Chuck (00:18) Hello, Kathy. Thank you very much for being here today. Congratulations on being named one of the 32 Most Influential People in Dentistry at Benco. We’ve been putting together this list for four years and you’ve been on the list every year. No big surprise for those of you who don’t know Kathy. She is the Executive Director of the American Dental Association (A.D.A.). Her biography goes down two pages, but just to give you some of the highlights – she is the first female Executive Director of the A.D.A., which dates back to 1859. A graduate of Tufts Dental School and winner of many awards from Tufts. She was named an Icon in Oral Health by the Forsyth Institute. She has faculty appointments at the University of Illinois at Chicago and Tufts University. So, you’ve been around, and you’re involved in a lot of things, which is probably why you’re not surprised to be named one of the most influential people in dentistry. So, congratulations and thank you for being here.
Kathy (01:19) Thank you, Chuck. To be honest with you, I’m always surprised by anything that happens. I fell into the dental career almost unintentionally. I did not grow up in fifth grade thinking I’m going to be a dentist when I grow up. It was quite the opposite. So, how I got here was not a very straight line at all. I know you’ve been in a family business and my dad was a dentist, but at that time there were no women in dentistry, and he thought it was inappropriate for women to want to be dentists.
Chuck (01:53) So, let’s talk about your father for a minute. What kind of influence do you think your father had on your choice of career? You chose something he tried to talk you out of or told you it wasn’t a great idea and you did it anyway. I mean, I went into my father’s business. Talk about the influence of your father on your career.
Kathy (02:14) Well, my dad was a great guy. He used dentistry to forward his personal aims, which I would say family first and then sports. He loved sports. He loved coaching football. He was an avid athlete when he was in college. He was of the generation where during senior year of college, you dropped out to enlist in World War II. He had a lot of deep beliefs. He was very much an active member in his church and very active on the parish council and volunteered every minute of time he had.
Kathy (02:48) He chaired the Public Health committee in my town, and he was Campaign Manager for several mayors. I mean, he was just one of those guys. I think dentistry to him was a means to an end. His patients loved him. They all called him Doc Trainer. Everywhere I went, you know, your dad is great. And so, I think that had a huge influence on me.
Chuck (03:09) And you grew up in New England?
Kathy (03:12) Yes, outside of Boston. I grew up in a town called Medford.
Chuck (03:21) Did you join his practice when you graduated?
Kathy (03:23) No. This is kind of a sad story. I started dental school in 1978 and it was still that three-year curriculum that went 12 months a year. So, it was brutal. In March of my second year, my father died, and he left a significant practice. My mother had been his office manager for many years. He died on a Sunday and Monday morning we had to call his patients and tell them. So, it was pretty traumatic. I thought about dropping out of dental school because my mother really needed help and I still had a high school age brother. So, it was a very tough time.
Chuck (04:08) How do you think your father’s passing changed and influenced your life? And then second, watching him practice dentistry, how has that influenced your role at the A.D.A?
Kathy (04:19) I think I learned to become resilient because I had had a pretty blessed childhood. I don’t have a lot of bad memories from being a kid. We were well cared for and my parents were great. That was the first major loss in my life, and it was extremely difficult. I think that’s when I decided to either crawl into a hole somewhere or pick yourself up and just keep putting one foot in front of the other. Since I was in dental school, I was automatically assumed to be the major “how to deal with this” person. We ended up selling the practice after a very difficult period of time. I remember my father’s patients, who are very loyal to him as all patients are loyal to their dentist, call up and say they didn’t like the person we sold the practice to and asked what I was going do about it. Well, I’m a junior in dental school and I had hoped to do a residency, but because I had a baby the day I graduated, the residences back then weren’t keen on taking a woman with a new baby. So, I postpone that and went out and found a job. When I graduated, everyone knew I had a baby. It made the front page of the local newspaper. Everybody knew I was class president and graduated at the top of my class. So, people were a little intimidated and I didn’t have any job offers. So, I went to work for Omnidentix. I don’t know if you even remember.
