A conversation with the president-elect: Part 1
September 17, 2012
Dr. Robert A. Faiella, a young associate in a Boston periodontal practice, saw an opportunity one day in 1987 and proceeded, as he says, to do everything the wrong way.
Dr. Robert A. Faiella: Dr. Faiella will take the office of ADA president Oct. 23 before the House of Delegates in San Francisco.
“I found a town that I thought was really nice. I thought I’d like to live there some day, but I knew I couldn’t afford it. But if I did live there, I thought I would like to work there, too.”
On a visit to Duxbury, Mass., the young periodontist spotted a building he liked, and walked in as a man was exiting to empty some trash. Dr. Faiella quizzed him on how he liked the building and discovered he was a podiatrist that was moving offices and his was now available. “He said he loved the building but was consolidating to one location with his son and didn’t want two offices. He invited me in, and I realized the layout would be ideal as a dental office.”
The moment felt right, and Dr. Faiella went immediately to the management office and put $200 down to save the space—just in time. The next day, other tenants were upset they had missed the chance to rent the space. “The building manager called and said I had to let him know for sure that I would take it because others wanted the space. I thought if the space was in demand, and there was no vacancy in the building, it just might be a good thing.”
The office is still his today, located in Duxbury off a major highway between Boston and Cape Cod. “I figured the location was good, and decided—at that spontaneous moment—to open a practice. I did not investigate the demographics; I did no market research; I had no idea how many dentists or specialists were in the area. I didn’t even think about where I would find the money. I just rented the space and started talking to banks and equipment suppliers, and over the course of six months I started to build a practice. When you are young, you figure you can always move somewhere else if it doesn’t work out.”
It’s not an approach he recommends to new dentists today, but it worked for him in the economic and practice climate of the late 80s so well that he opened a second location six months later in Osterville, on Cape Cod. He discovered it was more affordable for him to live closer to Osterville than Duxbury, and a friend of his in Osterville suggested it as a good location for a periodontist. “I didn’t think I’d be busy five days a week in Duxbury, and as a specialist, I would not be competing for the same referral base in Osterville. So I opened the second office six months later, and I have been in solo practice in both locations ever since.”
Students facing current debt loads would not be as likely to get started as quickly as he did. His debt was manageable: he had practiced as an associate with periodontist Dr. Marilyn Canis in Boston and had completed a National Institutes of Health fellowship at Harvard. “I was pretty fortunate,” he says simply in summing up his start in dentistry.
His initial foray into the health sciences was with the objective of becoming a physician, in response to his father’s heart attack at age 46.
With that in mind, the New Jersey native (from the real family-oriented Jersey Shore, a world apart from anything depicted on the television show—”No one was like that when I grew up there. It was a great place to grow up,” he emphasizes) attended Villanova University outside Philadelphia where he turned his attention to dentistry. “This was the late 1970s. It was a very competitive time for applications to dental and medical schools. It was academically a cutthroat environment as students competed for the available seats to get into professional school. I discovered over time that three of my closest friends were applying to dental school, not medical school.”
2011 Annual Session: Dr. Faiella with his wife, Kelli, at the Presidential Gala last year in Las Vegas. Photo by EZ Event Photography
Their discussion with him about the advantages of a dental career convinced him to apply. Recalls Dr. Faiella, “They said it was a great way to be in the medical field, but with more normal hours and family time. I went to my adviser and asked about applying to both. He said, 'Oh, no, no, you can’t do that. If medicine finds out you are applying to dental school, they will disregard you, and if dental school finds out you are applying to medicine, they will do the same.’ He told me to put all my 'eggs in one basket’, decide what I wanted to do, and go for it.”
He decided to take some time off and learn more about dentistry. He spent a year at a dental laboratory where he learned every aspect of laboratory technology. Through the lab owner, he also met Dr. Bob Saporito, whose father, Louis, was a former president of the ADA. “At the time I was a forgettable college kid, but he gave me a lot of information, and supported my initiative. Based on those experiences, I decided to apply to dental school.”
