UDA Action

CONTENTS PRESIDENT'S MESSAGE 4

The Dental Team – Your Best Friend And Most Valuable Asset

OFFICIAL PUBLICATION OF THE UTAH DENTAL ASSOCIATION

CONTRIBUTING WRITERS

ASSOCIATION 5

What The ADA—And UDA—Can Do For You!

6

Open The Door . . . Or Not

Dr Bruce Burton

12

Professional Conduct For Our Professional Organization

Dr Cody Calderwood

16

We Are All Looking For the Same Thing

Dr Rich Fisher

16

ADA Membership Dues To Decrease By 5% In 2024

20

ERISA Plans – What Dentists Should Know

ADA News Dr Terry L. Buckenheimer

Dr Laura Kadillak Dr Alex Mellion Dr Chris Salierno Dr George Shepley

CONVENTION

Dr Mark R. Taylor

4

Convention Hosting

Dr. Bryan Trump

8

UDA Convention 2024

Denise Williams-Jones

10

We Have a Plan

COVER PHOTO Photo Credit: visitutah.tandemvault.com/ Adam Clark Cedar Breaks National Monument, Utah

PUBLISHER: Mills Publishing, Inc. PRESIDENT Dan Miller OFFICE ADMINISTRATOR Cynthia Bell Snow GRAPHIC DESIGNERS Ken Magleby Patrick Witmer

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ADVERTISING REPRESENTATIVES Paula Bell Dan Miller

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HEALTH 14

Taking A Stand To Promote Systemic Health

LICENSING 4

Controlled Substance Database Tutorial

5

E-Prescribing Law

6

New Dental License Classification

PRACTICE 10

Is It Important To Set Goals In Dentistry?

11

Dentistry Is Changing!

15

Oral Pathology Puzzler: Do You See What I See?

18

There's No Hiding From AI

22

Where Are All The Dental Assistants And Hygienists

PRESIDENT'S MESSAGE THE DENTAL TEAM – YOUR BEST FRIEND AND MOST VALUABLE ASSET For every young football player, learning and mastering the fundamentals of the position they play is invaluable. Whether blocking, tackling, hitting, catching, or throwing, all are vital skills that each player must learn for their respective positions in order for the team to do well. The same could be said for any team sport. Another key ingredient for success is teamwork, or the ability to work well together. In fact, this is far more important to the success of a team than to have one or two extremely talented stand-outs that, for whatever reason, do not play well together.

I think we all have witnessed teams with immense talent, but lacking the chemistry to work well together. The less talented team that masters the art of teamwork will usually come out on top. Good teams are synergistic. The sum total of their output is far greater than just a tally of their individual components.

Dentistry is a team sport. Yes doctor, in the above analogy, you may be the quarterback; but if you do not have good blockers, or someone to catch your passes, your success as a dentist will likely be stifled. Every member of the dental team plays an important role. Each team member has a position to play, and each position is fundamental to the overall success of the team. When everyone plays their position well, the team does well. While there is no team without you as the dentist, no one is any more important than anyone else on the team, including you, doctor. The sooner you understand that, the better off for everyone.

Like many of you, I have been a part of some incredible dental teams over the years. Not only have they been a key element to my success, but many of these dental team members have become some of my best friends and closest confidants. I often marvel at how well many of them do what they do. Take the hygienist for instance. They put patients at ease, gather key diagnostic information and then wade through mung, gorp, and yesterday’s lunch, enabling you to clearly see everything and to expeditiously complete the examination. How about that dental assistant who can whip out temporaries, at least as well, or even better then you can, so you are able to move on to be productive

CONTROLLED SUBSTANCE DATABASE TUTORIAL For License Renewal by May 31, 2024, DOPL is requiring the completion of a ½ hour tutorial on the controlled substance database.

You will receive a notification by email.

Please make sure your email address is correct in DOPL’s system.

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with another patient in a nearby treatment room? Then there is that front office person who is so skilled with language, and so good with people, that patients look forward to conversing with them, even while sometimes parting with large sums of money.

These people are professionals. They are expert at what they do. They understand their position on the team, and often carry out their duties with near flawless perfection.

Doctors, are you listening to your team members? Most know their positions on the team very well, and understand their roles much better than you do. Doctors, are you adequately compensating your team? Every good team member deserves a piece of the action. Give them a stake in the success of the operation.

Incentivization is a wonderful motivator. Doctors, are you generous with your sincere praise and appreciation for each member of your team? Do you frequently let them know just how much they are valued?

Now, it goes without saying, some team members are better suited to play on your team than others. Do what you need to do to get the right people on your team, keeping in mind that no one is perfect. But then again, neither are you. Look for good team players that are teachable and get along well with others. Then invest in them. Give them the tools to be successful. Then, get out of the way and let them do their job. Lead, delegate and expect outstanding performance from each team member. Avoid the tendency to micromanage.

Now, all of this sounds pretty straightforward and easy; but I must admit, implementation can be challenging. Nevertheless, it is doable, and well worth doing. Doctor, do what you can to invest in your most valuable asset as a dentist, your dental team.

Treat them like family, because in many ways, they are family.

Be genuine, and do it for the right reasons. Do it because you care about them and their success. Do it because it will bring you more in dividends than any other single investment in your practice. This is especially important in our current marketplace, when finding and keeping good team members can be especially difficult.

Mark R. Taylor, D.D.S. UDA President

CONVENTION HOSTING Would you be interested in participating in the UDA Convention at no cost?

The UDA Convention Committee is actively seeking hosts to support our presenters throughout the two-day event. By volunteering as a host, we will waive your registration fee.

Reach out to Becky at the UDA Office if you’re interested in this opportunity.

November / December 2023

ASSOCIATION WHAT THE ADA—AND UDA—CAN DO FOR YOU! As we wrap up another year at the ADA, I was struck by the number of strides taken by hundreds of dentists to make sure our profession has a strong future. I was able to attend the ADA House of Delegates for the first time at a national level and want to share my experience with those members who, like me, may have had no idea what really happens in running the organization. The House of Delegates meets after the annual ADA Conference, with representatives from every state around the country. There is thorough discussion, debate, and amending of proposed resolutions for the ADA to adopt as policies. Throughout the meeting, districts meet to discuss important changes and goals for the coming year. In addition, the House votes and elects the future leaders of the ADA. The 4-day meeting is the accumulation of months of hard work from leading dentists across the nation, who voice and represent the concerns of dentists from every state. Though it was a new experience for me, I am glad to be able to learn from the veteran representatives and pass on the knowledge to the rest of our Utah members.