Chuck (06:05) I remember Omnidentix. They were a large group practice early on when they were there.
Kathy (06:11) They were one of the first DSOs right up there with the Sears dental clinics, remember? And David Slater, also known as, Mr. Donut money was the VP. That was my first job and I learned an awful lot. As soon as the residency slot opened up again, I took it. I spent seven years in a public health hospital, which was an amazing experience because there were specialists right there and the chairs next to me.
Kathy (06:38) It was a teaching facility for Tufts and Harvard. So, I always had dental students coming in and out. I would say that’s where I really learned how to be a competent dentist. It was delightful because most of the patients we saw were Department of Defense and God Bless service people. They were grateful no matter what you did, and they would all say, “Thank you, Ma’am”. It gave me a keen appreciation for these people.
Kathy (07:09) I was across the hall from the primary medical clinic which was great too. We had great relationships with the internal medicine people. Since we had a lot of retirees, we had a lot of complex medical patients and we worked together. It was a great influence on me for the rest of my life. I kept teaching at Tufts, even when I left the hospital and moved back to my hometown because my dad’s patients were still waiting for me to come back. They kept saying, “When are you going to open up a practice here”? So, I rented an office space and Benco was quite helpful to me. I bought my first piece of equipment from my Benco Rep. I rented an office space, put in an operatory and paid rent for about five to six years. Then I outgrew that space. I’ve always had dentist mentors who were very critical in certain periods of my life. For example, when my dad died very suddenly, two dentists who were very close mentors of mine, an Oral Surgeon named Howie Kessler, and a General Dentist named John Meade, who were faculty at Tufts. I knew them, so they were over my house, calling me up, taking me to lunch and keeping me on track. Howie Kessler knew I was looking for an office because I needed to move out of this rented space. One day he called me and said, “I want you to come see a house with me at lunch”. I’m like, “What are you, a real estate broker now”? A friend of his who was a surgeon said, “I want to sell my home office. Do you know anybody who might be looking”? Howard said “Yeah, I do”. So, he took me to this house. It was a gorgeous home office the surgeon had built. It had a beautiful attached office, a beautiful center entrance, hip roof, colonial – you know, classic New England. He told me what the asking price was for the house and I said, “Well I’d love to buy this house, but I have no money”. I had debt. It’s the same situation as today. I had debt and we were living off one salary. I was paying almost my entire salary for daycare. And he said, “Well, don’t worry”.
Kathy (09:42) He said, “Howard tells me you’re a good bet, so I’ll balloon you the mortgage. You pay me interest for five years and then you’ll have time to go to a bank and get a real mortgage”. I said, “What if I don’t pay you”? He said, “Oh, I know your family. You’re good for it”. Things were kind of accidental and lucky. Then my practice was great! It took off. I loved it. I was still teaching a day or two a week at Tufts. When I hit my late forties, I started looking out the windows saying, “Maybe there’s something else out there”. So, I asked a friend of mine, “What do you think I should do”? And she said, “You’re crazy. You’ve got a great practice. Wat are you talking about”? And then, of course, I talked to Howard Kessler and he said, “You know, if you’re bored, go find something else to do”. Now, this was an oral surgeon who had all kinds of jobs in his personal and professional life. So, it was a no brainer for him that if you’re getting a little bored, move on to something else. So, I went back to school when I was in my late 40s.
Kathy (10:56) I went back to Harvard and got a Public Health degree and a Health Management degree. It was while my kids were in middle school. So, we all did homework together.
Kathy (11:05) I could schedule my patients around my class schedule, and it was probably the most important thing I did at the time.
Kathy (11:14) I stayed in clinical practice for another two years, but it opened up a lot of doors and made me think very differently. I would say post-graduate education was in my case, a life changer.
Chuck (11:30) Looking back, how did it change your perspective on dentistry or on your own practice? You grew up in dentistry and all clinical dentistry, and now you’re doing some professors, but now you’re studying public health. How did that change your perspective?
