Your curiosity became aroused when you started to see a trend. Bob has a thriving pedodontic practice. Although he had not been a consistent referrer as long as you’ve known him, his patients used to enroll in your service as soon as they met you. But within the last year, you’ve noticed a curious trend. Your conversion rate among his patients seems to be approaching zero. You haven’t changed your chairside approach or your fees, but lately his patients disappear after your initial examination. Your sister-in-law helped unfold the mystery. Apparently, Bob hired a young orthodontist who had a nefarious plan. She’d ask the parents of Bob’s patients to bring their children to her only after a consultation was conducted elsewhere. Then she would ask the parents the fee quoted by the preceding orthodontist and propose her services at a considerably reduced fee—sometimes $1000 less than the previous estimate. Her intent was “to make the parent an offer he or she couldn’t refuse.” You are unsure if Bob is aware of this modus operandi, but he mentioned candidly that the volume of orthodontic patients who now remain in his practice had grown significantly. It’s a tricky maneuver, but if cost is equating a parent’s choice to the selection of an orthodontic provider, this scheme seems to be highly effective.
The coronavirus pandemic has evoked some interesting behavior patterns. Aware of the keen need for vaccinations, a 22-year-old graduate student envisioned an opportunity to convert the nightmare into a quick profit. What began as a small cadre of college friends intended to provide a benevolent gesture to address the crisis in Philadelphia ended in a perverse effort to capitalize on the city’s desire for prompt vaccine distribution. This psychology major from a local university—with no experience or education in health care—devised a plan to swiftly vaccinate 500,000 to 1.5 million people. He planned to construct multiple venues to vaccinate 10,000 patients a day. The city saw the plan as a potential outreach to its diverse population, especially for those who otherwise might not have access to the vaccine. But once this conniver enticed the city’s leadership with the plan, he deftly converted the enterprise into a for-profit company. He planned to bill insurance $24 per dose, intended to generate a quick profit of between $12 and $36 million. He recommended ignoring established vaccination practices, claiming that the time-consuming vaccination protocol and postinjection observation period “can mostly go out the window.” Fortunately, Philadelphia’s leadership realized that his motivation was far more entrepreneurial than benevolent, and abandoned the plan. But not before he made off with a quantity of vaccine for distribution to other people of his choosing.
Aristotle believed that one of the distinguishing characteristics of humans is that they strive to coexist in social harmony. Ethics provides the guidance for such interaction and is fueled by an individual’s conscience to do social good. This is the essence of responsible citizenship . Responsible citizenship involves interaction between community members to aid and support others, and in so doing, promotes overall social benefit. Good citizenship precludes selfishness, greed, and other self-serving behavior. It’s the antithesis of the attitude that “it’s a dog-eat-dog world” in which success reigns supreme, even at the cost of harming your neighbor to advance your own interests. It’s upholding the virtues we learned long before we knew what an edgewise bracket was. Good citizenship is a concept that is not only essential among those in our specialty, but is also imperative in sustaining the morale and fellowship of us as constructive members of our great country.
One would hope that if Bob knew his orthodontic associate’s strategy, he’d demand that she cease her antics immediately. Bob, like any good citizen, should know that when it becomes “every man for himself, the tribe ceases to be a tribe.”