First off, I was able to interact with many of the national leaders that stand out in the field of dentistry. I was lucky enough to witness the campaigns of the new President-elect, Brett Kessler, and other competitors as they sought to fill leadership positions.

Brett Kessler, a Colorado based dentist, has been our District 14 Trustee for the last 4 years, and I am proud to say that the Utah Board helped support his success in becoming the 3rd person from our District to become ADA President. Though the competition was high, the campaigns of all the candidates centered around some main topics of importance: how to evolve as a professional association as the workforce changes, how to include DSO-based and employee dentists in our profession, encourage and support newer dentists, and how to handle social media

with all its implications on our individual members. These topics were all so thoroughly discussed and debated in not only our own district but at a national level as well. Utah is only one state, but it made me realize that many of our struggles are shared across the country, and strong representation is important in addressing these issues. Having these conversations with your district and state representatives ensures that your voices are heard, which is the first step to enacting change.

The ADA has many policies and resources in place, which are built to support and aid dentists in many aspects. For example, the ADA offers guidance with private practice support, legal advice, and even tips on physical and mental wellness for practitioners. There are standards and guidelines established by the ADA based on scientific and evidence-based sources, such as how to approach the treatment of patients with varying conditions. These resources are often developed through the work of the House of Delegates and the committees that work to make policies and support available for all members. As a first-time delegate from Utah, I was able to see firsthand how changes can be made by even just a few individuals. Even legislative changes can be easier to enact with the support available from national experts. Massachusetts was recently able to head extensive change in their state on insurance reform with ADA support. Now the ADA is pursuing similar changes at the federal level and encouraging other states to follow suit. When I hear members complain that the ADA “doesn’t do anything” for them, I would encourage those members to reach out to their representatives for whatever help they need. If the resource doesn’t already exist, then create it! Many changes were made because of individuals who saw a need and proposed a solution. Contact your local or state representatives to advocate for you, and you may be surprised at what the ADA—and UDA—can do for you!

Dr Laura Kadillak ADA Delegate

LICENSING E-PRESCRIBING LAW Beginning January 1, 2022, Utah Code Annotated 58-37-22 requires that most prescriptions issued for a controlled substance be transmitted electronically as an electronic prescription.

1. Submit the required form to DOPL for the exemption.

This is an agreement to write very few Controlled Substances Prescriptions a month. (This form will be available in December 2023)

Many of you filed a waiver or extension with DOPL that allowed you up to two years before implementing an E-prescribing system in your office. These extensions expire on December 31, 2023.

The Utah Dental Association has worked with DOPL and negotiated an exemption for those providers that prescribe very few Controlled Substance Prescriptions per month. This exception is expected to go into effect in January 2024.

In order to qualify for this exemption, you must.

2. You will need to write or print on EVERY Controlled Substance Prescription. “Unable to submit electronically” or “Exempted from e-prescribing.”

DOPL reminds prescribers this rule applies also to Benzodiazepines.

The UDA office will send information when the form for exemption is made available. Or watch the DOPL website for availability. https://dopl.utah.gov/dentistry/

UDA Action

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ASSOCIATION OPEN THE DOOR . . . OR NOT Earlier this summer I was busy helping coach my son’s soccer team. It was an evening like most others with the sun falling in the west. Just as we began running a drill there was a loud explosion followed by another minor explosion adjacent to the field. Heads snapped toward the sound as a large white and black object crashed back to the ground. At that instant fear and a desire to help flooded my mind and body. Realizing that the object was a vehicle, practice took on less importance, and a couple of us coaches ran to hop a fence to get to the vehicle. Assessing the situation up close with wheels still spinning, liquids covering the ground (radiator fluid not gas), traffic had stopped, one guy was calling 911 but most surprising to me, I could not see inside the vehicle. All the windows were covered with exploded airbags making it impossible to see what was going on inside the vehicle. Screams for help mixed with sirens in the background and now odors of melting plastic but again the biggest surprise feeling was the fact that I had to do more to help. I had to find out exactly what was going on with those who were screaming inside. I had to open the door! I hesitantly tried the passenger’s front door; it would not budge. The next door was the passenger rear door and with some effort and wiggling I was able to get it ajar to expose the interior content.

Since being asked to consider running to be an officer in the Utah Dental Association (UDA) I have been asking dentists their thoughts about the American Dental Association (ADA).

Most have said they are members and are aware of the benefits, “happy” with what the ADA is doing for them. Several have revealed that they are no longer involved, either life just being too busy with other things or because they felt that organized dentistry failed them in some cause.

I liken the ADA to the vehicle and its contents. Twenty years ago, when I graduated from dental school, it seemed like if you surrounded yourself by dentists who were involved with the ADA you joined and stayed a member. For a long time, the

ADA has been traveling down the road very much acting like everything is just fine and believing membership percentages would return if they just stayed the course. Today the ADA has been flipped on its head. In the past the ADA believed that dentists would stay active because of their vision of science and research, evaluating standards, the ADA seal of acceptance, or advocacy. Now I would say they are in fact screaming to all dentists trying to get input as to what we as a profession value most. Some answers are dental insurances are too involved in machining our policies, or we need better workforce legislation, or how can we improve mental health awareness to assist dentists and their teams, or how do I even do dentistry in the real world outside of dental school?

The UDA and ADA leadership is listening, not just because membership is falling but because they want to improve the unity and health of our profession now and into the future.

However, if you don’t open the door, you will never know what the ADA is working on nor will your voice be heard. I did finally find out what was inside the upside-down vehicle. It was a mother and an infant. I emerged with a baby in my arms and the other coach a near non-consolable mother. She had struck a parked car when traveling 45-50 miles an hour while trying to reach behind her to return a pacifier to her baby’s mouth. The force of the impact launched the parked car up an embankment 10 feet and, in the process, threw her own SUV up into the air causing it to spin and land on its roof. Not what she had expected. I invite you to open the door and take action. Don’t just stand around watching. Let’s make the UDA /ADA what you want it to be! BUT you will have to make the effort to get the door open.

Dr Rich Fisher 801-948-3053 UDA Treasurer Please reach out to me or anyone of your UDA presidency or Utah ADA delegate members if you have questions like how to get involved or to just vent.

LICENSING NEW DENTAL LICENSE CLASSIFICATION 2020

DOPL has made adjustment to the license classification hopefully making it simpler.

