Starfish and Ripples - Musings from Guatemala dental mission trip

Recently, my wife, Dr. Gina Kessler and 15 other colleagues from Dentistry Making a Difference went to Guatemala for a dental mission trip.  We have always wanted to do something along these lines.  The opportunity presented itself so we decided to go for it.  Here are some of my musings. 

March 7, 2018 - I am in San Pedro, Guatemala on a dental mission trip with my wife, staff and several colleagues.  We are seeing people who are in extreme poverty with huge dental needs.  My comfort zone is being stretched in huge ways as I am not in my "cushy urban" office anymore.  We are in a 5 chair clinic that opened recently through the Spear “Open Wide Foundation”. 

One patient I will never forget.  Her name is Araceli. She is a beautiful 5 year old girl, dressed in a pink jacket and a traditional style dress. I haven’t treated a child this age since dental school.  I don’t know who is more nervous - her or me.

Araceli (5 y.o) looking into the clinic

In the morning, she had been outside watching us do our work from a window outside the clinic.  Her turn was in the afternoon.  She came in terrified and reserved - probably frozen by fear.  I had a translator help with the communication. I looked in her mouth and my heart sank. She had dental needs in every tooth due to rampant decay. I consulted with the staff dentist at the clinic hoping that she would say refer her to a pediatric dentist - this kid needs to go to the OR for her treatment.  There were none to be seen. The staff dentist and I consulted, it was decided to take out her five front teeth (c-g).  This was just scratching the surface of her dental needs.   

I gave her injections and pulled her teeth.  

She screamed, I cried. I fought through my own emotions and got to work as quickly as I could.  She screamed some more, I cried some more. 

When it was over she calmed down and gave me a hug, thanked me for helping her. I am not really sure if I helped her.  She is a kid that, if she was in the states, she would be brought to the operating room for her treatment. My mind was racing with questions probing the unknown.   Did I really help her?  Did I traumatize her?  How will she get the help she needs?  How will her dentition turn out?  How will her psyche be affected?  I took out 5 infected front teeth. Will her adult smile reflect the beauty of this girl as she grows into adulthood.  If her teeth are this infected, how is her overall health?

Gina, Araceli and me after her treatment.

There is so much dental disease here. There are not enough dentists in the world to fix all the decay here.  How can I possibly be making a difference?

Starfish story link - 

https://www.youtube.com/watch?v=Z-aVMdJ3Aok

I have come to the conclusion that I made a difference for Araceli. I may not have been able to address all the needs in this town.  But I made a difference for her.  Our team of 5 dentists and 12 assistants/hygienists made a difference for the 100 or so patients that were seen in our clinic these past 5 days.  

Hopefully she will start to brush, floss and change her diet. I am not sure if there is clean water where she lives.  She probably doesn’t even have running water let alone indoor plumbing in in her house.  I tried to explain Araceli’s dire need for more dental work to a lady that said she was her grandmother. (She also said she was the grandmother to the several other kids that were there that day).  I am not sure if she understood - I didn’t speak Spanish, she didn’t speak English.  My recommendations were translated to her, but was it heard? 

Guatemala has what is considered extreme poverty.  The average income for a family is $300/month.  Over 25% of the population is considered illiterate.  School is mandated for 6 years, but the average is a little over 4.  There just aren’t resources for them - especially in the rural areas.  

I know that there are similar situations happening in our communities back in the states as well.  I feel that for most though, they have a chance. There is infrastructure to provide opportunities to get help.  I also know there is not enough.  

The dental future for Araceli and her family may have changed trajectory based on this experience.  I hope so. I also hope that her experience in our clinic will ripple out in ways that she will be able to contribute to the world in her own unique way. Who knows, she may become a staff dentist at a similar clinic in her community.  

We never know who we impact or how we affect someone - be it our patients, friends, colleagues, acquaintances, etc.   It could be that we get someone out of pain, fix their smile, remove infection.  It may be that a conversation that we have with our patients every single day finally sticks with someone.   We never know when someone hears something that catalyzes a much needed change in their life.  All we can do is keep doing the best we can - sharing our unique skillset to those in need.  I have had many patients come back for their six month cleaning and check up and tell me how our conversations changed the trajectory of their lives.  I feel that a smile is a window to the soul and we do everything we can to help our patient’s soul shine through. A smile can change a person’s life.  

I have come to the conclusion that we made a difference today for Araceli.  We barely scratched the surface, but we made a difference for her.  

I hope that the difference we made for her (and our patients back at home) ripples out into the world to create more positive difference.  

Starfish and ripples. 

BK

Who is John Galt? How Corporate Dental Offices are Disrupting the Status Quo.

Who is John Galt?

Disruptors in Dentistry

By Brett Kessler, D.D.S., CDA President

"I started my life with a single absolute
That the world was mine to shape in the image of my highest values
And never to be given up to a lesser standard, no matter how long or hard the struggle" Ayn Rand, Atlas Shrugged

Disruptors are innovators.  They are businesses that shift a mindset of how consumers think, purchase, etc. – thereby challenging established businesses.

