For Immediate Release
Date: Apr 28th, 2015
Contact: Dr. John Thompson
The View from No Mans Land
Having never done this before, I had no perspective of what it would be like to really retire from clinical dentistry. When asked, “What do you do?” my experiences over the last two-plus years have led me to say in response, “I am a recovering dentist.” My continued participation as a dental editor and as an Interim Executive Director for our state dental association, combined with my tendency as a professional meddler has kept me close to the profession I have loved.
To say that this transition period of my life has been interesting would be at best an understatement of, “Oh, what a ride!” A busy dental practice is not self-managing and it consumes the greatest majority of our time and emotional resources. Psychologists say that many of us define our ego and self-worth with what we identify as our work. When I left the management of an established dental practice with wonderful patients, great partners and an incredible staff, I felt as if I had moved to a different place in time with a much altered view. I was suddenly seeing this profession from the outside for the first time since I began dental school in 1967.
I have tremendously enjoyed my involvement with the American Association of Dental Editors and Journalists over the years. There is so much that this group has shared and so much that is personally owed them. AADEJ takes seriously the role entrusted them by the profession and as one esteemed member has said, “Editors are tobe the conscience of the profession.” To be a good editor you first must be a great observer. If not an observer, the choice of subjects for your missives will be both limited and fictional. This is not a good combination for professional journalism. I will only claim that in my efforts as a dental editor, I know I have become a very good observer.
As a retired dentist I am looking at an economic, demographic and political landscape that does not resemble the time line in which I practiced, or at least the perspective I had at the time I was in practice. I see so many of my colleagues who look as if they are in a dental practice foxhole wondering “What can happen next?” and asking if I just hunker down, “Will it all go away?”
With time on my hands, I actually get to study the Wall Street Journal and read more than ever before. I have time to go to dental meetings and talk with former students, now fully engaged practicing dentists. I can spend more time distracting my peers and dental vendors who have been friends for many years. Occasionally, I will take in a continuing education program, but not because I have to renew a license or enhance a clinical skill. There is time to look at public policy that is impacting dentistry and use personal contacts developed over many years to improve a MEDICAID program for both, dentists and patients. My wife and I were able to enjoy our South Carolina beach home and a more tropical February. For the first time in my adult life, I really controlled my schedule, at least for one whole year!
Flexibility and a great wife make for the ability to seize an opportunity. In March of 2014, while attending the Kentucky Dental Association Board of Directors meeting as the seated Dental Editor, our Executive Director of many years unexpectedly retired. As unexpectedly, the board turned to me and requested that I serve as the interim Executive Director while a search began. Thinking to myself, “Three months - this could be fun!” I said yes. Two days later my wife and I had begun looking for a one-bedroom apartment in Louisville and we closed our Lexington home as we relocated to the KDA headquarters only seventy miles west. Thus began my adventures with another great staff and not a clue as to what I was going to do. The one thing I was already certain of was that this would have no semblance to the practice of dentistry.
There were several things that came to mind as I drove back to Lexington from that Louisville meeting. As the editor for many years, I had written a commentary for each publication published. That board already knew that there were issues of which I had been trying to raise awareness and many things I thought we ought to be doing, but were not, as a professional association. It is easier to write about tough issues and ask the tough questions, as an editor, than it is to actually provide the answers as a collective body. My first thought was that it was amazing that our Board of Directors knew so much of what I thought and still turned to me for this position. The second thought was that I must move from the editor’s grammatical first person in what I say and do and begin to act in the third person. I was now an official spokesperson for the profession in Kentucky. The third consideration was that I could now make a difference. As an interim, I could act fearlessly; the worst that could happen was that I be replaced with a real Executive Director. And my other thought was that I would need HELP and fast!
My first phone call was to my friend, Tennessee Dental Association Executive Director, David Horvat, who helped me form a liaison with the organization and list serve for dental executive directors, which proved to be my lifeline. The staff and I were in the same boat and we had no intention of being other than successful during this time of transition. In some ways, those first weeks were like drinking water through a fire hose, but with great support and seventy-hour work weeks, it became my passion. The best experience was the interaction I was having with dentists throughout the state and listening to the things that concerned them. I was in a position to intensely observe the profession from the highest vantage point I could ever have been afforded. It is from this perspective, as a recovering dentist, that I write and not my experiences in the seven months I served the association.
