Issue 7 WSDA News July 2017

Issu

WSDA 7 201 ly · · ju e7

The voice of the Washington State Dental Association

news

ADVOCACY & ACTION

Also in this issue: PNDC IN PICTURES th e wsda ne w s · issue 7, july · 2017 · www.wsda.org · 1

“The entire construction process was completed in 60 days as promised. There were no hidden surprises and no unexpected costs. The finish of my office is exceptional and truly reflects my style. The whole experience was a lot less stress than I expected and there was never a moment I felt things were not right” —David Buck, DDS LVIM

C O N S TA N T 2I N· EthB I L Dne EwRsS·. issue C O M7, july · 2017 · www.wsda.org eU wsda

a day in the life

Dentists attend the special WDS session at the PNDC

WSDA news PNDC Images by Scott Ecklund/Red Box Pictures

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editorial

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guest editorial

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member news: delta initiative part 1

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member news: delta initiative part 2

8-11 12-15

legislative review legislative news, dso review

16-23

pndc in pictures

24-29

dentistry 2040, part 2

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issue 7 · july 2017

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in memoriam

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letter to the editor

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clinical corner

39, 41, 43, 45 54

classifieds

first person: dr. brittany dean

regulatory news

Like us on Facebook: www.facebook.com/WashingtonStateDentalAssociation WSDA News Editor Dr. Mar y Jennings

Dr. Ashley L. Ulmer Dr. Amy M. Winston

Continuing Education and Events Coordinator Sarah Quigley

Editorial Advisor y Board Dr. Brittany Dean Dr. John Evans Dr. Julie Kellogg Dr. Stephen Lee Dr. Joseph Vaughn

WSDA Staff:

Membership Ser vices Coordinator Rachel Gunderson

Washington State Dental Association Dr. Bernard J. Larson, President Dr. Cynthia R. Pauley, President-elect Dr. Nathan G. Russell, Secretary-Treasurer Dr. Bryan C. Edgar, Immediate Past President Board of Directors Dr. Theodore M. Baer Dr. Marissa N. Bender Dr. Dennis L. Bradshaw Dr. Christopher Delecki Dr. Linda J. Edgar Dr. Todd R. Irwin Dr. Christine L. Kirchner Dr. Eric J. Kvinsland Dr. Randall H. Ogata Dr. James W. Reid

Executive Director Bracken Killpack Assistant Executive Director Kainoa Trot ter Controller Peter Aaron Director of Government Affairs Mellani McAleenan Director of Operations Brenda Berlin

Membership and Communications Coordinator Emma Brown Bookkeeper Joline Hartman Administration and Financial Coordinator Tom Harshbarger Association Of fice: (206) 448 -1914 Fax: (206) 443 -9266 Toll Free Number: (800) 448 - 3368 E- mail/web: info@ wsda.org/wsda.org

Ar t Director/Managing Editor Robert Bahnsen Director of Continuing Education and Events Emily Rademacher, CMP Government Affairs Associate Emily Lovell

th ee wsda wsda ne ne w w ss ·· issue issue 7, 7, july july ·· 2017 2017 ·· www.wsda.org www.wsda.org ·· 3 3 th

In the event of a natural disaster that takes down the WSDA web site and email accounts, the WSDA has established a separate email address. Should an emergency occur, members can contact washstatedental@gmail.com.

The WSDA N ews is pub lishe d 8 time s ye arl y by t he Washington State Dental Association. Copyright © 2017 by the Washington State Dental Association, all rights reser ved. No part of this publication may be reproduced without permission of the editor. Statements of fact or opinion are the responsibility of the authors alone and do not express the opinions of the WSDA, unless the Association has adopted such statements or opinions.

Subscription price is $65 plus sales tax per year for 8 issues of the News. Foreign rate is $97.92 per year. Advertising is published as a service to readers; the editor reserves the right to accept, reject, discontinue or edit any advertising offered for publication. Publication of advertising materials is not an endorsement, qualification, approval or guarantee of either the advertiser or product. Communications intended for publication, business matters and advertising should be sent to the WSDA Office, 126 NW Canal Street, Seattle, Wash.

98107. ISSN 1064-0835

Member Publication American Association of Dental Editors.

Winner: 2016: Platinum Pencil Award, 2015: Platinum Pencil Award Honorable Mention, 2014: ADA Golden Apple Award for Outstanding Achievement in the Promotion of Diversit y and Inclusion, 2013: Journalism Award, Platinum Pencil, 2012: Journalism Award, Best Newsletter, Division 1, 2012: Platinum Pencil Award Honorable Mention (2), 2008: Best Newsletter, Division 1, 2007 Platinum Pen Award, 2006 Honorable Mention, 2005 Platinum Pencil Award, 2005 Publication Award; International College of Dentists

table of contents issue 7, july 2017

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editorial dr. bj larson

New practice ownership law: legislative success with patient safeguards

Dr. BJ Larson President, WSDA

“WSDA believes that this legislation provides the strongest enforcement mechanisms in the nation to curb the unlicensed practice of dentistry by third parties, and that it can serve as a model for the dental practice acts in other states.”

Dr. Mary Jennings, WSDA News editor, welcomes comments and letters from readers. She will return in the next issue. Contact her at her email address: mjenningsdds@ gmail.com.

The Washington State Dental Association successfully coordinated a major effort to protect patients of Dental Support Organization (DSO)-connected dental practices.

These new safety measures were unanimously approved by legislators in Olympia and signed into law by Gov. Jay Inslee.

This new law represents the culmination of three years of hard work by your association and key legislators. Our action was rooted in the belief that the best dental care results occur when treatment decisions are left to the patient and his or her dentist. Over the years, we have been told of many instances where nondentists employed by some DSOs were interfering in the all-important doctor-patient relationship. Passage of this legislation is a significant achievement in our ongoing efforts to protect the sanctity of the doctor-patient relationship from third-party influences.

The new law confirms that dentists have the right to contract with DSOs for space and support services, but also establishes strict prohibitions on nondentist employees interjecting themselves into the doctorpatient relationship. It also clarifies that only Washington-licensed dentists can own dental practices in our state, and includes strong language regarding patient abandonment. Importantly, it also explicitly spells out actions that constitute the unlicensed practice of dentistry, which will be expressly prohibited going forward. These issues are discussed in detail

by Mellani McAleenan, WSDA Director of Government Affairs, and Emily Studebaker, outside counsel for WSDA, on pages 12 through 15 of this edition of WSDA News.

It is important to recognize that many parties came together to reach this positive outcome. A strong staff and lobbying team effort began with research into legal precedents in Washington and other states, as well as review of government studies on the DSO issue.

This background research was buttressed by the committed involvement of WSDA member dentists, who provided first-hand accounts of working in the DSO environment and helped identify patients who would be willing to share their stories with lawmakers. Many of these individuals, dentists and patients alike, provided testimony in public hearings or in direct communication with lawmakers. The result was that a human face was put on what

could have seemed like a mundane dispute between different business models.

Hundreds of other dentists from across the state contacted their local legislators or participated in our three most recent Dental Action Days in Olympia, demonstrating the importance of the issue.

Another key element was the dedicated leadership provided by Sen. Curtis King, RYakima, and Rep. Michelle Caldier, R-Port Orchard. They provided a strong voice at the table during intense negotiations between the WSDA and DSO representatives, and their commitment led to strong bipartisan majorities in both chambers.

So, you might ask, what’s next?

WSDA believes that this legislation provides the strongest enforcement mechanisms in the nation to curb the unlicensed practice of dentistry by third parties, and that it can serve as a model for the dental practice acts in other states.

The new law defines any interference by nondentist third parties in patient care as a violation of the state’s uniform disciplinary act, which is a gross misdemeanor. Each day that such violations occur is treated as a separate offense, and the Washington State Department of Health can issue financial penalties and place a cease-anddesist order on violators, which would prohibit their continued operation.

Our work on this issue is far from done, but our focus now will move from legislation to enforcement. In the months ahead, WSDA will work with state regulators to ensure they understand the importance of this new legislation and are made aware of instances where third parties are negatively influencing patient care and the doctor-patient relationship.

We need your help to ensure that regulators hear of these problems. If you are aware of a situation where you believe nondentists are impacting patient care, please contact the WSDA office. Our association staff can discuss the issue confidentially, and explain your rights to whistleblower protections, if needed.

As dentists, we take an oath to protect and serve our patients. Our ability to do so depends on the sanctity of the doctorpatient relationship. Protecting that relationship in all aspects of our profession remains a top priority of WSDA.

The views expressed in all WSDA publications are those of the individual authors and do not necessarily reflect the official positions or policies of the WSDA.

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The Washington State Dental Association is working with member dentists throughout the state to demand fundamental changes in the business practices of Washington Dental Service/Delta Dental of Washington (Delta). Over the past several years, most of us have been subjected to Delta policies and actions that negatively impact patient care. Examples include: inconsistent claim processing; poor and misleading communications; rapidly escalating executive compensation; and an unexplained increase in other administrative expenses. Delta has consistently dismissed recommendations from its Member Advisory Board. Around the nation, we have seen Delta brazenly exert pressure on dentists, especially in states where Delta has a large market share. Our colleagues in California and Massachusetts are actively pushing back against these intrusions on the doctor-patient relationship, and we must as well.

That process has begun. Over the past few months, WSDA leadership has directed a team of seasoned attorneys to help develop a series of proposed bylaws amendments. We held a special meeting at our annual Pacific Northwest Dental Conference to explain these proposed changes to our members. I am proud to report that our petition received 650 signatures in 24 hours, more than enough needed to force Delta to schedule a special membership meeting. If adopted, these amendments will require Delta to be more patient-focused in its operations, more responsive, and more transparent to providers.

Our fundamental concern with Delta is that the organization has lost its patient focus. One of the symptoms of this problem is the systematic elimination of dentist input. Increasing dentist input, which will be well-informed with the new transparency requirements proposed, will reverse that trend and put Delta’s focus back on the patient.

I want to highlight a few of the most critical amendments: • We are demanding that Delta implement a 94 percent loss ratio. This will mean that 94 percent of all premium revenues collected by Delta will be restricted to patient care. If Delta fails to achieve this loss ratio, then it will be required to issue refunds to its policyholders in an amount necessary to

achieve the 94 percent loss ratio. Employee compensation, advertising, donations to its foundation, advocacy, and other similar expenses will be capped at 6 percent of total revenue.

• We propose requiring that Delta cooperate with the Office of the Insurance Commissioner to implement an independent review board for standalone dental benefit plans. Currently, medical insurance plans must have a comprehensive grievance and appeal process, allow an independent organization to hear disputes related to decisions made by carriers, and have a written utilization review criteria based on reasonable medical evidence.

By law, Delta and other standalone dental benefit plans are not required to have these important patient protections. In fact, Delta has opposed legislative efforts led by dentist Rep. Michelle Caldier to enact independent review board legislation for dental plans. This bylaw amendment will force Delta to support patient protections it currently opposes.

• Delta uses an overly restrictive definition of “independent director,” which essentially means that anyone who has a dental degree cannot be “independent” of Delta.

While WSDA leaders understand the desire of Delta to have a majority of its directors be “independent,” we cannot support Delta’s current definition of “independent,” as it greatly exceeds the requirements of the Internal Revenue Service. We are proposing that Delta redefine the independent director role to align with the instructions set forth in IRS Form 990 (the tax document for all nonprofits).

Dr. Cindy Pauley President-elect, WSDA

ests of the patients we all serve. However, given its lack of response to past issues, we must prepare to take action if Delta rejects the bylaw amendments. Please be assured that WSDA has been evaluating options and will be prepared for every potential outcome of the special meeting. We will be communicating with our members accordingly, and in a timely fashion.

We have worked together over the past several years to build a strong grassroots voice in Olympia to advocate for our patients. We now need to expand our advocacy efforts beyond Olympia to ensure that insurance companies put our patients front and center.

It is vitally important that you attend the special meetings. We are fighting for nothing less than the health of your patients, and the future of your practice.

• We are proposing a significant change in how Delta elects its Board of Directors. We strongly believe that contested elections lead to stronger boards. Our proposed amendments encourage a broader diversity of candidates beyond those currently handpicked by Delta’s Governance and Nominating Committee.

(A more complete list of the proposed amendments can be found online at www.wsda.org/ delta.)

We hope Delta will recognize that our proposals are based upon the best inter The views expressed in all WSDA publications are those of the individual authors and do not necessarily reflect the official positions or policies of the WSDA.

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guest editorial dr. cindy pauley

Putting patients first at Delta

member news delta initiative: what it is, and what it isn’t

DELTA INITIATIVE: WHAT IT IS AND WHAT IT ISN’T

When the WSDA recently orchestrated an information session at the PNDC to discuss Washington Dental Service/Delta Dental of Washington (Delta), there was considerable dialogue about what we could and should say in advance of the meeting, and what we could not. We didn’t want to play our hand, nor did we want to suggest that reimbursement rates would be discussed.

The power of antitrust laws

Antitrust laws expressly forbid discussions and activities that could result in agreements or concerted actions among WSDA members or other licensed dentists that could be seen as unlawfully restraining competition.* As such, this initiative is not about reimbursement rates or collectively taking action against Delta. Instead, this initiative is focused on patients, and specifically, the harm Delta’s actions and lack of transparency are inflicting on patient care.

The WSDA is committed to finding an innovative solution to these problems and has steadfastly examined ways to create change from within, using Delta’s own bylaws and rules to help institute governance changes that will give Delta member dentists a greater role and voice in Delta and put Delta’s focus back on patient care.

To that end, the WSDA enlisted Hall, Render, Killian, Heath & Lyman to draft bylaws amendments that would allow Delta member dentists to influence change from within Delta.

