A conversation with the president-elect, Part II
October 21, 2013
Editor's note: This is the second part of a conversation about the issues facing the profession with Dr. Charles H. Norman III, ADA president-elect, who will be installed as ADA president Nov. 5 during the Annual Session in New Orleans. Part 1 was printed in the Oct. 7 ADA News. ADA News Editor Judy Jakush interviewed Dr. Norman.
ADA News: How is dental practice as a business model changing? Do you see the ADA as the umbrella for all types of dental practice as new models emerge in group practice, corporate ownership as well as the traditional solo practice? How do you want to see ADA respond and grow with these changes?
Family celebration: Dr. Norman and his wife, Sharon, have one grandchild, Claire Richards. Gathering at her baptism last year are (from left) Dr. Norman, Mrs. Norman, Brian Richards (son-in-law), Emily Richards (daughter), Chandler Norman (daughter-in-law) and Dr. Matt Norman (son).
Dr. Norman: Recent occupational data reveals a definite trend indicating growth in group practices as part of the dental delivery system. The economic reality of a modern dental office makes small and large group practices an attractive alternative to the more traditional single practitioner. As an organization, we welcome and embrace all dentists committed to the values of the ADA regardless of their practice setting. The rapidly changing practice models raise a significant operational question. Who in the practice makes the clinical decisions? Whether dentists are owners or employees, it is their responsibility to diagnose the clinical conditions and in consultation with the patient develop a treatment plan, including the selection of materials and laboratory that can produce the best result for the patient.
ADA News: The ADA Center for Professional Success (Success.ADA.org) debuted in September. What does it do for members?
Dr. Norman: This is the culmination of a major effort by the Association to deliver member value. When we did the 2012 Member Loyalty Research, the top two reasons members gave for belonging to the ADA were to support the profession and advocacy.
The ADA research on member value and loyalty reveals that member benefits have the biggest impact on member value overall, and analysis demonstrates the importance of providing practice management resources to help dentists succeed.
We are trying to respond to what our members need, which is help with managing the business part of their practice. The Center for Professional Success is designed to provide that kind of support. We have an opportunity to really make a difference with the practice lives of our members and provide a platform for assistance with education, lifestyle and practice management. I'm excited about this new benefit for members.
We talked about this initiative at the New Dentist Conference, and the fact we are including resources like student debt calculators was received very positively. The Center provides a reliable source of information in what is otherwise an endless sea of Internet information—some good, some bad.
This is the 21st century version of the ADA's practice management resources. When I started my practice, the ADA provided practice management materials in paper form, such as information on how to start a practice, what kind of insurance was required, how to hire staff and other operational manuals. We still have those resources, but in addition, the Center will offer a wide variety of other content for professional development.
ADA News: The Taskforce on Dental Education Economics and Student Debt has prepared a report with five proposed resolutions that the Board has endorsed. The resolutions include support for advocacy related to student finances, expanded relevant information resources on ADA.org, expanded research by the ADA in dental education financing, a comprehensive study of the current educational model and a request to the Commission on Dental Accreditation that it specifically include debt management and financial planning requirements in the standards for dental education programs. What are your thoughts/concerns about the ever-increasing costs of dental education and/or higher education in general?
President-Elect's Conference: Dr. Norman leads discussion during the January conference at ADA Headquarters.
Dr. Norman: We were at the New Dentist Conference this summer and I was asked what the ADA could do about the rapidly rising student debt. I told the dentists in attendance that while we sympathize with their concerns, we have to be realistic. How much direct control does ADA have over student debt? The simple answer is none. If you look at higher education in general, the rate of inflation for tuition to all schools is outpacing inflation in the general economy with no end in sight. There are things we can do to help students and influence policy, and the taskforce resolutions [which are posted in the House of Delegates pages on ADA.org in Board Report 13] are a multifaceted approach. We can also work together with the American Dental Education Association to develop strategies to educate students about debt management. We need more data about market opportunities for new graduates and whether their potential incomes can support their debt. Students considering dentistry deserve realistic calculations about how much debt can be serviced over the course of their career.
ADA News: Why are universities interested in establishing a dental school? Some of the new schools are in universities that offer other health profession education programs such as osteopathic medicine, optometry, nursing and physical therapy. Is this a change in the overall setting of dental schools? Do you think this will have an effect on practice?
Dr. Norman: The demand for an education in dentistry is driving the interest in opening more dental schools. I'm a pretty big believer in the marketplace. I don't know how long it will take, but if the debt situation continues and the trends we see in net incomes continue, there is going to be a point where students are not as attracted to dentistry. Those that are passionate about service and treating patients and who want to go into a health care field will do so, regardless. But others, the ones looking for a profession based more on economic success will look to other places, other careers. That scenario may put pressure on dental school enrollments. It happened before in the mid-'80s and it could happen again.
I'm not sure we are losing research institutions, as some suggest. I believe my experience at UNC, which has a proud history as a research-intensive dental school, was enhanced by the research exposure. Is that absolutely necessary for success? Probably not. The burden on the Commission on Dental Accreditation is to assure that each program meets the quality assurance standards upon which each school is evaluated. The standards are considered minimums, and schools can teach to a level beyond the standard.