The playing field on which dentistry is being practiced is changing faster than ever before. So many of the rules of the game are being rewritten by those other than the practicing dentist. The most important discovery was that dentistry has become a topic at almost every discussion of healthcare and its delivery. I also noted that dentistry was not present at the table when many of these discussions were being held. There will always be someone who will have an opinion on how dental care can be delivered. Will it be someone who knows something about dentistry? It will not be if we are not represented and involved in healthcare discussions. I immediately found that our association leadership was willing to seek engagement and collaboration with our state policy makers. This is an engagement that is rapidly finding traction with policy administrators and legislators who are willing to listen, willing to look for solutions and willing to see dentistry as a necessary partner in achieving better healthcare for our citizens.
There seems to be a disconnect between practicing dentists throughout the state and their interpretation of the tripartite association. While we have an impressive list of services and discounts available to members, it no longer seems to be a highly-valued benefit. We provide an incredible annual meeting, both, nationally and here in the state, with continuing education venues that cannot be improved. Yet the fact is, only a small number of dentists will take advantage of a well-designed comprehensive program that is supposed to be a great benefit of membership. Indeed, even when the programs are opened to non-members there are few who will attend. Membership, itself, is being evaluated and our younger practicing dentists are finding professional association membership lacking value. We must reach them with a new message and undeniable benefit available from no other source.
As an association executive I was able to go before local dental societies where we had essentially “town hall” discussions. I found passion and I found profound frustration in the practice communities regarding the MEDICAID issues, insurance programs and a general feeling of helplessness in the face of changes that have and are occurring.
I would describe the changes as if there are two fast flowing streams. The first is the economy that demonstrates a decline in adult dental visits that began even before the Great Recession. The recession, itself, is an event from which, according to the Chief Economist and VP for the American Dental Association Health Policy Institute, lawyers, coffee and dentists are not recovering. (1) Added to this stream are increasing student debt, the ascension of multi-state large group practices and the opening of proprietary dental schools.
The second fast flowing stream is associated with the implementation of the Affordable Care Act, the growing absorption of dentistry into medicine, the rapid expansion of the MEDICAID and other public paid dental care programs and shifting policy that looks at population access and outcomes, cost of services and patient satisfaction. The confluence of these two streams is an out-of-control river of change in healthcare that is, in many ways, overwhelming our traditional fee-for-service model.
All of this is observation. I don’t have the answers, but I do know that all of the solutions will be provided by someone and it had better be by people that understand dentistry. There is only one way this will happen and that is through intentional ADVOCACY. Advocacy is the one product that only the association of professional dentists can provide. Going forward, the most important singular value of professional association membership that transcends age demographic, gender, model of practice, urban/rural and political affiliation will be our advocacy. Advocacy that allows dentists to SUCCEED and the public to be provided accessible and affordable dental care is the real value of membership. I emphasize that the dental practices, large or small, must be financially successful as the small businesses that they are. Our advocacy must be mutually inclusive of both goals.
At the recent Kentucky Meeting in Louisville, Tom Spangler, Director, Legislative and Regulatory Policy at the American Dental Association’s Washington D.C. office, admonished dentists attending a seminar on effects of the Affordable Care Act that “It is not going to be easy, but it is doable.” I have been in the “no man’s land” between dental practice and public policy for the last two years and I do see peril and I see genuine opportunity. Doing what we have been doing is not going to work well going forward, but changing the model is not changing the service we provide. One of our passionate member-leaders likes to say that providing dental care is an “intimate service”. I don’t think anyone who has had a root canal would ever argue with this statement. To become the voice that protects the ethical integrity of this wonderful profession, we are all going to have to start rising from our practice foxholes and begin scouting around us, not for enemies, but for both, allies and opportunities, to bridge the gaps that are opening. We are the only advocate for dentistry that will ever place value on ethical integrity and it is up to us to make this the highest mission of local, state and our American Dental Association. This is the real reason that membership is the priority, no matter where or how you practice the profession that is dentistry.
1. Journal of the American Dental Association, March 2014, Of Lawyers, Lattes, and Dentists, Marco Vujicic, PhD