The strategy behind bylaws amendments

If approved, the bylaws amendments will substantially change the way Delta conducts itself in the areas of patient care, transparency, and governance. Not only will the proposed amendments benefit patients, but by modifying current rules regarding the Board of Directors, changes would give dentists in Washington a seat at the table they’re currently denied. We think it’s important to make sure we have a voice in all future decisions made by the Delta board.

Patient care amendments Loss ratio requirement

This amendment would require Delta to implement a 94 percent loss ratio, meaning that 94 percent of all revenues collected by Delta must be spent on patient care. If Delta does not spend 94 percent of premiums on patient care in a fiscal year, it will be required to issue refunds to its policyholders in an amount necessary to achieve the 94 percent loss ratio. Employee compensation, advertising, donations, advocacy, and all other expenses that are not related to patient care will be capped at 6 percent of total revenue.

Independent review process

This amendment would compel the Delta Board of Directors to make Delta cooperate with the Office of the Insurance Commissioner to implement an independent review board for standalone dental insurance plans. This independent review process will require Delta to have a comprehensive grievance and appeal process, allow an independent organization to hear disputes related to decisions made by carriers, and require a written utilization review criteria based on reasonable medical evidence.

Vote requirement

The final patient care-based amendment would require the Delta Board of Directors to vote on all recommendations made by the Member Advisory Council. These votes will have to be made public to the general membership.

Transparency amendments Administrative expenses

This amendment would require Delta to disclose its administrative expenses by category, as well as detailed financial statements of all affiliated entities, including corporate contributions to its foundation and how these contributions are used, particularly regarding lobbying and commercial advertising.

Claim denials and review

This amendment would require Delta to disclose the percentage of claims denied and, of those, the percentage reviewed by a licensed dentist in making the denial decision.

Corporate records

This amendment would require Delta to make corporate records, including Board of Directors and all committee meetings minutes, available to Delta members for their review consistent with state law.

Governance amendments Definition of an Independent Director

This amendment would modify the Delta bylaws’ definition of an independent director. Currently, Delta has included several stipulations around the qualifications that make a director “independent” beyond those that are required by the IRS. Our amendment simply redefines independent director to align with the instructions set forth in IRS Form 990. This would allow someone with a dental degree, but without a financial interest in Delta to serve as an independent director.

Governance and Nominating Committee

This amendment would eliminate the requirement that independent directors constitute the majority of the Governance and Nominating Committee.

President and CEO Board provision

This amendment would remove the provision that the President and CEO is automatically a member of the board without a vote of the Delta members.

Director nominations

This amendment would provide new opportunities for Delta members to nominate individuals to serve as directors of the corporation.

Contested elections

This amendment would provide new opportunities for Delta members to nominate individuals to serve as directors of the corporation. *This includes discussing reimbursement rates, pricing, fee schedules, or other competitively sensitive information. It also includes making any agreements not to deal with Delta or otherwise boycott Delta.

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WHAT’S NEXT IN THE PROCESS

WSDA President Dr. BJ Larson and WSDA Executive Director deliver the signed petitions to Washington Dental Service/Delta Dental of Washington (Delta)

On June 16, 2017, the Washington State Dental Association held a special information meeting at the 2017 PNDC about Washington Dental Service/Delta Dental of Washington (Delta), and proposed amendments to its bylaws (see facing page for details about the amendments and their ramifications). In less than 24 hours, nearly 650 signatures of practicing dentists were collected. On June 19, WSDA President Dr. BJ Larson hand-delivered the signed petitions to WDS. Because WSDA was able to collect signatures from 10 percent of Delta’s member dentists, it is required to schedule the requested special meetings and announce the date of those meetings within 30 days. The meetings must be then be scheduled within 30 to 50 days of the response.

Scheduled meeting

As of press time, Delta had neither responded to the request for

meetings nor scheduled meetings to review the bylaws amendments.

Each of the proposed bylaw amendments reflects our efforts to enhance the doctor-patient relationship by shifting Delta’s focus back to patients and their providers. The changes are also designed to give Delta member dentists more visibility into its operations.

Further, this initiative seeks to more closely align Delta with the patients it exists to serve, and ensure that those members of Delta most knowledgeable about oral health and patient care have a voice when it comes to the best interests of patients.

Review materials

Please visit wsda.org/delta for updates on meeting times, and to review all materials distributed to WSDA members and Delta members.

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member news delta initiative: what’s next in the process

DELTA INITIATIVE:

legislative news legislative efforts in review

WSDA LEGISLATIVE EFFORTS IN REVIEW ALSO: WHAT’S AHEAD IN 2018

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Most of the policy work, however, was completed during the regular session. With a focus on ensuring that issues of import to organized dentistry remained in the forefront of the legislators’ minds, WSDA was able to obtain key victories during the 2017 regular session.

2017 Accomplishments Protecting patient safety

WSDA achieved a major success this year with the passage of Senate Bill 5322. Some companies, known as dental support organizations (DSOs), provide administrative support services to dental practices, but experience in Washington and other states has shown that those services sometimes cross the line into the corporate practice of dentistry, with non-dentists calling the shots on patient care. WSDA supports choice in how dentists manage their practices, as long as proper patient safeguards are in place. Dental care decisions should be left to a patient and his or her dentist’s independent judgment.

With competing bills introduced by WSDA and the DSOs, legislators called on both parties to reach a compromise solution.

WSDA honored the legislators’ requests, engaged in discussions with the DSO representatives, and found a productive solution that will allow dentists to utilize the services of dental support organizations subject to the limits of important patient safety protocols and oversight by the Department of Health. Senate Bill 5322 takes effect July 23, 2017. Funding for enforcement was included in the state operating budget. For more information, see page 12.

Dental residencies

Dental residents are part of WSDA’s strategy to reach more low-

income patients and are a superior alternative to lesser-trained dental therapists. This year, WSDA supported capital budget requests to help fund facilities and infrastructure needed to expand dental residency programs. Providence Health & Services is looking to expand in Spokane and Olympia. In addition to the capital request, WSDA supported House Bill 1411, which expands opportunities for dentists to forego the licensure examination by completing a postdoctoral dental residency program to include general practice, pediatric, or advanced education in general dentistry residency program options. This bill expands residency settings to include hospitals and should encourage the creation of new programs. House Bill 1411 passed unanimously and takes effect July 23, 2017.

Medicaid

Rep. Michelle Caldier, the only dentist in the Legislature, prime sponsored House Bill 1314, which will create safeguards to ensure fair and transparent Medicaid audit processes. WSDA fully supported her efforts to direct the Health Care Authority to meet standards regarding auditing practices related to the recovery of payments, auditing timelines, the use of statistical sampling, and the submission of records as well as establish requirements related to expertise and reporting for contractors performing the audits.

The bill passed unanimously and takes effect on July 23, 2017.

Funding was provided in the operating budget for the Oral Health Connections Pilot Program in Yakima, Adams, and Cowlitz Counties. The pilot will include enhanced reimbursement rates for participating dental Medicaid providers and an increase in the allowable number of periodontal treatments. Medicaid clients who are diabetic and/or pregnant and who are receiving dental care within the pilot regions are eligible. continued on page 10

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legislative news legislative efforts in review

The Washington State Legislature adjourned its regular 105-day session on April 23, 2017.

Because the philosophically divided legislature did not finish their work on the state operating or capital budgets, nor agree upon a resolution to the McCleary education funding lawsuit, Governor Inslee immediately called them back into a 30-day special session and then directly into a second 30-day special session. With a shutdown of state government looming if the legislature did not pass an operating budget by the end of June, a third special session was necessary. They passed the operating budget on the 10th day of the third special session - the last day possible to avoid the shutdown.

legislative news legislative efforts in review

legislative news, continued from page 9

Opioids and suicide prevention

The overuse and abuse of opioids have become a crisis nationwide, and Washington’s legislature has reviewed a number of bills related to opiates. WSDA successfully defended against onerous infringements into the dentist-patient relationship such as hard limits on prescribing practices and worked toward more wellrounded legislation that requires the health care provider disciplinary committees, like the Dental Quality Assurance Commission, to develop rules establishing requirements for prescription opioid drugs. The bill will also enhance the use and availability of data through the Prescription (Drug) Monitoring Program (PMP) and will update opioid treatment programs. Funding was provided in the operating budget for the analytical work and increased reporting associated with the expansion of organizations eligible to receive information from the PMP. WSDA also supported bills that would address legislators’ concerns in different ways, such as House Bill 1612, which adds dentists and dental hygienists to the long list of healthcare providers who must receive training in suicide assessment and referral. While WSDA would generally oppose such a government mandate, the prime sponsor of the bill worked well with WSDA leadership to address our concerns. As amended based on those conversations, the bill that passed includes a three-year delay in implementation, and will allow WSDA to work with the University of Washington School of Dentistry to develop the curriculum.

The operating budget provided one-time funding for rulemaking regarding training for licensed dentists and dental hygienists.

Opportunities for future success “Advocacy work has become a year-round endeavor, and legislators enjoy hearing from their constituents even when they are not in session. WSDA member dentists are encouraged to reach out to their legislators to talk about how the Legislature can improve the practice of dentistry in Washington state.”

Even with the successes of the regular legislative session, much work remains for WSDA members and staff both this year and in 2018.

First and foremost, the Legislature is still in their third special session, which runs until July 20 unless they adjourn early. While the operating budget must be passed by June 30, it is still possible for them to pass a capital budget or engage in further policy work. Thus, WSDA remains vigilant regarding projects that are still pending during this legislative session.

2017 Capital budget

As mentioned above, the Washington State Dental Association teamed up with Providence Health & Services to request funding for residency projects in Olympia and Spokane. Both the House and Senate drafts of the capital budget include funding for these programs. Thus, we remain hopeful that a capital budget will pass before the end of the third special session and will include the $2.8 million in infrastructure funding necessary to make these programs a success.

Both drafts of the capital budget also include funding requested

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2017 Operating budget

Following a budget provision last year that required the Health Care Authority to report on how the administration of dental Medicaid could be contracted to an outside company, a proviso was included in this year’s operating budget that requires the Health Care Authority to contract with two dental managed care organizations. Funding is reduced by $6.1 million to reflect savings achieved through reduced emergency department utilization anticipated as a result of managed dental care. The proviso also requires that any additional savings incurred shall be used to increase dental provider reimbursement rates. As directed by the proviso, the Health Care Authority must now develop and implement a competitive procurement process with the idea that two managed care organizations will be under contract by July 2018.

WSDA will remain fully engaged in this process to ensure the best possible process and contract going forward.

WSDA also supported the House budget’s inclusion of the UW School of Dentistry’s $1.96 million request for infrastructure and personnel to expand the capacity and footprint of the Regional Initiatives in Dental Education (RIDE) program, which trains providers in rural and underserved areas. Unfortunately, this funding did not make it into the final operating budget bill.

Policy legislation

Speaker of the House Frank Chopp convened a dental “onetable” process to learn about what issues mattered to dental stakeholders this year. Several of the bills and funding provisions pending before the legislature this year were discussed in this setting. One such policy bill may still have the opportunity to pass this year. House Bill 2143 would expand the Washington State Opportunity Scholarship to students in eligible advanced degree programs in health professions who commit to a required service obligation. The bill passed the House during the regular session, and has been passed again in both the first and second special sessions, keeping it alive as budget negotiations continue. It remains to be seen whether the bill will pass before the legislature adjourns for good this year.

Additionally, because 2017 was the first year of the biennial legislature, all of the bills that were introduced this year will automatically be reintroduced next year along with all of the new legislation that will be introduced in the 2018 legislative session. Thus, we already know some of what will be on the agenda for next year.

Insurance reform

House Bill 1316, prime sponsored by dentist Rep. Michelle Caldier, would have required carriers to maintain a utilization review program description and written criteria based on the

prevention of dental disease and chronic disease implications. It also would have prohibited a carrier from retrospectively denying coverage for care that had prior authorization, and would have prohibited carriers from subjecting providers to additional oversight based on the provider filing an appeal or grievance on behalf of a patient. Finally, the bill would have required the Office of the Insurance Commissioner to convene a workgroup to examine current practices related to explanations of benefits. While this bill did not pass, WSDA supports ensuring patients have the same protections when accessing dental care as when accessing medical care and supports eliminating the unfair insurance practices of some dental insurance companies. We will continue to look for opportunities to improve insurance practices in Washington State.

Dental labs

The National Association of Dental Laboratories proposed legislation to address supply chain accountability through dental laboratory registration and disclosure. WSDA believes House Bill 1782 will enhance patient health and safety, and that a state-maintained registry will assure dentists that their dental laboratory is compliant and operating under high standards. Unfortunately, this bill did not pass the legislature this year and will remain on WSDA’s agenda for support next year.

Defending against midlevel providers

While a bill authorizing the practice of dental health aide therapists on tribal reservations in Washington State did pass the legislature this year, the bills relating to general midlevel providers that were introduced this session did not pass. House Bill 1364 and Senate Bill 5224 would have created a new licensed health profession called “dental therapists.” These dental therapists would only need about three years of post-secondary school education, but would be allowed to do many procedures a dentist (with eightplus years of education) is authorized to do, including drilling and extracting teeth. WSDA-member dentists testified in opposition to both bills, and WSDA successfully prevented these bills from passing. However, the bills will be reintroduced in the 2018 legislative session.

Conclusion

Advocacy work has become a year-round endeavor, and legislators enjoy hearing from their constituents even when they are not in session. WSDA member dentists are encouraged to reach out to their legislators to talk about how the legislature can improve the practice of dentistry in Washington State. WSDA staff will continue to work with legislators on behalf of WSDA members and stand ready to assist members in developing relationships during the interim that will improve our opportunity for success during session. Next year’s advocacy agenda will be developed at the House of Delegates meeting in September.

