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Daily Bite- Sept 2012
47% are freezing pay raises 39% are reducing/eliminating overtime 38% are cutting hours 36% are laying off technicians 25% are reducing/eliminating bonuses 16% are reducing/eliminating health insurance benefits 8% are cutting salaries 7% are instituting forces, unpaid vacations (percentages total more than 100 because respondents could select more than one answer)
LMT Original Research © 2010 - 2013
I find the China debate to be very interesting yet perplexing. Some continue to believe that the problems faced by today's lab owners are in some measure due to the Chinese. This is akin to standing at the plate and taking a called strike while swatting a gnat. If we don't keep our eyes on the ball, the game will be over before we realized what happened. While some dental laboratories might be adversely affected by offshore products, pricing pressures are occurring industry-wide and are mostly coming from the insurance industry. Specifically,...See more the insurance industry has depressed reimbursements to the point that many dental offices are fighting to keep their doors open. As a result, price pressures continuing downstream are falling on every domestic dental laboratory and manufacturer. Blessed with a bad economy, the insurance companies are continuing to promise purchasers even lower prices in the future while their margins remain healthy. All that, combined with inefficient laboratory business models, and we have a called strike! But the insurance companies are not entirely to blame. Dental industry silence plays a role and it comes in the absence of a unified voice sounding a singular purpose. The insurance companies have branded themselves with a single purpose cost control and now are the gateways for dental care, while we have done little. Despite the excellent leadership offered by dentist, laboratory and manufacturer organizations, the industry as a whole has been ineffective as guardians of care services. While each disparate organization has been tending to the unique needs of its members, we have failed to brand ourselves as the gateway and best keepers for patient care. As a result, the insurance industry has filled the void, wedged itself between patients and dentists, de-branded the profession and marginalized the entire dental industry. Today, the insurance industry defines itself as the keepers of quality care and the agents for dentist credentialing. It has presented itself as the "good cop" to protect beneficiaries from potential abuse and as the expert in keeping costs to a minimum. Today, thanks to our slumbering, consumers seek their dentists through insurance company websites, a clear indication of how the care brand is owned and controlled by a force we have failed to reckon with. The net result affects each sector of our industry in destructive ways and leaves consumers vulnerable to those with no experience in care delivery. I suggest a meeting of representative leadership from the aforementioned organizations to help develop a unified voice and message, and a strategy with which to deliver it, something OPT-In a national cooperative of small laboratories is currently working on. Let's take our eyes off the gnat and prepare for the next pitch. That's the only way to have any chance of remaining in the game. Dean Mersky, DDS Founder, OPT-In Dental Lab Cooperative
I'm a dental assistant with expanded functions in prosthodontics. I learned a long time ago that technicians have so much to teach assistants and doctors. I've worked with many of them to keep communication open between the lab and the office and promoted [the importance of communication] in an article I wrote with T.G. Hornischer. I'm passionate about small business and regret the slow demise of dental labs. In the U.S. our labs are dwindling while more students graduate from dental school and more dental schools are opening. In flipping through...See more LMT's June/July issue, I saw all the outsourcing ads--$23 to China! Beijing!--and then I looked at the cover story, The Future of the Small Laboratory: Grim or Great?, and thought to myself, "What the heck?!" I take issue with these Classified ads. Here we are trying to keep our labs in business, promote American-made products, promote American workers, promote our dental labs in general, mandate where our work is coming from and keep our patients safe. Yet the messages I see in these ads are: fire your lab employees, send your stuff overseas and save money. Is LMT that desperate for advertising dollars that it wants any company that can pay for an ad? I personally think this is an outrage! Many people look to LMT as a good source of information; this kind of advertising is uncalled for. Want me to answer the question of "grim or great"?¯ about labs? It's outsourcing like this that's causing the problem and you are helping to promote it. I don't understand it, and I don't like it!