Kathy (11:45) Public health and healthcare management and it was at the time when managed care was running wild and capitation was driving everybody crazy. So, I learned to think much bigger than a private practice. I wasn’t just thinking about my patients, I was thinking about populations and I was thinking about sustainability. Decisions you make today may have outcomes that don’t show up for five or six years. How do you understand the unintended consequences? So, I was lucky at Harvard. The people who wrote the textbooks were teaching the classes. I had Michael Porter. I had Clayton Christensen. I had the Governor of Massachusetts teaching health policy. Charlie Baker. So, I had a huge opportunity and it really changed the way I thought. That’s really what paved the way for me to build a portfolio of credentials where I could even think about applying for the ADA job.
Chuck (12:48) So, let’s talk a little bit because it’s interesting, and then we’ll come back to the ADA job. You have a background in clinical dentistry; first from your father and then from doing it yourself. Now a background that came later in public health. I think there are a lot of people that would say out of all the health care professions, dentistry spends more time on the clinical side than on the public health side. How does that change your perspective on your role now at the ADA? I think you’re expected to represent the clinical side, but also the public health side too.
Kathy (13:23) Yeah, and dental education too because I still continue to hold faculty appointments and I teach every chance I get. I think the important thing about clinical dentistry is to understand that you serve a community, that you don’t operate in isolation.
Kathy (13:38) This became important this year when practices were under stress as they were urged to reduce their practice to urgent and emergent care. But without understanding the real threat of transmission, without understanding what the disease entailed and what the science actually was, we had very little science. Those are things that I understood from my public health training, epidemiology and understanding evidence and the strength of the evidence. So, we could move quickly into the mode of not just worrying about what procedures dentists can do or not do, but what is the risk. How do we help the dentist assess the actual risk in their practice and then influence the legislators and the regulators on what the real factor is. What is the real safety issue? Is dentistry essential or not? Everybody says oral health is essential to overall health.
Kathy (14:56) I think it propelled us to a recognition that what dentists do is essential health care. It’s essential to overall health and we have evidence to show it. Despite a 20-year-old Surgeon General report that’s now being rewritten, it finally made the case that dentists are legitimate, equal players as essential health care workers. So how do we protect them? How do we make sure they stay open? How do we protect the patients? How do we make sure they get what they need? And I know I’ve had lots of conversations with industry about PPE and everyone was like “Oh my God, we don’t have any inventory because FEMA was buying all of it up”. We were getting calls like, “Why can’t I get PPE”? Well, because FEMA said no. So, then we had to go talk to FEMA 800,000 times. Finally, we got dentists on the list of essential health care workers. Finally, after weeks, we got FEMA to apportion some of the available PPE, which they already bought and paid for and were storing to the dental community. I don’t know if you know this Chuck, but they just gave us like three million more masks. It’s already paid for, so it wasn’t going to be routed through Benco or any of the other distributors. They wanted it to be distributed by the ADA because they wanted to make sure their lawyers didn’t make FEMA look bad. So, it’s been an interesting journey. I think without the public health training, without the experience of clinical dentistry, without teaching and understanding what dental students and residents are going through right now, I was well-prepared for this crisis. It’s all this convoluted experience I’ve had that’s not typical.
Chuck (17:00) You have a very atypical resumé. Talk a little about how you used a little influence and how you exerted influence on behalf of dentistry and the ADA. When was it helpful? When were you frustrated? Talk a little about the use of influence to get something done.
