By Joe Blaes, DDS, Editor
DE: Did you ever envision yourselves as the ADA's president and executive director?
ADA President Dr. Richard Haught, right, and ADA Executive Director Dr. James B. Bramson say their common goal is to improve access to oral care.
Dr. Haught: I started in organized dentistry simply to do whatever I could do to help my profession, colleagues, and patients — not to be ADA president. Jim and I both are passionate about our responsibilities and aware of the challenges that require the strong collective efforts of a unified profession. Becoming president or executive director is a great opportunity to lead, but the profession is much bigger than Jim and I. We're today's stewards, and we take that role seriously.
Dr. Bramson: No, of course not. My goal initially was to open and run my own private practice. Both Richard and I got involved as members and elected leaders. After my involvement in the Iowa Dental Association, I decided to take a management path. I figured the profession could use a few more dentists on the staff who'd been out in the trenches. That's what is so good about my relationship with Richard and our other presidents. I can relate to their everyday problems — I've been there.
DE: You mentioned improving the public's oral health. What do you see as the emerging oral health care needs, and how will you address them?
Dr. Haught: One of the greatest needs is to improve access to oral care. We do not need a two-tier system, where comprehensive care is for only those who can afford it and there is no care or inadequate care for others. Every human being, regardless of background or circumstances, should have the opportunity to enjoy good oral health.
Access to care encompasses many areas, including work force, financial, administrative, educational, and scope-of-practice issues.
The Give Kids A Smile children's dental access event that the ADA has coordinated the past two years accomplishes two important purposes. First, it delivers care. More than a million disadvantaged kids received oral care each year. More than 38,500 dentists, dental team members, and others — including more than 15,000 dentists — volunteered their time and abilities this year.
The other important purpose of this program is to call to the attention of the public, the media, and public policy makers the unmet needs that continue every day in millions of other kids. Dentists and charities cannot solve the problem. Through advocacy and public policy change, we can make certain that every child gets started on a lifetime of oral health.
We must strengthen and improve the Medicaid system. To help our members and others in advocating for Medicaid improvements, the ADA has published a national compendium highlighting state Medicaid programs. This is available on www.ADA.org. We just finished a white paper with five successful model programs to be used as a blueprint for change as states start to work with their legislators.
Dr. Bramson: Give Kids A Smile was created and is a success because of the vision, concern, and caring of our profession. Dentists have always been charitable and provide significant amounts of free care. In fact, the total value of charitable care is equivalent to about two-thirds of total expenditures from public sources, according to the National Medical Expenditure Survey. In other words, we're part of the solution — not the problem. Our vision, however, must be expanded into the national consciousness. Our greatest hope is that, in addition to delivering needed care to children, the Give Kids A Smile program will help make this happen. We're going to do this event annually, and the procedure for signing up for next year's event should be in place on www.ADA.org by the time this interview appears in Dental Economics. And I want to emphasize that everybody is welcome to participate. Give Kids A Smile isn't restricted to ADA members — it's for anyone who cares about the problem of access to care and anyone who wants to do something about it.
DE: Dentists have had to adjust their practices in response to governmental regulations at the national, state, and local levels. How has the ADA helped dentists stay ahead of these issues so they may practice successfully?
Dr. Haught: I'm just like all of your readers. I don't want regulations to compromise my ability to serve my patients. Here are two examples of how the ADA helps: When HIPAA regulations were being drafted, we represented dentistry to try to make the regulations as reasonable as possible. Then, when they became effective, we developed easy-to-use compliance materials to save dentists time and money. The HIPAA compliance kit we made available this summer gives dentists almost a year to prepare for the April 2005 compliance date. We also save members time and money by working with government and independent organizations to maximize HIPAA's benefits and resolve disputes with information system vendors.
We're also proud of the historic alliance the ADA entered into with OSHA in April to increase understanding between dentists and regulators in a cooperative, nonenforcement environment. This cooperative relationship is a complete turnaround from the relationship that once existed between dentists and OSHA.
