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WSDA ay ·m e6
The voice of the Washington State Dental Association
RESIDENCIES Their benefit to patient populations and practice stability
ALSO IN THIS ISSUE: Evolution of policy: Midlevel Providers
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... I just completed our new office build out with Constantine Builders.They are fantastic. We posed a tough challenge for them, they performed incredibly well.
Dr. Greg Vaughn 2 路 th e wsda ne w s 路 issue 6, may 路 2013 路 www.wsda.org
Dr. Danny Tremblay at work in the clinic (photo by Rick Baumgardner)
WSDA news
evolution of policy: midlevel providers
Cover story by Rob Bahnsen Cover photo of Dr. Danny Tremblay by Rick Baumgardner
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Like us on Facebook: www.facebook.com/WashingtonStateDentalAssociation WSDA News Editor Dr. Mar y Jennings Editorial Advisor y Board Dr. Victor Barry Dr. Richard Mielke Dr. Jeffrey Parrish Dr. Rhonda Savage Dr. Robert Shaw Dr. Mary Krempasky Smith Dr. Timothy Wandell Washington State Dental Association Dr. Danny G. Warner, President Dr. David M. Minahan, President-elect Dr. Gregory Y. Ogata, Vice President Dr. Bryan C. Edgar, Secretary-Treasurer Dr. Rodney B. Wentworth, Immediate Past President Board of Directors Dr. Theodore M. Baer Dr. Dennis L. Bradshaw Dr. D. Michael Buehler Dr. Ronald D. Dahl Dr. Christopher Delecki Dr. Christopher W. Herzog
Dr. Dr. Dr. Dr. Dr. Dr.
Gary E. Heyamoto Mary S. Jennings Bernard J. Larson Christopher Pickel Lorin D. Peterson Laura Williams
Director of Government Affairs Bracken Killpack
Association Of fice: (206) 448 -1914 Fax: (206) 443 -9266 Toll Free Number: (800) 448 - 3368 E- mail: info@ wsda.org/w w w.wsda.org
Art Director/Managing Editor Robert Bahnsen
In the event of a natural disaster that takes down the WSDA web site and email accounts, the WSDA has established a separate email address. Should an emergency occur, members can contact firstname.lastname@example.com.
WSDA Staff: Executive Director Stephen Hardymon
Manager of Continuing Education and Speaker Ser vices Craig Mathews
Assistant Executive Director Amanda Tran
Government Affairs Coordinator Michael Walsh
Director of Finance Peter Aaron
Membership Coordinator Laura Rohlman
General Counsel Alan Wicks
Exhibits and Sponsorship Ser vices Coordinator Katie Olson
Director of Operations Brenda Berlin Director of Membership and Comunications Kainoa Trotter
Bookkeeper Joline Hartman Office Coordinator Gilda Snow
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The WSDA News is published 8 times yearly by the Washington State Dental Association. Copyright © 2013 by the Washington State Dental Association, all rights reserved. No part of this publication may be reproduced without permission of the editor. Statements of fact or opinion are the responsibilit y of the authors alone and do not express the opinions of the WSDA, unless the Association has adopted such statements or opinions. Subscription price is $65 plus sales tax per year for 8 issues of the News. Foreign rate is $97.92 per year. Advertising is published as a service to readers; the editor reserves the right to accept, reject, discontinue or edit any advertising offered for publication. Publication of advertising materials is not an endorsement, qualification, approval or guarantee of either the advertiser or product. Communications intended for publication, business matters and advertising should be sent to the WSDA Office, 126 NW Canal Street, Seattle, Wash. 98107. ISSN 1064-0835 Member Publication American Association of Dental Editors. Winner: 2012: Journalism Award, Best Newsletter, Division 1, 2012: Platinum Pencil Award Honorable Mention (2), 2008: Best Newsletter, Division 1, 2007 Platinum Pen Award, 2006 Honorable Mention, 2005 Platinum Pencil Award, 2005 Publication Award; International College of Dentists
table of contents issue 6, may 2013
a day in the life
editorial dr. mar y jennings
Where's the beef?
For over a year ,the WSDA Board of Directors has heard and responded to several inquiries about the integrity of our leadership, finances, and staff. Several people's names have been bandied about with terms like deception, misuse of funds, and embezzlement. I can tell you that both our Board and staff were, frankly, shocked and horrified. As members of the Board, we have an ethical and fiduciary responsibility to the Association that we all take very seriously. We immediately opened the schedule on a subsequent Friday and invited all component presidents to come at any time to review any and all financial records. We had our accountants and our officers at the ready. No one came. During our House of Delegates in September, we had an open discussion to air out any concerns our delegates had about our finances. We had our accounting staff and our independent auditor present to answer questions. What I gleaned from that exercise was that nothing was out of order. Large, complex, non-profit corporate accounts are not quite the same as dental business offices. I felt we had gotten over that hurdle. I am still hearing the wildest of accusations. They seem to be coming from a small, vocal group of people. The accusations have been heavy on innuendo and light on substance. What disturbs me the most is that these are not routine questions. There is a strong accusatory tone. My Oklahoman gut tells me "them's fighting words," words that are meant to incite. It is impossible to fight rumors and innuendos. So let's open this discussion to the light of day. WSDA's finances are healthy. We have an in-house bookkeeper and an accountant. The seventeen members of the board and the five dentists from the Budget and Finance Committee review our finances on a regular basis. At each board meeting your board and staff go over all the spreadsheets and discuss any variances. Our Secretary-Treasurer ensures the integrity of our spending, and all the Association's finances are audited by an independent outside auditor. On the DentPAC front, all of the PAC's income and expenses are reported to the Public Disclosure Commission. This information is publically available on the PDC website. DentPAC finances are also reviewed and discussed by the DentPAC Board of Directors and the WSDA Board of Directors on a regular basis. I feel very comfortable with our check and balance system. The purchase of our building has also been criticized. I hate talking about buying cars or houses with anyone. Too many people channel Donald Trump and tell me what a better deal they could have gotten. The building was purchased three years ago. We got a great deal, and the building has appreciated significantly since the purchase. Our Board and the Budget and Finance Committee carefully monitor real estate transactions. Where's the beef? The midlevel provider issue has always been contentious. The bottom line is that none of us really think they are needed or will be cost effective. The problem is that we stand alone. There are many supporters, most of whom do not have a financial interest in a dental practice. Olympia offers an ever-changing landscape. This year, there were Democrats in the House Health Committee who stood their ground and opposed the midlevel, preventing the bill from getting out of committee. These legislators did this because of our ongoing grassroots advocacy. Our HOD has had to change tactics over Continued on page 53
Dr. Mary Jennings Editor, WSDA News
"Asking a question while referencing one's lawyer is a poor first step on the road to resolution. When a question is answered properly, it is time to let it go and not continue festering. We need resolution. I want us to work out issues professionally and ethically and get back to the good work we do." Dr. Mary Jennings, WSDA News editor, welcomes comments and letters from readers. Contact her at her email address:firstname.lastname@example.com.
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WSDA's strategy on fighting unsupervised dental midlevel providers reflects changing dynamics in Washington. The following is a detailed report on what has happened since the House of Delegates and discussion of where the Association stands today on this important issue.
The 2012 House of Delegates passed HD-13-2012, Alternative to Dental Midlevel Providers, by a vote of 58 yes, 20 no, 1 abstain. Based upon information available at the time, WSDA could not ensure the defeat of an unsupervised midlevel provider in the 2013 or future legislative sessions. HD-13- 2012 authorized WSDA to support a supervised dental extender as an alternative to unsupervised dental midlevel providers with the ability to diagnose. The unsupervised, dental midlevel provider model is strongly supported by the Children's Alliance, the W.K. Kellogg Foundation and several other organizations. The House of Delegates supported HD-13-2012 to ensure that the dental profession shapes the practice of dentistry in the state of Washington. The Board of Directors and the Committee on Government Affairs viewed HD-13-2012 as a policy option that could be advanced by WSDA and not as a mandate that required WSDA to request that legislation be introduced and passed. The House of Delegates decision was made before the 2012 legislative elections, the outcomes of which ultimately changed the legislative environment in Olympia. Prior to the 2012 elections and 2013 session, WSDA engaged key legislators and advocacy organizations in discussions about the legislative language included with HD-13-2012, the rationale behind its various provisions, and the fact that this position was the Association's compromise. It was also made clear that substantive amendments would not be supported by WSDA. These discussions were essential in determining the Association's legislative strategy heading in the 2013 legislative session.
Pre-Session Developments
In November 2012, WSDA made a decision not to request introduction or to support any mid-level provider legislation during the 2013 legislative session. Accordingly WSDA communicated the Association's position to legislators. The decision was made after extensive discussion and based upon the following factors: Rejection by the Children's Alliance In October 2012, WSDA organized a meeting with the Children's Alliance and Senators who have supported midlevel provider legislation to discuss HD-13-2012. During this meeting WSDA leadership discussed the Association's decision making process in developing the resolution and reaffirmed that this proposal was WSDA's compromise. The legislators in attendance stated that they appreciated WSDA's process and were glad that the Association had brought something to the table to discuss. Though the Children's Alliance had previously told WSDA and legislators that they were amenable to compromise on dental workforce legislation during and after the 2012 Continued on page 6
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Dr. Danny Warner President, WSDA
"In November 2012, the Children's Alliance informed WSDA that they had their own "core principles." This meant they would only support workforce legislation that allowed dental midlevel providers to work without the onsite supervision of dentist for all procedures and allowed the provider to diagnose."
evolution of policy dr. danny warner
Evolution of policy: Midlevel providers
evolution of policy continued
evolution of policy, continued from page 5
legislative session, the group rejected the HD-13-2012 supervised extender model. In October 2012, the Children's Alliance made comments that indicated they were not supportive of HD-13-2012. In November 2012, the Children's Alliance informed WSDA that they had their own "core principles." This meant they would only support workforce legislation that allowed dental midlevel providers to work without the onsite supervision of a dentist for all procedures and allowed the provider to diagnose. The Children's Alliance also told WSDA that they planned to introduce its own workforce legislation that was consistent with these core principles. The rejection of HD-13-2012 by the Children's Alliance combined with its intent to push their own bill were significant factors in WSDA not supporting any dental
bedded in the state's dental safety net. Previously, in 2005 and 2009, WSDA worked to pass legislation that allowed hospitals and community health centers to have their own dental residency programs. In 2007, WSDA advocated for state funding for the Northwest. Dental Residency Program based out of the Yakima Valley Farm workers Clinic Until recently, shrinking state budgets have prevented significant expansion of dental residency programs. However, an organization called Lutheran Medical (Lutheran) has changed the face of dental residencies in Washington over the last few years. Lutheran is based out of New York, but offers various dental residency positions in community health centers across the nation. Lutheran residents are not paid with
the state less money than midlevel providers and provide the dental safety net with workforce that provides the full scope of a dentist. Many dentists working in the dental safety net strongly prefer dental residents to dental therapists. Many legislators have been pressured to "do something" about dental access; dental residents have provided legislators with a substitute that they can support. WSDA will continue to advocate for more residents and an environment that is conducive to their success. Composition of the Legislature The 2012 elections provided WSDA with an improved environment to defeat dental workforce legislation. Though considerable opposition to WSDA positions on dental access and workforce remain, more members of the health committees in both chambers
"The legislative process is dependent upon compromise and building consensus. By directly engaging in the policy process with a workforce model, WSDA is now much more relevant in shaping the outcome of dental access legislation in Olympia. WSDA maintains its relevance by proposing solutions to dental access. This cannot be achieved by standing on the sidelines and always saying no." workforce legislation. Obviously, competing workforce legislation significantly complicated the legislative process. WSDA was concerned that legislators would attempt to combine workforce legislation supported by the Children's Alliance with workforce legislation supported by WSDA into a bill that permitted a new provider to work without supervision and/or diagnose. Expansion of Dental Residency Programs 2012 and 2013 have seen a significant increase in the number of dental residency positions available to recently graduated dentists in Washington state. Less than ten years ago, the only non-graduate, non-federal government residency programs were affiliated with the University of Washington. Since then, WSDA has actively sought to increase dental residency positions em-
state money, but instead are funded with federal Graduate Medical Education (GME) funding provided through Medicare. The Yakima Valley Farm Workers Clinic and Neighborcare Health were the first two community health center systems to accept Lutheran residents, but several other systems have followed suit. In 2013, Healthpoint, the Columbia Basin Health Association, and Community Health Care of Pierce County will also host dental residents from Lutheran. In all, seven new residency positions are being added in Washington state in 2013, bringing the total number of GPR/ community health center based residencies up to 40 (see page 22 for a table of all residency positions). The expansion of dental residency programs has provided a viable and implementable workforce alternative to dental midlevel providers. Dental residents cost
and the Senate leadership are supportive of WSDA's position on these issues. The results of the 2012 election slightly narrowed the Democratic majority in the House, which resulted in only a one seat majority for Democrats on the House Health Committee. There was also considerable turnover in the House Health Committee, as many of the committee members in 2012 were no longer in the House of Representatives. The largest changes occurred after the election in the Senate. Republicans picked up two Senate seats in the election and two Democratic Senators decided to caucus with the Republicans, which resulted in the new Majority Coalition Caucus. This change caused significant restructuring of the Senate Health Committee with a new Republican Chair and a Republican majority on the committee.
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The 2013 Legislative Session Three dental workforce bills were introduced in the 2013 legislative session. HB 1516 and SB 5433 were very similar to workforce legislation that WSDA worked with legislators to defeat in 2012. Both bills were supported by the Children's Alliance and the Washington Dental Access Campaign, a coalition which includes the Washington State Dental Hygienists' Association, labor groups, tribal groups, and poverty groups. Over the last three years, the Children's Alliance has received money as part of the W.K. Kellogg Foundation's five-state campaign to get dental midlevel providers passed into law. WSDA opposed HB 1516 and SB 5433 as they would have created dental practitioners with the ability to diagnose and perform irreversible procedures without the supervision of a dentist. HB 1514 was also introduced by legislators in the House Health Committee. Though the bill was patterned after HD13-2012, WSDA did not support the bill nor did WSDA ask for the legislation to be introduced. WSDA opposed HB 1514 as did the Children's Alliance, the Washington State Dental Hygienists' Association, and other advocates for dental therapists. Ultimately, no organizations supported HB 1514. After HB 1514 and HB 1516 were in-
troduced, WSDA and its lobbyists began an aggressive advocacy campaign that included voterVOICE messages, daily email blasts from the WSDA to all legislators, and individual meetings and phone calls between individual grassroots dentists and targeted legislators. This campaign highlighted the improvements in dental access among children, the lack of financing for dental care for low income adults, and information about dental therapists in other states and countries. WSDA's key messages were, and still are: 1) Washington's dental access issues are a problem of financing, not workforce and 2) Washington has equivalent or better oral health outcomes than areas that utilize dental therapists. All of WSDA's communication to legislators on dental workforce clearly stated that WSDA opposed HB 1514, HB 1516, and SB 4533. A hearing on SB 4533 was never scheduled in the Senate Health Committee. WSDA's lobbyists and grassroots dentists talked with committee members from both parties and explained why WSDA believed SB 4533 was not a solution to dental access. There was not significant support for SB 4533 among members of the Senate Health Committee, so neither a hearing nor a vote were scheduled for the bill. The House Health Committee held a hearing on HB 1514 and HB 1516 in early February. At the hearing, over a dozen dentists, lobbyists, and citizen advocates spoke in support of and against both bills. WSDA utilized a testimony team of dentists with practical experience in various parts of Washington's dental safety. Though there was some confusion about how Chair of the House Health Committee Eileen Cody (D-Seattle) would hear both dental workforce bills, WSDA signed in in opposition to both HB 1514 and HB 1516 and testified against dental midlevel providers during the public hearing for HB 1516. WSDA's panel of dentists questioned the viability of creating a new workforce member and spoke in support of better alternatives including dental residency programs and reinstating adult dental Medicaid funding. For the third consecutive year, dental workforce legislation was not voted out of the House Health Committee. Some individuals have stated that the 2013 dental workforce bills were killed because Republicans were united in opposition; this analysis simply does not reflect reality or make logical sense. Though the support of Republican legislators is very important, Democrats have had majorities on the House Health Committee for the previous
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twelve legislative sessions. Opposition to dental workforce issues would not have been successful with only Republican support. WSDA's grassroots dentists and lobbyists have worked with Democrats and Republicans who shared concerns about these midlevel providers. HB 1516 and HB 1514 were kept in committee because a majority of Democrats and Republicans in the House Health Committee did not support the bills and did not want to vote on them. WSDA has not made dental access a partisan issue; the Association seeks support from Democrats and Republicans alike. While HB 1514, HB 1516, and SB 4533 did not pass in 2013, all three bills will be automatically reintroduced in the 2014 legislative session. The Children's Alliance has continued to advocate for midlevel providers and has vowed to continue their advocacy on this issue into the future.
