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Dentistry’s dilemma

Dr. Tim Herman, left, a dentist with Personalized Dental Care of Lincoln and Roseville, consults with patient Ruth Lockman of Roseville at the practice’s Rocklin, Calif., office in October.  (Manny Crisostomo/Sacramento Bee/MCT)

Dr. Tim Herman, left, a dentist with Personalized Dental Care of Lincoln and Roseville, consults with patient Ruth Lockman of Roseville at the practice’s Rocklin, Calif., office in October. (Manny Crisostomo/Sacramento Bee/MCT)

SACRAMENTO, Calif. – It’s not the old-school way of doing dentistry.

At the Roseville and Lincoln offices he oversees, dentist Tim Herman has seven dentists, with different expertise in dentures, crowns, extractions or root canals. On weekdays, they start seeing patients as early as 7 a.m. and stay open as late as 7 p.m.

Last May, the group added Saturday hours, handling emergencies and routine appointments for six hours straight. In addition, they’ve got an orthodontist for braces and a periodontist for gum treatments and tooth implants, both of whom work as independent contractors.

For Herman, who’s been practicing since 1989, it’s all about adapting to what patients want.

“One of our biggest challenges: People truly don’t want to go to the dentist. So we’re in competition for their discretionary dollar,” said Herman, 52, head of A+ Personalized Dental Care. “I have patients come in and say, ‘Oh that (treatment) is so expensive,’ but they’ve just spent $200 on the slot machines in Reno. … It’s a reality we all live with.”

Like Herman, America’s dentists are stuck with a major, nagging toothache: Not enough people are going to the dentist; those who do don’t spend much.

And it’s been true for the last decade, well before the last recession, says the American Dental Association, which calls the current environment a “watershed moment” for dentistry.

Only 61.6 percent of adults, ages 18 to 64, said they saw a dentist in 2011, according to the most recent data by the National Center for Health Statistics. That’s a drop of nearly 4 percent from 1997.

Likewise, per-patient expenditures on dental care in recent years have largely flat-lined for children and working-age adults. And the outlook is bleak, ranging from 0.22 percent to 1.25 percent annual increases in per-patient spending over the next decade, according to the ADA. That compares with almost 3.9 percent a year between 1996 and 2002.

Further, the ADA noted, two out of five American dentists say “they are not busy enough and can see more patients,” a significant increase over prior years. Overall, the “near-stagnant growth seen in the last few years may be the ‘new normal,'” the ADA said in a recent report, “A Profession in Transition.”

A combination of factors are reshaping the dentistry mold. Dental benefits by employers are eroding. Reimbursements rates by insurers are stagnant. Some patients are postponing – or giving up – their routine dental care.

“Dentistry becomes the easy part … the hard part is managing the business,” said JoAnne Tanner, a Northern California dental management consultant based in Granite Bay.

For many, it’s about scrambling to figure out a new future. For some, like Herman, that means staggered scheduling and Saturday office hours in order to accommodate working adults, the folks mostly likely to have dental insurance. Or bringing in specialists as independent contractors, so that fewer patients have to be referred elsewhere for treatments.

“Dentists who are still only open 8 to 5, Monday through Thursday, are struggling,” said Tanner, a former U.S. Navy hygienist and business school graduate who’s done dental consulting for 20 years. “Patients don’t want to take time off from work to get a routine cleaning. They want to come in before or after work.”

Nor are dentists getting any pain relief from the new Affordable Care Act. Dental care isn’t among the “essential” health-care benefits to which all American adults are now entitled.

Although tooth care for children is a mandatory benefit, the low reimbursement rates are not expected to add much to regular dentists’ bottom lines.

Like all health-care providers, dentists are being pressured to bite down on costs, not only by insurers but by government, employers and consumers.

“It’s more and more expensive to operate a dental practice. It’s increasingly difficult for the fees to sustain a practice,” said Dr. Lindsey Robinson, president of the California Dental Association.

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