You were thrilled when you learned that Dr Kent accepted you as an associate. You graduated from your program last summer, and you were eager to begin treating patients and start whittling down those massive student loans. Your first day at the practice was almost a perfect one. The staff welcomed you enthusiastically, and you immediately felt you could be a viable contributor to all that was good in that place.
A few months pass before Dr Kent allows you to develop your own treatment plans for new patients. That was fine with you, as it took that long to get your bearings on the workings of the practice. Once you begin reviewing diagnostic records, it becomes clear that several of the growing patients need some form of restraint of maxillary growth to attempt correction of their mandibular deficiency. Your residency program used conventional headgear or functional appliance techniques, but when you approached Dr Kent, it was clear that he opposed either mode of therapy. “Neither are good for our image in the community,” he cautioned. “The reputation of our practice is that those treatment options are avoided here. I’ve always publicized our brand in comparison to our other local competitors. What we do is based on what will make us stand out among other practices.”
You suddenly feel as if you are in a dilemma. On one hand, you are as content as you can be as an associate in this practice, but on the other, you know well that the control of maxillary growth is often essential in an attempt to satisfy your treatment objectives. And now you are being restricted from using what you know is required and appropriate for your patients.
Health care, including orthodontics, differs from the typical merchandiser delivery model. In the latter, a posture of caveat emptor—let the buyer beware—is applicable. Most purchase or service agreements are entered with the posture that both the buyer and the seller are entitled to develop an equal knowledge base to approve of the transaction. It is common to use puffery—the vendor’s exaggeration of the benefits of the sale—or even to refrain from revealing all negative aspects of the transaction to incur a commitment. The seller is justified in attempting to maximize profit as long as the buyer is not deceived in any way.
In contrast, shared decision making in the health care arena should be based on the doctor’s intent to do what is physically, mentally, and emotionally best for the patient, irrespective of the anticipated profit. The doctor’s freedom to offer this form of autonomy is essential to his or her happiness and sense of freedom. A 2022 survey of 2100 physicians strongly associated rigid control over decision-making and burnout with dissatisfaction in practice. Only 58% of the physicians surveyed said that the level of autonomy and authority that accompanied their professional life was sufficient for their sustained happiness in practice. The conclusion of the study was that job satisfaction was not about money, but predominantly about freedom and productivity toward achieving positive objectives. The level of autonomy was inversely associated with the physicians’ tendency to seek employment elsewhere. Is that inclination somewhat applicable to the motivation behind the retention of our cherished employees? Many of us know that a staff member’s inclination to leave our practices is based less on salary than on the respect, appreciation, and level of autonomy we afford them, free from micromanagement of their office tasks and obligations. This autonomy confirms that they have earned our trust, as well as our confidence that they hold our patients’ needs and our practice values foremost.
Your discussion with Dr Kent will require all the tact you can muster. You certainly do not want to be critical of his practice philosophy or his clinical decisions. Yet, you know the support that your clinical experience and the available evidence offer. It is a balancing act you cannot afford to ignore.
References
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