Dr. Bramson: The Washington, D.C., office of the ADA gives the profession a presence on the hill and ensures dentists have a seat at the table and are heard on important legislative and regulatory issues. The ADA publishes several newsletters to help keep its leaders and grass-roots member activists up to date on the issues in Washington, D.C. and state legislatures. And we provide updates on our progress on lawsuits and other advocacy activities through the members-only content area of www.ADA.org. Most recently, we responded to member needs by producing "Frequently Asked Legal Questions: A Guide for Dentists and the Dental Team." This exclusive member resource contains basic legal information and will help dentists identify, frame, and think through key legal issues pertaining to their practices, including regulatory compliance. It answers 150 important legal questions we have received during the past decade and contains many sample contracts.
DE: Clearly there have been challenges for dentists in dealing with third-party payers. What has the ADA done to help dentists face these challenges?
Dr. Haught: Our lawsuits against major insurers over interference in the dentist/patient relationship have made the entire insurance community take notice and reassess the way it does business. The terms of the settlement with Aetna this summer call for sweeping changes that strengthen the dentist/patient relationship and streamline claims processing. This was a significant victory for both dentistry and the public.
DE: The lawsuits and the settlement are just the latest developments in the ADA's ongoing commitment to help members with this business aspect of dental practice. Have you seen the benefits?
Dr. Bramson: Clearly our legal advocacy efforts have been important, but now I am seeing a greater interest by the third-party industry to work with the ADA on a number of issues such as EOB language. On another front, we recently completed a licensing agreement with the National Association of Dental Plans for them to market the code to their members. These activities are a direct result of the third-party industry and the ADA building bridges and sitting down to work things out.
DE: Our seasoned and new readers have all passed through a dental education system that is severely challenged. How does the ADA see its role, and what can be done to ensure the excellence of dental education for the future?
Dr. Haught: No one group or individual can tackle the current crisis in dental education alone. We see the ADA's role as mobilizing action among all the communities of interest. Starting with the heavy levels of debt many students must incur to fund their educations, the ADA has worked with the American Dental Education Association and the American Student Dental Association and successfully advocated to expand tax deductibility for student loan interest deduction.
The ADA Foundation has begun an enormous effort to develop a campaign for a National Fund for Dental Education involving all stakeholders. We have to help our dental schools, which face skyrocketing costs, and in many cases deteriorating or out-of-date facilities, and we have to do something about the number of unfilled dental-faculty positions. The ultimate goal is to ensure that ours remains the finest dental education system in the world.
It's important to understand that the Fund for Dental Education will complement and support other dental education fund-raising efforts. Through a profession-wide collaboration with coalition partners, the fund will provide dental schools resources for academic development, endowed faculty positions, and student scholarships. What's really exciting about the fund is that it gives us a chance to bolster faculty development, recruitment and retention, facility improvements, innovative education models, and programs to enhance the diversity of the profession.
Dr. Bramson: In addition to keeping dental education strong, we need to continue improving the dental examining and licensure process. Currently, 43 states plus the District of Columbia grant licenses to dentists who are currently licensed in another location without requiring further examination. That's made a difference to new dentists in transition, as well as more seasoned dentists in dual-career marriages when their spouses are relocated. You might think that after setting up a dental practice, dentists don't move much, but that's not true.
Most recently, we brought together an interagency task force to study the role of patient-based exams and other potential methods for evaluating clinical competency for licensure. This brings together key stakeholders in the licensure arena — practitioners, including new dentists, the dental examining community, educators, and students. What's interesting now is that all communities seem to support the concept of a common clinical examination. The ADA is highly motivated to work with the dental education community and the American Association of Dental Examiners, which has indicated its intent to develop such an exam. The ADA is appointing a National Clinical Licensing Examination Consensus Committee to advance this development. A national clinical licensure examination will greatly expand the opportunity for freedom of movement for dentists.
Dr. Haught: We're also working to encourage careers in academic dentistry to help address dental faculty shortages and ensure there is a cadre of well qualified faculty to prepare future dentists. We're building resources for practitioners who may be interested in full- or part-time teaching careers in academic dentistry. The practicing community has a lot to offer in terms of expertise and experience.
DE: There's a lot to be done, and the ADA has limited resources. How do you handle that?