You should have received an updated license from DOPL in October which shows which classification you are in. Please make sure you received that and are classified correctly.

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2023 Conversion

For 2024

Local and Nitrous only A & B- (No Oral Sedation)

Class A

Local

Class B Class C

Nitrous only Minimal

Class D

Moderate

D- Moderate

Class E

Deep

E- Deep

C- Minimal

November / December 2023

PROTECT THE VALUE of Your Practice Practice owners should always have an up-to-date Practice Valuation,

meaning a professional appraisal that has been completed or updated in the past 12 months.

Besides helping you set a listing price when you are ready to sell your practice, Practice Valuations are needed to: • Evaluate what factors are affecting the value of your practice • Write a Letter of Instruction (LOI) • Apply for financing • Form merger/partnership agreements A Henry Schein Dental Practice Transitions valuation considers both tangible and intangible assets of the practice and can provide the many key factors that influence the practice’s value.

To get started on your practice valuation, give me a call at:

801-319-4161

or scan the QR code to schedule a complimentary consultation.

Jeff Harmon Transitions Sales Consultant 801-319-4161 Jeff.Harmon@henryschein.com

www.henryscheinDPT.com

© 2023 Henry Schein, Inc. No copying without permission. Not responsible for typographical errors. 23PT2801

n PRACTICE TRANSITION PLANNING n SALES & VALUATIONS

n BUYER REPRESENTATION

CONVENTION UDA CONVENTION 2024 It’s an amazing time to be involved in the profession of dentistry. We have wonderful technology at our disposal to make our lives much easier and to help our patients enjoy better oral health care. We have a high level of job security many industries don’t experience in this turbulent economy. And we have access to an incredible amount of continuing education.

We are fortunate to have the Utah Dental Association convention coming up on February 1-2, 2024, at the Salt Palace. We have dozens of speakers presenting a variety of topics that should interest the entire dental team from dentists, to assistants, to hygienists, to administrative team members. In terms of continuing education, it easily the best bang for your buck that you can find for in person CE. Please feel free to check out the program and find some courses that you would like to attend.

While you are there, I encourage you to go check out the exhibitor hall and visit some of the vendors that you use in your practice. You will find that they offer convention-specific deals that will save you some money on items or services you are already using. Who doesn’t like to save money? I often am able to save a

few thousand dollars by ordering items there. As you browse the hall, you might find that there are some new products and services you were not aware of. I know that I have been the beneficiary of finding and implementing new and improved products from my time interacting with the vendors.

One of the best benefits from attending the UDA convention is the camaraderie that we can find while there. Interacting with our colleagues and catching up with friends is a huge bonus of attending the convention. As humans we are social creatures.

We need that interaction and connection with other individuals.

Sometimes as dentists we can feel isolated in our dental practices.

Let’s look to engage with each other and support each other in our dental journeys, and the UDA convention is a good opportunity to do just that.

Mark your calendars, set aside those days to attend, and encourage your office team members to accompany you. It’s a great opportunity to help them feel energized about their profession and to help your team grow closer together by engaging in dentistry outside of the office. I’m looking forward to another wonderful convention. Come say hi if you see me there!

Cody Calderwood, DDS UDA Convention Scientific Chair

MORE INFORMATION AT WWW.UDA.ORG 8

November / December 2023

2024 UDA CONVENTION Over 20 Presenters Over 50 Different Presentations Hands-On Courses for Dentists, Hygienists & Assistants

Over 150 Vendors in the Exhibit Hall

PRACTICE IS IT IMPORTANT TO SET GOALS IN DENTISTRY? Convention Speaker Preview

We all talk about setting goals. Whether it is in our personal life or career it seems to be the subject on everyone’s lips. We make lists, set dates, and constantly refer back to them and gauge if we accomplished what we set out to do. But here is the question I would like to propose, is setting goals important in dentistry or a waste of our time?

What is a Goal?

The definition of a goal is “the result or achievement toward which effort is directed; the object of a person’s ambition or effort; an aim or desired result.” Goals are accomplishments you want to reach over a precise period. Setting goals is a way to improve your performance and reach new heights. It can give you short-term motivation and drive. Goals can push you beyond your limits, inspire new behaviors, provide direction, and give you purpose in life.

Value of Goals in Dentistry We all want to be successful in our dental office. Regardless of your position, you want to be successful. You want the win for the team and setting goals in your practice can help you achieve those wins. Goals provide you with a sense of direction and purpose. They give you a clear target to work towards and help you stay focused on what is important to you. They help you get the job done. Working in dentistry is very stressful at times and it can get a bit overwhelming trying to get everything done on time. Let’s use the example of patient care and goal setting and see how this all ties in together.

Our main purpose is to deliver optimal service to our patients.

We want our patients to walk away from their interaction with us and feel that they receive the best possible care. To accomplish this, we must have a particular way that we want our practice to operate and make sure it happens the same way every time. If we set a goal for this, we become more accountable for our actions, thus holding ourselves responsible for taking the necessary steps to achieve it. We begin to prioritize our tasks and activities.

One Goal Fits All? One goal does not fit all. There are yearly goals, quarterly goals, monthly goals, weekly goals, and daily goals. Why so many?

Because you cannot manage what you do not measure. Remember one of the purposes of the goal is growth and self-improvement. In this case, team improvement. Goals are typically quantifiable or measurable. This allows you to track your progress and see how far you’ve come.

Once you can measure your progress, you can properly manage your progress. Next, you can allocate your time and resources to the things that will help you achieve your goals.

When you set goals, it forces you to think about what you want, and instead of allowing others to tell you what to do and how to do it, you start living a life of your conscious conceptions.

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You stop practicing on autopilot. You start running your practice with mindfulness and it propels you to the next level of success.

Ready, Set, Go! Goal setting does not have to be boring. Tony Robbins said, “Setting goals is the first step in turning the invisible into the visible.” No one wants to go through life being invisible and going through the motions. You surely do not want to run your dental practice in this way. The competition is tough and there is a dental practice on almost every other corner. If you want to stand out, you must find a way to set yourself apart from other dental offices and retain your patients. When you set goals, it gives you a vision to work toward. It ensures that you are doing things with a purpose. You are not waiting for things to happen; you are making things happen. You stop being invisible and start to showcase why your office is the best choice.

Once you set your goals, remember that goals can be adjusted and adapted as circumstances change. So, feel free to adjust as needed. When you meet obstacles do not give up. Figure out a way with your team to solve whatever problems arise. In turn, your problem-solving skills are being sharpened.