Harvard Business School professor and disruption guru Clayton Christensen says that a disruptor displaces an existing market, industry, or technology, and produces something new and more efficient and worthwhile. It is both destructive and creative.

Some examples of disruptors are companies like Apple, Netflix, Amazon, and Uber.

I identify Apple not for the computers that it builds, but for another niche that it took over – music and listening device sales.  iPods, iPhones and iTunes have changed how we buy and listen to music. There are hardly any CD stores remaining other than those that sell used discs.  When I grew up, I would buy records.  The cover art would attract me to give new bands a listen.  I judged the band by entire albums that it recorded.  Today, we buy songs, not albums. They are instantly downloaded onto our computers.  No waiting in lines; no browsing through tedious shelves of records/CD’s.

We create playlists with the drag of a mouse.  We use auto shuffle and the “genius” feature to create our own personal radio stations. They connect to our cars, our phones, our tablets and all are stored on our computers.  CD players are becoming a thing of the past.  Music is stored on hard drives, flash drives, iPods, etc.

Netflix took how we rent movies to a new level.  For a low monthly fee, we can have unlimited movies shipped to our house – hassle free – or immediately available to view on our computer or smart TV’s through an internet connection.  Blockbuster used to charge late fees, “you-didn’t-rewind-the-VHS” fees, etc.  I dreaded having to pay this fine. The buying experience was a hassle and expensive.  Netflix is easy, customized to my preferences and instant. Are there even any Blockbuster stores left?

Amazon capitalized on the fact that a book is still readable after it had been read, music is still listenable after it had been listened to, and anything should be able to be purchased on the internet easily!  They created a personalized buying experience based on your browsing and buying habits.  It greatly affected the big chain bookstores like Borders or Barnes & Noble.  It also helps you find the lowest price for a commodity and they deliver it right to your door.  If it wasn’t exactly what you were looking for, ship it back.  Hassle-free!

Lastly, Uber is putting a huge dent in the taxi business. With Uber, you can press a button on your phone app and a nice clean car will be at your location within 15 minutes. Taxi’s get to you when they get to you and the entire cab experience pretty much stinks!

All of these disruptors have innovated, streamlined and penetrated market share. They have challenged and even ruined wildly successful businesses, while reinventing the delivery of these services.  They have changed the consumer’s mindset and changed the paradigm on how these services should be purchased, used and consumed.  The consumer experience is exactly the way the consumer prefers.  We (the consumers) wouldn’t have it any other way.

Another commonality of these disruptors is that they didn’t just enter the marketplace and were welcomed with opened arms.  The status quo or “established” business model was not happy and tried to stop them.

In reality, the status quo was asleep at the wheel. They were lazy and arrogant. They felt they were too big to fail. Those established business models that survived disruption evolved their business models to better serve their consumers.

The question, “Who is John Galt?” comes to mind from Ayn Rand’s book “Atlas Shrugged.” John Galt represents creativeness and innovation.  In the book, the status quo was constantly putting up barriers to protect its own interests in how things always have been done.

The status quo must constantly channel its inner John Galt if it wishes to remain relevant to the people it serves.

There are disruptors popping up in every niche of business, and dentistry is definitely not immune. 

Large Group Practices, better known as Dental Support Organizations, are delivering dental services cheaper, quicker and more efficient than the typical private practice. A Dental Support Organization takes care of all of the business aspects for the dentist – the billing, HR, marketing, equipment, materials, etc. 

They are aggressively growing around the country.  They are aggressively hiring new dentists.  They are aggressively advertising their services.  They have created a niche for themselves and continue to attract patients.  Some may say that they haven’t perfected the consistent customer experience yet, but at some point, this too will change.

As in private practice there are good practitioners and those who could use a little nudge to “up their game.”  The reality with the Dental Support Organizations is that they are being judged by the lowest common denominator.  For every bad patient experience, the entire organization’s reputation takes a hit. If these companies are going to take their disruption to the next level, they need to shore up some of the weaker links in their organizations.  Trust me; they are aggressively evolving their internal practices to do just this. 

I recently attended a forum on Dental Support Organizations. DSO’s are growing 15-20% per year with over 7000 dentists employed, it was illustrated that the trend in healthcare is moving toward consolidation.  Consolidation breeds efficiency, in theory.  If you look around, there are very few privately owned pharmacies; there are very few private physician offices.  They have all been engulfed by corporate entities that manage the business side of the practices. Has it improved healthcare? I’ll leave that for the reader to decide. 

Many of us in private practice (the status quo) are complaining.  Of course, it’s only natural.  The realities are, however, if the private practitioners aren’t evolving their games, they will soon be wondering where their patients have gone. Maybe some of us already are!

Graduating dental students are being hired in droves by these practices.  I asked a recent graduate who was working for a Dental Support Organization what his favorite part was about working in this environment?  He answered that he has mentorship and professional networking instantly available to him.  He admitted he gives up some of his autonomy, but implied that no job is 100% perfect.  I would agree with that statement in private practice too.  There are parts of my day that I don’t look forward to doing (usually administrative) as well. 