Kathy (17:29) How do you feel about being influenced by somebody? First of all, if they’re not nice and lack a basic human decency and lack humility, they’re not going to have much influence over people. They’re just going to discount you or move on to someone else that they feel is more in touch with them. So, I think you have to do all the things that Carter talks about in change management. You have to be the kind of person that people want to be with – empathetic, kind, caring, listening skills. If you come in like “I’m all it and you better do what I tell you”, that kind of hierarchical leadership is inappropriate during a crisis and will be ineffective. I think women tend to be more collaborative in their leadership style, that helped a lot. So, if we were going to influence FEMA, we had to be nice and had to be patient. We had to defer to them, and we had to develop. Mike Graham, our Government Affairs guy, developed a very close personal relationship with several of the FEMA higher ups, and that gave him credibility. He understood DOD and he understood how the military thinks about logistics. So, I think that’s critically important. I also think you have to overcommunicate, overcommunicate, overcommunicate and then understand if people can’t see that vision of where you’re heading, if you can’t crystallize it for people, if you’re zig zagging and they don’t know what you’re saying anymore because you’ve said 20 different things in the last hour and a half – you have to reduce things to simple terms and create that vision so people can get it, understand it and some will latch on. Some won’t but that’s OK. Then help people get through the anxiety. I think COVID has created a whole situation on grief that we have forgotten about or we put aside. This is profound sense of loss for everything we have given up in the last seven months and nobody talks about it. I lost the ability to go have a restaurant date. I lost the ability to get a haircut without 18 steps. I lost the ability to hang out with my neighbor and sit on their back porch and share a glass of wine. I lost the ability to go into my office. I don’t know about you, but I have employees who live alone and don’t have big extended families. That sense of social isolation is really bad for you. Human beings were made to live in tribes, right? The stages of grief were real, and we could see people go through them. Anger, like my dentists were angry at the ADA.
Chuck (20:42) I wanted to talk about that because that was an influence challenge. So, go ahead.
Kathy (20:46) So angry dentists, dentists in denial. We had a lot of people who then went into extreme anxiety and sadness. So, mental health started really being an important issue. We started seeing dentist suicides and started seeing dental students with extreme anxiety. We sent a survey to dentists to assess their mental health and they were scoring really high on anxiety compared to other years.
Kathy (21:20) So, there’s a lot going on during this pandemic. I think as a leader, I feel like I have to keep it simple. I have to overcommunicate the simple stuff, keep optimism and keep them optimistic.
Kathy (21:35) They have to see a bright future someplace, maybe not in the next five or six months, but it will come, and we’ve got to hold ourselves together and keep moving forward. So, we also started mobilizing our teams in different ways, letting them self-govern, letting them make decisions, putting agile teams in place. And they would just keep me posted. I wasn’t trying to over control everything going on in the ADA because that would have been utter chaos if I was making every single decision. And so, the ADA is a very hierarchical organization, as you know, our governing body.
Kathy (22:14) How do I influence volunteers? Very carefully. Executive Directors are not one of them. Even though I’m a dentist, I always tell my team to put a volunteer dentist in between you and every decision. It’s their club. It’s their society. They are in charge. Our job is to give them all the right information, best information, pros and cons. Guide them. Advise them when needed. But at the end of the day, they make a decision and we have to go with it. And that really requires resilience. And that means sometimes they’re going to make a great decision. And sometimes they make a bad decision.
Chuck (22:59) think there’s a lot of good points. For the first one, it seems like the other side of influence is resiliency. I think that’s an interesting dichotomy. I don’t think we often think of that if we’re talking about influence. What I heard you say was you need to be resilient if you’re going to try to be influential because you’re not always going to get your way.
Kathy (23:18) And you have to be elegant when you lose. Did you play sports?
Chuck (23:24) I did. Not as much as others, but I did.
Kathy (23:27) You have to learn how to lose as much as you had to learn how to lose with grace and dignity and don’t dwell on it. Just look forward. So, I think resilience, especially this year, has been incredibly helpful. I’ve had a lot of setbacks in my life, everybody has. Just keep moving forward is the main message right now.
Chuck (23:48) And then the other one was really you’re in a bit of a unique situation compared to some of the other people we’re going to podcast with in that you’re constantly trying to influence. You have volunteers. What you didn’t say is the volunteers are your bosses, right?
Kathy (24:01) Oh, they’re my bosses and I get new bosses every year.
Chuck (24:03) So, you just happen to have Dr. Gehani as the president this year? He’s done a great job. I did a podcast with him a little while ago. He’s really stepped up to the plate. And every year you get a new boss who’s also a volunteer, who you have to influence while you’re trying to influence the other members, while you’re trying to influence the dentists who are not engaged in the ADA. One of the things that makes this year very different is usually there’s a group of dentists who are very engaged in the ADA and there’s a lot of dentists who are not. This year you’ve needed to influence all dentists, right?
