Focus Magazine
The Focus magazine is the official MDA publication. On this page, you'll find links to recent issues (click on the cover image) as well as select articles from each issue.
Fall 2024
We Cannot Do This By Ourselves
Additional Resources | Visit the ADA Managing the Dental Staff page with topics on effective team meetings, avoiding hiring mistakes, dental employment agreements and dental team training, to name a few. Don't miss this great all-in-one resource, Guidelines for Practice Success: Managing the Dental Team, a free download. It’s filled with practical and easy-to-implement ideas to help you lead your team.
I want the dentists out there to think back a little to your beginnings in the dental profession. The journey began as we entered dental school. I am sure you remember the hours spent inside the four walls of your training grounds. The blood, sweat and tears that came with progressing through the rigorous training.
Four years later, a day arrived that seemed so distant: you received your diploma. You were the fledgling in the nest, about to embark on your future as a dentist. You had completed your training to the point that your instructors and training institution said it was time to leave and continue your journey. They provided the training necessary for you to pass boards and go on to provide care in whatever modality you had chosen.
At this point, if you were like me, you were on top of the world. You had labored long and hard and conquered the requirements it took to get your license. Suddenly, however, you probably came to the same realization I did — I had learned how to do the treatment and provide the care for my patients, but there were so many other pieces to the puzzle I now had to learn to put together. My training did not include many of the other necessities of a successful private practice: being an employer and trainer for my team, setting and collecting fees, getting and repaying loans, and all the other pieces we do daily.
And just like that, we were thrust back into the “learning” mode, but this time in the business of dentistry. Looking back, I can say this journey has been a continual learning process. The adage of “the older I get the more I realize I don’t know” is most appropriate. When I think about how I have arrived where I am now, one thing is very clear, I didn’t get here by myself. Many people have played a role in my success and for that, I am very thankful. I want us to focus on the group that has played a vital role for you and I and that is the dental team we work with daily.
The bottom line is we cannot do what we do by ourselves. It takes management, business, assistants, hygienists, lab technicians and other personnel to make a dental team successful. Attracting and retaining these teams is the key to our success. Some of you are more successful than others in the retention part of the puzzle, but no matter what, we must show appreciation in some manner to keep our teams together and build on that base. The following are some ways that I have witnessed in my time practicing:
PRAISE
A kind word can go a million miles. Giving words of encouragement to our team members builds self-esteem. Getting caught up in being negative and always criticizing will not build a positive environment.
SAY THANK YOU
Being polite is just the right thing to do. We must express gratitude for what our team members do for us daily. Even a simple “thank you” when an instrument is handed to us lets our teammates know we appreciate their help. Taking time to do this frequently is imperative.
BUILD CONFIDENCE
There are many ways to build confidence within your team. You must show you believe in and will stand by them in every way possible. When they know you are confident in their abilities, they will grow and help the team grow as well.
PROVIDE EMPLOYMENT BENEFITS
This varies from office to office. Determine what is valued and what you can do to work toward that. Building a good employment package with vacation, holiday pay, insurance and uniform allowance are some of the perks many of us use.
PAY COMPETITIVELY
They say money isn’t everything but having a competitive salary schedule for the area you are practicing in is key. As much as we would like to think this doesn’t play a significant role, it does. Team members who are content with their salaries have increased satisfaction.
INSTITUTE A BONUS PROGRAM
This may or may not be for every dental office around. I have seen this work in both positive and negative ways. Bonuses don’t have to be financial in nature. They can include additional time off or prizes, for example. There are so many ways to set up a bonus system, but make sure goals are clear and attainable.
CELEBRATE & HAVE FUN
You need to take time to celebrate your success and, in my opinion, it should be away from the office. Taking your team to dinner, going shopping, getting pampered at a spa or even going to the movies are some great ways to have fun and enjoy time team building.
Of course, this is not an all-inclusive list but some of the ways I have seen other colleagues build great teams and say “thank you” to those who make the doctors and practices the best they can. No matter what we do, we must take the time to be appreciative of those who make our days go smoother. We need them to know we have their backs just as much as they have ours. Go out there and have fun with this and positively encourage your team. It will make your time in the practice go much smoother.
A President's First 100 days
Change will not come if we wait for some other person or some other time. We are the ones we have been waiting for. We are the change that we seek. — Barack Obama
For nearly a century, American Presidents have been judged by their accomplishments in their first 100 days.
This started when FDR took the reins from Herbert Hoover at the height of the Great Depression. Roosevelt brought about sweeping changes in an attempt to pull the country out of the biggest crisis since the Civil War. One way Roosevelt was very different from Hoover was communication. FDR instituted “Fire Side Chats” to explain to Americans, over the radio, what he believed was wrong with America and how he was going to fix it. Using this new medium, he was able to explain in simple terms what was happening.