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legislative news legislative efforts in review

by the Community Health Network for construction and equipment directly associated with dental facilities in local communities.

legislative news dso legislation

DSO LEGISLATION:

A CONVERSATION WITH MELLANI MCALEENAN AND EMILY STUDEBAKER

Photo by Scott Eklund Left to right: Mellani McAleenan, Emily Studebaker

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baker specializes in healthcare law.

Mellani McAleenan: We spend a lot of time talking about DSOs. What exactly is a DSO? Emily Studebaker: According to the Association of Dental Sup-

port Organizations (ADSO), DSOs, or dental service organizations, “contract with dental practices to provide critical business management and support, including nonclinical operations.” Basically, DSOs provide “back office” or administrative support to dental practices.

There was a time when dentists simply started their own independent dental practices after graduating. However, a one-size- fitsall practice model doesn’t work as well in today’s society. Dentists today need to have the flexibility to contract for support, work for another dentist, or create or join a group practice of dentists.

MM: This is the third legislative session in which both ADSO and WSDA have proposed competing legislation. What changed this year to foster compromise now?

ES: WSDA has been advocating for legislation that provides stron-

ger patient safeguards that restrict third parties from interfering with the dentist/patient relationship for the past three years. A strong advocacy effort and increasing media attention brought this issue to the forefront during the 2017 legislative session.

As I understand it, legislators wanted to find a solution this year, and helped facilitate a compromise that ended up passing the Legislature unanimously.

MM: What has been the concern with DSOs?

MM: You and I, and many others, spent countless hours reading, drafting, and redrafting potential legislation. Talk about what happened this session.

ES: Some DSOs operate exactly as they should by providing the

ES: Legislators who had been hearing emphatically from both

MM: In the past, WSDA has been accused of being anticompetitive. What’s your perspective about comments like that?

MM: That compromise bill, Senate Bill 5322, passed the Legislature unanimously and was signed into law by Gov. Inslee on May 16. It becomes effective on July 23, 2017. What does this bill allow a DSO to do?

support a dentist needs to effectively run his or her practice. But experience in other states and here in Washington has shown that, if left unchecked, some DSOs cross the line from providing support to, essentially, employing the dentist and dictating the terms of how the dentist provides care. When profit motives are put ahead of patient care and safety, and corporate judgment interferes with the independent judgment of the licensed dentist, that should be cause for concern.

ES: Having worked with WSDA members and staff for a few years

now, I know that WSDA supports choice in how dentists manage their practices, as long as proper patient safeguards are in place.

Government reports, legal settlements, and firsthand patient and provider experiences provide many examples of interference from third-party for-profit corporations placing corporate profit ahead of patient care.

sides for the last three years were ready to find a resolution, resulting in pressure to bring both sides to the table. While there were several legislators who were deeply engaged in the issue and deserve thanks, Sen. Curtis King and Rep. Michelle Caldier put in dozens of hours on top of their other legislative responsibilities to convene a series of meetings during which the issues were hashed out and a compromise bill was drafted.

ES: The bill addresses a practice that has been going on in Washington and other states for years without much oversight or enforcement. This new law authorizes DSOs to provide business support

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continued on page 14

legislative news dso legislation

Over the past few years, one of WSDA’s top legislative priorities has been to clarify the rules under which Dental Support Organizations (DSOs) can provide services to dentists in our state. Government Affairs Director Mellani McAleenan sat down to discuss some big developments from the 2017 legislative session with attorney Emily Studebaker of Hall, Render, Killian, Heath & Lyman. Stude-

legislative news dso legislation

dso legislation, continued from page 13

and management services to a dental practice and to receive fees for these services, as agreed to by the dental practice owner or owners.

DSOs may own or lease assets used by a dental practice, including real property, furnishings, equipment, instruments, materials, supplies, and inventory. However, DSOs may not own patient dental records.

DSOs are also allowed to employ or contract for the services of personnel, but the DSO cannot employ or contract for services with licensed dentists, licensed dental hygienists, licensed expanded function dental auxiliaries, certified dental anesthesia assistants, or registered dental assistants. Only a dentist licensed to practice in Washington may employ such staff.

MM: This new law clarifies that a person must have a Washington license to practice dentistry in order to own, maintain, or operate a dental practice. At what point can providing supportive services cross the line into the unlawful practice of dentistry?

ES: The new law makes clear that a DSO — or any other non-

dentist — cannot interfere with a licensed dentist’s independent clinical judgment.

A nondentist third party cannot interfere with a dentist’s right to access patient records or a dentist’s decision to refund any payment made by a patient for dental services performed by the dentist.

Nondentists, including DSOs, may not limit or impose requirements on: • The length of time a dentist spends with a patient • Performing dental services • The number of patients a dentist treats in a certain period of time • The number of certain types of procedures a dentist completes in a certain time period • A dentist’s decision regarding the course of treatment for a patient • The manner in which a course of treatment is carried out by a dentist • The manner in which a dentist uses dental equipment or materials • The use of a laboratory or the materials, supplies, instruments, or equipment deemed reasonably necessary by a dentist to provide diagnoses and treatment consistent with the standard of care.

MM: If dentists find themselves in a situation where these kinds of limits from a DSO or other corporate entity interfere with the clinical judgment of the dentist, what should the dentist do?

ES: Senate Bill 5322 makes it clear that state “whistleblower” pro-

tections apply to these kinds of circumstances. If a dentist, patient, or other person is aware of undue influence over a dentist by a nondentist, that person can and should make a complaint to the Washington State Department of Health concerning the unlawful practice of dentistry. The department of health has enforcement

power, can subpoena contracts or other evidence, and can hold the nondentist legally accountable, including seeking action by the Attorney General.

MM: Does the new law offer any additional protections to the patients who are being treated by dentists working with DSOs? ES: The new law clarifies that an attending dentist, regardless of

employment status, is prohibited, without reasonable cause, from neglecting, ignoring, abandoning, or refusing to complete the current procedure for a patient. If a dentist chooses to withdraw responsibility for a patient, the dentist must advise the patient of the termination and that the dentist will remain reasonably available for up to 15 days, but the patient should seek other care. A dental practice owner who is discontinuing or moving a practice must also comply with these requirements.

DSOs are prohibited from intentionally preventing a dental practice owner from complying. If the dentist provides services on an employee or contract basis, the law clarifies that it is the employing dentist or entity that maintains responsibility for the patient, so the employed dentist will not be deemed to have abandoned the patient.

MM: This new law doesn’t exist in a vacuum. What other existing rules and laws will help guide the enforcement of these new provisions?

ES: While the compromise may not include every safeguard envi-

sioned in WSDA’s original bill, this legislation, along with existing state and federal law related to fraud and abuse, provides the state with strong enforcement that can more clearly shine a light on third-party activities that interfere with the dentist-patient relationship.

To sum up, Senate Bill 5322 clarifies, in law, a practice that has been happening for many years. That is, nondentists have already been providing supportive services, equipment, and facilities to dentists. But the new law sets parameters around when those services cross the line into the unlicensed practice of dentistry, and it outlines what should happen if that line is crossed.

MM: The bill becomes law on July 23, 2017. What happens next?

ES: This new law should serve as a deterrent against unlicensed

practice and undue influence in DSO settings. However, any law is only as good as its enforcement. WSDA will continue to work with enforcement agencies, including the Department of Health, Office of the Attorney General, and the Dental Quality Assurance Commission, on the significance of this new legislation, and ensure that they are made aware of any instances WSDA discovers where third parties have negatively influenced the dentist-patient relationship.

WSDA will also embark on a robust education effort to ensure that dentists are fully aware of all relevant laws that affect the contractual relationships they may enter into with third parties, and will continue to work diligently to safeguard the dentist-patient relationship.

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KNOW BEFORE YOU SIGN…

Any agreement, policy or procedure, or employment or other handbook: 1. That limits or imposes requirements on: • The length of time a dentist spends with a patient • The number of patients a dentist treats in a certain period of time • The number of certain types of procedures a dentist completes in a certain time period • The performance of dental services by a dentist • A dentist’s decision regarding a course of treatment for a patient • The manner in which a course of treatment is carried out by a dentist • The manner in which a dentist uses dental equipment or materials • The use of a laboratory or the materials, supplies, instruments, or equipment deemed reasonably necessary by a dentist to

provide diagnoses and treatment consistent with the standard of care • The professional training deemed reasonably necessary by a dentist to properly serve the dentist’s patients • The referrals by a dentist to any other practitioner the dentist determines is necessary • The advertising of a dentist’s practice • Communications with a dentist’s patients

2. That interferes with: • A dentist’s right to access patient records • A dentist’s decision to refund any payment made by a patient for dental services performed by the dentist

3. That provides or has the effect of: • Requiring a dentist to pay the DSO a percentage of revenue as a management fee, especially an excessively high percentage • Denying a dentist the traditional rights associated with ownership of the practice, including: • Entitling the DSO to replace the dentist at will • Prohibiting the dentist from selling the dental practice • Prohibiting the dentist from issuing additional shares of capital stock in the dental practice • Prohibiting the dentist from amending, supplementing or terminating the dental practice’s Articles of Incorporation, Bylaws,

and/or other governing documents • Prohibiting the dentist from determining the schedule or number of patients that the dentist see each day • Prohibiting the dentist from hiring or firing employees

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know before you sign what to look for when signing a contract

sidebar: what to look for in a contract

pndc news the 2017 pndc in pictures

2017 PNDC IN PICTURES FROM SOCIAL EVENTS TO CONTINUING EDUCATION, THE PNDC HAD SOMETHING FOR EVERYONE 1 6 路 th e wsda ne w s 路 issue 7, july 路 2017 路 www.wsda.org

pndc news the 2017 pndc in pictures How do you measure success? Is it in the smile of attendees, the popularity of speakers, increased attendance among dentists, hygienists and dental assistants? The answer is YES! Attendance at the 2017 PNDC was up across the board, reviews of lectures and workshops were overwhelmingly positive, and we saw a lot of people having FUN throughout the three days. Even exhibitors, who are often our toughest critics, were impressed with the traffic in the exhibit hall. th e wsda ne w s 路 issue 7, july 路 2017 路 www.wsda.org 路 17

pndc news the 2017 pndc in pictures

From a special information session to time spent laughing with colleagues and friends, the 2017 PNDC offered a range of ways to connect.

Whether the issue was the future of dentistry or living in the moment, the PNDC continues to offer a wide range of experiences for all participants.

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pndc news the 2017 pndc in pictures

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pndc news the 2017 pndc in pictures

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thing in between, lectures at the PNDC continue to offer more value than many other conferences.

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pndc news the 2017 pndc in pictures

The PNDC Exhibit Hall is much more than just the place you buy supplies and equipment for your practice. It’s a meeting place, a place of revelry, and the space attendees use to reconnect with friends and colleagues From dental photography to restorative dentistry and every-

pndc news 2017 pndc in photos

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pndc news 2017 pndc in photos

PNDC hands-on workshops continue to be popular among attendees at the conference. Shown here: Dr. Oscar Gonzalez-Martin’s aesthetic crown lengthening workshop had attendees working on pig jaws.

Other popular offerings included Diane Millar’s session on peridontal scaling and Art Cole’s perennial favorite BLS and Heartsaver workshops. th thee wsda wsda ne new wss ·· issue issue 7, 7, july july ·· 2017 2017 ·· www.wsda.org www.wsda.org ·· 23 23

in the news dentistr y 2040, part 2

DENTISTRY IN 2040: THROUGH THE LOOKING GLASS, PART 2

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in the news dentistr y 2040, part 2

In the last issue of the WSDA News, we spoke with key influencers about dentistry in the year 2040, covering topics including insurance, silver diamine fluoride, debt, and integration of medical and dental services. In this issue we continue the conversation, tackling dental school curriculum, changes in the licensure process, and plaque biofilm research.

The WSDA News sat down with Dr. Sara C. Gordon, professor of oral medicine, Associate Dean for Academic Affairs at the University of Washington School of Dentistry, Dr. Jeffrey S. McLean, a professor and researcher at the UWSoD who teaches first-year dental students microbiology and immunology, and Dr. Bryan C. Edgar, Immediate Past President of the Washington State Dental Association, to get their take on what the future might hold for dentists.

cover stor y dentistr y 2040, part 2

Dr. Sara C. Gordon, professor of oral medicine, Associate Dean for Academic Affairs at the UWSoD Dr. Sara C. Gordon is well versed in the curriculum changes at the UWSoD, having been brought on to serve in a newly created position to oversee administration of the School’s academic programs, as well as curriculum development, student progress, academic regulations, educational technologies, regional academic operations, and the continuing dental education steering committee. Gordon, who joined the UW nearly three years ago, helped shepherd the recently graduated the class of 2017, which got the third and fourth years of the new curriculum. Clearly, the new curriculum is working. UWSoD students taking the national boards part two scored two standard deviations above the mean. In the past, they had hovered around the mean. “They really knocked it out of the ballpark. We’re proud of them for that,” says Gordon. For their part, students are excited about how much they’re learning in the new curriculum. And while there have been some challenges (particularly as it relates to the labor intensity of the program), Gordon is pleased with the progress and acceptance of the new system. “I like the ways things are evolving here. I came to Seattle, and the UW specifically, because of the vision that the UW had for the new curriculum,” she says. “When I was looking for a new dental school home, my top priority was finding one whose vision matched my own, and that was tough. The UW was doing exactly what I was looking for.”

to use them as tools as clinicians in 10 or 20 years.” Integration training will likely focus on the interwoven nature of the health of all body systems, she says. “You can’t separate the health of the oral cavity, or the stomach, or the brain, or any part of the body from the health of the other parts of the body. This understanding of the integral nature of all of our body systems, including the oral cavity, may eventually lead to dentistry rejoining the rest of the medical profession, which in turn could even influence insurance patterns. For instance, if we can prove beyond a shadow of a doubt that treatment of periodontal disease has an impact on cardiac health, then it might be covered under medical insurance. Those are all potential directions for dentistry that argue to beefing up the internist approach in dental education.”

