Yours Toothfully (ad space for sale)

What do you do when your ang moh husband who has been paying for your complex dental treatment in installments decides to dump you? You sue the dentist for substandard work so you won’t have to pay the rest of it yourself. How to get a certification of substandardness? You just have to see another dentist to ask for his “second opinion”. That might have been pretty difficult 20 years ago, but not today. Things and times have changed.

A medical colleague of mine doesn’t believe that the Singaporean dentist’s median income could be as low as $4060. He reasoned that assuming 2 patients/hour, minimum $60/patient and 8hours/day and 24 working days/month, that’s already $25,000 in takings. Minus overheads should be a least $10,000/month.

Tell that to all the struggling, debt-ridden dentists out there. Of course, there are super-dentists out there who earn a million a year, but those are very few and far between. The majority of “serious” dentists (like me) work long hours and get little pay by international standards. The “dabblers” do basic dentistry part time and sell vacuum cleaners, carpets or some MLM product for a living.

True, there are some busy practices with long queues, finishing 2 patients per hour. These places tend to charge way below the average and can only afford the time to do simple, basic dentistry. Good money? I don’t think so. For the majority of dentists, 2 patients per hour is simply wishful thinking. It’s more like 2 patients a day for many new and struggling practices. The keyword here is struggling. Contrary to popular belief, many of us are indeed struggling.

If you have nothing better to do, stand outside a few typical dental clinics for the whole day and you’ll see that their waiting rooms are empty about 60% of the time. And not every patient pays a minimum of $60. Some come in to fix a problem like denture sores for free. Others refuse to pay consultation. Some even owe money after fixtures have been installed. More and more patients threaten dentists with “I complain to MOH” upon the slightest dissatisfaction. Others say “I sue you” for the slightest mistake that can be easily rectified. Some even complain about untidiness or unprofessional behaviour when they are really just unhappy about the charges or some politically incorrect comment that
the dentist or his/her staff has made.

One frequently mentioned phrase during the last General Elections was “track record”. Look at what Singapore has become. Frankly, there are two diametrically opposing ways to look at “what Singapore has become”. We now live in an ultra-high-tech, crowded, fast-paced society where people have very little concern or respect for one another. Any form or kind of emotion is just a tweet away from mass circulation.

Face to face, it translates into extreme impatience and a propensity towards a nasty, unforgiving attitude. In the past, when we made staff assessments, we always withheld unfavourable comments when it affected the person’s career. In the army, I’ve never given any regulars any bad reports. Nowadays, people take unbridled and immediate action for every unpleasant experience that they get. They treat people like characters in a computer game that they blow off without even thinking. They won’t bother to discuss the case calmly or try to negotiate and meet each other halfway. Just press the button rapidly and blow everything off to vent their anger. Consequences? What consequences?

With competition so keen (and that’s an understatement), the fraternity is turned into a gladiator’s arena. The highly qualified and sophisticated folks at HQ may need fanciful reports or costly, elaborate research to come to the conclusion that we already have too many dentists on our little island. Being less qualified and sophisticated, I see more than enough evidence that we are all desperately snapping at a rapidly shrinking pie. You may need the Yellow Pages to look for a plumber, but you certainly don’t need them to look for a dentist or doctor.

Bring in the gladiators. Fraticide is the order of the day. Suddenly, like never before, your juniors are criticising your work or attributing failures to your negligence. Some even recommend lawyers to your patients. Clinics monitor one another for infringements of regulations. They click on one another’s Google ads to exhaust their competitors’ funds. Others go anonymously on the internet to badmouth other practices and praise their own. A few even employ professionals to sabotage a competitor’s website with DDOS attacks. The regulations make no mention of these way too common practices. Are they allowed? Or are the regulators thinking that simply and openly encouraging people to visit your practice (without sabotaging others) is a more serious offence?

