What is Your Practice Model?

Posted on January 7, 2017

Where is the profession of dentistry headed? That is the multi-billion dollar question many in and around dentistry are always asking.

Avrom King, was particularly interested in this question, as he was both a social psychologist working in dentistry as well as a “futurist”, attempting to project what dentistry would look like 10-30 years ahead of time.

Back in the 1970’s Avrom identified social, technological, and cultural trends which he then interpreted and then projected as a likely future.

Avrom saw dentistry essentially fragmenting into three functionally different professions – all providing dental services, but all providing them under different business models and with different missions.

Avrom identified these three distinctions as “The Three Tiers”, with Tier I being “closed panel” service providers where patients are restricted to who and where they go. Consequently, they are in a dependency relationship with the provider who will offer care under their institution’s philosophy and mission.

A good example of Tier I is military dental care, which tends to be basic, immediately functional, and not particularly focused on the long-term health of the patient. This is because the purpose of military dentistry is “readiness” – can the person defend the country today without a significant level of distraction caused by dental problems? This does not make military dentistry bad or low in quality, as it is neither of those, but because of the transient nature of contact with patients, military dentists function more on an intervention level than on a prevention and health-development level. Another example of Tier I is the British National Health Service.

Avrom identified Tier II as “the merger of the entrepreneurial model with fee-for-service dentistry”, where “marketers and systems engineers realize maximal profit in the delivery of dentistry.” Notice the different mission from Tier I – maximal profit. Notice also that health promotion is not the primary purpose of the organization. This type of practice model is called “transactional” by some, where money or insurance benefit is traded for a service. Although health care services are provided, this does not necessarily make the transactions health-centered. Some patients successfully pursue health within the practice model, while many do not and remain in a passive-dependent relationship with the Care Team.

Avrom also projected the evolution of what he identified as “Tier III” which was fee-for-service, independent, and built around a “Wellness Model”, where the focus was not so much on the repairing of deficits (although this does happen there), but on the pursuit of more “wholeness” as personally defined by the individual client. This is achieved through a significant helping relationship which is intentionally established between by the Care Team with the client. (The word “client” is used here to signify that the relationship that the person has with the practice is both voluntary and growth-oriented as in Rogerian psychology model). “Health” in this case is individually defined and intentionally pursued by the client, and the Care Team is used as a resource by the client to pursue that purpose. Hence we have a third and different practice philosophy in Tier III – a developmental philosophy centered around helping others grow and move more and more toward health.*

Where do you see your practice and career path today? Does it align with one of Avrom King’s Tiers? If so, in what ways? Why? And is that where you would like to be positioned professionally long-term?

Paul A Henny DDS

*It was interesting to read that the FDI Dental World Federation’s new definition of oral health is as follows, and the achievement of such a goal is beyond the capacity of all transactional practices.

“Oral health is multifaceted and includes the ability to speak, smile, smell, taste, touch, chew, swallow, and convey a range of emotions through facial expressions with confidence and without pain, discomfort, and disease of the craniofacial complex.”

More than 200 national dental organizations, including the American Dental Association, adopted the new definition.