrate on patient care. Particularly for the dental specialties, shared emergency coverage affords free time away from practice responsibilities. There is an opportunity for quality assurance within the group practice through shared oversight of the member dentists.
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