Regardless, she says, digital revolution is having the greatest impact on teaching. Distance learning, scanning, digital dentistry, and social media are changing the way dentistry is taught and learned. Because of the internet, curriculum is increasingly asynchronous and online. UWSoD students spend much of their fourth year working in communities, making even Skyping into class impossible with time zone and schedule conflicts. “We’ve had to totally change our teaching methods last year to accommodate that. We can have lessons online, but we try to do more thoughtful exercises, where students are given information and then have time to think about and process it,” says Gordon. “You may have seen the recent article about the death of the lecture.

While it may not be dead, there’s good evidence that active-learning techniques can be far more effective.”

Dual approach to teaching

Emerging tech: Digital tools, educational integration

Curriculum changes

The future, according to Gordon, will include a blend of teaching both technique-oriented dentistry and the newer internist approach. She explains, “There is a dichotomy of vision happening in dentistry, much the same as happened in medicine, where you have surgeons and internists. They coexist. I think the same kind of dichotomy is emerging in dentistry, not surprisingly, where you have the technique-oriented dentists and those who are more diagnosis and medically oriented. The UW has strengths in both fields. We have an outstanding restorative dentistry department, and always will, and we’re trying to bolster our students’ internist approach. There are some clear indicators that show this will be important to dentistry in the future.” Those, she says, include patients demanding a patient-centered approach that views them as a whole and not just a collection of body parts and teeth. Secondly, while prevention has always been cheaper and more desirable than treatment, options have been limited. Now those options are expanding every year. “I loved what I was reading in your first article with Jeremy Horst about silver diamine fluoride,” Gordon says, “and there will be more treatments like that in years to come.

It’s not a surgical approach, it’s a medical approach at its heart.”

Gordon acknowledges that teaching integration of medicine and dentistry is vital if students are going to be prepared for technological advances. She says, “We’re training our students in that manner right now, because with the advent of immunotherapy and genetic information, if we don’t they’ll be dead in the water.

They have to be able to think about these things in order to be able

Gordon, who is an oral pathologist, notes that dentists are expanding their use of digital tools, not just for surgical approaches, but also for diagnosis and treatment planning, and says that dentists will be impacted by advances for the foreseeable future. She’s a selfproclaimed fan of “Star Trek” and the technologies imagined in the shows and movies, and wonders how much of that could translate into real-life scenarios: “Fifty or 60 years down the road, will manual procedures be something we delegate, will they be something we do, or will robots perform them? Will we use robots or algorithms to diagnose? Even something as artistic as diagnosis may be different in the future.” Moreover, she muses if rote memorization will fall to the wayside in favor of teaching dentists to access what they need digitally, make an assessment of the facts and materials rigorously, and apply that to patient care. “That’s a concept that’s not quite fully baked yet, but I think in 10 years we’ll be further along with how we use that type of technique,” she says.

Already, dentists are on the cusp of using genetic information for diagnosis and treatment in dentistry. Gordon says, “We’re going to find that individual approaches are more possible in patient care. We’re certainly using genetic analysis more and more in pathology diagnosis, and I can see that expanding into other realms of medical care, including certain aspects of dental care. As someone who looks at oral cancer, for example, I’ve seen the impact that immunotherapy is starting to make in oral cancer care, and the impact is going to start to be felt in other aspects of dentistry, like periodontal disease, and maybe even caries. Maybe someday we’ll

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have vaccinations that will prevent caries that we now treat with interventions.”

Encouraging rural practice

We wondered, does Gordon think that programs like Regional Initiatives in Dental Education (RIDE) can help ameliorate access to care issues? She says, “We have a problem with supply and demand in the right places. We have tons of dentists in Seattle and other big cities… the nice, shiny places where dental students go to school and graduate as young adults. They’re part of the community, and they just want to stay. I saw this happen in my own alma mater. I went to school in eastern Canada at Dalhousie University in Halifax, the biggest city in the region. We had people from all over, but everybody wanted to stay in Halifax when they graduated. There were a ton of dentists in Halifax, but a lot of the communities that the dental students came from didn’t have one. The same thing happens here. That’s why we love the RIDE program. It trains dentists in smaller communities, so when they graduate, they tend to want to practice in those types of communities.”

However, she points out, many factors influence decisions about practicing, and isolation in a small community can be a deal killer for a young dentist. “Young dentists need to feel like they’re not going to be the only dentist working in a small town. They want to be part of a team, so that if they’re sick or want to take a vacation, they can,” says Gordon. “Everybody wants to have a life, and dentists are no different. They need to feel that there is a support system in place. I think community health centers play a nice role in that, but we as a society need to make sure that dentists aren’t on their own when they go to practice in small communities.”

The future of funding the UWSoD

for years. They claim the tests cross ethical boundaries in several ways, including paying patients and forcing them to wait for treatment. While Edgar has eschewed live testing, he’s not entirely sure he agrees with the students’ din over ethics, other than in terms of the potential harm to patients through substandard care. As an example, he recounts a story about the time a candidate performed three separate treatments on the wrong teeth during a regional exam he was observing. Needless to say, that candidate didn’t pass. This highlights the quandaries of live testing: Is working on live patients necessary, and is it ethical? This has been the source of constant consternation for 50 years.

“We’re testing the competence of candidates by having them work on live patients,” Edgar says, “but would you allow them to work on your family? Probably not. That’s why I believe that live-patient testing is flawed. Canada, as you know, eliminated live testing years ago. They have the OSCE (Objective Structured Clinical Exam), a station-based exam which utilizes typodonts in the place of live patients. And while I’ve never witnessed an OSCE in person, I’ve worked side by side with many Canadian dentists and have never seen a difference or deficiency as compared to U.S. dentists. I think we’ll have a similar model in the near future, even though the exam community has been fighting this for at least 20 years.”

Though long in the works, Edgar feels confident that an OSCElike test will be used in Washington state, if not nationally, within the next five years. He also believes that a single standardized exam isn’t far off either, but there are other hurdles in the way, like New York’s required residency, which could delay that process.

Residency as a path to licensure

Dr. Bryan C. Edgar, Immediate Past President, WSDA

In Washington, Gov. Jay Inslee recently signed a bill into law allowing a residency as a path to licensure, but it’s still not required.

It’s only required in New York and Delaware. California, Colorado, Minnesota, and Ohio offer licensure applicants the option of completing an accredited postgraduate education program in lieu of an exam. Edgar is a huge proponent of residencies as a path to licensure, and only sees the trend increasing in the future, saying, “The advantage of a residency is that they are trained at a much higher level than when they graduated from dental school, and that surpasses the live-patient exam by light years. That’s the plus side of residencies, and it’s what allows them to replace a regional exam like the WREB. The downside in people’s minds is they worry that a director of a residency program could allow someone who is not competent to receive the certificate from the residency. I used to think that was a possible downside, but the more I see residents and their skills, the more impressed I am. It is a great alternative to a licensing exam.”

Changes in licensing process

Maintaining standards for foreign-trained dentists

As you may be aware, the UWSoD is in the middle of a budget crisis. With a large shortfall, much will be needed to be done to right the ship, and Gordon is acutely aware of this. “You know,” she explains, “state funding has dropped 70 percent for the dental school versus a decade ago, and Medicaid reimbursement is low. I don’t think any of us really knows what’s going to happen with that.

We have to make sure that our organizational structure is realistic and our budget is balanced, and we have a lot of work going on in that area right now. It may take a while. As in dentistry, you have to have the right diagnosis before you can find the right treatment.

We’re in our diagnostic period right now, and we can’t start hopping on a treatment until we have the right diagnosis. But we’re well underway with the process of righting things, and we’re already seeing improvements with the fiscal situation at the dental school.”

Dr. Bryan Edgar is well-known in Washington for his work with the WSDA and the ADA, and at the University of Washington.

Since Edgar’s service to organized dentistry has included serving as a WREB examiner for 20 years, we thought we’d approach him with our questions about licensure.

Live patient testing has raised the hackles of dental students

But, we wondered, what about a residency program for foreigntrained dentists? Was that something Edgar would support? It isn’t, and he explains why, “CODA has an international accreditation program that most of the leadership in dentistry were opposed to when it was first envisioned. They worried that dentists with substandard training would be allowed to practice in the U.S.. However, since it

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cover stor y dentistr y 2040, part 2

DENTISTRY IN 2040, PART 2

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DENTISTRY IN 2040, PART 2 was first implemented, there hasn’t been a single foreign program in the world that met the standards set by CODA.” The current laws in most states require that foreign-trained dentists go through a training program of a minimum of two years, and that the dean of the dental school has to certify that they meet the standard of a graduating dentist from the dental school. That’s in the ADA guidelines for licensure and most state laws, and Edgar doesn’t imagine it will change. Canada, of course, is the one exception. We have had a reciprocal relationship with accreditation since the 1960s. Dual accreditation has also allowed for hygienists trained in Canada to work in the U.S. Additionally, Canadians send a representative to every CODA meeting, and while we accredit our programs separately, we recognize the validity of the other’s accreditation standards.

Working together

Edgar knows that change can be a hard sell in the testing, but believes this is the time for real change to happen. He looks forward to having a voice in the process and working collaboratively with colleagues and academics alike to create a fair and equitable test for dentists of the future.

Dr. Jeffrey McLean, Associate Professor, Periodontics at the UWSoD Plaque biofilm research

Dr. Jeffrey McLean teaches first-year dental students microbiology and immunology, and is a researcher in the perio department at the UWSoD who receives his funding from the National Institute of Health through the NIDCR. He studies the types and functions of the bacteria in the mouth, explores how they may cause disease and disrupt host interaction, and tries to understand what happens when dysbiosis occurs.

Much of what McLean does is only possible because of advances in genomic sequencing. He spends his days uncovering new and novel bacteria and discovering which functions lead to disease, including caries, periodontitis, and gingivitis. He says, “A lot of what I do is genomic-based work on the bacteria that are in the plaque biofilm. With the new advances in sequencing, we now know that the average person carries about 200 different types of bacteria in the biofilm. The biofilm is everything bacteria excrete to hold themselves together: sticky substances, extra cellular DNA, and proteins.

It’s protection, a way to store nutrients, and a way to facilitate interactions between other bacteria. Biofilms are probably the predominate form of life for most bacteria. What we know now is that the places in your mouth are all different, and there are different types of bacteria growing together in different proportions.”

It’s not common for researchers to study both bacteria that are linked with caries and periodontal disease, but it makes sense because McLean uses similar research techniques in both areas. He explains why he was drawn to this research, saying, “When van Leeuwenhoek invented the microscope, his plaque was one of the first things he looked at. What interests me is that oral plaque is the first place that bacteria were discovered, so it’s the longest, most well-characterized community of bacteria ever.” In fact, he says, many of the bacteria in our mouths today were found in the mouths of Neanderthals, as well. Exploring how the bacteria have changed over time is one of the many things he finds exciting and fun about his work as a researcher.

Chairside sequencing

McLean was motivated to research plaque biofilms, in part, because caries should be preventable, given that they are primarily caused by the bacteria metabolism. The problem was that when he began his research 16 years ago, they didn’t know which bacteria caused caries, and they lacked the tools and techniques needed to determine what was going on in the mouth. He says, “We made advances in sequencing that helped us understand their genome, their capabilities, and gene expression, and that there was coordination between bacteria. There are certain bacteria that do certain things at certain times, and that fundamental understanding helped us target specific time points and pathways that the bacteria use to live and grow. Hopefully, we can manipulate those to keep our plaque healthy. In the future, we should be able to sequence your bacteria while you’re sitting in the chair. Caries and periodontal disease have key bacteria that are highly associated with the disease progression, so if we could identify which teeth, which sites, and where they are, we could take care of them.

And we could ultimately determine if that person is likely to have wider spread systemic diseases due to exposure of certain oral bacteria based upon what we find in their mouth.”

Tech is available now

Not surprisingly, some of the technology already exists. There are nanopore sequencers that plug into your cell phone, and microbiome tests that are already being utilized in medicine. But dentistry is lagging behind. Insurance companies currently won’t cover the costs of micoribome sequencing for diagnostic purposes, and even if they did, researchers still aren’t sure yet what the tests can accurately predict. McLean explains, “We need accurate tests for a strong biomarker that indicates disease progression. We still don’t understand how caries and periodontal disease are triggered by the bacteria, so that’s what a lot of the research is focused on right now, proving that biomarkers do what we think they do.”

McLean says that true implementation of today’s technology is five to 10 years off, but it’s hard to tell when fundamental research will result in something definitive.

Other research

McLean is excited about other research happening now – including bacteria manipulation through human signaling or genetic manipulation, and identifying systemic links between overall health and bacteria in the mouth – and the work he is doing with his UCLA collaborator, Wenyuan Shi. McLean says, “He started a company based on a way to kill a single bacteria called STAMPS (specifically targeted antimicrobial peptide), which is the first microbiome therapeutic that is going through phase 2 trials. It allows us to go in and kill just one bacteria. It will be used to treat caries, we’re studying how this peptide targets one bacteria and shifts the microbiome towards a more healthy composition.”

The excitement of the future

We’ll continue covering advances as they happen, and look forward to what the future holds for dentistry, education, research, and tech advances. If you know of emerging tech that you would like us to cover, send your ideas to Rob Bahnsen at rob@wsda.org.

