Seattle King County Dental Society Summer Membership Quarterly by Bill Newcomer

MEMBERSHIP

Quarterly SUMMER 2021

VOL 19 / ISSUE 5

Tackling Workforce Issues Making Time for Wellness Medical Teams International 1111 Har vard Avenue Seattle, WA 98122-4205 206.448.6620 www.skcds.org 2021 SKCDS SUMMER QUARTERLY

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SUMMER 2021 Volume 19, Issue 5

Seattle-King County Dental Society Summer Quarterly

TABLE OF CONTENTS

Contributors: Ms. Sandra Anderson Ms. Angela Bond Dr. Adam Kennedy Ms. Megan Nakanishi Dr. Randy Ogata

President’s Message...................................................................................5 From the Desk of Dr. Ogata ........................................................................6 Member Feature........................................................................................8 MTI Vans...................................................................................................9 Bank of America.......................................................................................11 Nakanishi Dental “Favorite Things”....................................................................14 Locum Tenens..........................................................................................16 Access, SKCDF, DEI, Workforce: An Interview with SKCDS Leaders...................17 Make Time for Wellness........................................................................... 18 & 19 New Members.................................................................................................19 Dr. Munk........................................................................................................22

Publisher: Bill Newcomer, BNC Printing & Graphics, Vancouver, WA OFFICERS Dr. Adam Kennedy, President Dr. Christy Kirchner, President-Elect Dr. Austin Baruffi, Past-President Dr. Christopher Jean, Secretary Dr. Ryan O’Connor, Treasurer EXECUTIVE COUNCIL Dr. Mark Egbert, Executive Council 2022 Dr. Emily Yepez, Executive Council 2022 Dr. Kate Christian, Executive Council 2023 Dr. Rica Mackert, Executive Council 2023 Dr. Elena Andronova, Executive Council 2024 Dr. Christine Shigaki, Executive Council 2024 Dr. Christopher Shuye, Executive Council 2024 Dr. Randy Ogata, Executive Director Contact and Change of Address: To ensure continued receipt of issues, change of address must be reported to: SKCDS Central Office , 1111 Harvard Avenue, Seattle, WA 98122-4205, as soon as possible Phone: 206.448.6620 | Fax: 206.443.9308. Email: skcds@skcds.com | website: www.skcds.org The information in this publication is for the exclusive benefit of Seattle-King County Dental Society members. Neither the Society nor the publisher makes any express or implied warranties as to the information herein, including the contents of any advertising. Opinions in The Quarterly do not necessarily express the official policies of the Seattle-King County Dental Society, nor the opinions of the editor, unless so stated. Publication of advertising is not an endorsement, qualification, approval or guarantee of either advertisers or product. For advertising and publishing details, contact: Mr. Bill Newcomer, BNC Printing & Graphics, 503.318.5916, bill@bncprinting.com; www.bncprinting.com

OUR ADVERTISERS HOME/OFFICE SERVICES

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INSURANCE

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PROFESSIONAL SERVICES

Keller | Rohrback Law Offices.......................................................................4 Handpiece Rescue......................................................................................7 Knutzen McVay Group.................................................................................7 Katharine Christian DMD - Sleep Apnea and Snoring .......................................7 Nelson Boyd Attorneys..............................................................................10 Jeffrey W. Doneskey DMD Sleep Apnea and Facial Pain Ctr............................12 Next Level Consultants..............................................................................13 Nakanishi ...............................................................................................15 Practice Management Associates................................................................18 Garde Capital...........................................................................................19 Tacoma Quick Sale...................................................................................21 Ann Durham Attorney at Law.....................................................................21 Dental Group LLC......................................................................................23 Omni Practice Group.................................................................................24 Dentofacial Imaging Northwest.............................................................. Insert

Cover Photos: Volunteers 2021 SKCDS SUMMER QUARTERLY

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The

President’s Message

Resilience We all remember our first patient encounter during dental school. Mine was certainly unforgettable. It was overall positive: a periodic exam, adult prophylaxis, and, of course, fluoride varnish. However, the anxiety brought on by the D1110 code was immeasurable in those early days. Particularly when the periodontal resident would verify my probing depths. “Three? Two. Three?” they would politely ask as my stomach twisted in knots. While I can confidently say the accuracy and precision of my measurements has improved over the years, the adult prophy has returned as a source of significant grief for a very different reason.

