美国牙医面临身份危机：将为人们接种疫苗
今年3月新冠疫情爆发后，牙科诊所停业，仅接诊急诊患者。当时个人防护装备（PPE）紧缺，许多牙科医生向本地医疗机构捐赠了急需的关键防护装备。但随着美国各地的牙科诊所纷纷复工，开始提供洗牙和补牙等服务，牙科医生们发现他们很难买到防护装备。在牙科治疗过程中会产生无数在空气中传播的飞沫，而眼下这种飞沫可能会致命，因此牙科医生们迫切需要防护装备，以保护顾客和员工的安全，维持他们安全的形象。
作为最大的行业组织，美国牙科协会（American Dental Association）曾经与联邦应急管理署（Federal Emergency Management Agency）合作，将牙科医生申报为必要医疗工作者，并纳入联邦应急管理署的个人防护装备分配计划。早在今年6月，急需防护装备的牙科医生收到了国家储备的KN95口罩。美国牙科协会的首席经济学家兼副总裁马科·伍吉西奇说：“三个月前，我们的处境非常糟糕。”
最初牙科诊所没有被纳入个人防护装备分配计划让许多医生义愤填膺。美国牙科协会的复工委员会联席主席、执业牙医科克·努尔波表示：“我们最近的口号是‘牙科属于必要医疗服务’。将我们视为非必要医疗，使我们随时可能再次停业，这对任何人都没有好处。”
在最近一次会议中，美国牙科协会还全力支持在新冠疫苗面世后，允许牙科医生为人们接种疫苗，虽然他们以前从来没有承担过这种职责。
专家们介绍了牙科行业目前存在的冲突、财务压力和严重焦虑。虽然牙科行业从停工期间业务量骤减93%，到最近几个月已经出现了明显反弹，但专家们表示，他们所提到的情况已经开始让整个行业陷入动荡。
今天，几乎所有美国牙医及其96%的员工都已经复工，包括牙科卫生师、牙医助理和办公室经理等。患者可能会注意到牙科诊的氛围有所不同，比如更多个人防护装备、预先筛查和额外卫生措施等。在新冠疫情时期，人们对这些变化已经习以为常。
伍吉西奇预计，牙科诊所未来几个月的患者数量将维持在新冠疫情之前的80%左右。至少在目前，个人防护装备的供应情况已经稳定，许多牙科医生表示现有物资足以维持两周。伍吉西奇表示，随着美国大部分地区进入疫情爆发以来的第一个冬季，牙科医生的短期状况，无论是供应还是需求，都相对稳定。毕竟，众所周知，从人体解剖学角度来看，牙齿问题让人十分头疼，而且牙齿的健康问题不会等到疫情结束之后才爆发。
但改变正在发生。伍吉西奇说：“眼下我没有看到新冠疫情问题的解决方案。”美国牙科协会的预测显示，假设在冬季现状没有太大改变，牙科行业2020年的业务量将减少38%，2021年将减少20%。他指出，按照这个数字计算，牙科诊所当前的业务量是无法持续的。
他说：“我们最近的分析结果不容乐观。”
背景故事
这是美国牙科行业在过去50年间，第二次面临由病毒引发的公众对安全的担忧。上一次是艾滋病毒。安全、无菌和预防组织（Organization for Safety, Asepsis, and Prevention）的执行理事米歇尔·李表示：“当时牙科行业完成了第一次重要转变，开始重视感染防治。”该组织主要开展牙科行业卫生状况的研究和教育工作。
米歇尔·李说：“从上世纪80年代开始，我们一直采取通用预防措施。”这些措施包括在治疗过程中佩戴口罩和手套、安装先进的空气过滤器以及卫生设备等，这些措施可以防止人类免疫缺陷病毒这种血液传播病原体在牙科治疗过程中传播。此前曾经发生过与牙科护理有关的HIV感染事件，引起广泛关注，动摇了公众的信心，在这种背景下，牙科行业做出了改变。工作人员开始将每一位患者视为病毒的潜在传染源对待，努力防止进一步传染，并帮助解决公众信任危机。
非营利组织牙科生命线网络（Dental Lifeline Network）的总裁兼首席执行官弗雷德·列维通表示：“应对HIV病毒变成了一个现实问题。牙科医生为此采取了大量预防措施。”
米歇尔·李等人认为，牙科诊所复工后，到目前为止尚未有可以追溯到诊所的新冠病毒感染病例，这都要归功于牙科医生的这种防范意识。他表示，虽然有些预防措施比较新鲜，比如在新冠疫情之前没有人佩戴防毒面罩，但医生们预防病毒的观念已经根深蒂固。
尽管如此，美国的牙科医生们要再一次面临信任危机，这一次来自他们的员工和患者。之前被临时解雇或辞退的牙科诊所工作人员，在疫情期间被召回。他们担心在诊所里的自身安全，以及是否会把病毒带给家人。
圣安东尼奥的牙科医生约书亚·奥斯丁在一份牙科刊物上，就这个问题发表了一篇颇具争议的评论文章。他在文中呼吁牙科医生与工作人员保持沟通，特别是牙科卫生师在举报任何情况之前，应该首先将他们的顾虑报告给雇主。
奥斯丁在自己的诊所中说：“我们必须坐下来开会，让大家说出每个人内心的顾虑，而我则要向大家证明，我正在尽最大努力采取各种保护措施，以减轻他们的顾虑。”
他说他的许多同行朋友也会进行类似的对话，尤其会与牙科卫生师进行交流。奥斯丁说：“作为专业人员，牙科卫生师们希望继续留在家里，不想到他们认为非常危险的环境当中。”
爱达荷州立大学（Idaho State University）牙科卫生教授、美国牙科卫生师协会（American Dental Hygienists’ Association）复工委员会主席乔安·古伦连却有不同的看法。她说，牙科医生和牙科卫生师基本上是在考虑同样的问题：他们个人和患者的安全。虽然双方在复工问题上会有些摩擦，但她认为：“这些摩擦算不上冲突。关键在于如何采取措施保证所有人的安全。”
