Howard: I cannot believe the honor I have today to be podcast interviewing the 153rd president of the American Dental Association, Dr. Gary Roberts. He is a general dentist from Shreveport, Louisiana, who spent 33 years in private practice. He is here today to talk about what's going on at the ADA. And, my gosh, when you guys are the president of the American Dental Association, how many days of the year will you be gone this year from your home?
Gary: I average being home five to six days a month.
Howard: Holy moly! I mean that's just... But the good news is you're paid what, a couple of million dollars a year?
Gary: About $8 an hour.
Howard: About $8 an hour.
Gary: And I'm over paid at that, some say.
Howard: Well, you know, you and I have a very common good friend, Dr. Jerome Smith, a great guy. [00:00:57] Karl Rove. [0.9] So you know Jerome, right?
Gary: Oh yeah, I know him well.
Howard: Yeah, and his partner, [00:01:05] Danny Dominique? [1.4]
Gary: Don't know Danny near as well as I know Jerry, but he's a good guy, a great dentist.
Howard: Well, you know, they say, you know ... so you're the most connected man of the year. I mean, nobody travels to more meetings and presses the flesh and shakes hands with more. What are you hearing? How's dentistry? Number one: how much do you regret being the 88th president this year? How many times a day do you tell yourself, "What the hell did I sign up for this for?"
Gary: It's been one of the greatest experiences of my life. I wouldn't trade it for anything in the world. You know, my favorite thing to do is get out at meetings and talk to people, grassroots members, who aren't in leadership. And finding out what they need and how we can help them. And there's a few things that we're doing that I'd like to talk about today that some of them may not know about but that we need to get them all involved in. First thing I'd like to talk about is we have ... last year the House of Delegates voted 18 million dollars for a consumer advertising campaign. They're targeting specific demographics. You probably will never see the ad because you're not one of the people they're trying to target. They're targeting people who have insurance, are generally middle income and they just need a little nudge to get over the edge to get into the dental office. We have a program called FindADentist, which we've had for years but we've updated that program and we're encouraging every member to go in and update the profile. In their profile they can put their specialty, they can put the insurances they take, the education they've had, but one thing they really need to put in there's a picture because they're eleven times more likely to get a hit on their site if they have a picture. We started this July the first, and from April to July we had five hundred and forty one thousand hits on the Web site. That's a fourteen hundred and twenty percent increase over the last year.
Howard: How many hits?
Gary: [00:03:19] It's already sparking. [0.7] Five hundred and forty one thousand.
Holy moly! Yeah. I see ... every time I log onto Facebook I see these sponsored ads for FindADentist.org, so, I see it all the time. And how many times more likely will they click on it if there's a picture?
Gary: 11 times more likely to click on it if you have a picture.
Howard: Do you think I should take down my picture and put up Brad Pitt's face?
Gary: You know, I've been thinking about same thing. But we ... no, it really is something that the more member involvement we have the better it's gonna work. We're directing these people to ADA Dentist. And if you just get in there and work a little bit on your profile - might take you five, maybe ten minutes - and you'll get a lot better success out of it. You'll even be able to go into your FindADentist profile and you'll find out how many hits you've had on your site.
Howard: So they just need to go to www.ADA.org if they're a member and then you said it'd only take them 10 minutes to fix it up?
Gary: That's about what it's averaging. And it's ADA.org/myADA.
Howard: OK.
Gary: And then it'll take them directly, once they've logged in, it'll take them directly to their account.
Howard: So ADA.org/myADA.
Gary: That's it.
Howard: Nice. So, what else is on your mind?
Gary: Well, we're starting ... we're gonna launch in the middle of October a new credentialing service. Going around the country, what I have found that people tell me that one of the biggest pain in the butts that they have is credentialing 'cause when Obamacare came in they required these people who were credentialing every four to five years to re-credential every year. And we have some hospitals and some entities that are requiring you to re-credential every four months. I have talked to one gentleman, a dentist in western New York who has a group practice and there's six of them and they belong to 19 different plans and they have to re-credential with every plan, every one of them. So, they have staff members that that's about all they do. Our credentialing plan we've partnered with CAQH, which is a nonprofit alliance of health care plans and trade associations. They've been around about 15 years and their mission is to make the business end of medicine better and dentistry better. And they already have 1.4 million health care providers who are providing credentialing services right now.
Howard: Is that CAQH.com or .org?
Gary: Just CAQH is the people. You go to the ADA website to get to them. And we have a secure portal where they can put in their information. If they have all their credentials and they have everything together, it generally takes about 15 minutes to do it. Then once they attach to it and verify it, then all they have to do is tell us who they want it sent to and when and they have a one time one stop, takes me 10 minutes to do this, where they were spending a half an hour to an hour on every credentialing application. We'll even send them a reminder every 120 days if they need to update.
Howard: So, is that ADA.org/CAQH, or...?
Gary: No, it'll just be ADA.org. Just go to ADA.org and type in "credentialing service" in the search bar and it'll take them right to it.
Howard: Type in "credentialing...
Gary: Right.
Howard: ...service". And you said the name of that company was what? C...?
Gary: CAQH.
Gary: CAQH. OK.
And it's, you know, it will just save our members the repetitive assignment of having to do this every year, some of them every three months, and it'll be so easy for them and saving ... what we're about is saving them time. Another thing we wanna talk about is licensure portability. You know, we've been working for years to try to get different State boards to accept every licensure exam and we've had some success but not near as much as we'd like because the majority of students in over half of our dental schools don't practice in the State with their education.
Howard: What percent?
Gary: Fifty percent of the students in over half of our dental schools don't practice in the same State that they are educated in and therefore they may have to take a different State board in a different state, and you know how expensive that's gotten to be. There was one young man that I knew that went to Colorado. There was a exam that they accept in Hawaii because he's from Hawaii and - the ADEX exam - and they didn't give it in Colorado. So, he had to go to Detroit Mercy, take his patients, pay their way up there. I mean, it cost the young man about $10000 take that board.
Howard: I hear you.
Gary: That's that ridiculous. That's just absolutely ridiculous.