As you read this, I will be somewhere near my first 100 days as president of your MDA, so here is my “chat” with you to share my perspectives at this juncture.
Simply put, what I have seen in my first 100 days is change. Some of the changes can be seen as positive or as negative, but change, nonetheless.
On a positive note, I have attended white coat ceremonies at ATSU in Kirksville and KCU in Joplin. When I was in dental school, we didn’t have these sorts of events for incoming students. I must say, they are exciting. Students are excited for the change from an undergraduate to a professional student and embarking on the first stages of their careers. A fair amount of pomp and circumstance at these events end with the reading of an oath to our profession, which serves as a north star as the new dental students embark on their journeys to join us in our profession.
Within the first 100 days, I have run my first MDA board meeting and completed an officer induction for the Southeast Dental Society. Both events are full of member dentists passionate about leadership and the preservation of our profession.
Your MDA Board is made up of a solid group of well-rounded representatives from components and committees with diverse backgrounds in dentistry. They are forward thinkers and embrace the changes we are experiencing across the tripartite and within the MDA. As a board, we have been tasked with many things recently including adapting the MDA strategic plan to a current framework, increasing non-dues revenue, addressing workforce shortages, and developing our 2025 legislative agenda. All while trying to find ways to engage and retain members.
In August, Vicki Wilbers, Ron Wilkerson, Mack Taylor and I attended the Mid-States Conference in Louisville. This meeting brought together leaders from 13 states from Minnesota, Tennessee, Oklahoma — and everywhere in between — to engage and learn from one another as we discussed common areas of interest. Change was at the forefront of this meeting as well. It was evident to me the MDA shined above many of the other states at this event. We were “in the spotlight” because of the lead we have taken on workforce issues and related legislative changes over the last few years. Other states are looking for areas of non-dues revenue and are struggling, but at my last check, 54 percent of MDA income is from non-dues revenue — higher than most. That does not mean we can continue to lose members at the current rate. We must embrace change at the ADA, MDA and local component level to have a stable membership future.
As my first 100 days conclude, I hope we, as member dentists, can look at the possibility of embracing change. It is going to take some vulnerability on all our parts, and it might be a little uncomfortable, but it is our only chance at organizational survival.
Always Advocating
by Halie Payne
Although we are in the middle of the legislative interim, the MDA’s advocacy work never stops.
Recently, you received an email notifying you of a Dental Insurance Reform Survey. The MDA has not done an insurance survey in four years, and it was due time to reach out to MDA members to inquire about potential insurance issues the advocacy team might not be aware of. The survey received an incredible response from 319 dentists. To share just a few highlights:
- 91 percent of respondents experience regular occurring issues with third-party payers
- 78 percent experience issues with customer service and long wait times or unreturned calls
- 71 percent experience issues with downcoding
Thank you to all our members who completed the survey. These results will help drive much-needed action in future sessions to help fight major insurance issues.
The Legislative Session officially begins January 8, 2025, and the MDA Board of Trustees approved the 2025 legislative agenda at its August 2024 Board Meeting. The MDA’s top two priority items for 2025 will be Dental Loss Ratio (DLR) and the Oral Preventive Expanded Functions Dental Assistant (OPA).
In 2024, MDA introduced legislation in Missouri establishing a DLR at 85 percent for both large and small group plans. This legislation was filed later in session, and due to facing great opposition from insurance carriers as well as the climate in the legislature, it did not pass. In 2025, we will re-file the legislation. Sponsors are being secured during the interim and hopefully the bill will be pre-filed in December, giving it a head start.
In 2021, the MDA formed an exploratory workforce committee charged with investigating workforce shortages within Missouri’s dental community and finding possible solutions. One solution discussed by the MDA for many years, with similar models successful in other neighboring states like Kansas and Illinois, is a type of expanded function dental assistant who can provide scaling on patients with specific types of periodontal health.
The creation of this new health care role — called “Oral Preventative Assistant/Expanded Function Dental Assistant” (OPA/OPA EFDA) — must be done through the legislative process. You can see this issue's article for an update on the status of the pilot project, which directly correlates to the creation of legislation. In 2025, the MDA will pursue legislative action to create a permanent OPA EFDA in the State of Missouri after enough data has been collected from the project. Like DLR, we are working to secure sponsors and looking forward to this next step.
The MDA Board of Trustees also approved the possibility of supporting the Dentist and Dental Hygienist Compact should it again be filed by the American Dental Service Organization. MDA supported the legislation last year, but it was ultimately defeated due to a stalemate in the Senate. The advocacy team will also continue to support and push for maintaining and increasing appropriations such as the dental Medicaid reimbursement rates, Donated Dental Services and Elks Mobile Dental Services.
