A growing number of experts are calling for dentists to have a greater role in patients’ overall health care. While the movement has its skeptics, the theory of disruptive innovation and the “jobs-to-be-done” framework suggest that a move toward primary care may be a logical next step. Dentists and primary care physicians (PCPs) could align along value metrics too often missing in health care – access, convenience, and disease prevention. And if designed and executed properly, the expansion of dentistry into primary health may be able to help stem the rising physician shortage.
History tells us it’s not such a radical idea. The cultural and legal barrier between medicine and dentistry is a relatively modern phenomenon. In fact, the earliest medical practitioners were categorized very differently, via two camps: those who dealt with medical problems using tools or instruments and others who treated disease with internal remedies. Teeth were more visible and integrated with the surgical trade. Medieval dentists were usually tradesman like blacksmiths and barbers who had access to scarce metal tools suitable for pulling teeth. But, side effects and bad practices among “street dentists” led to a series of royal decrees in 15th century France banning most dental practice outside of the Guild of Barbers, who also practiced surgery. The clear delineation between dentistry and other types of surgery, however, didn’t happen until the 1850s, when the first dental school was established in Baltimore.
Much later, some dental and surgical specialties actually reintegrated to create oral and maxillofacial surgery. This realignment happened because patients demanded a complex “job-to-be-done”, and the industry responded by merging expertise.
Still, the cultural divide is significant. General dentistry and primary care have largely remained segregated in training and practice. Looking ahead, we foresee two possible ways that general dentistry and primary care practices could achieve closer alignment.
Event #1: Dentists can work with PCPs to streamline the consumer experience. Most customers experience dental and basic primary care problems similarly – they’re both inconveniences to fix as quickly as possible (their “jobs” align). Therefore, it makes sense for dentists and PCPs to offer more coordinated primary care, including oral health. We foresee the creation of “one-stop shops” in an emerging retail health market where patients can receive comprehensive care in streamlined, accessible venues. This dentist-PCP partnership could pave the way for dentists to eventually do other types of non-dental triage. Integration of dentists and PCPs will require a new integrated business model that optimizes around rules-based processes and efficiency.
Event #2: Dentists can potentially disrupt aspects of primary care medicine.
- Need for More PCPs. PCPs will exit unprofitable, low-margin markets and are moving upmarket themselves, often by delegating to PAs or RNs. Dentists also can move into the space created by the PCP upmarket exit and burgeoning population. Although estimates vary, experts agree that the US faces a huge PCP shortage, especially in rural and urban areas. Instead of scrambling to train more doctors, we could repurpose a large dental workforce already interacting with patients. For instance, patients with diabetes have a high risk for peritonitis, or gum inflammation. Dentists can play a role in alerting patients with potential risk profiles as part of dental care.
- Common Training. The two main dental degrees, Doctor of Dental Surgery (DDS) and Dentariae Medicinae Doctor (DMD), involve heavy training in physiology and surgical techniques. Dentists are already trained in many of the same diagnostic tools used in primary care, like X-rays and tissue biopsies. Dentists could possibly handle imaging of simple fractures, since they already have the technical expertise and infrastructure to do the same thing for jawbones.
- Commoditization of Dentistry. Dentistry is becoming commoditized by technology, opening the door for dentists to be disrupted by less skilled practitioners. Dentists spend a large volume of their time cleaning teeth, drilling for cavities and urging preventative care. But skilled dental assistants can now reliably handle much of the dentists’ work volume. This has both reduced the dentist’s value-add and saturated the low-end dental market supply. Dentists will be motivated to move upmarket into primary care because of dental commoditization.
Disruptions in health care provide more affordable solutions to patients who weren’t consuming because of high cost or access issues. Still, cultural challenges will be formidable. The key for dentists is to not become full-fledged PCPs overnight, but to introduce small, but meaningful changes to the traditional model by slowly taking on some of diagnostic responsibilities that can be performed as part of dental practices. Over time, however, the changes will become more profound and significant, eventually establishing a new standard and availability of care.