Howard: I graduated from UMKC Dental and all my classmates who graduated there were taking central regionals, they could practice in Missouri, Kansas, all around there. I wanted to go to Phoenix, so I had to take a patient - and I didn't have the money to fly - and drive to Redlands, California, from University of Missouri Kansas City and do this dental stuff and I thought it was an outrage, you know. So, it's great that you're working on that. It's so cool.
Gary: You know, I'm not saying that every exam is equivalent, but what I'm saying ... what we're saying is that every exam seems to be fulfilling the purpose of that exam and that's to see that the practitioner is qualified. And we've had some States that are accepting every exam, which is a great deal. But another thing that we're working on [00:09:53] that, as the students are really up on is [4.0] they don't want to work on patients anymore on exams.
Howard: 'Cause it's not standardized if you bring in a patient.
Gary: It's not standardized. There are all sorts of ethical issues there and we're working to try to get, you know, get away from patient-based exams. In February the ADA Board of Trustees authorized to go ahead and begin developing an OSCE exam: an objective, structured, clinical exam that is a non-patient-based exam; it's a critical thinking and problem-solving exam. It is, you know, it's been used in Canada for years and years and years. It is non-patient-based but it shows to be valid and reliable. All the tests on the psychometrics are showing it to be a valid and reliable test and has been for years - even more so than the clinical exams that the five testing agencies are giving. So, you know, my thing about the five testing agencies, Howard, did you ever know anybody never passed it, eventually?
Howard: Yeah, I do. I know several people that took the boards three times and it's three strikes and you're out. So, they had to go work the rest of their life where they don't have to have ... were all they needed was a dental degree but not a State license which out here in Arizona is Indian reservations.
Gary: Right, and it ... but, I mean, you have to admit those are rarely ... that's a rare occasion. And our statistics have shown us it's about one tenth of one percent that that happens to. So...
Howard: Well, I will not relay that news to my buddy.
Gary: They don't like that. State boards and the testing agencies don't like to hear that. But it, you know, we're trying to get them to take this OSCE exam and two States have already accepted. Colorado and Minnesota already accept an OSCE exam.
Howard: And you're saying OSCE is O - S - K - I?
Gary: No, O - S - C - E. It's an Objective, Structured, Clinical Exam.
Howard: OK.
Gary: And it is, like I said, three States ... two States accept it now, one has passed everything and it will probably go into effect by the end of the year. So we've got three already. We have two more that are looking at this type of exam. And, you know, by this time next year we could have five States that accept this type of exam. And then if we go from there, this year we have formed the committee that is overseeing this and we've hired two psychometricians - and don't ask me to spell that 'cause there's no way I can do that - and they're preparing the exam. We're going to try to do a pilot in 2019 and have it ready to go out by 2020.
Howard: That is nice, and I'll tell you where it's also really nice is half the class is women dentists and it's very stressful for them when they go work someplace and they're married to a man and say he works for a big Fortune 500 company and he gets transferred, you know, she wants portability and it's very, very tough to say, "Oh, well, my husband has just got transferred from Phoenix to Chicago and now I got to get all stressed out about what are the boards for Chicago." She should just be able to pick up and go.
Gary: Well, you know, what really brought it home to me was I was at the Air Force Base outside of Anchorage, Alaska, last year and there was a gentleman there who was a, I believe he was a periodontist in the air force; his wife was a general dentist. She couldn't practice in Alaska because she didn't have the right board. And, you know, especially ... I mean this disproportionately affects our military families and we really ... that's one reason why we really got involved and really tried to start to get people to think about this portability of licensure. And I realize that many States have a licensure by credential after you practice for five years but you know we're working really hard to try to, you know, tell them that these exams are pretty much equal and they do what they say they'll do and we really need to let people go where they need to get. My big fear is somebody else in the government is gonna get involved in it and I want us to solve our problems; I don't want the government solving our problems.
Howard: That's an issue dentists don't understand. When dentists don't police themselves then you have a vacancy of checks and balances, so then the government will step in. And if you want the government to stay out of your life, you have to police yourself internally and most industries just say, "Well, we don't want anybody to police us!" and that's just never gonna happen. Government stepped in when there's a market failure.
Gary: No, you're right. And, you know, after the North Carolina case, the FTC is just looking for a way to make a big splash in our little, bitty pond. And this is one way they could do it. So that's why we're working so hard and we're, you know, trying to get people together and trying to get agreement, so, and we'll continue to do that. Well, that's about all I've got. What do you want to know?
Howard: Well, I got so many things. Thanks for that update on all that stuff. I'm just gonna go through things that are stressing a lot of people out, one being the dental students are saying, "You know, I graduated with $350000 of student loans." Do these dental schools have any concept of trying to make dental education faster, easier, higher quality but lower in costs. I mean with all the advances in online training and don't have to buy a book you can get it on a CD or download the audio version. Why are these kids graduating with so much student loan debt?
Gary: Well, I think that ... what I am told is the main reason is because the cost to produce a dentist is the highest of any profession that the facility and the faculty and everything that goes with that are much higher than medicine. Medicine has hospitals, they have hospitals they can work with - dental schools don't have that. My biggest ... student debt is one of ... it's one of the things that keep me awake at night, to tell you the truth, because I think it's a real threat to our profession. As long as these students can pay this debt off in a reasonable amount of time, you know, we'll continue to attract the quality best students that there are. But if we reach that tipping point where they can't, then you're gonna see what happened in '78, '79, 80 when you had closures of schools like Georgetown and Emory and Northwestern and Loyola and Fairleigh Dickinson. You had some really good dental schools that just said, "You know, it's just not worth it anymore", and then they pulled out of the market. And what bothers me are the dental schools that are gonna do that if this happens again are our schools that are doing research, our schools that have our speciality programs. So I'm, you know, we're worried about a lot. In fact, the ADA has a program to help these students refinance their debt at about half what the government charges and it can save a student between thirty and sixty thousand Dollars on a ten-year loan, generally.
Howard: How do they get information on that?
Gary: Well, they can go to the ADA or they can go to ... Laurel Road is the company - used to be Darien Rowayton Bank out of Connecticut. But they can get their loans as low as four and a quarter percent and they can refinance them any time they need to. If, god forbid, something happens and they're disabled, their loan is paid off. If they are in an accident and something happens and they pass away, their loan is paid off, they don't have to worry about family worrying about that. And it's, you know, it's really a good deal and they all ought to look into it. If they're in speciality training right now in a residency program, they will refinance them while they're in that residency program, and, you know, right now there're most government loans are between eight and nine and a half percent right now and you save them half of that interest for two to three years.