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*

IS YOUR WEBSITE ACCESSIBLE UNDER THE AMERICAN WITH DISABILITIES ACT? Editor’s note: WSDA members and dentists across the nation have recently received letters from attorneys or service providers alleging their websites violate the Americans with Disabilities Act because the websites are not accessible to people with disabilities, such as blindness or hearing impairment. Because such claims appear to be on the increase, WSDA reached out to healthcare attorneys Emily Studebaker and Katie Miller at Hall, Render, Killian, Heath & Lyman for their perspective.

Additional information from the American Dental Association can be accessed on WSDA’s members-only website at wsdasource.org.

In 2010, the Department of Health and Human Services (HHS) issued anti-discrimination requirements under Section 1557 of the Patient Protection and Affordable Care Act (ACA). In May 2016, HHS issued a final rule implementing the Section 1557 requirements, with the expectation that covered entities would come into the compliance with the requirements by October 2016. Under Section 1557, providers of healthcare programs and services that receive federal financial assistance, which includes Medicare and Medicaid payments, must comply with specific requirements to ensure equal access to healthcare services by all, including individuals with disabilities protected by Section 1557 and the ADA.

Background: Requirements of the ACA and the ADA

Section 1557 of the ACA requires that healthcare providers comply with Title II of the ADA by mandating that providers ensure electronic information technology (EIT) is accessible to individuals with disabilities, unless doing so would result in undue financial and administrative burdens, or a fundamental alteration in the nature of the health program or activities. Many healthcare providers are generally subject to Title III of the ADA as places of public accommodation. However, Section 1557 requires that all providers subject to Section 1557 comply with the more stringent Title II requirements that normally apply to state and governmental entities.

How and when a healthcare provider is supposed to comply with these provisions of the ADA, however, is not entirely clear.

While HHS recommends providers comply with the Web Con-

tent Accessibility Guidelines (WCAG 2.0 AA), compliance with these standards is not mandated, and does not guarantee that a provider will be in compliance with Section 1557 or the ADA. While we expect further guidance from the DOJ, there is currently no standard or way to ensure a website is “ADA compliant.”

Enforcement Actions

There has been an influx of lawsuits stemming from plaintiffs’ claims that companies have violated the ADA because their websites are not sufficiently accessible to individuals with disabilities – mainly individuals with vision impairments and hearing impairments. Specifically, in 2013, the National Federation of the Blind brought an action against two tax preparation websites for failing to be ADA-compliant. The Department of Justice intervened in the case, stating that the United States had a significant interest in the pending litigation because it would help define the application of the ADA to websites. Additionally, providers, particularly dentists, have noticed an upswing in letters from plaintiffs’ attorneys warning of potential noncompliance and demanding such providers comply with the ADA.

Practical Takeaways

Providers can anticipate and expect increased correspondence from attorneys regarding ADA compliance as it relates to websites.

If correspondence regarding website compliance is received, an attorney should be consulted because updating a provider’s website to comply with WCAG 2.0 AA may not be necessary or sufficient to comply with applicable sections of the ACA and the ADA. However, these demand letters should not be ignored or taken lightly.

Affirmative action should be taken to respond to such an inquiry.

About the authors

Emily Studebaker and Katie Miller are attorneys with Hall, Render, Killian, Heath & Lyman, P.C., the largest healthcare-focused law firm in the country. Please visit the Hall Render blog at http://blogs.hallrender. com for more information on topics related to healthcare law.

th e wsda ne w s · issue 7, july · 2017 · www.wsda.org · 31

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3 2 · th e wsda ne w s · issue 7, july · 2017 · www.wsda.org

Dr. Marc W. Anderson

Dr. Marc William Anderson passed away on Nov. 24, 2016. He was born on Feb. 3, 1943 in Rockford, Ill. He and his three brothers and two sisters were raised in a family steeped in the traditions of their Swedish heritage. The entire family took part in running the family grocery store, Howie’s Royal Blue.

Anderson attended Augustana College in Rock Island, Ill. and the University of Illinois, Dental School in Chicago. While in Chicago he met and married Mary Christensen. After graduation he accepted a Hospital Dentistry Internship at the University of Washington. Seattle seemed to be the perfect place for him to start his family, while uniting his love of the outdoors and dentistry.

Anderson served as the Chief of Hospital Dentistry at the University of Washington Hospital, where he taught residents. He formed lasting bonds with his students and colleagues. He later attended the pediatric dentistry program at UW and then became the Director of Pediatric Dentistry at Children’s Hospital. At COH he provided care for children with complex health challenges. He spent the final years of his career in private practice in Bothell and Seattle.

Anderson was very proud of his sons, Christian Eric and Scott Colin Anderson. His quiet Swedish manner may have masked this abounding love for his boys, but he would want it stated clearly how important they were in his life. He loved to take them fishing and boating, but most of all, to spend time with them at Priest Lake in Idaho. It was there that he found peace and serenity, be it on the lake or in a huckleberry patch.

Anderson is survived by his wife, Debbie; son Scott; brothers David, Paul, and Noel; sister Kathy; very special childhood friends Dale and Jan Engberg; and dear friends Mary Anderson, Dennis Egerton, and Carla Grau-Egerton.

Dr. Joseph C. Asterino

Dr. Joseph Charles Asterino died on Oct. 18, 2015, surrounded by his family.

He was 80.

Asterino was born to Charles and Leontina Asterino on March 9, 1935 in Spokane, Wash. He grew up in Spokane with his brother, Robert, and his sister, Linda Smith.

Asterino went to high school at Gonzaga Preparatory School and attended Gonzaga University in Spokane. After graduation, he attended Loyola Dental School in Chicago.

He met his wife, Iolanda, on a blind date

set up by her sister, and they were married in 1960 at St. Augustine’s Catholic Church.

He joined the U.S. Air Force as a captain, where he first practiced dentistry.

Asterino practiced dentistry in the Hillyard area in Spokane for 40 years, and was loved by his patients and colleagues alike. He was compassionate and charitable, providing no-cost and low-cost dentistry to Catholic clergy and those in need.

Even after retirement, he continued to do voluntary dentistry. He was a member of the American Dental Association, Spokane District Dental Society, International College of Dentistry, and numerous dental study clubs.

He was a trustee, board member. and past chairman of the Washington Dental Service. Asterino lived a full life. Besides being a husband, father, and professional, he was accomplished at many things. As a young man, he was a pitcher for an American League Farm team. In later years he was a scratch golfer, competitive poker player, gardener, and so much more. An avid outdoorsman, he spent his whole life hunting and fishing. By himself or surrounded by friends, he loved exploring waterways with a fishing pole in his hand or fields and forests with his dog by his side.

Asterino is survived by his wife of 55 years, Iolanda (Plastino); children Rosemarie, Joseph, Marla Fruit, and Meri Raffetto; eight grandchildren; and two greatgrandchildren. He was predeceased by his brother, Robert.

Dr. Al Cunningham

Dr. Al Cunningham, 93, passed away peacefully at his home in Spokane, Wash. on April 25, 2017.

Cunningham was born on Nov. 15, 1923 in Oakland, Calif., attended City College of San Francisco, and received his Doctorate of Dental Surgery from the University of the Pacific. He had a successful dental practice in Spokane until he retired in 1986.

Cunningham enjoyed retirement to its fullest, having more time to dedicate to his love of fly fishing and golf. He was at his happiest when out on the lake or on the golf course with his buddies. He was an active member of the Inland Empire Fly Fishing Club for 55 years. He stayed busy, active, and fit into his 90s. He was golfing, attending the Fly Club meetings, and going to the gym weekly into his 93rd year.

As much as he loved his hobbies, he loved and appreciated his many dear friends. He frequently said he lived in the best place in the world, and had the best neighbors

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anyone could hope for.

Cunningham is survived by his wife of 60 years, Burnelle; and his daughter, Mary, her husband, Andy, and their children, Spencer and Nina.

Dr. James G. Smiley, D.D.S.

Beloved husband, father, grandfather (“Bubba”), brother, uncle and dear friend to so many. He passed away peacefully May 12, 2017 at home in Palm Springs, surrounded by family and friends. He was 72.

At his request there will be no service in the Seattle area, but to honor his memory he asked that you each treasure and make the most of time spent with family and friends. And maybe floss every now and then. He will be dearly missed. He was a longtime volunteer with PROVAIL at the Johnny Johnson Memorial Dental Clinic, providing dental care to patients with Cerebral Palsy; he dearly loved the patients and the experience of working with them.

In 2014, PROVAIL partnered its dental care program with the University of Washington’s Uncompensated Care Fund for DECOD (Dental Education in Care of Persons With Disabilities). He asked that if anyone wished to make a charitable donation, it be to this program. To do so, please contact Christina Vanosdoll at 206-8971404 or harrc@uw.edu.

Dr. Lloyd W. White

Dr. Lloyd W. White of Brewster passed away on March 25, 2017. Born in Nebraska, White graduated from the UW School of Dentistry. During a career that spanned Washington state, he served as President of the Washington State dental board. There is nothing he enjoyed more than spending time with family and friends fishing in Mexico.

White is survived by his beloved wife, Abril; three children; four grandchildren; and sister Joan.

in memoriam drs. andersonasterino, cunningham, smiley & white

in memoriam

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letter to the editor I love what you do and what you have devoted your life to. But the question you have asked in your column begs a much simpler answer. You yourself have identified two different groups within your patient population: regular poor and the immigrant poor. The regular poor should be the focus, as this is the population that community centers have failed. Rampant decay, missed appointments, and poor adherence to oral hygiene are the norm.

While you propose a potpourri of reasons like skin color and generational poverty, I would claim that there really are only two: lack of a value of health and lack of power in their own lives.

If we examine the effect of the structure the community center puts on its patients, we will see that it produces the outcomes that we see. Values that a person holds generally come from the parents and other mentors, and occasionally from a peer group. Two of the major indicators of a person’s values are where they put

Be Inspired October 19-21 Atlanta

their money and where they put their time.

Community centers generally require very little from their patients in terms of money.

The lack of commitment from a monetary standpoint erodes the value of treatment in the patient’s perspective. The patient’s problems with their health and their dentition, in particular, become the problem of the government. As a result patients do not brush or floss consistently, and experience much more oral disease than is found in other populations.

Imagine this type of effect happening in every aspect of the “regular poor” lives, with work, housing, and food. By taking a person’s commitment out of the equation, we end up devaluing what that person can achieve. The end result is a population with no sense of its own power, beyond how to get the government to provide everything in their lives. We get what we have created: a powerless population.

Now we get down to what is achievable and what is not. Is it possible to instill values in a population? I would say yes,

but programs need to be in line with that value. Services should not be free. They should be achieved as a patient completes a health goal. Programs need to reward the values that we wish to see, not work against them.

How do we empower the patients we see?

The short answer is we do not. Empowerment is such that it must be found by the individual. What we can do is recognize what we have created and develop programs to encourage powerful people. Rather than make excuses for why our patients do not do simple things to ensure their own health, we should create programs that reward how powerful people act.

— Dr. Tim Verharen, DDS

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letter to the editor issue 7, july 2017

Dr. Jennings —

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Call 425-216-1612 or jennifer@cpa4dds.com us today to see how we can help you!

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Diffuse black palate

Figure 1

Contributed by:

Drs. John Malan and Neal Futran, Montana Oral Surgery and UWMC Otolaryngology

History of present illness

This is a 63-year-old male who presented to his dentist with the chief complaint of a palatal lesion that was of about one month’s duration. The patient stated that about a month prior, he had started to notice roughness in his palate. He consulted with his dentist, who noted a discolored mass on the palate (Figure 1). The patient was referred for a biopsy. The patient’s health is otherwise stable with no symptoms related to swallowing or speech difficulty. There are no neck nodes or any other symptoms. The patient’s past medical history is significant for a diagnosis of malignant melanoma of the buttock region in 2004, which was successfully treated with surgery. His past medical history is also significant for rhinoplasty in 1980, cataract surgery in 2009, and surgery on his right foot in 2008.

Test your knowledge!

Visit https://dental.washington.edu/oral-pathology/case-of-the-month/ and see if your assessment of the case is correct.

th e wsda ne w s · issue 7, july · 2017 · www.wsda.org · 37

clinical corner issue 7, july 2017

CLINICAL CORNER

After more than 30 years of coaching Doctors, Blatchford Solutions is excited to announce a new, full-service brokerage business, Blatchford Transitions, Inc. Blatchford Transitions will offer services nationwide, helping dentists to buy and sell dental practices.

We are here to help Doctors prepare for and make rewarding transitions by expanding their thinking beyond what is presently being offered by other brokerage firms.

Dr. Bill Blatchford

We look forward to working with you when it is your time to buy, sell or merge a practice. Please visit our website blatchfordtransitions.com or call us toll-free at (844) 735-7600 to discuss your transition needs.

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OPPORTUNITIES AVAILABLE

OPPORTUNITIES AVAILABLE

DENTIST NEEDED — General dentist wanted to join our experienced compassionate dental team 2-3 days a week in Zillah, WA. Serving diverse people of all ages with quality, comprehensive, gentle dental care. Contact Andrea: (509) 8954066 drstafforddental@gmail.com.

PART TIME ENDODONTIST — Looking for a parttime Endodontist to work a day or two day a month.

Nice modern office located in Bothell Area. Please respond with resume to bellevuedentists@gmail.com.

DENTIST NEEDED — Seeking skilled dental associate with 2+ years experience. 3-4 days/week for a general practice. Offices in Lynnwood / North Seattle. Must be able to work on Saturdays. Please send resumes to dentaladsml@gmail.com.

