I have become increasingly concerned about the writings of Dr. Roger Levin, a regular contributor to JADA. His latest comments in the August and September issues were especially troubling ("The Purpose of a Business" and "Setting Your Practice Goals," respectively).
He indicates in both either a lack of knowledge or a lack of respect for the historic concept of profession, and dentistry as a profession, assuming rather that dentistry is primarily (predominately) a business. Without question, there are business dimensions to dental practice. However, these are in the context of dentistry being a profession. He seems to make the classic mistake of failing to distinguish between ends and means.
Maybe times have changed, and today dentistry has become only a commodity to be sold and purchased in the marketplace, and therefore primarily a business. However, I do think the members of our profession deserve to understand what sociologists and bioethicists have for many years argued are the distinctions between professions and businesses.
Professions are distinguished from businesses in that the professional relationship is one in which the professional (dentist) holds considerable power, as a result of knowledge, over the individual (patient), placing the patient in a vulnerable position. Thus, the need exists for the dentist to place the patient’s interest at a level equivalent to or above that of his or her own. The professional dentist’s primary motivation and responsibility is, or should be, "caring" for patients.
This is contrasted with the classical understanding of a business, in which the proprietor of the business and the customer are generally in comparable power positions, with each competing with the another for the best price for the commodity. The primary motivation for the business owner is to make money (profit), and for the customer to save money. Professionals focus on serving, with financial rewards derivative from serving well. Businesses focus on profit, with serving being the means to that financial end.
I was particularly challenged by Dr. Levin’s September piece on practice goals. Certainly, goal setting is an important dimension of personal (and practice) leadership. However, in explaining his point, he used only examples of setting financial goals: "[do you] want a $500,000 practice, a $1 million practice or a $1.5 million practice?" Advocating setting such goals for one’s practice is very clearly a business orientation, and one that stands in sharp contrast to classical understandings of a profession.
How about setting such goals as improving the breadth and depth of one’s clinical training to better serve patients, or enhancing one’s informed consent process, or committing to spending more time in community education efforts promoting oral health, or serving more disadvantaged patients—all goals worthy of a professional?
Clearly, there are tensions between dentistry as a profession and dentistry as a business. I both acknowledge and lament that the "culture" of organized dentistry is looking increasingly like that of a business, with the ADA seemingly more concerned with protecting the interests of its members rather than promoting societal best interests—the historic justification sociologists posit for professionals organizing into democratic, collegial organizations.
To the extent dentistry forsakes its professional orientation, society is increasingly likely to treat dentistry as a business, with adverse affects including, but not limited to, taking away the "monopoly" society has granted dentistry to practice—as a profession.