古伦连表示，美国牙科卫生师协会每天仍然会收到数百封卫生师的电子邮件，他们担心牙科医生不遵守美国牙科协会、美国牙科卫生师协会和美国疾病预防控制中心（Centers for Disease Control）提出的国家建议。
前牙科卫生师、牙科行业顾问特蕾西·安德森·巴特勒说：“牙科诊所在仓促之下采取了这种艰难的应对方式。我认为这种做法打破了牙科医生和卫生师之间的信任。”安德森的职业生涯大部分时间都在为牙科诊所提供咨询，协助他们解决如何维持正常运营和处理人际关系等问题。她说自己对牙科医生和牙科卫生师的霸凌行为有所耳闻，还听说过因为安全措施而引发的职场冲突。
大部分牙科医生都是小企业主和执业医生。他们要招聘和留住员工，要负责解决各种冲突，还要监督卫生师等工作人员的行为。但牙科卫生师本身也是科班出身的医学专业人员，由于某些州的立法允许他们独立执业，因此他们可能会另起炉灶。
安德森·巴特勒和古伦连都认为，会有更多的卫生师选择自立门户，甚至有可能会彻底改行。古伦连说：“我认为这场疫情会让牙科卫生师们觉醒。”
这种混乱带来的一个短期影响是，牙科医生目前很难找到新员工和挽留现有员工。美国牙科协会的数据显示，约四分之一的牙科诊所最近或目前正在招聘牙科卫生师或牙科助理，但招聘工作的进展并不顺利。
牙科保健联盟（Dental Care Alliance）的执行董事长米奇·奥兰表示，在新冠疫情期间，求职者的数量大减。从长远来看，他希望牙科保健专业的应届毕业生能够填补牙科诊所的职位空缺。
供应和需求
随着牙科服务的成本上涨，需求减少了五分之一。
伍吉西奇说道：“我看到牙科诊所采取的短期响应措施是提高收费和裁员，有些到退休年龄的牙科医生直接退出了这个行业。”
美国牙科协会的数据显示，牙科诊所增加个人防护装备和卫生设施的额外成本为每位患者每次就诊10至15美元。伍吉西奇表示，有些情况下，诊所可以从保险公司收回这笔支出，因为保险公司愿意看到牙科诊所维持营业。但也有一些牙科医生目前只能够自己承担这笔费用，尽管美国牙科协会并不确定这种情况发生的具体频率。伍吉西奇表示，在中期内，美国牙科协会调查的大部分牙科医生都表示将提高价格以支付额外增加的成本，这意味着成本将转嫁给消费者。
牙科诊所希望自身在患者心目中依旧是一个安全的环境。在疫情期间，许多人出于对潜在风险的担忧，减少了各种活动。牙科医生们非常中肯地表示，目前没有可以追溯到牙科诊所的新冠肺炎感染病例，但在非正常时期，患者应该像接受其他任何治疗时一样小心谨慎。
牙科医生们的说法与公共卫生机构的建议存在分歧。今年8月，世界卫生组织（WHO）公布的指导原则称，在出现新冠病毒社区感染的地区，应该避免常规牙科保健，而且目前美国几乎每个州的感染病例都在增加。
时任美国牙科协会总裁的查德·格哈尼在一次发布会中“心怀敬意但强烈”反对说：“无论是在全球疫情还是其他灾难期间，只要佩戴适当的个人防护装备，就可以继续提供牙科保健。”
从这件事情能够看出，在整个疫情期间，在有关牙科保健的对话中，公共卫生部门有一个鲜明的特点，那就是立场的反复。我们对于新冠病毒的了解迅速发生了变化，而各种公共卫生建议也在随之变化。我们刚刚才开始了解到病毒在牙科诊所环境中的传播情况。
美国牙科协会在今年早些时候通过电子邮件对美国的牙科医生进行的调查发现，牙科医生的新冠肺炎感染率极低，不足1%。该协会还在大力宣传牙科医生们普遍采取的更严格的保护措施。这项调查仍然在进行当中，最近还增加了对牙科卫生师的调查。
但由于有大量无症状感染者存在，而且病毒肆虐增加了接触者追踪的难度，因此该项调查的准确度无法保证。该项调查的作者承认，牙科医生不足1%的感染率可能低估了实际情况，而且仅调查了牙科医生，并没有调查患者。有一个更重要的问题是，牙科诊所是否属于高风险环境。在采取预防措施的情况下，答案似乎是否定的。
但古伦连表示，更重要的是“并非每一家诊所都会遵守指导原则。并非每一家诊所都有足够的个人防护装备。”
牙科医生也渴望被认定为必要行业。美国牙科协会在7月下旬召开的一次会议中提出了新的口号。该协会的相关政策条款中将必要牙科保健定义为“为防止和消除传染、保护牙齿以及口腔颌面软硬组织的结构和功能所做的任何护理保健。”他们建议在宣传中使用新的术语，放弃之前使用的紧急牙科护理和选择性牙科护理这种说法。
但新冠疫情证明，如果牙齿健康是人体健康的重要部分，并且牙科诊所应该在紧急情况下继续营业，对牙科从业人员就应该执行与其他医护专业人员类似的监督机制。古伦连质疑为什么牙科行业没有类似的监督机制，比如举报雇主不遵守相关卫生规程和没有进行业内特定的接触者跟踪等行为。她说，事实上，“我们需要有向卫生部门和国家机关举报的意识。”
未来前景
早在疫情爆发之前，牙科行业已经在发生变化。旧的牙科用品零售模式逐渐被淘汰，取而代之的是在线购物，同时远程牙科行业也在缓慢发展，一种由牙科服务组织（DSO）创建的相对较新的牙科经营方式也在不断壮大。行业观察者认为，在新冠疫情的冲击下，这三个因素的影响可能会变得更加突出。
从牙科医生改行成为牙科用品在线零售商的斯科特·德鲁克表示，牙科行业遭遇个人防护用品短缺时，牙科医生们首先找到了传统供应商，结果发现成本比预期翻了几番，或者有些物资根本无处购买。这种情况迫使牙科医生扩大了搜寻范围。他说：“由于许多牙科医生只能从其他途径购买，因此更多人找到了我们。”