Most of these dentists are not joining organized dentistry.  Why?  The most common response: they are made to feel “less than” for working for those companies. 

This must stop.  We (organized dentistry) are being judged by this fact, just as some may be judging those who work for entities different than private practice. The Colorado Dental Association is charged with advancing oral health in our state.  The DSO’s in Colorado are helping us achieve this.  They are just doing it differently than the “status quo”.

We need to be much better at welcoming our colleagues.  They are working the best that they can with the opportunities that are presented to them.  I always remind young dentists to keep the patient’s best interest as their main focus.  We have a must maintain our code of ethics as a profession.

The Association of Dental Support Organizations (www.theadso.org) has emerged to help set standards for it’s members and is looking to ensure that ethical practices are in place.

Evolution is the survival of the fittest.  Those who can adapt and create change will evolve into the new paradigm, and address the needs and desires of the consumers.

The status quo does not exist indefinitely.  It will constantly be challenged.

“Who is John Galt?”

Disclaimer: I am not passing judgment on these disruptors mentioned in this article.  I am just sharing my observations and thoughts.  I may or may not subscribe philosophically with various paradigm shifts occurring in the dental marketplace.  Each serves a niche that is attractive to various people.  That is why they are growing/gaining the market share and shifting the perceptions of the consumers. When I mention “organized dentistry” I mean ADA, state associations and its components.

If you like this blog post, I would love to hear about it.  Please comment or share it on Google+, Facebook, Linked in, Twitter, etc.  If you are looking for a dentist in the Denver area, we are always looking for new patients.  Please visit our website http://www.tcdodenver.com/ or like our facebook page,  https://www.facebook.com/TCDOdenver.  Or you can contact us  the old fashion way - call us at 303-321-4445.

Thanks for reading!  BK

TEDMED 2014

For the second year in a row, I attended the TEDMED conference.  TEDMED is a corner of the infinite TED universe specifically focused on innovation in health care. 

Innovation is much too small of a word to describe what TEDMED is.

They try to introduce it on their website (www.tedmed.com): "TEDMED is a global community dedicated to unlocking imagination in service of health and medicine. Our goal is to seed the innovations of today, making possible the breakthroughs of tomorrow...for a healthier, more vibrant humanity." 

But even this is incomplete.  One must experience it to understand.

To attend, one must go through an application process.  TEDMED is always searching for the proper mix of delegates that will be allow for stimulating networking and friendships to be made.  This year the event was hosted in two cities, Washington D.C. and San Francisco.  I chose the latter.

There were 80 presenters, 2000+ delegates, 80 start up companies from various sectors of health.  This year's theme was "Unlocking Imagination".

240 page conference program

The presentations were thought provoking and expertly delivered in the classic TED style.  If you have ever seen a TED "talk", you know where I am coming from.

They shared how they were improving the design of hospitals to improve both the health of the patients and the communities they serve by leaving no footprint.  One was looking at diseases in different ways - for example, What role does childhood trauma play in all future diseases?

They challenged our paradigms at every turn. For example, legalization and government compensation for the harvesting of organs to reduce black market activity while saving lives.

They inspired us with virtual reality games to reduce pain in patients.  They gave us a glimpse of a new plastic that amorphically changes shape via electric manipulation to be used in cardiac catheterization.

One speaker was collecting voice samples to "donate" to people (kids and adults) who cannot talk - thereby giving them a voice and a personality.

Several bioethicists asked an uncomfortable audience on how messages to the public about drug use should be altered drastically.  One asked, should doctors be totally transparent? While another shared courageously about physician assisted death or discussed the ethics of genome mapping to tell our future propensity to disease.

My favorite speaker was Abraham Vergehese.  He is the author of several books including NY Times bestseller "Cutting For Stone".  I had the opportunity to meet him afterwards and have him sign a book that I read in 1999 titled, "The Tennis Partner".  I told him how important that book was to me and charged me with the impetus to live each day to the fullest.

After sharing life stories for a bit, he signed my book with the last line from the narrative, "...Get the ball back over the net just one more time."  (never give up!).  He gave me a hug and told me that I made his day (how cool!?!?!?!).  http://abrahamverghese.com/

Abraham Verghese and I at TEDMED 2014

     

The "convention floor" is known as the hive.  The hive is always buzzing with activities.  The start up companies are all there on display with things to play with.  Of course, I had to go to the obligatory brainwave activity detector to verify that the old neurons are still sparking once in while.  And, like last year, contrary to most people's opinion, I do indeed have a brain that is functional....I will leave it at that.

Verifying that I do indeed have a brain.

The hive is where it all happened.  The space was designed very deliberately to maximize our experiences. There were several areas for lounging, networking, working, watching presentations, eating, etc.  There were speaker meet-ups where you can have very in depth conversations with the speaker and other curious fellow delegates.