Howard: Oh, yeah.
Gary: You know that that's a lot of money right there and we're hoping that that's gonna help. But as far as the cost of dental education coming down, I'm ... quite frankly, Howard, I don't see it. I don't see it anytime soon.
Howard: But why do you think Emory University dental school closed in 1988, Fairleigh Dickinson in 1990, Georgetown in 1990, Loyola in '93, Northwestern in 2001? Why do you think in that period from '88 to 2001 five schools closed down but now if you go back over the last 10 years in America, you know, six or seven schools have opened and there's three or four on deck to be built. What do you think?
Gary: Back when I was ... of course, I'm an old fart; I graduated in 1977 and back then the government had done Institute of Medicine study that said there's gonna be a great shortage of dentists. Well, that shortage never occurred, but they paid for new facilities for most of these schools if they would agree to increase their enrolment. When I went to Baylor they were taken 130 people a year, you know, and they were doing about the same thing at U-T in Houston and San Antonio. We were graduating almost 400 to 450 dentists a year just in Texas back then. So it ... I think we got too many dentists and I think it, you know, they went down and they saw well the demand's not here. You know, when you're on a big complex ... health complex dentistry is always low man on the totem pole. And if the medical center, the medical schools want the facilities and you have a situation like that they pretty well get them. I think the thing about all the new schools opening is ... and 10 years ago, Howard, we were graduating 4000 dentists a year. This year we graduated 6300. So, you know, there's no shortage of dentists. When people come up and say, you know, we need different providers because there's not enough practitioners, that's just wrong. You and I both know it's all [00:21:10] about distribution. [1.1] It's not the numbers there. So, you know, we ... I think these schools opened up because they saw an opportunity. And most of them that have opened up, I think all but one, maybe two, have been proprietary, for profit, and then they're doing very well; they're doing very, very well.
Howard: Well, the ... you know, the school deans ... I talked to the dental school deans a lot regularly for, you know, decades and they say, "Howard, every time I raise my tuition $10000 a year, I have no decrease in qualified application." So, I mean, they have a zero price elasticity in their pricing. I mean, they can ... they've gone ... you know, some of these schools in the last 10 years have gone from 50000 a year to 100000 a year and they still get the same number of applications. And dentists would probably do the same thing. I mean, if every time they ... if they doubled the price of their crown they had no decrease in the number of crowns, you know, dentists would be doing it. But, you know, you said something very interesting, you said 10 years ago we graduated 4000 dentists and last year we graduated 6300, so then the question begs, then why do we need mid-level providers?
Gary: Well, that's our whole point. What we need to do is get these folks into places where they're needed. And the way you're gonna do that is with this ... especially with this enormous debt is with loan forgiveness and we have ... there are several different ways to do that. There's the federal government. Right now you were talking about the Indian Health Service: the Indian Health Service has, I think, over 300 open positions. I know there are a ton of them right now and they can get about twenty to twenty five thousand Dollars a year in loan forgiveness on that.
Howard: You said that the Indian public health system has 300 openings?
Gary: I think that's ... I think that's right. Now, don't hold me to that number but I think it's between two and three hundred and they, you know, they're begging for people. We ... in fact, I was out there in ... a couple of three months ago, I flew to Albuquerque and we drove over to Window Rock, Arizona, and met with the vice president of the Navajo Nation, Jonathan Nez, who is in charge of healthcare, and we had some pretty good discussions with him. He never mentioned mid-level providers when I was there. We talked about the CDHCs, the Community Dental Health coordinators and what they could do.
Howard: Say that one again. The C?
Gary: The CDHC, the Community Dental Health coordinator.
Howard: CDHC. Community Dental Health coordinator.
Gary: Right. And they have ... they even have a school there in Albuquerque. They've got several all over the nation but they've got a school in Albuquerque and three or four of the community health workers from the Navajo nation are taking the courses right now and should be through this year. They go back into the community, these folks go into the community - most of them are culturally competent in the same way that you and I would be - and they go in and they teach prevention, they teach education and they help navigate these people to the dentist. We have some CDHCs in Wisconsin on one of the Native American lands up there and they reduce the no-show rate at the clinic from 50 percent to 10 percent in about six months. So, if you wanna get these folks, which are people who absolutely are the most desperate in need, in to see people - that's the way to do it. It's not throw mid-level providers at them, because most ... you know, I always find it funny that they are talking about mid-level private providers who are probably potentially gonna treat the most complicated of cases. They talk about simple extractions; you and I both know you don't know whether it's a simple extraction till it's over.
Howard: It's part of the elitism backlash that Americans have been expressing for so many years. Because, like, I mean, I don't want to get into politics, sex, religion, violence, I want to talk about this professionally. Like, I remember when there was a, you know, certain presidents of the United States that were against vouchers so you could take your money to a private school and they were against that saying, "No private, public school's the way." But then they would send their kids to private school. And these people that are out there talking about mid-level providers should go to the rural, they're getting treated at the Mayo Clinic and the Cleveland Clinic, but the little people, they just need, you know, a quarter trained dentist. They don't even get a fully trained dentist. So, the hypocrisy, it's just kind of icky.
Gary: Well, I just ... I ask them when they ask me, I said, "Well, I tell you what, let's let these mid-levels treat your grandchildren."
Howard: Yeah exactly. And it's always like, "Well, I deserve to be going to the Mayo Clinic because I'm all that. But the little people they just need a half trained doctor." And it's like...
Gary: That's the whole point. And we...
Howard: And the other problem is that even when you become a dentist and you graduate from these amazing dental schools, it's gonna take you five years of just doing fillings and crowns over and over and over before you even get competent. I mean, those kids ... I mean, so, to say we're gonna give them less education - my god, you need a full education and at least five years before you really should be working on my grandchildren.
Gary: Yeah, you know, I tell people ... I tell students, I said, "You know, the biggest thing that you have something in common with every dentist who's ever graduated from dental school going all the way back to Baltimore, is that the day you graduate you've had a good education. You feel like you know what you're doing but you don't have a clue as to how much you don't know.