德鲁克的公司Supply Clinic为许多零售商提供了一个交易平台。他表示，为了应对新冠疫情带来的需求，传统经销商也加强了对网店的经营。他说：“整个行业都在大规模地向在线购物模式转变。”除了供应问题，还有另外一个事实：为了应对新冠疫情所执行的社交隔离和空间限制措施，导致现在已经无法执行传统的销售模式，即由销售代表带着样品到牙科诊所，并现场下订单的做法。
德鲁克说：“最近的产品供应出现了质量参差不齐的情况，而且我们许多物品的采购都出现过问题。”先是口罩，然后是防护服，还有消毒湿巾。他说，现在最难买到的是手套。但通过在线平台，牙科医生有很多机会找到必需的物资并进行比价，因此他们更有可能用优惠的价格买到合适的物资。
这个过程与消费者的转变截然不同。消费者行为的改变动摇了传统的牙科收入来源。互联网使患者能够查找广受好评的牙科医生，并对牙科服务进行比价，而且互联网还催生了新型的远程牙科市场，比如生产透明矫正器的SmileDirectClub等。德鲁克表示，在牙科诊所停业期间，远程牙科的业务在短期内大幅增加，但他并不确定它是否可以维持这种快速发展的势头。然而，德鲁克和奥兰都认为远程牙科的市场份额会继续扩大。
《财富》杂志采访的许多人都提到了另外一种会延续下去的趋势，即牙科行业会逐渐合并成规模更大的诊所，并由牙科服务组织运营，比如奥兰所在的牙科保健联盟。这些组织也被称为牙科支持组织。
目前，18%至20%的牙科诊所附属于牙科服务组织。严格来说，按照法律规定，牙科医生依旧是其诊所的所有人，但他们同时隶属于一个更大的组织，这个组织负责监督诊所的行政管理和市场营销。包括奥兰在内的牙科服务组织模式的支持者认为，通过与牙科服务组织合作，牙科医生可以专注于治疗患者，无需为诊所的商业经营费心。但反对者认为，牙科服务组织以患者护理为代价，助长了行业整合。
奥兰预计，未来5至10年，牙科服务组织的市场渗透率会提高30%至35%。他说：“新冠疫情的爆发，使牙科医生除了经营诊所以外，还要承担额外的责任和压力。”
与多年前相比，牙科专业的学生毕业后将面临一种截然不同的行业环境。美国牙科教育协会（American Dental Education Association）的总裁兼首席执行官凯伦·韦斯特说：“毫无疑问，未来的牙科教育将变得与以前截然不同，因为它现在已经在发生变化。”
她的组织一直在密切关注牙科教育的报名人数。她表示目前的报名人数已经与疫情之前相当。奥兰表示，现在毕业的牙科学生平均要背负30万美元教育债务。他说，许多学生可能并不想走成为个人从业者的老路。他们的加入会给变革中的牙科行业产生深远的影响。
虽然牙科行业目前处在风口浪尖，但你或许依旧抑制不住去洗牙的冲动。古伦连表示，随着冬季来临，“我们更应该格外小心，照顾好自己，这比其他任何时候都重要。”（财富中文网）
翻译：刘进龙
审校：汪皓
今年3月新冠疫情爆发后，牙科诊所停业，仅接诊急诊患者。当时个人防护装备（PPE）紧缺，许多牙科医生向本地医疗机构捐赠了急需的关键防护装备。但随着美国各地的牙科诊所纷纷复工，开始提供洗牙和补牙等服务，牙科医生们发现他们很难买到防护装备。在牙科治疗过程中会产生无数在空气中传播的飞沫，而眼下这种飞沫可能会致命，因此牙科医生们迫切需要防护装备，以保护顾客和员工的安全，维持他们安全的形象。
作为最大的行业组织，美国牙科协会（American Dental Association）曾经与联邦应急管理署（Federal Emergency Management Agency）合作，将牙科医生申报为必要医疗工作者，并纳入联邦应急管理署的个人防护装备分配计划。早在今年6月，急需防护装备的牙科医生收到了国家储备的KN95口罩。美国牙科协会的首席经济学家兼副总裁马科·伍吉西奇说：“三个月前，我们的处境非常糟糕。”
最初牙科诊所没有被纳入个人防护装备分配计划让许多医生义愤填膺。美国牙科协会的复工委员会联席主席、执业牙医科克·努尔波表示：“我们最近的口号是‘牙科属于必要医疗服务’。将我们视为非必要医疗，使我们随时可能再次停业，这对任何人都没有好处。”
在最近一次会议中，美国牙科协会还全力支持在新冠疫苗面世后，允许牙科医生为人们接种疫苗，虽然他们以前从来没有承担过这种职责。
专家们介绍了牙科行业目前存在的冲突、财务压力和严重焦虑。虽然牙科行业从停工期间业务量骤减93%，到最近几个月已经出现了明显反弹，但专家们表示，他们所提到的情况已经开始让整个行业陷入动荡。
今天，几乎所有美国牙医及其96%的员工都已经复工，包括牙科卫生师、牙医助理和办公室经理等。患者可能会注意到牙科诊的氛围有所不同，比如更多个人防护装备、预先筛查和额外卫生措施等。在新冠疫情时期，人们对这些变化已经习以为常。
伍吉西奇预计，牙科诊所未来几个月的患者数量将维持在新冠疫情之前的80%左右。至少在目前，个人防护装备的供应情况已经稳定，许多牙科医生表示现有物资足以维持两周。伍吉西奇表示，随着美国大部分地区进入疫情爆发以来的第一个冬季，牙科医生的短期状况，无论是供应还是需求，都相对稳定。毕竟，众所周知，从人体解剖学角度来看，牙齿问题让人十分头疼，而且牙齿的健康问题不会等到疫情结束之后才爆发。
但改变正在发生。伍吉西奇说：“眼下我没有看到新冠疫情问题的解决方案。”美国牙科协会的预测显示，假设在冬季现状没有太大改变，牙科行业2020年的业务量将减少38%，2021年将减少20%。他指出，按照这个数字计算，牙科诊所当前的业务量是无法持续的。