Another area was called the campfire where they served gourmet smores and had a vast array of topics to talk about about current and future trends in health care.

The attendees were medical students, PhD. students, biomedical engineers, heads of various prominent medical school departments, angel investors, artists, employees of tech, medical devices and marketing firms.  I was "wowed"by practically everyone I met. I was humbled my the creativity and intelligence of my fellow delegates.  I was inspired for their zest and zeal to change the world from their specific niche.  I met people from all over the world - US, Israel, Canada, UK, Australia, South America, Hong Kong, etc.

I WAS THE ONLY DENTIST.....too bad....I would encourage some of my fellow colleagues, (especially the thought leaders) to consider coming in the future.  I wasn't lonely, but I was the only dentist!

The over arching theme:  No matter what new technology is becoming available to better treat the patient's physical maladies, nothing can help a patient's psyche more than a healthcare professional (Physician, Nurse, Dentist, etc) that genuinely cares and connects with his/her patients on a human level.

Thanks to all the TEDMED-er's involved in putting on such an amazing experience and allowing me to attend once again!

Peace.

If you like this blog post, I would love to hear about it.  Please comment or share it on Google+, Facebook, Linked in, Twitter, etc.  If you are looking for a dentist in the Denver area, we are always looking for new patients.  Please visit our website http://www.tcdodenver.com/ or like our facebook page,  https://www.facebook.com/TCDOdenver.  Or you can contact us  the old fashion way - call us at 303-321-4445.

Thanks for reading!  BK

What will your verse be?

Robin Williams's death is a tragedy that has rocked my world.  I didn't realize how much he affected my life until I look at all the movies/tv shows/appearances that he was in.  

In "Dead Poet's Society", he challenges his students by asking the question,  "What will your verse be?"

A question of epic proportion.  Imagine being in his class posed with this question.  

What would your verse be?  What are you passionate about? How will you impact the world?  

Ironically the character that Professor Keating (Robin Williams) inspires most, Neil, commits suicide too.  He takes a chance and follows his dream, parents are unimpressed and pressures him away form his passionate path and he sees no other option but to die.  

Suicide is a permanent solution to a temporary problem. More tragic irony spoken by Robin Williams - 

My wife said to me this morning, "It is so unfortunate that people who struggle with addiction and depression cannot see how much their world around them love them"

So true....

I know many dentists and friends that have chosen to quit the fight.  Their demons, like Robin's, finally got the best of them.  Robbing them of the opportunity to see the light in their lives. Robbing their family and friends of what could have been.  

Today I shed a tear for Robin Williams; I am grateful for his verse; his impact on me and the world.  

The court jester is back with his maker; making heaven's souls laugh hysterically as he did for us.

Thomas Crum suggests:

"What would it be like if you lived each day, each breath, as a work of art in progress? Imagine that you are a masterpiece unfolding, every second of every day, a work of art taking form with every breath."

I believe that everyone has gifts that are completely unique.  Our purpose is to explore/grow those gifts and share those gifts with the world.

Everyday is a gift; I choose to treat it accordingly....

If you like this blog post, I would love to hear about it.  Please comment or share it on Google+, Facebook, Linked in, Twitter, etc.  If you are looking for a dentist in the Denver area, we are always looking for new patients.  Please visit our website http://www.tcdodenver.com/ or like our facebook page,  https://www.facebook.com/TCDOdenver.  Or you can contact us  the old fashion way - call us at 303-321-4445.

Thanks for reading!  BK

Advocacy in Dentistry - ADA Storms Capitol Hill - Washington, DC

United States Capitol at Sunrise

I was honored to be part of a delegation that went to Washington DC to provide dental care advocacy on behalf of the Colorado Dental Association and the American Dental Association.  We had a chance to meet with most of our Colorado legislators in person and if they were unable to meet with us personally, they had their health care staff expert meet with us.

This year we had three issues to bring forth.  The first was a reform on student loans hoping to get a reduction in interest and an increased tax deduction.  This is for everyone with student loans, not just dentists.  An interesting stat - Americans collectively owe $1.1 trillion dollars in student loans, much of it subsidized by the government.  It is quickly approaching the amount of money that we owe China ($1.4 trillion).   Congressman Paul Gozar, DDS (R-AZ) calls this a bandaid, a good start - but not a comprehensive solution.  The cost to go to college/graduate school must evolve as it is unsustainable.  Dentistry is the costliest of the professions to train and it is not unheard of for a dental student to finish with a $500,000 student loan debt.  This is a 30 year mortgage, not a student loan.

The second issue we discussed was an ask for grant money to help start initiatives that will serve those in need.  These grants will help states with initiatives such as "Give Kids a Smile", "Missions of Mercy" and community coordinators that will help people find a dentist via emergency room referrals, nursing homes, schools, etc.  The legislators asked where is the money going to come from.  We call this designated grant money an investment, not a cost.

