Frank conversation with Florida dentist Dr. Michael Barr
by Dr. Michael W. Davis
Dr. Michael Barr is a private care general dentist at Palm Beach Smiles in Boynton Beach, Florida. He began his dental career spending three years in the U.S. Navy. Two of those years were onboard an aircraft carrier, the USS Independence, which was the first response in the Persian Gulf (Operation Desert Shield).
Dr. Barr’s dental passions include Cosmetic and Reconstructive Dentistry. He served on the board of the local affiliate dental association (South Palm Beach County Dental Association) up to President. He has also served on the board and as a lecturer and clinical instructor (currently) at the Atlantic Coast Dental Research Clinic. He writes an eclectic blog about dentistry, marketing, current dental events, and frequent musings about personal safety, security, and armed self-defense at www.TheDentalWarrior.com. You can also find him stirring the pot on DentalTown.com.
Question 1
Dr. Davis: Dr. Barr, you’ve been very outspoken on how government administered healthcare like dental Medicaid has not served the public favorably. We’ve seen disadvantaged patients abused, taxpayer monies wasted, and ethical caring doctors forced out of this dysfunctional government program. Please give our readers an overview of your perspectives.
Dr. Barr: I have not had any personal exposure to Medicaid. But, my first “wake-up call” was when a dentist posted (on DentalTown) about his run-in “with the law” as a Medicaid dentist. He ended up doing time in prison for, if I recall correctly, $5,000 worth of administrative errors over the course of five years. He lost everything.
Another frightening case involved Dr. Morse, in New York. He was suspected of Medicaid fraud. They shut down his practice. The state attorney was intent on “cracking down” on Medicaid fraud (and make examples of the offending doctors). The short version of the story is that not only was this dentist exonerated, but the state attorney’s office was found to have fabricated false evidence against him. In such cases, the defendant can sue the state. And, so he did… and won a $7 million settlement. Of course, it dragged on for 11 years and made it all the way to the Supreme Court. (No kidding!) You can read about his case (and others) in my blog and read Dr. Morse’s own comments at the bottom of my article.
I wouldn’t accept Medicaid if they offered to pay double my fees. If you are suspected of fraud, you can be shut down BEFORE Due Process. You can have your assets frozen or seized BEFORE Due Process. It can take years to clear your name, and even then, you’ve already lost everything. No thanks. No way. Never. Too risky.
Question 2
Dr. Davis: Dr. Barr, could you give us your ideas on a few mechanisms, which might help ameliorate our toxic dental Medicaid program? Further, what suggestions might you offer for a financially disadvantaged parent who relies on the dental Medicaid program for their children?
Dr. Barr: I honestly don’t know the answer, but I’ll submit that the answer to these problems is never made better by government involvement. In some areas, there are other charitable programs run by various agencies, including dental organizations. I think most dentists would gladly donate some time periodically, if it meant they didn’t have to sign their Rights away, risking their livelihoods and even liberty.
Most of us are willing to pitch in and help the less fortunate… on our OWN terms. No government strings attached! Many of us DO exactly that, quietly, without fanfare or publicity, in our private practices. But, as soon as the government gets involved, it’s a treacherous minefield. If there was a way to remove those significant risks, I think many dentists would be more enthusiastic.
Of course, there is the issue of dismal reimbursement by Medicaid. But, an even bigger issue, from what I hear, is the lack of reliability and accountability of Medicaid patients who miss some 50% of their appointments. This causes all kinds of problems, all of which cost the dentist even more money.
Question 3
Dr. Davis: You’ve been a highly outspoken critic of the dental insurance industry. You’ve highlighted numbers of insurance issues, from subtle misrepresentations to blatant deception and lies. What would you like to advise our readers in the public, which best serves, themselves and their families?
Dr. Barr: I believe it’s difficult, if not impossible, for people like us to change the minds of the public about so-called “insurance.” Many people believe they MUST have insurance in order to obtain preventive dental care. They have become emotionally reliant on it. As you and I know, “dental insurance” isn’t insurance at all. It doesn’t behave like actual insurance. It’s a pre-paid dental benefit. Or as my friend, Dr. Alan Mead, aptly called it, “a gift card from a control freak.” But, it’s a tall order to convince the public that it isn’t “insurance.”
The typical dental plan, invented in the mid 1960s, had a $1,000 maximum annual benefit. Back in the 60s, $1,000 went a long way towards repairing a mouthful of dental problems. Today, 50 years later, the maximum annual benefit remains at $1,000. Dentists now call that “Tooth of the Year Club.” If we were to inflate that 1965 value of $1,000, it should be close to $8,000 of benefits today. The maximum annual benefit (in pure dollars) has not increased in over 50 years! If we factor in inflation, it’s decreased by 88%.
