This year, at the Western Regional Dental Experience, the Arizona Dental Association was treated to two presentations by the ADA’s new Executive Director: Dr. Ray Cohlmia. Dr. Cohlmia hails from a family full of dentists and he has several children who are dentists or dental students. As a result, no one I have ever met cares more deeply cares about the dental profession and its future. It is for this reason that Dr. Cohlmia is turning the entire ADA upside down. Instead of the usual practice of tweaking the existing strategic plan, he has scrapped it entirely to start from scratch. Dr. Cohlmia aptly calls himself a “disrupter”—breaking all the rules that are preventing dentistry from moving forward.
I had the distinct privilege of serving on four ADA councils and I am intimately familiar with the ADA’s bureaucratic protocols. I whole-heartedly agree with Dr. Cohlmia and I applaud him for his courage and out-of-the-box thinking. I have known for many years that there are structures and protocols within the ADA that are actually interfering with fulfilling the goals of the association. In our rapidly changing world, it is clear to me that the conventional approach is no longer working.
One of the reasons why, as Dr. Cohlmia pointed out, is that the landscape of society has completely changed. The landscape is rapidly being morphed by consumerism, disruptive events, technological advancements, market changes, increasing customer/client demands and the acceleration of timelines. The ADA does not function in a vacuum, and it is being mercilessly bombarded by these forces. Within this backdrop, the profession itself is facing confrontation with generational shifts in the workforce, increasing patient expectations, shortages of adequate personnel, technological advancements, and changes in traditional dental practice. “You can either bemoan that,” says Robert Iger, CEO of the Walt Disney company in his book The Ride of a Lifetime, “and try with all your might to protect the status quo, or you can work hard to understand and embrace it with more enthusiasm and creativity than your competitors. It’s very simple. Innovate or die…”
One thing the ADA does well is compiling and examining data from changing patterns in dental practice. Statistics show that there are fewer solo dentists in practice and that consolidation of practices into DSOs is rising rapidly. This trend is responsible for a large generational divide in the ADA—lots of young dentists and senior dentists. However, the number of middle-aged dentists (40s) has dropped rapidly during the last 20 years. Approximately 30% of dental school seniors are now joining DSOs compared to 12% just seven years ago. The rapid rise of employee dentists has created a drop in dentists seeking practice ownership.
I am concerned that this trend does not bode well for the profession’s future unless we ensure that DSO dentists are active participants in the ADA. Employees think differently from practice owners. One need only look to medicine to verify this concern. Most physicians work for insurance companies and hospitals, and it is clear that most have that “employee” mentality. They do not understand why it is important to band together behind their professional association and make it reflect what they want. They do not appreciate how the American system of representative government works. They do not understand why their testimony to issues and pending legislation is critically important.
The truth is that failure to support your professional association is like shooting yourself in the foot. I have actually heard physicians badmouthing the AMA and exclaiming how the AMA does not represent them. Their failure to support the AMA has resulted in such a poor market share of physicians that the AMA can no longer speak for the majority of physicians. As a result, physicians have nothing to say about how they will deliver medical care. I firmly believe that if the physicians had banded together behind their AMA, they would not have had to deal with the consequence of (mis) managed care legislation—care that is dictated by administrators and not by medical doctors. Had physicians been proactive through their AMA, such legislation would never have passed, no matter how badly the politicians wanted it. They would have been afraid of losing their jobs from a huge doctor-patient voting bloc. Physicians need to understand that if they don’t like the AMA’s policies, it is their duty to become involved and change them!
The ADA has enjoyed a majority market share of dentists in the past, but it is becoming clear that this market share is eroding. Dr. Cohlmia is right on target with his urgency to make appropriate changes NOW. If the ADA becomes an irrelevant dinosaur, the dental profession will be destroyed in the blink of an eye—just like the medical profession. The profession of dentistry is much smaller than the medical profession and is even more vulnerable to the many groups (with deep pockets) seeking to take the practice of dentistry away from dentists. We—the ADA member dentists–have to ensure that new dentists join the ADA, participate in making policy and contribute to the PACs (ADPAC and state PACs) that are working hard to protect their ability to practice dentistry as they see fit. We have to make new dentists understand that it is not only important to become great dentists, but to make the practice of dentistry great for future generations.
Dentists have every reason to be proud of their ADA:
The ADA is the premier organization and voice for the 2.2 million people that live and work in the dental profession to deliver care to over 175 million people each year. ADA dentists make people healthy. The ADA serves the public, the profession, individual dentists, the tripartite organizations (state and local associations), and business and enterprise related to dentistry.
With such a mission statement, ADA must be seen as the premier business and supportive entity for all aspects of market penetration, care, and delivery of healthcare to the public. It must also be seen as the global leader of oral health care. These roles require the ADA to achieve and maintain financial stability, create innovative products and services, and be equipped to nimbly respond to market changes, consumer dynamics, and emerging opportunities.
Becoming proactive through strategic forecasting is the ADA’s new direction under Dr. Cohlmia—rather than remaining reactive through strategic planning, which is the current system. Under the current system, the House of Delegates meets once annually. The wheels turn slowly, and it is quite common for the entire behemoth of the ADA to come to a grinding halt until the House can convene. This arrangement certainly does not allow agility to quickly address major issues or enact new projects. Dr. Cohlmia envisions entirely new roles for the chief components of ADA governance: The House of Delegates’ mission is to be strategic forecasting; in other words, “deciding where we need to go.” Electronic advancements have made it possible for the House to conduct business between in-person meetings. The Councils are to be in charge of proposing resolutions and supporting initiatives according to HOD’s vision. The ADA trustees and staff will be custodians for funding the work, getting it done, and measuring progress.
Under Dr. Cohlmia’s leadership, the ADA has outlined several goals:
1. Member-focused governance that includes the agility in responding to issues that arise, efforts that are goal-based and team-based, strategic forecasting in order to be proactive rather than reactive, accountability for each mission, and greater engagement in global interaction.
2. Collegiality and Synergy that target ADEA and dental college visits (30 visits are planned for 2023), specialty organizations, affiliate organizations, dental industries, and international organizations.
3. Digital Transformation of the ADA with new development of apps relevant to upcoming generations that facilitate interactions with members and the global community. Already in the works are new digital experiences and the replacement of Aptify and ADA Connect.
Dr. Cohlmia is working hard to ensure the ADA is proactive and meets the needs of a rapidly changing, uncertain world. The question every dentist should now be asking is not “What can the ADA do for me?” but “What can I do to help the ADA realize Dr. Cohlmia’s vision?” The ADA needs more than your financial support; it needs your input and participation. Don’t let dentistry go the way of medicine. Get in there and make the ADA address your views, needs and concerns. We look forward to working with you as we strive together to make a difference for our patients, our practices, our profession, and our world.
–Dr. Ray Cohlmia
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