Howard: Right.
Gary: It takes about five years before you start trying to figure out how much you don't know and then you'll spend the next rest of your life, you know, trying to catch up and trying to be the best you can be.
Howard: No doubt, no doubt. So I wanna talk about another extremely emotional issue. Dentists, I mean, you just say the word "Delta Dental" and their heart starts going into defib. So, I'm not a lawyer. Some people say that they, you know, they don't compete fairly with us, that they get to do things to the providers, if the providers did it to Delta it'd be antitrust, you know. What do you think of the current insurance situation - dental insurance situation?
Gary: Well, number one, I don't feel like it's insurance because it's, you know, there's a finite amount they can spend and they have actuaries that can calculate to the penny to make sure that they make money, and they make it on the backs of our members. You know, I heard a ... they were speaking ... I was speaking in, I think it was Arkansas, and Delta Dental had put up like $30000 for some program and they were up there thanking Delta Dental and I got up and the first thing I said, "Well, I wanna thank the dentists of Arkansas for allowing Delta Dental to have the money to do these projects because it's the dentists of Arkansas that actually paid for it, it wasn't Delta Dental." And I think they're all the same, I think we've had some problems with Delta, with their EOB's, where they have come in - and it's not just Delta, there's other insurance companies too - but they've come in on their EOBs and given a list of their provider dentists and telling patients, "You may save money if you go to one of these people." That's not what an EOB is for, you know. An EOB is just to say this, that and the other, what you've done, what we paid, what you owe. They also were having a lot of problem with a lot of them denying claims just out of hand and having to go back and forth. It's a pretty tenuous situation right now. The ADA has written ... our chief legal counsel has written several rather scathing letters to different Deltas and we've gotten some pretty good results with the EOBs. They've quit, they have taken this type of information that they were giving off of the EOBs, which they shouldn't ever have been there to begin with. So, we've had some good success with that as far as all of the refusals, you know, that's a State thing. You know, where we are in Louisiana you have to be a licensed dentist in Louisiana to review a claim and they have to tell the dentist who that person is and you have the right to talk to that person. So, you know, if we would get more of that all over the country I think we could slow this stuff down.
Howard: So, you're saying that you believe that you should have to be a licensed dentist to review a claim on an x-ray.
Gary: Yes.
Howard: But at fifty States though, what percent of the States do you have to be a licensed dentist to own a dental office?
Gary: Well, I know you don't in Arizona.
Howard: I know, I know.
Gary: There are a few States that you don't have to be licensed. Now, where I am, you do have to be. You have to be a licensed dentist practising in that State to own that ... or not practising, but you have to be a licensed dentist to own that office. I mean, I could own that office is a retired dentist and hire people to work there, but you're still being run by a dentist. And some States are not that way. And, Howard, I'm not sure ... I know Arizona is the big one but I know that we're seeing a lot more corporate in those type States.
Howard: Yeah, you know, corporate - that's another emotional deal, you know. It's kind of like everybody complains about lawyers until they need one and then they want the best one, and, you know, so, in my last 30 years all my friends who had really large dental practices in the two to four million range, they were illiquid assets - no-one could come out of school and buy that. So Heartland, you know, Rick Workman, he was the only guy who could write these guys checks, so that he was providing liquidity to the oversized, illiquid asset, dental office, and these dentists who'd complain about corporate, they won't hire these kids that come out of school. They say, "Well, you know, I want five years' experience." Well, how do you get five years' experience if no-one'll hire you? And so, a lot of these big corporations have been a godsend for these kids who just wanna come out and get a job and start getting some, you know, experience. So...
Gary: I agree with you. I mean, when you've seen one DSO, you've seen one DSO, because they're as different as daylight and dark. I mean, you have some that are very, very good and are very, very ethical and do everything that they should be doing and you have some that don't. But you have general dentists in private practice who are very, very ethical and you have some that aren't. So, you know, you can't paint these ... all of these entities with one brush because they are different. And, you know, there are some people who just don't want to run the business end of a dental office and, god, don't you know you and I would have loved to have not had do that; just sit down and practice dentistry. Used to be the only way you could do that is if you went into the military. But, you know, they do have a place. They are providing a service to young people and I can see why they're attractive to young people because they can offer them a good salary comin' out. And, you know, they ... a lot of dentists ... you know, my wife says that most dentists go to dental school because they couldn't work for somebody else.
Howard: I agree with that. I agree with that.
Gary: And she's probably right. She is with me - I couldn't have worked for somebody else. I have a hard enough time .
Howard: When I hear my physicians friends tell me that to have privileges at some of these hospitals in Phoenix, you've got to be wining and dining and golfing with, you know, some bigwig physician, chief of staff and, you know, if he has a birthday party or wants to go golfing, all of his minions have to ... it's like, oh, my god, I knew that when I was in high school that I didn't have the personality to do that. That's what I knew. I got accepted to med school at Creighton and dental school. My backup plan was dermatology. So Creighton dental, Creighton ... I could have gone to medical, dermatology or ophthalmology, 'cause that was the only one I saw that you could own your own land, own building, and didn't have to be anybody's employee.
Gary: When I was an undergrad...
Howard: By the way, you know how I got into med school? I think, I seriously think you know how I did it. It was with a Jesuit, and I told him, I said, "You know, my number one plan was dental school because my next door neighbor, Kenny Anderson, was my idol and role model and he went to Creighton", and I got accepted in Creighton Dental, but when I went to the medical school, before I'd got accepted, he said, "Well, why are you applying here?" I said, "Well, this is my backup plan." He goes, "Howard, you should never tell an interview that that I'm your backup plan," he goes. And I said, "Well, I just want to be honest." And he said, "Well, what is your number one backup plan?" And I said, "Well, I think dermatology." And he goes,"Why dermatology?" and I was just covered in acne. I said, "Every time I look in the mirror I think God's trying to give me a sign." He laughed so hard that was the end of the interview, then I got a letter later on so I think that one joke got me into med school! But, yeah, most of these dentists don't have the personality to be an employee.
Gary: You know it ... you know, I went to ... when I was in undergraduate school, I worked in a hospital as an orderly in an emergency room. And back then there were no such thing as emergency room physicians. Everybody came in and took care of their own people. And, you know, I'd seen physicians that had been up there three and four days and never been home. And I decided, you know, that's not the kind of life I want. And dentistry gives you so much better of a lifestyle, I think. And that's the main reason I wanted to go to dental school instead of med school.
