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District Meeting
  September 17th, 2009
The Brickyard at Riverside
 6:00 Social 
7:00 Dinner
8:00 Program - GDA's officers -
Updates from President Kent Percy and Executive Director Martha Phillips.  She will be giving an in depth look at how health care reform can impact our practice as well as keep us up to speed on State issues that we will be facing this year.

Tuesday, September 15th at 7:00 PM 
- Lindsay Holliday's office - 360 Spring St., Macon

All Committee Chairpersons, Delegates, and Officers are members of the Executive Committee and are required to attend. Other interested district members are welcome to attend.

GADPAC

  ADA Delegation 
- Kara G. Moore

I know the last thing some of you want to read about in the CDDS newsletter is health care reform. However, as I sit here trying to think of the most important battles the ADA is fighting for us right now…health care reform is the answer. Most believe that some form of “health care reform” will pass during this President’s administration. Right now the ADA is trying as hard as they can to lessen the blow to dentistry. Dr. Findley, President of the ADA has written President Obama and other national leaders several letters outlining the views of the ADA. In these letters he presents that a great deal of “reform” can be met more affordably by doing three simple things. First, restore the Medicaid safety net by eliminating barriers and increasing reimbursement rates. Second, Rebuild the dental public health infrastructure and focus on retaining and recruiting more dentists in to public health practice. Finally, adequately fund community based prevention measures including fluoridation and dental education programs. In Washington, we have individuals who have no idea of how the dental delivery system operates making the decision on how to “reform” dentistry. Hopefully, by educating some of these law makers positive reform can be made to help improve the oral health of the citizens of the United States. The ADA is fighting for you, but they need your help. Contact your representative and senators and let them know what YOU think needs to be done with health care reform. Martha Phillips the executive director will be at the next meeting and will have some more up to date information. I hope you will all be able to attend.

On a more positive note, most of you have already heard about Dr. Lee Hawkins’ decision to run for United States Congress. We have never needed a dental advocate in Washington like we do now! He is one of us and he needs your help. Please consider making a donation to Lee’s campaign. You can send any donation to the GDA office written to Lee Hawkins for Congress. Please make sure all donations are written from personal accounts.

Today’s topic is inflation.  It is the buzz word that the talking heads are inserting in their shows to make sure that if you weren't scared already, you will be now.  Why?  Inflation!!!  If you didn't lose your shirt (aka your 401K plan and other pension assets) in the last 18 months, you are to be congratulated and envied.  But now some of the talking heads are telling you that if you have cash it is going to be eaten alive by the ravages of inflation.  Of course, some of the other talking heads are talking about a bout with inflation followed by a long run of deflation.  Others not to be ignored are singing “Happy Days are Here Again.” 

Now, let’s take the words inflation and deflation and use them in a different context.  When it concerns the likes of 401Ks and retirement assets, the dentists that we know who are the most concerned are the grey heads like me (OK bald heads).  In this new context it is the young guys who need to pay close attention.  The classification of young guys (and gals) should be defined as how you remember the 1980’s.  If you graduated from dental school in 1990 and are 44-years-old or younger, you won't remember them the way those of us who are 55 or older do.  If you’re between 45 and 55, you can decide where you fit in this equation.

Unless you've been on Mars for the last five years, you know what I think about the Alaskan DHAT (Dental Health Aide Therapist).  However, when the ADA settled the lawsuit with the Alaskan Native corporations, the genie was out of the bottle.  Organized dentistry gave up exclusive rights to the scope of practice that allows us to practice dentistry.  Then the ADA with its Community Dental Health Coordinator (CDHC) and the American Dental Hygiene Association (ADHA) with its Advanced Dental Hygiene Practitioner (ADHP) began to compete to decide which organization could create and market a mid level provider to solve the so called “access to care” problem.  The ADA in its wisdom crafted the CDHC after much hoopla in the House of Delegates.  This was suppose to both help the access to care problem while not giving away too much of the dentist’s scope of practice.  The ADHA used the situation to create a true junior dentist much like the DHATs in Alaska. 

