Managing Private Practice in a War Zone

Ivan V. Nagorniak

Journal of Diagnostics and Treatment of Oral and Maxillofacial Pathology (DTJournal). 2022;6(3):35–6

Ivan Nagorniak is the author of this article, originally published in a peer-reviewed academic journal, DTJournal.
Manuscript received: March 13, 2022 · Accepted: March 14, 2022 · Published online: March 15, 2022.
DOI: https://doi.org/10.23999/j.dtomp.2022.3.1
© 2022 OMF Publishing, LLC. Open access article under the Creative Commons Attribution-NonCommercial 4.0 International license.
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The private sector [in wartime] can help steer the whole social and economic environment towards a better, more functioning state. — James Robinson, Professor

Eighteen days into the full-scale Russian invasion of Ukraine forced us to urgently rethink how a private dental and oral and maxillofacial surgery practice is organized. Wartime dictates an entirely different, and at times extremely risky, agenda.

In order to provide urgent dental and oral and maxillofacial surgical care to residents of cities and villages who cannot or will not evacuate from combat zones, some private practices continue to operate. Although they do not provide a full range of services, their activity remains highly effective even when limited to emergency care. For instance, during the first 13 days of the Russian-Ukrainian war in February–March 2022, 16 private dental practices were operating in Kyiv.

Let us pray for our entrepreneurs. … Every workplace [in wartime] is sacred. — Oleksiy Honcharenko, Member of Parliament of Ukraine

Problematic aspects of running a private practice under conditions of active hostilities include: (1) disruption of supply chains for dental and oral and maxillofacial surgical materials; (2) suspension or complete cessation of dental technicians' work due to evacuation or lack of materials; (3) shutdown of diagnostic centers whose results are necessary for establishing a diagnosis and monitoring treatment effectiveness; (4) difficulties (increased taxi costs and risk to life) for patients and staff traveling to the clinic; (5) substantial reduction in clinic staff due to possible evacuation; (6) a significant decrease in the number of procedures performed as a result of factors 1, 2, 3, and 5; (7) the need to go down to a shelter when an air raid siren is announced, forcing interruption of a treatment procedure; (8) injury to staff members; (9) a substantial reduction in financial resources as a result of factors 1, 2, 3, 4, 6, and so on.

In some cases, the entire clinic staff may be evacuated from the workplace and the locality. Modern video technologies with remote-control functionality via laptop or smartphone can certainly help monitor the state of the private practice's infrastructure and provide the ability to call the local police should looters break into your premises. However, if this happens and the police do not have enough personnel to arrive at your business location in time, defending your property with a weapon in hand may become the measure that stops looters from committing criminal acts.

Another positive aspect for practice owners who continue to operate in the private sector even under wartime conditions is the gratitude of patients who received care for acute pain, maxillofacial trauma, or postoperative complications, as well as a sharp rise in the reputation of that particular healthcare facility within the region.

Williams (2013) emphasized that for businesses (i.e., private clinics) that take the risk and survive, the long-term benefits in a rapidly expanding market can be very significant.

Doing business in conflict zones is discussed in detail by Rosenau et al. (2009). The authors concluded that entrepreneurial activity contributes to "state-building," the organization of security measures, improved relationships with local communities, and the formation of an acceptable level of risk for conducting business (a predictable environment is acceptable even when it is not peaceful). "State-building" and "support for defense forces" can be carried out through paying wages, paying taxes, and even creating new jobs for internally displaced persons.

Thus, each clinic owner decides individually whether to remain and keep the practice operating during wartime. Depending on the decision made, the business may even grow, the owner may purchase expensive equipment, and may make either a direct (financial transfer) or indirect (job creation, wage payment, and tax payment) contribution to supporting the national Armed Forces and the economy, helping the army achieve victory over the occupiers faster and strengthening the state's economic standing. While the safety of employees' lives is a priority, some practice owners may continue to work, taking into account the intensity of hostilities and the presence of missile defense systems in the relevant region of the country.

The private sector creates prosperity, fosters socio-economic development, and contributes to conflict prevention and resolution. — Dean C. Alexander, Associate Professor of Homeland Security, Western Illinois University, USA
The government will do everything possible to help the regions adapt to the new realities [of wartime]. — Oleksii Reznikov, Minister of Defense of Ukraine

About the Author

Ivan V. Nagorniak, MSc, PhD, is a chief physician and private practice owner based in Kyiv, Ukraine.

References

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