Dr. Bramson: First, you have to listen well. We work to earn the privilege of our members' support, and we're accountable to them on how we use their dues. If we advocate well, collect and share valuable information, and build their professional community, they will join and stay as members. Our membership market share is the highest it's been in a decade, and this gives us resources that allow the ADA to create innovative programs that, in turn, add value to membership. We've challenged our staff teams to take smart risks, and we're cultivating new opportunities through collaboration with corporate sponsors in the dental industry. And we regularly measure our programs and services against the goals and objectives identified in our strategic plan.
Dr. Haught: You've seen the results of our collaborations in initiatives such as Give Kids A Smile, the Oral Cancer Awareness Campaign, the ADA Institute for Diversity in Leadership, our OSHA alliance, and many others that have exceeded expectations. We also have an opportunity in our tripartite network. When you open your dental office, the federal, state, and local legislative and regulatory issues follow you. Through tripartite leadership, our collective resources at all three levels can be used more effectively for our members. We're staying true to our mission, we're listening to our members, and we're doing the work they value most.
DE: How do you keep yourself focused and know you are addressing the right issues and staying ahead of emerging issues?
Dr. Haught: It starts with understanding members' needs. We do this through our house of delegates, board, councils and committees, and relationships with state and local dental societies, along with formal research, of course.
As with any organization, it's our obligation to understand the environment in which our members are practicing and what external forces impact them and to stay focused on opportunities that bring a return on investment in terms of really adding value to membership. We use a three-year planning process with our board of trustees that involves all of our volunteer agencies and our staff teams.
The issues that face our profession are really all about protecting the doctor-patient relationship, preserving the oral health of our communities, and enabling more people to benefit from what dentistry can do for them. The issues are incredibly complex, with many stakeholders. That's why the board spends significant time at each meeting on strategic discussion about a key issue. We're using a knowledge-based management approach that requires us to analyze the vast amounts of data and seek the input of experts outside the ADA. We just finished a strategic discussion at our house of delegates on access to care. They considered the white paper providing a vision for the ADA and dentistry as a whole in leading an effort to improve access to oral health. Four hundred and sixty delegates set aside time from their regular business to engage in this dialogue.
Dr. Bramson: Richard's comment about involving stakeholders really plays out with our tripartite structure, our common bond with state and local dental societies. We've come together on what we call tripartite core values to build our capacity for collaboration. After all, we are serving the same members, and they expect us to make the best use of their dues and the resources these provide. We have to understand the needs of members and nonmembers as well.
The outside experts Richard mentions are important to us because those outside the traditional community have a lot of insights. For example, when we began looking at accrediting international dental schools, we brought to the board a representative from veterinary medicine, which has experience in this area.
DE: We're seeing increasing diversity in the U.S. population and the dental profession. How do you see this affecting the profession and oral health care?
Dr. Bramson: Let's start with the patient. Successful dentists will need to be able to manage patients from different racial, ethnic, and cultural backgrounds. We'll be asking dentists about the issues and needs they face in multicultural practices so we can develop resources to help. Our practice management resources include "Diversity in the Dental Practice" to help dentists market effectively in multicultural communities. We're planning multicultural regional workshops to assist dentists and their teams in meeting the oral health care needs in major metropolitan areas. We're doing a lot to connect with these communities, including developing public health messages to reach the 40 million Spanish-speaking people, an expanding dental consumer base in need of key oral health care information.
We're also strengthening our career resources to attract qualified students into dental careers, including positions on our dental office teams, to reflect the diversity of the population. We're planning a program to bolster oral health literacy and cultural awareness to support dental professionals' communications with patients through resources on www.ADA.org and ongoing continuing education available to all member dentists.
We've recently completed work on a video guidebook oral health education package for African Americans, on which we collaborated with the National Dental Association. We're excited about this project, which was underwritten entirely by Church & Dwight. It's our first education project with the NDA, and it will be distributed free of charge through a national umbrella organization of black churches and will air on network affiliate stations around the country. Copies of the video guidebook package will be available at a low cost.
Focusing on building cultural awareness and inclusiveness is part of the way we now do business at the ADA. But we need to make sure the ADA is a welcoming place for people of diversity. One of my staff came back from a seminar with this and it really rings true: "Changing members doesn't change the culture. Changing the culture changes the members."