GENERAL DENTIST — Thriving high tech dental practice in healthy, growing community has a position for part-time general dentist. We desire to bring on a younger practitioner who wishes to associate in anticipation of a buy out or a mature dentist who would like to keep his or her skills up by working two or three days per week in an environment on the Olympics Peninsula that includes diverse recreational opportunities and a relaxed pace of life.

Email: dentalpracticeopportunity2@gmail.com.

GENERAL DENTIST ASSOCIATE POSITION — Option to buy. Existing DDS with is looking to be retired within the next year or sooner. This private practice (30+ year patient base) is open Mon-Thurs (Mon-Wed 8-5, and Thurs 9-3). Prefers someone with at least five years of experience. Part time to start, (3 days) building into full time. Substantial patient base! Salary DOQ. Email: lori.leonarddds@outlook.com.

ASSOCIATE NEEDED — Three days a week in rural family practice in Northeast Washington, 40 minutes north of Spokane. Should be proficient in all aspects of dentistry including crowns, bridges, dentures, molar root canals, and third molar extractions. A minimum of three years clinical experience required. 30 year well established practice.

Please send resume to newportdental@povn.com.

SPOKANE — Seeking full-time general dentist, able to work a varied shift schedule including weekends; must be able to do all aspects of general dentistry including molar endodontics and 3rd molar/surgical extractions; able to adapt to new systems and paradigms; great opportunity to grow and learn; 1-5 years experience preferable. Unlimited income potential! Send resume to Dr. Bradley J. Harken; bradharken@hotmail.com.

ASSOCIATE PERIODONTIST, SOUTH SOUND — Established periodontal and implant practice seeks associate periodontist 2 - 4 days per week.

Eventual buy-in is feasible but not an employment requirement. Beautiful water-front newly built office with delightful experienced staff. Owner periodontist has 25 years of experience with all surgical techniques and available for on-going mentoring. Please respond to helmstetter.barbara@gmail.com or by calling 503-799-4743.

HYGIENIST WANTED — Established downtown Seattle, two-dentist practice. Work with long term, dedicated staff. We are a patient centered office with patient needs placed first looking for someone with the same philosophy. Experience preferred but everyone will be considered. Two to three days per week. Retirement benefits, end of year bonus, free dental & others open to negotiation. Access to in house workout facility, close to transportation hubs, retail (i.e. Nordstrom, Pacific Place, etc.). Reply to (206) 623-6263, ask for Paula or Vickie or email langohrdds@gmail.com. We look forward to hearing from you.

ASSOCIATE DENTIST- Progressive Dental Group in Mill Creek, WA is a three dentist partnership focused on patient relationships, high quality care, and cutting edge technology. In-office Cerec, cone beam and implant placement. Due to consistent and solid growth of 80 to 100 new patients per month we are looking to add an associate dentist. Monday, Friday and Saturday opportunities with flexible hours for the right candidate. Great mentorship with future partnership possibilities. Email your resume and cover letter to ranjivh1@comcast.net.

ENDODONTIST NEEDED- Progressive Dental Group is a three dentist partnership in Mill Creek, WA. We are focused on patient relationships, high quality care and cutting edge technology. In-office Cerec, Cone Beam and implant placement. Due to a high number of Endo referrals and only one local Endodontist, we are looking to add an Endodontist on Mondays and/or Fridays. We will provide staff and support, just bring your microscope! Email your resume and cover letter to: ranjivh1@comcast.net.

GENERAL DENTIST — Redmond, WA, Seeking experienced dentist for a busy, well established successful dental practice to work 3+ days a week.

We are looking for an experienced doctor who is energetic, productive, great with patient communication and a team player with other doctors and staff. Come join our professional, modern office and become apart of our wonderful team. Please send resume and direct any inquiries to dentalofficeresume@gmail.com.

HYGIENIST NEEDED — Thriving high tech dental practice in healthy, growing community has a position for a dental hygienist 4 days a week in an environment on the Olympic Peninsula that includes diverse recreational opportunities and a relaxed pace of life. Please email resumes to dentalpracticeopportunity2@gmail.com.

ASSOCIATE NEEDED — Established Seattle dental office looking for an associate dentist to work 3-4 days a week. Clinical staff consists of two dental assistants and a licensed denturist. Please e-mail your Resume to HealthySmilesDDC@comcast.net if interested. New graduates welcome to apply.

GENERAL DENTIST — A rare opportunity in beautiful Bellingham Washington for a general dentist. Piper Family Dentistry is seeking a 2-3 day per week associate to join our successful, thriving dental practice. The ideal candidate has a desire to work in team environment, is highly skilled, and is dedicated to providing unmatched patient care. Bellingham Washington is ideal for enjoying outdoor activities of every kind, just 90 minutes away from the traffic and congestion of Seattle.

Ski in Mt. Baker’s record setting snowfall, paddle, wakeboard or fish in magnificent Lake Whatcom, or bike/hike on endless interurban trails or world class Galbraith Mountain. Bellingham also enjoys excellent public schools and Western Washington University making this beautiful waterfront college town an ideal place for starting a career and/ or raising a family. Julie@trgcoaching.com.

ASSOCIATE DENTIST — Position immediately available. Well established successful Enumclaw dental practice seeks a full time associate dentist.

We provide comprehensive quality care for the entire family and have a great team of support staff.

Our office is modern and utilizes state of the art technology including CBCT and digital impressions. We are looking for a dentist who is friendly, professional, a team player, has great communication skills and a passion for quality patient care.

Expectations are mostly treatment planning, restorative and crown and bridge. The office is not currently doing oral surgery, endodontics or implant placement so these skills would be a plus but aren’t necessary. Compensation is based on production/collections. The position supports compensation of $275,000+ per year working 4 days/ week (Office is open M-F). Experience highly preferred but willing to interview recent graduates.

Please email CV to Enumclawdentist@gmail.com and Call Kim at 360-825-4696.

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DENTISTS NEEDED — Dental Professionals is recruiting dentists for temporary and permanent positions throughout western Washington – Vancouver to Bellingham and the Olympic Peninsula.

No fee to you and you pick the days and geographic locations that you are available to work. This is a great opportunity to earn supplemental income or find a permanent position. If interested please call Bob at (206) 767-4851.

MULTI-SPECIALTY GROUP PRACTICE OPPORTUNITIES — With more than 400,000 patients throughout our 50+ practice locations in Oregon, Washington, and Idaho, and a built-in specialty referral network to more than 30 specialists, Willamette Dental Group has been a leader in preventive and proactive dental care since 1970. What makes this multi-specialty group practice unique, and better, is a commitment to proactively facilitating the best possible health outcomes. We currently have openings in Oregon and Washington for general dentists, endodontists, oral surgeons, pediatric dentists, and locum tenens dentists. As a member of the Willamette Dental Group team, we offer a competitive salary commensurate with experience. We are a performance based culture and offer a generous and comprehensive benefit package. Among the many amenities we offer are competitive guaranteed compensation, benefits, paid vacation, malpractice insurance, in-house CEs, and an in-house loan forgiveness program.

Please contact Kelly Musick at kmusick@willamettedental.com and visit www.willamettedental. com/careers to learn more!

ASSOCIATE NEEDED — Family-owned, fee-forservice office in Bend, Oregon seeking a full-time (4-day week) associate. Office is modern and alldigital. Treat your patients like family. Competitive pay, benefits, and equity (partial ownership) opportunities available. Want to be part of something special? Tell us a little more about yourself. info@purecaredental.com

classifieds issue 7, july 2017

OPPORTUNITIES AVAILABLE

David Anderson, CDT Implants Implant Department Manager

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4 0 · th e wsda ne w s · issue 7, july · 2017 · www.wsda.org

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PEDIATRIC DENTISTS — Outstanding Opportunities in North Central Washington Pediatric dentists needed for associateship. Wenatchee Valley Dental Village is a large private group practice and is seeking two or three pediatric dentists to join our busy and well-established 10-chair office. We provide comprehensive, quality-focused dental services to pediatrics and adolescents, including endodontics and in-office general anesthesia. Our experienced, bilingual staffing model consists of hygiene assisted restorative care for efficiency and stress management. The ideal candidate should be energetic, motivated and share a passion for treating children of all ages. Interpersonal and technical skills with strong work ethics and moral values are a requirement. Experienced current owners are willing to mentor. Excellent compensation with a bonus program, 401(k), vacation, holidays, continuing education allowance, medical and malpractice insurance. Loan Repayment Possible. Call Anne at (509) 886-2500 or email aknappert@wvdentalvillage.com.

PART-TIME DENTIST — Needed 2-3 days per week in Spokane Valley general practice. We value someone with excellent clinical and interpersonal skills to join North Pines Dental Care. Please email: rosemaryosborn@comcast.net.

ASSOCIATE OPPORTUNITY, YAKIMA — We have a great associate opportunity for a new graduate or a long term home for a seasoned dentist looking to be compensated well with less of the headaches and stress. Group practice composed of general dentists, orthodontists, and oral surgeons. For new grads it’s the perfect opportunity to learn your craft by working side by side with generalists and specialists while being paid very well. Base salary of $150,000 for new grads plus bonuses. Base salary of $175,000 plus bonuses for experienced dentists. Opportunities to earn much more with our full schedules! Both positions have the opportunity to earn well above $200,000. Full benefits package. State of the art clinics and equipment. Mix of children and adult dentistry. Mix of state and private insurance. Full time opportunity available. Moving expense reimbursement offered.

Please send inquiries to jbabka@applesmiles.com.

DENTISTS NEEDED — Light Dental Studios is a private group practice that started as a solo dental practice in South Puget Sound in 1997. We are looking for dentists to join our reputable group as we continue to grow and expand. While many of our dentists graduated in the top of the class or are members of OKU, it is not a requirement.

We want doctors looking to provide exceptional care to patients and are genuinely nice people.

The culture in our company is positive and loving. There is a camaraderie between doctors and a ton of mentorship available to expand your skill set as many of our general dentists work with our specialists to provide expanded services including wisdom teeth, implants, sinus lifts, comprehensive ortho, and more. We are only interested in dentists looking to stay in the area to maintain our low doctor turnover rate. Benefits are great, pay is above average, and opportunities for growth extend managerially as well as professionally. Please send your resume to Angie Dunn (UWSoD 2009) at adunndds@lightdentalstudios.com to find out more.

OPPORTUNITIES AVAILABLE

OPPORTUNITIES AVAILABLE

ASSOCIATE OPPORTUNITY, SPOKANE VALLEY — We have a great associate opportunity for a new graduate or a long term home for a seasoned dentist looking to be compensated well with less of the headaches and stress. Group practice composed of general dentists, orthodontists, and oral surgeons.

For new grads it’s the perfect opportunity to learn your craft by working side by side with generalists and specialists while being paid very well.

Base salary of up to $150,000 plus 30% production bonus for new grads. Base salary of $175,000 plus 30% production bonus for experienced dentists. Opportunities to earn much more with our full schedules! Full benefits package. State of the art clinics and equipment. Mix of children and adult dentistry. Mix of State and private insurance.

Full time opportunity available in Spokane Valley.

Moving expense reimbursement offered. Position starts August 1, 2017. Please send inquiries to jbabka@applesmiles.com.

DENTIST OPPORTUNITY IN WESTERN WA. — Seeking experienced dentist for busy, well established, successful, fee for service, group dental practice. Full-time position available. Excellent immediate income opportunity ($180,000 to $375,000 + per year) depending on productive ability and hours worked. Secure, long-term position. You can concentrate on optimum patient treatment without practice management duties.

Modern well-equipped office with excellent staff, and lab services provided. If you are bright, energetic with a desire to be productive, very personable, and people oriented, and have great general and specialty clinical skills, Fax resume to Dr. Hanssen at (425) 484-2110.

ASSOCIATE DENTIST — With buy in opportunity.

Experienced GP needed for our Des Moines practice.

Must be proficient in all phases of dentistry. Can discuss buy in opportunity upfront or later. This position is three days per week Monday through Wednesday.

Please email me at baljinderbuttar1@gmail.com.

GENERAL DENTIST NEEDED — For busy Community Health Center in Yakima County. Dentist will see all ages, children and adults. Support staff include bilingual dental assistants, registered hygienists, and connection to a strong integrated team of medical and behavioral health, nutrition, optical, and essential needs providers. Clinic has integrated Electronic Health Records, and state of the art equipment. Looking for compassionate individual interested in serving low income individuals, including agricultural works and homeless. Dentist works four 10-hour days, competitive compensation package. YNHS is an eligible site for National Health Service Corps scholars, loan repayment, and Washington Health Loan Repayment. Contact rhonda.hauff@ynhs.org.

GENERAL DENTIST NEEDED — We are interviewing for a general dentist position in our growing practice. The dentist should have at least five years of experience and should feel comfortable doing molar root canals and surgical extractions. We have clinics in South Seattle and Kent.

We need a dentist that can work 2 to 4 days in a week. Please send us your Resume to jobs@buriendentalcare.com or call 425-647-4318.

ORTHODONTIST NEEDED — We are looking for an orthodontist for 1 to 2 days a week in our Kent clinic. The orthodontist needs to bring his/her team and supplies. We get 10 new ortho patients per week. We provide excellent compensation based on collection. Please send us your resume to jobs@buriendentalcare.com or call 425-647-4318.

GENERAL DENTIST, SUNNYSIDE — Full time position. Work beside specialists. Offering a great schedule, great compensation and guarantee.

Great opportunity to expand skill set as you work or a perfect opportunity for an experienced dentist to utilize a wide range of skills. For more information, please contact Jolene Babka at jbabka@ applesmiles.com

th e wsda ne w s · issue 7, july · 2017 · www.wsda.org · 41

GENERAL DENTIST, TRI CITIES — Great associate opportunity for a new graduate or a long term home for a seasoned dentist looking to be compensated well with less of the headaches and stress.