For example, in Colorado - we have an event called Colorado Mission of Mercy (COMOM). COMOM is a 2 day event where dental professionals set up a temporary dental clinic in a big way.  Over a thousand patients are treated for free over the course of the event.  All of us bring our own dental tools and supplies and treat what is needed.  The cost to put on a COMOM is $160,000.  The amount of dentistry given to the community over a $1,000,000. This is money that won't have to come from government benefits such as medicaid.  The next COMOM is in October in Henderson, CO.

The third issue was a letter initiated by Rep. Paul Gosar, DDS (R-AZ) that we want our legislators to join in and sign.  This letter asked the Center for Medicaid and Medicare services to improve the fairness and transparency of Medicaid recovery auditors and their review process.  We believe that audits of medicaid providers should be done to catch providers trying to beat the system, but not on those that are doing their best to serve those in the community in need.

Currently, in some states, the process is "guilty until proven innocent" with very little opportunity for the provider to have any recourse to defend him/herself. It is difficult for dentists to want to join up to become medicaid providers when these type of audits are in place.

We also had a variety of speakers give us the current state of the political climate in Washington.  There is less than 40 legislative days left in session and due to stalemate political party posturing, they predict that very little legislation of any significance will get done.  Sad that this is the case.....

One of the best speakers was Rep. Peter Roskam (R-IL).  He was preaching to the choir when he said that the Affordable Care Act cannot put a price tag on caring for our patients.  He predicts that the "commoditization of health care" is going to drive down the opportunity for us to truly care about our patients.  I am doing everything in my practice to not let this happen.  I hope my colleagues will too.

A big revelation was how important our political action committees (PAC's) are.  Both ADPAC (national) and CODPAC (Colorado) raise funds to advocate to keep dentistry a profession of relevance.  This year alone, these PAC's have allowed us to spend time with our legislators to explain our needs so we can provide the best dentistry and services to our communities that we serve.

Who is John Galt? - Disruptors in Dentisty

Disruptors are innovators.  They are businesses that shift a mindset of how consumers think, purchase, etc.  thereby challenging established businesses.

Harvard Business School professor and disruption guru Clayton Christensen says that a disruptor displaces an existing market, industry, or technology and produces something new and more efficient and worthwhile. It is both destructive and creative.

Some examples of disruptors are companies like Apple, Netflix, Amazon, and Uber

I identify Apple - not for the computers that it builds, but another niche that it took over – music and listening device sales.  iPods, iPhones and iTunes has changed how we buy and listen to music.  There are hardly any CD stores anymore other than those that sell used ones.  When I grew up, I would buy records.  The cover art would attract me to give new bands a listen.  I judged the band by entire albums that it recorded.  Today, we buy songs, not albums. They are instantly downloaded onto our computers.  No waiting in lines, no browsing through tedious shelves of records/cd’s.

 We create playlists with the drag of the mouse.  We use auto shuffle and the “genius” feature to create our own personal radio stations.  They connect to our cars, our phones, our tablets and all are stored on our computers.  CD players are becoming a thing of the past.  Music is stored on hard drives, jump drives, iPods, etc;

Netflix took how we rent movies to a new level.  For a low monthly fee we can have unlimited movies shipped to our house  - hassle free; or immediately available to  view on our computer or smart TV’s through an internet connection.  Blockbuster used to charge late fees, “you didn’t rewind the VHS” fees, etc.  I dreaded having to to pay this fine.  The buying experience was a hassle and expensive.  Netflix is easy, customized to my preferences and instant. Are there even any Blockbuster stores left?

Amazon capitalized on the fact that a book is still readable after it had been read, music is still listenable after it had been listened to, and anything should be able to be purchased on the internet easily!  They created a personalized buying experience based on your browsing and buying habits.  It greatly affected the big chain bookstores like Border’s or Barnes&Noble.  It also helps you find the lowest price for a boxed item and they deliver it right to your door.  If it wasn’t exactly what you were looking for, ship it back.  Hassle-free!

Lastly  -Uber is putting a huge dent in the taxi business.  With Uber, you can press a button on your phone app and a nice clean car will be at your location within 15 minutes. Yellow Cab gets to you when it gets to you and the entire cab experience pretty much stinks!

All of these disruptors have innovated, streamlined and penetrated market share, challenged, and even ruined wildly successful businesses while reinventing the delivery of these services.  They have changed the consumer’s mindset and changed the paradigm on how these services should be purchased, used and consumed.  The consumer experience is exactly the way the consumer prefers.  We (the consumers) wouldn’t have it any other way.

Another commonality of these disruptors is that they didn’t just enter the marketplace and were welcomed with opened arms.  The status quo or “established” business model was not happy and tried to stop them. 

In reality, the status quo was asleep at the wheel.  They were lazy, and arrogant.   They felt they were too big to fail. Those established business models that survived disruption evolved their business models to better serve their consumers.

The question “Who is John Galt?” comes to mind from Ayn Rand’s book Atlas Shrugged! John Galt represents creativeness and innovation.  The status quo must constantly channel it's inner John Galt if it wishes to remain relevant to the people it serves.

