Doctor Eclectic

Doctor Eclectic
Doctor Eclectic

Wednesday, October 26, 2011

Corporate Dentistry

I just returned from the annual American Dental Association where I had the privilege of being an Alternate Delegate to the House of Delegates, the ruling body of the ADA.  For the last several years the ADA has been hosting an intense discussion group on a topic of the future.  This is attended on a volunteer basis by as many of the 450 delegates and alternates as the room can hold; this year about 250.

The topic was “What will be the dentist of 2034?

Part of the relevance for the subject stems from the fact that the ADA is losing membership; due to age, the economy, and failure to attract the new dentist.  The latter deserves some thought.  The biggest problem is school debt.  In California a recent graduate would begin paying on from $200,000 to $500,000 unless he or she was able somehow to have found a parental way to pay as you go.  The interest on those loans has escalated dramatically in recent years and can now approach 8%.  Do the math and you can see it is a career decider.

So, the new dentist no longer can afford to set up a solo practice and, while independence is one of the great motivators to enter dentistry, most have to work for someone else on some sort of salary, often tied to production.

This concerns the ADA and they have labeled this career choice as becoming a “Corporate Dentist”.  The general opinion is that this dentist has less concern for the ethics of good dentistry, less concern for the needs of the patients, and fails to establish the doctor-patient relationship so important in patient satisfaction for the subjective services of dentistry.

My personal experience is different.  Of course I was a corporate dentist for my entire career: first, as a Navy dentist for 25 years, and subsequently as Dental Director for at least five Health Plans.  In both arenas I witnessed dedicated young dentists who, if anything, were free to practice good dentistry without concerns for who was going to pay for it.

On the other side, especially on the insurance side, I saw patients making bad choices of service and failure to accept responsibility for their own care: quick to blame the dentist for failure of treatment not appropriate to their needs.

One of the speakers in the preliminary presentation to the discussion was Jack Dillenberg, Dean of the Arizona School of Dentistry and Oral Health.  Jack is an evangelist to Public Health and has dramatically incorporated the curriculum of his school to include service to the community, previously underserved.  Of the last class graduated, sixty percent went into Federally Qualified Community Health Centers, a topic I covered in an article titled "Will Change in Dentitry Come from Within?"

Which leads me to a proposal I made to the California Dental Association in a presentation I gave more than ten years ago: Find a way to set a career path for dental graduates that mimics their non-dental peers.  Perhaps a three year obligation in community health or research with an accompanying major forgiveness of their debt, then a three to four year stint in underserved areas with a salary supported by Third-party Payers who have need for dentists in those areas, finally, assistance in setting up a solo or group practice in an area of their choice, supported by loans from the dental materials industry.

They would have had six or seven years of doing needed dentistry without concern for revenue and they might have established the ADA hoped-for ethics by the time they enter general practice.

This solution would work equally as well for specialists, since they are also needed in the areas I mention.

Alternatively, the country might embrace what I observed when we visited Ireland about five years ago: secondary school was free, paid for by the government as long as skill and merit goals were met.  They did this for immigrants as well as naturalized citizens and within 15 years they had a labor force that met the technological needs of the country.  Immigrants to the United States began to return and, if the new middle class had not fallen into the housing trap of the rest of the world, they would probably continue to prosper in the European Community.

In my next post, whether they are ongoing or not, I will give you my take on the OWS movement.  Like it or not.

Saturday, October 22, 2011


I read or heard recently that the Baby Boomers are the first generation in America who, as a group, have no plans to leave an inheritance to their children. Not to imply that they are selfish or that times are so tough that there is nothing to leave.  More, that they are essentially planners, who have ensured their children’s education and, having done so, feel their obligation has been met.

 And perhaps it has.

 I remember in my own case, when my father died, he left my mother about $300,000 in equities and a house with no mortgage.  My mother, who at the time had no income other than social security and a small pension from the Navy, pretty much burned through that in the next seventeen years; selling the house to move into a condominium, which she eventually sold to me and rented from me.  All would have been gone had she lived long in long-term care.

 And that threat, of living dependently for a long time, is what I think drives the Boomer’s decision.

 There is also the case on how to make division of wealth even among their 2.3 children.  I have two children, now grown, and got them both through college and into the work force free of debt, as my father had done for me.  I certainly hope that Mary has some reserves when she passes on; assuming I pre-decease her, but if not, then I feel my children have been well-provided for.

 Perhaps for no apparent reason other than the news, I began in this context to think about Steve Jobs.

