Dr. Chad P. Gehani offers thoughts on dental benefits, workforce, future
August 19, 2019
Gehani family: Dr. Gehani, third from left, stands with his wife, children and their spouses, all of whom are medical professionals. From left is Biraj Patel, M.D., Dr. Kiren C. Gehani-Patel, Dr. Chad P. Gehani, Dr. Rekha C. Gehani, Vijal Gehani, Dr. Daniel C. Gehani, Neal C. Gehani, M.D., Tejus Gehani, M.D., Ph.D.
Editor’s note: This is the second part of a conversation with Dr. Chad P. Gehani, ADA president-elect, who will be installed as the 156th president of the American Dental Association Sept. 9 in San Francisco. The Aug. 5 ADA News featured Part 1. ADA News Deputy Editor Kelly Ganski interviewed Dr. Gehani.
ADA News: Why are you a member of the Association? Why should a nonmember join?
Dr. Gehani: I am a member because we must have unity in our profession. United, we can overcome any obstacle. There are so many decisions being made by lawmakers every day, that our strong presence is almost mandatory. I tell all nonmembers that they must belong, so that not only do they benefit from the actions of the ADA, but so they can be a part of the ADA’s policymaking process. There are so many benefits of being a member of the ADA, it’s almost too long to list. Advocacy on behalf of our patients and our profession is the most important one. If it were not for the ADA, we would not be practicing independently the way we do it now.
ADA News: What was the first step that you took into organized dentistry — a step that eventually led you to become president-elect of the ADA? How did you find yourself in a leadership role? Describe your leadership style.
Dr. Gehani: In the early 1980s, dentists with diverse backgrounds perceived that they were not welcome by the ADA. The ADA started considering some resolutions by the Council on Dental Education, which appeared to be, on the surface, that they were against foreign-trained dentists. So, we in New York, created a national organization called the Indian Dental Association (USA). I was asked by the Indian Dental Association (USA) to speak on their behalf at an ADA reference committee on dental education, science and related matters. I did testify and I made a lot of people very upset, including the dean of New York University, where I was teaching at the time. In 1988, I was invited by the ADA Board of Trustees during their Board retreat to discuss ways in which the Indian Dental Association, National Dental Association and Hispanic Dental Association could work together with the American Dental Association. They wanted to find out if there was a common ground so we could work together to make all practicing dentists our members. This was followed by a visit by Dr. Richard Mascola, former ADA president, who recruited me to volunteer at the Queens County Dental Society. Volunteering and community service has always been my passion and the process began. I became a board member and in two years, they asked me to be an officer. So in 2003, I became the Queens County Dental society’s first internationally trained dentist to become president. After that, I thought I was done. Then I became president of the New York State Dental Association, and again, that was not something I planned for. I am forever grateful to Dr. Mascola for opening so many doors for me. My leadership style is that I like to treat everyone as I like to be treated. I follow empowerment, empathy and creating a sense of ownership.
ADA News: Questions to the Association regarding dental benefits have skyrocketed in the past few years, according to the ADA Center for Dental Benefits, Coding and Quality. The Decoding Dental Benefits series in the ADA News has become one of its most popular features, and the ADA has implemented a number of resources to help members with their questions, including the ADA Third Party Payer Concierge and ADA.org/dentalbenefits. Why does this issue occupy many of our members’ minds, and what can the ADA do to showcase and boost its advocacy on this issue?
Dr. Gehani: Dental benefits are very difficult to navigate both by our patients and our dentists. This causes severe confusion in our patients’ minds and is the biggest source of frustration between our patients and our staff. Rekha and I have been living through this since 1981. The ADA has done a great job in advocating for our patients and all dentists, including nonmembers. I hope nonmembers are reading my comments. This is one thing that the ADA has been excellent at. ADA volunteers and staff spend countless hours with the insurance industry, regulators and other agencies working on so many codes, standards and communication, so that we can properly help our patients get the benefits that they are entitled to receive.
ADA News: The Association is expected to deploy a pilot of its Dental Licensure Objective Structured Clinical Examination (DLOSCE) early next year. From your perspective, why was it important for the ADA to take a lead in creating this exam, which is intended to be a national clinical exam to be used by state dental boards. How does this exam benefit future dental school graduates, ADA members and the profession?
Dr. Gehani: I feel a single national exam is important for our future graduates so that they can have a more simplified licensing process along with freedom of mobility.
ADA News: What is your insight on the status of the student debt issue? The ADA has a partner in Laurel Road, but what other steps is the Association taking or should take?
Dr. Gehani: This is a very complex issue. Rather than discussing student debt by itself, we should also be concentrating our efforts on debt management. I have six young professionals in my family; our three children and their spouses. I do discuss debt management with them at our breakfast table. As an educator, I understand the cost of educating dental students keeps increasing due to rapid changes in technology. Another avenue to pursue for our graduates is debt forgiveness in exchange for working in underserved areas.