He picked a school close to home and family, Fairleigh Dickinson University School of Dental Medicine (which closed in 1990). After graduation in 1982, he decided to specialize. “I was applying for an early decision on a residency in oral and maxillofacial surgery. At the time, Dr. Mike Alfano, former New York University dental dean, and Dr. Ira Lamster, who was a first-year, out-of-the-program assistant professor in periodontics [and who stepped down as Columbia’s dental dean this year], were early mentors for me. They are both periodontists, and we had long discussions about the direction of the profession and research. They encouraged me to apply for NIH-sponsored fellowships at different schools. I was accepted to Harvard on an NIH fellowship in a combined program in periodontics at the School of Dental Medicine and as a research fellow in the Department of Orthopaedic Surgery at Massachusetts General Hospital. I presented my master’s thesis to the faculty of medicine with the chief of orthopedic surgery at Massachusetts General Hospital, Dr. Henry Mankin. I have been very fortunate to have many thoughtful and generous mentors, including Dr. Mankin and Dr. Ray Williams, my program director at Harvard (and currently Dean at SUNY Stony Brook School of Dental Medicine).”
Dr. Faiella earned his master’s of medical science at Harvard Medical School, and the fellowship paid for his tuition and included a tax-free stipend. “It was a wonderful way to become educated,” Dr. Faiella notes. “I was very fortunate to be awarded the fellowship.”
The terms of the fellowship included teaching and/or research for at least 20 hours a week during his time in the program. “I stayed on as part-time faculty in the periodontal postdoctoral program at Harvard and did research at with the Department of Orthopaedic Surgery at the Massachusetts General Hospital, while also practicing privately.”
Over the course of his career, Dr. Faiella has held many leadership positions in the ADA tripartite, including four years as ADA 1st District Trustee, service on the ADA Council on Dental Benefit Programs, the ADA National Healthcare Information Infrastructure Task Force and the ADA Essential Oral Health Care Needs Task Force. From 2009-2011, he was the chair and sole director of ADA Business Enterprises, Inc. Board of Directors, and is currently on the ADABEI board as a nonvoting consultant. He also previously chaired CDBP’s Dental Benefit Information Service/Third Party Issues Subcommittee, the ADA Electronic Health Record Workgroup, and served as liaison to many councils and committees as a member of the ADA Board. He was also a delegate to the ADA House from 1998-2007.
Issues: Dr. Faiella attends the 2009 Collaborative Chairs Conference, which brought together ADA council chairs and leadership to discuss the issues facing the Association and the tripartite.
He is a past president of the Massachusetts Dental Society, former general chair of the Yankee Dental Congress and former consultant to the MDS Council on Government Affairs. He served as chair of the MDS Council on Membership and Manpower Affairs, the Committee on the Young Dentist, and as a delegate to the MDS House. He is a fellow of the American College of Dentists, the International College of Dentists, the Pierre Fauchard Academy, the Academy of Osseointegration, the International Team for Implantology and the Academy of Dental Science. He is also a Diplomate of the American Board of Periodontology, and a member of both the American Academy of Periodontology and the Academy of General Dentistry.
Dr. Faiella will be installed as the 149th president of the American Dental Association before the ADA House of Delegates on Oct. 23 in San Francisco. He was interviewed this summer by ADA News Editor Judy Jakush. The first part of the interview follows here, and the second will be published in the Oct. 1 ADA News.
ADA News: Based on your early academic career, you obviously had an intellectual passion for dentistry, periodontology and research. You found your niche in private practice while still keeping active as a lecturer and clinical instructor at Harvard. What was the spark for you to look beyond practice and teaching to become involved in organized dentistry in Massachusetts and nationally?
Dr. Faiella: My first year in private practice was in associateship with Dr. Marilyn Canis, a well-respected periodontist in Boston who also served on the state dental board. I was her first associate. She was also a graduate of Fairleigh Dickinson and very involved in organized dentistry. She absolutely encouraged me to become involved in our local component society and particularly its membership committee. So I was engaged early at the local level, and after one year, I was asked to serve on the Massachusetts Dental Society Council on Membership. ADA Executive Director Kathleen O’Loughlin and I started our careers in organized dentistry at the same time on the same council in the 1980s.
I found I enjoyed my involvement with recruitment and retention membership efforts, and became really engaged at the state level. At that time, the Commission on the Young Professional (later to become the New Dentist Committee) was getting off the ground at the ADA. Massachusetts and many other states followed suit, and I was asked to be the first chair of the MDS Committee on the Young Dentist.