Howard: I wanted to say one thing about the ADA, you know, so many people ... well, compare ADA membership to American Medical Association membership, I think that's profound. What percent of the dentists are in the ADA versus what percent of physicians are in the AMA? Do you know those numbers off the top of your head?
Gary: We're right at 64 percent for the ADA and I think the AMA is about 18 to 20 percent.
Howard: Yeah, and what dentists don't understand, I mean, look at ... I mean, you went to school and you became a dentist and the ADA, I mean, they're the only person at bat for your profession and most of their at bat is at all these little State meetings and federal Washington D.C. meetings, but somebody has to be at bat against the government at the State level, I mean, and that's why I did a podcast with my director here of the Arizona Dental Association and I always tell him, I say, "You know, the number one problem that the Arizona Dental Association has is, my homies that I go drinking with and eating cheeseburgers and watching football games, they don't even know 99 percent of what you're doing, you know. They don't know you were at the House all day, they don't know that you were talking to the city councilmen and State representatives and U.S. congressmen and senators and, I mean, so, I'll ask what he does is I'll say, "Well, why are you a member of the ADA?" and they'll say something lame like, "Well, actually, it's the only place I can get my health insurance." You know, as you get older, you young Millennials don't realize, you know, when you sit there and you see these advertisements where you can buy a million dollar life insurance policy because you're 39 or under. Yeah. Yeah. 'Cause no-one dies at 39 or under. But when you're 55 and have grandchildren, your term life just goes through the roof, and I was looking at my rate from when I turned 50 to 60, but god darn it, it goes crazy again from 60 to 70, then 70 to 80 - by the time you're 80 years old your premium is pretty much what your benefit is every year minus, you know, four dollars and eight cents. And so, these guys, I'll say, "So, you're a member of the ADA because that's where you get the best benefits package?" And it's "Yeah." And I'll say, "Well, do you know ...?" and then I'll rattle through, "Did you know there were this hearing? Did you know...?" I mean, just little things like I'll say, "Do you know there are four dentists in the Congress of the United States of America; there's none in the Senate, none in the White House, but there's four dentists in the government?" and they don't know it. And I've asked those four to come on the show and I didn't even get a return e-mail. And I think if those dentists were telling them ... you know, so, I guess my deal is I'm so glad two out of three dentists are members of the ADA, and if you don't like the ADA, well... It's the same as your parents, I mean, there's a lot of things I like and didn't like about Mom, Dad, Grandma and Grandpa, but they're still your only parents, you know what I mean? And if you don't like something about the ADA, then you start going there after work and volunteering on all these committees, you know, week after week, year after year. But, so, go through those four dentists - one of them's from Arizona, Paul...
Gary: Oh, Gosar.
Howard: Paul Gosar. Do you know that Paul and I both went to Creighton University and we were in the same dormitory, Swanson Hall? He was on the eighth floor, I was nine. So, there's Paul Gosar from Arizona; who are the other three? There's one from...
Gary: Mike Simpson from Idaho.
Howard: And he's the oldest, most...
Gary: Right, he's been in office the longest, and then there's Brian Babin from Texas.
Howard: Yeah.
Gary: And then our newest one is Drew Ferguson from Georgia.
Howard: Drew Ferguson?
Howard: And he is...
Howard: Why ... if you ever talk to those guys tell them I think it's so vital that they come on and tell them from their perspective, I mean, they're the only four dentists in the federal government, to tell them what does the ADA do because, like, say, "You guys are doing so great with the FindADentist campaign. I love MyMouth.org, all these things you're doing. But I think you need a internal marketing campaign by these four guys to explain to these dentists, 'Dude, you don't know what your dues are doing. There's battles going on all day, every day'."
Gary: Howard, Tuesday and Wednesday I was in D.C. and I met with about twelve different congressmen and senators and we were all talking about the Medicaid and healthcare and what was coming up, and, you know, we have covered 50 percent more children in the last 10 years and we don't want to see that lost. And we were talking ... I mean, I saw, I talked, I had dinner with Marsha Blackburn; I had lunch with Steny Hoyer; dinner Wednesday night with - gosh, what's his name? He just came out [00:41:25] with the tax base. [0.8] He's chairman of Ways and Means from Texas - Kevin Brady. Kevin Brady. And they all have different ideas, I mean, they're all over the map on what they want to do on this, and, you know, we've got to get them together and we've got to talk to them and explain to them: we don't care what you do as long as you make sure the children are taken care of. That's all we care. Now, I'm here today and tomorrow; I will leave Sunday and fly back to D.C. because Monday afternoon we have a meeting with Secretary Price of HHS, and that one is - there were twenty groups that were invited and the ADA was one of them - and it's, okay, let's talk about what regulations we need to get rid of. There's talk about cutting the red tape, on how to make life easier on practitioners. So, you know, that's some of the things that we're doing for them that they never know and, you know, that's partly our fault. We should be tooting our own horn and we should do it more than we have.
Howard: Yeah. Can you get a message to Paul Gosar, Mike Simpson, Brian and Drew and tell them I'd love to get them on the show?
Gary: I'll probably see them Monday. I can do that.
Howard: Oh, please tell them! And, I mean, I just think it's so amazing. We also had Kathleen O'Loughlin, an ADA executive director, who is also a dentist.
Gary: Right.
Howard: And, I mean, like you say, I think I ... when I talk to dentists and I'm on the message boards and all that stuff, I just flat out believe, by talking to them, they don't know ninety five percent of what you guys are doing all day every day. I mean, Kathleen, she's got ... her schedule's almost as crazy as yours is.
Gary: It is. She's on the road almost as much as Dr Crowley and I are. But, you know, you're right. You are so right, that we need to be better about tooting our own horn. One of the big things ... a lot of things we do are things we keep from happening, things we keep from going forward. There was an international ISO rule that was getting ready to go into effect that had - now I'm trying to remember exactly what it had to do with - but, anyway, it was gonna cost every dental office in the country about $4000 to comply with this rule. Well, Dave Preble, with the ADA, and his people met with all these folks, they went to all these meetings and they got that killed. So, you know, we do things like that that nobody ... I mean, I didn't even know about it until Dr. Preble told me about it. And so, that's the kind of things we do and that's why, you know, that's why everybody needs to be a member of the ADA; because we are the only, we are the only one out there looking after every dentist's back.