他说：“我们最近的分析结果不容乐观。”
背景故事
这是美国牙科行业在过去50年间，第二次面临由病毒引发的公众对安全的担忧。上一次是艾滋病毒。安全、无菌和预防组织（Organization for Safety, Asepsis, and Prevention）的执行理事米歇尔·李表示：“当时牙科行业完成了第一次重要转变，开始重视感染防治。”该组织主要开展牙科行业卫生状况的研究和教育工作。
米歇尔·李说：“从上世纪80年代开始，我们一直采取通用预防措施。”这些措施包括在治疗过程中佩戴口罩和手套、安装先进的空气过滤器以及卫生设备等，这些措施可以防止人类免疫缺陷病毒这种血液传播病原体在牙科治疗过程中传播。此前曾经发生过与牙科护理有关的HIV感染事件，引起广泛关注，动摇了公众的信心，在这种背景下，牙科行业做出了改变。工作人员开始将每一位患者视为病毒的潜在传染源对待，努力防止进一步传染，并帮助解决公众信任危机。
非营利组织牙科生命线网络（Dental Lifeline Network）的总裁兼首席执行官弗雷德·列维通表示：“应对HIV病毒变成了一个现实问题。牙科医生为此采取了大量预防措施。”
米歇尔·李等人认为，牙科诊所复工后，到目前为止尚未有可以追溯到诊所的新冠病毒感染病例，这都要归功于牙科医生的这种防范意识。他表示，虽然有些预防措施比较新鲜，比如在新冠疫情之前没有人佩戴防毒面罩，但医生们预防病毒的观念已经根深蒂固。
尽管如此，美国的牙科医生们要再一次面临信任危机，这一次来自他们的员工和患者。之前被临时解雇或辞退的牙科诊所工作人员，在疫情期间被召回。他们担心在诊所里的自身安全，以及是否会把病毒带给家人。
圣安东尼奥的牙科医生约书亚·奥斯丁在一份牙科刊物上，就这个问题发表了一篇颇具争议的评论文章。他在文中呼吁牙科医生与工作人员保持沟通，特别是牙科卫生师在举报任何情况之前，应该首先将他们的顾虑报告给雇主。
奥斯丁在自己的诊所中说：“我们必须坐下来开会，让大家说出每个人内心的顾虑，而我则要向大家证明，我正在尽最大努力采取各种保护措施，以减轻他们的顾虑。”
他说他的许多同行朋友也会进行类似的对话，尤其会与牙科卫生师进行交流。奥斯丁说：“作为专业人员，牙科卫生师们希望继续留在家里，不想到他们认为非常危险的环境当中。”
爱达荷州立大学（Idaho State University）牙科卫生教授、美国牙科卫生师协会（American Dental Hygienists’ Association）复工委员会主席乔安·古伦连却有不同的看法。她说，牙科医生和牙科卫生师基本上是在考虑同样的问题：他们个人和患者的安全。虽然双方在复工问题上会有些摩擦，但她认为：“这些摩擦算不上冲突。关键在于如何采取措施保证所有人的安全。”
古伦连表示，美国牙科卫生师协会每天仍然会收到数百封卫生师的电子邮件，他们担心牙科医生不遵守美国牙科协会、美国牙科卫生师协会和美国疾病预防控制中心（Centers for Disease Control）提出的国家建议。
前牙科卫生师、牙科行业顾问特蕾西·安德森·巴特勒说：“牙科诊所在仓促之下采取了这种艰难的应对方式。我认为这种做法打破了牙科医生和卫生师之间的信任。”安德森的职业生涯大部分时间都在为牙科诊所提供咨询，协助他们解决如何维持正常运营和处理人际关系等问题。她说自己对牙科医生和牙科卫生师的霸凌行为有所耳闻，还听说过因为安全措施而引发的职场冲突。
大部分牙科医生都是小企业主和执业医生。他们要招聘和留住员工，要负责解决各种冲突，还要监督卫生师等工作人员的行为。但牙科卫生师本身也是科班出身的医学专业人员，由于某些州的立法允许他们独立执业，因此他们可能会另起炉灶。
安德森·巴特勒和古伦连都认为，会有更多的卫生师选择自立门户，甚至有可能会彻底改行。古伦连说：“我认为这场疫情会让牙科卫生师们觉醒。”
这种混乱带来的一个短期影响是，牙科医生目前很难找到新员工和挽留现有员工。美国牙科协会的数据显示，约四分之一的牙科诊所最近或目前正在招聘牙科卫生师或牙科助理，但招聘工作的进展并不顺利。
牙科保健联盟（Dental Care Alliance）的执行董事长米奇·奥兰表示，在新冠疫情期间，求职者的数量大减。从长远来看，他希望牙科保健专业的应届毕业生能够填补牙科诊所的职位空缺。
供应和需求
随着牙科服务的成本上涨，需求减少了五分之一。
伍吉西奇说道：“我看到牙科诊所采取的短期响应措施是提高收费和裁员，有些到退休年龄的牙科医生直接退出了这个行业。”
美国牙科协会的数据显示，牙科诊所增加个人防护装备和卫生设施的额外成本为每位患者每次就诊10至15美元。伍吉西奇表示，有些情况下，诊所可以从保险公司收回这笔支出，因为保险公司愿意看到牙科诊所维持营业。但也有一些牙科医生目前只能够自己承担这笔费用，尽管美国牙科协会并不确定这种情况发生的具体频率。伍吉西奇表示，在中期内，美国牙科协会调查的大部分牙科医生都表示将提高价格以支付额外增加的成本，这意味着成本将转嫁给消费者。
牙科诊所希望自身在患者心目中依旧是一个安全的环境。在疫情期间，许多人出于对潜在风险的担忧，减少了各种活动。牙科医生们非常中肯地表示，目前没有可以追溯到牙科诊所的新冠肺炎感染病例，但在非正常时期，患者应该像接受其他任何治疗时一样小心谨慎。
