What is Rationalization?
George Ritzer, an American sociologist, established the four dimensions of McDonaldization: efficiency, calculability, predictability and control. Efficiency is finding the most optimal method of completing a task, calculability seeks out quantitative metrics that often increase profits for sellers, predictability keeps products and services consistent across time and space, and control is exerted to streamline procedures (Ritzer 2020). Ritzer illustrates these concepts by demonstrating the ways in which McDonald’s has shaped the fast-food industry. By standardizing cooking, preparation and delivery times, along with delivering the same products chain-wide, McDonald's has set the standard for fast-food restaurants. This model of maximizing profits while minimizing waste has inspired similar trends in other industries.
People are able to acquire what they want or need almost instantaneously and to get it far more conveniently.
In dentistry, technology is revolutionizing the way dental appointments are shaped, making visits more efficient while still tending to all the patient’s needs. Performance and success is generally measured across the quality and quantity with which treatments are done. In order for practitioners to utilize their time well so they can maximize profit, the steps of a procedure – planning, surgery, prostheses – are all standardized so that treatment times can be easily calculated and treatment outcomes are consistently predictable (O'Brien 2021). The four forces of rationalization have undeniably transformed dentistry, but rapid rationalization has led to several irrationalities, such as the dehumanization of patients and the disenchantment of the patient experience through corporate dentistry.
Origins of Dentistry
While the profession of dentistry was not formally established until much later, the first recorded dentist in history was an Egyptian scribe named Hesy Re who passed away in 2600 BC. His tomb was filled with panels engraved with a message which read “the greatest of those who deal with teeth, and of physicians.” In China, several medicines were created for different forms of toothaches in the form of pills and mouthwashes derived from plants with medical properties. A variety of aromatic powdered leaves were used to relieve tooth pain, and acupuncture was also a popular method of treating toothaches and pains. In 500-300 BC, Aristotle and Hippocrates wrote about dentistry in regards to the eruption of teeth, decayed teeth and gum disease, transferring their findings into words and allowing generations after them to continue their work (Britannica).
The Development of a Profession
In the 16th to 18th centuries, there was a strong intellectual push to make notable progress in the sciences. The Scientific Revolution allowed discoveries to be circulated widely and rapidly, and with this push came a greater desire to expand a general understanding of oral health. In 1723, a French surgeon named Pierre Fauchard published his book “The Surgeon Dentist, A Treatise on Teeth,” the first book to describe a comprehensive system for dentistry, and in 1746, Claude Monton developed the first gold crown. Perhaps the most well-known early American dentist, Paul Revere was both an ardent patriot and a skilled artisan who used skills to fabricate dentures out of walrus ivory and animal teeth. In 1776, Revere was the first to use post-mortem dental forensics. Through these collective discoveries, dentistry evolved from a scattered practice to a more formal, widely recognized profession.
The Effects of Rationalization in Dental Education
After the first dental school, Baltimore College of Dental Surgery, was founded in 1840, the training process for dental students has evolved primarily due to transformative technology. For example, at the University of Michigan School of Dentistry, a Faculty Request System (FRS) was implemented to minimize the time that dental students spent waiting for faculty to check their work. Both students and patients found this old system inefficient and time-consuming. With the FRS in place, students can spend more quality time with their patients and shave down appointment times. Not only has the FRS improved efficiency at this teaching clinic, but it supplies the school's database with timestamped information which keeps students accountable for their own work (Virun 2019). Rationalizing manual tasks, such as waiting for a faculty check, allows room for technology that complements the worker as opposed to replacing them entirely.
Advancements in Technology
From discovering different dental techniques to implementing innovative technology, the field of dentistry is often shifting and evolving to make practicing more efficient and noninvasive for the patient. By shortening treatment time and improving productivity, dentists are able to increase the number of patients they see each day, and patients are able to spend less time in the dental chair. In a field where the potential for advancement is so vast, clinics will have to adapt to new technology fast in order to remain competitive in their field and cater to as many patients as possible. These patients have several options when choosing which dental clinic to visit, so naturally, they’ll choose the clinic that provides the most comfortable, efficient, and streamlined services.
The Creation of Digital Dentures
Finding comfortable, noninvasive alternatives to traditional techniques is at the forefront of all new dental technology. Traditionally, dentures are created with goopy impressions that made a mold of the mouth. Now, intraoral scanners make quick digital scans of a patient's bite and teeth and can even be rescanned over and over. These images are stitched together to make a 3D surface model which can be used to create dental restorations and orthodontic appliances. Digital dentures only take a couple of appointments, and since they are created with digital softwares, those files are stored and can be reproduced at any time. By utilizing 3D printing, clinics also reduce the cost and time that is typically required to create dentures.