In response to Claus Dampmann's letter, Labor--Not Material Costs--is Key Factor Driving Selling Price of Chinese Crowns, in your June/July issue, please allow me to point out some things he failed to mention. While it's true that ProLab Solutions, Inc. and many other offshore labs are FDA-, ISO- and DAMAS-compliant, many of the American labs that buy crowns and bridges from them are not. Also, even though ProLab Solutions is "very supportive of full disclosure"¯ the same can't be said for a great number of its lab customers. Dampmann is...See more either naive or less than forthright when he states that offshore outsourcing is only labor driven. If a 10-person lab grossing $1.5 million per year decided to outsource 50% of its work to China (for $40 per unit or less), five technicians at that lab lose their jobs, American dental suppliers lose 50% of that lab's annual purchases, American refiners lose 50% of the lab's scrap business, and the list goes on and on. It's irresponsible to claim that all of this is driven by the "lack of new technicians entering the dental laboratory profession." By facilitating the cheapening of our profession, the offshore business model has helped make it a less attractive field to enter and, consequently, many of our technical training programs have closed their doors. I personally know of several labs that have fired most of their technicians because they can get restorations from China much cheaper than those they themselves can produce. Finally, let's call a spade a spade. In the end, outsourcing to China is a greed-driven business model that's undermining the future of dental technology in the U.S. ~ Bill Thomas, CDT, President Smile Science, Inc. Cleveland, GA
A counter viewpoint to those who have concerns about the materials being used in China.
Dear LMT: A recent issue of Dentistry Today featured an article, "Dental Lab Registration: Dentists Leading the Way", written by attorney and NADL Chief Staff Executive Eric Thorn, who points out some interesting trends in states that are creating legislation or proposals requiring dental lab registration (including Virginia, Georgia, Minnesota, New York, New Jersey, California and Washington). Thorn says that, in many cases, the reason for the growing push for lab registration is the leadership of dentists and state dental associations. I wrote...See more a letter to Dentistry Today in response to the article, and also wanted to share some of my sentiments with other lab owners through LMT. Are dentists really leading the way? If so, which way? Dental laboratories, I would argue, are most interested in engaging, educating and empowering both dentists and patients about choices, benefits and risks of source materials. But dental lab registration does little to accomplish those goals. If the health and well-being of patients is really at risk (and I believe it is), why does it seem that many dentists allow insurance reimbursements to dictate what they will pay for crowns and other restorations? Of equal importance, do they know which materials are used to make these restorations? Is the consumer even aware that many crowns for U.S. patients are made overseas (the majority in mainland China)? As a full service lab owner with more than 25 years experience, I know as do most lab owners, the patient is generally unaware a dental lab even exists, let alone that a patient's crown is custom made for him. In a global economy, the opportunities to buy products from many countries other than the U.S. are vast, and the reason is almost always price. Dentistry is not exempt from this. Many dentists both knowingly and unknowingly use these overseas labs. Yet dentists I have spoken to seem either unaware of or claim to be unaware of this proliferation of global providers, even though they advertise in nearly every dental journal. When I've asked dentists about this, their responses remind me of a former policy of our armed services: Don't ask, don't tell. You have to wonder why a number of the state legislative movements are requiring labs to register yet the patient still has no idea what is going in his mouth. Shouldn't the patient be aware of the origin of the product and the materials being put into his body? Why is the dentist exempt from providing the patient with options; shouldn't the patient have a choice between using an overseas laboratory versus paying a premium for a lab that follows U.S. health and safety standards? Informed consent is always important and should be here, too. I believe patients value the freedom to choose, especially when their health could be at risk. Until these fundamental questions are answered and acted upon, there is little reason for any of us in the dental profession to think we're moving ahead in the best interest of the patient by requiring the registration of dental labs. Like many lab owners, I readily accept (and embrace) the idea that all labs should voluntarily comply with origin and material disclosures. We would also welcome dentists to truly lead the way in offering the patients the ability to make an informed consent decision. ~ Larry Borman Owner Tetra Dynamics West Babylon, New York Also see Laboratory Owner Terry Fohey's Letter to the Editor, "Why is Dentistry Afraid of Transparency?" Ā»
