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Adapting to the retail revolution: Lessons for the dental profession in an era of consumer‐centric care

2024; Wiley; Volume: 88; Issue: 8 Linguagem: Inglês

10.1002/jdd.13692

1930-7837

Michael S. Reddy, Romesh Nalliah,

Dental Education, Practice, Research

Dentistry is a profession with a rich history. We all take pride in being a part of this history and being associated with such legends as Pierre Fauchard, Greene Vardiman ("GV") Black, William J. Gies, Lucy Hobbs, and Ida Gray. However, we must also look to the future in order to assure sustainability of the standards of care and widespread respect for our profession. A change in the business model for delivering oral healthcare is underway. We are more than two decades into the 21st century, and advances in technology have led to sweeping changes, including in how to conduct business. Two decades ago, solo-practice accounted for roughly 75% of dental offices and now that figure is well below 50%. Those of us who lead oral health clinics must consider modifying our approach and learn lessons from retail operations, not just to keep current but also to catch up. Consider the 20-year shift in retail commerce to e-commerce. At the turn of the century, shopping online was a novel experience, but these days, it is a standard option—and an appealing one. We save effort and time using our phone to get what we need. The online model also focuses on customer satisfaction, which we have all become accustomed to. Customer, or in our case patient, satisfaction is essential. At academic health centers, we must consider the full patient journey and begin with how patients find their providers. Still today, patients must ask family members and friends for recommendations or rely on websites such as Yelp.com or ZocDoc.com to find their dentist. Yet consider our peers in medicine—patients can go online and find outcomes data to compare hospitals and help them decide where to receive care.1 Dentistry is so far behind—let's ask the simple question, "how many small practices formally measure outcomes?" Leave alone the concept of making that data publicly available to empower patients as they seek to find a provider match. The unscientific way in which patients must choose their dentist also has implications for patient satisfaction. When we consider patient satisfaction, we tend to focus solely on the dental chair experience. While that is critically important, the patient journey in an Academic Dental Center is much broader. It might begin with someone looking online for a clinic to get their teeth cleaned. They find a website with a phone number and wait to call during business hours only to get an appointment weeks out, if they are lucky enough that someone answers the phone without a game of "phone tag." The patient waits for their appointment day and drives to the university, struggles to find parking, and makes their way to the clinical building. If all go well, they are greeted by staff and directed to their clinic—one of many in the building. They may ask themselves, as they walk past several clinics on the way to the one where their appointment is, "How do I know this clinic is the best fit for me?" Eventually they arrive at the correct clinic, where they provide their insurance and health information and are told to sit and wait. What can we learn from retail to improve this process? The internet profoundly changed our perspectives. We have all become advanced consumers of information, goods, and services. We can arrange for anything online. It makes sense that our patients want the same convenience when they coordinate their healthcare. This explains why the largest online retailer recently acquired a highly rated, membership-based primary care program. Increasingly, we are seeing membership-based concierge health services where patients pay an annual fee. Patients can schedule appointments easily through an app or website. These services often boast same-day or next-day appointments and use technology extensively to streamline healthcare delivery. This includes telehealth options for virtual visits, electronic health records accessible to patients, and digital tools for managing health information. The experience is characterized by convenience, accessibility, and a commitment to patient satisfaction through modernized healthcare delivery methods. For the early part of the 21st century, there were lingering barriers to healthcare transitioning to a retail model—what value is a virtual visit in dentistry? How can we send and receive patient intake forms electronically? How can we minimize our time in the dental clinic? Can we be reimbursed for virtual visits? But, like much of recent history, COVID-19 has changed everything. Telehealth had been around for years prior to 2020, with 76% of hospitals in the United States offering some versions of remote patient visits.2 From March to June 2019, telemedicine visits in the United States increased 766%, rising from 0.3% to an astonishing 23.6% of all patient interactions.3 Not only is there no going back, but people now expect convenience in all areas of healthcare. In primary care medicine, the traditional doctor's office has lost patients to urgent care clinics, and increasingly to retail pharmacies that offer non-emergency care. Patients, primarily millennial and Gen Z, are more concerned with convenience than credentials. More than half of these younger patients prefer to seek help from the pharmacy with vaccinations, smoking cessation counseling, contraception, and diabetes prevention rather than taking the time to schedule an appointment at a conventional doctor's office.4 Of course, oral health providers are not going to lose our patients to other healthcare providers. However, Academic Dental Centers with highly specialized care will likely suffer without catering better to patients and learning lessons from the retail industry. But whether we are looking to adopt a concierge model or just strive for a better patient experience, there are some ways we can improve our practices. First, our patients must be able to reach us easily. Every phone call or electronic message should be answered promptly. Additionally, can we expand our hours to give patients the opportunity to come in during evenings or weekends? Not everyone can take time off work to come in for care. And if they have had to postpone care and call when they are having pain, they are not going to be enthusiastic to hear that the soonest appointment they can get is 2 months from now—we must be flexible and accommodating. Moreover, can we learn from the way big retailers build customer loyalty through programs, special benefits, and special opportunities? Explaining procedures and costs to our patients helps them make an informed treatment decision. However, we must ask ourselves, how much of these critical conversations should be conducted by students? And in the era of Entrustable Professional Activities, can these conversations be observed and evaluated? As an aside, these critical conversations that explain procedures and costs and compare options are essential to the success of the future dentist. But how much time to we teach, monitor, and assess this? But here is perhaps the most important reason to learn rapidly from the retail industry: retail is coming after us! Walgreens5 and CVS Health have pilot programs offering direct dental services.6 These are not theoretical—even today CVS and Walgreens are our direct competitors. Not only are these huge companies, which are experts in retail, they are also enormous employers. We have not even touched on the fact that such large employers could have tremendous influence on dental insurance plans, expectations, and movement toward value-based care. The transition to the 21st century has not been kind to all businesses. Some retail giants sat back and watched as Amazon got a 20-year head start on them. Belatedly, some brick-and-mortar retailers pushed into e-commerce, but not everyone acted in time to survive. As oral health clinicians, we are confronted with a choice: do we want to be like Amazon, or do we want to be like Sears? And if you are asking "What's Sears?" I think you already have your answer.