ADA News: The future of the Association is its membership, and recruiting new dentists is a high priority. What would you like to see the ADA do?
Dr. Gehani: Let us think from the perspective of the new dentist. Do we want the new dentist to join us as a check-paying member or must we provide more? How do we gradually transfer ownership of the ADA to this next generation? I presume that we do want new dentists in a leadership role. I would like to see a blend of new dentists and seasoned dentists working together, with seasoned dentists slowly backing out into a mentorship role. Years ago, when I was president of the Queens County Dental Society, we gathered all the diverse dental associations and we had a great exchange of dialogue. These types of events we need more often to be inclusive.
ADA News: Have you learned something about the ADA since joining leadership that you didn’t know previously that you wish every member knew?
Dr. Gehani: Our volunteers may have diverse opinions, but they all work very hard to make our profession better and they strongly believe in serving the public. They are hard-working, dedicated and honest people. Our ADA staff is second to none. They take their jobs very seriously and feel proud of working for the best organization in the world: our American Dental Association.
ADA News: What should members know about the scientific work the ADA does?
Dr. Gehani: The entire worldwide dental community relies on our scientific work. We regularly present many important position papers to improve the practice of dentistry. Among other things, both big and small, the ADA is responsible for front surface mirrors, composites and the Panorex X-ray machine, just to name a few. These all were invented at what we know as The Volpe Research Center.
ADA News: Should the ADA better recognize dentists who accept or want to accept Medicaid patients?
Dr. Gehani: Dentists who have made a conscious business decision to serve Medicaid patients are underappreciated even among many in the profession. They treat the underserved population on a daily basis and many times they are the victims of over regulation by their Medicaid administrators. I have heard of a recent situation in Nebraska where a dentist was being asked to return money due to an aggressive auditor’s action. We certainly need to prevent fraud, but we also need to stand up for injustice that sometimes sweeps up these honest dentists.
ADA News: Can you discuss the importance of the ADA’s work on combatting opioid abuse?
Dr. Gehani: We should be very proud that the ADA was the first major health organization to agree to certain mandates or even discuss them. We were already raising awareness and urging cautious prescribing, but here we self-regulated and our profession did the right thing to help the public.
ADA News: Dentistry is regularly ranked by U.S. News & World Report as one of the best careers. Why do you think that is? How does ADA help maintain that?
Dr. Gehani: I am proud to call myself a dentist and a member of the American Dental Association. General health and well-being begins with good oral health. We are trusted by the public. We change people’s lives forever. We take patients out of pain. We may detect many systemic diseases before anyone else does. We are doctors of the mouth, but our responsibility to our patients doesn’t end at the uvula. As dentists, many of us are also small business operators, we run a small operating room in our offices by doing surgical procedures every day. We are entrepreneurs. We set our own schedules and are often our own boss. No other profession affords all of these wonderful opportunities.
ADA News: Are there any resolutions going to the House of Delegates that you would like to highlight?
Dr. Gehani: There are three topics that are hot button issues right now. One is direct-to-consumer dentistry. Everyone is interested in it because of patient protection. And the patients may not be aware of the harm that it may cause to them. They are only looking at getting the job done in a cheaper way. The best example I can give you of that is through my wife, who’s an orthodontist, saw a patient about two months ago for a consultation. The patient had used this plastic aligner that she purchased through the mail and afterward, her front teeth looked to be reasonably OK, but she’s now having headaches and pain in the temporomandibular joint and she’s not able to bite on steak because her back teeth are not occluding well. The patient will need braces all over again, and it will, perhaps, cost her more money, more time and be more of a challenge to her body. It became clear that it was more trouble than good. The patient may not know they have cavities or a gum condition, both of which are standard items a dentist would check prior to putting in any orthodontic appliance. There are also companies where you can buy, over-the-counter or through the internet, veneers. It’s also possible for people to create partial or full dentures, without giving any regard for having a balanced occlusion. Workforce is another hot button issue. There is no one-size-fits-all there. Sometimes, even state leaders will fight about it. Half of the leadership will say, ‘OK, we’re going to let the midlevel provider legislation pass with the following criteria.’ In general, people will get very emotional when you talk about having somebody else come in and do the procedures that are traditionally done by dentists. Dentists’ relationship with third-party payers is another hot button issue. What has happened is the annual maximum that the third-party payers has reimbursed has not changed in the last 30 years. They have not kept up with inflation. Whereas, from the dentist’s point of view, the regulatory issues, employee issues and overall maintaining of the office, as well as lab costs, have gotten too high. So it’s becoming impossible for certain dentists, especially the ones who accept Medicaid, to survive. They’ve been closing their practices. They have not even been able to get somebody to buy their practices. So that creates a different type of access-to-care issue, even in the larger cities.
ADA News: What does the ADA do best?