牙科医生们的说法与公共卫生机构的建议存在分歧。今年8月，世界卫生组织（WHO）公布的指导原则称，在出现新冠病毒社区感染的地区，应该避免常规牙科保健，而且目前美国几乎每个州的感染病例都在增加。
时任美国牙科协会总裁的查德·格哈尼在一次发布会中“心怀敬意但强烈”反对说：“无论是在全球疫情还是其他灾难期间，只要佩戴适当的个人防护装备，就可以继续提供牙科保健。”
从这件事情能够看出，在整个疫情期间，在有关牙科保健的对话中，公共卫生部门有一个鲜明的特点，那就是立场的反复。我们对于新冠病毒的了解迅速发生了变化，而各种公共卫生建议也在随之变化。我们刚刚才开始了解到病毒在牙科诊所环境中的传播情况。
美国牙科协会在今年早些时候通过电子邮件对美国的牙科医生进行的调查发现，牙科医生的新冠肺炎感染率极低，不足1%。该协会还在大力宣传牙科医生们普遍采取的更严格的保护措施。这项调查仍然在进行当中，最近还增加了对牙科卫生师的调查。
但由于有大量无症状感染者存在，而且病毒肆虐增加了接触者追踪的难度，因此该项调查的准确度无法保证。该项调查的作者承认，牙科医生不足1%的感染率可能低估了实际情况，而且仅调查了牙科医生，并没有调查患者。有一个更重要的问题是，牙科诊所是否属于高风险环境。在采取预防措施的情况下，答案似乎是否定的。
但古伦连表示，更重要的是“并非每一家诊所都会遵守指导原则。并非每一家诊所都有足够的个人防护装备。”
牙科医生也渴望被认定为必要行业。美国牙科协会在7月下旬召开的一次会议中提出了新的口号。该协会的相关政策条款中将必要牙科保健定义为“为防止和消除传染、保护牙齿以及口腔颌面软硬组织的结构和功能所做的任何护理保健。”他们建议在宣传中使用新的术语，放弃之前使用的紧急牙科护理和选择性牙科护理这种说法。
但新冠疫情证明，如果牙齿健康是人体健康的重要部分，并且牙科诊所应该在紧急情况下继续营业，对牙科从业人员就应该执行与其他医护专业人员类似的监督机制。古伦连质疑为什么牙科行业没有类似的监督机制，比如举报雇主不遵守相关卫生规程和没有进行业内特定的接触者跟踪等行为。她说，事实上，“我们需要有向卫生部门和国家机关举报的意识。”
未来前景
早在疫情爆发之前，牙科行业已经在发生变化。旧的牙科用品零售模式逐渐被淘汰，取而代之的是在线购物，同时远程牙科行业也在缓慢发展，一种由牙科服务组织（DSO）创建的相对较新的牙科经营方式也在不断壮大。行业观察者认为，在新冠疫情的冲击下，这三个因素的影响可能会变得更加突出。
从牙科医生改行成为牙科用品在线零售商的斯科特·德鲁克表示，牙科行业遭遇个人防护用品短缺时，牙科医生们首先找到了传统供应商，结果发现成本比预期翻了几番，或者有些物资根本无处购买。这种情况迫使牙科医生扩大了搜寻范围。他说：“由于许多牙科医生只能从其他途径购买，因此更多人找到了我们。”
德鲁克的公司Supply Clinic为许多零售商提供了一个交易平台。他表示，为了应对新冠疫情带来的需求，传统经销商也加强了对网店的经营。他说：“整个行业都在大规模地向在线购物模式转变。”除了供应问题，还有另外一个事实：为了应对新冠疫情所执行的社交隔离和空间限制措施，导致现在已经无法执行传统的销售模式，即由销售代表带着样品到牙科诊所，并现场下订单的做法。
德鲁克说：“最近的产品供应出现了质量参差不齐的情况，而且我们许多物品的采购都出现过问题。”先是口罩，然后是防护服，还有消毒湿巾。他说，现在最难买到的是手套。但通过在线平台，牙科医生有很多机会找到必需的物资并进行比价，因此他们更有可能用优惠的价格买到合适的物资。
这个过程与消费者的转变截然不同。消费者行为的改变动摇了传统的牙科收入来源。互联网使患者能够查找广受好评的牙科医生，并对牙科服务进行比价，而且互联网还催生了新型的远程牙科市场，比如生产透明矫正器的SmileDirectClub等。德鲁克表示，在牙科诊所停业期间，远程牙科的业务在短期内大幅增加，但他并不确定它是否可以维持这种快速发展的势头。然而，德鲁克和奥兰都认为远程牙科的市场份额会继续扩大。
《财富》杂志采访的许多人都提到了另外一种会延续下去的趋势，即牙科行业会逐渐合并成规模更大的诊所，并由牙科服务组织运营，比如奥兰所在的牙科保健联盟。这些组织也被称为牙科支持组织。
目前，18%至20%的牙科诊所附属于牙科服务组织。严格来说，按照法律规定，牙科医生依旧是其诊所的所有人，但他们同时隶属于一个更大的组织，这个组织负责监督诊所的行政管理和市场营销。包括奥兰在内的牙科服务组织模式的支持者认为，通过与牙科服务组织合作，牙科医生可以专注于治疗患者，无需为诊所的商业经营费心。但反对者认为，牙科服务组织以患者护理为代价，助长了行业整合。
奥兰预计，未来5至10年，牙科服务组织的市场渗透率会提高30%至35%。他说：“新冠疫情的爆发，使牙科医生除了经营诊所以外，还要承担额外的责任和压力。”
与多年前相比，牙科专业的学生毕业后将面临一种截然不同的行业环境。美国牙科教育协会（American Dental Education Association）的总裁兼首席执行官凯伦·韦斯特说：“毫无疑问，未来的牙科教育将变得与以前截然不同，因为它现在已经在发生变化。”
她的组织一直在密切关注牙科教育的报名人数。她表示目前的报名人数已经与疫情之前相当。奥兰表示，现在毕业的牙科学生平均要背负30万美元教育债务。他说，许多学生可能并不想走成为个人从业者的老路。他们的加入会给变革中的牙科行业产生深远的影响。