In a letter to the ADA Board of Trustees in 2006, I pointed out that if we were going to solve the access to care problem, we needed to train more dentists in this country.  Forget the details; I was summarily dismissed with copious amounts of laughter.  The ADA said that it would be a problem if we created more dentists.  I countered with the fact that it doesn't matter what you call someone if they perform dentistry, it amounts to the same increase in dental manpower.  Now depending on your point of view, creating more dental producing units could be considered manpower inflation.

The point is that in Alaska the US Public Health Service is training preceptor dentists (DHATs) as we speak.  In Minnesota, the legislature has decided to train something that looks like the ADHP (think junior dentist) [See the ADA NEWS, March 24] and in Maine they are working on their own version of the ADHP (think more junior dentists).  In the ADA NEWS, March 10, 2009, there was an article detailing the plans for five new dental schools which are to be added to the two already being build and the plans for the MCG (Medical College of Georgia School of Dentistry) expansion which will increase the class size by 80% (Thank you Gov. Perdue – the original plans called for far fewer new students in the increased class size).  That amounts to about eight new dental schools.  Amazing, when you consider that after the debacle that was the 1980’s when new graduates couldn't find a place to practice, we only closed seven schools.  Now we are going to open eight dental schools and create mid level providers.  That ladies and gentlemen is manpower inflation. 

So what happens when you create manpower inflation in today’s world?  Well, let’s remember the 1980’s for a minute.  PPO’s proliferated and the insurance industry began to take control of dentistry.  Fortunately, we closed some schools (manpower deflation), the economy took off in the 1990’s and a dentist could make a living.  Now, the economy is in the tank and all across the country, we hear stories of business problems.  So what do you think is going to happen in an economy that is inflationary (printing lots of money with no base) leading to deflation (a situation where costs are depressed).  In the case of ADA Corp, we have a situation where the world is creating more dentists and “junior dentists” (manpower inflation) and the insurance industry and the government are determined to solve everybody’s health needs (income deflation)? 

Perhaps I am over reacting, but you take the words inflation and deflation and work with them a little and see what you come up with this time next year when you prepare for April 15th.  Maybe we will move April Fool’s Day from the 1st to the 15th. 

You may deduce that the ADA has lost its mind and is acting like the US Congress.  That argument can be made.  But remember:  You need the ADA.  If you don't like it, get involved and change it.  Like the US Congress, it is the only act in town unless you plan to move to New Zealand and Australia where dentistry is already socialized to a large extent.  Then you will not have any need for the ADA or the US Congress.

Bankruptcy is another event were hearing a lot about today, as Chrysler is already bankrupt and GM is on the brink with stock at $1.61 as of this writing.  So one asks, what does bankruptcy have to do with the American Dental Association? 

Let’s ask how AIG, Lehman Bros. and Chrysler arrived at bankruptcy.  Publicly traded companies are led by extremely wealthy and very bright people.  The members of their boards of directors are, in their own rights, titans in their respective fields.  The company (let’s use GM) pays big salaries to these board members.  They meet in posh surroundings and no expense is spared to make sure that these GM board members can come together and make decisions for this car giant, using all of their corporate brainpower to make General Motors a great company with a great product.  So, when the Chrysler Corporation wakes up bankrupt and General Motors nearly bankrupt, whom should we blame?  Five Star Dodge in Macon, Georgia?  The guy in Detroit who attaches seats to the chassis?  The lady in Fitzgerald, Georgia who makes batteries to start the engines?  These are just everyday people doing a job.  The board of directors of GM had the benefit of a previous bankruptcy by Chrysler.  There is a clear assault from the Japanese auto industry on GM’s markets.  GM’s directors collectively have countless years of industrial experience available to them.  Their job is to put these pieces of information to work for the benefit of General Motors Corporation and its stockholders.  And yet, Chrysler is again bankrupt and GM is about to follow.

How does bankruptcy apply to our “corporation” – The American Dental Association?  First let us ask, who are the stockholders?  There are two classes of stockholders, those who hold common stock and those who hold preferred shares.  Common stock holders are the average dues-paying members of the ADA.  They receive dividends and stock appreciation.  They prosper economically when the ADA interacts properly with the various forces affecting the dental profession; such as overseeing insurance intrusion, watching CODA, lobbying Congress appropriately, etc.  The common stock holders also receive value from camaraderie at meetings, state and national association staff support, the opportunity to insert their own opinions into the process through serving as association volunteers and much, much more.  Of greater importance is the fact that Common stock holders (unlike preferred shareholders) have voting rights. 