Across the country, more and more dentists are finding themselves picking up scalers on a daily basis. In fact, I’m writing this after wrapping up a full day of dentist-assisted hygiene visits in my office. While the lack of staffing at the hygienist position is anything but breaking news, there is a clear trend forming of a shrinking demographic of dental auxiliary team members in most areas of our state. According to the 2020 Washington Dental Workforce Dr. Adam Kennedy Survey administered by the WA Department of Health, there are 444 open dental hygienist positions in King County (926 statewide). Our colleagues across the country are facing a similar crisis with a May poll from the ADA Health Policy Institute indicating “more than 80% of hiring dentists find hygienist, assistant recruitment extremely or very challenging.” If you’re reading this, it’s likely you are dealing with these challenges. The low applicant volumes, astronomical pay rates, and rising overhead costs are forcing many to reevaluate the practice model. We’re working diligently with local and state leaders to find creative solutions to address these issues. In an effort to tackle the urgent need for hygienists, SKCDS has developed an online job board. These listings will be advertised in neighboring states to recruit fresh talent to our area. There has also been a significant push from the WSDA to evaluate and alleviate any burdens of hygienist licensure within our state. We are hopeful that this two-pronged approach will deliver quality team members. We are currently assessing the feasibility of more long-term solutions such as: increasing the capacity of existing training programs, raising awareness of the opportunities within the field, and creating new programs to help supply the urgent need. While hygiene has likely caused most practice owners some anxiety, if not significant turmoil as of late, I want to challenge us all as dentists to continue to show our toughness. Resilience, a term used often throughout this pandemic, is our strong suit. Our ingenuity and level of dedication to the oral health of our community is awe-inspiring. Leadership expert, John Maxwell, once said, “The pessimist complains about the wind. The optimist expects it to change. The leader adjusts the sails.” SKCDS is determined to support and guide you through to fair winds and calmer seas. I welcome any suggestions to tackle the workforce shortages, and I’m proud to serve as your Society’s President. Sincerely,

Dr. Adam Kennedy Dr. Adam Kennedy

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From the desk of Dr. Randy Ogata

Summer 2021

Executive Director

A storm has been brewing on the horizon for many years, but it’s been masked by the fog of reimbursement rates, legal fights and other issues. Now the critical shortage in dental workforce is causing the traditional delivery of care model via a dental team to be compromised, even though we have enough dentists to provide care. When SKCDS dentists have ads out for four or six months and still can’t hire a hygienist…there’s a problem. When SKCDS dentists have ads out for six to nine months and still can’t hire an assistant…there’s a problem. These are family living wage jobs in Seattle that are going unfilled because the pipeline to train hygienists and assistants is unnecessarily convoluted. Washington State and King County does not need midlevel providers nor restorative training for the majority of the hygienists whom dentist need to do cleanings. There is enough dental workforce in the dentists present to provide the needed restorative and emergent care, without additional non-dentist restorative options. Making the restorative option just that, an option to hygienists who want to go back and take the additional training, would decrease the amount of time it takes to graduate. Why is it that Washington State requires a different basic standard for hygienists, which reduces the ability of hygienists from other states to move to Washington to earn a living? Wouldn’t it make sense for a physician in Washington to be a physician in Oregon? A dentist in Idaho to also be qualified as a dentist in Wyoming? Yet a hygienist in most other states is unable to be a hygienist in Washington without restrictive additions to a basic RDH training that is not taught in most other program’s curriculums. We need dentists who treat legislators to help educate these patients and let them know that dentists want to help their constituent base, only we are limited by the workforce shortages that are currently plaguing the entire state of Washington. But with their help, if certain restrictions were lifted or rules rescinded, we could help them by allowing the free enterprise model to take place in King County, while providing more jobs for their districts. We need every SKCDS dentist to swarm Olympia during Dental Action Day when it comes up next year – one voice, one message, one profession. SKCDS leadership has heard its membership and appropriated funds to advertise King County in another state’s classifieds ads, plus has started a dedicated job board for dentists to post opportunities for these hygienists to look at and contact prospective offices. This is a SKCDS member benefit and will be free through the end of 2021 for those that wish to post an ad. Last quarter I challenged every SKCDS dentist to encourage at least one of their patients to attend a dental assisting training program in our area. The response received from dentists was “why didn’t I think of that sooner”; it is such a simple idea that we would encourage patients who we know and trust us to join our profession with an open invitation to come back to our offices when they graduate. If dentists want more dental assistants, we have to take action. In South King County, dentists could even encourage high school students to attend the Puget Sound Skill Center, which can teach these students the basics of dental assisting before they graduate. John F. Kennedy once stated, “Ask not what your country can do for you, but what you can do for your country? So on behalf of SKCDS President Adam Kennedy, “Ask not what SKCDS can do for you, but what can you do for your dental profession?” SKCDF has not sat idle, in fact it is funding events and projects to make a difference in the lives of hundreds of families. SKCDS dentists, including then President Austin Baruffi, helped staff the first Medical Teams International (MTI) / SKCDF / UW School of Dentistry event at Jubilee Reach in Bellevue where we treated 48 patients, performed 157 procedures, referred 20 patients and delivered over $21K in dental treatments; plus as a bonus 30 individuals were vaccinated. More recently, the SKCDF Board voted to fund the expansion of the Shoreline RDH program at the UW SOD so they can increase the class size back to 25 by next year. For SKCDF to continue to do “great things” like these, they need SKCDS’s dentist’s generous donations in restoring the Foundation’s financial base; with funds going out for the two fantastic projects, and several more on the way, SKCDF needs your support! I will end this Executive Director’s column with one of my favorite Seuss-isms, UNLESS someone like you Cares a whole awful lot, Nothing is going to get better. It’s not. -The Lorax Honored to serve SKCDS Dentists,

Dr. Randy Ogata

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MEMBER FEATURE: Dr. Jeanne Bertino

The following interview-style article details Dr. Jeanne Bertino’s path in life and in dentistry. All words and thoughts are her own, with minor editing for clarity and length.