Group practice composed of general dentists, orthodontists, and oral surgeons. For new grads it’s the perfect opportunity to learn your craft by working side by side with generalists and specialists while being paid very well. Base salary of $150,000 for new grads plus bonuses. Base salary of $175,000 plus bonuses for experienced dentists.

Full benefits package and moving allowance. State of the art clinics and equipment. Mix of children and adult dentistry. Mix of state and private insurance. Position available in coveted Pasco, Washington facility this Spring. Please send inquiries to jbabka@applesmiles.com.

GENERAL DENTIST REQUESTED, MAPLE VALLEY — Our multi-doctor, family practice is looking for an outgoing, professional doctor skilled in all aspects of dentistry to join our team. Our beautiful, modern office has been providing excellent dental care to our ever growing community for over 10 years. We offer a generous compensation package along with the opportunity to work with an established, efficient and personable team.

Please email your resume to wendyloconnell@yahoo.com or you may fax it to 425-413-8599.

GENERAL DENTIST, SPOKANE — We have a great associate opportunity for a new graduate or a long term home for a seasoned dentist looking to be compensated well with less of the headaches and stress. Group practice composed of general dentists, orthodontists, and oral surgeons. For new grads it’s the perfect opportunity to learn your craft by working side by side with generalists and specialists while being paid very well. Base salary of up to $150,000 for new grads plus bonuses.

Base salary of $175,000 plus bonuses for experienced dentists. Opportunities to earn much more with our full schedules! Full benefits package and moving allowance. State of the art clinics and equipment. Mix of children and adult dentistry.

Mix of State and private insurance. Full time and part time opportunities available. Moving expense reimbursement offered. Please send inquiries to jbabka@applesmiles.com.

classifieds issue 7, july 2017

OPPORTUNITIES AVAILABLE

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4 2 · th e wsda ne w s · issue 7, july · 2017 · www.wsda.org

OFFICES FOR SALE OR LEASE

OFFICES FOR SALE OR LEASE

FULL-TIME ASSOCIATE IN BELLEVUE — We are looking for full time associate in Bellevue to work 4+ days a week . We are a top office in our area. Beautiful modern office with state of the art technology. Fantastic patients and team. Fully digital. Must be highly skilled and experienced.

Ready to learn and be a part of the team. Outstanding earning potential. Please email resume to bellevuedentists@gmail.com.

BELLINGHAM — Lease turnkey dental suite. Formerly successful pediatric and orthodontic ClassA office space. Save $200,000+ construction costs.

Ample parking. Interstate-5 access. High-traffic/ visibility location. Customization available. Lincoln Professional Center: 360-739-1421 adengst@ gmail.com.

FOR SALE, BELLEVUE — Ideal for a specialist or a general dentist start-up. Beautiful turn-key dental space for sale in Bellevue, top quality construction, DanNix design. Located on the growing Bel-Red corridor close to Microsoft, 520, new multi-family development, and the new REI corporate headquarters. Fully equipped with three operatories, all ADEC, Pano, plumbed nitrous, and separate storage space with compressor. The lease term is excellent and structured simply with base monthly rent. There is no triple NNN pass through for expenses. Please contact financial@ belmoddental.com for more details.

ORTHODONTIST ASSOCIATE NEEDED. Two Saturdays per month to take over for retiring orthodontist. Flexible start date. Established general family practice in beautiful Fall City on Snoqualmie River. Long-term staff and patients. Also possibility for general dentistry and endo/surgery. Call office at (425) 222-7011 or email fawcett@nwlink. com. www.fcfamilydental.com OPPORTUNITIES WANTED OPPORTUNITY WANTED — Graduate of Rutgers University, School of Dental Medicine, seeks periodontics and dental implant surgery position in greater Seattle area.

View my CV here: http://drive.google.com/ f i l e /d / 0 Bz G C 8 0 f B f j s l a H Y 5 djN6 a DF n R m s / view?usp=sharing.

OPPORTUNITY WANTED — 2017 University of Washington SoD graduate looking for a general dentist position in the Seattle area. View my CV here: http://docs.google.com/document/d/18 0LWbHv4gjRD2SA3kV9uD0z0-mp8qsOXtttVn4D3ac8/edit?usp=drive_web.

OFFICES FOR SALE OR LEASE PERIODONTAL/RESTORATIVE PRACTICE FOR SALE. Poulsbo, WA. Turn-key. $683K production.

Four operatories. 2,150 SF, digital, Piezo, Nobel/ Straumann implant systems. Active periodontal/ restorative patients. Build practice starting with immediate income patients. PPIC95@icloud.com.

FOR SALE — New listing. Great location in Lynnwood. 1,000 square foot fully equipped three operatory dental office. Dentist is retiring. Contact Dirk at dirk1@msn.com UW PRACTICE FOR SALE — Three ops, 1,268 sqft, averaging 15 new patients/month. June production 52k in 11 working days without endo/OS/ implants. Awesome location and potential. Contact Sean (206) 765-6725 - mihendeavors@gmail.com.

FOR SALE — Vancouver pedodontic practice and building for sale. Three equipped ops with room for 4th, 1,700 square feet, two baths, lab, sterilization, lounge, laundry, private parking lot, older equipment including Pano, paper charts. Price negotiable. Call or email: (503) 320-8991 or john@ greensailtransitions.com.

DT REDMOND LEASE, $20K BACK TO YOU AT SIGNING! — Downtown Redmond lease available. Located at the base of Education Hill, dense family population! Four operatories, private office. Equipped with Nitrous, vacuum/compressor and CBCT, recently remodeled (2014). Rent: $45k per year includes operating expenses. Will give $20,000 upon signing for working capital. Great start up opportunity or local dentist interested in relocating and reducing overhead expenses. Please email redmonddds@gmail.com.

GENERAL PRACTICE FOR SALE — South King County. Large, profitable multi-disciplinary practice. Digital radiography. I-V sedation. Separate digital pan/lateral ceph. CBCT. CEREC. Approximately 5,000 sq/feet. For more information contact: Jennifer Paine: (425) 216-1612 or Jennifer@ cpa4dds.com GENERAL PRACTICE FOR SALE — South Snohomish County. Fantastic visibility within close proximity to aerospace giant. Collecting $625K. Three fully-equipped operatories. Lab. 1,000 sq/ ft (approximate). For more information please contact: Jennifer Paine at (425) 216-1612 or email Jennifer@cpa4dds.com GENERAL PRACTICE FOR SALE/Merger Opportunity — Eastside/North. State-of-the-art office located in a prime medical-dental area of the Eastside. Three fully-equipped operatories w/room for one additional. 1,685 sq/ft (approximate). Collecting 516K. Nitrous. Digital x-Rays. Soft-tissue laser. Intra-oral camera. Treatment includes: adult prophylaxis; pediatric; root-planing; periodontal maintenance; composite/metal-free fillings; crowns/bridges; veneers; dental implants; root canals; mouthguards; bite balancing. For more information please contact: Jennifer Paine at (425) 216-1612 or email Jennifer@cpa4dds.com FOR LEASE — Great Bellevue location, four ops, fully equipped, warm and inviting dental office for sale. Perfect for a start-up practice. Instruments and supplies included. 70K. Long-term lease available per negotiation with landlord. Contact nwicd@aol.com.

FOR SALE, VANCOUVER — General dentistry practice for sale in Vancouver WA. Practice is well established and has been in the same location since 1980s. Practice has low rent and low overhead. Three operatories, paperless, digital (Dexis) X rays, wireless intraoral camera. Practice is in a busy intersection across from Safeway. Annual collections $ 430,000. Well trained staff. Please email indentation534@gmail.com.

FOR LEASE — Beautiful first floor office in a three story professional building. Has been the location for an oral and maxillofacial surgeon for nearly 30 years. Two surgical and three exam rooms with lots of parking. Post op room and private door to drive up. One block from medical center and hospital. Park-like setting with private gardens and floor to ceiling windows. Owner of the building is a general dentist who is an owner occupant. Also an endodontist, orthodontist and other general dentists in the building. There is a need for another Oral surgeon in the valley! Owner will make the lease attractive. Call for more details and a showing. (509) 670-7593.

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FOR SALE — Pediatric practice located in the South Sound. $500,000+ per year on 3 days per week. Great location and referral sources. Contact rod@omni-pg.com for details.

G/P PRACTICE FOR SALE IN LINCOLN COUNTY — Annual collections over $430,000. Four operatories, doctor works three days per week.

Practice is located within 35 miles of Spokane.

Practice has been in same location since mid-60’s.

Doctor owns the building and will sell it now or in the future. Well-trained staff will assist with the transition and will stay with the practice after the transition. Well-established practice with an excellent collection policy in place. Excellent cash flow for a practice of this size. Please contact Buck Reasor, DMD, cell: 503-680-4366, Fax: 888317-7231, email :info@ reasorprofessionaldental. com, www.reasorprofessionaldental.com. PO Box 14276, Portland, OR 97293.

FOR SALE — General practice in Battle Ground WA. Three fully equipped operatories, busy main street location. Contact Vicki at (360) 521-8057 or lyledkelstrom@gmail.com FOR LEASE – Maple Valley Dental office for lease. start-up or move your existing practice. Fully built out with five operatories. Plenty of parking in plaza. Approximately 1,524 sq. ft. with favorable lease terms. Email Steve Kikikis steve@omni-pg.com.

FOR SALE —Investment opportunity in Maple Valley for sale. Mix of office and retail uses Asking price is 1.4 million for this visible building on .95 acres is 6,400 sq.ft Contact Steve Kikikis at steve@ omni-pg.com.

FOR SALE — Price reduced - South Sound perio practice and real estate available for sale. Collections over $1.5 million. Great referrals and low overhead. Building is also for sale. Call Rod at Omni 206-979-2660 or rod@omni-pg.com.

FOR SALE - Grays Harbor - Fee for service general dental practice for sale. Annual collections over $200,000, four operatories, lots of parking on busy street. Contact Rod Johnston of Omni Practice Group at 206-979-2660 or e-mail rod@ omni-pg.com.

EASTERN WASHINGTON — Practice for sale.

Annual collections $400k on three days/wk. Enjoy the outdoor lifestyle the other 4 days/week.

Low overhead, high profit, no stress. Contact Jim Vander Mey at jim@omni-pg.com.

classifieds issue 7, july 2017

OPPORTUNITIES AVAILABLE

first person dr. brittany dean, continued

continued from page 46

quickly to the protocol of a boardroom. Their familiarity with ADA policy, acronyms, and protocol enables them to adapt to leadership roles more quickly than many more seasoned dentists who have not had such exposures. The new dentists from the 11th District who currently serve on ADA councils, as ADA delegates, and on boards and committees locally are excellent examples of this talent. It’s true that new dentists can have time pressures that take them away from leadership, but looking at proportional representation (one new dentist out of every four 11th District appointees to an ADA council, for example), there really are not a whole lot of spots to be filled. It is one of my personal leadership goals to help identify those people.

In order to ensure that organized dentistry at all levels is a place that new dentists can call home, we need to promote new dentist leadership. This is a benefit for our membership numbers, and also for the health and vibrancy of our association. I am requesting your help in identifying leadership candidates and encouraging their involvement. First, simply ask a new dentist if they would like to be more involved. New dentists who did not attend dental school in Washington (and there are many) may not have the connections to know where to start volunteering. For those who don’t have the baseline knowledge to hold a specific position, introduce them to mentorship opportunities so that they can build that knowledge.

Finally, contact me (brittanydeandds@gmail.com) about accessing the newly formed 11th District New Dentist Leader Pool, so that we can better collaborate to plug new dentists into the right roles.

If you’re a new dentist looking to lead at any level, email me as well to add yourself to the database. I welcome any further suggestions.

We all want a bright future for organized dentistry.

1. ADA Best Practice Standards for Diversity 2016 2. Hewlett, Sylvia Ann, Melinda Marshall, and Laura Sherbin. “How diversity can drive innovation.”

Harvard Business Review 91.12 (2013): 30-30.

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4 4 · th e wsda ne w s · issue 7, july · 2017 · www.wsda.org

OFFICES FOR SALE OR LEASE

OFFICES FOR SALE OR LEASE

FOR SALE — Fully equipped dental office for sale in Arlington. Three operatories, dental chairs, and sterilization, equipment included in purchase. No Patients Included. Approx. 950 sq. ft plus storage room. Asking $180,000. Email Steve Kikikis steve@omni-pg.com

NEXT/ANNIE MILLER & ASSOCIATES — Providing consulting services to the dental community for the past 35 years. New practice start-ups, practice transitions, sales and valuations. Dental space planning and architecture; real estate leasing and acquisitions, employment benefits; staffing resources and training; financing. Call today for your free consultation…we can’t mint money for you, but we can sure save what you have now! Annie Miller (206) 715-1444. Email: annie@nextnw.com.

EASTERN WASHINGTON CHELAN — Practice for sale. Established 1978. New building and equipment 2006. Four complete ops, 1500 sq.ft building, digital x-rays and pano. By owner/ dentist. Doctor wishes to retire. Will stay to transition new doctor.

Reply: crgav523@aol.com.

NORTH WHATCOM COUNTY — General dental practice for sale. Annual collections of $400,000.

Located next to Starbucks on busy street. Newer equipment, pano, etc., Beautiful city on the Canadian border. E-mail rod@omni-pg.com NEW LISTINGS — Downtown Seattle – One has annual collections of $680,000 just doing basic dentistry with specialty procedures referred out.

The other practice has annual collections of close to $1 million and was remodeled four years ago.