There are disruptors popping up in every niche and dentistry is definitely not immune.  They are here and they are aggressively working to innovate and change the status quo. 

Disruptor #1 - Large Group Practices are delivering dental services cheaper, quicker and more efficient than the typical private practice.  They are aggressively growing around the country.  They are aggressively hiring up new dentists.  They are aggressively advertising their services.  They have created a niche for themselves and continue to attract patients.  They haven’t perfected the consistent customer experience yet, but at some point that they will figure it out. 

There are some really lousy dentists that practice in this setting.  There are also really good dentists in this arena too.  To be fair - There are also some really lousy dentists in private practice settings.   There are also some really good dentists in this arena too.

The unfortunate reality with the large group practices is that they are being judged by the lowest common denominator.  For every bad patient experience, the entire organization’s reputation takes a hit. If these companies are going to take their disruption to the next level, they need to shore up some of the bad players in their organizations.  They need to do this from within.

A dental organization in the Pacific Northwest is self-regulating through a peer review process similar to the one used in organized dentistry.  I commend them for taking the initiative to self-regulate and get rid of the bad apples from their branches.   

Disruptor #2 – Dental Insurance has been a driving factor in changing consumer perception with respect to the dentist.  There is a mindset that if one doesn’t have insurance they can’t go to the dentist. 

Dentistry is equal parts art and science.  The product that we deliver is a unique service and experience every single time.  The dental insurance industry has been really good at “commoditizing” these services. They view all fillings, crowns, and other procedures as commodities.  They don't take into account level of the level of difficulty it took to achieve a positive result.  Dentists must impart the value of their services to their patients and that dental insurance is a nice benefit but it the cure all to their dental health.

On the flip side - Dental insurance does help with the basic preventative services - cleanings, check ups, xrays etc.  And many people go to the dentist because of the benefits that they receive.  

Disruptor #3 – New Technology is continually changing how we practice.  Film based x-rays are as antique as the horseless carriage.  CAD/CAM, digital impressions, articulations, etc are going to make dentistry more efficient and even more predictable.

Disruptor #4 – This past year, Metropolitan Denver Dental Society (MDDS) built the first and only dental learning center operated and run by and component of organized dentistry.  The new facility has 4 fully operating dental operatories that are being used for hands on learning opportunities.  They have functioning lab benches, auditorium and video streaming from the operatories into the various remote video-viewing stations.

The Metropolitan Denver Dental Society is dedicated to supporting its members, promoting the highest ethical practice of dentistry; providing continuing professional education, including a premier annual dental convention; and oral health education to the public.  This learning center, The Mountain West Dental Institute, will help them fulfill their mission.  Many dental associations around the country are very interested to see how this works.  Some people say they took a big risk....that is what disruptors do.

The Colorado Dental Association recently hosted a presentation in which approximately 100 dentists showed up in person and an equal number viewed the presentation remotely via live streaming technology.  This new use of technology will allow dentists from around the state/country meet, learn, network and communicate.

America is the land of opportunity.  Anything is possible with creativity, hard work, perseverance and a little bit of luck.  Every business must constantly raise the bar if it is to remain relevant and vital.  The business models must evolve to stave off the disruptors and to keep the consumers interested in their product or service.

Evolution is the survival of the fittest.  Those that can adapt and create change will evolve into the new paradigm and address the needs and desires of its consumers.

The status quo does not exist indefinitely.  It will constantly be challenged. 

“Who is John Galt?”

Disclaimer –I am not passing judgment on these disruptors.  I am just sharing my observation and thoughts.  I may or may not subscribe philosophically with various paradigm shifts.  Each serves a niche that is attractive to various people.  That is why they are growing/gaining the market share and shifting the perceptions of the consumers.

If you like this blog post, I would love to hear about it.  Please comment or share it on Google+, Facebook, Linked in, Twitter, etc.  If you are looking for a dentist in the Denver area, we are always looking for new patients.  Please visit our website http://www.tcdodenver.com/ or like our facebook page,  https://www.facebook.com/TCDOdenver.  Or you can do it the old fashion way - call us at 303-321-4445.

Thanks for reading!  BK

Organized Dentistry

The Colorado Dental Association is starting a public relations campaign to promote who we are and what we do.  For as long as I have been a member of organized dentistry, I have felt that we are the best-kept secret both to our members and to the patients who we serve.

                                       Click here to view the commercial

Why the PR campaign?

We are at a critical juncture.  There are many entities that are marketing their positions in the dental world.  As a result, dentistry is becoming a commodity and the general public doesn’t really know who to listen to with regards to oral health. 

In the near future, we will be updating the dental practice laws in Colorado.  We are positioning ourselves, once again where we belong, as the dental experts.

For years, we have not done much.  We dentists don't like to talk about ourselves.  Through our non-action, these entities have taken over the public's perception while we have been quiet.  

We are not going to be quiet anymore.  

What does it mean to be a member? 