I owe my multiple science careers and my journey to dentistry to the Russian satellite, Sputnik, launched into space in 1957 and the NDEA (National Defense Educational Act). This satellite launch caused the USA to panic when they thought that the Russians would win the space war. In 1958, the Defense Department sponsored a program which funneled money into select schools for top students who would benefit from small class sizes with the best teachers, in an effort to foster math and science skills. We had equal numbers of males and females in these classes in my suburban New York school, so I never thought that “girls” could not do science or math. I also did not find out about this program, or how it directly impacted me, for many decades. Who knew that thirty years later I would be a “gum gardener” who sewed for a living as a periodontist in Seattle! I came from a long line of seamstresses who fed their families with these talents. My grandma in Brooklyn was an Italian immigrant who worked in the clothing factories and my grandma in Texas was a farm lady who sewed clothes for the rich ladies in town. My mother was an artist, a seamstress, and a tailor who taught women in state sponsored home extension programs. As a child of the 50’s, most little girls were taught to knit, crochet, darn socks, sew clothes and play piano or violin. Unbeknownst to me, these activities developed natural fine motor skills, which later benefited dental skills. Subsequently, I concluded that many of the early women dentists had an edge over the men once we got to clinic, except for those who played instruments or made model airplanes. The next step in my career planning was a pivotal, and emotionally crushing, conversation with my very practical father who informed me that I was NOT a debutant and that he was NOT a rich man who would subsidize my future career as a concert pianist. I was a talented classical pianist and was being encouraged to apply to the Juilliard Conservatory in New York City. Dad reminded me that musicians often went hungry and got side jobs as waiters in restaurants. I was skinny and energetic and often ate five porkchops in one sitting. Dad thought that a career as a science teacher would guarantee more steady meals. He would send me to college, but thereafter would only feed me five meals in a row - then I was out the door to fend for myself. So my lofty dreams of a debutant ball; studying at the Sorbonne, and a year of travel on the European continent followed by a concert piano career…went out the door as well. With a strong science background, I went to Cornell University to train as a science teacher. I taught junior and senior high school and then worked as a medical editor in a scientific publishing company in Philadelphia. My husband was at the University of Pennsylvania Dental School. In 1972, the Title IX Educational Amendment was passed, leading to dental and medical schools actively seeking out women with strong math and science skills. I knew some “girls” who were in dental school and decided to apply myself. It presented a challenge and an adventure. I was privileged to get a great education at Penn, especially in Periodontics. Traditionally, many male dentists entered the military after graduation because they had a deferred draft obligation. They received advance training and lots of experience. So I decided that I would do the same. My first assignment was Yokota Air Force Base near Tokyo, Japan where I had three years of supervised rotations in various specialties and lots of clinical experience. I lived in the Japanese community and learned to eat sushi and to ski in the Japanese Alps. Next stop was Denver, Colorado where I had more clinical rotations and skied every weekend. My favorite specialty was Periodontics because it involved microbiology, immunology, pharmacology, surgery, psychology and patient education. The decision to continue my education brought me to the University of Washington and Seattle where I have lived ever since. The mountains and lakes were the great attractions for skiing, hiking and kayaking. My private practice associateships were with Dr. Terry Thomas and Dr. Murray Robinovitch, who both taught me so much about private practice and emphasized the importance of establishing strong community and professional relationships. So, after twelve years in group dental settings, I launched my own solo practice in October 1994 in North Seattle. I’ve enjoyed the challenge of periodontics and feel that I am still learning every day. Every day is an adventure and every person I meet is a potential new friend, with many patients becoming long-term friends. The Pacific Northwest has a skilled and dedicated dental community whose members collaborate and encourage each other to rise to our greatest professional potential. A lot of friendships develop over wine, beer, and good food while we listen to evening dental lectures. We are the envy of the dentists across the country who tell me grim stories of competition and adversarial situations in their practice communities. Recently, we have welcomed a talented and well-trained associate, Dr. Anusha Etikala, into the office. It is exciting to share knowledge and to consult on cases. My enjoyment of practice continues, and I marvel that we are surviving COVID-19. I am so proud of my staff for their efforts. There is always a new mountain to climb and some are harder than others. Dental training makes us strong, disciplined, and mostly resilient. I am so proud to be a member of this community. My volunteer work at the Union Gospel Mission Clinic has been very gratifying. It is a well-organized program in a modern clinic. “Business as usual” has been placed on hold due to COVID-19 restrictions but once the community is back to normal, they will eagerly welcome more volunteer dentists. I enjoy helping the people in their programs and I leave with humility and immense gratitude for the wonderful personal and professional life I have experienced. Currently, my husband Stan and I spend time in both Wyoming and Washington. My stepchildren (four) and grandchildren (six) are avid ski racers, so we spend a lot of time in the snow in the winter. In the summer, we enjoy sailing and kayaking in Seattle. Two of my granddaughters are at Cornell University, my undergraduate alma mater. 8 l 2021 SKCDS SUMMER QUARTERLY

