VCs are already doing this. They have offered to buy both the oral surgery practice and the dental practice I use in town.
The care they provide turns worse and worse because the model you envision turns a professional (someone who should have a fiduciary responsibility to the patient’s best interest above their own) into an employee of a non-professional corporation. All of the pre-and postoperative care that you envision being done by less highly paid individuals in order to free up the surgeon to “generate profit” gets done cheaply and more slapdash resulting in worse and worse patient care. Either the oral surgeon fights back and attempts to maintain the physician patient relationship and gets fired from their own practice that they sold out (pretty common already with Derm and Optho) or they don’t and you get the actual medical version of the plastic surgery chop shops common in Miami. This ethical problem is why non-lawyers cannot own a legal practice and yet we failed to recognize the same destruction of the professional relationship when it comes to physicians.
Aspen dental is a franchise based venture capital funded organization that already does this.
This is where rationalists fall apart. Everything you say makes sense, but it doesn’t take into account the sociocultural aspects that make a physician patient relationship different than the value extractive relationship that you propose.
Aspen dental is a franchise based venture capital funded organization that already does this.
This is interesting, thanks for sharing.
I asked my friend about your other concerns regarding enshittification of the dental industry. If you’re interested, this was their response:
Patients tend to do better with DSOs. There’s a number of reasons:
The first is doctor supervision—when doctors have their own offices, no one checks their work or holds them accountable. In a corporate setting, there is typically a clinical director that the doctors will report to.
The second issue is that the worst case is actually the doctor being the owner—that’s when they have the strongest financial incentive to do bullshit. The more the doctor is removed from being the owner, the less I think their judgement is influenced.
Now in nearly all DSOs and private practices, revenue is the chief KPI for doctors. So the pressure is there still to a degree.
With us, revenue is not a KPI—we don’t ever tell the doctors how much they produce And so we remove the financial biasing of their diagnosis and treatment.
But we are unique in this—definitely an outlier in how much we are trying to have the doctors be unbiased by the finances.
What’s also ironic about some of the replies is that our lobby goals are to actually get real regulation put into place so patients are protected from doctors doing whatever to maximize revenue But these somewhat personal ideals and goals being acted out—that do run counter to the pure capitalist logic
A doctor being accountable to a director seems like it could work in both ways. Even both ways in parallel; the director could call out some kinds of problems and cause some different kinds of problems.
The actual outcome could depend on the specific doctor and the specific director, and therefore be difficult to predict. It could even change in time, like maybe at first the directors would behave a certain way to attract more doctors, and when the customers learn that the big centers are the norm, then it would become the right time to squeeze more profit out of the system.
There are a boundless number of reasons for or against anything, because real world things happen in an infinite dimensional space of possibilities… so just a listing some opposing points for those in the parent doesn’t add much.
Interesting case. Are there other cases where VC-run businesses have similar issues, perhaps in other industries? I would like to see and understand a pattern if possible.
VCs are already doing this. They have offered to buy both the oral surgery practice and the dental practice I use in town.
The care they provide turns worse and worse because the model you envision turns a professional (someone who should have a fiduciary responsibility to the patient’s best interest above their own) into an employee of a non-professional corporation. All of the pre-and postoperative care that you envision being done by less highly paid individuals in order to free up the surgeon to “generate profit” gets done cheaply and more slapdash resulting in worse and worse patient care. Either the oral surgeon fights back and attempts to maintain the physician patient relationship and gets fired from their own practice that they sold out (pretty common already with Derm and Optho) or they don’t and you get the actual medical version of the plastic surgery chop shops common in Miami. This ethical problem is why non-lawyers cannot own a legal practice and yet we failed to recognize the same destruction of the professional relationship when it comes to physicians.
Aspen dental is a franchise based venture capital funded organization that already does this.
This is where rationalists fall apart. Everything you say makes sense, but it doesn’t take into account the sociocultural aspects that make a physician patient relationship different than the value extractive relationship that you propose.
This is interesting, thanks for sharing.
I asked my friend about your other concerns regarding enshittification of the dental industry. If you’re interested, this was their response:
Patients tend to do better with DSOs. There’s a number of reasons:
The first is doctor supervision—when doctors have their own offices, no one checks their work or holds them accountable. In a corporate setting, there is typically a clinical director that the doctors will report to.
The second issue is that the worst case is actually the doctor being the owner—that’s when they have the strongest financial incentive to do bullshit. The more the doctor is removed from being the owner, the less I think their judgement is influenced.
Now in nearly all DSOs and private practices, revenue is the chief KPI for doctors. So the pressure is there still to a degree.
With us, revenue is not a KPI—we don’t ever tell the doctors how much they produce And so we remove the financial biasing of their diagnosis and treatment.
But we are unique in this—definitely an outlier in how much we are trying to have the doctors be unbiased by the finances.
What’s also ironic about some of the replies is that our lobby goals are to actually get real regulation put into place so patients are protected from doctors doing whatever to maximize revenue But these somewhat personal ideals and goals being acted out—that do run counter to the pure capitalist logic
A doctor being accountable to a director seems like it could work in both ways. Even both ways in parallel; the director could call out some kinds of problems and cause some different kinds of problems.
The actual outcome could depend on the specific doctor and the specific director, and therefore be difficult to predict. It could even change in time, like maybe at first the directors would behave a certain way to attract more doctors, and when the customers learn that the big centers are the norm, then it would become the right time to squeeze more profit out of the system.
What exactly is the counterargument here?
There are a boundless number of reasons for or against anything, because real world things happen in an infinite dimensional space of possibilities… so just a listing some opposing points for those in the parent doesn’t add much.
Investors have offered to buy both, but why do you believe those investors were VCs? It seem very unlikely to me that they were.
Those kinds of VC-run business can also often have other problems. For example, Aspen Dental was sued for deceptive marketing.
Interesting case. Are there other cases where VC-run businesses have similar issues, perhaps in other industries? I would like to see and understand a pattern if possible.