That was my first leadership role as a chair at the state constituent level, and I quickly learned to write an agenda, run a meeting and keep it on time. I quickly learned the most important lesson for a committee chair is to clarify the charge to the committee, and help them gather the information necessary to lead to a consensus report.
I have also been active in meeting planning with the American Academy of Periodontology. I served for 10 years on their CE oversight committee, which is a meeting planning group that manages AAP education at their annual session. I chaired that committee for six years and also served on the ADA liaison committee of the AAP. The goal of that group is to help the AAP become more engaged with ADA policy and activities, and hopefully I have contributed in a meaningful way to that objective.
In the end, it was a combination of my early experiences and mentoring that fueled my interest in those issues that potentially affect our profession.
ADA News: How did you manage these time commitments then? How do you do it now?
Dr. Faiella: Here is my perspective on being productive and engaged: many people talk about time management, but it’s not about managing your time—it’s about managing your energy. Given that approach, I have always felt that if I compartmentalized my life and focused on what was important in those different areas, and kept them evenly balanced, things would work out. Sometimes things can be out of balance, but you learn to get through those times because you learn to focus on solutions when your energy level is high.
I didn’t come from a large immediate family. I had only one sister, who was five years younger than I and who passed away at age 44. My father also died at age 60, far too young. I remember him saying that when he retired, he and my mother were going to take the foregone vacations they missed while working and providing for my sister and me. He worked very hard, and he never made it to see his goal become reality. His passing made me realize you only have one life, and he taught me how to be happy and to make every day count, no matter what your goal or challenge may be.
This is my time to serve the profession. My family understands that, and my staff understands that. It challenges my personal time, but I always try to make the right time for each part of my life—the “compartmentalizing” piece again. This is a seven-day-a-week job, but there is never one single aspect of the job that is dominant all the time. As a result, everything is engaging—it’s a little exhausting at times, but far more than that, it’s empowering. I love what I do in clinical practice: that’s why I’m here at the ADA. That is what drove me to membership and involvement as a volunteer. I would never personally give up my clinical practice. But all the facets of the profession, not just clinical practice, but education, research, the military—any dentist engaged in any way—are affected by what happens outside the four walls of your office, and the ADA provides the opportunity to have the greatest impact. That’s what makes it empowering.
ADA News: Do you have a specific goal you wish to see accomplished this year?
Dr. Faiella: In 2007, I was excited by the opportunity to be a trustee at the national level, and over the past five years, that excitement has grown. I never requested any specific assignments as an ADA trustee but simply asked each president to place me where they felt I could make the best contribution. I was fortunate to serve many meaningful assignments during my tenure on the board, each one teaching me more about how the Association works. After serving on several committees, workgroups, task forces and liaison assignments, my perspective broadened. The experience is similar to solving a Rubik’s Cube—it’s really a matter of experience teaching you to see more and more possibilities. At first it seems impossible—how will you ever get the work done? As years go by, you are able to snap a few colors together on the same side, and you start to see how it all connects. In spite of my years here, I still have more to learn, and I’m still putting colors together.
I realize the opportunity to serve at the officer level is an opportunity that few people receive, and it has such a large potential to make an impact. I think of every ADA president as steering a very big ship. If you can just keep your hand steady on the rudder, and commit to keep it on the correct course, the profession will move forward.
As such, my goals are the strategic goals of the Association. Building membership value among all member segments, including working with the state associations to find the right value proposition for them, and keeping our advocacy for oral health strong through our Washington office, are a few areas of focus. Also, challenges by the media to our workforce policy, the need to help our students find the right career path, and tying our budget process to our strategic and operational initiatives are a few of the emerging issues we face. The opportunity to lead these efforts is one I can’t pass up.
ADA News: What have you learned in your travels on behalf of the Association this year?
Dr. Faiella: I find traveling as an officer to be really empowering. It presents an opportunity to meet and speak with our members and find out what is important to them. Being on the road can be tiring, but you learn a lot more and it’s an opportunity to become better informed in your role for the Association.