MTI VANS

By Dr. Randy Ogata

In 2020, when I took over as Executive Director of SKCDS, one of the first things outgoing SKCDF President Dr. Princy Rekhi gave me as a gift was a memorandum of understanding (MOU) with Medical Teams International (MTI) to co-host dental van events over the next five years. What I didn’t realize at the time was the amount of work, sweat, tears and efforts that had gone in for the years before this to bring this MOU to fruition. It had been a labor of love for member dentists, for our community, and for the thousands of lives we are yet to touch. Shortly thereafter, COVID hit the US shores and what was important “yesterday” suddenly wasn’t as important “today”, so the MTI dental van events were temporarily put on hold as we helped all dentists navigate this pandemic – and since we couldn’t even treat dental patients for just over two months. Late in 2020, as King County slowly began to allow public and group gatherings, SKCDF and MTI resumed discussions to schedule co-branded dental van events as well as completing the wrap on the co-branded dental van. And oh, there were lessons learned along the way. Lesson #1: It takes much longer than one might think to come up with a mutually agreeable van wrap design. Lesson #2: Cold weather is not conducive to van wraps, unless you have a huge garage. Lesson #3: It is much easier to schedule upcoming events during the winter than it is to wrap a van. Lesson #4: Efficiency is cut 50% when limited to only one of two operatories in a dental van. Working with key personnel within MTI and the UW School of Dentistry (SOD), we scheduled our first event for April at Jubilee Reach (Bellevue), our second event for July at New Life Church (Renton), and our third event for October at Recovery Café (SODO). One of the most satisfying things to watch is when proper planning sets volunteers up for success. On April 24-25, 2021, SKCDS dentists, including then President Austin Baruffi, helped staff the first MTI/SKCDF/UW SOD event at Jubilee Reach in Bellevue. This was the first time that the UW SOD students were allowed back outside to treat patients and they brought their “A Game” both days. On day one, we treated eighteen patients, referred six for further treatments, and the seventy-two procedures performed carried an estimated value of $6,658 in care. Finally, as a bonus on day one, thirty individuals were provided their first dose of COVID-19 vaccine. On day two, the team saw thirty patients, referring fourteen for additional treatments; and the eighty-five procedures provided were valued at $14,351 in donated care.

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The practice for sale below is on the waterfront in Mukilteo, Washington. Is there a dentist who dares to ditch the production/collection/active patient algorithms and rely on their own ability, skills, personality, and vision? Just open the doors and watch the patients flow in to this dream practice and enjoy the lucrative career you have always dreamed of having. This 3-op (plumbed for 4) fully loaded practice with nitrous plumbed throughout, Forest® massaging dental chairs with custom bronze powder coated hardware, solid surface epoxy floors (resembling marble), and panoramic Puget Sound Views took over $600k to build. The office is centrally located, highly visible, and a place where people like to be. The dentist who designed and built this practice spared no expense to make it a place where she would enjoy spending time (8+ hours a day) and many anxious patients could find solace in the peaceful atmosphere. How many dental offices can truly say patients look forward to their visits?

A NO BRAINER This practice for sale is on the waterfront in Mukilteo, Washington. Is there a dentist who dares to ditch the production/collection/active patient algorithms and rely on their own ability, skills, personality, and vision? Just open the doors and watch the patients flow in to this dream practice and enjoy the lucrative career you have always dreamed of having. The 3-op (plumbed for 4) fully loaded with the nitrous plumbed throughout. Forest® massaging dental chairs with bronze powder coated hardware, solid surface epoxy floors (resembling marble) and panoramic Puget Sound views took over 6000k to build. The office is centrally located, highly visible, and a place where people like to be. The dentist who designed and built this practice spared no expense to make it a place where she would enjoy spending time (8+ hours a day and many anxious patients could find solace in the peaceful atmosphere. How many dental offices can truly say patients look forward to their visits?) This Mulkilteo office is up for sale at a highly reduced price for a quick sale. The owner has relocated out of state with her 2 kids after the premature and tragic death of her husband. Respectfully speaking, this is a situation where one’s loss could be your gain! For more information please contact Lindsey Pierce (425) 466-8595 10 l 2021 SKCDS SUMMER QUARTERLY

This Mukilteo office is up for sale for at a highly reduced price for a quick sale. The owner has relocated out of state with her 2 kids after the premature and tragic death of her husband. Respectfully speaking, this is a situation where one’s loss could be your gain! For more information please contact: Lindsey Pierce (425) 466-8595

2021 Road Map to Practice Acquisitions Acquiring a practice is one of the most significant purchases in a dentist’s career, but it can also be one of the most challenging. There are several things you can do in both the pre- and post-transition period that can be critical to the success of the business. To help ensure a smooth journey, here are six “stops” you should consider taking along the way.1

Get started As you set out, it’s important to evaluate your buying power with your lender through an in-depth financial analysis. You should understand your credit, know your production capacities and be mindful of your liquid assets. Your lender can help you avoid common mistakes and find the best possible financing for your situation.

Build a dental specific team Take full advantage of resources that are specific to the dental industry, including attorneys, CPAs, consultants and lenders. It’s never too early to start conversations with your team to ensure that you’re on the right path to acquiring a practice. The industry knowledge of these professionals will also help you navigate the twists and turns of practice ownership once you’re open for business and as your practice grows.

Identify a practice There are a number of ways to find a location, including a listing from a broker, purchasing the practice you’re associating in or being approached by a potential seller directly. Your team of industry experts can help you pinpoint a practice that fits the philosophy, location and demographics you want.

Make an offer Once you’ve identified the practice, your attorney can help you put together a Letter of Intent to allow for any contingencies. The attorney can also help with the back-and-forth communication of the offer between you and the seller.