There’s a reason the names on the tallest buildings in our major cities are insurance companies. They didn’t get there by paying out dental benefits.
The best bet for most patients would be to put away ~$50 / month in a savings account rather than giving it to the insurance companies.
Some offices, like my own, offer patients an in-house membership-based dental savings program (like Quality Dental Plan). It’s not insurance. It’s better, actually. It’s similar to a Costco or Sam’s Club membership. Members get very real and significant savings on dental care without the insurance company middle man. It’s an agreement directly between the patient and the dentist, as it should be.
Question 4
Dr. Davis: Dr. Barr, organized dental groups such as the American Dental Association (ADA) are experiencing a progressing and substantial decline in membership. One might assume, national organized dental groups could be positioned to mutually serve interests of the dental profession and the public welfare. The ADA too often falls short of these goals. What are your perspectives?
Dr. Barr: I could go on a long time about this! The ADA has lost sight of what it means to support practicing private dentists. From what I’ve been told, they’ve gone from an 85% market share to ~55% in the last several years. That’s a problem, and the problem lies within the ADA. In my opinion, they have utterly failed to recognize or acknowledge what dentists expect and need from them, which is to support THEM (rather than primarily cater to corporate dentistry and the insurance industry).
Some of the executive positions at the ADA headquarters are former insurance company executives. Can you say, “conflict of interest?” Furthermore, according to my research, 44% of all revenue goes to pay salaries and benefits for the ADA. My state dental association spent 47% of its revenue just on salaries and benefits in 2014 (filed form 990). By comparison, the NRA spends 13% of revenue on ALL administrative expenses. Arguably and objectively, whether you agree with them or not, the NRA is a far more effective organization than the ADA. I compared the two in more detail in an article on my blog.
When the typical tripartite dues for an ADA member approaches $1,200, a dentist MUST ask himself or herself, “What am I getting for that money?” And, the answer(s) SHOULD come easily. But, apparently, for half of the dentists in the U.S. (and increasing), the answer is elusive at best, and painfully and obviously absent at worst. The VALUE is not there.
Today’s dental graduates are burdened with $300,000 - $500,000+ in JUST education debt. The local private dental school here charges $62,000 / year tuition. The same school pays adjunct faculty / clinical instructors $100 / day. I turned down an opportunity to become adjunct faculty for that reason. The numbers are just CRAZY. The new graduates will likely never own a private care practice. Most have to go to work for corporate dental stores and struggle to cover a very large after-tax school loan payment. That’s never minding the ethics of reported pressure to “produce” in corporate dentistry combined with the need to make those big student loan payments.
So, what do THEY get from a $1,200 per year ADA membership? Why on Earth would young dentists be interested in joining “organized dentistry?” This is a BIG problem, not only for those recent graduates, but also for those dentists looking to retire and sell their practices in the future. I think this may be the single biggest threat to dentistry as we have known it.
If the ADA doesn’t figure this out soon, the trend of diminishing membership will continue, and they will fade into oblivion. I fully expect that to happen… sooner rather than later.
Question 5
Dr. Davis: We’ve both witnessed a growing segment of the public, which is hungry to develop a long-term relationship with a dentist they can trust. These dental patients or their families may have formerly experienced some highly disturbing and problematic dental care. Often this is from a corporate dental chain, and other times not. What advise can you offer the public?
Dr. Barr: Do your homework, and decide what is important to you when you consider dental care. Dentistry is a service, not a commodity. A crown isn’t a crown isn’t a crown, so to speak. Attention to detail and quality can vary, of course. And, that can be true for corporate chains and private offices.
Can you get a personal recommendation from a friend or coworker? Research the office online, too.
I recommend that people follow their instincts, as well. Your instincts will rarely deceive you. How did they answer the phone when you called the first time? Was the person who answered the phone attentive? Interested? Or short and distracted? How do you FEEL when you’re at the dental office? What is the vibe? Do they pay attention to you? Do they LISTEN to you? Do you feel informed about your treatment options and costs? Do you feel welcome and comfortable?
Conclusion
Dr. Davis: I can’t begin to thank Dr. Michael Barr for his selfless efforts in answering these questions for our readers, but more importantly his service to the dental profession and raising public awareness on dental health matters. I absolutely believe Dr. Barr’s most important contributions are yet to come.
Dr. Barr: I remain cautiously optimistic about the future of dentistry and our country. I am beginning to see hints of a new trend leading away from dependence and an increasing trend of self-reliance and accountability. Those who claim to be our leaders and have our interests at heart should be held accountable to those stated goals. Einstein famously defined insanity as “doing the same thing over and expecting a different result.” It’s time for those of us “in the trenches” to stand our ground and take charge. It’s time to do things differently and hold our “leaders’” feet to the fire.
