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MyView: Advocacy: Your critical role

September 17, 2012

By James C. Kulild, D.D.S., M.S.

My home state of Missouri has been a "swing state" in presidential elections for the past century. This means that, in an election year, Missourians can’t escape the onslaught of campaign ads from all political parties. I’m a fan of American history, and presidential campaigns have provided some very memorable slogans over the years like "Tippecanoe and Tyler too," "I like Ike," "A chicken in every pot and a car in every garage," "Don’t swap horses in midstream" and "Happy days are here again." They’re clever, but they really didn’t mean much or have any objective significance.

What strikes me in an election year is how easy it is to focus on catchy slogans and ads and forget that the real work of government is going on every single day in Washington, D.C., as well as all the state capitals. That’s where the rubber hits the road and where legislation that impacts the lives of ordinary Americans is introduced, debated and voted on—most of the time without any of us knowing about it unless it was splashed in the print or visual media.

It is easy to think that legislators and lobbyists are the cogs that turn the wheels of government—and that’s true in many cases. However, there is also important work performed by ordinary citizens—voters who make the effort to be heard on issues they care about and take action on them, instead of just complaining and blaming their future on someone else. Legislators are ultimately responsible to voters who can "fire" them by voting them out of office. The Supreme Court recently reaffirmed that principle by stating that, even though the so-called Affordable Care Act was ruled constitutional in the most part, there was nothing to stop voters from electing officials who would rescind it.

In dentistry, the ADA is the lead voice in Washington, D.C. On any given day, ADA staff are tracking and responding to dozens of legislative and regulatory developments that may impact dentists. When Congress is in session, it’s like a nonstop game of Whac-A-Mole for those folks, as they try to whack down efforts that are negative for dentists and negative for the patients for whom we are responsible. And unlike the view of some courts, it’s not about infringement of trade; it’s about ensuring quality care for the unsuspecting patient who is being operated on by someone who learned his "skill" at a weekend course. As I write this, ADA staff is working overtime on legislative strategies to exclude dental devices from a new medical device tax before Congress adjourns.

The American Association of Endodontists supports ADA advocacy in a number of ways. In the past two years, the AAE has stood shoulder to shoulder with the ADA in successful efforts to exempt dentists from the so-called Red Flag Rule and to repeal a provision in the 2010 health reform law that required a business to issue an IRS form to any individual or corporation from whom they purchased more than $600 of goods or services in a tax year. These provisions would have added major administrative burdens to all dental practices.

However, the most important way we support the ADA’s work in Washington is by encouraging AAE members to get involved by supporting the American Dental Political Action Committee and joining the ADA’s Action E-list so their voices can be heard. Visit to sign up for the E-list and get alerts.

I can personally attest that it makes a difference. I am registered for the E-list, and my profile reflects that I spent most of my career in the U.S. Army Dental Corps. In April, I received an alert that both the Senate and House versions of the 2012 National Defense Authorization Act contained language that reduced the rank of Army, Navy and Air Force chief dental officers from Major General (two star) to Brigadier General (one star) as a cost-cutting measure. In a couple clicks of the mouse, I was able to email my federal representatives to explain why passing this provision would be very bad for the future success of the members of the Dental Corps in each of the three uniformed services. I was also able to coordinate our actions with those of many retired Corps chiefs, who were also collectively working the same issue—teamwork from all sides.

That April email alert was just one component of the aggressive advocacy on this issue. The ADA coordinated its e-alert with nursing organizations, because the provision also impacted the rank of the Nurse Corps chiefs in all three services. Members of Congress received many emails and calls on the issue.

Then, in May, dentists attending the ADA’s Washington Leadership Conference were message-bearers, personally delivering letters to their representatives. The House Armed Services Committee completed its mark-up of the NDAA shortly after and removed the provision, and the Senate Armed Services Committee is expected to do the same. A number of AAE members participated in these efforts on behalf of their districts. I encourage AAE members who are interested in seeing the political process "close up" to attend the 2013 WLC.

I understand that we all have tremendous personal and professional demands on our time these days. But even the busiest AAE member can spare the minute or so it takes to send an e-alert. The ADA has made it easy for you to be heard. And gone are the days when we could just practice in our towns and cities and presume that everything will turn out all right, either because someone else was minding the store in organized dentistry, or there were no external pressures on dentistry that could cause any real harm to the profession.

I strongly encourage AAE members to stay informed about what’s happening in your state legislature through your state dental association and local dental society. States have a huge impact on health care, including licensure of midlevel providers and scope of practice. State dental associations take the lead in developing legislative strategies based on the local political realities, with support from the ADA.

Here’s an example of how this can work. For the past two legislative sessions, the Washington State Dental Association has successfully defeated proposed midlevel provider legislation. The ADA State Public Affairs Program provided support, and there was significant participation by the Washington State Association of Endodontists, supported by the AAE. Because of this coordinated effort, the number of dentists (including WSAE members) attending a hearing on the bill significantly outnumbered hygienists who were present. Showing up makes a big impact on legislators—numbers at these events represent voters as well as subject matter experts.

The AAE has a new Advocacy Web page at AAE (available only to AAE members) that provides concise information on the many different ways AAE (through its members) impacts policy. We also have a Special Committee on Advocacy that is evaluating our current advocacy program and will make recommendations on inevitable improvement and enhancements in the way we do business in this area.

But remember that all the work of AAE, ADA and state dental society staff is "toothless" without the constant informed voices of dentists who influence the process in a variety of different ways. In the wise words of a brigade commander I once worked for, "Jim, hope is not a plan." Those words ring so very true in this arena. We can’t "hope" our way to success any more than we could hope that the boogeyman wasn’t in our closets by pulling the blanket up over our heads. So, please stay informed, get involved and coordinate your efforts with those of others through the ADA Action E-list. There is strength in truth and there is also strength in numbers—add your name to those on the team!

Dr. Kulild is the president of the American Association of Endodontists. His comments, reprinted here with permission, originally appeared in the September issue of the Journal of Endodontics.