Due diligence You’ll want to fully review all aspects of the practice with a dental-specific attorney, who can help you examine: ●

Financial information for the practice

●

Utilities, leases and titles

● ● ● ●

Marketing programs in place Systems and technology currently in use Current licenses and vendor information Any legal, regulatory or compliance issues

Business Banking Solutions Be sure to obtain the banking services your practice will need, including a point-of-sale machine for processing credit cards, payroll services, business checking and savings accounts, and a business credit card. These tools offer a direct route to streamlining practice operations and managing your cash flow.

Congratulations—you’ve reached your destination! You’re now the CEO of your own business. From the beginning of your journey to the moment you achieve practice ownership, Bank of America can assist you at every stop through vast industry knowledge and customized financial solutions. To learn more about practice acquisition loans and current promotional rates, visit bankofamerica.com/practicesolutions or call 800.497.6076.2

The content herein is for illustrative purposes only, are for your discussion or review purposes only, and should not be used to make your financial decisions. Bank of America makes no express or implied warranties with respect to any aspect of the content herein, nor does it guaranty any success or promise any results or success, and hereby disclaims the same to the extent allowed by law. You are not bound by any recommendations provided herein and retain full responsibility for the results achieved by your professional practice. Please consult your financial, legal and accounting advisors, as neither Bank of America, nor its affiliates or employees provide legal, accounting or tax advice. All programs subject to credit approval and loan amounts are subject to creditworthiness. Bank of America may prohibit use of an account to pay off or pay down another Bank of America account. Small Business Administration (SBA) financing is subject to approval through the SBA 504 and SBA 7(a) programs. Loan terms, collateral and documentation requirements apply. Actual amortization, rate and extension of credit are subject to necessary credit approval. Bank of America credit standards and documentation requirements apply. Some restrictions may apply. Bank of America Practice, N.A. is a division of Bank of America Corporation. Bank of America is a registered trademark of Bank of America Corporation. ©2021 Bank of America Corporation.

2021 SKCDS SUMMER QUARTERLY

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Nakanishi Dental Laboratory’s “Favorite Things” 2021 By Megan Nakanishi

3D-Printed Nightguards

There wasn’t much about 2020 we liked… except the launch of this revolutionary new material for nightguards and splints! Our “Keysplint” 3D-printed nightguards are designed digitally by our experienced technicians and printed on our state-of-the-art Carbon 3D-printers for highly accurate nightguards and splints. This “body-activated” material softens with the heat of the oral cavity, providing superior patient comfort. Because of the digital technology used to produce these nightguards, they are our most economical and fastest nightguard option. The best part about these nightguards though, is we keep a digital record of the design, so if the dog decides to eat it… we can fabricate a new one with no new impressions!

The Nakanishi Denture eXperience

The future of dentures is here! Simplify your denture process with our new 3D-printed denture workflow. Instead of multiple try-ins of teeth in wax, we can digitize occlusal rims or an existing denture and send you a precision fit denture at the very next visit. This technology allows us to fabricate dentures that are 2x stronger than traditionally made dentures, for a fraction of the cost. The digital design record is stored in our cloud system indefinitely, so if the patient loses their denture, we can remake without starting from scratch. #LifeSaver.

Virtual Diagnostic “Wax Ups”

Raise your hand if you want more predictability in complex restorative cases! Using our computer-aided-design software, we can digitally design diagnostic “wax ups” and communicate the designs in a variety of ways: emailed images, 3D-printed models, or milled wax. The ability to design these virtually gives us a true blueprint when it comes time to fabricate the Provisionals and eventually the definitive restorations.

Simplified Guided Surgery

Guided surgery has never been easier! Send us impressions or a model and a CBCT file, and 24 hours later we will email you a link to review and approve the guide at your convenience. Once approved, we will send you a precision-fit 3D-printed guide and a detailed report to aid in your implant placement. Our lives are complicated these days, let’s at least make this simple!

14 l 2021 SKCDS SUMMER QUARTERLY

Life Member Bios 2021

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2959 Northup Way | Bellevue, WA 98004 Call/Text 425-822-2245 | 800-735-7231 team@nakanishidentallab.com www.nakanishidentallab.com

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The appeal of the Locum Life By Sandra Anderson