Howard: Yeah, I mean, it'd be like you go into a church saying, "But I refuse to tithe because I don't agree with the pastor or the priest on this one issue." It's like, you know, you have to have someone at bat. You know, politics - the only way you can describe it is, you know, everybody wants to go to McDonald's and eat a hamburger, everybody wants a charcoal steak but nobody wants to see the cow shot in the head and slaughtered and quartered; and politics is just gross and it's tough because you ... people are not reasonable and rational and they just, I mean, look at that the two parties in America, they hardly ever work together. I want to ask you a question that confuses a lot of young Millennials. These podcasts, about 25 percent of these ... so Dental Town's a quarter million dentists, 60000 downloaded the app but they're mostly born after 1980, and podcasters, I mean, my god, you'll never meet someone who listens to podcasts over 30, probably a quarter of them are in dental school and the rest are all Millennials, they're commuting to work, they're on the Stairmaster or whatever but they often have asked me, you know, there's too emotional ... there's so many emotional issues in America that aren't emotional anywhere else, like gun control. I mean, obviously, the country has more guns than people; they're never gonna part with their guns; there's no sense talking about it. But one is healthcare. Why is healthcare so emotional in America, but it's not even really a subject in Canada or Australia or New Zealand or Scandinavia? Why do you think it's so polarizing, controversial, crazy, divided? What would be your perspective since you see this industry at 35000 feet?
Gary: It's kind of perplexing, to tell you the truth. I mean, we ought to find a way, you know, we need to find a way for everybody to get taken care of. That's the whole point. And that, you know, that doesn't come easy. And when you're talking politics, you're talking 'I win, you lose'. You know, very few politicians work on a 'I can win and you can also win' situation. And I remember, you know, Reagan used to say, "If I can get 80 percent of what I want, I'll just be tickled to death", you know, and I don't see it that way. As much time as I spend in Washington, I don't see it that way anymore. They're so one-sided and 'we're never gonna do anything that's gonna help the other side'; we don't care if it helps, you know, people; we don't care what it does; we're so entrenched in our ideology that we're not going to move out. And I think, Howard, I think all this started back when they started going to Washington on Tuesday and coming home every Thursday night. When they all lived up there and they lived together and their kids went to school together and their families socialized, it was a whole different ballgame. You know, it's hard to call somebody a sorry SOB if your son's dating his daughter, you know. So it ... you know, I think just the civility, from what I can tell, is just gone from D.C. and I don't know how to get it back.
Howard: Yeah,it really does. It's hard ... I hate to tell these young 25 year old graduates that in my lifetime politics have just been getting worse and worse and worse - and so is the media. I mean, what they don't understand about the media is the business of the media. You know, when we were little, it was only three networks - so they had a lot more advertising 'cause you didn't spread out much - but all that stuff was big budget stuff like 'Bonanza' and 'The Big Valley' and 'The Brady Bunch', where they had, you know, fifty to a hundred employees and actors for a show and then, as the cable came out and you didn't really have the advertising revenues, they said, "Well, let's just throw all that away and we'll just have 'Wheel of Fortune', we'll have a talk show, we'll have a 'Tonight Show' with just one employee." Well, media's done the same thing. As the subscription to a newspaper's gone down, all the local reporters are gone, so the only thing they can do for low cost is talk about things like Putin and North Korea and, you know, Trump and Hillary and Obama and all that stuff like that. There's no, you know, where I'm at in Ahwatukee there's almost zero reporters going to the high school meetings, the city council meetings, you know, HOA meetings. The beat reporters are all gone. And so, when you had that massive checks and balance with a really healthy profitable press has gone down the drain and now it's just national news, it just ... I think the only way they can make money on national news is having two talking heads that are for cheap, that are, you know, one's Rush Limbaugh, one's Michael Moore and that ... it's almost like an entertainment, low cost deal instead of in-depth reporting, you know.
Gary: I agree with you. It ... you know, now with the 24 hour news cycle, they've got to find something to fill it up and they will fill it up ... well, you know, CNN came out with a story last week about a study, a so-called study that was done in Mexico that even the people that did the study said you can't go by this, this is a one time event, said that fluoride in the water ... too much fluoride in the water caused a young person's IQ to be five points lower, you know, by the time they were 10 or 12 years old. Well, I mean, this ... even the people that did the study said it wasn't reliable.
Howard: I know, they said...
Gary: But CNN grabbed it. They grabbed that sucker and went on with it and, you know, and shook it like a dog with a ragdoll.
Howard: Yeah, it was a blog on the Harvard Business Review. So, then they translate that to 'it was published by Harvard', and then, the second, it was an area in China where they open pit burn coal for electricity and they were actually getting the high fluoride levels through the atmosphere, breathing it in, and it was like eleven times higher than anything anybody drinks, but they weren't drinking it, they were inhaling it. And again, they don't have the money to say, "Hey, reporter, can you really look into this for what ...?" You know, the only news that I think is in-depth journalism, the only source left is Vice News on HBO, 'cause it's subscription so they don't have to care about advertisers. And it's so funny, I can't even watch the news on cable anymore because the first half of the commercials are all for prescription pills and then the warning telling you everything that can go wrong including, you know, killing yourself, and then the second half of the show is a bunch of commercials by malpractice law firms that are doing class action lawsuits against the advertisers who advertise in the first half. I mean, is that insane or what?
Gary: Yep. It ... you're right. And like I said, you got 24 hours to fill up. And if they can fill it up with advertising, no matter how cheap, because you can't tell me that this advertising isn't cheap, or they, you know ... some of these people couldn't afford to do it.
