Executive Outlook: Corporate influence in delivery of dental care

Bryan Edgar, DDS, joins State of Reform’s Executive Outlook as a guest columnist. Dr. Edgar has been practicing dentistry in Federal Way for more than 30 years. He holds the rank of colonel (retired) in the U.S. Army Reserve and serves as president of the Washington State Dental Association.


There is an increasing trend toward expansion and consolidation in many industries, from cell phone carriers and cable companies to banks and mortgage companies. The dental industry is no different and corporate-owned dental practices are slowly spreading.

In its 2012 story, “Corporate dental chains see big profits in adults who can’t afford care,” the Center for Public Integrity catalogues the variety of ways companies motivated by profit over patients are operating. These corporate chains often consolidate the supportive services needed to run a dental practice – from clerical services to equipment leases.

No one disputes that doctors and dentists are subject to competitive pressures when it comes to the business side of their practices. But shareholder-owned corporate entities can tip the equation – at times, with disastrous effect – toward return on investment and away from quality patient care.

Bryan Edgar, DDS, President of the Washington Dental Association

Bryan Edgar, DDS, President of the Washington Dental Association

At the core of the issue is a simple truth: the oath dentists take as health care providers binds them to the best interests of patient health and well-being. This promise is a far cry from the drive to make a buck that motivates some investors in corporate dentistry. Of equal concern is that in situations when outside influence leads to poor quality care, there is no remedy. Washington’s health care disciplinary process relies on the license of the practitioner. If there is no license to sanction, patients have little recourse for substandard care they may have received when it was influenced by non-licensed individuals.

Legislation will be introduced in 2016 that will affirm critical patient protections (such as Washington’s Dentistry Licensure Law, Anti-Rebating Statute, Uniform Disciplinary Act, the federal Anti-Kickback Statute and Physician Self-Referral Law) to ensure that decisions about a patient’s dental care are made first and foremost between a patient and their dentist. There are states where a rush to expand access to dental care has resulted in painful and unnecessary treatment as well as class action lawsuits and even Congressional study. This new legislation ensures Washington state can confirm and clarify the rules in place to protect patients before anyone is harmed.

The bill will require that agreements entered into by dentists and unlicensed, non-dental organizations are set out in advance, reflect fair market value, are commercially reasonable and don’t allow referrals that violate anti-kickback statutes that protect patients from unneeded treatment. Simultaneously, the legislation will continue to support choices in the marketplace for dentists who want to focus less on the administrative and clerical needs of their practice. These simple, straight-forward requirements will help to curb the potential for outside, revenue-driven interests from interfering with patient care and treatment decisions.

Organizations and programs of every kind can be a part of a comprehensive solution that helps people access dental care from licensed professionals committed to their health and well-being. By putting patients first, we can focus our attention on prioritizing dental care and connecting patients to licensed dental professionals who can help them.