Dr. Gehani: Advocacy. The ADA also fights very hard for the profession on coding. The average member, or even many leaders, does not realize how hard the ADA has worked to create, let’s say a code for taking an X-ray and a code for a root canal. People come up to me and say, ‘Hey Chad, why can’t the ADA create a code for me doing this?’ We don’t manufacture those numbers on the 22nd executive floor. We’ve got to meet with an entire group of people and the industry and their peers and we have to reason out lots of things. That’s not something that’s appreciated well by our members, but yet is a very useful function of the ADA.
ADA News: The ADA has adopted a new mission statement: “Help Dentists Succeed and Support the Advancement of the Health of the Public.” What role does this statement play in the upcoming strategic planning process? What does the mission statement mean to you?
Dr. Gehani: I believe in inclusion, not exclusion. We wanted to include all dentists, when we speak about helping professionals to succeed, we included members and potential members by saying “helping dentists succeed” without regard to members or nonmembers. We know that good general health begins with good oral health: we want the public to achieve excellent oral health assisted by easily accessible dental benefit programs, both with private and public funding.
ADA News: ADA Practice Transitions, a wholly owned subsidiary of the Association, began a pilot launch June 1 matching dentists who are seeking to join a practice in Wisconsin and Maine with owners in those states who are looking for a partner, associate or someone to purchase their practice. Why is this a smart move for the Association? Do you see the project expanding?
Dr. Gehani: It’s a smart move for the ADA because it can become an extremely helpful member benefit as well as recruitment tool. If it’s as successful as we think it will be I would hope to see it expand nationwide. Members can learn more at adapracticetransitions.com.
ADA News: How do you assess the ADA Find-a-Dentist consumer advertising campaign?
Dr. Gehani: From both statistical analysis and member feedback, this was a very successful pilot. It will continue in 2020, but the level of funding it receives will need to be considered by the House of Delegates.
ADA News: What are the challenges to recruiting people into leadership tracks within the Association governance structure? What is the ADA doing to engage new dentists and underrepresented groups?
Dr. Gehani: I am known for treating any challenge as an opportunity. That said, we have great opportunity to transition these very smart, young dentists into leaders with responsibilities in our governance structure. One of the things we’ve done is put a new dentist on every ADA council as a voting member. I will be constantly reaching out to young, diverse dentists who are willing to serve. If this sounds like it might apply to you, please reach out to me at email@example.com.
ADA News: What is the financial outlook for the ADA?
Dr. Gehani: I am one of the baby boomers who are now slowly aging out. That means I am still working, but now I am in the discounted membership category and this category keeps increasing. This is the time where we need to look at this more seriously. Also, the ADA has too many discounted membership categories. I urge all of us to look at this issue very seriously and consider making some hard, painful decisions for the future of our Association.
ADA News: How can the ADA work effectively with ever-expanding dental service organizations in a way that is advantageous and ethical for patients, dentists and both groups?
Dr. Gehani: Dental service organizations have come to stay. Dentists who work for the dental service organizations are our colleagues. We need to welcome them with open arms as long as all of us remain totally devoted to an unimpeded doctor/patient relationship. As long as treatment choices are made by the patient with proper, sound advice rendered by the dentist, without corporate interference, I respect that as a practice model.
ADA News: The concept of midlevel providers continues to pop up in legislatures. The ADA offers the Community Dental Health Coordinator. How do you see the status of both and what the future may bring?
Dr. Gehani: There is no shortage of dentists in our country. We do have a maldistribution of dentists. The access-to-care issue has many reasons, some of which involve the economics of maintaining a practice in small rural communities. There is no one-size-fits-all solution. The Community Dental Health Coordinator is a good model that connects patients to care that exists but is underutilized.
ADA News: The 2018 House of Delegates adopted a policy urging dentists to support and administer the HPV vaccine. How should dentists talk to their patients about this?
Dr. Gehani: I applaud our House of Delegates for thinking out of the box in adopting this policy. We are proving to the public and public policymakers that we strongly believe in interprofessional service. Dentists see teenagers very often, and we are aware that HPV and oropharyngeal cancer are correlated. Now we need to encourage state dental associations to reach out to their legislators to bring necessary regulatory/scope of practice changes in their states. We also need to provide educational materials to dentists, to share with their patients. We have a long way to go, but this is a good step in the right direction.
ADA News: Do you have priorities for your year as president? Specific goals you are aiming to achieve?
Dr. Gehani: As I said during my campaign, I want our ADA to be the go-to source for all dentists for any dental question, whether the question is about science, practice management, insurance or anything that affects the practice of dentistry. Especially in today’s world of fake news, we need to be the trusted source and be easily accessible. We must be the Google of the dental profession, and this is doable. As I stated earlier, I also want the entire profession to be united and working for one common cause, which is to serve our patients. I am a firm believer that sometimes we must agree to disagree with respect, and yet after the debate is over, we come together as a profession once again united.