Howard: I want to give you another kudo for that one out of three. I mean, it's just not fair that two out of three dentists have to support the entire tripartite system of the ADA national, the State and the county level. That's, I mean, you're basically a vagabond, gypsy free-rider. I mean, you know, pay up! But number two, and if you don't like, it get involved, I mean, you know, but it's free, so you don't want to work for free and you don't want to pay your dues. But one more proof that the ADA is doing something right, not only has the ADA got two out of three, sixty four percent members, and the AMA has only 18 percent, but your revenue - it's not even majority dues anymore. There are so many products that the dentists buy from you, which again, I mean, you're proving yourself on the free market - if you sell a product and you say it's all that but nobody buys it, it's not all that. And you guys have a list of products and services that you sell. What percent of your revenue now only comes from the due membership that the one in three that won't pay up are complaining about?
Gary: Howard, I am not sure, but I think it's about 50/50.
Howard: Yeah, so 50 ... so not only do two out of three dentists pay the dues, and one out of three rides for free, but these dentists that are paying the dues, they're paying almost the same amount of money in other things that you sell which, if they didn't like they wouldn't buy, and if they found them someplace else, better, faster easier, cheaper, they'd buy them there. And that's got to be, I mean, that's got to be a real source of self-esteem to know that you get just as much revenue from these dentists again by knowing what they want and need and providing it for them. That's pretty damn cool.
Gary: Well, we do that. We provide a lot of things for them but a lot of non-dues revenue comes from other sources too. We have marketing programs for credit cards; if you buy a Mercedes you can get up to $3000 off depending on which one you buy if you're an ADA member; all of those type things that we're doing, that are actually services that our members do use, you're right, but the money that we get from these services comes from the company that's selling them - it does not come from our members. So, and they have to be ... before we will endorse something like that it has to be a good deal for our member. And we've been very judicious about what we have, we will endorse. We make a lot of money out of the SEAL program. We make a lot of money out of testing. You know, a lot of people don't know it but we provide the, I think it's the equivalent of the DAT test, but it's for optometrists, and we make a lot of money out of that. We find out what ... and we're very, very good in high stakes testing. We've, you know, done a lot. We know what we're doing. We know how to provide this kind of service to other people other than dentists and it, you know, it's helped us keep our members' dues lower.
Howard: You know what program you need to figure out with Mercedes though?
Gary: What?
Howard: Why ... you need to figure out a program of why I can't afford a Mercedes Benz but my ex-wife can!
Gary: Anything I say will get me in trouble!
Howard: Can you ... can the ADA fix that problem?
Gary: I don't think so. I don't think so.
Howard: Well, my...
Gary: If we could, we could probably go dues free, if we could do that - figure out a way to market that.
Howard: I think the coolest thing now is, you know, when I got out of school I listened to all these male dentists complain about how unfair it was that their stay-home ex gets all this alimony and now it's so cool to see women dentists complaining about it now. I'm like, "Yes, finally!" I love it. There's nothing I love more than listening to some 55 year old woman dentist complain about her alimony payments. I said, "Equal rights, baby.
Gary: That, you know, you're right about that. If you're ... if you make the money, you're gonna pay the alimony.
Howard: Oh, and same thing with a product. If you're [00:56:37] rich, Mercedes Benz, and [1.3] some idiot can't put on the seat belt and leaves their window down with their arm hanging out, driving drunk, smoking a cigarette while texting, guess who's gonna pay.
Gary: Yup.
Howard: Yeah, you know, the rich always pay down - the poor never pay up. It's the rich always paying down, when it comes to lawyers. But I cannot believe, I mean, I felt sorry podcasting you in the evening because, like you say, you're only home five days a month and then what am I doing, I'm interrupting you for an hour of your time - and we're just past an hour. So, my final question would first be: is there anything I wasn't smart enough to ask or anything else you want to talk about or anything that you think you guys do that the listeners aren't even aware of what you're doing?
Gary: I'm trying to think of something that we do. We've covered most of the major things, the new things that we do right now. But, you know, I just want everybody out there that, you know, one of our mottos is to help every member succeed and no matter what type of practice you choose to practice in. And we're gonna continue to do that. We're going to continue to travel the country. I have another 25 days - but who's counting - and then Dr. Crowley will be president for a year and we'll have a new president-elect who will hit the road at the same time.
Howard: How do you spell Crowley?
Gary: C-R-O-W-L-E-Y.
Howard: Well, tell us about Dr. Crowley.
Gary: Dr. Crowley is a great individual. He's from Cincinnati, Ohio. He's a general dentist. He just sold his practice and he was supposed to practice two days a week, but since he sold his practice in January I think he told me he's practised four days since January. But, in fact, he's in there today practising.
Howard: What's his first name?
Gary: His name is Joseph Crowley.
Howard: Joseph Crowley, general dentist from Cincinnati.
Gary: Right. And good head on his shoulders, really cares about members, really cares about people, and he's gonna make an absolutely great president. And he, you know, like I said I'll probably talk to him tonight and tell him that he needs to do this too next year.
Howard: Yeah, absolutely! Have him do that because these dentists have to hear. Why do these ... how many hours do you think you and Joseph volunteered for free with no reimbursement in your entire career before you made it to the president of the ADA?
Gary: I don't even want to think about it.
Howard: But what...
Gary: You know, you have no ... but ... Howard, you don't do it, you don't think about it that way. You think about it ... the way I thought about it was, you know, I grew up on a farm in West Texas. I never thought I'd be here. I never thought I'd get off that damn farm and...
Howard: What'd you guys farm? Small grains? Or what?
Gary: Well, we raised cotton.
Howard: Cotton.
Gary: And soybeans and maize and had a few cattle but it ... you know, you get to the point where you get off that, and I was so thankful. Somebody asked me why I went to LSU, and I said, "Because it was 813 miles from that farm!" I was lucky enough I had a lot of help from a lot of people. I got in dental school. I married very young. I was 20 and Teresa was 19 - been married almost 47 years.
Howard: Nice.
Gary: And, you know, if it wasn't for her I wouldn't be here, I can promise you that. But a lot of people helped me along the way. And dentistry has been so good to me, it's given me a great lifestyle, it's educated my children and, you know, helped them have a good lifestyle. I just, you know, I just felt like you need to give back. And this was one way we can do it. And also I'm not really good at saying no, you know. My wife tells me, she says, "You know, you never tell anybody no", and I said, "Well, that's, you know, if I can help somebody, we're gonna do it."
Howard: You know that...
Gary: That's my story.
Howard: You know, that West Texas - a lot of people don't realize, I'm in Phoenix - that's only six hours to El Paso, but El Paso to Houston is 12 hours.
