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I was very interested to read your editorial in the October issue of Dental Update, as I have been an associate dentist with a dental corporate for a number of years. In early 2012, the corporate set up its own laboratory and encouraged its dentists to use this lab. This idea was promoted to us by highlighting their competitive prices and giving an initial extra 10% off lab fees. Having tried the lab for a few simple cases, I was not satisfied with the standard of the work or service, and so reverted to my usual trusted technicians. By all accounts, the laboratory had been set up in too much of a hurry, with too few qualified technicians, and was unable to cope with the volume of work suddenly coming its way. Over the following months, the corporate persistently tried to persuade us to use the laboratory, with personal visits from head office staff, promises that standards had improved, and assurances that my cases would be personally overseen by the lab director, so I continued to send a minority of cases, but with no discernible increase in quality or service. We were informed that the corporate for whom I worked planned to make it a contractual requirement to use its own laboratory for all laboratory work in 2013. I strongly raised concerns and protested against this, for the reasons highlighted in your article, with various members of the head office team, but was met with a complete unwillingness to negotiate. The company's managing director (a non-dentist) told me, in an open meeting, that I obviously had no idea what I was talking about when I raised concerns about the quality of the work, as he has ‘an experienced’ dentist in another practice who does lots of private work and has been pleased with the quality.
Frequently (more often than not), I receive denture models with several teeth which have fractured off and been glued back on. I have received crown dies with 3 mm airblows. Basic instructions are often not followed and there is a general obvious lack of care in the finish of the work, especially for simple things like denture additions. The corporate uses a delivery service, with unpredictable practice pick-up times, which means that alginate impressions taken on Monday morning may not be picked up until Tuesday, delivered to the lab on Wednesday, and are often not poured until the Thursday.
In April 2013, I was told either to sign the new associate contract or find another job. With little other option at the time, I signed the contract and have been using the designated laboratory for the last six months. Over that time, the laboratory has increased its prices, and so is significantly less competitive (which of course only affects the associate not the corporate, who owns the lab anyway) and there has been a significant increase in remakes. Many appointments have had to be rescheduled due to lab work not arriving on time or, in some cases, being completely lost, and there has been a noticeable recent increase in the numbers of dentures and crowns which are fracturing post-fit, all of which has had a large impact on wasted surgery time, staff morale and patient satisfaction. If the laboratory were not owned by the corporate, this would be a massive false economy.
I thank you for bringing this matter to the profession's attention, as many of my colleagues working at independent practices find the situation hard to believe.
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