Kevin Lewis warns how commoditisation is the greatest threat to the future of UK dentistry and we are unsure where things are going.
The internet has a lot to answer for. I will refrain from calling it (and anything that flows from it) ‘new technology’ simply on the basis it didn’t exist back in the day when my fellow baby boomers and I were dependent on ‘old technology’. And anyway, my go-to expert on these things, Paul Redmond, assures me anything that is around while you are growing up, is not even ‘technology’, let alone ‘new technology’. It’s just ‘stuff’.
Paul has a sure-fire generational acid test for one’s relationship with technology. You fail the test if you ever refer to possessing a ‘mobile phone’, and you pass the test if you regard the adjective ‘mobile’ as superfluous. It’s a phone. You graduate with honours if you find the adjective positively confusing: after all, was there ever a time in history when a phone was not ‘mobile’? Please don’t feel compelled to answer that question – nor indeed to ask it. My feelings are easily hurt.
There will be those among our readers who, like me, remember a time when all phones needed to be linked by a cable to the wall. Then came the technological miracle of phones that didn’t need the cable. Or the wall. The phones were mobile in a sense, I suppose, but only actually portable if you had a couple of Sherpas on hand to carry the battery packs for you.
The internet has certainly been the essential transformative tool for the information revolution. It puts a boundless range of information at our fingertips, 24/7 and (almost) wherever we happen to be at the time. It makes it easier and more convenient to compare products, and often cheaper to buy and sell, and do business generally.
But, as has become increasingly apparent, it has also become the platform for access to misinformation: the internet makes it easier to access fake news, scam and ‘lookalike’ websites purporting to be genuine ones (but just as keen to accept your money).
It is easier to mislead and deceive others, easier to access bigger slices of the population and – here’s a paradox – easier for dishonest people to remain anonymous, but more difficult for innocent people to maintain their privacy. It is a funny old world, but at least you can get lost with much greater accuracy.
Commoditisation
The internet has, of course, been a catalyst for rapid social change as much as technological change and a valuable adjunct to education and for self-improvement.
It has transformed the way many of us find out about things, compare things, and decide how and from whom to buy goods and services. It has sounded the death knell for some businesses, and the dawn chorus for others.
One business at a time, it has been dismantling the cohesiveness and inter-dependence of the traditional high street, while simultaneously empowering the ‘no street’ virtual business community.
But where does dentistry fit into all of this? Unlike many of the products gracing the shop window of the internet, the sharp end of dentistry hardly lends itself well to search engines. You may be able to compare different prices for precisely the same seat on the same flight, or for the same hotel room, or dishwasher, or lawnmower, and so on, but searching for the cheapest molar endo in town makes about as much sense as searching for the cheapest heart bypass. Even if you could find it, who would want it?
Furthermore, 99% of dentistry is necessarily delivered from a physical location, by and to real people in real time – and therein lies the crucial difference between one source of dental services and another. These are attributes that can only be assessed at first hand. That should be the end of the story, yet primary care dentistry has been increasingly sucked into the dangerous and short-sighted world of commoditisation.
The lure of the internet has been enough to turn intelligent graduates into masters of hype and unthinking imitation.
It is hardly surprising dentists so often break the basic rules of business because they didn’t feature on the dental school curriculum. It is easy to be thrilled with the success of your ‘deal of the day’ promotion if you don’t grasp the difference between turnover and profit.
A restaurant that aims to be the cheapest in town, with so many special offers that it redefines the meaning of ‘special’, has a completely different business model to the high-end restaurant that prides itself on exclusivity, impeccable service and quality – and charges accordingly.
The first enterprise needs to be full all day, every day, to repair the damage inflicted by the low price it has committed to. The latter can not only afford to have tables sitting empty, it makes it heaps easier to satisfy people who show up. Less obviously, it has already priced for the empty tables. In the first model, food is made a commodity and price is all they have left to compete on. In the second, you are buying something altogether different, and the food itself is only one part of it.
Promising top quality at lowest price has always been the strategy of fools and/or deceivers. The NHS does it, of course, but the key difference is that it promises that you will deliver top quality, while it is paying you the lowest price. Not the same thing at all.
Nevertheless, a cursory review of a selection of dental practice websites reveals dentists talk a lot about the range of ‘products’ they offer and some talk quite a lot about themselves – as if to avoid the trap that they are offering essentially the same list of products as others.
The payoff for bigging up yourself, your skills, your knowledge, training and experience is that you fall short at your peril. The bigger the bigging, the deeper the hole you have dug. You may – in theory – attract more patients, but they will all be patients with much higher expectations than they might otherwise have had.
So good luck with that! Whenever you unilaterally raise the bar, you set yourself up to fail and disappoint; but to make matters worse, your failure doesn’t sit quietly and privately in the shadows as might once have been the case. Yes, you will get complaints, financial disputes and, perhaps even litigation to deal with, but more damaging is the negative feedback that gets posted – sometimes without your knowledge – on a plethora of online feedback portals and across social media.
Genie in a bottle
I genuinely believe commoditisation presents the greatest threat to the future of UK dentistry and, like the proverbial genie in the bottle, we can never be quite sure where things will finish up, now that the cork is out (we won’t be offered three wishes, that’s for sure).
Commoditisation manifests itself in surprising ways and one of them is that once you have reduced something to a mere commodity, you can use your metaphorical search engine to seek out the cheapest provider. We have unwittingly been facilitating that process, and the direction of travel is that primary care dentistry is becoming disaggregated into a series of products and services, and then streamed into simple, intermediate and complex.
You can work out for yourself whether third parties (whether government, patients or others) will want a specialist or a ‘tier two’ provider, or any registered dentist or someone else, to provide them.
That ‘someone else’ is worth keeping a close eye on, because that may well prove to be the end game.
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