The Future of HD-13-2012
After deliberation and review, the Board has determined that HD-13-2012 had served its intended purpose and is therefore no longer needed. The Board of Directors passed BD-25-2012/13 at its April meeting. The resolved clause of the resolution reads as follows: "the legislative proposal contemplated in HD-13-2012 Alternative to Dental Midlevel Providers does not apply beyond the 2013 legislative session." The passage of this resolution maintains WSDA's opposition to dental workforce legislation in the 2014 legislative session. Some have argued that HD-13-2012 was a tactical error. The Board of Directors and WSDA's lobbyists and staff strongly disagree with this assessment. Many understood the significance of the Association's attempt to compromise and this demonstrated to legislators that WSDA can be reasonable and engage in improving access to dental care for the underserved. This action made our policy alternatives more credible. The legislative process is dependent upon compromise and building consensus. By directly engaging in the policy process with a workforce model, WSDA is now much more relevant in shaping the outcome of dental access legislation in Olympia. WSDA maintains its relevance by proposing solutions to dental access. This cannot be achieved by standing on the sidelines and always saying no.
evolution of policy continued
Additional Research After the House of Delegates, WSDA continued to research dental midlevel providers and how they have been implemented in the U.S. and Canada. WSDA has continued to communicate with the Minnesota Dental Association and dental clinics in Minnesota and other states engaged in dental workforce legislation. In the fall of 2012, the Journal of Dental Education published a series of articles on the feasibility of midlevel providers in private practice, community health centers, and school-based clinics. This research was funded in part by the Pew Charitable Trusts, a prominent supporter of dental midlevel providers. The research concluded that dental midlevel providers did not provide any significant cost savings in any of the practice locations studied, and that there was limited need for a provider with the scope of midlevel provider. Another article published in the Journal documented the closure of all the dental therapy education programs in Canada. This research provided validation of many of organized dentistry's concerns with a new provider.
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2013 WALL OF WINE All that learning can make you thirsty
WOHF Wall of Wine The Wall of Wine is an important fundraiser for the Washington Oral Health Foundation. This year, all the proceeds from the Wall of Wine will go towards purchasing hygiene kits for the more than 2,500 kids who need them across Washington state. Here's how the event works: In return for a $20 donation, you'll get to choose any individually wrapped bottle of wine at the WOHF Booth, some valued as high as $50. Bring cash, check or credit card to the WOHF table, choose any remaining bottle of wine, and benefit a great cause. Come talk with WOHF staff and volunteers about how the Foundation can help support you. Salut!
Phone-A-Thon Thanks! Without the people listed below, the 2013 WOHF Phone-A-Thon couldn't have been the success it was. The Foundation has collected $106,993 in pledges to date — a considerable increase over years' past. WOHF Co-Director Ruth Abate couldn't be more pleased, saying "Our volunteers' efforts really were outstanding this year, we're incredibly excited about the possibilities ahead, and owe a huge debt of gratitude to everyone involved in this year's Phone-A-Thon!"
Dr. Michael D. Aslin Dr. Dexter E. Barnes Dr. Victor J. Barry Dr. Gary E. Berner Dr. Albert R. Bird Dr. Dino A. Cacchiotti Dr. John B. Carbery Dr. Randle T. Carr Dr. Douglas L. Coe Dr. Todd T. Cooley Dr. Richard A. Crinzi Dr. Ronald D. Dahl Dr. John T. Darling Dr. Bryan C. Edgar Ms. Diana Ehli Dr. Barry A. Feder Dr. Sarah D. Fraker
Dr. R. Terry Grubb Dr. Sally J. Hewett Dr. Susan M. Hollinsworth Dr. Michael T Horn Dr. Todd R. Irwin Dr. Spencer S. Jilek Dr. Aaron J. Lemperes Dr. Garrick J. Lo Ms. Angela Lykins Dr. Philip W. Madden Dr. Robert Merrill Dr. Keith E. McDonald Dr. David M. Minahan Dr. Michael T. Oswald Dr. Sammy B. Pak Dr. David G. Petersen Dr. Christopher Pickel
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Dr. James Ribary Dr. Karen D. Sakuma Dr. Rhonda R. Savage Dr. Patrick Sharkey Dr. S. Tyler Shoemaker Dr. Ronald K. Snyder Dr. Kurt R. Swanson Dr. Steven D. Waite Dr. Mark V. Walker Dr. Douglas P. Walsh Dr. Timothy E. Wandell Dr. Danny G. Warner Dr. Michael R. Warner Dr. Sue Weishaar Dr. Rodney B. Wentworth Dr. Carrie K. York
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member news dr. linda edgar
DR. LINDA EDGAR thee wsda wsda ne new wss ·· issue issue 6, 6, may may ·· 2013 2013 ·· www.wsda.org www.wsda.org 1100 ·· th
member news dr. linda edgar
Few people run triathlons, or have qualified for the Olympic trials. Even fewer of those are women, but WSDA member Dr. Linda Edgar did all of that in the 80s — and had it not been for an accident while training for the Hawaii Ironman, she might still be running today. The drive and perseverance that Linda harnessed throughout her life has carried her through both triumph and personal loss to where she is today — a successful dentist who has practiced for 22 years with her husband, Bryan, and is now poised to become president of the Academy of General Dentistry (AGD) — the second-largest dental association in the country. For Linda, a hard working, nononsense type with a surprising, self-deprecating sense of humor and an easy laugh, the road hasn't always been paved with opportunity. In the 70s, when she first thought of attending medical school, she remembers that, "… very few people were encouraging women. There's been a huge movement of women in healthcare, medicine and dentistry since then. But I was fortunate, because Bryan always championed me." The Edgars started dating in high school and later attended UW together – Bryan pre-dent, Linda pre-med,
Photo: Meryl Schenker Photography
continued on following page
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and they struck a deal — once she graduated, they would marry and Linda would work and put Bryan through dental school. When his practice was underway, she would attend medical school. In the end, It wouldn't be quite so easy — as Edgar says, "Life happens when you're busy making other plans." She got her teaching degree, and began teaching math and science while studying for her masters at night. Bryan was a 4th year in dental school when the couple faced the first of two personal tragedies — they lost a child early in pregnancy. Nine months later, after the couple had relocated to Ft. Riley in Kansas where Bryan was completing a two-year residency, the couple lost yet another child under the same circumstances. With starting a family on hold, Edgar recalibrated, and began to apply to both medical and dental schools a few months later.
A miracle
A few months later in 1977, Bryan was doing an anesthesia rotation when a young woman, just 19 and nine months pregnant, presented at the hospital and told staff she wanted to give her child up for adoption. She was due in 24 hours. Linda, who calls the unfolding narrative "miraculous," remembers, "Without even applying to adopt, we were blessed with a three-day old newborn." Once again, she put her dream of attending dental school on hold, recalling, "This was the 70s, very few wom-
en were in dental school and no one had a baby. So I taught, which allowed me to be both a mother and still work."
Photo: Meryl Schenker Photography
member news dr. linda edgar
"If you want to be an engineer or a mechanical engineer, don't let someone tell you that women can't do that. They told me that when I wanted to be a doctor, and I didn't let that stop me."
When her son was 3, she started running for fun, and a friend later encouraged her to enter her first race. She ran her first 10K in 51 minutes, and continued to improve — increasing her mileage and adding speed workouts to her regimen. Three years later, she would run an average of 107 miles a week while continuing to race, entering some 45 marathons, and winning almost as much money running as she made teaching. Edgar later set the record in the Seattle Marathon and qualified to run in the 1984 Olympic Trials—the first woman's marathon—but she had pulled her Achilles training to qualify for the trials. In 1987, while doing the Penticton Ironman in Canada to train for the Hawaii Ironman, Edgar crashed on her bike, splitting her helmet and breaking her ribs. Her running days were over. Bryan, her biggest supporter, encouraged her to get back in the game and apply to dental school.
and knowing all the answers on the tests to being a mom and dental student and not knowing any of the answers. My son became a teenager — which is always a tricky time in a child's life, and I was commuting a long distance to the University. I remember wanting to quit every Friday." She didn't though – it simply isn't in her DNA. Bryan's commitment to Desert Storm was short —just a year — and she finished her studies a year after his return. Soon after, she joined Byran's general practice. Linda says she's never wanted to specialize – she likes the diversity of training she's gotten as a general dentist (some 2,500 hours of CDE, and counting), and says, "I do some orthodontics, and I do oral surgery — Bryan places implants, so I don't. The nice thing about general dentistry is that you can bring somebody in whose mouth is in chaos, and take them from start to finish — even if they need ortho — and really make a difference in their life. As a specialist, you don't really have that. I have patients who have been with me for 22 years who came to me at age five, and now they're adults. That's pretty special."
The university and beyond
More than dentistry
Her competitive spirit
She was immediately accepted and began dental school in 1988, when son David was 11. In her third year, Bryan got called up for active duty for Desert Storm — it was a tough time. She remembers, "I went from being a teacher of honors chemistry
As you might imagine, a person with Edgar's drive would likely not be satisfied with her roles as wife, mother, and dentist alone, and to that end she began participating in organized dentistry 22 years ago, forging opportunities for women in
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engineer or a mechanical engineer, don't let someone tell you that women can't do that. They told me that when I wanted to be a doctor, and I didn't let that stop me. Look at the ADA," she notes, "In 150 years they've only had two women presidents – and there are a lot of smart women. And yes, it's a little scary to be moving into this position as President — I know that I will be more scrutinized because I am a woman — I stick out. But I also know that if you ask me to do something, I'll give 100 percent. I'm personal, genuine and authentic, and I think people respond to that."
Proud service with AGD
A national agenda
Nationally, her roles in both the AGD and ADA have given her entrée to the world of D.C. policy-makers, allowing her to get her message to even more influential ears. And, while some of organized dentistry's most pressing issues — midlevel providers, dwindling insurance reimbursements, and student debt — seem to be reaching their zenith, she's unfazed. "I think what's most rewarding about serving at this level is that if you can make a difference, now's the time. If we're going to continue to exist as family practices, we're going to have to be more efficient. And both AGD and ADA are working on practice management issues — It is imperative that ADA and AGD work together to help dentists be efficient and profitable in their practices while still retaining excellence. We just came back from Washington, D.C.," she says, "And while I was there, I talked with the representatives with the Department of Education — and while I'm not sure that will make a difference, it has made me want to contact Michelle Obama about brushing and nutrition programs in the schools." With Dr. Linda Edgar's track record and dogged determination, we're guessing the First Lady will take the call.
Photo: Meryl Schenker Photography
Other then her commitment to mentoring women, Edgar is passionate about the work AGD has done, and continues to do, to make room at the table for dental students saying, "We have about 38,000 members and we're growing — unlike many other organizations — because we have established a very special relationship with ASDA. They're tremendous, and we're excited to give them a voice early in their career. It's important to involve the new generation, and to that end we have local representation of students on our state board."
member news dr. linda edgar
particular. She reveals, "I realize now that being a role model is still important, even though fifty percent of graduating dental classes are now women. While our world is becoming less gender sensitive, it continues to be imperative to spread the message that you need to look at the person, not the gender." Edgar mentors women dental students, encouraging them to come to the practice to see what they're doing — she also invites them to call or email her with questions. "There's no reason why a woman can't buy a practice," says Edgar, noting that women dentists still face some gender-related hurdles, "There's still a cultural bias that suggests women will work less to accommodate having children. To that I say look at the Carrie Yorks of the world! In Washington and elsewhere, there are a growing number of women who are very successful — often producing more than their male counterparts — because they have husbands willing to stay at home in a more traditionally female role. How wonderful is that? It may still only have limited acceptability in society, but that's changing." And while there still may be much work left to do to achieve gender neutrality, Linda is a determined ally, "If you want to be an
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Location, Location, Location
Bellevue Collection VIP Passport: Macy's welcomes WSDA to
At the risk of sounding like a broken record, download the app, download the app, download the app. Really! Don't have a smart phone? Make friends with somebody who does. Seriously though, we won't leave you adrift — we'll have electronic reader boards, our Map & Guide, and tons of onsight signage — but the mobile app really is the way to go. It's got every piece of information you could ever want, from lecture and workshop descriptions, times and locations, to the deets on the Scavenger Hunt and great restaurants in the area.
Bellevue! Stop by the Macy's Cosmetics department and show us your PNDC badge for a chance to win! Spin the prize wheel and you could win one of 250 gift cards valued between $5-$100 (One spin per customer). Next, stop by the six different cosmetic stations on your passport (included in your WSDA bag) and get a quick beauty fix as you fill your goodie bag with freebies. Once your passport is complete, drop it off at the raffle box in the cosmetics area for a chance to win a fabulous basket containing full sized beauty products and a Clarisonic sonic skin cleansing system valued at $119. Indulge in sweet treats and refreshments in our VIP room, dedicated to WSDA attendees only — all while supplies last! Passport hours: Thursday, June 13 from 11 a.m. - 9 p.m. and Friday, June 14 from 11 a.m. - 4 p.m.
Comfortable shoes
Just a reminder, the PNDC is in Bellevue this year, and every year going forward. It's our new home, and we're excited!
Download the app
Every year at the Pacific Northwest Dental Conference, we marvel at how fashionable people in organized dentistry are — especially women — who seem to dress to the nines for the Conference. And, while we think it's great, we'd like to offer a suggestion this year: wear comfortable shoes! We'll have a shuttle to take you between properties, but June weather can be gorgeous and you may want to walk between the Hyatt Regency Bellevue and the Meydenbauer Center.
Shuttle Service Not a walker? We've got you covered — free continuous shuttle
Download the app. You'll hear this from us a lot this year, because the mobile app is chock full of information, including parking and shuttle locations. The following facilities allow parking during the PNDC, if you choose an alternative site, please pay attention to their regulations so that you are not ticketed.