Dear LMT: A number of months ago, I went to a Georgia Work Ready meeting in an attempt to be a good participant in my local government. Georgia Work Ready is a government-funded program that creates programs to improve job training and marketability of Georgia's workforce. I was shocked to see that only three businesses were represented. Due to the low turnout, I had plenty of airtime to voice my concerns in regard to the dental laboratory community. I explained that many restorations are fabricated outside the U.S., which is taking jobs away...See more from U.S. technicians and about the lack of disclosure and the fact that the patient has no clue as to where his crowns are being made. I don't want to prevent work from being sent offshore but I feel the patient has a right to know. If the consumer is given a choice, I believe that, based on China's dismal track record with numerous manufactured goods and its disrespect for the intellectual property of others, many will choose the American-made product. At the conclusion of the meeting, Senator Frank Ginn and I continued our discussion and he later visited my laboratory. He listened to the staff members, who share my concerns, and recognized that we provide a nice work environment, health benefits and what he considers to be a high-tech kind of a business in which people with a vocational education can actually get a good job. After a couple of months, I received a phone call from Senator Ginn and he shared his intention to propose legislation— SB375—requiring any dental laboratory conducting business in Georgia to disclose to the dentist the material contents and the point of origin of every dental restoration. It would also require the dentist to disclose this information to the patient prior to placing it in his mouth. I told him I was willing to do anything I could to help. To promote support, I invited my friends in the business to stand behind the legislation. I contacted Bill Thomas, CDT, from Smile Science in Cleveland, GA, who is a member and participant in the NADL and Georgia Dental Lab Association. I also contacted several of my clients who hold influential positions within the Georgia Dental Association (GDA) and other good dentists around the state. The amount of support among the dentists I contacted was shocking. Many of them agreed that SB375 [disclosure of materials and point of origin] was great legislation and the right thing to do. We collectively began an enormous grassroots effort to gather further proponents, including dentists, labs and patients. The GDA board of trustees, who wrote the proposed legislation, assured me everyone was behind the bill and they were confident the Governor would sign it. However, when I then spoke with the Executive Director of the GDA I heard a different story. Although she acknowledged the benefits of the bill, she also said association members were Republicans and they believed we don't need more regulations on our businesses. Therefore, she claimed, the GDA would not work against SB375 but it would not work for it. I went to the Capitol and spoke with the Health and Human Services Subcommittee that was reviewing the bill. I explained that crowns from China and other countries being sold here claim to use the same high quality materials we use at NuCraft yet are being sold for less than we can even purchase those same materials for—never mind our labor costs. For that to be possible, I said, there had to be something dishonest and not transparent in regard to the materials they claim to be using. But the subcommittee members had zero questions. Based on their lack of interest, I knew the bill would never make it out of the subcommittee. In fact, the bill is officially dead for this year. It can be brought up again next year but would have to be resubmitted by a Senator, rewritten and reassigned a new number. In frustration and disbelief, I called all the dentists who had supported the bill and explained that I couldn't understand what happened. I cannot overemphasize how many very fair, honest and good dentists actually tried to fall on the sword for the dental lab profession just to ensure this bill passes! So, now I wonder: are the politicians scared of transparency? Are dentists? Are dental laboratories? All I know is that I have not encountered a single patient who doesn't think he has a right to know what is being placed in his mouth. I ran into a friend of mine who is a large vegetable supplier for Publix supermarkets in Georgia. When I told him the story about the legislation, he was in disbelief. He said, "You mean that for every potato I sell, I have to be able to tell the government what field it came from, what truck it rode on, etc. and dentistry can make a restoration and put it in my mouth and never have to tell me where it came from? You have to be kidding me!" So, why are dentistry and politicians so afraid of a bill from a freshman Senator who recognized a real problem and proposed a solution? SB375 is simply about disclosure. It does not restrict anyone from importing dentistry. Instead, it just makes us all play by the same rules. ~ Terry Fohey, CDT, Owner NuCraft Dental Arts Bogart, GA
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