The preferred share holders are the dentists in this country who are not members of the ADA.  They receive a prearranged interest payment from the activities of ADA Corp, but they do not have a vote and they cannot participate in organization decisions.  However, it should be clearly understood that both common (members) and preferred (non-members) are affected by the actions of the Board of Trustees when decisions are made that affect dentistry. 

I believe we are a General Motors equivalent.  We are almost bankrupt and our survival as a relevant corporation is doubtful at best.  Why, you might ask, is this the case?  Here is my opinion.  In July 2007, the ADA Board of Trustees settled the lawsuit with the Alaska Native Tribal Consortium and abandoned the defense of the Scope of Practice.  This opened the door to alternate pathways to practicing dentistry because the ADA had signaled that they would not defend the Scope of Practice.    In April 2008, the Board of Trustees of ADA Corp fired the Executive Director (CEO) of ADA Corp.  This decision was way overdue (in my opinion).  Still the Board of Trustees was divided on the issue and the flash point, if you believe the rumors, was a very trivial matter. 

ADA has been pressured from many fronts and space does not allow us to bring new readers up to date.  Let us list a few of our national concerns:  access to care, dilution of the scope of practice led by the US Public Health Service through the creation of mid-level providers such as the Alaskan DHATs, continued efforts of the American Dental Hygiene Association (ADHA) to create junior dentists from their ranks, and an ongoing assault from the insurance industry to control all aspects of health care.  So in this environment of attack from without, you would think that the ADA Board of Trustees would have moved rapidly to find an executive director who would support the scope of practice of the general dentist in this country and support the educational system that developed our model of dental care that is the best in the world. 

Now, let me make something very clear, I hope Dr. O’Loughlin, who was hired as the new Executive Director of the ADA over a year after the firing of the previous executive director will be a wonderful executive director of the ADA.  But, I would like to pose three questions for her and the average dentist in this country to consider:  
1 – Do you care if high school graduates with 18 months of training are allowed to prepare and fill teeth, place chrome crowns and perform “simple” extractions?
2 – Do you believe that insurance companies such as Delta Dental are acting in the best interest of either the patients or the average practicing dentist?  To give credit where credit may be due, rumors are that Dr. O’Loughlin left Delta Dental for being too dentist friendly.  And, 
3 – Do you believe that public health dentistry, with its support of mid-level providers and teledentistry (that topic will be discussed later) is going to strongly support the scope of practice of the average mainstream dentist?
These are but a few of the questions that you must ask if you are paying attention to your future in dentistry today.

Back to the ADA, we must reflect on the notion that appears to have become embedded in the thought processes of its Board of Trustees.  The notion was that the ADA needed a dentist to serve as its executive director.  The last two have been dentists.  They have pushed dentistry to follow medicine’s pathway and to embrace the concept of mid-level providers.  Their rationale:  If we don't do it ourselves politicians will do it to us.

So have we selected the right type of leader this time?

If the House of Delegates (all dentists) is the ruling body and the Board of Trustees (all of whom are dentists) the interim policy makers, and the selectors of the executive director, why does the ED need to be a dentist?  If it is such a good idea, why have we forced the last two out?

Again, I hope Dr. O’Loughlin saves the day for dentistry, but there are those who wonder if any dentist, let alone a Harvard Public Health grad and past insurance company director is the right fit for the ADA at this time.  Should we have been looking for an ED with business and political sense who will take direction from the BOT?  And should the BOT be taking more direction from the House of Delegates.  And should all of the above be taking more direction from (and interest in the opinions of) the common shareholders – you and me?

If we wake up one day soon and find that ADA is bankrupt (meaning that we the stockholders have lost our most valuable asset – control of the scope of practice), then we will ask “who is at fault”?  In my opinion, with recent actions of the ADA as our benchmark,  the Board of Trustees must decide it is time to protect its Common stockholders and  make some new plans for saving the ADA Corp from bankruptcy.  The recent actions of the current ADA Board are woefully similar to those actions of the Boards of Chrysler and General Motors.