 In all the stories, little was said about distribution of his 8.3 Billion dollar estate, or for that matter, of his four children.  What was said, and is relevant to inheritance, is that he quit Stanford because his parents were mortgaging everything they had to keep him in school, and he thought that was unfair to them.  Clearly he felt they had given him enough.  After all they adopted him.

 Seemingly he never knew much about his biologic parents until he found his mother and eventually his sister, Mona Simpson, in 1984.  While he respected his mother, he was less impressed by his father who had gone from Political Science professor at St. Norbert to owner of a Bay-area coffee shop, which Steve frequented on occasion without recognizing his father.  Steve’s affection for his adopted parents, “the only real parents I ever knew” was public and deeply-rooted.

 So, one way to think about the inheritance his children were left is to repeat what Steve said in a 1995 interview.  “I want to have been as good a father to them as my father was to me, something I think about every day.”

 I could make the same wish.  Anything else they get would just be icing on a very good cake.

 My next posting will cover a new definition I heard about, the Corporate Dentist.

Saturday, October 15, 2011

The O’Reilly Factor

 A year ago or so, Mary and I visited some Wisconsin friends who have the TV set turned on to Fox News literally 24/7.  We found that odd, but not disturbing and found it stimulated some interesting conversation along the way.  I don’t know if that is when Mary started watching O’Reilly or not, but she is now a faithful fan and, in fact, we have tickets for a rare visit he will soon make to Orange County.

 In trying to analyze what attracts her to the show, I moved from politics to content to guests and think I have it figured out.  While she was hooked by the guests, she is mesmerized by the Factor Word of the Day.  For those of you who have recently returned from another planet, Bill ends almost every daily session by leaving the audience with a word, which he uses in a sentence, for them to use, look up or both.

 I remember a similar exercise from my sixth-grade nun and credit it with the fact that most people think I have a pretty good vocabulary.  This would not seem surprising, since O’Reilly was a teacher before he entered the commentary field.  My older son today reminded me that my use of the word “embrasure” could be considered ostentatious, as he had never heard the word before I used it in talking about his son, and doubted  if anyone in the pool hall had heard it either, a fact I conceded might be correct.  This from a boy/man who took Advanced Vocabulary from a teacher who would leave high school teaching to become Elizabeth George.

 Recently O’Reilly hit Mary on three successive days with words she couldn’t find in our dictionary:  Blooter, Broozle and Niding.  I could have guessed pretty well only on Blooter (bumbling idiot as in, “Don’t be a blooter.”) and truthfully could care less about knowing that broozle means to perspire profusely and niding means a coward.  And as for not find the words in our dictionary, I chalked that up to the fact that the dictionary remains the only wedding gift still in regular use after fifty-plus years together.  I note as I write this that Bill Gates also seems not to be familiar with any of the three words .

 I suggested to Mary on our fifth anniversary that we acknowledge those gifts still in regular use with another thank you note to which Mary replied, “I sent out the last ones.  If you want to do it, be my guest.”  They never got sent.  Nor have I mentioned  the idea on any successive anniversary

 As I write this post, I am reminded that words change and get added (and sometimes subtracted) from dictionaries all the time.  My Elizabeth George-trained son said my six year old grandson impressed his Principal when his mother passed on the comment to Ms. Norman that Ethan thought his first-grade teacher, Ms. Feeney “owned”.  This stymied the Principal and prompted Ethan’s mother to comment that she thought it meant, “totally smart” (which she is) and in any respect was a compliment.  The Principal was going to see if her children knew the term.

 I am not as surprised with what the new words are and how they come into being as I am about how they seem to become verbs from nouns (“Let me Google that.”) or how specific items become the category of the item: Xerox, Kleenex, or Tablet.  Intellectual property rights are beginning to blur.

 I wonder if some of you share my feelings of inadequacy in maintaining pace with the changes in our language.  Maybe time will bring an App on my iPhoneto keep me from being a blooter.  Or maybe there already is one for me to download.

 My next blog will contain some interesting information on inheritance that I picked up on in the last few weeks.

Sunday, October 9, 2011

Small Treasures under Our Noses

Mary and I went to an opening exhibit at the Bowers Museum in Santa Ana.  The Bowers is one of those small, originally private museums that always seem to have something interesting to see along with their standard collection of pieces.  This time it was an exhibit called Warriors, Tombs, and Temples, featuring some of the Terracotta soldiers from the Han period in China.

We had seen the tombs when we visited China some twenty-five years ago, and the exhibit brought back several pleasant memories.  I also learned several new things.  The Han Period was roughly from 200 BC to 200 AD and encompassed the period where the very developed Asian countries flooded the emerging Rome with items such as precious jewels from India and food, animals and silk from China.  In return the Roman Empire exposed Asia to gold and glass and porcelain art.