Chuck (24:34) Even the ones who’ve said, I’m never going to listen to the ADA. Now, guess what everybody listened to the ADA this year.
Chuck (24:40) And I think there were moments where dentists were speaking of you in terms that were not very flattering.
Kathy (24:46) Oh, no I got hate mail. “How dare you tell us what to do” or “How do you tell me how to practice”? We just want to keep you safe. We boiled it down to our core value that’s on top of the list right now is safety.
Kathy (25:02) Along with all the others, but safety and it did pay off. We have not had a reported case of a dental office cluster of COVID transmission. All of the ones we uncovered were outside the dental office and then brought in. Don’t go to weddings unless you know everybody. 3,000 dentists are deeply involved. 100,000 – 200,000 are not. I would say this year we had webinars with 10,000 people on them routinely. That level of engagement was unheard of a year ago. But I think when you have value and you make it accessible, we put everything in front of the firewall. We didn’t distinguish between members and nonmembers. We did something very smart. I think we made it all available to everyone, but we captured nonmember data. So, we could go back to them and say, “You know, you really liked this, and you downloaded this tool kit”. We have more good stuff. Would you consider joining? You know, I think we took that approach rather than say, “You know, if you’re not a member, forget it. You’re on your own”. I felt that was ethical to make it available to everybody.
Chuck (26:23) So, let’s talk about the ADA as a lobbying organization. I think this year showed us one of the secrets to success of the ADA is the government affairs area that Michael Graham runs. We’re going to do a podcast with him as well. Talk about how that kind of influence works and how does influence on the government level differs from influence with regular everyday dentists.
Kathy (26:49) So, Michael also made it to the list along with Marco, I think. So, we think we’re pretty hot right now.
Kathy (27:01) So, I would say building trusted relationships, as hard as that may seem with elected politicians is critically important.
Kathy (27:11) Then if you do that over time, those relationships pay off. But you can’t go to a legislator you don’t know and ask for something. You have to have that relationship in place. We have a very active pack and they hold lots of fundraisers. These are local dentists who know their local House of Representative or know their Senator. I can tell you Lindsey Graham loves the ADA because our Doc Watson had an event in his home for this guy that blew his socks off.
Kathy (27:47) And those relationships have been built over years and years. Michael has spent his entire career in D.C. He’s been with the ADA well over 20 years. When I talk to legislators or politicians about Michael, you know what they say to me? “We can trust him”. Do you know how hard it is to be a trusted lobbyist?
Kathy (28:16) But he is trusted because he doesn’t go back on his word; he tells the truth. He is good for a deal when he makes a deal and that has paid off for the ADA this year. So, he had credibility. We also have five or six dentists in Congress now. We send them to candidate school. When a dentist says, “I want to run for office”, we send them to school to teach them how to run a campaign, how to get elected and how to give stump speeches. And I’ll tell you, Drew Ferguson and Charlotte, they’re amazing with how much they’ve helped us this year with PPE, SBA loans and with the Payroll Protection Program (PPP).
Chuck (28:59) I think there are more dentists in Congress than there are physicians. I think five is a lot considering that the dental community is not particularly big. We noted that in our in our magazine. It’s just interesting to see how influential those congress people can be and how helpful they can be. I think going into this entire deal, I’m not sure if I would have said to you six months ago, “Part of your job, Kathy, is going to be negotiating with FEMA for masks so the dentists could practice”. You would have said to me, “That’s the craziest thing I ever heard”. And yet here’s a situation where it became very important to have the ADA have the influence that it has.
Kathy (29:36) And the same thing for our regulatory bodies, too, like OSHA and CDC. We’ve always been really good supporters of CDC. I would say my relationship with their Oral Health Director, Casey Hannan, has never been better. We help each other. We get the science out together. We look at the science together. We got out of the gate a little bit ahead of them, but they caught up. The same thing with OSHA. We committed to doing a hazard assessment for dentists to evaluate their physical plans to keep their employees safe, and we were good to our word. We got that out before OSHA did. So, I think all of these relationships have been incredibly helpful. Who would have ever guessed COVID-19 would pop up in January of this year? We do crisis planning and I have a business continuity plan.