Of course, everyone will be watching election results in November. Your MODentPAC has been engaged on the frontlines by delivering more than 60 contribution checks to candidates, as well as volunteering and having conversations with various candidates. It is important to remember the MDA’s legislative success does not happen without a strong PAC. With the new ADA membership login system, it will be easier than ever to contribute monthly or one-time. I encourage you to contribute and invest in your profession. And please remember to vote on November 5!
Before we wrap up the year, Vicki, me and our Gamble & Schlemeier lobby team of Jorgen, Nikki and Grace, will attend the ADA Lobbyist Conference in December. This annual event is important because it allows states to hear valuable information from the ADA regarding issues on the federal level, such as ERISA. It also allows states to share results and experiences from previous legislative sessions, which is helpful as we look to the next. We always come back with new ideas and strategies to tackle dental insurance reform, workforce, Medicaid and other hot-button issues in the dental profession.
The MDA has a long-standing successful legislative history, and our agenda items show a full plate is in store for 2025. We cannot be successful without the involvement and support from our members and their teams. Be sure to save the date for 2025 Dental Day at the Capitol on March 5! We had an outstanding attendance record last year with 80 plus attendees and hope to be as or more successful in 2025. We’ll provide more details as we move into the new year. Please reach out to me with any questions regarding our legislative efforts.
OPA EFDA: An Update
This summer, the Oral Preventive Assistant (OPA EFDA) pilot project advanced through another significant hurdle: rule promulgation.
The promulgation of the rule to accept the waiver, sent by the Missouri Dental Board so this project can officially commence, was stamped with approval by the Joint Committee on Administrative Rules (JCAR) in late August. This was following the rule being officially published May 1, at which time we encouraged members to send letters of support for the proposed OPA EFDA rule during the 30-day comment period.
During this period, the MDA engaged in significant advocacy and communication efforts to its members, who resoundingly responded with letters of support which were instrumental in this moving forward successfully. There are numerous members who, for months, have met and communicated consistently with their representatives and senators to explain the OPA project and what this type of EFDA can provide for the benefit of the dental workforce, dental practices and patient care.
At the same time the OPA EFDA rule was advancing, so too was the full promulgation of rule to allow dental hygienists to administer local anesthesia under general supervision. The rule specifies the ASA classification of patients a hygienist can provide this service to without a dentist present; it is not all classifications of patients. The MDA has been supportive of this rule, which also works for the benefit of the dental workforce, dental practices and patient care. Members can read these rules here.
The OPA EFDA rule is now in the process of moving to a final order of rulemaking and will be published in the October 1 register with a November 30 effective date, with the pilot to begin as of December 1. While this process has taken longer than the MDA had wished — we began working with supervising doctors from the clinical sites participating in the pilot in November 2023 and trained OPA candidates in January, February and March of this year — we are grateful to finally begin the pilot and report on its outcomes.
“We are looking forward to getting started with actual care and collection of data,” said Vicki Wilbers, MDA Executive Director. “We are hosting a refresher course at the end of September for all candidates, and the dentists and teams at pilot sites are poised to begin.”
She also noted that in this period of waiting, pilot sites have been collecting data on patients for a comparative analysis that will be part of the reporting. Pilot sites will report various metrics to the ADA Health Policy Institute (HPI) to analyze the data.
“We often talk about the Power of Three: what the ADA, MDA and local levels provide in member benefits,” said Wilbers. “This is a great example of that, because the HPI team is a trusted powerhouse that will analyze this data and communicate it effectively to all stakeholders, which adds validity to the pilot, and at no cost. Ultimately, this data will be paramount to the OPA EFDA becoming available for more practices in the state, which will be a great benefit to members who continue to communicate to us the great need for this.”
What’s next for the OPA EFDA project?
The MDA continues to receive interest in the OPA program from both doctors and assistants asking about participating in the training. At this time, the project remains in the pilot stage, which requires the MDA to limit the training and certification to dental sites already approved. The information from the data gathered at these pilot sites will be used in legislative and regulatory work in the future.
In the meantime, the MDA remains committed to EFDA and dental assistant education. MDA continues to host all five current EFDA courses at its new clinical training center in Jefferson City. This facility offers the latest technology, with all courses taught by MDA member dentists who have been trained specifically for teaching EFDA programs. So far this year, 18 courses have been hosted, successfully training 227 dental assistants.