Hyatt Regency Bellevue
Hyatt offers self-parking for $25 per day for Sunday night through Thursday night stays. Friday and Saturday night stays are complimentary (8 p.m. Friday until 12 a.m. Sunday).
Lincoln Square
service is available between the Hyatt Regency Bellevue and Meydenbauer Center. Please refer to lobby signs to familiarize yourself with the shuttle bus schedule at both locations.
Lincoln Square garage parking: $7 for 4 hours, $9 for 6 hours, $11 for 10 hours. Free parking after 8:00 p.m.
Boarding locations:
Meydenbauer Center's 434-stall parking garage is located at 11100 NE Sixth St. It does not accommodate vehicles over 6'9" tall. $14 for 6-8 hours, $15 for 8-12 hours, $18 for 12-24 hours.
Hyatt Regency Bellevue
Pick-up and drop-off: NE 10th Street, which is on the same floor as the Evergreen ballroom and foyer
Meydenbauer Center
Pick-up and drop-off: NE 6th Street on the south side of the building
Freebies and other goodies
We love giving stuff away, and this year is no different — from free passes to the uber-swank David Barton Gym, to our traditional totes sponsored by WDIA and NORDIC, we've got a collection of fun stuff for you to do while you're in Bellevue at the PNDC.
Bellevue Collection Guest Services: Show your PNDC badge to receive a free gift
Meydenbauer Center
The Bravern
The Bravern lot can be accessed by turning left onto NE Sixth Street. Turn right onto 110th Ave NE and then turn right into the Bravern's 110th Ave NE garage entrance.
Bellevue Corporate Plaza Garage
Bellevue Corporate Plaza Garage is located at NE Sixth St on 110th Ave NE. This is the closest overflow lot to Meydenbauer Center. Proceed up the hill past Meydenbauer Center. Turn right at the light, and left into the parking structure.
Griffin Parking Lot
Griffin parking lot – surface lot. This parking lot is accessed easily from Eastbound NE 8th St or Southbound 110th Ave NE. Before 9 a.m. is $11 for 10 hours.
Free gift Cards will be given out randomly throughout the two-
day conference!
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pndc news comfortable shoes
Congratulations on the following successful transitions: Dr. Ben An to Dr. Zachary Cargill Bellingham, WA Dr. Dennis Luiten to Dr. Rick Nash Burlington, WA Dr. Farad Bell to Dr. Nadeem Merchant & Dr. David Au-Yeung Seattle, WA Dr. Terrance Cliney to Dr. Jeff Knudson Seattle, WA North Seattle Perio Practice—NEW 4 ops, good location, collecting over $400K, strong hygiene base.
4 ops (wired/plumbed for 5th), $706K collections, $320's net on 130 days. Large office space with private Dr's office and staff locker/ break room. $625,000.
East King County—NEW
8 ops, $1.7M collections, Net $650K+. Associate to purchase, 4 yr. term. Large office with private Dr's office, lab, sterilization and break room. Large hygiene base, over $800K in hygiene.
Newly listed. Very visible location. 3 ops. Paperless, digital. Collecting high $700K.
Tri-Cities—NEW PRICE
Sandpoint, Idaho
Western Washington Area
Associate to Purchase option
4 ops in a well established general practice. Just installed all digital! Strong hygiene but room to grow. Dr. is tired and ready to go. Great location with excellent visibility. Bldg. possible in the future. $458,000.
4 day week, 4 ops, 6 days per week hygiene with crown/bridge/implant. Stand alone building owned by practice. (Bldg purchase optional) Well established in community and prefers transition period. Great opportunity in a smaller community.
4 ops with availability for 3 more. Wellappointed, digital, view, located within minutes of Microsoft campus. Poised for growth, seller ready for quick transition. Great start-up opportunity.
Well-established general practice in new building. 6 ops, private office, separate consult area and large staff room. Collections over $100K/monthly with net $500K. Seller will stay to assist transition.
Wenatchee Spokane
Coming Soon
Spokane Northgate Downtown Seattle
Stop by and see us at the PNDC in Booth #515
Space Only Edmonds and Everett
Congratulations to the following successful transitions: West Edge Dental Dr. Nicole Leiker To Dr. Jessica Emard South Seattle—New Listing
Affluent area, stand alone dental bldg, 5 ops, beautifully appointed, digital, x-ray, lots of room to expand
2 ops, part-time practice, digital, recently remodeled
4 large ops, room for 5th, currently 2 days a week, great location in downtown.
4 ops, in the heart of downtown Poulsbo. Updated Medical/Dental complex
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As you build your financial portfolio both for your financial security now and in anticipation of enjoying a long retirement, you need to factor in the cost of care for when you need assistance in your home or become a resident of a nursing home or assisted living facility. The average length of stay at a nursing home is 2.4 years, which in Washington State could cost you over $200,000. You can designate money in your portfolio to cover the costs or you can purchase Long Term Care Insurance. For 2013, the average annual cost of a nursing home in Washington is $95,000; an assisted living facility or in-home care with a health aide is $51,000. Long Term Care Insurance will help you meet the cost of your spouse's and your care should you need assistance with daily living. It gives you the flexibility to choose when and where you receive care and to provide emotional and financial support for your family. Seventy percent of people over the age of 65 will require long term care services at some point in their lives. Long Term Care Insurance is similar to Disability or Life Insurance in that you are paying a monthly premium to have a pool of money available to you when you need it. Unfortunately, "Long Term Care" is not an accurate description of the benefits provided on a Long Term Care Insurance policy: "Family Freedom Coverage" may be a bit more accurate. This type of insurance frees you from the substantial financial burden of paying for care while it frees your family from the burden of caring for you at the detriment of their time, finances and physical and emotional well being. Forty-one percent of people receiving long term care are between the ages of 18 and 64. Since the need for assistance, not age, is the trigger for receiving long term care benefits, this insurance will cover you should the unexpected happen at any age. For example, if at age 47 an illness or accident leaves you needing care, you would be eligible to receive benefits. This would allow your spouse to continue working or caring for your children while a professional caregiver came to your home to help you with your daily needs such as bathing, dressing or getting in and out of bed. Washington Dentists' Insurance Agency strongly encourages you to add Long Term Care Insurance to your insurance portfolio. Along with Disability and Life Insurance, Long Term Care Insurance will protect your family and you from the large financial burden that an accident or illness may cause. Purchasing coverage will relieve your family of having to center their lives around your personal care while giving you the freedom to choose where you would like your care to take place. To learn more about Long Term Care Insurance and to receive quotes, please contact WDIA at 206-441-6824 or 1-800-282-9342 or at firstname.lastname@example.com.
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Matthew French Director of Insurance Services WDIA
"Since the need for assistance, not age, is the trigger for receiving long term care benefits, this insurance will cover you should the unexpected happen at any age."
wdia news why you need long term care insurance
Why you need Long Term Care Insurance
cover stor y residencies: their benefit to patient populations
RESIDENCIES Their benefit to patient populations and practice stability
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Left to right: Drs. Bart Johnson, Amy Winston and Noah Letwin of Seattle Special Care Dentistry, and the Swedish Hospital GPR
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Photo: Meryl Schenker Photography
continued on following page
cover stor y residencies: their benefit to patient populations
Dental schools across the country do a remarkable job of educating the next generation of dentists, but as sound as those programs are, recent graduates could all benefit from additional practice, mentoring, and education. Cuts to Medicaid have diminished patient loads in the university setting, forcing students to scramble to complete clinic requirements, often performing procedures on extracted teeth rather than live patients. It's unclear at this point when state legislatures will revisit Medicaid funding. General Practice Residencies (GPR) and their counterparts, Advanced Education in General Dentistry (AEGD), could hold the key to providing the additional education, while at the same time increasing access to underserved patient populations in the state.
cover stor y residencies: their benefit to patient populations This page: Dr. Taylor Berry works on a young patient
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Photo of Dr. Taylor Berry: Meryl Schenker Photography
A combination of both clinical care and didactic education, residency programs provide more advanced training than universities can offer, even in elective course study. In the past five years, the number of residency positions in the state has swelled to 24, with seven more positions on the way this summer. Each program lasts a year, from July to June, using anywhere from two to eight recent graduates from across the country — with some international students from as far away as India. The residencies vary in size, location, and specialty; ranging from hospital-based programs in Seattle, to those in community health centers in rural towns. They all expand the dental safety net, utilizing dentists who can perform the full scope of procedures, while teaching them advanced skills, increasing their speed and confidence, and leaving them better prepared for the practice of dentistry. The WSDA News recently reached out to ten dental professionals who know the value of residencies first hand — from attending dentists and dental directors Drs. Amy Winston, Bart Johnson, Noah Letwin and Mark Koday, to current residents from across the state — Drs. Danny Trembleayy, Jennifer Westcott, Amanda Spivey, Taylor Berry, Peter Dang and Kim Siler. All of the residents we spoke with called the experience invaluable — and noted that time spent in a resident program could only enhance the abilities and confidence of new dentists. Each, too, professed a commitment to continuing to help the underserved, no matter where their futures take them. At the WSDA, we see the value in this model as well, and are actively working on a capital budget proposal to help community health centers in Toppenish, Othello, and Walla Walla expand physical clinic capacity in order to increase the number of dental residency positions available in rural Washington.
Choosing a residency
Why does a new graduate make the choice between going directly from dental school into practice, versus taking another year to explore a residency or specialty? For the people we spoke with there was no question that something more was needed — no matter how robust their dental education was. "People don't know what they don't know," said Dr. Amy Winston, of Seattle Special Care Dentistry, who along with Dr. Bart Johnson runs the Swedish GPR, one of the state's most intense residency programs, where they work primarily with challenging, medically-complex patients. "They get out of dental school and they think they're ready, but really, without doing a residency there's so much they
haven't seen or done that they inadvertently limit themselves." Dr. Danny Tremblay was in one of the first graduating classes at UWSoD to be affected by the cuts in Medicaid. He took a residency in Yakima at the Yakima Valley Farm Workers clinic under Dr. Mark Koday because, while he says the UW did a tremendous job of training him to be a competent clinician, he felt he needed more experience — not only get faster, but to develop a routine and an understanding of how long a procedure would take. And while Tremblay was appreciative of the didactic offerings of his residency, he completed even more CDE on his own, attending the ADA Annual Session, the PNDC, and the American Academy of Cosmetic Dentistry annual session. Dr. Amanda Spivey, who is finishing up her year in Seattle over at the Swedish residency program with Drs. Winston, Johnson and Letwin, originally thought about going into a specialty, but didn't know what she wanted to specialize in. Her mentor dentists from school steered her in the direction of a residency instead. Spivey knew she wanted to continue her education to expand her knowledge of surgery and medicine, and so she chose a GPR over an AEGD, because the focus is more medically-based. "I really see no downside to a person doing a year of residency," she said, "Had I gone directly into a dental practice out of dental school, my potential for learning about these advanced dental procedures and complex medical patients would have been limited to CDE courses; this year I have been able to learn about them didactically, while also being able to treat these patients clinically. It has been a great year and has given me an education base that will allow me to grow more as a practitioner in the future." Over in Spokane, Dr. Peter Dang took an AEGD residency because, "I simply did not feel ready to take on and be responsible for my own clientele right out of dental school. I needed more time — not only to hone my skills, but to find my voice, and develop my philosophy of dentistry. I did not do enough in school to be able to determine who I was, or what I was willing or able to do. At NYU, there were many more opportunities for hospital-based GPRs because of the urban setting, but I thought an AEGD matched my needs more closely." The program exceeded his expectations, and he feels the AEGD is the way to go — as long as a resident isn't planning on specializing in oral surgery later — comparing it to an accelerated first year of private practice. "Sure," he admits, "I don't know how to intubate a patient, or place an IV, as I would if I had done a GPR, but I've done a tremen-
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dous amount of dentistry, regardless." Dr. Kim Siler is also in the Spokane residency, and always knew she'd invest the time in some sort of residency program, but settled on an AEGD because she knew she would likely land in a general practice upon graduation. "If I could have found a dentist willing to mentor me through the transition phase, I might have done that instead, but it's hard to find somebody like that. In a residency, they're not so concerned about taking longer to do a composite, as long as you continue to improve. This program allowed me to improve at my own pace, and that fit my style of learning the best." And, while having a dentist mentor might sound good, it's not without some serious limitations, as Johnson points out, saying "The power of residencies is that they have multiple attendings, hours and hours of formal seminars, educational structure, and accreditation standards to meet —none of which is available in a apprenticeship in a private practice." Dr. Noah Letwin has a unique perspective — three years ago he was a resident at the Swedish residency, today he is an attending dentist for the group. When he arrived for his residency he was overwhelmed, likening the flow of information to "trying to sip water from a fire hydrant," while adding, "I don't think there's any substitute for the kind of hands-on experience you get in a residency. You may have been exposed to some of this in dental school, but once you've seen a sufficient number of patients in a residency program, your understanding of complex problems — be it heart disease, renal failure, or liver disease — becomes much more cemented. The residency took my skills to the next level, and allowed me to treat a much broader patient population than I would have been able to with just a dental school education." Letwin says that because of his year in the residency, he has a better understanding of dental complexities, is able to perform sedation and work with an anesthesiologist, and understands hospitals. Moreover, once he finished his residency he knew that he would be able to treat anyone. Dr. Jennifer Wescott, another resident at Swedish, concurs with Letwin, and even though when she returns to private practice in June she's not likely to have the kind of patient population she's working with now, she plans on growing it. She'll be returning to Florida to practice with her father, who for 30 years has run a successful "breadand-butter" practice. Westcott found the Swedish residency on the internet, and felt its appeal immediately, saying, "This program is unique because it is based out of a private practice rather than a university or hospital, so it felt more applicable to life
cover stor y residencies: their benefit to patient populations
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cover stor y residencies: their benefit to patient populations
Washington's General Dental Practice Residencies (GPR) Community Health Center Based Residencies: GPR/CHC Based Residencies Organization University of Washington Northwest Dental Residency Neighborcare Swedish Hospital Yakima Valley Farmworkers Clinic ‐ Pediatric Dentistry Yakima Valley Farmworkers Clinic Columbia Basin Health Association Healthpoint Community Health Care Totals after the residency. I was drawn to the emphasis on procedures that I wanted more training in — particularly IV sedation and treating medically-complex patients. Even if I'm overtraining in complex procedures now, I know that when I'm treating run-ofthe-mill patients I'll feel confident to handle any issue that arises. Also, I think that patients with complex issues have trouble finding care, and this program provides me the tools and information to treat them competently once I graduate, which I fully plan to do." Life after residency should have an interesting dynamic for Westcott, who goes to her father's practice as the expert on procedures like placing implants, extracting third molars, IV sedation and treating medically-complex patients.