My visits to the states have affirmed for me how much dentists actually care about what happens in this profession. Some people say that there’s a segment of the profession that is not as engaged, but when I travel and speak to people, whether at the component or constituent level, I find they are very engaged and appreciative of the work that we all do.
They fully express their viewpoints, and it would be a pretty boring organization if we were all similar in our opinions. Thoughtful discussion and good debate makes us better and stronger as an Association. It’s an opportunity to appreciate everyone’s perspective a little more when you go to visit them where they live and work. I have gained a better appreciation for the breadth of opinion and thoughtfulness people have for the future of our profession.
ADA News: Membership recruitment and retention are always a topic of discussion at the ADA. Do you have an insight to share with peers on how to make the contribution both as a clinician and through involvement in organized dentistry?
Dr. Faiella: Don’t convince yourself you don’t have the time to do it. It’s easy to say that, because time is limited. Again, it’s about energy management and keeping your priorities straight with family, practice and engagement in organized dentistry. That’s a big commitment, but if we don’t do this, then others will make decisions that affect your clinical practice, how you make your clinical decisions, how you pursue your livelihood, how you provide services to your patients and what services they receive. People outside the profession shouldn’t be the only parties determining how the profession provides oral health care to the public. As a clinician and as a professional, you need to have input into that critical process. And we can only do that through the strength of membership. It’s a matter of getting outside the four walls of your practice or your day-to-day role and being engaged in the profession you have chosen. It is a privilege to be in this profession. Everyone thought so when they applied to dental school, and I’m sure everyone remembers how excited they were when they ripped open the envelope and read the acceptance letter. That excitement wanes over time, and you can easily forget what drove you to become part of a profession. Becoming involved is a way to give back, and respect what made you excited in the first place.
ADA News: There have been many conversations at the Board of Trustees level in the past few years about changes in dental practice models, particularly the growth of large group practices. What implications does this growth of large group practices have on the profession and the ADA? Will special efforts be made to reach out to dentists in these practice settings and to organizations such as the Dental Group Practice Association? Are there ways the ADA can collaborate and be meaningful to dentists in these practice settings? How do you envision dental practice in 20 years if this trend continues? Are high student loan debts causing new dentists to enter into different practice models for financial reasons or is this a more efficient delivery model?
Dr. Faiella: Large group practices are not similarly defined, and we should be careful not to put them all in same box. In terms of large private equity supported group practices, 20-plus dentists, the reality is the marketplace is growing. Early studies indicate there is an expectation the numbers may quadruple in the next several years. We expect exponential growth in this area. We know there are concerns with defining ownership of a dental practice from a regulatory perspective, and we support the best interests of patients by helping our constituent states whenever necessary on this issue.
What is driving that growth? Possibly some of the decisions younger dentists are making are related to their student debt, but it could also be a lifestyle decision because a dentist in the millennial generation may think differently about how they want to engage their work lifestyle than the baby boomers or Generation X. We have to respect that.
That said, I think there are tremendous opportunities to look at how we can approach members and nonmembers who are in relationships with corporate practices. The opportunity is there to provide a value proposition for ADA membership that may be decidedly different than the value proposition for someone in private practice, the military or academics. That’s OK. We need to figure out how that value is defined. We definitely want every dentist to know that the American Dental Association is his or her professional home.
For dentists in a corporate arrangement, we want to help ensure that their delivery of care is never subordinate to a for-profit policy. All dentists should have autonomy in how they care for their patients. No one wants to see a contract potentially put someone’s dental license in jeopardy. It’s important that the individual understand the full ramifications of any contractual relationship, and we want to help members with this type of risk management whether they are in solo practice or in a corporate relationship. By engaging in this dialogue, we hope to find other areas where we can be helpful, too.
ADA News: Regarding student debt, there is an ADA initiative under way to study its impact (Taskforce on Dental Education Economics and Student Debt, based on Resolutions 66H-2011, 91H-2011 and B-204-2011). What is the ADA’s role in this issue? Is there anything the Association can do for the profession’s newest members and their unprecedented levels of educational debt? Are debt levels manageable? Are they having an impact on practice choices of the new dentists?
