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I’d like to increase my income, and my staff, of course, would like more also. So I’ve offered them a financial incentive for each patient they can convince to replace old restorations with composites, veneers or crowns. My hygienist refuses to participate because she says it’s unethical. Is she right?
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The first place you should seek guidance is your state’s dental practice act, to determine whether this sort of fee-sharing arrangement complies with the law. Many states permit dentists and other professionals to share fees for professional services with partners, employees or associates in a professional corporation, but have prohibitions against splitting fees and giving kickbacks to others.
If it is not illegal, several areas of the ADA Principles of Ethics and Code of Professional Conduct can help address your dilemma. Of course, the principles of nonmaleficence (do no harm) and beneficence (do good) are the first to come to mind. Are you certain that your proposed treatment actually will help and will not harm your patients? Is there a justifiable reason (other than increased income) to do the work you seek? Also, the principle of veracity (truthfulness) demands truthful communication.
You alone have the responsibility to diagnose and recommend treatment, always in accordance with the patient’s wishes. According to Section 2.C of the ADA Code, you are ethically obliged to prescribe and supervise the patient care provided by your auxiliary staff. Right on point is Advisory Opinion 5.D.2, which deals with marketing or sale of products or procedures. It indicates that dentists who employ auxiliaries to market or sell dental products and procedures to their patients must take care not to exploit the trust inherent in the dentist-patient relationship for their own financial gain. The dentist should not induce patients to purchase products or undergo procedures by misrepresenting the product’s value, the necessity of the procedure or the dentist’s expertise. As the dentist, you are ethically obliged to ensure the disclosure of all relevant information the patient needs to make an informed decision.
Dentists who offer services to patients to improve esthetics or function are not per se uneth ical. However, replacement of functional restorations primarily for the purpose of increasing income is engaging in unethical conduct. If your office’s marketing practices and your motivation do not run afoul of these guidelines, the arrangement does not appear to be unethical. Yet, I can understand your hygienist’s concern. The financial incentives might raise questions about the true motives for the professional recommendations conveyed to your patients. You and your staff need to take time to discuss this proposal openly and honestly with each other. Then everyone can be comfortable with the final decision.
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