Achieving your goals can bring a sense of accomplishment and satisfaction to the whole team. It will boost the office’s self-esteem, and this will reflect in how you treat your patients. Another thing it will do is strengthen communication and support between the team because you are all working on a mutual outcome.

So, back to my original question, is setting goals important in dentistry or a waste of our time?

I hope after reading this article you realize the answer is yes, it is very important and is a powerful tool to bring your office closer together, create a higher standard, and ultimately provide better care for your patients.

Denise Williams-Jones, RDA Next Level Success Denise Williams-Jones will be presenting at the 2024 UDA Convention on Thursday, February, 1.

WE HAVE A PLAN! If you think the UDA convention could be better but don’t want to complain or worse yet, be put on a committee. I have a plan for you. If you are good at extracting information (pivot charts, etc) from a spread sheet, contact me, Dr Craige Olson, Dotty Tanner or Becky Waters. We receive survey information every year after the convention. We feel it could be used better. You can do all this from the comfort of your own home and at your convenience! Your help could make a big difference.

November / December 2023

PRACTICE DENTISTRY IS CHANGING! Dentistry is changing! One of the last, “Cottage Industries,” is undergoing consolidation! Small and large group practices are being formed and taking the shape of Dental Service Organizations (DSOs), corporate entities and private equity holdings.

The practice of dentistry used to be single dentists owning their concierge, solo practices.

But, as the market changes, the American Dental Association’s (ADA) Health Policy Institute (HPI) is finding that fewer dentists are privately owning their own practices and dental procedures are being done by dentists in these consolidated clinics with profit, overhead control and EBITDA (earnings before interest, taxes, depreciation and amortization) being the key ingredients to success.

Some dentists fight the changes occurring, while other accept this new market of dentistry and sell their practices at above-average prices. Neither approach is right nor wrong, and it all boils down to how we, as dentists, want to treat patients that have entrusted their oral health to our care. ... Although my past experiences as president of our local society, component and state dental associations and trustee of the

ADA have influenced my thought processes, I hope this article will not be viewed as prejudiced toward any particular workforce model.

Solo practitioners could work at a pace that fits their needs. They knew their margins and needed enough income to cover overhead and team member costs and then have enough left to live comfortably, provide for their families and save for retirement. The patient care models for DSOs and corporations is more geared towards production. To ensure a high patient flow, patients are driven to these practices by marketing plans and social media campaigns. Staff in these locations perform quicker to see more patients. Dentists in these settings are asked to generate a certain amount in fees to keep the engine running. It can lead to higher incomes for staff because of the increased work, but burnout can happened because of the more rapid pace of the practice.

Because dentists are employees of the corporation or DSO, they know the amount of income they are guaranteed, and then bonuses are sometimes worked on the amount of production generated. They can sign a contract providing enough income for their debts and a nice living. But they are employees, and

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UDA Action

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thus there are limitations to earning power of the dentist. Getting several dentists to work in these settings is relatively easy. New graduates looking for a place to settle and older dentists selling their practices and working for the corporation are all sources of dentists looking for work at a DSO. When a dentist and staff member do not make a good team, there are enough places within these settings to change locations for one or both employees. Since pay is typically higher at the DSO practice, assistants and hygienists are attracted. In traditional models of solo dentists or small groups, assistants, hygienists and front desk staff have a “normal” workflow but advancement to higher-paid positions maybe somewhat limited.

Another trend impacting dentistry is the advancements in technology. Diagnostic tools, digital imaging, practice software systems, scanning, 3D printing and many other advancements are costly. Because of their structure and financing, large DSOs and corporate practices can pool their cash together to purchase these advanced technologies. Single-owner practices may be more limited in their revenue to make such large technological purchases. Large practices with several offices usually acquire better prices when purchasing larger quantities. As for the workforce, those more seasoned assistants and hygienists may need help keeping up with the demands of modern practices. Their choice might be to retire early or become employed part-time to avoid the demands.

The ADA has something to offer dentists working within the DSO’s and corporate practices.

Advocacy for the proper treatment of patients, oversight of insurance practices and governmental agencies interference are all issues best handled by organized dentistry. The HPI of the ADA provides insight into both the newest trends in dentistry and into making the best decisions concerning the economics of the dental profession. Trends can also be determined regarding artificial intelligence and its use in providing common and predictable diagnostics within a practice using multiple providers.

Even with the effects of COVID, the loss of many employees in the dental field, and the changes in the way dental care is delivered, the future is bright for dentistry. The efforts of dedicated people especially dentists who put the care of patients before all else will eventually solve the problems associated with the trends we face today.

Terry L. Buckenheimer, DMD 12

ASSOCIATION PROFESSIONAL CONDUCT FOR OUR PROFESSIONAL ORGANIZATION Our Board of Trustees and Executive Director have done a wonderful job expressing why it is time for urgent and widespread change for the American Dental Association. The changes for the Tripartite (what I like to call TEAM ADA) that is made up of the component, constituent (state) and national organization will be exciting and challenging. Going forward, we, as members of the ADA, will be discussing the changes put forward by the Trustees, the Strategic Forecasting Committee and the Councils.

We, your teammates on the Council of Ethics, Bylaw and Judicial Affairs (CEBJA) want to encourage everyone that we should all look at everything through the lens of our Principles of Ethics and Code of Professional Conduct (“Code of Professional Conduct”) and the ADA Member Conduct Policy.

Per the Principles of Ethics and Code of Professional Conduct; the five principles of ethics are 1.

Patient Autonomy “Self-Governance”

2.

Non-Maleficence “Do No Harm”

3.

Beneficence “Do Good”

4.

Justice “Fairness”

5.

Veracity “Truthfulness”

It is extremely critical that we all live by these principles so that dentistry remains a profession and does not become a trade. The public trusts dentists to self-regulate to a large degree, and it is imperative we continue to live up to this responsibility.

The vision for CEBJA is to enhance the ethical conscience of dentists by promoting the highest ethical and professional standards in the provision of oral health care to the public. We need your help to achieve our goal by fulfilling this vision.

The Code of Professional Conduct and the ADA Member Conduct Policy address how we as dentists interact

with our patient and also with each other in a respectful and safe manner.

