The commoditization of choice

As a presenter at hands-on composite meetings, I take the opportunity to ask my audience about the materials that they use. On many occasions in the recent past, when I asked this question, I was astonished to hear that a sizeable proportion did not have any choice regarding the materials that they used! Having been a dental practice principal myself for many years, I realize that a delicate balance often has to be struck between carrying out good dentistry and making sufficient ‘profit’ for the practice to be viable, given that the practice owners are responsible, not only for their own salary, but also for the livelihoods of all of the practice team. However, when the decision regarding the procurement of materials is made purely on cost and not made by the clinician treating the actual patient sitting in his/her chair, there is surely a massive dilemma for the clinician, and indeed strong moral and ethical issues are brought into the equation. Such matters are made even more acute when the decision to purchase a given material is made by an accountant or book-keeper with no knowledge of dentistry other than its profitability. Can this ever be justified? In my view no: yet this is happening up and down the UK on a daily basis and possibly in other parts of the world. Dentists affected by such a regimen must feel hot under the collar every time they use a material which is not optimal for the job, yet they are under pressure to keep themselves employed (in this era when jobs are relatively scarce) rather than to complain to the practice owner(s) or the chief executive of a corporate, if that is who they are working for. The alternative is to purchase the materials of their choice – and I know that some actually do this – but, given that many are already being paid a low rate for the job, they feel disinclined to do so.