As a business owner, and a health practitioner, you wear multiple hats. As such, you sometimes need to bring extra help into your practice. When your hardworking Associate has a skiing accident and is in a cast for six weeks, what do you do? This is the time for a Locum Tenens. On the flip side, you might be at a point in your career where you are experiencing some burnout and looking for more opportunities to travel and see new places. You need the Locum life. Locum What? Most medical and dental professionals are familiar with the term Locum Tenens. But where did it come from? Merriam Webster defines locum tenens as “one filling an office for a time or temporarily taking the place of another.” The definition of locum tenens, roughly translated from Latin, means “to hold a place.” The term was originally used in medieval times as a reference for Catholic clergy. A priest would serve as Locum Tenens, for a parish, until a permanent priest could be found. According to CHG Healthcare, when founding CompHealth in 1979, Dr. Therus Kolff thought this term would be fitting to describe physicians working temporary assignments. Other sources suggest that the term was first used at the University of Utah, in the 1970’s, following a study using temporary doctors in rural locations. Either way, the term migrated into the dental community which leads us to today. Why Hire a Locum Tenens? As previously described, life in a dental practice does not always go according to plan. There are times when, as a practice owner, you will need to be gone. Or, you will have an Associate who needs to be gone. Unless you can keep patients in the chair, you are losing money, so it could be very worthwhile to hire a temporary practitioner. For many years, Locum Tenens has been commonplace in the medical world. The Dental community is starting to catch up on the benefits of this approach. Locum Tenens dentists can frequently be found through a placement service. Sometimes independent dentists work as Locum Tenens as their primary source of income. Most Locum Tenens dentists work through a staffing agency, and the agency takes a cut. That covers the administrative costs, as well as contributing to the agency’s profit. The ADA’s Career Center website also offers job listings, including Locum Tenens positions. Locum Tenens positions are sometimes offered on the WSDA job board as well. If you are considering hiring a Locum Tenens, be aware that some dental insurance plans only allow for work to be done by the dentist who is “in network.” If the dentist who is working as a Locum Tenens and is not an in-network provider, there is potential for problems. According to the ADA Council on Dental Benefits Program, “Plans have various practices and policies when it comes to Locum Tenens dentists and while some of these policies may be similar, they do have their differences. It is important for dental offices to understand the need for Locum Tenens dentists and to completely understand how this is handled by various dental plans.” ADA staff from the Center for Dental Benefits, Coding and Quality can help dentists with dental benefits-related and coding problems, questions and concerns; and can be contacted via the ADA’s Third-Party Payer Concierge at 1-800-621-8099 or email dentalbenefits@ada.org. Why Do Locum Tenens? There are many reasons why a dentist would work as a Locum Tenens provider, such as earning extra money, gaining more control of where and when they work, to fill the gap between permanent employment, to work part-time after retirement, or to travel. Some dentists work as Locum Tenens to battle burnout with flexibility and autonomy. Others are looking for a break from the “daily grind.” It can also be seen as an opportunity to travel and work while exploring different parts of the country or even to earn a better wage. According to an article in DentistryIQ, Locum Tenens dentists are paid one of two ways. There is a per diem option and a production option. In the production option, the practice pays a percentage of the revenue generated by the Locum Tenens dentist once an agreed upon baseline of revenue is reached. Challenges to Locum Tenens work While there are benefits to this type of work, there are also some challenges. One of those can be negotiating a contract with either a placement service or directly with a prospective employer. The ADA Center for Professional Success website offers “General Guidelines for Mutual Aid Agreements,” that outlines a process in which a formal contract with colleagues is made in the event of the sudden illness, injury or death of a dentist. The signer(s) to such an agreement commit to temporarily cover for the stricken colleague until either his or her recovery or up until such time that a deceased dentist’s practice is sold. Please note that detailed contract questions should always be discussed with an attorney. Another challenge to living the Locums life can be finding your own insurance coverage. As an independent contractor, you will need to provide your own healthcare, disability insurance, malpractice insurance, and more. Some staffing services will cover you. Sometimes you need to purchase your own policies. The website ‘The Locums Life’ describes the need to purchase health insurance as follows: “It’s like the insurance companies are giving us one last gut punch as we walk into the sunset, as if to say, we still own you!” While it may feel like they still own you, the reality is that as a Locum Tenens provider, you are free to take the jobs you want, move to the places that intrigue you, and get paid what you feel you deserve. Whether you are interested in shoring up your practice during a challenging time, or exploring a new way of doing dentistry, Locum Tenens can have very concrete benefits. With a little advanced planning, this can be a winning solution for your dental practice.

