It would not be the first time that a down economy has produced tradesmen and specialists out of thin air that profess to have an expertise in just about everything from building homes to laying new tile in your bathroom. In hard times, everyone is looking to putting food on the table and jobs are often scarce for what was previously an individual’s selected profession. Unfortunately, the dental profession is no different. As discretionary funds are redistributed by patients to other more critical life-sustaining items, the professional in both dentistry and medicine may begin looking to taking on treatments that he or she may otherwise not have considered doing or at the very least would have sent to a specialist. In its worst form this practice can result in a fraudulent misrepresentation of the professional’s education, ability and even licensure as it relates to what they are providing for the patient.
In our specialty, the most dangerous and possibly deadly form of this is the “itinerant” general dentist posing as an oral surgeon who professes to have skills to perform surgical procedures while administering intravenous anesthesia. In a case such as this, the traveling dentist poses as a surgical specialist and will often contract with the more constituted or larger practicing dentist to visit their office and treat their patients on-site in some declared area of expertise (oral surgery, periodontics, etc.). The compensation for such an arrangement can range from simply paying the established dentist for his or her overhead to a payment scheme called “fee splitting.” Fee splitting is the practice of splitting incoming revenues between the provider and the referring dentist. It is an illegal practice in medicine and dentistry since it wrongfully encourages the referring professional (dentist or physician) to recommend a treatment by another clinician in return for a personal financial benefit. By contrast, the typical referral pattern of sending a patient to a specialist outside of the generalist’s office divides their financial interest and promotes treatment for the sake of need and results in no financial gain for the referring professional.
What is even worse about the aforementioned scheme is that very often the visiting “specialist” is actually an imposter who proclaims to have an expertise in one specialty area of dentistry or another for which they were neither trained nor certified. More often than not, he or she is simply a general practitioner who is having trouble keeping themselves busy in their own office and need to supplement their income by other means. These other means, however, can have grave consequences. Not only is the imposter giving you a slice of unskilled surgery but he or she is often not licensed to provide ambulatory anesthesia in another individual’s office. If unlicensed, it means that the facility, equipment and staff have not been properly certified by the state Department of Public Health to handle emergencies that may arise in such circumstances. An even greater risk is the possibility that the dentist providing the anesthesia is not likely to have been trained by an accredited program for this kind of practice. While the patient is often the last to know, the truth of the matter is that this practice is both illegal and dangerous.
While this article acts as a general point of information to the patient, the moral to the story is the next time your restorative dentist suggests that he has someone who can put you to sleep and take out your bad tooth, ask him the following questions:
- Is the surgeon Board Certified to perform these procedures?
- Is your facility licensed and certified by the State Department of Public Health to provide ambulatory anesthesia?
- Is all of your staff trained and certified in Basic Cardiac Life Support?
If the answer to any one of those questions is no…do yourself a favor…start running for the hills and don’t look back!