Adding value to their practice
For the attending dentists, having residents adds much to their practice — from increasing their productivity by having more licensed dentists on board, to the influx of enthusiasm and new dental techniques that residents bring with them. Having their salaries paid for by the federal government makes the program even more enticing, especially at Community Health Centers, which lost most state funding two years ago. There, having residents not only helps with their bottom line, says Koday,
2012 Growth 2013 Total in 2013 Total 9 0 9 6 0 6 5 1 6 3 1 4
Location Seattle/Yakima Yakima County Seattle Seattle Yakima County Spokane, Walla Walla Counties Grant, Benton Counties King County Pierce County
"It keeps us challenged. For me, and many of the other dentists, it reminds us of the excitement we felt when we first graduated from dental school, we're always pumping them for information, and they are constantly pumping us for information. Being able to do a procedure and being able to teach how to do a procedure are two very different things — so it forces you to go back to the books. You have an obligation, and you can't give residents incorrect information, or information that isn't current. It renews you — they're a fun group to work with. The other part of it is — and I think I can speak for all dentists — the dental profession has been good to us, and this is a way of giving back to the profession. By working with residents you're ensuring that they have a good start to their career." Johnson, agrees, saying "We give them a skill set that they cannot get in dental school, which will have a huge downstream effect over the course of their careers. It's fun, exciting and brings a lot of energy into the practice, which keeps us young. It helps us tremendously to treat the needs of the population we're trying to reach." Plus, Johnson says, he just loves teaching — "I have been teaching residents for all of my career and I just love the residency model – I love to teach, I love the idea, I love everything about it. We're turn-
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ing out three (soon to be four) highly qualified dentists a year, which gives them a jump-start on their career." Winston adds, "Having residents allows us to see more patients and increase our volume significantly. Additionally, they bring positive, youthful energy to the place that is really exciting. We get to learn what they're being taught in dental school – we've all been out a certain number of years, and it's really nice to keep up on what's being taught currently. We are allowed to do a lot more charity care because of the residents — it enables us to provide care to underfunded patients that we wouldn't be able to do otherwise. Plus, we've been able to participate in some amazing things in the community, like the NW Kidney Center Program, and the SCSC Clinic over at Swedish. The residents provide exponentially more opportunities to our practice." Even with federal funding paying their salaries, having residents on staff is a labor of love, according to Johnson, who relates, "While we don't pay their salaries, we pay with our time, our energy and our expertise. The biggest problem with business people who want to set up new residencies is that they often think they can start one up, get free labor and not have to do anything more. Nothing could be further from the truth!"
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they need it." Letwin adds, "The thing to keep in mind is that a dentist graduating from dental school can go out and perform dentistry as they please. These are folks coming from dental school for additional training – but that doesn't mean that they wouldn't be able to treat patients on their own. You have no such guarantee with a midlevel provider." Koday agrees, saying "I clearly believe in dentist-driven care, and one of the things I like about the residency program is that they are dentists – they have graduated from dental school, they are already well-trained and competent, and have a wide skill set, so all we're really doing is broadening those skills and giving them more experiences. Residents do require supervision, but they can do far more complicated care and a wider range of procedures, so I don't think there is any comparison at all. And when our residents have graduated they can go out on their own and continue to perform a very wide range of procedures, versus a very narrow set for the midlevels."
Getting started
In Eastern Washington, where it can be
Photo: Rob Bahnsen
Much has been said in the past decade about midlevel providers and access to care, but for the most part the real culprit is not access, it's funding. Until the economy rights itself completely, Medicaid funding for adults is nonexistent except for emergency procedures, and even then it's limited to a single extraction for pain management. And while the Pew Charitable Trusts and the W.K. Kellogg Foundation have thrown money at the conversation by insisting that a midlevel provider would alleviate the problem, the resident model is a much better, less expensive, and easier fit. Winston says, "I've never worked with a midlevel provider, so I'll say that off the top, but there's no limit to what a resident can do legally – they all come from good dental schools, armed with a core set of skills they've been required to learn to graduate. These are people who have already invested a number of years in their education, and they take this very seriously. In our residency model, they are able to perform any skill that a licensed dentist can do, the only difference is that one of us has to be available to them, if
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harder to get and keep good dentists in the CHC system, they had an idea: if they created a niche that combined education and community health, they might attract dentists from private practice who were more skilled. Reasoning that if dentists liked the niche they'd stay longer, they set out to design a residency program that would meet both targets. At the Yakima Valley Farm Workers Clinic, Dr. Mark Koday's residency program began as an offshoot of a cooperative agreement with the UWSoD started in 1989 as part of a senior dental student rotation. He explains, "We had established a really good working relationship with the school and they agreed to cosponsor the residency program. They were a tremendous help in getting us started and keeping us going. And the other big supporter was WSDA – they were very helpful in getting us crucial, initial state funding, and have remained a strong supporter of the program. Without their support, I doubt if we could have pulled this off, and it certainly wouldn't have been anywhere as easy or good as it turned out." Because of residency model they had created, they began to see a dramatic up-
cover stor y residencies: their benefit to patient populations
Comparing models
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each with their own attending dentists. "Now," she says, "If you talk to Swedish they would say that we're keeping people out of ERs, we're taking care of people before they get to ICU, we're making people healthy before they go in for cardiac surgery and transplant, and we're improving the lives of their cancer patients — making it possible for them to successfully tolerate their treatments — which is critical for success. And now we can show other hospitals how these programs can be successful." Johnson adds that while any community can benefit from their model, not every community will have a need for a practice treating the same patient population as theirs does. He says, "Our role in the community is that we take care of patients who are really challenging from a medical, behavioral, and physical standpoint, and we serve as a resource for the dentists and the medical doctors in this community – that's the niche we fill for Seattle. The residency model is powerful because it allows different communities to identify what their needs are, and then building a residency that fills those needs. So I know the core model can certainly be duplicated, but the types of patients and the mission will be dependent on the geographic location." Dr. Taylor Berry, who is finishing up his year of residency at the Swedish GPR, says, "The quality of health care providers that these programs produce is so far above what comes out of dental school that I think it benefits everybody. We have new skills that we're using, we're more competitive in the job market, and we're better educated and informed — which benefits the community. I can't imagine having gone straight into private practice without the benefit of a program like this."
What's next
So where do the residents go once their programs end? In Yakima, Koday did a survey a few years ago, and of the 40 graduates they were able to contact, about 70 percent had stayed in dental Health Professional Shortage Areas, including CHCs, and rural areas. "I think that more would have gone to that type of practice," he says, "But when the economy fell and dentists weren't retiring out, some of our graduates ended up in corporate practices because those were the only places hiring. We believe, as they do in the Regional Initiatives in Dental Education (RIDE) and Washington, Wyoming, Alaska, Montana and Idaho (WWAMI) medical programs, that when you train residents in rural areas, a much higher percentage will stay in those areas." In Seattle, Winston and Johnson have seen their residents go into many different types of practices — "Two went on to specialize, one in pediatrics, one in orthodontics, the others have all become general dentists," Winston continues, say-
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ing, "One went on to set up a practice very much like ours on a much smaller scale in rural Montana, working with cancer patients and doing general anesthesia. He's bringing something to that Montana community that didn't exist before — which is the ultimate goal of our program. The educational piece is huge – we're laying the framework for the future of our profession. We're providing care to the underfunded, and the program is incredibly educational. The investment is exponential, when you consider the number of graduates who will go out and do this type of work in private practice and have the skills to do it right." Danny Tremblay, who has spent the year commuting between Yakima and Seattle so that his wife, Rikki, could continue as a CPA in the city, is looking forward to becoming more involved in organized dentistry at the state and component levels. He hopes to join a private practice when he graduates, but not with just any dentist — he's looking for a dentist who will continue to mentor him through his first years of practice, saying, "I believe that is so fundamental to the practice of dentistry — we're always learning, and when you have someone who is willing to mentor you as I've been mentored this past year, you can have an even better experience in dentistry." Tremblay also said that because of his experience in the CHC system, he'll always make time to volunteer his expertise to them. Taylor Berry has accepted a position as an attending dentist with the Swedish SCSC extraction clinic, and fellow resident Spivey is looking for an associateship here in Washington, preferably one where she can continue to use the complex skills she has acquired. In Spokane, Dr. Peter Dang has already begun working part time in a practice, and would like to continue to working in the community health system, as well. Fellow Spokane resident Dr. Kim Siler has signed a contract to be at a private practice in the area. Each of the state's residents is now armed with insight, education and skills they could never have received in dental school, creating scores of opportunities for access to populations that are woefully underserved. In contrast, midlevel providers offer only a narrow range of procedures without the benefit of the robust education a dental school provides. In Washington state, we've begun a dialogue about whether residency training should be mandatory and welcome your comments. Regardless of the outcome of that conversation, we'd like to ask you to join with WSDA in helping to create residency opportunities across the state — your voice will help make expansion of this program a reality. To find out how you can be involved, contact Bracken Killpack at email@example.com.
cover stor y residencies: their benefit to patient populations
tick in the quality of dentists applying to work in their clinic — skilled dentists from the private sector who were excited about teaching and mentoring the new generation of dentists. The gamble had worked. Having better dentists on staff benefits their patients, and it affects the staff in a good way, as well — and stabilizing the staff led to better continuity of care. Now, Koday has dentists on staff producing between $800,000 and $1 million in gross production a year — something they had never done before. "We've figured out what we were doing right and what we were doing wrong," Koday says, "And we've been able to fine tune the system really well, which also is good for the patients and the residents. For some time we had a revolving door — dentists would come for loan repayment and maybe stay a year or two. We no longer have that problem." Additionally, Koday says, "Before we started the residency I felt that I was isolated from organized dentistry — you had private practice, you had education, and you had community health — and the three practically never talked to each other. The thing that I really like about the program is that it is a combination of all three — we couldn't do it without the private dentists who help us with the teaching, we couldn't do it without the University of Washington, so it's a dentist-driven team effort. I'm really sold on it as a way to increase access in the state of Washington." At the clinic, they see two types of patients — emergencies, which they see every day — and patients of record, as you would see in any private practice. Having residents has enabled the facility to take more emergency patients, see more adults after the loss of adult dental Medicaid, and expand treatment to patients of record. Koday adds, "We never could have considered introducing implants or a number of the upper end procedures that we now offer without the residency program." When Bart Johnson and Amy Winston first submitted their proposal to Swedish, administrators there were not sure what to think. They were open minded to the concept, but wondered, "We've been around 100 years and never had a dental program, why do we need one now?' Winston smiles as she relays the story — she and Johnson were undeterred, and the first year they did everything by themselves — including all of the emergency room and inpatient services. But after that first year, Swedish was sold — their hospital services and the cancer center had seen so much improvement that the Swedish doctors went to bat with the administration for the pair. Today, residents in the program are based in their private practice, with rotations at the Swedish SCSC extraction clinic, the Odessa Brown Pediatric Clinic, an anesthesia rotation, and an ER rotation at Swedish First Hill,
the source it's easy being green
It's EASY Being Green:
Michelle Wilson, where they're incorporating some green ideas and technology into their new practice space. Whether you're looking for simple ways to reduce your energy consumption and create a healthier environment for your staff and patients, or ready to build your own Leeds Certified (more on this later) practice, these two endorsed companies can help make it happen. Much of this work requires an up-front investment, so you'll need to think about all the potential returns on your investment – not just that you're saving water or energy, but that going green can be a better business decision as well, with far-reaching potential for your practice, staff and patients. The WSDA News recently spoke with principals from both companies about the myriad options out there.
How important is being green to the consumer/patient?
John Adams, Stuart Silk Architects: Other than energy savings, people really see value in healthy buildings – there's a lot of discussion about indoor air quality – the EPA believes the air quality in buildings is far worse than outside air, even if you're in a metropolitan environment. And by doing relatively simple and increasingly cost neutral things — like carpeting and paints that are low or no VOC* — green solutions are trumping traditional options. These are easy to implement – soft goods like carpet in an office might be replaced in a lobby every five years, and putting in good walkoff mats are simple and effective ways that every office can be more green. LED lights are another great example — five years ago, compact fluorescent bulbs were all the rage, and now LEDs are becoming the standard and are more cost effective. We resisted using LEDs just a couple of years ago because they weren't dimmable in an intelligent kind of way, and our customers wanted that. Now we're able to install them with much more certainty, and it's starting to work. Technology is changing and getting better all the time, and we're starting to see more standardization — just as we did perhaps five years ago with organic foods – what was organic, who was certifying it, etc. It just takes time.
How does going green increase the value of a building?
JA: Some studies have shown that green properties have increased or held their value a little better than their counterparts that aren't green. If somebody is leasing their office for ten years, they're seeing that if they have a choice of two similar properties where one is green and one isn't, all
things being equal, they'll often take the green building. Currently the properties that are green move faster on the market. They might not lease for more money, and they might not necessarily be generating higher revenues for building owners, but they are leasing out better. Additionally, some green products allow us to build in more square footage, and that creates additional value when leasing and selling a building.
How does the cost of building green compare to building using traditional materials and methods? How does it affect the timeline of a project?
George Constantine, Constantine Builders, Inc.: It depends on the project and technology being discussed. In general, if properly planned before the start of a project, the cost of going "green" can be extremely low. For example a more efficient HVAC system may cost more to install initially, but may have a economic pay back of three years. In that case, many of our owners have elected to install the more efficient HVAC system. CBI has a LEED Accredited Professional on staff who leads the effort for all our green projects.
In the ADA's Practical Guide Series, you talk about tax incentives for building green. What are they?
JA: That's a constantly shifting market. Municipalities are always offering new and different incentives while others are expiring because of changes in legislation. They tend to be equipment-oriented and are similar to residential incentives — efficient hot water heaters, windows, insulation, and solar collectors all have significant credits available (for a list of current incentives, check here: http://www.ecy.wa.gov/ programs/swfa/greenbuilding/Bincentives. html). We have to evaluate with each project, and you have to have a good accountant to weigh cost benefits of employing any of these in your building.
There are so many different certification programs, how do I know which, if any, is right for my practice?
JA: They all hit different points — there's an emotional part of certification – being a good guy, and contributing to an overall environmental solution, the other part is the return on investment. Since the great recession most of our clients are evaluating things less on an emotional level and more about the potential ROI. If you're really interested in long term performance – you're not just a dentist, but you're a building owner and you're really
the source it's easy being green
For years, conservation and going green meant sharing an objectionable esthetic with tree huggers, Kalso Earth Shoes and the Cadillac Cimarron (anyone remember these? Parrish, you don't count). And even some recent efforts seemed to have skipped the design phase entirely, with Kriston Capps noting in The American Prospect in 2009, "The field of architecture is experiencing a design crisis, with clients ranging from private owners to cities demanding that architects prioritize sustainability above all else — as if design itself were an obnoxious carbon-emitter." Jump ahead to the present — to work being done here in Washington by WSDA endorsed companies Stuart Silk Architects and Constantine Builders, Inc., and you'll quickly understand that all is not lost when it comes to building and designing green. Not only can the structures save energy, provide a healthier environment for its inhabitants, and save money (that's right, save money), but they can be beautiful, too. Silk principals John Adams and Stuart Silk were recently tasked with authoring a chapter on creating a green office for the ADA's Practical Guide Series, in part because of their award-winning Orion Dental Building in West Seattle. The winner of the National Association of Industrial and Office Properties (NAIOP) award for Office Development of the Year in 2011, the Orion Building was honored for its quality construction, design and use of sustainable materials. The architects at Silk cut their teeth in sustainable design on upscale residential homes — with clients every bit as concerned with aesthetics as they were with embracing the green movement — through a program called Built Green devised by the Master Builders Association (http://www. builtgreen.net). John Adams of Stuart Silk explains, "It was very successful because people became adamant about wanting their houses built green – they wanted a healthier air environment, more sustainable product choices, and energy savings. Homeowners drove the conversation, and in relatively short order, we completed something like 30 houses over five years." The firm was successful because they continued to design great homes without sacrificing the look, aesthetic and function to make the house green. Rather, they figured out green strategies that fit in with the way their clients live. It helps, too, that new materials and options are rolling out every year that make being green easier and more aesthetically pleasing, even in dental practices. In fact, Silk and Constantine recently broke ground on a project for WSDA Member Dr.