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Access, SKCDF, DEI, Workforce: An Interview with SKCDS Leaders It goes without saying that the COVID pandemic brought about tremendous change and upheaval to “everything”. But another major change of the last year has been the increasing push to prioritize Diversity, Equity and Inclusion (DEI). DEI is not a new concept, the protests of Summer 2020 highlighted many of the racial and gendered inequities in our society, and highlighted the need to carefully consider how diversity, equity and inclusion are navigated in the workplace, as volunteers and at home. One of the biggest lessons reflected on as we closed out 2020 was the glaring differences between DEI intentions vs reality. The unfortunate but unsurprising reality is that lackluster efforts have been put forth to cultivate an environment where marginalized groups feel valued. That must change, and it will only change if each and everyone of us, do our part. This is the first small step by SKCDS to help dentists become agents to help make those changes. Seattle-King County Dental Society’s (SKCDS), President Austin Baruffi appointed a Task Force on DEI led by Past-President Lisa Egbert to develop a society DEI statement and guide our strategic thinking as SKCDS works to better integrate these principles into our everyday way of doing business. At the same time the Seattle-King County Dental Foundation’s (SKCDF), President Nina Svino tasked the SKCDS Access Committee Chair, Rolf Christensen, assigned this to a work group of whom Dr. Doug Jackson was one of the authors of a white paper to SKCDF.. As we welcomed 2021 with hope, Dr. Randy Ogata interviewed Drs. Egbert, Svino and Jackson to share some of their thoughts on access, SKCDF, DEI, education and the workforce with SKCDS – so we could share them with our members. The amount of information they shared was so extensive that this will be the first of a multi-part article on DEI and related topics. The following is the truth, and it may make some feel uncomfortable – a good thing, it may make some sad or others angry – a good thing too. But if it encourages you to really think about the issues facing our world– that is a great thing. OGATA (O): What are your current position(s) in SKCDS and Organized Dentistry? EGBERT (E) – I am a Past President of SKCDS, Board Member of SKCD Foundation, and Former Chair of SKCDS Diversity and Inclusion Task Force. SVINO (S) - I am the current President of the Foundation as well as an active member of the Society‘s Events Committee. JACKSON (J) - I am a member of the SKCDS’s Access to Care Committee, a committee on which I have served on since 2012. O: What do you think SKCDF asking the SKCDS Access Committee for recommendations on developing a longitudinal action plan can accomplish for dentistry & the public? J - I think it is a great thing! After being inactive for the last few years, the Access to Care Committee is in a period of renewal. As the work of this committee is taking shape, being mindful of the need for there to be alignment between the beliefs, values and priorities of the Foundation and the initiatives being proposed by the Committee is important. S - I think as awful as these last 12 months with COVID has been in curtailing our many activities, it gave us the unique opportunity to methodically evaluate past accomplishments or failings and focus on improvements in a tangible manner. Since we are not able to have as much community exposure, it seems an ideal time to create long term goals. E - One of the key components of the SKCDS Strategic Plan is to increase opportunities for members to serve the community. Ideally, by creating more synergy between the Society and Foundation, a large-scale access to care initiative will captivate the membership. Dentists are caring, generous people. They are also results-driven and busy. J - These conversations are not only assuring this alignment, they are also providing a new level of excitement to members of the Foundation as they are actively engaged in conversations about the inputs, outcomes and impacts of the initiatives on the communities in King County that will be served. E - If there are easy ways for members to give their time, skills and financial support and see real results in the community, they will do so enthusiastically. If the public is healthier and dentists have full hearts from seeing the results of their philanthropy, everyone wins. O - How do you envision SKCDF’s partnership with MTI to host six events a year for the next five years working into a longitudinal action plan? S - Initially, the Foundation wanted to have it’s own Dental Van but after much discussion and investigation, we determined that the Foundation was not in the Business of RUNNING a Mobile Dental Clinic. We were in the business of facilitating the Dental Vans with donated funds [and volunteer dentists] and MTI was arranging bringing the dental vans into areas with the greatest needs and to the locations they had already established with our Dentists from Washington and our Dental Society members. So now we are finalizing the “coverings” to be placed on these vans that will see 30 site visits over the next five years. E - SKCDS members have been providing mobile dental care on MTI vans in local communities for years, so it is a natural partnership for SKCD Foundation. Dentists know, however, that there is no substitute for a dental home. Anything that can be done at the SKCDF/MTI mobile events to motivate people to establish a dental home rather than using an emergency resource is beneficial. J - The partnership with MTI gives SKCDF a unique opportunity to move beyond the transactional nature of a patient using MTI services to receive needed treatment to one in which not only are treatments provided to individuals in need, information is shared with communities about topics ranging from the importance of oral health and prevention to introducing those seeking careers with livable wages to the workforce needs and opportunities in oral health. S - Hopefully as COVID phases progress, we would like to incorporate additional activities at these sites ie. family health screenings, job fairs etc., with communities becoming aware of job opportunities in assisting, hygiene, and dentistry that they may not have previously known about. E - By creating larger events around the MTI van, we can engage communities by developing relationships and meeting people where they are. Through upbeat community health festivals, including the availability of dental services on an SKCDF/MTI van, people can learn about good health and about the possibilities of entering the rewarding profession of dentistry. J - The day will return when people are able to safely return to celebrations and other events in their communities. With some careful planning and trust building with communities that have great oral health needs, the SKCDF and MTI partnership can be leveraged to not only meet the treatment needs of individuals, but to invest in the well-being and vitality of communities. O – As COVID restrictions are lifted, SKCDS would love to expand the MTI/SKCDF/UW SOD events to provide so much more than emergent care. If we could partner with community health centers or private practice dentists from those areas, to schedule patients that day for follow up at a potential dental home.

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Make Time for Wellness: A Dentist’s Story of Lessons Learned This column, written by Dr. Ardi Pribadi, was originally printed in the Snohomish County Dental Society newsletter. Dr. Pribadi is the former Board President of the Snohomish County Dental Society. He owns a practice in Arlington, Washington. Reprinted with permission. Hello again everyone, Spring is here! Isn’t it wonderful? The rain has slowed, the days are longer and the air is wonderfully dusted with an infinite variety of allergens. In this letter, I want to share a personal experience I had this past month - I went to the emergency room. For a few weeks, I had been experiencing headaches, blurred vision, malaise and one night I had diaphoresis, which I thought was really odd considering I had never experienced that before. When I went back to work the next day, I decided to take my blood pressure. I couldn’t believe what I was reading. I took it 3-4x before I accepted the readings— 180/110~. “I’m a young guy,” I thought.” I’ve ran 6 marathons! I run every day! This can’t be me.” I called up Providence’s urgent care center and was connected to a virtual provider within minutes (much more convenient than sitting in the urgent care waiting room for hours). I had a virtual session with an ARNP in California and explained my needs. She instructed me to take it again in front of the camera and this time the reading exceeded 200/120. She told me to go to the emergency room right away. I said, “I can’t do that. I have a full schedule. In fact, there’s a patient in the chair right now waiting for me to seat his crown.” She said something that I’ll never forget, “If you don’t make time for your wellness, you will be forced to make time for your illness.” (continued on page 19)