Offline and in the more traditional forms of publicity, more and more doctors and dentists are spending more and more money advertising and organising seminars. It has become an absolute necessity for practices which have departed from conventional toothache dentistry and moved on to sophisticated elective, aesthetic procedures. Some spend tens of thousands of dollars on print ads in glossy magazines and newspapers. Where do you think the costs are going to be recovered? How cost effective are these legitimate means of publicity? Already, print ads are not paying attention to piecemeal projects. They want yearly contracts costing tens of thousands of dollars. Small practices obviously can’t afford this sort of advertising budget, but they too may be capable of doing the sort of work that the big practices are doing. They too may have a message for the public. So how do they get their messages across? They may do it economically, effectively and creatively using the internet. That’s when they hit a brick wall called regulation. So what is allowed? A static and electronic online brochure which may have attracted some attention when the internet was in the Stone Age. Not when there are now some 300 million websites around.

What else is allowed? The mega practices, the GRCs of the industry, in conjunction with dental supply companies (which will never allow negative publicity of their products), organise massive, legitimate promotional events. The objective? To provide “unbiased” information to the public in posh convention halls or function rooms. Like the many American health books out there which talk about exercise and nutrition and also mention (in great detail) the author’s unique product (and where to get it), is there also an intention on the part of the organisers of these dental seminars to draw the crowds to their clinics and increase the sales of the dental products supplied by the sponsors? Apparently not. Why? Because soliciting and even an attempt to encourage patients to visit the practice is against the regulations. If these events/functions are allowed, then they certain can’t be deemed as doing that, can they?

So do these legitimate campaigns, events or seminars “inadvertently” draw new patients to the clinics? For a few, they do, but for the vast majority of young dentists working as associates in the well-known and prestigious practices, work can be unglamourous and pay can be lower than the median income of $4060! Such high costs but permitted ways to promote practices will needless to say, bring up the costs to patients. Are our patients really that price-insensitive? Like all the <$100 bank balance slips littered outside the ATMs readily demonstrate, a lot of our highly visible wealth is actually and ironically based on debt. Another frequently mentioned phrase during the last General Elections was "lost touch with the ground". Indeed, some practices have gone into the clouds to attract high value, well-heeled patients. Are they doing well?

A patient of mine was doing medical tourism until recently. I asked her why she stopped. Her reply? The clinics/hospitals took 6 months to pay her. The folks at HQ may have a different interpretation, but my conclusion is, we’ll never succeed in becoming a medical/dental hub. I’ve already expounded on my pessimism in my blog years ago when everyone was so optimistic. Thailand is the clear winner for Asian medical hub (Vietnam is up and coming) and in spite of our “advantageous” position in terms of language and education, their numbers for medical tourism continue to put ours to shame.

And what about the little guys like us who have no posh and elegant means to show the public what we are capable of? Very economical and convenient ways of educating the public like showing before, during and after pictures of a large, representative number of clinical cases on the internet are not allowed. It is said that it creates “pressure” for the patients to visit the practice. So listening to someone talk and show slides on stage apparently doesn’t create the same pressure. Seeing a full-page ad in the papers about mini implants doesn’t create any pressure. Of course not. These are “elegant” and expensive means to advertise. How not to allow and accept them? In contrast the exoteric, user-friendly, economical, lively, interactive and dynamic website that costs little to maintain if done with passion by the dentist himself, is all to easy to ban or restrict based simply on the unconventional or even revolutionary approach.

Given such an uneven playing field (another frequently used phrase during the last elections), what chances do we stand against the big boys? That question is not only asked by dentists. Every small business in Singapore from provision shops to bookstores, is facing the same problem. The income gap between private practitioners and those in government service will gradually narrow. I foresee we in small practices will all be weeded out one day and everyone then becomes an employee of the biggest organisation in the country in one way or another. I certainly hope I would have left Singapore or this world by then.

From the attitudes of patients to the fierce battles fought in the dental arena, it is quite obvious to those who don’t need to conduct research and studies to conclude that there are already too many dentists around. Yet, strangely, people who need a locum to hold the fort while they go for incamp training often have trouble finding help. Those looking for associates are often greeted by a young graduate acting like he’s been headhunted by a mega corporation even though he can’t cut a bridge (before the patient’s jaw goes into spasm) in 4 hours. I guess, these young, virile practitioners also need to be protected from all kinds of misleading information.