Management Company Control, Fee Splitting, and a Suspended Clinical Director
Dr. Chen, a dentist in Kansas City, is negotiating with a management company, BrightSmile Partners, owned by a non-dentist investor. The proposed contract gives BrightSmile 35% of monthly collections, control over hiring and firing of hygienists, authority to set production quotas, and the right to approve which procedures Dr. Chen offers. BrightSmile also wants to advertise that a dentist whose license was suspended six months ago for record falsification is the "clinical director." Dr. Chen will remain the only owner-dentist and will be listed as the treating dentist. BrightSmile says the arrangement is common and that "the dentist keeps clinical control on paper." Dr. Chen asks whether he can sign.
1. What Board rule problems does the proposed contract create?
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Several. First, paying a non-dentist management company a percentage of dental collections looks like fee splitting, which Missouri prohibits when it amounts to sharing professional fees with an unlicensed person or entity. A flat management fee for specified administrative services is different from a percentage of professional revenue, but the percentage structure here is a red flag. Second, giving a non-dentist control over hiring and firing of hygienists, production quotas, and which procedures are offered can amount to unlawful control of dental practice by a non-dentist. The dentist may use business managers, but clinical judgment and the professional practice must remain with the licensed dentist. Third, advertising a suspended dentist as "clinical director" may mislead patients and may aid unlicensed or prohibited practice if he is held out as providing clinical services. "Clinical control on paper" does not fix an arrangement that gives real control to the company.
2. How should Dr. Chen respond to BrightSmile's proposal?
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He should not sign the contract as written. He should ask an attorney familiar with Missouri dental law to revise it so that: the management fee is a fixed or fair-market administrative fee, not a percentage of professional collections; the dentist retains sole authority over clinical decisions, procedure selection, hiring and firing of clinical staff, and patient care policies; the company has no authority to direct or pressure clinical production in a way that compromises care; and any advertising is accurate and does not hold out an unlicensed or suspended person as a treating dentist. If BrightSmile insists on control, he should walk away. He should also check whether the arrangement would cause him to aid unlicensed practice or to split fees, and document his own independent clinical judgment. A contract that looks common in the market is not a defense if it violates Board rules.
3. What issues does the proposed "clinical director" create, and what should Dr. Chen do about it?
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A dentist whose license is suspended may not practice dentistry or hold himself out as authorized to provide dental care during the suspension. Advertising him as "clinical director" can mislead the public into believing he is available to treat patients or supervise care. If he would be making clinical decisions, supervising staff, or seeing patients, that would be unauthorized practice and Dr. Chen could be disciplined for aiding it. Even if the title is purely advisory, the public-facing advertisement must be accurate. Dr. Chen should refuse to use the suspended dentist in any clinical or supervisory role, require that any advertisement be truthful about licensure status, and confirm the dentist's status with the Board. If BrightSmile will not remove the reference, he should not proceed with the contract.