I haven’t said this often, but a comment from a patient’s mother made me disappointed in my profession. And I found it personally insulting. I was doing a new patient exam. After we were finished, the mother looked around my nice office, sized me up and decided I didn’t quite fit the bill for what she was about to sheepishly ask about. She wanted to know if I knew of any orthodontists who took Medicaid. She had a young relative from Belarus and “he has the worst mouth you’ll ever see.” I told her that since I’m on a cleft team that I often see children on Medicaid and I would be happy to see her relative. She seemed very relieved that her search was over. I asked her why she was so surprised that I took Medicaid. She replied that they had checked with an orthodontist in another nearby town. He told them, “you’ll only find orthodontists who take Medicaid in bad, immigrant neighborhoods and they’re not very good.”
This is what I would like to say to my colleague: “Excuse me sir, but I’m one of only three orthodontists in our fine state who are on staff at Children’s Hospital Colorado. I’m certified by the American Board of Orthodontics. I completed a General Practice Residency and a three-year orthodontic residency that included Nationwide Children’s Hospital. I guarantee you I’ve completed more orthognathic cases than you can imagine. So, I’m damn good, despite your assertions to the contrary. I also work with a great pediatric dentist and two outstanding oral-maxillofacial surgeons on our cleft team who take Medicaid to serve this population. Because of this type of bias in our profession, I don’t want to be known as a “Medicaid orthodontist,” but when I have time I will see some noncleft Medicaid patients as a service to them and our community. Yes, I know that the marginal reimbursement rates wouldn’t pass muster with a practice management consultant as a good business decision, but I make it work. We all know there are Medicaid mills that manipulate the system but there are also many fine dentists in rural areas who serve this population. Before you cast aspersions on the work we do, why don’t you come down and see what kind of complex cases we do and their outcomes. I just started an interdisciplinary case this morning on a patient who suffered horrific cerebral and facial trauma in an MVA. Her parents have been through enough. I don’t want them thinking that their daughter will receive less than the best simply because this family disaster means she is now on Medicaid.”
By telling this citizen that, “you’ll only find orthodontists who take Medicaid in ‘bad, immigrant neighborhoods and they’re not very good,’ you have informed her, and anyone she talks to that 1. dentistry and the state tolerate a double standard of care for those of means and those without; 2. ditto for immigrants; 3. if her relative receives care through Medicaid, that the doctor and the care provided are suspect in quality.
I fully understand if you don’t have the training or experience to competently treat these kinds of cases. I fully understand if your practice isn’t doing well enough financially to be able to do this kind of work for your community. However, don’t impugn the integrity and competency of those dentists and staff members who are willing to do their bit to help the less fortunate when you can’t or won’t. Instead, take a few Medicaid patients, share the load, share the smiles.
Mark J. Bentele, D.D.S., M.S.