Downtown practices sell fast. Contact Frank Sciabica, DDS at frank@omni-pg.com.

NEW LISTING! — Olympia practice for sale. Annual collections over $1 million. Building also for sale.

Call Frank Sciabica, DDS at frank@omni-pg.com.

NEW LISTING! — Tacoma ortho practice for sale – Annual collections over $600,000, six chairs, real estate also may be for sale. Contact john@omni-pg.com NEW LISTINGS, SKAGIT COUNTY — Two new listings in Skagit County! One is west and one is east Skagit County. Annual collections of $350,000 on both. Contact frank@omni-pg.com NEW LISTING, SNOHOMISH COUNTY Snohomish County Annual collections of $360,000 on 3 days per week. E-mail frank@omni-pg.com See all our listings at www.omni-pg.com BELLEVUE OFFICE SPACE — Fully built out for lease. Four ops, high end finishes, 1,250 sq. ft.

Plenty of Parking. Contact steve@omni-pg.com.

FOR SALE — Marysville dental building! 6,065 sq. ft. nearly fully occupied building + residential home + additional 12,870 sq. ft. lot to grow = Great investment. Contact steve@omni-pg.com.

FOR SALE — Maple Valley building for sale with existing dental office space for lease. Building is 6,400 sq. ft on .95 acres. Dental space has four operatories. Growing area contact steve@omni-pg.com.

FOR LEASE — Bellevue medical/dental office space for lease – 2,890 sq ft. of space. Prime location on the future light rail corridor. Contact steve@omni-pg.com.

FOR LEASE — Dental office space for lease in Lynnwood, Renton, Bellevue, Edmonds, Kirkland, Seattle and other King, Snohomish and Pierce County areas. Some space is already built out or plumbed for a dental office saving you thousands of dollars. Contact Steve Kikikis at steve@omnipg.com for details.

BELLEVUE — General practice for sale in Lake Hills neighborhood. 20+ years. Great location with good street visibility. Three chairs with room for four, approx. 1,500 sq. ft. , fully digitized, Dentrix, Invisalign, mostly adult restorative and families. Ave. 600k+ annual production, staff wlling to stay, doctor will work through transition. Please reply to: Piega@delaneytransitions/ (425) 890-8271.

FOR IMMEDIATE OCCUPANCY — A fully plumbed dental office. 1,350 sq ft , three operatories, air, water, vacuum, nitrous oxide and oxygen, private office, lab, staff lounge, separate staff entrance. This office has exceptional exposure to the Southcenter Mall traffic. Please call Dr. Jerome Baruffi at Medical Centers Management (206) 575-1551.

YAKIMA/SUNNYSIDE — We have a great associate opportunity for a new graduate or a long term home for a seasoned dentist looking to be compensated well with less of the headaches and stress.

Group practice composed of general dentists, orthodontists, and oral surgeons. For new grads it’s the perfect opportunity to learn your craft by working side by side with generalists and specialists while being paid very well. Base salary starting at $165,000 plus bonuses. Full benefits package and moving allowance. State of the art clinics and equipment. Mix of children and adult dentistry.

Mix of State and private insurance. Position available in Yakima/Sunnyside, Washington. Come try out the East side of the state where there’s 300+ days of sunshine, beautiful landscaping, the gorgeous Columbia River and family friendly communities! Please send inquiries to jbabka@applesmiles.com.

FOR SALE, TUKWILA — Newly upgraded dental practice in Tukwila for sale. $725,500.00. Six ops with the latest in imaging upgrades, new computers, software and hand pieces. One of the last feefor-service practices left. Seller will pay for new floor covering throughout, leave the security deposit for the new buyer on the lease assessment and help with the transition. Call today for a tour.

Annie Miller, (206)-715-1444.

AVAILABLE, SOUTHCENTER — Just available.

1200 square foot fully equipped four operatory dental space. Cerec , Panoral, four chairs, lights, nitrous, air and vacuum all available and in place.

Please call Dr. Jerome Baruffi at Medical Centers Management (206) 575-1551.

FOR LEASE — Quality professional office space for lease in the heart of the Renton Highlands in the Highlands Professional Plaza medical dental building. Excellent place for an oral surgeon and/ or endodontist to open a satellite office or start up practice. Currently there are two GP dentists, a pedodontist, an orthodontist and a large physical therapy clinic. This building has a proven track record of successful businesses because of its location and quality. The building sits across the street from Bartells, QFC, and Starbucks. There are six elementary schools and four high schools within two miles. Get close to where the people live and enjoy fast practice growth. Call (206) 595-9100.

th e wsda ne w s · issue 7, july · 2017 · www.wsda.org · 45

SPACE FOR LEASE, WENATCHEE — Dentist moving to new location. 3,504 sq.ft + 300 sf basement. Presently 10 ops can be split-up call 509-4214914 or email drharveyopenwide@gmail.com.

SERVICES HAVE SEDATION, WILL TRAVEL! — Make fearful patients comfortable with IV Conscious Sedation.

I am set up to come to your office and sedate your patients so that you can perform needed treatments the patients avoid due to fear. I have over 19 years experience providing safe IV Conscious Sedation.

Serving Washington and Oregon. Richard Garay, DDS. (360) 281-0204, garaydds@gmail.com.

EQUIPMENT FOR SALE DENTAL EQUIPMENT FROM REMODEL — Rolling chairs, valves, compression gauges, tools, towel and glove dispensers, computer, grinding equipment, pluming parts, loads of cabinets with formica interiors. Make offer. Chris (206) 595-5791.

FOR SALE, LOWER PRICE!!­— Gently used 2 yr-old Digital Pano (Instrumentarium OP30)$13k This unit has the Extra-Oral Bitewing program as well as TMJ Projection. The images are brilliant and easy to diagnose from. Buyer responsible for cost of moving, installing and insurance for the move. admin@UptownDentalGigHarbor.com.

USED/REFURBISHED EQUIPMENT — Adec, Gendex, Pelton Crane, DentalEZ, Porter, Air Tech, Midwest, Midmark and etc. Lab equipment. Parts are also available for almost all equipment. Call Dental Warehouse at 800-488-2446 or http:// cascade-dental.net.

OFFICE CONSTRUCTION CONSTANTINE BUILDERS INC. (CBI) — WSDA endorses CBI as their preferred builder of Dental facilities with over 25 years of experience from ground up buildings, renovations, remodels, and interior tenant improvement projects. All projects are completed on time and within budget. CBI provides the highest level of quality service with integrity that exceeds our client’s expectation. Please see our display ad on page two and website at www. constantinebuilders.com for additional information and how you can become another satisfied client.

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ALLIED CLINIC BUILDERS — Premier healthcare contractors in the PNW for over 35 years. On time, on budget and providing quality you can afford. Call today for a consultation. George McBee. alliedclinicbuilders@comcast.net (425) 941-3088

classifieds issue 7, july 2017

OFFICES FOR SALE OR LEASE

first person dr. brittany dean

The significant contribution of new dentists

Dr. Brittany Dean Editorial Advisory Board

“I have also been told that new dentists are not equipped with the experience in organized dentistry that is necessary to be a leader. On the contrary, many new dentists have resumes today that rival those of leaders nearing retirement.”

The views expressed are those of the writer and do not necessarily reflect the opinion or official policy of the WSDA.

It is easy to overlook the significance of new dentists. Some see the first 10 years after graduation as a time when practitioners are still getting their footing and testing out their wings, but this period of life constitutes a full quarter or more of the years that a person holds an active dental license. New dentists already comprise more than 26 percent of ADA membership.1 With more dental schools opening and class sizes increasing, that percentage is projected to continue rising.

For the purposes of brevity, I will discuss new dentist leadership at the ADA level in this article, but I mean this to encompass each segment of the tripartite (national, state, and local) since a robust new dentist presence is vital at all levels. Association best practices (including the ADA’s own 2016 best-practice standards) assert that an organization’s leadership should be reflective of its membership composition. If our metrics were on target, one of every four ADA council members, state and local delegates, and society board members would be a new dentist. While I am proud to say that we in the 11th ADA District often lead the country in these numbers, there is ample room for improvement.

For the part of my identity that is distinctly dentist, the ADA is my home. Within organized dentistry, I feel heard and cared for. Like most associations, however, the dental tripartite has seen an unfortunate trend in market share decrease, suggesting that the sense of value that I feel by belonging to this group is not universal. Recent ADA research reveals that different generations of dentists are looking for vastly different things from organized dentistry. When we look at the makeup of today’s leadership, which is overwhelmingly mid-to-late career dentists, it is easy to understand why new dentists might question whether the ADA is really a place for them. I want my peers to feel that they fit at the ADA, that they can call it home. But as anyone who has ever moved to a new house can attest, it takes personal touches and a reflection of your own character to make a house truly feel like a home. New dentists will be much more likely to feel welcomed into the ADA if their peers have a hand in shaping it.

The rationale behind proportional representation in leadership for new dentists is not only to make the association more attractive to this cohort. The 2013 Harvard Business Review article “How Diversity Can Drive Innovation” highlights another benefit of engaging a wider range of viewpoints. Upon evaluation of a survey of 1,800 professionals, 40 case studies, and additional interviews and focus groups, the article’s authors assert that “leaders who give diverse voices equal airtime are twice as likely as others to release value-driven insights….”2 They found that the conversations about a company’s trajectory were more fruitful if the people talking represented a diversity of backgrounds. At a time when the ADA is facing pressures to evolve, hearing what new dentists have to say can strengthen the association as a whole.

I would argue that new dentists are often the first ones to come up against the paradigm shifts that later filter through to the rest of the dental profession. Recent examples of this include social media marketing, digital appointment reminders, and the shift towards group and corporate practice. This is not to say that new dentists are the only ones to be first in these spaces, but due simply to the fact that there are so many transitions in the new dentist stage (first job, associateship, practice purchase), the timing is ripe to adapt or conform to new trends. When these changes are first beginning to affect dentistry, we need to be having smart, high-level conversations about how we can help dentists navigate these shifts. Doesn’t it make the most sense to include those most affected by the challenges? Too often we have seen organized dentistry reactive rather than proactive. If the ADA wants to remain relevant, new dentists must be a part of the conversation.

I attribute much of my involvement in organized dentistry leadership to being in the right place at the right time. I took the initiative to become my ASDA class representative my first year in dental school. At my first national meeting, the trustee recommended that I run for the following year’s position. After a tight race with only one other candidate, I was suddenly a part of national ASDA leadership. It seems as though my trips to Chicago haven’t stopped since. I am grateful for the tremendous support from WSDA volunteers and staff at each point along my leadership tenure.

In part, my success at the national level is due to the relationships I forged along the way. Appointing leaders know me and my abilities because of the time I have put in. As I approach my final year on the ADA New Dentist Committee, I am especially cognizant that I need to identify the leaders who will come next, and work to help them be successful, too.

Fortunately, many new dentists are well-prepared to be involved at the highest levels.

By their final year of new dentist membership, individuals who dove into involvement as students could have 14 years of formal leadership under their belt. This could include voting in the ADA House of Delegates, lobbying in Washington, D.C., and working as liaison to multiple ADA councils or workgroups, among other opportunities. The individuals who get involved in this way are invariably voracious learners who adapt continued on page 44

4 6 · th e wsda ne w s · issue 7, july · 2017 · www.wsda.org

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Can you say the same about your insurance broker?

Steven M Stanley, DDS

I have had the pleasure of working with Matt French at WDIA for the last 15 years. He has always proven to be both knowledgeable and helpful with our insurance needs. With the constantly changing and confusing array of insurance products out there, Matt has always been very helpful and straight forward in deciphering all these options.

ley ne Stan n a e J d an Steven

I want to provide very good medical insurance for both my family and my staff, and the resources at WDIA assist me in doing so. Three years ago my wife was diagnosed with Multiple Myeloma and given but 1 to 3 years to live. This diagnosis came at the same time as the renewal of our group medical plan for my office. Just hours before signing on to a new plan, Matt called me to let me know that the plan we were considering did not cover treatment at Seattle Cancer Care Alliance, which was where we were seeking treatment for my wife. Due to Matt’s diligence and foresight, we were able to sign on to a different plan which not only saved me tens of thousands of dollars, but has saved my wife’s life.

When the insurance company denied treatment to which my wife was entitled, Matt went to bat for us contacting the Washington State Insurance Commissioner and the insurance company. With his assistance, we were able to get the insurance company to agree that they were responsible to assist paying for the proposed treatment.

In addition to assisting me with my office policies, Matt and his staff have always been both gracious and extremely helpful in assisting our kids and former employees as their insurance needs have changed.

My wife and I both highly recommended Matt French and his wonderful staff at WDIA. We will always be indebted for the service he provides us. He always exceeds our expectations and for that we will be eternally grateful.

Sincerely,

Steven M. Stanley DDS

The Obvious Matt French · Kerri Seims Choice for 206.441.6824 · 800.282.9342 Washington www.wdiains.com th e A wsda ne w s · issue 7, july · 2017 · www.wsda.org · 47 Dentists WSDA Company

YOUR WDIA TEAM:

Washington State Dental Association 126 NW Canal Street Seattle, WA 98107

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CHANGE SERVICE REQUESTED

We're not the norm…

Anytime we discover exposures our doctors are facing beyond professional liability, we work to develop and offer exceptional dentist-specific products.

For instance, NORDIC was one of the first northwest companies to offer dentists comprehensive cyber risk coverage.

Can the big box companies say that?

For more information about cyber coverage, call ……

NORDIC – the Gold Standard

800-662-4075 nordicins.com melissa.sanchez@nordicins.com

Sole broker for NORDIC

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4 8 · th e wsda ne w s · issue 7, july · 2017 · www.wsda.org