During the four years I have been on the Council, I have witnessed increased breakdowns in how we engage fellow leaders at the constituent and component levels. All ADA members are obliged to follow the Code of Professional Conduct as members of the ADA. We encourage constituent and component society volunteer to consider the ADA Member Conduct Policy if they have not done so already. It is a great reminder of how we should conduct ourselves as leaders and teammates. If unhealthy conflict happens, the Code of Professional Conduct and the Member Conduct Policy provide a baseline for what is acceptable and what is not. If you would like any help with this, just let CEBJA know. Contact us via email at cebja@ada.org.

A quote from football coach Chip Kelly of the UCLA Bruins: “If you are not going to say it, who is? Sometimes, that excuse of “Well, I’m not a vocal guy” is your excuse to being selfish. To be a leader, you have to serve.

You have to be able to get out of your comfort zone. Maybe you don’t like talking in front of a group. But that’s what this team needs. Are you willing to do that to get us to compete at the level we have to?”

As we navigate the changes ahead for our organization, I hope all of us will speak up and move beyond our comfort zone. I ask that we let our Principles of Ethics and the Code of Professional Conduct and ADA Members Conduct Policy provide us with a guiding ethical lens while we take advantage of the opportunity to change TEAM ADA for a brighter future.

Dr Bruce Burton Chair of CEBJA November / December 2023

HEALTH TAKING A STAND TO PROMOTE SYSTEMIC HEALTH For more than a century, the American Dental Association (ADA) has been the leading voice of oral health in our nation.

Today, as we continue to understand the integral role oral health plays in systemic health, the ADA is uniquely positioned to take its leadership further and forge new paths toward a healthier society. Addressing the harmful effects of excess dietary sugar consumption on oral and systemic health is an important step in that direction.

Added sugars, found in a wide array of ultraprocessed foods and beverages, have become a staple of the modern diet. Although a little sugary sweetness may be fine as an occasional treat, the overconsumption of added sugars (the US Food and Drug Administration recommends no more than 50 g of added sugars per day) can contribute to oral conditions like caries and periodontitis which may increase the risk of systemic conditions like type 2 diabetes and cardiovascular disease.

Dentistry has long been at the forefront of disease prevention and treatment, and although oral health is the ADA’s area of expertise, the concern for the whole-body health is an area of focus as we strive toward a vision of optimal health for all.

Recognizing the impact of nutrition and diet on oral and systemic health – as we have done with the use of tobacco products for example – has proven to be an important next step in that pursuit.

Through its policies on diet and nutrition, the ADA advocates for education, public awareness, patient information, and continued research on the impact of sugar on oral and overall health.

This year, I appointed a Presidential Task Force on Sugar, Nutrition, and Diet, which includes representatives from the Board of Trustees, the ADA Council on Advocacy for Access and Prevention, The Council on Government Affairs, the Council on Scientific Affairs, other ADA members and subject matter experts from dentistry, dietetics, and endocrinology. The members of the Task Force have completed their requirement of reviewing the existing policy, making recommendations for policy changes, and proposing future strategy considerations to expand the ADA’s involvement with other health care stakeholders and facilitate dental-medical collaboration on the topic. This information will be presented to the Board of Trustees and the action of the Board of Trustees will determine future steps and efforts.

Interdisciplinary collaboration continues to emerge as a path forward in the future of oral health care, and the ADA has embraced this concept in reaching key populations. For example, as part of our health equity activities, the ADA works with the American Academy of Pediatrics’ Section of Oral Health and its network of Chapter Oral Health Advocates, which is composed of pediatricians and pediatric dentists who educate families about oral health in medical settings. I believe that similar

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collaborations on diet and nutrition could make a meaningful impact on the state of oral and systemic health in our nation.

The ADA is among other major oral health and health care organizations sharpening its focus on this topic. In addition to the World Health Organization, which has issued guidance on how best to limit sugar intake, the FDI World Dental Federation has policies on sugar consumption and also launched initiatives to address excess sugar consumption through its Vision 2030 capacity-building workshops in partnership with the Indian Dental Association. Some outcomes of these workshops were the development of the “Mumbai Declaration on Sugary Drinks and Healthy Foods” and the observation of the National No Sugar Day, which was held for the first time on November 1, 2022.

The momentum from India spurred leaders and dental associations from the Caribbean Community (CARICOM) to become involved, resulting in the development of the “CARICOM Declaration on Sugar-Sweetened Beverages,” creating a model that can be adapted for use in other nations. In addition, the FDI World Dental Federation is working on a white paper to address the issue.

In the United States, nutrition is also an area of interest for the Biden Administration, which has launched an initiative to end hunger and increase healthy eating by 2030. One of the objectives is to reduce the national incidence of diet-related diseases like diabetes, obesity, and hypertension.

In March I had the honor and privilege to serve as the ADA’s representative at the White House Conference on Hunger, Nutrition, and Health in Washington DC. I joined other health care leaders from across the country, and experts challenged those in attendance to take action to reduce diet related diseases. I am pleased that with the ADA’s latest efforts, dentistry is well posed to do just that by taking a leadership role in the critical discourse on the impact of diet on oral health, and overall health.

To continue the conversation for instance, the ADA Council of Advocacy for Access and Prevention hosted a webinar in March in honor of World Oral Health Day and Nutrition Month to provide awareness and a deeper understanding of the connection between nutrition and its impact on oral health.

Through education, research, advocacy, and interdisciplinary engagement, the ADA can transcend its role as a leading voice in oral health and become a respected leader in shaping health care at large. We can pave the way toward a healthier society in which oral health is not only a priority but an essential pillar of overall well-being. Ultimately, we have the power to drive positive change and improve the overall health of our nation. We make people healthy, and now is the time to put it into action.

Dr George Shepley ADA Past-President

November / December 2023

PRACTICE ORAL PATHOLOGY PUZZLER: DO YOU SEE WHAT I SEE? Case History: 31 year old male with “dark lesion” on attached gingiva apical to tooth #9 that was excised 4 years ago. New lesion noted in same area.

Which of the following represents the best diagnosis for the clinic findings: A)

Pyogenic granuloma

B)

Peripheral giant cell granuloma

C)

Peripheral ossifying fibroma

D)

Fibroma (inflammatory fibrous hyperplasia)

(continued on page 17)

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UDA Action

15

ASSOCIATION WE ARE ALL LOOKING FOR THE SAME THING Current graduates now turn to their favorite dental “influencer,” podcaster or YouTube channel to find the latest tip or review of the latest dental material.