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(continued from page 18) After the virtual session, I went back to my patient, still crownless, and as I was in the lab sandblasting the crown and preparing it for cementation, I had a temporary episode of dysphasia in which I couldn’t articulate anything that my brain was trying to say. My assistant and hygienist both thought I was having a stroke and I myself, thought I was having a stroke; turns out it was a panic attack and the dysphasia passed. I was able to collect myself, instruct my hygienist to reseat the provisional and tell the front desk to reschedule the day. My assistant drove me to Cascade Valley Hospital and I was checked in immediately. The ER doctor must have seen me in my scrubs and gave me the medical professionals’ treatment because I never had such a great experience from a hospital before. The entire staff was friendly and attentive. I had the full work-up -12 lead, chest x-ray, CBC, etc. I was there for five hours, while they ran tests and kept me on a monitor. Finally, I was discharged with an Rx for a Beta Blocker and instructions to follow up with my PCP, but not before a friendly counseling session from one health professional to another about work, life, and health. He asked me if I was under a lot of stress lately. I pointed to the logo on my scrubs and said that I’m a small business owner in a high risk profession in the middle of a global pandemic. I can’t recount the whole conversation but in essence, he advised me to make time to take better care of myself or he’ll be seeing me again soon. This emergency I had was a wakeup call and I felt I had dodged a huge bullet. The following week, I saw my PCP and discussed my experiences with my family and my staff. We discussed the importance of a balanced life, and that health and wellness cannot take a backseat anymore. So now, after careful planning with particular attention to diet, exercise, ergonomics and mental health, I feel relieved that I can see a healthy pathway through this profession. I’m comforted in knowing that the time I’m taking now for my health, will be that much time less spent in illness. Editorial note: For those feeling overwhelmed or stressed, the Washington Physicians Health Program (WPHP) offers confidential resources at 206-583-0127 or 800-552-7236 or www.wphp.org.

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Dental Assistant By Al Munk DDS Reprinted from a previous issue with permission.

All of us have worked with dental assistants during our careers. If we were lucky enough to have one while in dental school, we were in awe of their talents as their knowledge if techniques and materials far exceeded our own. Since it was still an all-male bastion during my tenure of dental education, I was also in awe of their beauty and dated a few when I had the chance. During a public health internship, IU worked in a federal prison as a dentist and have male inmates for dental assistants. These were generally large men with scars on their faces, guilty of armed robbery and murder. It was best not to get angry with these assistants unless you wanted a cleoid through your jugular. I felt no urge to date them. In the twenty-four years since graduation, I have experienced a serial monogamy of assistants whose talents have left me laughing, crying, but never bored.

EXPOSURES My first assistant was one of my best. She had never assisted before and since I had seldom worked with one, her abilities perfectly matched my expectations. She came with me on my year-long sojourn to British Columbia as a traveling dentist, about which I have previously written. She learned the procedures easily, was quick to laugh at my jokes and always came to work since there was nowhere else to go. An assistant who does not perceive you to be the second coming of Jack Benny is one to consider for early termination. After returning to Seattle and private practice, I found that I had to hire my own assistant and embarked on that learning experience. I placed an add in the paper, got lots of calls and began the interview process, which of course, I knew nothing about. Once, after talking to about a dozen people, I called the one who seemed to be the best all-around applicant. When she showed up for work the next day, I was horrified to discover that I had called the wrong one! I was too embarrassed to ever say anything, and she ended up working for me for five years. She was very good but of course, had her quirks. During one event, I was asking for a particular instrument, something I did about a thousand times a day, when instead of handing it to me as she had done every other time, she said with an exasperated tone, “You could say Please!” This was quite a shock but changed my behavior considerably. “Suction please, Dycal please, etc.” The patients must have thought I attended a Swiss finishing school.

This is actually kind of fun but I have to be careful not to watch her while she is mixing cement. She hates it when I watch her and will kick me under the chair if I do so. She is the only one I will go in the darkroom with. If another dentist or lab sends me some flowers because I did them a favor, I always bring them home to her like it was a special purchase just for her. My assistants have always felt this is the tackiest thing in the world and constantly chide me for it. I, on the other hand, being a man, see the practical side of floral recycling. I always wondered how much the patients are aware of the clandestine events of the dental office. My (then) assistant, Amy, is one of the more interesting staff members I have had. She was twenty-three years old at her date of hire. The first shock was that I was two years older than her father. I have always considered assistants to be my peers, not my children. Amy was very sweet and gentle and got along with other staff and patients. However, early on, I discovered she was afraid of the sight of blood. This is not the best phobia to have as a medical professional. When I would be doing surgery, sometimes the vacuum would be sucking up the patient’s ear wax as Amy would have her head pointed towards magnetic North. Another little problem she had was she was always sleepy. She would occasionally fall asleep while perched on the assistant’s chair during a long, boring root canal and come crashing down on us. This was fairly exciting, and I learned to fend her off with a left forearm before disaster struck. She had a social life that made Melrose Place look like Mr. Rogers neighborhood and kept us constantly entertained with sordid stories of young love. Despite these apparent failings, she was a good assistant and has taken a significant place in the social register of past employees of A. Munk DDS.

I have had older assistants who tried to mother me. I have had younger That’s all for now from Ballard. ones who I had to father. I have had religious ones who tried to convert me. My wife has filled in more than a few times between regular assistant hirings.

The views expressed are those of the writer and do not necessarily reflect the opinion or official policy of the Seattle-King County Dental Society.

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