虽然牙科行业目前处在风口浪尖，但你或许依旧抑制不住去洗牙的冲动。古伦连表示，随着冬季来临，“我们更应该格外小心，照顾好自己，这比其他任何时候都重要。”（财富中文网）
翻译：刘进龙
审校：汪皓
Dental offices shut their doors to all but emergency patients when COVID-19 began spreading in March. Many dentists donated personal protective equipment (PPE) to local health care facilities desperate for the hard-to-find but crucial gear. But as dental offices around the country began to reopen for cleanings and fillings, dentists found themselves hunting scarce marketplaces for the protective gear they needed to keep their clients and staff safe and shore up their image of safety in a time when aerosols—tiny airborne droplets produced in countless numbers during a dental procedure—can be deadly.
The American Dental Association (ADA), the largest industry body, worked directly with the Federal Emergency Management Agency (FEMA) to have dentists declared essential health workers and included in FEMA’s PPE distribution plan. As early as June, dentists in need were receiving KN95 masks from the national stockpile. “Three months ago, we were in a much more dire position,” says Marko Vujicic, ADA chief economist and vice president.
The fact that they weren’t included at the outset rankled many. “‘Dentistry is essential health care’ is our latest motto,” says Kirk Norbo, a practicing dentist who is cochair of the ADA’s back to work committee. “For us to be looked at as nonessential and be at the whim of the next possible closure doesn’t help anybody.”
In a recent meeting, the ADA also threw its weight behind efforts to have dentists qualified to administer COVID-19 vaccines when such a thing exists—a role they have never held before.
Experts describe ongoing conflict, financial stress, and profound anxiety in the dental industry. While the industry has made an impressive recovery in recent months from a staggering 93% business downturn during the shutdown, these circumstances, they say, have only just begun to destabilize the industry.
Today, almost all of America’s dentists are back in the office, along with approximately 96% of their dental staff, who include hygienists, assistants, and office managers. Patients will likely notice some differences that have become all too familiar in the COVID-era world: enhanced PPE, prescreenings, and extra sanitation.