Chuck (30:33) So did we. It was like, really? I mean, if you would have said to me six months ago, “Dentistry is going to be shut down for eight weeks”, I would’ve said “That’s the most ridiculous thing I ever heard”. And yet there we were.
Kathy (30:46) Yeah. And I know the industry was in the same duress we were in. To watch 25% of your revenue evaporate in one week, we had the same issue. So, we’re going to dig ourselves out of the hole. We are seeing some rebound and recovery, and that’s hopeful, but will we ever get a whole quarter back? I’m not sure.
Chuck (31:15) On behalf of industry, thank you for everything you and your team have done because it has been a great partnership. So, thank you. In the few minutes that we have left, talk about where you see dentistry going for the next four or five years and how you hope to be influential.
Kathy (31:37) So no matter what I say, half of my members will hate it and the other half love it. So, what I would say is COVID has accelerated every trend. We’ve been saying good and bad. The trend towards aggregated larger practices, it’s accelerating that. It’s accelerating the retirement cliff; the boomers, the giant group of boomers, are moving out faster. It’s accelerated the need for students to deal with debt.
Kathy (32:04) The hardest hit group are the employed dentists. They tend to be younger and they did not go back to work right away, and their schedules are not full. I had one community health center dentist tell me his community health center reopened, but he’s yet to get a full week schedule now. So, I think it’s accelerated all the trends that we’ve been concerned about. I do think it will be harder for solo practitioners to compete with these larger practices because of the cost of everything. Technology is king. If we didn’t have Zoom, I would have been out of business in March. So, the technology platforms have now delivered on the promise of automation and being able to reduce your expenses and become more efficient. But how do we help dental practices digitize completely?
Kathy (33:01) We still have a lot of practices that have paper records. So, I think all of the trends that we were seeing will continue the trend of aggregated practices that are not necessarily DSO backed or venture backed, they’ll just be dentists saying we’ll do better if we own five practices in five locations and systematically make all the practices run on the same business platform. You can buy one CAT scan or one 3D printer and have five offices network to it, right? So, the digital transformation is going to accelerate.
Kathy (33:48) And I think scope of practice is going to change dramatically. Now that dentists are by the U.S. government essential health care workers, I think people are going to start looking at dentists as people who can screen and vaccinate.
Kathy (34:02) There’s going to be a scope of practice enhancement because dentists will start being seen as people who are operating in the primary care sector. So, I think it’s all good and bad, but it’s change, and change is something that we all have a hard time with.
Chuck (34:21) And dentist especially. I mean, we all know that from the inside. But change is important and it’s good that we’re changing together.
Kathy (34:29) So, my hope for the future is that dentists see the benefit of change and are not too frightened because honestly most dentists my age will tell you nothing I learned in dental school is the way I still think about providing care. That slow, incremental change is easier to digest than the COVID crisis change that we’re all being forced to go through. But change is good, and change is healthy. Take a deep breath. Let go of the anxiety. Like I said before, just keep putting one foot in front of the other and life will turn out fine. Dentists are very lucky. They have a great profession. I could not have done what I’ve done without going to dental school and without going back for public health. I mean, it changed my life so I’m very grateful. This has been the best job I’ve ever had. I’ll be it the hardest, but it’s been a great run and I’m excited for the future. I think dentistry is still an awesome profession. None of my four children decided to go to dental school, which was very sad for me.
Chuck (35:42) I’m sorry about that. That’s not good. But there’s nothing we can do about that.
Chuck (35:50) Kathy, thank you very much for the time today. This was a terrific interview and we really appreciate your insights. Congratulations again on being one of the most influential people in dentistry and honestly, in this year of COVID, we needed your influence more than ever. So, thank you very much. And on behalf of the industry, thank you very much for everything you do for dentistry and thanks for today.
Kathy (36:11) Oh, you’re welcome. Stay well.