Additionally, the MDA has created and continues to host a quarterly Basic Skills Review Course. This in-person review, taught by Linda Twehous, CDA, EFDA and longtime dental assistant educator, has been successful in preparing students to pass the Missouri Test of Basic Dental Assisting Skills, which is a prerequisite to take EFDA courses. The final review course of 2024 will be October 18. Learn more and register at moefda.org.
The MDA is in the process of creating a Nitrous Oxide Monitoring course, which members continue to express is greatly needed as it is hard to find this training consistently provided in the state. The MDA is finalizing the curriculum, clinical course components and testing to present to the Missouri Dental Board for approval, and hopes to begin offering the hands-on course at its clinical training center in Jefferson City in early 2025.
“I can’t say enough about the MDA EFDA program and all the work related to it,” said Wilbers. “I am grateful for the members who are so committed to developing curriculum, training assistants and advocating as needed to continue moving this program forward. We know how important the entire dental team is to practice success and excellence in patient care — and the MDA EFDA program is one of the integral dental team pieces.”
Dental Profession Preview 2025
The 2025 year arrives less like the uncanny result of a series of vague, subtle shifts over time than the hazy aftermath of a meteor strike ... The beginning of a new era that everyone has seen coming, with varying levels of dread, from a hundred miles away.
by Paul Roberts
Sage advice says to write about what you know and love. For me, that’s often football and dentistry. Hopefully you like one, or both, as well. It’s October now so what better time to combine the two?
In late August I read a college football preview article by Matt Hinton on my favorite SEC football media site, Saturday Down South. I give props to both the author and the site. Strangely Mr. Hinton’s article made me think of organized dentistry. Funny how similar challenges and themes show up in every walk of life.
For fun, I took the liberty to use the structure of his article and paraphrase parts of it to comment on dentistry today while keeping many of the well-appointed words of a professional writer. Consider it my 2025 Dental Profession Preview. Like any prognostic work, it’s imperfect and there will be those with different opinions or loyalties. Kind of like me preferring to yell “War Eagle” over “Roll Tide”. See what you think and feel free to yell at me!
When we talk about distinct eras, it’s usually in the past tense. One day you stop, take a look around, and realize everything that was once familiar has changed so slowly you barely noticed. Not so for the MDA or for organized dentistry, in general. Instead, the 2025 year arrives less like the uncanny result of a series of vague, subtle shifts over time than the hazy aftermath of a meteor strike. Quakes, fissures and extinctions have convulsed the profession, culminating in a dramatically altered landscape that has rapidly taken shape before our eyes. It feels palpably different: The beginning of a new era that everyone has seen coming, with varying levels of dread, from a hundred miles away. Consider how much has changed recently.
Practice Modalities
Gone Bonkers. Remember when most dentists were solo private practice providers? For the first time we are seeing a proliferation of franchise practices and boutique specialties. The FQHC delivery model has exploded. And now you are dealing with DIY online solutions that often mislead the public into worse dental health.
Longstanding Scheduling Formats
(Read reliable patients) have been scrapped, and now you use every tool available to keep your chairs full.
Your Favorite Authority
Diluted into a thousand voices leaving organized dentistry somewhat in pieces. While custom platforms and new voices are valuable in many ways, they can overlook the unifying power of the common ground you share as dental professionals.
Dentistry in Print
Waning. Reading habits and attention spans have changed. The profession’s new media focuses on digital, social media and podcasts.
The Traditional Dental Workforce
In flux but optimistic. On the heels of Covid, the dynamics shifted. Finding and retaining skilled team members is a challenge. The MDA steps into the void and provides first rate Expanded Function Dental Assistant courses in its dedicated training center. The result develops team member loyalty and enhances practice efficiency. New solutions like the recently approved Oral Preventive Assistant pilot project could help expand the universal goal of more care for more Missourians.
Meanwhile, the existing 100-year-plus-old membership structure has (finally) officially begun a needed facelift raising the culture of dentistry to be even more sophisticated and efficient and inclusive. Just last month a new association management system was launched promising members a much more user-friendly and connected membership experience. New membership models are being piloted to simplify and customize the member experience at value-driven rates. The best minds are investing wisely, using cutting edge resources, working with new tools, and displaying great passion with a win-now mentality to both modify and preserve the profession for this generation and beyond.
How will all this play out? How many of you will ride the occasionally turbulent wave of transition? How many wins will it typically take to secure success?
There could be some difficult seasons. Just how committed are you to this grand profession and the effort it takes to protect it, promote it and advance it to the trophy presentation? We’re all going to find out together.
Whether all this strikes you as exciting or disorienting, or both, is up to you. New expectations and new rhythms on the calendar are going to take some getting used to. But there is no going back. At the end of the day — or the end of an era, as it were — it’s still dentistry, being conducted at a higher level than ever before.