For the next few months, Vujicic anticipates a lull with about 80% of pre-COVID patient volume. The PPE situation has also stabilized, for now at least, with most dentists reporting a two-week supply. As most of the country heads into our first pandemic winter, he says, the short-term situation for dentists is fairly stable, both on the supply and the demand ends. After all, teeth are a notoriously troublesome aspect of human anatomy, and dental troubles don’t wait for a pandemic to end before they strike.
But change is coming. “I don’t see an imminent solution to the COVID problem,” Vujicic says. ADA projections show a 38% reduction in the dental industry overall for 2020 and up to a 20% reduction for 2021—assuming no major changes to the status quo over the winter. Given these figures, he says, the current volume of dental practices isn’t sustainable.
“Our latest analysis doesn’t paint such a rosy picture,” he says.
The backstory
This is the second time in the past 50 years that American dentistry has found itself dealing with public worry about safety caused by a virus. The last time, it was HIV. “That’s when dentistry made its first major transition in infection control,” says Michelle Lee, executive director of the Organization for Safety, Asepsis, and Prevention (OSAP), an organization that does research and education on dental industry hygiene.
“Since the ’80s, we’ve been following universal precautions,” Lee says. These precautions—masks and gloves during procedures, advanced air filtration, and sanitation—are credited with preventing the spread of human immunodeficiency virus, a blood-borne pathogen, through dental procedures. The dental industry made these changes in the context of several high-profile HIV infections related to dental care, which shook public confidence. Staff started treating every patient as if they might be infectious, preventing further infections and helping to resolve the crisis in public trust.
“Dealing with HIV was a real issue. Dentists took a lot of precautionary measures,” says Fred Leviton, president and CEO of the nonprofit Dental Lifeline Network.
Lee and others credit this ethos for being a major reason that dentists have been able to reopen with no COVID-19 infections to date being traced back to their offices. Although some of the precautions are new—no dentist ever wore a respirator in pre-COVID days, for instance—the mindset was already established, she says.
Even so, America’s dentists are facing a fresh crisis of trust, this time from their staff as well as their patients. Dental staff, asked to return to work in the midst of a pandemic after being furloughed or laid off, worried about whether they would be safe and whether they would bring the virus home to their families.
San Antonio dentist Joshua Austin authored a controversial editorial for a dentistry publication on this issue. In it, he called for dentists to keep in communication with their staff, and for hygienists, specifically, to raise concerns with their employer before blowing the whistle.
At his office, he says, “we had to have a sit-down meeting where we talked about what their concerns were, and I had to show them all the different things I was trying to do to mitigate them.”
Many of his friends who are dentists were having the same kinds of conversations, he says—especially with the dental hygienists they employ. “As a profession, they wanted to stay home and didn’t want to be out in what they perceived as a dangerous environment,” says Austin.
JoAnn Gurenlian, a professor of dental hygiene at Idaho State University and chair of the American Dental Hygienists’ Association (ADHA) back-to-work committee, tells it differently. Dentists and hygienists largely want the same thing, she says: safety for them and their patients. There was tension about coming back to work, but, she says, “it wasn’t really about conflict. It was about, How do we put all these pieces into play?”
The ADHA is still receiving hundreds of emails from hygienists concerned that their dentists are not observing the national recommendations leveled by the ADA, the ADHA, and the Centers for Disease Control (CDC), Gurenlian says.
“There was this really hard and quick reaction, and I think it really broke some major trust bridges,” says Tracy Anderson Butler, a former hygienist and dental industry consultant who spent a large part of her career advising dental practices on how to keep operations running smoothly and deal with interpersonal issues. She’s heard about bullying by both dentists and hygienists, she says, and workplace conflict over safety measures.
Most dentists are small-business owners as well as medical practitioners. They hire and retain their own staff, and they’re responsible for resolving these conflicts as well as overseeing the practice of hygienists and others. But hygienists, who are themselves trained medical professionals, can strike out on their own in some states, thanks to legislation that allows them to practice independently.
Both Anderson Butler and Gurenlian expect to see more hygienists taking this option, as well as some leaving the profession entirely. “I think it’s an awakening for dental hygiene,” says Gurenlian.
A short-term symptom of all this unrest is the fact that dentists are having trouble finding new staff and maintaining their existing staff right now. According to ADA numbers, roughly a quarter of dental practices were recently or currently looking to recruit hygienists or dental assistants but having a challenging time doing so.
Mitch Olan, executive chairman of Dental Care Alliance (DCA), says the pool of staff looking for positions has decreased during COVID. In the longer term, he’s hopeful that new graduates of dental care programs will fill those gaps.
Supply and demand
Then there’s the fact that one-fifth of demand for dental services has evaporated at a time when costs are going up.
“The short-term response I see coming is higher fees, layoffs, and potential exits among retirement-age dentists,” says Vujicic.
ADA numbers peg the additional costs of added PPE and sanitation at between $10 and $15 per patient visit. Sometimes that money is being recouped from insurers that are keen to see dentists stay in business, says Vujicic. Other times, although the ADA doesn’t know how often, dentists are eating that cost—for now. But in the medium term, he says, most dentists whom the ADA has asked say they’ll have to raise prices to account for their added costs, which means consumers would bear this additional cost.
Dental offices are keen to be seen as safe. During the pandemic, many people are just doing less of everything, concerned about the potential risks. Dentists rightly point out that no COVID-19 infection has been traced back to a dental office, but patients should be careful, just like with any other medical procedure at this strange time.
