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By: Victor M. Sternberg, D.M.D.
October 4, 2024
Many of us have observed the enormous changes in healthcare institutions. What used to be the Mount Kisco Medical Group became the Caremount Medical Group and now has become Optum Healthcare.
Individual practitioners have been absorbed by these different corporations, whether it be Langone, Montefiore or Columbia Presbyterian.
The absorption of all physicians into these groups has created a corporate environment where physicians are now employees or providers and are evaluated based upon the income they generate for the institutions. Patients, more often than not, become a source of insurance revenue for these monolithic hospital groups.
A particular personal example comes to mind.
A very prominent cardiologist in our community who practiced for 45 years had his practice absorbed into the Optum Healthcare organization. He wanted to slow down and spend more time with his patients. One day, without notice, representatives from Optum came to his office and told him he was no longer an employee of the organization; please clean out your desk and leave. He was not producing enough income to justify his continued maintenance as a member of an organization where the bottom line had become more important than retaining experienced, committed physicians.
If you remember, when we adopted Obamacare early in the administration of Barack Obama, we were promised two things. One was that we could keep our physicians and more importantly, medical costs would go down.
Being an individual who pays for the healthcare for a number of my employees, I have watched the premiums accelerate at a rate far faster than inflation.
I am not offering an answer to this conundrum of providing healthcare and the enormous costs except to say that having 600 patients over 80 years old and 110 over 90 years old, the burdens on Medicare are exceeding our ability for all the services our population will require. These issues require an adult conversation. Unfortunately, all conversations at the political level are only based upon which party will seek power.
In dentistry, another form of corporatization is taking place. Many practitioners who have reached a point in their careers when they want to slow down or retire, are selling their practices to hedge funds and other corporate entities. This enables the doctor to recoup greater value for his practice than would be received by selling it to another practitioner. However, this creates another problem.
The corporations or hedge funds have only one interest. The monetization of the practice in order to increase revenue so that the investors make a profit.
What has exacerbated this problem is that young practitioners, graduating from dental school and/or graduate school with a special degree such as I had, are incurring often between $500,000 and $750,000 of debt as they pursue their college, dental school and graduate degrees.
This makes affording a dental practice for the vast majority impossible, thus there is a large network of practitioners who are willing to work for a corporate practice to at least pay their rent while they struggle to pay back their loans.
Having watched this all too often, I’ve also observed that patients then become similar to the medical model, a means to an end rather than as a patient whose needs are to be met.
The holy shrine of the cost of higher education has not been challenged. Aside from the fact that the level of education that our institutions of higher education are providing is significantly lower than existed 50 years ago, the cost in many cases is ten times higher.
The first question is why, and the second question is should education costs be an important national issue? As Thomas Jefferson said, “our democracy can only survive if we have an educated populous that can make clear distinctions and decisions.”
As I have mentioned before, indebtedness has followed education, but knowledge and critical thinking has not. This is leading to some of the problems allowing the corporatization since young practitioners are no longer in a position to start or purchase a practice.
Two issues now that are near and dear to home. Many patients in my dental community use some form of device for sleep apnea. This condition can be very serious, and even life threatening. One of the devices that is often employed to increase the oxygen flow while you sleep is a mask that provides you with a constant flow of oxygen.
Recently a patient came to me exhibiting severe recession of their gums, around the two upper eye teeth which are on the corners of the upper jaw, that had not existed before. The 85-year-old gentleman presented with an infection in one of those teeth and a great loss of gum tissue. I surgically corrected that area and did not see him again for about a year. When I saw him the second time, I noticed that not only had the gums receded even further, but it had also occurred on the tooth on the other side. He showed me the mask he was wearing at night and it was clear that it was applying direct pressure right over his lip at the corners of his mouth. Thus, for eight hours a night, that pressure was being applied not only to his lips, which were not the problem, but the thin gum tissue over his teeth, resulting in the severe recession around his two upper cuspid teeth.
We switched him to a mask that was much wider so it would only rest on his cheekbones, eliminating pressure from his upper lip.
I have discussed this with many of my colleagues who have also observed a similar phenomenon, but never tied it to the masks their patients were wearing. A word to the wise. If you are wearing one of these masks, make sure that the mask rests on your cheekbones and not firmly against your upper lip.
One final note. A recent article in the New York Times discussed silver amalgam fillings. The amalgam fillings had become a standby early in the 20th century to restore teeth that had dental decay. They became the standard of care right through the 60’s and into the 70’s and was taught at all dental schools as the sine qua non of restoring decayed teeth.
It was only when the decay was so extensive or the tooth broke that a crown was fabricated. I’m sure many of you have experienced that in your own dental history.
However, beginning in the late 70’s there was concern about the mercury that was in silver amalgam restorations. With no scientific evidence, it was postulated that this mercury could cause health issues if it remained in your mouth in these restorations for a long period of time. Thus, dentists stop doing amalgam restorations. Restorations that were needed in the future were tooth-colored restorations made of a plastic-like material.
Now, further down the road, epidemiological studies comparing populations with amalgam restorations and those without have revealed that there is absolutely no safety issue. In fact the only time that mercury gets into your oral cavity is when a dentist removes one of these amalgam restorations and the particles fill up your oral cavity until they are suctioned out. It is now considered unethical in dentistry to remove an amalgam restoration unless the patient has decay or it is broken badly and being replaced with another material.
I have observed in my practice, where many of my patients are senior citizens and as I mentioned 110 are over 90 years old, that some patients have had amalgam restorations for over seventy years.
It was, and still remains, the best long-term restoration for natural teeth when there’s decay, as long as there is enough tooth structure around it to prevent it from breaking.
So just a word of advice. If someone wants to remove your amalgam restorations that have been there for a long time that do not have decay or have not broken, please use this information to make an informed decision.
Science has, unfortunately, become politicized, even in the field of dentistry as it has in other venues of our lives.
As always, I appreciate your feedback.
Yours truly,
Victor M. Sternberg, D.M.D.
By Westchester Center for Periodontal & Implant Excellence
December 31, 2023