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How do you advise clients when they are interested in certification?
GC: It is extremely important that the team is committed and that both the architect and contractor are knowledgeable in the certification process and what is required. We advise our clients on the cost/benefit of various strategies being dis-
cussed by the team. We educate the owner so that he can make an informed decision on what is best for their project. Our job is to implement the team's project vision as efficiently as possible and make the process as turn key as possible for our clients.
You talk about additional savings by building green, what are they?
JA: People submitting green permits in Seattle can shave at least two weeks off the permitting process, and Seattle offers them a single point of contact – a permitting liaison, if you will — which is typically not the case. Every permitting authority has different programs, of course. Expedited permits can save money a number of ways, through lower carrying costs, lower professional costs (if the permit is expedited, it's easier for your professional design team, which in turn should lower your costs).
LIVE AT THE PNDC: Green Office Design
Fri, Jun 14, 2013, 12 – 12:50pm Speaker: John Adams Location:Hyatt - Juniper Implementing green strategies into building or remodeling your office can make a real difference to the success of your business. A well-designed green practice can attract patients, improve staff morale, and save money on utility bills. A green office is no longer just an experimental idea; instead green construction and practice are becoming the norm if not a de facto requirement. This lecture will explain why green design requires your attention as well as explain how it can affect your bottom line. The lecture will also present methods for evaluating green strategies so you can know where to start.
What about energy collection and other options? Are they a part of the conversation here in Washington?
CG: We have looked at solar panels for several clients, but Washington has some of the lowest electrical costs in the nation, which diminishes their ROI. As the cost of solar panels come down, and if the price of electricity increases, we may see more individuals choosing to put solar panels on their projects. We have installed several living roofs which help reduce the heat island effect of the building and the level of storm run off from a building, and we have also installed several large cisterns for clients that collect rain water to be used for watering their landscaping
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What are the most common retrofits clients can do to make their buildings more green?
GC: The most common is increasing energy efficiency by reducing consumption. This can range from replacing light fixtures with more efficient models and bulbs to installing sun shades to shield their space from the sun, minimizing the use of their HVAC system.
How has the Bullitt Building in Seattle altered the conversation about green building?
JA: Prior to this, certification programs were largely about an upfront approach to sustainability – by making initial decisions about the environment and the building, you choose materials and methods to achieve a goal. That got the ball rolling, but these new projects are much more focused on the ongoing benefit i.e., once the architects and contractors are gone, how does the building perform? The Living Building Challenge is the next frontier in sustainability, requiring energy-saving systems that can be monitored and verified — in fact, they must be monitored for a year before the building can even be certified. GC: The Bullitt building is a fantastic showcase of green technologies. It should be interesting to see both the performance of the technologies and the participant's enjoyment of the space as companies move into the building.
Finally, is there any argument against building green?
JA: If you're a dentist who owns a building and you're not paying attention to how much you spend on energy, maintenance and content costs to run it, you could be throwing money away. As the technologies become more cost effective and ubiquitous, it makes good business sense to use them. And while it may not be something a dentist wants to concern him or herself with, it would be smart to hire someone to handle those details. Just because a building is green doesn't mean it has to look or smell a certain way — a practice doesn't have to look like an Aveda store to be green, and you don't have to change your fundamental philosophy to start to make these choices and benefit from them. If you would like to talk with either firm about ways to reduce energy consumption in your practice or home, visit The Source today at http://www.wsdasource.org/officeresources. *(Volatile organic compounds (VOCs) are emitted as gases from certain solids or liquids. VOCs include a variety of chemicals, some of which may have short- and long-term adverse health effects.)
the source it's easy being green
passionate about sustainability, then the Living Building Challenge (http://livingfuture.org/lbc) might be something you might want to look at (The recently finished Bullitt building in Seattle is an example — www.bullittcenter.org). That's oriented towards long term, ongoing verification, and that could be very beneficial to you to be a part of that movement. If you're just more interested in saving energy and water and cutting your utility bills, Energy Star is more oriented toward energy usage. LEED (Leadership in Energy and Environmental Design — http://www.usgbc. org/leed) certification has been the gold standard for many years and continues to be, and if you're interested in having a very well known, credible and highly marketable credential, it is probably most appropriate. Each dentist or client has to determine which certification program is best, and then must decide if they even want to pursue certification — it is costly and timeconsuming, and often just completing the bricks and mortar work towards certification is satisfying enough. The choice of builder can be critical, especially if you're certifying. There are many hoops to jump through, and even when the builder has done their best, things can go wrong. Even something as simple as using the wrong caulk can hinder certification. Everything from materials to waste disposal must be tracked, and you often have to do a commissioning and verification afterwards. Certification alone can cost one percent of the total cost of the building, although it varies greatly. Some people don't have the stomach for the bureaucracy of certification — it's not a government run program, but it might as well be. With issues like that, it's easy to understand why the certification process can be so costly. In Centralia, the Wilson's weren't interested in certification, so we ended up focusing on passive green strategies that made the building more healthy and habitable, like low VOC paints and carpet, a reflective roof, and plenty of natural light to curtail the use of electricity — simple ways to be greener and save money. They feel good that they're doing the right thing for the environment and energy resources, and they can tell their patients who are interested in conservation about the choices they made without having to certify the space.
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FAIRBANKS, AK – Exceptional G/P collecting $1.8M+. Excellent cash flow and 100% fee for service! Newer facilities, CT scanner and more! Flexible transition options.
SW ALASKA – Great G/P situated in a sportsman's paradise! Collecting $700K+ working only 37 weeks per year! Associateship also available!
RURAL ALASKA – High profit practice collecting $350K+ working only 10 weeks per year! Includes small apartment and SUV. Perfect satellite practice!
NEW! ANCHORAGE, AK – Exceptional G/P collecting $1.2M with low overhead! 5 ops, digital xrays, pano and newer equipment throughout.
NEW! BELLEVUE, WA - Biological practice collecting $500K+ annually. This amalgam free/amalgam safe office features 7 ops (5 equipped), digital x-rays and new pano.
NEW! REDMOND, WA – G/P collecting $570K in 2012. Very strong hygiene program! 4 ops and laser. Lots of potential! IDAHO PARTNERSHIP – Group practice seeking partner. Multiple rural locations available! Numerous transition/ownership options. WESTERN OREGON OMS – Excellent, high profit practice with tremendous growth potential. Great location close to a major hospital. N. OR COAST – Excellent, well established, fee-for-service G/P collecting $1M+ with high profit.
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3 0 · th e wsda ne w s · issue 6, may · 2013 · www.wsda.org
The WSDA and The Source welcome Office Depot as the newly-endorsed vendor for practice supplies. "Office Depot has systems and programs in place that will not only save our members money but time, as well," said Kainoa Trotter, Director of Membership and Communications, "And they have a number of additional services that will streamline the ordering process, whether your practice is big or small." Kevin Patton, Office Depot's liaison with the WSDA ,says, "We offer uncompromised ease of ordering for WSDA members. Once members have registered at the online portal, they can purchase anything Office Depot sells through the website, in any of the 37 brick-and-mortar locations we have across the state, even on our app – the only one like it offered." Office Depot creates value for members several ways. First, they looked at the products that WSDA members typically buy from office supply vendors and consolidated those products to a core contract — the first items WSDA members will see when they log on to Office Depot's business portal. By identifying which products WSDA members order the most, they can offer steep discounts on those items, averaging about 55 percent-off. Then, when members are shopping in brick-and-mortar locations, store systems will identify them as WSDA members by their registered credit card number and automatically give them the best price – whether it's the special in-store pricing for a promotion, or the member-discounted rate. Thirdly, Office Depot creates value for members by allowing for consolidated ordering, saving your staff time — they offer a wide variety of services and products, including printing and medical supplies. "Our medical supply costs are extremely competitive," Patton notes. They even sell break room snacks and goods more commonly associated with competitors like Costco, including coffee. To keep WSDA members in the loop, Office Depot will present web meetings to highlight program amenities and offer education about using the system and taking advantage of savings. The meetings are live, interactive, and allow members to hear the other participants' comments and questions. Patton says, "The best thing about Office Depot's business portal is the ease of ordering, and the fact that office staff will no longer have to call multiple vendors. There's a real convenience factor with Office Depot, leaving them more time to focus on other practice business." Register today by logging in here http://www.wsdasource.org/office-resources/pages/office-depot or scanning the QR code below to start taking advantage of WSDA member pricing!
th e wsda ne w s · issue 6, may · 2013 · www.wsda.org · 31
the source office depot
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Ready to rally? Contact me today for your complimentary practice consultation 3 2 · th e wsda ne w s · issue 6, may · 2013 · www.wsda.org Tonya Loving, DDS | 425-221-8816 | lovingdentalsolutions.com
Dr. Christopher Delecki, director of the Dental Program at the Odessa Brown Children's Clinic, recently accepted a position on the King County Board of Health (BOH) for a three-year term. Delecki is the first dentist ever appointed to the Board, which sets county-wide public health policy, enacts and enforces local public health regulations, and carries out other duties of local boards of health specified in state law. When interviewed about the post, Delecki said, "For some time now, dentistry has been a 'siloed' profession, off by itself, not considered part of 'real' health care. I think in today's environment, that is problematic, because people don't see it or value it as much as medical care." Delecki is passionate about educating people and creating "healthcare literacy" to change that perspective — so that people truly understand the mouth-body connection, and how good oral health and overall health are interconnected — and that's why getting this post was so important to him. Delecki calls himself a "silo-buster," and says that he's looking for expanded opportunities to improve the overall health of everyone in the community through creative projects that include a focus on oral health. One of those projects — mandatory dental exams for all children entering the first grade — will have to wait a bit. Delecki explains, "I'm the new kid on the block. The board has cyclical strategies and projects that it focuses on that are formed in October, November and December, and I missed that opportunity for this year. I'll have to wait to put forth my efforts and interests for a little while." That suits him just fine though — it's a tactic that he's been using since joining the WSDA Board late last year — "I'm pretty quiet at this point because I'm trying to understand the dynamics of the room, so I'm more of an observer. I see myself in the same role at the Board of Health. I need to really understand what the playing field is all about." And while he's not sure his presence on the Board of Health will change the dynamic of the Board, he does expect it to create more integration for oral health information and preventative opportunities to be embedded in community programs throughout the state. Delecki is well suited to the task, with more than 21 years of supervisory, clinical, teaching, management and leadership experience in the U. S. Public Health Service (USPHS) as an employee with the Indian Health Service (IHS). Additionally, Delecki has personally developed more than 25 oral healthcare prevention programs. Other than serving on the WSDA Board of Directors, Delecki is a committee mem-
ber on Washington State Oral Health task force for Children with Special Health Care Needs, a member of the health advisory committee for Seattle Public Schools and ECEAP Head Start programs, has served as president of the Seattle-King County Dental Society (SKCDS), and is an active member of the SKCDS Access Committee.
DQAC resumes CDE Audits
This year, the Dental Quality Assurance Commission (DQAC) resumed audits of dentist's continuing education. Every month, DQAC staff randomly selects between ten and 30 dentists who have renewed their dental license that month and asks them for their continuing education documentation from the previous year. Dentists in Washington state are required to complete 21 hours of continuing education each year; more information about the state's continuing education rules can be found here: http://www.wsdasource.org/ member/login?return_to=/new-dentistsguide/tools/continuing-education-faqs. If you are required to undergo an audit, you will need to submit documentation of your continuing education. If any of your CE was completed at the PNDC, a component society event, or any other event where you scanned your WSDA membership card, then the only documentation you need for these CE credits is a printout of your CE credits from The Source. To access your CE records, login using your last name and your WSDA ID number and select "Continuing Education Credit Tracking." On this page, all of your credits tracked through a WSDA CE scanner will be recorded in one section and all of your manually entered CE will be recorded in a separate section. CE that was not tracked through a WSDA scanner will require additional documentation such as a paper certificate of completion. Audited dentists who have not met the state's CE requirements will be sent a notice of correction and be required to submit CE documentation for review the following year. Dentists can complete 16.5 of their required 21 hours by attending the Pacific Northwest Dental Conference (PNDC) this June 13 and 14. You can register online here: https://pndc2013.expotracker.net/index.aspx. Questions about CE audits, continuing education, or DQAC can be referred Mike Walsh, WSDA's Government Affairs Coordinator, at email@example.com or by calling 800-448-3368.
Kirkland dentists rally
In Kirkland, dentists have been providing care to a local tent city for three years,
th e wsda ne w s · issue 6, may · 2013 · www.wsda.org · 33
treating most of the 70 residents who call the makeshift camp home. On April 13, more than 29 dental professionals treated 27 of the shelter's residents, providing in excess of $45,000 in dental care — including dentures, partials, extractions, fillings, and more. Participants including Drs. Ellen Reh, Jeffrey Zent, Donald Stewart, Benjamin Dorantes and Chris Allemand worked with staff volunteers Jennifer O'Donnell, Christy Allemand, Dawn Stewart, Amy Talor, Lilly Garcia, Alma Garcia, and Becky Miller in this successful annual event. Organizers Ellen Reh and Jeffrey Zent coordinate the event with the help of the international aid group Smile Power, and would like area dentists to know that they can help the cause by donating their time and expertise. For information about volunteering, please visit www.smilepower.org.
Clark County dentists turn their attention to adults
Clark County dentists recently produced their first Adult Dental Health Day in conjunction with the Free Clinic of Southwest Washington. On Saturday, April 20, WSDA member dentists Drs. Kyle Ostenson, John Sundell, Justin Hollar, Brandon Rehrer, Judith Ris, Brian Alder, and Kirk Shillinger, along with Drs. Kevin Low, Leanna Gordon and Donald Lunt worked with a phalanx of volunteers to treat 71 patients. As a group they performed more than $45,000 in dental care, including 63 fillings and 131 extractions.
Join the crusade — give back!
To find out how you can help in your community, call or email Ruth Abate of WOHF at 800-448-3368 or ruth@wsda. org.
