Money Where Your Mouth Is: How do Dentists Manage Conflicts Between Commercial Pressures of Practice and Professional Obligations?

Background This research examinesthe phenomena of professionalism and commercialism and how these concepts interact with one another in the context of private dental practice. Dentists are the predominant member of the registered oral health workforce,and in Australia the majority of dental care is provided in private settings. Poor clinical data means that there is a lack of information on overtreatment in dentistry. This research provides insights into how private dentists have experienced pressures from commercialised clinical environments and how these have affected treatment decisions. Literature Review A scoping review was carried out to examine the current literature base that had considered the phenomena of commercialism and professionalism within the context of dentistry. Forty seven sources were included within the qualitative synthesis of the review. The review found that,while there was a plethora of lively commentary extolling the threats of commercialism to professional values, there was a lack of pragmatic discussion on how the realities of practising in a commercialised environment could be managed. There was also a lack of consideration of how the emergence of corporate dental businesses might impact upon the nexus between commercial and professional dental practice. Methods Private dentists from a variety of clinical settings and backgrounds within private dentistry were recruited using sampling from several sources, including social media and through a dental professional association. All participants were interviewed at least once,and their data were transcribed verbatim to allow thematic analysis to be used to develop rich insights from the texts. Participants were also invited to keep a journal to record further details about how they experienced commercialism in the context of their clinical practice. Findings A total of 20 private dentists participated in this research. Participants were from a mix of private practice environments;dentists working in both corporate and independently owned practices were included. Across the participants,there was a wide range of practice experiences, including length of practice, business owners and associates, and generalists and specialists. Following thematic analysis, three meta-themes emerged from the data: 1) Dentists and their role in Society; 2) The relationship between commercialism and professionalism in dentistry, and; 3) The effects of commercialism on patients and professionals. These themes and their constituent sub-themes are discussed at length to reveal how dentists experienced, conceptualised and managed the relationship between their commercial and professional obligations. Conclusion This research shows that multiple contradictions exist within private dentistry regarding the concepts of professionalism and commercialism. Dentists valued dentistry as being on par with medicine and the work of physicians, and yet many participants spoke about the commercialised and service-driven nature of dental practice, which participants recognised would not be supported in the medical field. Dentistry was described as being an essential service, but also one that was a luxury. This attitude towards oral health contributes to stigmatisation of those who cannot afford to access private dental services and those who suffer from poor oral health. The findings demonstrate that managing commercial obligations in the context of professional dentistry is a matter of balance. Patients who have become consumers through accessing private dental care, whilst empowered, remain vulnerable to abuse of the inequal power dynamic that is persistent within the clinician-consumer relationship. The dental profession must be resistant to becoming a commercial determinant of health; whilst there are elements of consumerism and commercialism that may enhance the mission of dentistry, dentists should be cognisant of how they may also damage oral health and the public’s trust in the profession