Photo: Image licensed by Ingram Image

How we communicate as dental colleagues has changed quite a bit in the last 10 years. Younger dentists share stories in text threads with dental school classmates and you may connect with a referral through a text rather than sending a letter or picking up the phone. These changes can be felt throughout organized dentistry as the “baby boomer” generation is beginning to retire and the new generation of “Gen Z’s” communicate differently than past generations. I feel that the heart of membership is still about creating and maintaining the community of our profession. That community looks different now than it did a generation ago, as the monthly membership meeting or local society golf outing is not attended as it once was. But community is still at the core of the dental profession. While our profession is made up of dentists of different generations, I feel that many dentists are looking for their community or “tribe” but want to connect in their own way.

When I graduated from dental school 12 years ago, online discussion boards were popular but there was little additional learning that was done online. Over the last 10 years, online social media groups and virtual study clubs have given the sense of community that previously existed in written journals or in-person meetings. Almost any clinical question can now be answered in minutes with a photo and a quick post online.

It has been encouraging to see the American Dental Association recognize and embrace these changes in learning and communicating as they have found ways to evolve their messaging and reach younger dentists. One recent initiative is the ADA Member App. It is an easy way to stay up to date on the latest news, events and research topics in dentistry. It also allows colleagues to connect directly with a mentor or directly reach a dentist in a easy-to-communicate platform. In its current form it highlights the success of organized dentistry at the national level and I’m excited for future iterations that will allow it to become the goto for all discussions and topics dental related.

Next, there have been different dental influencer pilot programs from the ADA New Dentist Committee. The goal has been to share the message of organized dentistry on different platforms that reach younger dentists differently from traditional print or email. This approach has been a great success as students have reached out to these influencers for advice and to speak at the ASDA programs. For those on Instagram, check our @jamesleedmd and @thedailydentist for a glimpse of these successful “dental influencers.”

Lastly, I personally listen to podcasts daily and I know many of my colleagues do as well. Check out the ADA’s Dental Sound Bites or CEBJA’s Dental Dilemmas for a different take on current trends and ethics in dentistry. These podcasts bring up some great topics of discussion and keep you up to date on the changing landscape of dentistry.

While these means of communication are different from the traditional peer-to-peer interactions that were commonplace a generation ago, building on these communication successes will help to keep organized dentistry as the premier organization when it comes to all things dental related.

Dr Alex Mellion ADA District 7 New Dentist Committee

ASSOCIATION ADA MEMBERSHIP DUES TO DECREASE BY 5% IN 2024 Active ADA member dues will decrease to $570in 2024 as part of the Association’s commitment to supporting the tripartite and its members.

The ADA House of Delegates voted October 10 to adopt the dues rate proposed by the ADA Board of Trustees. The decrease of $30, or 5%, from 2023 will help keep the ADA rate in balance with the dues rates of state and local organizations, which may need to increase their own rates because of inflation.

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“This approach can help lessen the net impact to our members,” said ADA Treasurer Ted Sherwin, DDS. “Moving forward, membership dues will drive budgets rather than budgets driving membership dues. Our 2024 budget process is designed to be member and mission focused and be delivered on a quarterly basis in order to improve member value at the speed members want it.”

ADA News November / December 2023

Oral Pathology Puzzler (continued from page 15) Correct answer: (b) peripheral giant cell granuloma When a patient presents to the dental office with a “bump on the gums” it usually represents one of the diagnoses below but a biopsy and histologic examination is the standard of care as it may represent something completely different.

A pyogenic granuloma is not a true granuloma, but rather a reactive lesion to local irritation or trauma (poor oral hygiene). It can exhibit rapid growth and has a predilection for the gingiva.

It tends to be more erythematous due to the increased vascularity from proliferation of capillary blood vessels within the granulation tissue. It occurs most commonly in children and young adults. Treatment is surgical excision. Lesions occasionally recur. For lesions developing during pregnancy, defer treatment (as they can spontaneously resolve) unless functional or esthetic problems develop.

Peripheral giant cell granulomas are also reactive lesions caused by local irritation or trauma and occur exclusively on the gingiva or edentulous ridge. Clinically, they are often more blue/ purple compared to the bright red of pyogenic granuloma, as noted in the clinical photo submitted. The overlying mucosa is ulcerated in 50% of cases (Neville). As the biopsy is performed, a “cupping” resorption may be noted in the underlying alveolar

bone. Treatment is local surgical excision down to underlying bone. In this clinical case, the previous “melanotic lesion” noted years prior is consistent with the blue/purple discoloration present with peripheral giant cell granulomas. The previous biopsy material was reviewed from 2019 and was a peripheral giant cell granuloma. The present lesion represents a recurrence. A 15% recurrence rate is noted in the literature.

Peripheral ossifying fibromas also occur exclusively on the gingiva and may appear as a nodular mass, usually originating from the dental papilla. Half of cases occur in the incisor-cuspid region. These lesions can appear more “pale” to pink in color due to the formation of osteoid within the lesion. Treatment is excision down to periosteum and scale adjacent teeth. There is a reported 15% recurrence rate (Neville).

A fibroma is the most common “tumor” of the oral cavity and represents a reactive hyperplasia (not neoplasia) of fibrous connective tissue in response to local irritation or trauma. The most common location is the buccal mucosa along the occlusal plane.

Conservative surgical excision is curative.

Works Cited Neville, Damm, Allen, Chi (2016). Oral and Maxillofacial Pathology, 4th Ed. St. Louis: Elsevier.

Dr Bryan Trump

UDA Action

17

PRACTICE THERE’S NO HIDING FROM AI

Photo: Image licensed by Ingram Image

“How AI is used depends on why AI is being used.”

Sree Koka, D.D.S., Ph.D., dean of the University of Mississippi Medical Center, laid out the general and societal impacts of artificial and augmented intelligence to more than 75 people Oct. 6 at Promises and Challenges of Artificial Intelligence Applications in Dentistry (6152), part of a series of continuing education courses that focused on AI. Dr. Koka was among the speakers at the session, including Gregory G. Zeller, D.D.S., professor emeritus at the University of Kentucky; Christopher Balaban, D.M.D., vice president of clinical affairs at Overjet; Aruna Ramesh, D.M.D., associate dean at Tufts University School of Dental Medicine; Cindy V. Roark, D.M.D., senior vice president and chief clinical officer at Sage Dental Management; and Chris Salierno, D.D.S., Curious Consulting.

Health care providers will hear that AI improves efficiency and saves costs, Dr. Koka said. But they have to determine whether that relates to the quantity of care or quality of care. Is it to improve efficiency or cram more into the day, he said.