ADA News: Give Kids a Smile/NASCAR and other GKAS efforts are a yearlong effort. Another tool for outreach is the Ad Council and the Partnership for Healthy Mouths, Healthy Lives campaign—2min2x.org—brush kids' teeth for two minutes, two times a day. What is the value of these types of programs in your eyes?
Dr. Norman: ADA GKAS, the world's largest oral health charitable program, is a major avenue for increasing awareness about the importance of oral health, and now our collaboration with NASCAR, ADA Foundation, Henry Schein Cares, CareCredit and 3M ESPE Dental has taken public awareness to another level. NASCAR has one of the largest annual attendances of any professional spectator sport, so we are reaching very large audiences. We are educating the people who attend the races about the value of good oral health care for children. Of course, the Ad Council campaign reaches an even larger community with a targeted focus. Our participation in the Partnership for Healthy Mouths, Healthy Lives which supports the campaign allows the ADA to leverage limited resources for tremendous returns. Survey data after one year shows that we are reaching key audiences. More parents in 2013 reported that their child brushes at least twice a day compared to before the campaign launched. That is 55 percent of English-speaking parents in 2013, up from 48 percent last year and 77 percent of Spanish-speaking parents this year, up from 69 percent in 2012.
Before the House: Dr. Norman thanks delegates after his election Oct. 22, 2012.
ADA News: How do you assess the progress the ADA Foundation has made in the past few years and what do you see as its role?
Dr. Norman: The Foundation has made great strides over the last couple of years. Under new leadership by the executive director, Gene Wurth, and Board president, Dr. David Whiston, the Board is committed to moving the Foundation forward in support of its four pillars: access to care, education, research and charitable assistance. Since its reorganization, the Foundation has refined its focus and a great example is the revitalization of the ADAF research center at the National Institute of Standards and Technology. The center, through funding from Colgate as well as ADA and ADAF, has been renamed the Dr. Anthony Volpe Research Center. A research fellowship has been established in Dr. Volpe's name, and the annual student conference is now known as the Colgate Dental Student Conference on Research.
From the member's standpoint, the progress of the Foundation is a tangible indication that we have a functioning philanthropic arm dedicated to the public and profession. In addition to research, education, and access, it is also ready to assist with emergency grants in times of crisis, such as the hurricane and tornado damage that occurred in the past year.
ADA News: The ADA Library has gone through a number of changes in the past year. The ADA Library Transition Plan Taskforce, working in response to Resolution 159H-2012, made several recommendations that the Board adopted (Board Report Six, posted in the House of Delegates area on ADA.org). What is the status now and where is it headed?
Dr. Norman: I thought the taskforce recommendations were very straightforward and sensitive to the needs of our members. All libraries are going through major changes as information technology advances. When considering changes to the Library, the role within the ADA must be addressed. The final plan must support our staff in their research needs and provide our members with enhanced resources. We modernized the Library for the 21st century by making a commitment to digitize many of our publications and add digital databases so our members will have better access to knowledge.
ADA News: The expansion of dental therapy in some states continues to raise concerns about how to address access to care issues for the profession. What's ahead?
Dr. Norman: Dental therapy will continue to be an issue depending on an individual state's needs. Different stakeholders are searching for that one solution that will solve all access to care barriers, and frankly, there is not one solution. Recent data suggest that there is adequate workforce to address the demand for care. Almost all the issues surrounding legislative initiatives to address access to care are really about the cost of access to care. We have data that shows many dental practices could treat more patients if demand were there. In fact, some states have demonstrated that there is as much as 25 to 30 percent excess capacity in the dental delivery system. Why are emergency rooms being inundated with dental problems when an office two blocks away says they can handle more patients? So what's keeping patients in need of care from presenting for treatment? In other words, what are the real barriers to care? Appropriate, effective solutions depend on identifying the specific barriers in each state that are impacting access, such as geographical ones, transportation shortfalls, cultural differences, oral health literacy or financing options.
As an association, we can advocate for solutions that can have an impact on access and ultimately oral health. For instance, we should continue to insist that there is a properly funded safety net. The Action for Dental Health is designed to help states select from a suite of initiatives that can address their unique access barriers.
ADA News: As you travel to dental meetings across the country, what are the concerns you hear from members?
Dr. Norman: No. 1, when I talk to leadership, they are concerned about their membership numbers and the resulting reduction of their organization's dues base.
No. 2, when I talk to younger dentists, the conversation is about student debt and the impact it may have on where and how they will practice.
No. 3, when I talk to established practitioners in a state with a high penetration of preferred provider organizations, they want to know what the ADA is going to do about rapidly eroding insurance reimbursements.
All those issues revolve around finances and the financing of care. I think all dentists want to know “How can I deliver good quality care in this changing environment?”
ADA News: What scientific developments intrigue you?
Dr. Norman: Implants, bone grafting and tissue engineering have certainly improved treatment options and patient outcomes, but I am most intrigued by the future of salivary diagnostics and early screening for chronic diseases. There is a significant percentage of the population that sees a dentist regularly and not a physician, so we could play a role in improving their overall health by performing early screening and then referring the patient for proper diagnosis and treatment.