WOHF in your community
The Washington Oral Health Foundation continues working across the state, one event at a time, engaging communities and working woth local organizations to deliver oral health messaging. Here is a listing of recent outings. If you would like WOHF to present in your community, please call Tom Tidyman at 800-448-3368, or email firstname.lastname@example.com. Rolling the Dice - Oral Health and Substance Abuse education Monday March 25 Enumclaw Middle School WOHF educated 150 middle school students on the dangers of drugs and tobacco while linking the importance of oral health and overall health. continued on page 37
newsflash issue 6, may 2013
Delecki named to BOH post
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3 4 · th e wsda ne w s · issue 6, may · 2013 · www.wsda.org
Above: Dr. Sally Hewett provoked a moment of fun with the group
In recognition of their willingness to care, commit, listen and lead, the Dan G. Middaugh Student Leadership Awards were presented to the UW School of Dentistry class officers on April 24, 2013 at a dinner hosted by WOHF and WSDA leaders. Recipients of the award received $1,000 and special recognition of their service by WSDA Past President Dr. Dan Middaugh, who established the award in 2000 to encourage students to continue their involvement in organized dentistry as dental students, and as practicing members of the profession after graduation. At the event, WOHF President Dr. Sally Hewett asked each of the recipients where they envisioned themselves in a decade and how they imagined they would incorporate dental philanthropy in their practices,
sparking a lively and inspiring conversation. "I am proud to have these inspiring student leaders as our professional colleagues," said Hewett, "Their stories are not only aspirations for themselves, but also an enthusiastic vision for the positive future of oral health and our profession. Cheers to them all, and to Dr. Middaugh for his enduring leadership." WSDA President Dr. Danny Warner gave a brief history of the Middaugh Award, praising the past president for his generosity in establishing the award, and UWSoD Dean Dr. Joel Berg addressed the group,
discussing the present and the future of the Dental School, and thanking them for their dedication. The recipients for 2013 were: Phil Matson, President, Class of 2013; Eric Olendorf, President, Class of 2014; David Ludwig, President, Class of 2015; Christine Oldenkamp, President, Class of 2016, Brian Christensen and Tyler Smoot, Student Council Co-Presidents. For more information about the work of the Washington Oral Health Foundation, please visit their site: www.wohf.org.
Dan G. Middaugh Leadership Awards
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uw news dan g. middaugh leadership awards
Left to right: Phil Matson, President, Class of 2013, Eric Olendorf, President, Class of 2014; David Ludwig, President, Class of 2015; Dr. Joel Berg (back); Dr. Sally Hewett; Dr. Dan Middaugh; Dr. Deck Barnes (back); Tyler Smoot, Student Council Co-President; Brian Christensen (back), Student Council Co-President; Dr. Danny Warner, and Christine Oldenkamp, President, Class of 2016.
letters to the editor issue 6, may 2013
letters to the editor Dr. Jennings — I want to congratulate you on this article in the WSDA News, and tell you that I think your comments hit the bullseye. As a past director of WDS and chairman of the board of that organization, I can assure your readers that indeed the founders whom I had the privilege to know created WDS to be a good steward for dental health. While I was involved, our mission was to treat our customers as we would like to be treated. We considered that purchasers were not the only ones. Our subscribers and our dentists were equally important and all customers deserved our respect and support. Most certainly our paid staff were never hired to feather their own nests with large salaries at the expense of any of the customers. Truly the company has been hijacked, and there are too many dentists who do not recognize the power they have to straighten out the problem by discontinuing their membership. — Dr. John Barrett Dr. Jennings — I read your letter in the WSDA News April
2013, and it is refreshing to hear someone stand up and call WDS on their crass behavior. It is clear they do not care about the providers at all. I can not understand our profession's inability to stand up and walk away from this abuse. If they did WDS would be changing their tune. I doubt that will happen, however, and that is what WDS is banking on. Thank you for the article — maybe it will make a difference. — Dr. Daniel J Gallacher Dr. Jennings _ How are you? Great article on WSDA News about WDS! — Dr. Miki Suetsugu Dr. Jennings — Thank you very much for your editorial in the April WSDA News. I think you were bang on. — Dr. Tim Hess Dr Jennings — I believe there is a hierarchy at WDS, and that it takes awhile for the slime at the top to ooze to the bottom. — Dr. Mel Trenor
Dr. Jennings — I have been thoroughly impressed by the skill and professionalism of Dr. MacInnes. I first came to him with my family after another dentist insisted that I had to have a crown replaced. He assessed the tooth was causing me no concerns, that it was structurally sound. It has been well over five years later and today I asked about that same tooth, but Dr. MacInnes again put the patient first and told me that the tooth is fine. I guess what I really want you to know is that honesty, integrity, and consistent professionalism never go out of style. Dr. MacInnes is not an average dentist, he's top nothch. He has completely improved the dental health and wellness of our entire family. We really appreciate him for repeatedly doing the right thing and for his commitment to being the best dentist, but also for treating his team around him really well. I used to work for Merck, where our founder stated: "Put the patients first, and the profits will follow." I believe this serves as a great reminder to the industry, and Dr. MacInnes clearly leads by example. Please find some way to recognize him for his efforts. — With gratitude, Keith Dougherty and family
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School Science Fair Saturday March 30 Open Window School K-8 in Bellevue Open Window School hosted a science fair for students and their families. WOHF was on hand to educate children on the science of dentistry and the importance of good oral health. More than 300 were in attendance! Elementary School Health Fair Wednesday April 24 · Puesta del Sol Elementary in Bellevue Dr. Kevin Kay was on hand to talk about oral health to 200 students during an Elementary School health fair. WOHF provided 3-D materials and handouts for students and parents. Girl Scout STEM Event Saturday May 11 · Einstein Middle School in Shoreline A Troop of fourth and fifth grade scouts organized a special event for Girl Scouts, with a focus on encouraging girls to engage in inquiry and envision a future that might include a career in science, technology, engineering or math (STEM). The 200 girls were between the ages of 5-12, and the event featured a short presentation by astronaut Bonnie Dunbar, as well as hands-on exhibits that got the girls thinking and moving. Research indicates that girls decide by third grade whether or not they will pursue a career in a STEM field, so it is especially important to introduce them to all the exciting possibilities at a young age.
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uw news in their own words: uwsod students in haiti
Words and images:
UW STUDENTS IN HAITI 3 8 路 th e wsda ne w s 路 issue 6, may 路 2013 路 www.wsda.org
Photos these two pages courtesy of Mehak Ahluwalia.
Mehak Ahluwalia
As I stepped out of the plane onto the terminal I felt a gust of warm wind and the faint sound of the steel drums floating through the air. "Wow," I thought, "I really must be spending my Spring break in the Caribbean!" Although we certainly landed on a Caribbean Island, our team had just arrived into the poorest country in the western hemisphere, Haiti. Sharing the Island of Hispaniola with the Dominican Republic, Haiti occupies the smaller western portion of the island. Haiti was not only the first independent nation of Latin America and the Caribbean and the first black-led republic in this world, but it is also greatly poverty stricken in terms of its economy, education, government, and health care. Fewer than 30 percent of the country's children make it to the sixth grade, and more than 90 percent of the children suffer from waterborne diseases and parasites due to their lack of proper educational system, sewage infrastructures and health care access. With the country already struggling to survive, a 7.0 earthquake devastated Haiti and its most populous city and Capitol, Port au Prince, on January 12, 2010. The earthquake left the country in ruins and exaggerated its need for stability and order. More than three years later, I was able to walk the seemingly unchanged roads and experience the aftershock of the earthquake as if it was only yesterday. Along with four of my fellow third-year classmates from the University of Washington School of Dentistry, I had the great pleasure and irreplaceable opportunity to spend our spring break with the remarkable organization, Medical Relief International, and its humanitarian team of professional dentists, dental assistants and volunteers in their mission to bring Haiti dental aid in their overall scheme of providing "sustainable worldwide wellness." Our team was split into three different locations that would each serve a different community in need. My team was led by Dr. Mark Walker, and included my fellow classmate Esther Ra, Chrissie Leiren (a dental assistant), Steffan Clements and John Judd. We were located in Port au Prince, and our days consisted of moving and setting up our dental equipment in local houses or communities and trying to
Mary and her father had traveled from four cities away to come see us that day.
treat as many Haitians as we could. The official language is Haitian Creole and French. Since none of us spoke French, the language barrier was a challenge that we would have to learn to overcome.
Meeting Mary
Despite not knowing more than a couple of phrases to get us through our day, I can clearly remember one particular girl whom you didn't have to speak to, to understand and see the pain and danger she was in. Her name was Mary and she was only 14 years old. She arrived the first day in an oversized, worn T-shirt, alone and terrified with tears steaming down her face. As she walked into our small crowded room, it was apparent the root of her pain was coming from a severe fascial plane infection on the upper right side of her face. I had seen examples of these types of dangerous infections in class, but never did I think I would experience it first hand. Knowing the potential systemic involvement and immense danger she was in, Dr. Walker sat her down immediately to discover a severe expansive infection that was destroying her upper right quadrant. Screams and cries of excruciating pain escaped Mary with every touch and movement of her mouth. Unable to calm her enough to treat her, we provided a ten-day regimen of antibiotics, explained the importance of taking them, and the dire need to return the next day…it could mean the difference between life or death. It was our last day of clinic, and we all were praying that Mary would arrive. As the day flew by, we grew more worried that she would not come and as a result would grow more ill as the days passed. After a solemn lunch, our spirits were raised when
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we saw Mary sitting in one of our chairs waiting nervously for our return. It was immediately apparent that she was not only feeling better, but her cellulitis had decreased from the previous day. Still in immense pain, we identified the culprit tooth and knew that it had to be removed in order for the infection to start resolving. After several agonizing and tear-filled deliveries of local anesthetic, we were able to remove the tooth and debride and clean the area as best we could. Once the tooth was removed, it was clear the infection had deteriorated her buccal cortical plate and had spread up into her maxillary sinus. After speaking to her and her father, we determined that Mary's infection had started with a fever more than three weeks prior, and had been getting worse since. Mary was not only the second youngest to her other seven siblings, but she was the first one to be seen by a doctor. Jobless, her father and mother could not afford any type of medication for their ill daughter. Desperate for a solution, her family was told that a doctor would be in the next town. Mary and her father had traveled from four cities away to come see us that day. Although they could not afford to ride the "tap tap" (Haitian taxi), the compassion of the Haitian people brought her to us. Although Haiti is considered a part of the Caribbean, the country is far from what we call "paradise". The damaging earthquake in 2010 in addition to its lack of order, stability and chronic health care shortage, makes Haiti one of the most impoverished counties in the world. If it wasn't for the compassion of the Haitian people in combination of our presence that day, Mary could have died in a matter of weeks.
uw news in their own words: uwsod students in haiti
Ed. note: When we learned that UW students would be heading to Haiti, we asked them to write about the people they helped while they were there — to tell their stories of courage. Four students — Mehak Ahluwalia, Sean Collette, Esther Ra and Ryan Zentz — did just that. Here, in their own words and pictures, are their experiences.
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The experiences and memories that I have attained from this trip will forever remain with me. It has not only shown me the significance and impact of dentistry, but more importantly the need to share it with the world.
Sean Collette
I had been on several humanitarian trips to Central America before attending dental school and was introduced to the challenges of poverty. My experience in Haiti was another sobering reminder of the scale of unmet dental needs in developing nations. Spending one week in Ferrier, a rural farming town with little infrastructure, led me to appreciate several things about the people. For example, when our truck got a flat tire several miles from town, we waited a few minutes for a traveler to show up. A motorcyclist arrived, recognized our trouble and taxied our driver and flat tire to be repaired at the next stop. Repairing tires is routine. After about 30 minutes, they returned and we were back on our way. Some people may walk several miles to reach a final destination, and it is common for drivers to pick up strangers and shuttle them. We had several Good Samaritan Haitians helping our dental crew. One of our assistants, Erlin, translated during the
last two days. He grew up in a large family from another farming area. He taught junior high school for two years before deciding on his career path. He is now a 3rdyear law student with a dream to plead for Haitians. Death threats are leveled against
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lawyers from time to time, but that risk doesn't deter him. He's more intimidated by the task of writing a thesis and defending it next year. But very few in Ferrier will have educational opportunities like Erlin. Most don't go beyond honing survival skills, farming, trading and recycling. Only two people in the town have a medical background: a recently employed nurse trained in the United States and a Haitian pharmacist. The pharmacy has limited resources. Some locals traveled over 180 miles to the capital to find a dentist, but gave up the search after a week. Dentistry is desperately needed in Haiti. As soon as the permanent teeth erupt, they face the insults of sugarcane and carbonated beverages. Decay was rampant in many mouths I examined. Even teeth with restorable lesions in the US may be nonrestorable in Haiti. This was the first time that I helped people out of lifelong chronic pain and I felt a strong sense of reward. It is easy to understand why they showed us warm gratitude on our arrival and thanked us again at our departure. Their kindness and appreciation reinforce my commitment to future humanitarian service. continued on page 43
uw news in their own words: uwsod students in haiti
Photos this page courtesy of Ryan Zentz
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Esther Ra
It was mid-afternoon when I met Andre, a 41-year-old Renaissance native who reluctantly sat in my lawn chair deemed suitable for patient care. I greeted him with a smile but received a faint murmur in response. It was obvious that he was trying to conceal his friendly disposition by refusing to raise his upper lip above resting position. I leaned him back and asked what was bothering him today. He slowly widened his lips revealing dark interproximal decay on his upper anteriors. I had never seen such a defined and organized pattern of chaos. I nodded and gave a firm pat on his shoulder and proceeded to remove all the decay. The situation was far worse than initially assessed clinically. Perhaps it was to his benefit that we did not have access to radiographs or his four front teeth would have had the dire fate of extractions without any mercy. My slow speed round was sinking fast and sinking deep into a soft brown haven. I became increasingly nervous but was determined to rid him of his disease. My goal was achieved but not without sacrifices. Pulp exposure was inevitable but with proper management and medicament, the odds were on our side. After about an hour, I straightened my back and handed Andre a mirror. He slowly lifted his lips. He had forgotten how to smile all these years. Surprise and disbelief is what I could interpret from his expression. I requested the assistance of an interpreter asking Andre if his life would be different now. He nodded and exclaimed that he could finally get married. He has four brothers and two sisters. His family network is extensive but he remains close to everyone. He works as an auto mechanic by trade and is the only remaining of his siblings to not be married. Despite the language and cultural barrier, we both laughed and exchanged hugs. I knew that I had made a remarkable difference in one man's life. All it took was an hour of my time. I felt a sense of accomplishment and was reminded again why I fell in love with dentistry not only as a trade but as a way of life.
Ryan Zentz
My name is Ryan Zentz and I am a third year dental student at the University of Washington. I was fortunate to be able to attend a trip to Haiti to promote oral health with a team associated with the Medical Relief International organization to provide people with dental care that they desperately need. The care that the Haitian people do receive in often inadequate and leaves the patient's with severe pain as well as extremely unfavorable esthetic results.
Back row, left to right: John Judd, Dr. Mark Walker, Steffan Clements. Front row, left to right: Mehak Ahluwalia, Esther Ra, Elliot (our hostess) and Chrissie Leiren. Photo courtesy of Mehak Ahluwalia.
