If you are a professional, you have experienced the scenario when someone is doing your job instead of you. Here we are not talking about others with equal credentials but about those that do not have them. Good model to explain the issue is relation between general dentists and orthodontists/dental surgeons in which first party plays a role of outsourcer and last one is outsourcee.

Yesterday I attended a meeting of General Assembly of European Federation of Orthodontic Specialists Associations EFOSA. That body is top organization in Europe that represent orthodontic specialists. Among other topics, we have discussed about dealing with General Dentists that are practicing orthodontics. We have heard that in Czech Republic orthodontic therapy is protected by the law, but this is not the case in other countries. There are countries where insurance companies do not want to pay orthodontic therapy to others but orthodontists and also those (like UK) where insurance will pay wherever patient finds a therapist.

We are witnessing that in modern times we are deregulating many things. Perhaps we must not deregulate this issue, but to put it in the protected list you have to find a good reason. In USA, American Association of Orthodontists have done a survey where they wanted to show that the result of therapies done by general practitioners statistically differ from those done by orthodontists. The result showed difference, but without accepted significance. But that does not mean anything because in USA anyone that does orthodontic therapy is very careful because of the American legal system. Doctors that are not officially educated in residence programs are very careful: they choose only simple cases, they invest large sums to their education, they follow scientific literature and they are counseling with orthodontists. All because of fear of mistake and in the end because of legal and financial consequences. We can see that effective legal system protects patients in this matter. In other parts of the world it is more complicated to determine doctor’s responsibility.

My opinion is that there is no legal instrument that can solve the problem. You can try to solve it by fighting its roots: to care about feasibility.

Why/where/when general practitioners are practicing orthodontics or dental surgery? After profound consideration you will see that in every case it is well linked to price levels. Everyday we can see more and more simplified approaches to medical and dental procedures. That is forcefully introduced by sellers of dental materials and equipment because they want to extend number of their customers to a larger group so they want to include general dentists to the business. New procedures help doctors to be quicker and to have better results in the end of any procedure. But, they also help general dentists to perform tasks previously reserved to specialists not because they are mean, but because they want to decrease their costs and to increase income, too.

In my experience, general practitioners basically do not want to do procedures reserved for specialists, otherwise they would finish a residence program. They only want to have excellent interdisciplinary team and not to lose money in vain. Specialists have to be aware that their services are required and that they have to be realistic and to adjust their fees. If your procedures simplify and/or your costs decrease, you have to consider changing of your prices, especially in the time of crisis. You have to be more reasonable and to offer good prices which will satisfy yourself, but which will not attract other dentists to start this unwanted behavior.

Be quick and well-informed. Be ready to make suitable deals for yourself, for patient but also for general practitioners. If you let them do easy procedures reserved to specialists, they will do more and more. That happened with dental implants and now everyone is inserting them. It is hard and very demanding to be a specialist. Specialists were educated to do complicated procedures and because of that they are recognized and well paid. But if they start to be overpaid, their dominion will decrease or in the extreme they will seize to exist.

The same story can occur in every other profession. What will happen if changing the wristwatch strap will cost you 100$ or if newspaper delivery 50$ daily? You know the answer: watch repairers and deliverers will be out of business!

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