By being part of organized dentistry, we are part of a bigger whole.  There is the local component - for me that is the Metropolitan Denver Dental Society.  There are several local components that all funnel into the state - the Colorado Dental Association -which I am currently President-Elect.  Every state has both state and local organizations.  We are all part of the national entity, the American Dental Association.  

This is who we are and this is what we stand for:

Our Colorado Dental Association core values:

Effective Leadership, 

Open Communication, 

Ethical Behavior, 

Moral Courage, 

Strong Advocacy, 

Fellowship, and 

Teamwork

Our Mission:

To provide the Colorado Dental Association membership and the public with superior service and to demonstrate effective leadership in advocacy, education, communication, and quality products and services that enhance member practices, professional growth, and patient care.

Dentistry, like all healthcare, is a profession in flux.  The delivery models are changing.  The business models are changing.  Access-to-care is expanding in Colorado. 

The one constant has been organized dentistry.  We have been around for over 100 years, preserving the integrity of the profession of dentistry.  The work that organized dentistry does today is to preserve the integrity of the profession.

Who would you like to be your dentist? 

Please choose one that is a member of organized dentistry.

If you like this blog post, I would love to hear about it.  Please comment or share it on Google+, Facebook, Linked in, Twitter, etc.  If you are looking for a dentist in the Denver area, we are always looking for new patients.  Please visit our website http://www.tcdodenver.com/ or like our facebook page,  https://www.facebook.com/TCDOdenver.  Or you can do it the old fashion way - call us at 303-321-4445.

Thanks for reading!  BK

Obamacare - How will it affect dentistry?

I was recently asked by a friend how do I think that the Affordable Care Act (ACA or Obamacare) will affect dentistry.  This took some thinking on my part.

I have spent the past 5 years going to Washington DC to discuss dental care with our legislators. When the ACA was being discussed prior to becoming law, we did everything we could to get a seat at the discussion table to very little avail.

The year after the ACA was passed in Washington, we had a political pundit,  Dr. Frank Luntz ask us the question, "Are you happy with the results?"

No one could really answer because no one really knew or understood what was being thrust upon us as dental practitioners.

Frank's dad was a dentist.  As a child growing up, he recalled the animated stories his father would share about his patients. He was truly a caring practitioner. He loved the practice of dentistry, but he loved the relationship that he had with his patients even more.  Improving the health of the patients that he cherished is what he looked forward to every day that he practiced.  This is what I look forward to every day that I practice too.

Tragically, I see this style of practice on the decline.

From his personal experience, he went on to say that dentistry, as a profession, should be thrilled that it was basically left out of the ACA.  He reminded us that -

Dentistry is the last free market health care system that is working in this country.  

The reason - We keep the doctor patient relationship sacred. For more elaboration see my blog from July, 2011 The Sacred Cow.

In all aspects of health care there is trending consolidation of providers.  This means that private practices are joining up with hospitals or large groups called medical service organizations (MSO's). Included in these MSO's, hospitals are joining up with other hospitals and insurance companies to improve efficiency and improve access to information and resources.

As with any new paradigm, there will be some confusion from both sides of the fence as this takes affect.  All-in-all it should improve health care delivery as long as the doctor patient relationship is kept in the forefront. I hope that doctors are allowed to treat patients like they know best as opposed to management making decisions based on financial impact.

I expect many people to be upset at the changes from what they are used to with how they received health care in the past.  I also expect many people to be thrilled with the heath care that they are now eligible to receive.  The old adage comes to mind - "You can't please everyone, all the time".

There are many (including me) who are upset how the bill was passed and what was promised to the citizens.  I don't think that the legislators knew or could predict the extent of the problem at hand.  Therefore, they couldn't predictably fix the problem with the ACA bill.  What our legislators on both sides of the aisle knew was that our health care system needed to change.

The ACA is a start to solving the problems, it will evolve over time but it will never solve everyone's problems, expectations or needs.  We must accept this fact.  It will cost more and provide less than what we are used to.  We must accept this fact too.

I personally trust my physician to recommend the finest care to me.  Whatever he needs to do to evaluate my health, I expect him to recommend.  This should be in a "patient bill of rights".  I am cautiously optimistic that this style of practice will continue.

The insurance industry is the real winner in the ACA as they will have 48 million more people in the system that are now mandated to pay their premiums.  As a small business owner, I have seen my own health insurance premiums rise significantly over the last several years.  I predict that they will continue to rise as the ACA is implemented.

My predictions on how the ACA will affect the dental profession -

  Please note that these are my views and my views only.

In dentistry, we are seeing consolidation in a different form - through explosive growth in corporate dental service organizations (DSO's).  They seem to be sprouting up everywhere.  They provide a niche for people who are looking for low cost dentistry. This could be either good or bad depending on the perspective of the experience.  This practice model has been around for decades. They are a safety net -providing basic dental services (cleanings, fillings, crowns, dentures, partials, etc.)