The route originally was a land route called the Silk Road.  Eventually, when ships became seaworthy, the route had an alternative route through the South China Sea, the Pacific, and eventually the Mediterranean.  That sea option did not become common until the time of Christopher Columbus who was inspired by the land travels of Marco Polo.  So the Silk Road had a history of some 1600 years.

We celebrate the history of Christopher Columbus this next Monday, remembering him not for opening the seas to trade with Asia, but rather for his four trips to the Western continents in an unsuccessful effort to find China.

A little known commodity of the travelers along the Silk Road was Bubonic Plague.  The rats with their fleas accompanied the traders and were responsible for wiping out more than a quarter of the European population in the Middle Ages.

One of the nice things about the Bower Museum is the fact that you can see the exhibits in a relatively short time.  The night we visited 250 people were assembled in four shifts to view the items on display at their own pace.  There was music, entertainment and wine for purchase to occupy one’s time until their group was allowed in.

We belong to other museums, some large and some small, including the Orange County Museum of Art (small) and the LACMA and LA Natural History Museum (large).  While we do not go to all on a regular basis, we mostly find at least one exhibit a year to make our membership worthwhile.

In my book “Harnessing a Heritage” I devote one chapter to museums and call for parents and grandparents to expose their children and grandchildren to the experience from an early age.  I repeat that in this post and hope that some of you will take it to heart.  There are few things near to us that provide a greater value for a short period of time.

In my next post I intend to share with you why Mary has a fondness for Bill O’Reilly.  Her reasons may surprise you.

Sunday, October 2, 2011

Wedding Anniversaries

It was almost like a scene from a commercial.  There I was, on the fourth tee, making some smart-aleck retort to a friend’s comment that he had been married thirty-four years; a comment like, “To the same woman?”  Followed by, “I’ve been married fifty, soon…in five days…to be fifty-one.”  Realizing, with a sudden revelation, that I almost forgot my anniversary.

Anniversaries for Mary and me have always been a special occasion.  Our first was dinner in Tijuana after attending our first Jai Alai match.  That was when the Dollar was literally worth its weight in gold in exchange currency and a poor Lieutenant Junior-grade Dental Officer could more easily impress a new bride outside the country than in San Diego where we lived.

Through the years there have been many changes from that first celebration.  One, I especially remember was also in a foreign country.  This time the Philippine Islands, where we celebrated our twenty-fifth on the shores of Subic Bay, sharing a bottle of pretty good champagne with a navy couple also married in October.  This year, as we have on several occasions since that evening, we met with Judy and Larry Donovan for dinner in San Francisco and spent three hours catching up on events since the last time we met.

Last year, the afore-mentioned fiftieth, our grown sons, arranged a special dinner at a favorite local restaurant, Lucca’s, where the owner-chef Cathy Pavlos and her husband Elliott planned a menu of our favorites and treated a dozen of our friends and us to an evening, unsurpassed in elegance and personal touches.  The evening culminated in a toast, long for our sometimes reticent son, Tim, waxing on about his and his brother’s memories of our long-lived marriage.

Tonight, will be quieter.  A meal for two in an elegant and very romantic Italian restaurant, Il Fornaio, after a mass where we won’t ask to be recognized.

The celebration of an anniversary is a time to reflect on the past, as well as a time, to anticipate the future.  What prompts a couple to live together for fifty-one years?  I may have said this in last year’s post, but Mary and I have slightly different explanations.  I contend that the glue for the union is mutual respect, where change in the partner’s life is greeted with the expectation that the change is for the better, and a tolerance is made anticipating the good effects of the adjustment. 

Mary contends that love or habit allows a tolerance for things that are not quite the way we would do them, knowing that what we cannot change is better tolerated than confronted and that enough love will get us through the rough spots.

My friend Sonia Marsh in her blog Gutsy Living recently discussed needs and wants and probably would suggest that those little flaws in our partner are things we might want changed but do not need, to have a rich and lasting relationship.

Perhaps the simplest explanation is captured by Alexander McCall Smith in his most recent novel of The No.1 Ladies’ Detective Agency series, TheSaturday Big Tent Wedding Party.  Precious, the lead character suggests, at the end of the wedding party that perhaps all those vows and promises at a wedding should be replaced by a much simpler declaration.  Where the Priest, Minister, or other official would ask only one question of the couple, “Does your partner make you happy?”  To which, one would hope a reply would come, simultaneously, loud, and in unison, “Yes!”

I know what my answer would be, and I think I know what Mary would say.

Next post, as a change of direction, I think I’ll discuss the origins of the Silk Road.  See you then.