The photos on page 42 shows a patient named Roberto. He is a member of the church in a local community named Merseilles (pronounced: m-air-zhay). This church was responsible for letting villagers know of services that our team (Medical Relief International) would be able to provide. Roberto, a single man, lives alone as he was not able to find a partner during his younger age due to the caries in his anterior teeth. The Haitian people place a heavy emphasis on the appearance of the teeth. Many who attended our clinic made it known that neither men nor women would find a partner without an esthetic smile. Roberto has no car, no bicycle, and no money to afford a "Tap Tap" (Haitian taxi which consists of a bed of a pickup truck w/ the canopy over it and bench in the back) he walked to our clinic from over 4 mi away. So it is no coincidence that he did not have the money to afford proper dental care as a young man. Roberto presented to us with missing teeth #7, 8, and 9. Each of these had a severely infected socket and profuse granulomatous tissue. The sockets were explored revealing root apices buried within the tissue in each of the sockets. When asked of how this happened he replied in the native language Creole, " My teeth were hurting and so I went to the dentist. He told me they needed to be taken out, so I let him." He had seen this dentist over two years
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ago. It was clear that the dentist had simply removed the crowns of the anterior teeth with total disregard for the roots, leaving Roberto in much pain and with no front teeth. Roberto was a rare case. He was missing a trio of esthetically concerning teeth, but with good posterior tooth support and occlusion that was suitable for a temporary removable partial denture. Dr. Michael Karr, my mentor on the trip and founder of Medical Relief International, guided me through the removal of the root tips. Once they were removed, I placed a series of interrupted sutures that were stable enough to allow an Alginate impression to be made. A stone model was fabricated and at night, by headlamp, Pastor Bill Mayes and I fabricated the TRPD through application of powder and liquid orthodontic resin to the stone model. This was placed in a small portable pressure pot and polished to the best of our ability on site. As shown in the photos at left, Roberto has a dramatic change to his appearance. Haitians are not accustomed to photography, and also very stoic in nature making a proper smile difficult to capture. However, when the partial was placed and Roberto left the clinic, there were crowds surrounding him to see what we had done. The next day there were countless patients desiring the same transformation that Roberto had gone through. From my experience, I am able to reflect on a great deal. The dental aspects of the trip I will take with me in all of my future clinical endeavors. The lifestyles they live will inspire me each day. The country was in the media constantly following the earthquake but I never knew just what kind of damage this caused their people. The Haitian people have very low household incomes, most totaling less than $5 a day. It is no surprise that this results in very difficult and inadequate living conditions. The buildings are not sound enough structurally to withstand such a forceful natural disaster. Coupled with the lack of government infrastructure and the result is what we saw in Haiti each day. Piles of rubble and litter all over the streets and rivers; polluted sewage running freely through streets of villages and cities; and finally a nation full of people doing anything, everything that they can to survive. I will not forget my time spent there. I have never seen people endure so much pain and struggle with such a joy and zest for life. It reminds me of just how fortunate that I am and how much I can contribute to those who may not be as fortunate.
uw news in their own words: uwsod students in haiti
continued from 41
membership recruitment and retention
The future
With more than half of the WSDA membership comprised of baby boomers aged 50 or older, it is more important than ever that we reach out to younger dentists to explain the benefits, both tangible and intangible, of organized dentistry. On initial review, we see that dentistry is thriving in Washington state, with one of the best dentist-to-population ratios in the nation, and yet in recent years we've seen our membership drop from 80 percent of all licensed dentists in the state to 70 percent. As might be expected, the numbers fall largely along a generational divide — older dentists tend to stay in the fold, newer members have not yet grown to value membership. It's our job to light the way — to demonstrate the real value membership can have, no matter where someone is in their career path. As the baby boomers begin to retire en masse, we can expect our membership numbers to continue to decline. By being proactive, creating opportunities and value for new dentists, transplants to the state, and even former members to actively participate in organized dentistry and join the WSDA, we hope to turn the trend around.
Our most powerful tool: our members
In the fight to keep and grow our membership, you — the members of the WSDA — remain our most powerful tool. We rely on you to champion the cause of organized dentistry and the WSDA to potential members. We make it easy for you to recruit, with unbelieveable benefits to both the recruiter and the new recruit, including free passes to the PNDC, complimentary component society dinners, and $100 cash from the ADA (for complete information, visit http://www.wsda.org/recruit-a-member). But we weren't content to stop there. To that end, we created the Task Force on Membership — a group responsible for developing a comprehensive recruitment and retention plan. The Task Force is chaired by Dr. Ted Baer from Pierce County Dental Society and includes Ms. Sandra Anderson, Seattle-King County Dental Society's Director of Membership Services, Dr. Sabrina Habib, Seattle-King County Dental Society, Dr. Jeffery Henneberg, Spokane District Dental Society, Dr. Randall H. Ogata, Seattle-King County Dental Society, Dr. Daniel Tremblay, Currently in Yakima Residency Program, and Dr. Michael Warner, Clark County Dental Society. Additionally, the WSDA created a recruitment contest called the 12th Man Challenge, and they're pleased to announce that since the start of the campaign 14 new members have been recruited. Dr. Mike Buehler of Yakima leads the way with the most new members recruited. For more information see opposite page and log on to www.wsda. org/12thmanchallenge. Deadline for recruitment submissions is October 17, 2013.
Continuing to evolve
But we're not making you do all the heavy lifting — we've created a fantastic return on membership investment with assets like political advocacy, the PNDC, The Source, The WSDA News, endorsed company savings, and many others. This year we held our first-ever Job Fair, where members with an employment opportunity in their practice were brought together with members looking for associateships and other practice opportunities. Of the more than 80 participants, 96 percent said it was a valuable member benefit, and an equal number said they would recommend the event to a colleague, calling it "A wonderful way to meet potential candidates." We're continuing to evolve to meet your needs proactively. For information about the next Job Fair or any membership recruitment program, please cantact Laura Rohlman at firstname.lastname@example.com or 800-448-3368.
Membership in decline:
A GENERATIONAL DIVIDE thee wsda wsda ne new wss ·· issue issue 6, 6, may may ·· 2013 2013 ·· www.wsda.org www.wsda.org 4444 ·· th
membership recruitment and retention The 12th Man Challenge The Goal: To draft as many non-member
dentists to join organized dentistry with a grassroots approach that centers around you — the active WSDA member.
The Game: Have all 17 component societies compete for the largest increase in membership based on the recruitment efforts of the component's members. Deadline for recruitment submissions is October 17, 2013. The Prizes: The top three recruiting components will win multiple pairs of tickets to a suite at the November 17 Seattle Seahawks game against the Minnesota Vikings (1:25 kickoff), and everyone who recruits a new member can win cash and free badges to the PNDC. Want to learn more? Visit www.wsda.org/12thman
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GENERAL DENTIST — Down to Earth Dental is a thriving four-operatory PPO practice in Tacoma. We're looking for an exceptional general dentist to join our team starting late August/early September. The team is competent and fun to work with. Excellent compensation and great working conditions. Check us out at http://www.downtoearthdental.com/. This is a long-term position starting at 24 hours/week with the opportunity to take on additional hours in the future, if desired. Please send your resume to email@example.com. ENDODONTIST WANTED — Oregon, Portland. Dynamically growing dental organization with nine offices is seeking an associate endodontist. Part-time (possibly leading to full-time). Opportunity for an endodontist to rotate between dental offices and stay busy. Opened in 2000, our high-energy organization has a reputation for providing excellent care and patient service. Our beautiful stateof-the-art dental offices are located in scenic Portland, Ore., and adjoining Vancouver, Wash. Very competitive compensation and benefits. Applicants are invited to send C.V. to firstname.lastname@example.com. DENTIST WANTED, SPOKANE, WASH —Spokane Dental Providers is searching for a dentist to run their North Spokane family dental practice. Northpointe Family Dentistry is a five chair, PPO practice in Spokane Washington. Searching for a full time dentist to provide comprehensive, patient focused clinical care. Opened in 2006, the growing practice offers a unique opportunity for a qualified energetic individual to receive generous compensation with future growth incentives. This individual needs to posses strong leadership and communication skills, and able to work independently. One to two years of clinical experience is preffered. Visit our websites: www.northpointefamilydentistry.com, www.libertylakefamilydentistry. com, www.thedentalsavingsplan.com, www. safetzeyewear.com. To apply contact Roxie Couchat (509) 891-5001 or email Roxie at email@example.com PEDIATRIC DENTIST — South King. Pediatric dentist opportunity. Part time but will eventually lead to full time. Potential to buy in. Please email CV to email@example.com. REDMOND — Outstanding and unique opportunity to practice here in a completed, beautiful space in a great location. If you want to practice in Redmond or want to upgrade your existing space or location get more information by calling Sandy at (425) 883-4099.
DENTAL ASSOCATE POSITIONS AVAILABLE — We are seeking an orthodintist, general dentist and pediatric dentist for paret time positions in our busy South King County Offices. Please email CVs to skcpedodds@ gmail.com. OPPORTUNITY AVAILABLE — Opportunity for dentist interested in TMD/facial pain practice. Poulsbo Wa. Call (360) 981-8796, firstname.lastname@example.com. ENDO OPPORTUNITY — High-end busy general dental practice in downtown Seattle looking for an endodontist to treat endo patients in-house. 2-4 days per month/days are flexible. Good chair-side manners are a must. Please email firstname.lastname@example.com GENERAL DENTIST NEEDED — Apple Valley Dental & Braces is seeking a general dentist for our growing group practice in Eastern Washington. We offer a great salary and great benefits. We are looking for someone who is confident, energetic and a people person! Earnings are production based and we are busy! Please contact Jolene Babka, Corporate Manager, at (509) 823-4484 for further information. DENTIST OPPORTUNITY IN PORTLAND, ORE — Do the clinical dentistry you want to do. We offer paths in which you can manage or open your own practice with profit sharing. email@example.com. ASSOCIATE OPPORTUNITY — Beautiful Ridgefield Wash. We are an excellent state of the art office in Ridgefield Washington, looking for an experienced conscientious associate dentist. This is an opportunity to work with a fabulous well trained staff in a great community just minutes from Portland. We offer excellent earning potential as well as benefits. Please fax your resume to Dr. Crusan (206)426-1099.
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FOR LEASE — 1,200 sq.ft. Dental Office space, incredible lake view, Kenmore. $21 per sq.ft. (+NNN). Build-out assistance available. Great location with proven track record. 253-896-4100 or firstname.lastname@example.com. PART-TIME GP IN BELLEVUE — We are looking for an associate in Bellevue to work 2.5 days Wed-Fri. More days possible. We are a top office in our area. Beautiful modern office with state of the art technology. Fantastic patients and team. Fully digital. Must be highly skilled and experienced. Please email resume to email@example.com. DENTIST OPPORTUNITY IN GRAHAM, WASH. — Seeking experienced dentist for busy, well established, successful, fee for service, group dental practice. Full-time position available. Excellent immediate income opportunity ($180,000 to $375,000 + per year) depending on productive ability and hours worked. Secure, long-term position. You can concentrate on optimum patient treatment without practice management duties. Modern well-equipped office with excellent staff, and lab services provided. If you are bright, energetic with a desire to be productive, very personable, and people oriented, and have great general and specialty clinical skills, Fax resume to Dr. Hanssen at (425) 484-2110. WANTED — Mobile Dental Clinic Manager, part time or full time in Redmond, Wash. The Mobile Dental Clinic Manager contributes to MTI's mission by efficiently and safely operating the mobile clinic. Learn more about this position visit our website at www. medicalteams.org. ASSOCIATE DENTIST — We are looking for a passionate doctor with exceptional interpersonal skills and a desire to deliver fivestar customer service to join our team. The position requires 1-2 years of experience. Applicant must have a current license in Idaho; Washington a plus. This position will be located in the Spokane and Northern Idaho area. If you'd like to learn more about our opportunity, send a cover letter and resume email@example.com.
classifieds issue 6, may 2013
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ORTHODONTIST NEEDED — Looking for a motivated and energetic Orthodontist. Compensation is on partnership basis with excellent earning potential. Please send your resume to email@example.com.
FOR SALE — Beautiful stand alone redecorated 2,000 sq. ft., open concept bldg with five ops and plumbed with N2O. This practice is nestled in the foothills of Mt. Rainier, just a 50-minute drive from Seattle. The area offers a recreational paradise, with skiing just 40 minutes away and great schools. 0ngoing practice for over 25 years with loyal patients and a experienced staff. For more details call (253) 797-1353.
FOR SALE — Attractive dental office: 5701 Bedford St., Pasco, Wash. New construction in 2003. 3,450 sq.ft main level with 1,350 sq.ft basement. Complete details can be obtained from: Victor C. Robisch, DDS, (509) 547-8955 or Derrick Stricker, NAI Tri-Cities,509-430-8533 or firstname.lastname@example.com.
DENTIST NEEDED — A wonderful practice in Olympia, Washington is looking for a caring dentist with a minimum of two years clinical experience to work four days a week. We have plenty of patients, a great staff and a competitive package for a personable doctor looking for a permanent home. State of the art office. PPO & fee for service. Voted Best of South Sound five years. Please send resume to email@example.com DENTIST OPPORTUNITY IN PUYALLUP — We are looking for an associate dentist to blend into our established, well-respected general practice serving patients of all ages. We have a state of the art office, a long-term team, and are fully digital including Cerec. Please email resume to firstname.lastname@example.com. OPPORTUNITY WANTED SELLING YOUR PRACTICE? — Do you want to sell your practice? I am a motivated, private Washington state licensed dentist with approved financing for purchasing a dental practice and building. Email keefejc@gmail. com or call Jason 509-675-0029. Looking forward to hearing from you. GENERAL DENTIST — General Dentist looking for an office in need of a dentist on Fridays and Saturdays in Western Wash. I have 19 years of private practice experience in all aspects of dentistry. Prefer endo and surgery. Call (360) 402-9370 or Email email@example.com OFFICES FOR SALE OR LEASE LYNNWOOD, NORTH SEATTLE — Dental office condo for sale or rent. Owner financing or four months free rent. 1,300 square feet. Three ops. Dr. Hertl (206) 300-7060. Email email@example.com. FOR SALE South Tacoma four ops general practice for sale. Practice has been in community since 1968. Annual collection $860K, all digital and paperless office. Please email your resume or question email@example.com. START UP OR SATELLITE — Fully equipped, ready to move in 1,630 sq. ft., four ops dental office for sale in the beautiful city of Mukilteo, Wash. $98,000 email: email@example.com. FOR LEASE —Vancouver, Wash. Next to Vancouver Mall. Brand new remodel 2,000 sq. ft., just move in equipment. Built-in cabinets, Pano room, private office. Very nice! firstname.lastname@example.com.
FOR LEASE — Newly remodeled dental space available in North Kirkland. Four chairs currently set up. Plumbed for five chairs. 1800sf includes Pano and lab. Assume lease or sublet. Email: firstname.lastname@example.com for details. FOR LEASE – Four operatory dental suite available in Factoria (Bellevue). Located at the main intersection of Factoria Blvd. and SE 38th. Place. Walking distance to T-Mobile's regional headquarters campus. 1276 sq. ft. with open configuration, equipped with electrical, air , vacuum and plumbing. Turn key with all equipment in place and available for purchase. Inventory list available upon request. Current appraisal of equipment also available. Lease rate is $38.00/sf/yr.NNN. Contact Adam or Doug @ First Western Properties, Inc. (425) 822-5522. FOR SALE — Dental Practice and 2,600 sq. ft. class A building in Shoreline. Located on one of the main N-S thoroughfares, easy access to I-5, on bus line, open and covered parking, handicap facility: ramp, bathroom and hallways. Office has two fully equipped operatories with Panorex, Lab, computers and sterilization area. Building was originally a five operatory configuration. Designed to house a small dental laboratory and plumbed for N202. Call Cindy at 206-362-2273 or email firstname.lastname@example.com for inquires. FOR LEASE — Great location, over 2000 square feet, five operating suites in beautiful Olympia, conveniently located on Martin Way close to St. Peter Hospital. Over 30 years of quality dental care provided here. Contact Don at firstname.lastname@example.com. SPACE FOR LEASE, CENTRALIA — Dental suite available in a premium health-services property. Beautifully appointed 2,982 sf with six operatories plumbed with oxygen, nitrous, water and air. Visible location on main thoroughfare is known for its highvolume practices. Adaptable for specialties, which are needed in the market. Lease rate is $18/sf/yr, modified expenses. For photographs and more information visit www. Century21Lund.com, or contact Greg Lund at Century 21 Lund, Realtors, office (360) 748-8619 or cell (360) 508-0752.