Dr. Haught: The ADA officers and trustees see this issue as a strategic focus for the ADA and our members. We're actively collaborating with the NDA and other national organizations on oral health care issues in the legislative and regulatory arena. It's our leadership obligation to prepare the dentists of the future when the current majority population will be the minority. We believe it's particularly important to foster opportunities for future dental leaders from diverse backgrounds. That's why we created the ADA Institute for Diversity in Leadership, in collaboration with the Kellogg School of Management at Northwestern University, one of the top five business schools in the nation. This is a year-long educational experience for promising leaders who are members of racial and ethnic groups traditionally under-represented in leadership roles. One of our participants told us that his involvement with the institute opened so many opportunities both inside and outside of dentistry. It's all about having a passion for the profession and investing in our future.
DE: What did you wish was available to you early in your practice career?
Dr. Bramson: When I started, about the only vision any of us had at the University of Iowa College of Dentistry was to go into practice. I found out that there are hundreds of ways to serve the profession and make it better. In 1986, I was a Hillenbrand Fellow, a one-year program that changed my life. It showed me how the profession is connected and what we can do collectively. Exposing young dentists to leadership programming is really important — we're going to need good, new leaders tomorrow. Thankfully, the ADA plans to reintroduce this program in 2005.
Dr. Haught: The new dentists who join organized dentistry today have a wealth of resources available to them. And the issues they face today are different than what Jim and I faced when we began practicing, although our hopes and dreams are probably the same. We all want a good life, an opportunity to make a difference, a chance to help people, and a desire to succeed. Dentistry offers so much to anyone today; I think it's the best job in America.
Dr. Bramson: And of course technology has changed the way we all work. If the personal computer and the Internet had been available to me early in my practice, I would have valued the access to online continuing education, networking, and convenient dental journal access.
Dr. Haught: Technology goes beyond the personal computer to changing the way we work by integrating high-tech tools such as intraoral cameras, digital and panoramic X-rays, and even CAD-CAM technology into our practices. I am excited by a project that we collaborated on with Henry Schein, Inc. called "Tomorrow's Dental Office Today!" It made its debut at our 2004 Annual Session. This is a mobile dental office that features the latest technological advances and inspires dentists to think about tools that can help them deliver better care. As young dentists, I know Jim and I would have valued the opportunity to be on the cutting edge. The new high-tech diagnostic and treatment tools will revolutionize the way we deliver care, run our practices, and educate patients.
DE: Speaking of the future, what does the ADA have on the horizon to help dentists?
Dr. Haught: We are in the planning stages of a leadership program that would combine aspects of strategic association management, health policy research, and master's-level business curriculum. Our goal is to complement the many outstanding leadership programs that already exist at the local level and provide additional opportunities for dentists who are interested. We are again involving the Northwestern University's Kellogg School of Business. This is not a practice management track, but rather an opportunity for dentists to strengthen their overall business acumen.
Each year, from a practice perspective, we hold a panel with dentists from across the country to evaluate our practice materials, and they assist us in developing new and useful products. We recently introduced resources to help dentists educate the public about two common behaviors that may be promoting tooth decay involving the use of unfluoridated bottled water and improper diet.
DE: Probably some of our readers are not ADA members. You've both talked about the value of ADA membership. What else would you tell the nonmembers if they were in this room with us today?
Dr. Bramson: I would want to tell them about how committed the entire staff at the local, state, and national levels is to serving our members. It isn't enough anymore simply to belong. We are finding, through research, that while some members join because they think it is "the right thing to do," other members are looking for tangible membership value. It is incumbent on any association to reach out to its members, and that the art form we are trying to perfect is listening. We're changing, and as Dr. Mike Alfano, dean at NYU, says, "The ADA is not your father's Oldsmobile anymore." I took that as a huge compliment. We're meeting new and different needs.
Dr. Haught: I would say to any dentist that you can't possibly do it all by yourself. Without the ADA, there is no consensus, no unified voice, no one speaking for the profession. Without the ADA research at Paffenbarger Center, there would be no high-speed drill, no panoramic X-rays, and no composite restorative materials. Who would have done that except us? We're more than 149,000 members strong, we represent more than seven out of 10 dentists, and we are able to influence change. Those numbers translate to power in our advocacy efforts, and our effectiveness increases as our numbers grow.
We need the active participation of as many dentists as possible to keep the profession strong and protect and improve the public's oral health. Would you like information about how to join? Email newtonp@ ada.org.