I am hearing that these corporate dental organizations are recruiting heavily at the dental schools to attract new dentists to work for them.  Many new dentists are taking jobs with these firms as it is very difficult for them to find jobs elsewhere that satisfy their needs - such as make a decent living and paying off their student loans (average $250,000).

There will also be a rise in Federally Qualified Health Care facilities (FQHC's).  This is also a safety net capturing those patients that are lower income and have medicaid as a primary coverage.  These offices also provide basic dentistry similar to the DSO's.

Dental insurance - There are health insurance plans that offer dental benefits as an add on.  These plans are what I refer to as "skinny plans".  They offer the absolute basic dental services such as cleanings and exams.  I hope that these companies that are offering these plans are being honest to their clients about the limited extent of these plans.

If the reimbursement rates to the dentists are too low, dentists will not participate with these plans
- making it hard for patients to find dentists that take their insurance.

If the insurance companies drive the costs down through lower reimbursements, dentists will evolve their practice model to accommodate.  Please note that most dental offices are small businesses and provide dental care to the community that they serve while providing jobs to their support staff.  As with any small business, they must be profitable to remain viable.

I bring this up because there is a precedent of insurance companies cutting reimbursements to dentists in several states including: Washington, Missouri, Idaho, New Jersey, and Connecticut.  To show how volatile the relationship between dentists and insurance companies are see Washington Dentists vs. Delta Dental.  

Episodes like this don't make dentists happy.  Dentists want to provide a service to their community.  At the same time, we wish to keep our businesses viable with minimal third party interference and regulations that affect the "sacred cow" (doctor patient relationship).

With lower reimbursement rates, dentists must either see more patients per hour or cut costs. This could affect the practice in several ways including less time with the patient leading to a less personalized service. The dentist could also choose to use cheaper materials that may not last as long or be optimal for the situation as what he/she is currently using.  

If there are not enough providers to fill this void, a new dental provider model has been making dental headlines over the past few years.  This "Midlevel" provider will be able to do irreversible dental surgical procedures with minimal training - usually 2 years after high school.  This scares me, but as with anything, survival of the fittest.  If this provider model can provide the care that dentists and hygienists currently provide, they will stay, if not they won't.

Again, this is a slippery slope that will create a potential two tiered dental system with a significant percentage of the population receiving care that is from a provider that is seriously under-qualified to perform.

There is a 2.1% medical device tax. It hasn't been defined yet on what is going to be taxed.  My prediction is that anything fabricated by a lab (crown, denture, veneer, etc) will be subject to this tax.  I also predict that this cost will be passed along to the patient in some way.  When we brought this up to our legislators, they weren't sure yet on what was going to be taxed.  The term medical device is not spelled out in the bill.  As much as we tried, this tax isn't going away.

Expansion of medicaid coverage to children.  All plans must include dental benefits for children up to the age of 19 (including medicaid).  This will put millions more children in line to have access to dental care.  I predict there will initially be a shortage of dentists that can provide proper care for these kids.

Expansion of medicaid benefits to adults.  The ACA is encouraging the states to expand dental services to adults.  I predict again that there will initially be a dearth of dentists that take medicaid.  Medicaid reimburses at around 30% of what the dentist's usual fees are.  Plus, medicaid creates a plethora of extra paper work and reporting to get reimbursement.  Again, not an incentive for dentists to participate.  Some corporate models have already stepped into this niche and I expect several more to adapt into this niche as well.

One potentially good thing the ACA incorporated is an increased focus on healthy lifestyle, and prevention strategies.  We dentists have been doing this for the past 50 years.  Dentistry can help lead the charge here. The goal of dentistry involves optimization of health and function.  The removal of infection that could potentially spread to other parts or systems of the body is imperative for optimal health.  The ultimate function of teeth is to chew food.  The best way to maintain optimal health is to have proper nutrition and lead a healthy lifestyle.  If you have no teeth, it is very difficult to get good nutrition.

Odds and Ends.  I hope that the ACA also consolidates the respect of all health care providers.  We all have an interdependent essential pieces of health care.  All health providers must learn to communicate better with each other and with our patients for the best interest to improve the delivery of healthcare to those that we serve.

Patient's responsibility. The ultimate responsibility of health lies on the citizen patient.  He/she must live a healthy lifestyle to remain healthy.  Many health problems are preventable. Many health problems are not preventable.  If the system is clogged with the health care problems of the preventable kind, there are not enough resources available to help those with the non-preventable kind.

With respect to dentistry - 

Clean teeth do not decay, most gum disease can be prevented with brushing and flossing! 

I welcome comments and perspectives on this.  I am no expert and would love to hear other opinions - especially if I am off base here.

If you like this blog post, I would love to hear about it.  Please comment or share it on Google+, Facebook, Linked in, Twitter, etc.  If you are looking for a dentist in the Denver area, we are always looking for new patients.  Please visit our website http://www.tcdodenver.com/ or like our facebook page,  https://www.facebook.com/TCDOdenver.  Or you can do it the old fashion way - call us at 303-321-4445.

Thanks for reading!  BK