There’s a divide between how dentists talk and the recommendations of public health organizations. In August, the World Health Organization (WHO) released guidelines saying that routine dental care should be avoided in areas with community spread of COVID-19, and cases are rising in nearly every state across the country right now.
Then–ADA president Chad Gehani “respectfully yet strongly” disagreed in a release, saying, “With appropriate PPE, dental care should continue to be delivered during global pandemics or other disaster situations.”
This story is a microcosm of the public health back-and-forth that’s been characteristic of the conversation around dental care during the whole pandemic. What we know about SARS-CoV-2 has changed rapidly, along with public health recommendations of all kinds. And how the virus could spread in a dental setting is only beginning to be known.
An email survey of U.S. dentists conducted by the ADA earlier in the year reported an extremely low rate of COVID-19 infection among dentists themselves—under 1%—and universally enhanced protective measures were widely publicized by the organization. The research is ongoing and recently added hygienists.
But because there are so many asymptomatic COVID-19 infections out there and contact tracing has been difficult owing to such rampant public spread of the disease, it’s impossible to say how accurate the survey results are. That less than 1% stat from the ADA study might be an underestimate, the study author acknowledged—and that study only looked at dentists: It didn’t look at patients. But as for the more important question, whether dental offices are high-risk settings, the answer seems to be “no,” provided precautions are being taken.
More important, though, is that “not every practice is following guidance,” Gurenlian says. “Not every practice has enough PPE.”
Dentists are also eager to be seen as essential. The ADA adopted their new motto in a late-July meeting. The terms of their related policy broadly define essential dental care as “any care that prevents and eliminates infection, preserves the structure and function of teeth as well as the orofacial hard and soft tissues.” They recommended the term be used in advocacy instead of some previous terms: emergency dental care and elective dental care.
But the pandemic is demonstrating that if dental health is an essential part of health, and should remain open in emergency situations, it needs oversight mechanisms for the dental profession that mimic those for the medical profession. Gurenlian questions why those mechanisms, like an ability to report employers who aren’t observing proper hygiene procedures and industry-specific contact tracing, don’t exist for dental professionals. As it is, she says, “I think we need awareness of reporting to health departments and reporting to our national organizations.”
What comes next
The dental industry was already in the grips of change before the pandemic started. The old model of retailing dental supplies was slowly being abandoned in favor of shopping online, while the teledentistry sector was slowly growing, and a relatively new form of dental practice shaped by what are known as dental service organizations (DSOs) was also gaining ground. Industry watchers think all three are likely to become more prominent as a result of the pandemic shock to the industry.
When PPE shortages began, says Scott Drucker, a dentist turned online dental supplies retailer, dentists turned to traditional suppliers and found costs to be multiple times what they had previously anticipated or products to be simply unavailable. That got them looking farther afield, he says: “Many more dentists have found us now that they were pushed to shop elsewhere.”
Drucker’s company, Supply Clinic, is a marketplace with multiple retailers, but, he says, traditional distributors have also enhanced online stores in response to pandemic demand. “There’s been a large shift in the industry to online shopping,” he says. Beyond supply issues, there was also the fact that the traditional model, which involved a sales representative entering dental practices with samples and taking orders on the spot, isn’t really possible right now because of COVID-19 social distancing and space restrictions.
“There have been waves of spottiness in supply, and we’ve gone through waves of different items being difficult to procure,” Drucker says. First it was masks, then gowns, then disinfectant wipes. Now gloves are the hardest things to get hold of, he says. But with multiple opportunities to find supplies online and compare prices, dentists are more likely to get a good deal on the right product.
This process is the mirror image of a consumer transition that has destabilized traditional dental revenues. The Internet allows patients to shop around for well-reviewed dentists and compare dental prices, and it’s also made new forms of teledentistry—like SmileDirectClub, which produces clear aligners—possible. Drucker says teledentistry saw a short-term bump when dental offices were closed, but he doesn’t know if it that accelerated growth rate. However, both he and Olan think teledentistry's market share will continue to grow.
Another trend that several people who spoke to Fortune believe will continue is the slow consolidation of the dental industry into larger practices and practices operated by dental service organizations (DSOs) like DCA, Olan’s group. These organizations are also known as dental support organizations.
Currently, 18% to 20% of dental practices are affiliated with DSOs. Technically, the dentists still own their practice, as is legally required, but they are part of a larger organization that oversees practice administration and marketing. Proponents of the DSO model, including Olan, say that partnership with a DSO allows dentists to focus on patient care rather than the business side of the practice. Detractors say that DSOs promote consolidation at the cost of patient care.
In the next five to 10 years, Olan expects DSO marketing penetration to increase by 30% to 35%. “The pandemic just added another layer of responsibility and stress on top of running a dental practice,” he says.
Dental students are graduating into a very different milieu than that of even a few years ago. “There’s no doubt that dental education in the future will be different from what it has been, because it is right now,” says Karen West, president and CEO of the American Dental Education Association.
Her organization has been closely tracking enrollment, and she says it’s currently on par with pre-COVID times. Dental students will graduate today with an average of about $300,000 in educational debt, Olan notes. He says many are unlikely to want to go the route of the sole practitioner. Their entry into the field will make its own mark on this changing industry.
For now, though, the dental business is in the eye of the storm, but you still might want to think about getting your teeth cleaned. As winter looms, Gurenlian says, “it’s more important than ever that we take extra care of ourselves.”