Dr. Faiella: When I graduated in 1982 from dental school, student debt averaged one-fifth of the net income for a dentist. Today it is equal to net income, if not higher. This is just educational debt. Total debt is even greater. According to the American Dental Education Association, the average graduating debt in 2011 ranged from more than $157,000 for public dental schools to $218,695 for private and private state-related schools. ADEA also said that when expressed in constant dollars, student debt upon graduation has increased by almost $100,000 in the past 20 years and almost $20,000 in the past five years.
We need to understand how debt drives recent graduates’ decisions regarding their practice choices or their professional choices. I think we also have to understand what we can do to help mitigate that debt burden, so that it doesn’t unduly affect their choices. The ADA is advocating for loan forgiveness, obviously, but we also need more than short-term incentives. Perhaps we need to explore long-term tax incentives that can be applied to anyone who establishes a practice in a health professional shortage area. Currently, the system provides an incentive for dentists to locate in these areas for the short term, and once that obligation has been met, they usually leave.
We know that the dentist-to-population ratio overall is fairly well balanced but that there are geographic disparities. Long-term tax incentives are one approach that could help improve the distribution of dentists in areas of need. We would like to work with the American Dental Education Association to mine more information from dental schools about the economic pressures dental students and schools face. The Taskforce on Dental Education, Economics and Student Debt had a slow start this past year and will need to be re-established and re-funded by the House to continue, but I am committed to seeing this work through completion of the charge the House gave them in 2011. It is an issue that is too important for us to ignore as a profession.
ADA News: As mostly small business owners, dentists have been particularly affected by the economic downturn. This is reflected not only anecdotally by dentists themselves but also by results from the ADA Health Policy Resources Center’s economic surveys. What is the ADA doing to help members get through this period? How will the Center for Professional Success, currently in development, support members?
Dr. Faiella: The ADA has four strategic goals. The Board this past year decided to focus primarily, not exclusively, on goals one and four, which are (1) helping members succeed in their practices and (4) to be a financially stable organization as an Association. We understand what the economic downturn has done to dentists, and everybody has felt that downturn.
What we are hoping to do is to provide practice management resources to dentists that can help sustain them through the tough downturn times. For instance, we are in the process of building the Center for Professional Success, a Web portal that will be a 24/7 resource to provide best-in-class information regarding practice management resources and support.
Interestingly, there is also an unexplained downturn in utilization of dental services that precedes the downturn in the economy. The ADA Health Policy Resources Center is working to help us better understand not only the reasons for that decrease in utilization, but some of the implications it may have for dental practice in the future. Hopefully, this information will help us find ways to turn that trend around. We know that many people who have dental insurance don’t necessarily use it, and understanding why will lead to potential solutions.
ADA News: ADA’s Mouth Healthy website launched in June, and our partnership in the Ad Council campaign (www.2min2x.org) debuted in August. What do you think of both? In what other ways is the Association reaching out to patients—both directly and indirectly through the media?
Dr. Faiella: We anticipate that both Mouth Healthy and the Ad Council’s Kids Healthy Mouths campaign will increase societal appreciation for oral health as never before.
“Brushing for two minutes now can save your child from severe tooth pain later,” is what the videos tell consumers. Having caregivers for very vulnerable target groups—children in vulnerable populations—having them understand something as simple as brushing twice a day with a fluoridated toothpaste is a great goal. This concept is taken for granted by most people, so it’s hard to realize that some populations in our country don’t engage in this practice. The most interesting finding from focus group discussions before the campaign is that the primary driver for parents is to prevent their children from having pain.
There are 36 organizations including the ADA that are supporting the Ad Council campaign. They have taken on oral health as an issue for the very first time ever, and we know what their success is in creating long-lasting messages of significant impact, such as Smokey Bear’s “Only You Can Prevent Forest Fires” and McGruff the Crime Dog’s “Take a Bite out of Crime.” An added plus is that it is in both English and Spanish. This is an incredibly important effort—it would cost us $100 million or more to launch a campaign like this. But it is also important to understand the ADA does not direct it.
We hope the campaign has the tangential benefit of educating children’s caregivers to better understand their own oral health needs. This campaign, combined with our consumer-based website, Mouth Healthy, could be a game changer for oral health literacy in dentistry. We are also reaching out through social media, and we anticipate that all of this movement will capture the attention of consumers to think about oral health in ways they have never done before, and in ways we’ve never engaged them before.