Dear RDH,
I found Ms. Lois Chandler-Cousins article [July 1995] interesting but illogical. She makes an odd argument for participation in managed care in alternative sites. She states plainly that the RDH must consider abandonment of private practice (where managed care will result in more work, less pay, and lower standards) in favor of HMOs, nursing homes, hospitals, and schools. However, managed care will exert these same forces regardless of the setting.
The insurance company "managers" would prefer all of us as salaried employees, and they would prefer to pay us as little as possible and treat as many patients as possible to "manage" their profits, no matter where we practice.
It rings hollow to achieve a goal of independent practice, if the insurance companies dictate the standard of care, ration care, and limit compensation.
Dentistry is principally elective health care. It is affordable to the vast majority of the population, not a privileged few. We have controlled costs and kept our part of that bargain. We are being dragged into the vortex of managed care. Managed care - not traditional care - providers will lower the standards. All of us will suffer if we embrace this concept, especially hygienists.
Dental hygiene will always be an integral part of the profession. Independent practice is a goal that should be pursued apart from managed care. The dental community at large has been unreasonably fearful of this concept. Independent practice will be a small percentage of all practice models. It will not undermine traditional practice, but serve as an adjunctive model. The inherent lack of convenience to the consumer in obtaining comprehensive care, and the high overhead involved will make it so. If hygienists are willing, it would be an opportunity to reach underserved populations that is not served by traditional practice.
If hygienists fall prey to the argument that managed care will pave the way toward independent practice, it will weaken our profession. It is vital that the dental hygiene professional not embrace the trend toward managed care. Pursue independent practice as a separate issue.
Barry Parrish, DDS
Benicia, California