“If we get lost in this volume game, we’re never going to give better care, we’re just going to provide crappy care and more of it,” Dr. Koka said.

Robert A. Faiella, D.M.D., ADA past president and AI session moderator, explained that all dentists need to understand how this technology is being used in clinical practice today, how in will evolve over the years and why.

“The future of practice will actively engage these technologies,

18

and it will become more and more central to the delivery of care,” said Dr. Faiella, who is former chief dental officer for Overjet and chair of ADA’s Standards Committee on Dental Informatics Working Group 13.8 that authored a recent white paper on AI. “While dentists need to remain responsible for assuring the interpretation and delivery of the appropriate diagnosis and treatment recommendations for care decisions, the technology provides dentists with unprecedented clinical decision support tools, and its business applications will aid dental practices as it looks to create new efficiencies to improve the patient experience.”

As a standards development body under ANSI and participation in ISO, ADA is actively involved in helping to set standards to make certain dentists have access to the best application of this technology to improve care, Dr. Faiella said.

This year’s CE program at SmileCon was created to help build a solid foundation of understanding for dentists about the technology, current applications, and glimpse into the future.

AI can help dentists by giving diagnoses when there is human fatigue and distraction; accounting for a human exam that’s subjective judgement; and there are early lesions or abnormalities that may not be visible to the human eye, Dr. Ramesh said.

“What I would like to think of as AI is computers systems that enable us to explore and expand our access to knowledge and application to benefit health,” Dr. Ramesh said.

ADA News

November / December 2023

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ASSOCIATION

ERISA Plans What Dentists Should Know What is ERISA? What is ERISA?

The Employee Retirement Income Security Act of 1974 — The Employee Retirement Income Security Act of 1974 — commonly called ERISA — is a federal law that regulates commonly called ERISA — is a federal law that regulates employee benefit plans, including those for dental care. employee benefit plans, including those for dental care.

In general, dental coverage can be separated into plans In general, dental coverage can be separated into plans ERISA/Federal Law State Laws ERISA/Federal Law State Laws that are defined as either: “self-funded” or “fully insured.”

Self-Funded plans Fully Insured plans that are defined as either: “self-funded” or “fully insured.”

Self-Funded plans Fully Insured plans This distinction determines how the plan is regulated.

This distinction determines how the plan is regulated.

Self-funded plans are when an employer pays fees to an insurance carrier for certain administrative services, but the Self-funded plans are when an employer pays fees to an insurance carrier for certain administrative services, but the employer bears the cost of any employees’ health care claims. These plans are regulated by ERISA. employer bears the cost of any employees’ health care claims. These plans are regulated by ERISA. Fully insured plans are when an employer pays a premium to an insurance carrier, and the carrier pays the cost of health Fully insured plans are when an employer pays a premium to an insurance carrier, and the carrier pays the cost of health care claims for anyone in the plan (employees). These plans are regulated by state insurance laws. care claims for anyone in the plan (employees). These plans are regulated by state insurance laws.

What’s the issue?

What’s the issue?

Some carriers administering ERISA plans argue that since Some carriers administering ERISA plans argue that since ERISA is a federal law, it supersedes, or “preempts” state ERISA is a federal law, it supersedes, or “preempts” state insurance laws that protect patients. For example, if there insurance laws that protect patients. For example, if there is a specific dental insurance problem that a state legislature is a specific dental insurance problem that a state legislature passes a law to fix, like assignment of benefits, the selfpasses a law to fix, like assignment of benefits, the selffunded plans claim ERISA preemption to avoid compliance funded plans claim ERISA preemption to avoid compliance with that law. with that law.

Nationwide, approximately 46 percent of subscribers Nationwide, approximately 46 percent of subscribers are covered by self-funded dental plans. Those plans are covered by self-funded dental plans. Those plans fall under ERISA, and ERISA has historically proven to fall under ERISA, and ERISA has historically proven to be very difficult to amend. Since so many plans are now be very difficult to amend. Since so many plans are now covered by ERISA, and that number is growing, statecovered by ERISA, and that number is growing, statelevel insurance laws protecting patients and dentists are level insurance laws protecting patients and dentists are being rendered increasingly irrelevant. being rendered increasingly irrelevant.

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46%%

of subscribers are of subscribers are covered by self-funded covered by self-funded dental plans which dental plans which are proven to be very are proven to be very difficult to amend. difficult to amend.

November / December 2023

ERISA Impact on Dentists ERISA Impact on Dentists

Noncovered Services Noncovered Services Dental insurers in most states used to Dental insurers in most states used to dictate the fee network contracting dictate the fee network contracting dentists could charge for services dentists could charge for services insurers never covered, like elective insurers never covered, like elective cosmetic procedures. Most of the cosmetic procedures. Most of the states have passed laws that prohibit states have passed laws that prohibit this. So, why are insurers still able to this. So, why are insurers still able to dictate the noncovered fees even dictate the noncovered fees even if there’s a law saying they cannot if there’s a law saying they cannot do that? If they are administering a do that? If they are administering a self-funded plan, they may cite ERISA self-funded plan, they may cite ERISA preemption. preemption.

Assignment of Benefit Assignment of Benefit Many states have laws that require Many states have laws that require insurers to pay non-network insurers to pay non-network participating dentists directly, instead participating dentists directly, instead of the patient, for covered services of the patient, for covered services if the patient/subscriber requests if the patient/subscriber requests it. These are called Assignment of it. These are called Assignment of Benefit laws. But why are insurers Benefit laws. But why are insurers ignoring the patients AND the law? ignoring the patients AND the law?

Carriers administering self-funded Carriers administering self-funded plans may be refusing to comply plans may be refusing to comply and cite ERISA. and cite ERISA.

U.S. Supreme Court Limits U.S. Supreme Court Limits Preemption Preemption Recent U.S. Supreme Court findings Recent U.S. Supreme Court findings in a pharmacy insurance case pierce in a pharmacy insurance case pierce the ERISA protection for insurers, the ERISA protection for insurers, suggesting insurers’ preemption suggesting insurers’ preemption claims may have gone too far. claims may have gone too far.

The U.S. Supreme Court found that The U.S. Supreme Court found that pharmacy insurers’ claim of state law pharmacy insurers’ claim of state law exemption under ERISA was wrong; exemption under ERISA was wrong; it is time to shine a light on all insurers it is time to shine a light on all insurers who use ERISA this way. who use ERISA this way.

What should I do about it?

What should I do about it?