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SPACE SHARING OPPORTUNITY — Presently working three days/ week and have ample room to share space in our five chair downtown Seattle general practice office with in-house lab and technician. Bring your patients and staff and share the rent, utilities and supplies. Contact Rick Nicolini, DDS at (206) 310-5709 or firstname.lastname@example.com. OFFICE SPACE TO SHARE — Excellent opportunity for specialist who wants to work one or two days a week or a start-up practice for any practitioner. Front office support. Contact Melissa at (425) 481-1038 or email firstname.lastname@example.com. NEXT/ANNIE MILLER & ASSOCIATES — New dental practice listings and sites for sale in Bellevue, Kirkland, Federal Way, Renton and Tukwila. Call today for tours and info. Annie Miller, Re Max Eastside Broker's Inc. (206) 7151444 or email at email@example.com. FOR SALE BELLEVUE — Beautiful Bellevue dental practice near Crossroads Mall. Open and spacious with three existing operative rooms, and room to expand. Pano and Ceph machine in office. Digital x-ray system in place. Convenient location on a main street near Microsoft. For more information, please call (425) 213-6606. OPPORTUNITY — Dental office for sale in Burien. 15+ years in the same location. Grosses over $350,000 a year, six operators and laboratory. Owner is retiring but will stagy for transition. Some financial available. Call JD at (206) 992-8771. FOR LEASE — 300 Pelly Ave N. Dental suite available in Renton, walking distance to the prestigious Landing, as well as Boeing. 1,361 sq. ft. on 2nd floor, with only two other dentists in building. Three operatories, open configuration, plumbed with electrical, air, vacuum, and plumbing. Corner lot with heavy traffic flow. Rate is $23.26/SF/Y NNN, Triple Net is $5.60 (incl utilities). Contact Dennis Schmuland (425) 417-1206. NEXT/ANNIE MILLER & ASSOCIATES — Providing consulting services to the dental community for the past 35 years. New practice start-ups, practice transitions, sales and valuations. Dental space planning and architecture; real estate leasing and acquisitions, employment benefits; staffing resources and training; financing. Call today for your free consultation…we can't mint money for you, but we can sure save what you have now! Annie Miller (206) 715-1444. Email: firstname.lastname@example.com.
classifieds issue 6, may 2013
Compliance QuickNotes
Basic Life Support
Preparing your team for a Patient Emergency Professional Management Associates, Inc
CURRENT LISTINGS Downtown Seattle Perio Practice Well-established practice Beautiful facility Over $1 million in collections
Seattle General Practice · Lake City Great location Three operatories Good starter practice New marketing strategies
We're looking for Associates for the greater Seattle area. Call us today! Ortho Space for Rent 1-2 days a week Potential for future ownership
Concerned About Fraud? We can help review your records in a discrete manner. Call for a free list of items to help thwart embezzlement in your office.
Linnell Isoshima Steven Kanzaki 1206 Olympic Avenue Edmonds, WA 98020 Pager: (206) 399-0242 Fax: (425) 712-1859
Dan Wells Most Basic Life Support training courses follow a time honored sequential format. The traditional BLS class is a bit like a flight simulator. Your instructor explains the changes since your last BLS course then demonstrates, in sequence, the steps for effective CPR, AED and emergency oxygen use. Some BLS courses also require that you watch instructive video on the proper sequences. Your instructor then observes you practicing the skills in the proper sequence with a mannequin. If you perform the tasks properly you are issued a BLS card. As you put your new card in your purse or wallet you may be secretly hoping you'll not be called upon to use the skills you just practiced. And the reality is that when you have a real world patient emergency, what you learned in the "flight simulator" can leave you unprepared. The sequential approach might be an effective way to conduct a BLS course but a simultaneous application of all the elements is required to respond effectively to a real patient emergency. Imagine a more comprehensive BLS course that measures your true level of preparedness with simulated emergencies in your dental clinic. The Harris Biomedical "Team Response to a Dental Patient Emergency" BLS course is exactly that. Our instructor will present the required BLS course, demonstrating proper techniques and guiding your staff members through a patient emergency as a team. In the final phase of the course, our instructor becomes the compromised patient in your dental chair. Your staff must use your equipment and function as a team to save the instructor, including CPR, using an AED and ventilating with oxygen and a bag valve mask. This "patient emergency drill" is timed with a stop watch by the instructor and is designed to reveal any inefficiency in your current emergency response procedures, which can then be corrected. By practicing as a team in your clinic with your equipment, you improve your emergency response and increase the likelihood of a positive outcome should a patient become compromised. We recommend that you perform a "patient emergency drill" at least monthly in your office to ensure that your staff remains prepared to function efficiently as a team in an emergency. You're required by Washington State Department of Health to have certain equipment, training and drugs to respond to a patient emergency and sustain the patient until EMS arrives. Most dental offices are in compliance with these requirements but preparing your staff to use them and function as a team requires more comprehensive training. Consider Harris Biomedical's "Team Response to a Dental Patient Emergency" BLS course. 5 2 · th e wsda ne w s · issue 6, may · 2013 · www.wsda.org
FOR LEASE, BURIEN, WASH — Brand new, 2,700 foot, six op dental office with pano room, lab, break room, two restrooms and private offices. Completely wired and plumbed for state of the art digital dental office. $10/ft, NNN or $2,200/mo. Must see to believe and appreciate. Great opportunity for start up or relocation. Contact (206) 9093863.
EQUIPMENT WANTED — Looking for w ide ra nge of used equipment. Adec, Kavo, Midmark, Pelton Crane, Midwest, Gendex, Air Techniques, Apollo, Porter, Cerec, Sirona. If you want to sell equipment, call (206) 260-3563.
GUEST DENTIST — Will fill in at your practice for maternity leave, injury, illness, family emergency, etc. 35 years of general dental practice experience. Personable and patient oriented. Dr. Ed Kardong (206) 842-6300.
EQUIPMENT FOR SALE USED/REFURBISHED EQUIPMENT — Adec, Gendex, Pelton Crane, Dentalez, Porter, Air Tech, Midwest, Midmark and etc. Lab equipment. Parts are also available for almost all equipment. Call Dental Warehouse at 800-488-2446 or http://cascade-dental.net. MOBILE DENTAL SYSTEMS — Mobile dental operatory suitable for a variety of locations ie..assisted living, missionaries. Excellent condition stackable containers. Approximately 45 lbs Contact (360) 981-8796.
SERVICES LOCUM TENENS DENTIST — Want to take a vacation? Need a knowledgeable, reliable ad personable dentist to help with your practice while you're away? Experienced locum tenens dentist will provide exceptional care to your patients. Over 25 years of private practice general dentistry. Serving all of Washington and Oregon. References available upon request. Contact Bob Houtz, DDS at (360) 457-9568. GUEST DENTIST — Time off, vacation, maternity leave? Temporary placement for day, week, or longer. Experienced, team and patient-oriented GP. Joe Schneider, DDS, FAGD. (206) 878-1237.
OFFICE CONSTRUCTION CONSTANTINE BUILDERS INC. (CBI)-WSDA endorses CBI as their preferred builder of Dental facilities with over 25 years of experience from ground up buildings, renovations, remodels, and interior tenant improvement projects. All projects are completed on time and within budget. CBI provides the highest level of quality service with integrity that exceeds our client's expectation. Please see our display ad on page two and website at www. constantinebuilders.com for additional information and how you can become another satisfied client. Telephone (206) 957-4400, O. George Constantine.
classifieds issue 6, may 2013
MOBILE I.V. SEDATION — Have your patients treated in your office with safe and proven techniques. Set your practice apart from others. Attract new patients. Increase quality referrals. Neil E. Bergstrom, DDS (360) 825-6596.
the years to navigate this unstable political ground. While we would like to just say "hell no," the legislative process will go on without us unless we engage. We are trying desperately to maintain our principles and legislative credibility. Lobbyists Linda Hull and David Michener guide us through Olympia's miasma. They have worked with us for over 25 years. They are paid to advise us on what the true picture is in the Capitol building, whether we like that picture or not. They have served us well. They have also taken hits by disgruntled members. I don't understand the logic. Linda and David led us astray to suit their own interests? They have no dental interests. It doesn't work that way. If they mislead or are unethical ,they lose their clients. Just like us. They have worked hard for us. I am ashamed that members have spoken harshly to them in person. They do not deserve that. I hear that WSDA discriminates against women because there are only two of us on the Board. I earned my seat on the Board
due to a specific set of skills I possess that are relevant for this point in time. That is the exact same reason the rest of the Board was elected. My gender has nothing to do with it. No one in this Association has ever treated me with anything but the utmost respect. WSDA leadership and staff have spent countless hours communicating with the membership through face-to-face meetings, phone calls, emails and letters. It has taken an enormous amount of Board and staff time. That time is desperately needed for our other issues and projects. When inaccurate or misleading statements have been made, we have done everything possible to respond with accurate information and an explanation of these issues. Despite our many attempts to correct the inaccurate information, the same accusations persist. Why am I telling you this? I think whenever the words fraud or embezzlement are thrown, we must drop everything, find the truth, and seek resolution. Festering
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kills bodies and organizations. It is not healthy and needs to stop. How do we stop this? We stop this through honesty, transparency and communication. I want you to listen and think. Talk to us when something does not ring true. Please ask questions. Your leaders have always been there to answer your questions and stand ready to help. We need truth to always triumph over rumor. Spread truth. A little kindness would go a long way in resolving problems. Asking a question while referencing one's lawyer is a poor first step on the road to resolution. When a question is answered properly, it is time to let it go and not continue festering. We need resolution. I want us to work out issues professionally and ethically and get back to the good work we do. WSDA has a million irons in the fire. It is time to stop the backbiting and get back to business. The important business of advancing our profession and taking exemplary care of the people we serve.
editorial continued
editorial, continued from page 4
parrish or perish
Dealing with paradoxes
Dr. Jeffrey Parrish "If everyone is thinking alike, then somebody isn't thinking." — George Patton
"In the end, she chose to go on KING 5 HealthLink to tell her story and beg others not to tan—one last unselfish gesture to leave behind some positive in an otherwise very negative series of events." The views expressed are those of the writer and do not necessarily reflect the opinion or official policy of the WSDA.
I recently had to attend a "Celebration of Life" that I really didn't want to go to. Oh, it's not that I was going to be bored or have to make small talk; the company was great, and I stayed for hours. It's not that there was nothing to celebrate; Ashley was a wonderful young woman who had a zillion friends and was a courageous spirit who touched the lives of many around her. And it's not that it was going to be a sad occasion; there was laughter and cheer all around. No, I didn't want to go because it meant Ashley's battle with melanoma had been lost. She fought a valiant fight, but it eventually got her…at age 40, much too young. It meant the "long goodbye" for her parents, brother, boyfriend and friends was sadly complete. Like so many other things in life, it meant facing another example of just how unfair and senseless things appear to be at times. To be sure, Ashley recognized her part in her own demise. Her teenage vanity led her to the tanning beds. And tan she did for more than a decade. Her mom warned her over and over, but the warnings were ignored in order to achieve that "bronzed look" she so desired and was the envy of her friends. In her early 30's she discovered the first lesion. While that surgery appeared successful, melanoma eventually returned, and, unfortunately, she delayed seeking care for a period of time. Ultimately she underwent various procedures, clinical trials and other immunotherapies for over seven years until nothing more offered any hope. In the end, she chose to go on KING 5 HealthLink to tell her story and beg others not to tan—one last unselfish gesture to leave behind some positive in an otherwise very negative series of events. See her story here: http://www.king5.com/health/Youngwoman-with-skin-cancer--192637701.html. Monumental moments in life often expose paradoxes we all must contend with. I readily confess I cannot offer any real resolution to any of those many have experienced as a result of Ashley's life and death. Her mother said to me that the Celebration of Ashley's Life was one of the saddest days and one of the happiest days she had ever experienced. It was obviously sad because she had to bury a child—a task so difficult and "out of sequence" that I doubt I would ever fully recover if I had to do so. But it was also one of the happiest because of the outpouring of love that she experienced via hugs, phone calls, social media, cards, flowers and well wishes from so many she knew and others she did not but who knew her daughter. Ashley's mom and dad were absolute rocks throughout her entire ordeal. Ashley's devoted boyfriend of many years told me about his holding her in her last days while under hospice care. She was suffering so much he wanted it to be over, but he was human and also wanted some miracle to heal her so that he would not have to give her up. You can imagine trying to deal with that set of conflicting values and finding some resolution. I have a question for God when I get there: how come my MD is always bugging me about needing more Vitamin D, but I should avoid the sun where there is a great source of it? I'm not advocating using tanning beds to excess, but I just have difficulty with the sun being a source of cancer. And I'm terrible about using sun block. Just another question I have for Him that I cannot reconcile. Those of us who have raised kids know there are things about their lives we wish were different; I'm sure our parents felt the same thing about us. Why is it that the voice of reason, wisdom and experience is often not enough to have someone avoid stupid mistakes? Why can't our kids realize and understand parents are not just "killjoys"; there are often good reasons for what we say. And how much do we dwell on the "if onlys" when we think about how we should have tried to do it differently to get the message and lesson across? Finally, there is the paradox of "she's in a better place." While I can intellectually accept that, it is still very unsatisfying because the rest of us are not. We are still here to deal with all the emotions we feel as a part of her death. We are still here to deal with more deaths of love ones. We are still here to deal with senseless acts like Boston and unfortunate events like the Waco, Tex., fertilizer plant explosion and fire. We are still here to bury some more of our best lost in Afghanistan and elsewhere. Some of those folks may have joined Ashley "in a better place", but we're not there yet. But as I often say, "I don't get to make the rules; I just have to live by them." Life can be a very slender thread. Hug your kids; hug your spouse; hug your significant other. Send the King 5 link to anyone you know who uses tanning beds. And try to enjoy the next Celebration of Life you have to attend. The person celebrated was someone's spouse, child, parent and is worth celebrating and remembering. Life is a gift; make the most of the opportunity you have been given…in honor of Ashley.
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50 is the new 40: It's also the ideal time to purchase Long Term Care insurance. Are you covered? Washington Dentists' Insurance Agency will make sure you are. You're in your 40s, and healthier than you've ever been. So it may seem counter-intuitive to shop around for the Long Term Care coverage, but it's actually the best time. At WDIA, we can guide you and help you make decisions for your future. Call Matt or Kerri today for a complimentary Long Term Care insurance assessment. They'll help you navigate through the myriad choices, and connect you with the best products available. Call us today!
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Washington Dentists' Insurance Agency: LONG TERM CARE INSURANCE
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5 6 · th e wsda ne w s · issue 6, may · 2013 · www.wsda.org
The Official Publication of the Washington State Dental Association