How Dentists are Taking Advantage of the Gig Economy
While many people envision freelance workers and delivery services as the only form of gig work to exist, the gig economy is emerging in dentistry as well. Some "gig economy marketplaces," such as Cloud Dentistry, connects dental offices to on-demand dental staff in their area. Founded in 2014, Cloud Dentistry is used by many clinics to hire and replace workers, minimizing the time and money the would typically spend on outsourcing labor. With this platform and potentially others, finding work as a dentist will become increasingly simple and straightforward.
Irrationalities
The rising trend of shifting from private practice to corporate practice encapsulates the principles of McDonaldization, reflecting the patient’s desire for instantaneous results and feedback, and the dentist’s desire to treat more patients in less time. Although rationalization is supposed to streamline and simplify processes, its outcomes often use quantity, not quality, as the preferred metric of success. This can lead to the erosion of the patient-dentist relationship and indifference.
Rational systems certainly bring with them many new or increased efficiencies, but this should not cause us to lose sight of the inefficiencies they spawn.
Fixating on Profit Dehumanizes Patients
When the commercial interest of a business overshadows healthcare professionals’ ability to properly provide quality care for patients, a system that champions efficiency to whatever extent will inevitably fall short. In such a system, does the worth of patients lie in their "value as paying consumers, [and] not as patients who may be experiencing dental disease" (Holden 5)? In a survey conducted in 2021, many dentists acknowledged that, while corporate clinics allow for dentists to practice without taking upon the burden of management, those practices run a very strict "numbers game" and focuses on meeting financial targets (Holden 3). However, private clinics also generate profit to stay afloat, they just utilize different marketing strategies to attract a loyal client base. Thus, the extent to which corporate practices are the sole issue in dental practices remain ambiguous.
Corporate Dental Structure Disenchants the Patient Experience
As a result of corporate practices following a business model that groups dentists in teams versus individual practice, employee turnover is much higher in comparison to private practice. This becomes an issue when patients are used to associating their visits with the same faces each time since humans naturally value consistency, familiarity, and predictability with each appointment. Being cycled through teams of dentists across multiple visits can disenchant patients through a lack of continuity and leave them with unsatisfactory visits. However, not all patients value a personal relationship with their dentist. With health insurance playing a large factor in receiving oral care, many patients are attracted to cost-efficient, accessible clinics, even if those are corporate clinics.
Concluding Thoughts
Rationalization has transformed the field of dentistry, replacing dangerous, rudimentary operations with safe, noninvasive and efficient methods. Dental education has been well-established globally, and consistent standards are followed by accredited schools and programs. By standardizing procedures and wait times, calculability has allowed procedures to be reproducible across clinics.
As a result of this rationalization, joining corporate dental practices have become an increasingly popular choice among emerging dentists. Unlike private practices, dental practitioners are not granted full autonomy and they are controlled by non-dental corporate leaders. While many dentists agree that this business model dehumanizes patients and takes away from the physician-patient relationship, there are patients who prioritize cost-effectiveness above all else.
The extent to which rationalization has truly benefited the profession is ambiguous, but with the myriad of changes in the past century alone, anyone would be excited to see what the future of dentistry holds.
References
- “Dentistry in 18th- and 19th-Century America.” Encyclopædia Britannica, Encyclopædia Britannica, Inc., https://www.britannica.com/science/dentistry/Dentistry-in-18th-and-19th-century-America.
- Ritzer, George. The McDonaldization of Society: Into the Digital Age. SAGE, 2021.
- O'Brien, Ken. “How to Apply Mcdonaldisation to Dentistry - Dentistry.” Dentistry.co.uk, 3 Sept. 2021, https://dentistry.co.uk/2021/09/03/applying-mcdonaldisation-to-dentistry/
- Virun, Vladyslav, et al. “Improving Efficiency in Dental School Clinics by Computerizing a Manual Task.” Dentistry Journal, U.S. National Library of Medicine, 1 May 2019, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6631225/.
- Holden, Alexander C. L., et al. “Rationalisation and 'Mcdonaldisation' in Dental Care: Private Dentists' Experiences Working in Corporate Dentistry.” Nature News, Nature Publishing Group, 25 June 2021, https://www.nature.com/articles/s41415-021-3071-3
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