We need your help to show state We need your help to show state officials the magnitude of the problem officials the magnitude of the problem and to keep the momentum established and to keep the momentum established under the recent court case. under the recent court case.

Talk to your patients and your colleagues Talk to your patients and your colleagues about the specific laws insurers should about the specific laws insurers should be complying with. Also, talk with your be complying with. Also, talk with your state lawmakers and Attorney General state lawmakers and Attorney General about how ERISA preemption is hurting about how ERISA preemption is hurting their constituents. Creating public their constituents. Creating public awareness of the problem is the first awareness of the problem is the first step to reforming this federal law. step to reforming this federal law.

If you’re experiencing issues firsthand, If you’re experiencing issues firsthand, talk to your state dental association. talk to your state dental association.

Talk to your Talk to your patients patients

Talk to State Talk to State lawmakers lawmakers

What can What can You do?

You do?

Create public Create public Awareness Awareness

Contact your Contact your State society State society

Take Action! If you find that carriers are refusing to comply with noncovered services, Take Action! If you find that carriers are refusing to comply with noncovered services, Assignment of Benefit law, or any other law you know has been enacted in your state, document it

Assignment of Benefit law, or any other law you know has been enacted in your state, document it and communicate with your state dental association. The more evidence of insurers’ ERISA over-reach, and communicate with your state dental association. The more evidence of insurers’ ERISA over-reach, the better the chances they will be held accountable. The ADA and your state dental association are informing the better the chances they will be held accountable. The ADA and your state dental association are informing state lawmakers and enforcement agencies of this concern, highlighting recent U.S. Supreme Court findings that state lawmakers and enforcement agencies of this concern, highlighting recent U.S. Supreme Court findings that insurers have gone too far. They are also making sure state officials are aware that insurers may be taking an insurers have gone too far. They are also making sure state officials are aware that insurers may be taking an unfair advantage of ERISA and not complying with the laws state officials’ pass and enforce. unfair advantage of ERISA and not complying with the laws state officials’ pass and enforce.

UDA Action

21

PRACTICE WHERE ARE ALL THE DENTAL ASSISTANTS AND HYGIENISTS Why Practices Are Struggling to Find Talent It’s always a challenge hiring great people. But something that all dental practices are asking right now is: Where are the dental assistants and hygienists?

According to the ADA, almost three quarters of dental practices that are hiring hygienists say that the process has been “extremely challenging.” More than half say the same for hiring dental assistants.

The problem is worse than ever before — and it’s only grown more challenging since the pandemic.

So, why is this problem happening? And, most importantly, how do dental practices solve it?

It’s incredibly difficult to hire these critical team members right now.

The market is still reeling from COVID-19. There was an estimated 8% reduction in the hygiene workforce due to the pandemic. That included people who said, “You know, I’m 60 years old, and I’m a hygienist trying to do my job in the middle of all this craziness.

That’s it, I’m out.” Maybe these folks were burned out, or maybe they had a significant other who earned enough to keep things steady. Whatever the case may be, they retired early.

There was also a rise in dental assistants and hygienists working part time. There’s still data coming in on this piece, but for the same reasons people quit, others decided to shift to a part-time role.

This falloff in full-time employees caused a dramatic increase in wages because demand grew seemingly overnight. If a hygienist or dental assistant didn’t feel attached to their employer, they could take a position nearby for more money. A lot of practices tried to simply throw money at the problem, rather than taking a deeper look at how they operated.

I want to pause here to say that these developments were good for dental assistants and hygienists.

And this is good for the dental community overall, because dental assistants and hygienists are so integral to providing oral health care. In some cases, these folks were being underpaid, and the sudden demand for their services helped correct the market.

When they’re happy, we all win.

Also, it’s worth pointing out: Higher wages are a normal phenomenon whenever workers are in high demand. We’re absolutely seeing that now. Hygienists and dental assistants are specialized, licensed, highly skilled professionals. You can’t just pluck them out of thin air; they graduate from accredited programs. There’s a real limitation on the supply side.

But in the short term, these developments caused a lot of practices, big and small, to scramble. Some haven’t been able to pay the table stakes in this increasingly competitive game; they simply weren’t able to increase their wages and lost out on talent as a result. Here’s a big reason why: Reimbursement rates from third-party payers have not kept up with inflation — or have even decreased, in some cases. This is also a major reason why more than half of practices 22

don’t offer benefits to their dental assistants and hygienists.

So, what is the solution?

First, and perhaps most obvious, is to compete on wages and benefits. But simply throwing money at the problem isn’t enough.

You need to also add to your value proposition as an employer.

Make sure you’re a “best place to work.” Now, everyone says they want to have a great culture, but what do you actually do about it? Start with an employee NPS. Check in with the folks who work for you. Actually listen to their feedback and see how you can improve. Make sure you give them ways to grow.

There are plenty of really talented hygienists and dental assistants who have aspirations to do something else. Maybe they want to take on leadership, educational and managerial responsibilities. If you’re able to create that clear pathway that internally promotes, rather than just recruits from outside, that’s very attractive and goes well beyond wages and benefits.

Once you’re a “best place to work” — and understand why you are — make sure that your value proposition as an employer is clear.

Then, increase the size of the recruitment funnel. There’s a lot of ways to do this. But one way that’s underutilized is peer-to-peer recruitment. Find brand ambassadors within your company who live your mission, vision and values, and are emblematic of the culture you’re creating. If they’re excited to be able to go and preach from the highest mountain top, then empower them to do so. We feature our evangelist team members in our social media posts and send them to community events. We let their personal brands shine. Their enthusiasm and their passion are arguably the most effective recruitment tool we have.

Next, you want to improve retention. So, in addition to providing clear career pathways for folks, you need a best-in-class onboarding program. Rather than just being shown where the cafeteria is, employees need to be truly welcomed into the culture. When onboarding is done right, it removes a lot of speed bumps that could lead to premature turnover. Set your people up for success.

Dental practices can take this as a challenge — and rise to the occasion.

Yes, the statistics are daunting. But health care business owners can take this as a challenge to evolve their value proposition.

What does it mean to be an employee in your organization? If you’re just throwing money at the problem, you’ll attract mercenaries — not missionaries.

Raising wages is in many cases necessary, but that alone is a stopgap measure. It doesn’t lead to sustainable growth and creating a better environment for your employees.

And if you’re creating a better environment for your employees, your practice will be better for it.

Dr Chris Salierno ADA News November / December 2023

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