Gary: Yeah.
Howard: And you said, you're on a farm doing cotton and cattle. The five Cs of Arizona are cotton, cattle, citrus, climate and copper, and, yeah, that Phoenix to El Paso ... I mean, El Paso, you might as well be in Arizona.
Gary: Well, my mother still lives in Lubbock, you know, in the Texas Panhandle and I get tickled, when I drive out there I go down I23 Dallas and I hit Abilene and it says 'El Paso' 600 and some odd miles from Abilene, and I've already been, you know, 450 miles.
Howard: Right, that is a...
Gary: So, yeah, it's a big State. It takes forever to cross it.
Howard: Well, so all you guys, he's being humble. They've volunteered thousands and thousands and thousands of hours their entire career while you were going home after work and sitting there in your underwear watching ESPN, drinking a beer, and then two out of three of your homies are paying your dues and you're not - you're a free rider. And the ADA, the number one problem the ADA does is they don't tell all you guys what they're doing all the time. And when you come up to me and tell me that you're only a member because you get discounts on your credit card processing or your term life insurance, it's like, "Dude, there are politics." Again, it's like slaughtering a cow, it's an ugly, gross process. And they're in there fighting it at the State level in fifty States. How many times a year do you think an executive director of a local State is meeting with a local State representative, politician?
Gary: Oh, a lot. A lot! Most of our State executive directors are also lobbyists.
Howard: Yeah, they live down there at the government.
Gary: They live at the Capital. They live, you know, and they work really, really hard for everybody.
Howard: Yeah.
Gary: And so it...
Howard: And I'll tell you another thing that nobody wants to talk about, the ugly 4000 pound elephant in the room, is that when you go talk to State legislators - and I have, I've known a lot of them - they don't have any sympathy for doctors making a hundred seventy five thousand dollars a year when the median household income in America is under fifty thousand. And, you know, the median hourly wage in your town might be twelve, thirteen, fourteen dollars an hour and then you're down there saying, "Well, the dentists, you know, they they make a hundred and seventy five; the endodontists, oral surgeons, are making three fifty." So, dude, these guys, these lobbyist from dentistry, they get massive, massive pushback. I mean, how many people do you know in America feel sorry for anyone making over a hundred and seventy five thousand Dollars a year?
Gary: Well, I don't know many people in America feel sorry for anybody. That's the number one thing. But we, you know, we are very successful in most legislatures and the reason why we're very successful is because we go in and ask for things that are good for patients generally. We have learned that, you know, every legislator has a dentist and we find that dentist and we work with them so they can help educate the legislator on what our needs are and what we're fighting for. And, you know, you have home fundraisers. That's the easiest thing in the world is to get ten or twelve of your friends, get a couple hundred bucks from each of them and have a home fundraiser for one of these legislators. That gets their attention and it doesn't bribe them but it does get you their ear. They will listen to you when you try to explain your side of the story. And that's all we ever ask, is just, please, listen to us and consider our side of the story. And we've been very successful doing that.
Howard: Again, Gary, I feel guilty bothering you on one of your few day offs.
Gary: Howard, it's no bother. This is part of it. It's been a pleasure.
Howard: And both of us send our love. Big shout out to my favorite Louisianans. Are you going to be my new favorite, Louisiana dentists? It's always been Jerome Smith for 30 years.
Gary: It still it ought to be. It still ought to be Jerome.
Howard: You know why it's Jerome? You know what he turned me on to which I didn't even think about it: missionary dentistry. You know, thirty years ago he said, "You got to do this." And I'm like, "Well, I can't do that. I'm busy, man. I've got an office, I've got a family. I mean, that's for old people to do when they're retired and bored." He goes, "No, no, you need to do it. You need to come with me." That was like the biggest religious experience I ever had in my life. Leaving the 24 hour day rat race owning a practice, you know, all that stuff, to going there where there were 5000 [01:05:39] Chopan Indians [1.2] without running water, electricity or sewage, and it just made you sit there for four or five days, just so making you realize, wow! I was really disconnected from reality. And the thing I'll never forget ever, not one single person ever flinched from a shot for five days. And then you come back to America and they got purple braids in their hair and they're on their iPhone and they got a big tattoo on their arm and they're like, "Uh, uh, uh, uh." And you're just like, "Why don't you go live in Somalia for a year and come back and tell me if that shot bothers you." You know what I mean?
Gary: You're right. You go down into these places where people have nothing and I mean less than nothing and it makes you take a look at your whole card.
Howard: Oh, it does!
Gary: You realize how lucky you are.
Howard: I remember sitting ... those kids, they'd be sitting on a table and I'd grab their ankle and they had little, bitty rocks embedded in their calluses because they were running around like you could not do that barefoot with your little, you know, little feet that had been in socks and shoes your whole life. I mean, they had embedded pebbles in their calluses and could run up and down the mountains just like they had boots on. I mean it was just, it was so awakening that I had to go back and take my boys. And I remember the funniest thing that any of my four boys ever said - and I'll give all this credit to Jerome 'cause he turned me onto this - Eric and I, he's my oldest, he's 28 now, I think he was 6 - so we go down to this charity missionary dentistry and after about half a day he says, "Dad, how come they don't have trampolines?" And that was his whole world. I mean they always loved jumping on the trampoline and I felt like, you know, saying, "Did you also notice they don't have refrigerators, air conditioners, running water, showers?" But he just noticed that these poor kids don't have trampolines.
Gary: Yeah, that, yeah, I mean, they don't have enough to eat either, most of them.
Howard: Yeah, I know. I know. All right. Well, thank you. Oh, one last story of the missionary dentistry, the thing I'll never forget the most is, you know, if you gave them money, they wouldn't know what to do with it, but I took down a bunch of loaves of bread and peanut butter and jelly. And these kids didn't know a word of English and I was sitting there and making them all PBJ's and, oh, my god, did they love it? And it was so cute the next day, every child in that village could ... the only English they knew, they'd come up to me and say, "Peanut butter and jelly." So, we actually ... it was so adorable, we actually got the SUV and drove miles into town just to be able to come back and build more PBJ's for them. They, I don't think they ever ... they thought that was the greatest thing in the world.
Gary: Well, and it was to them. And it made you feel good too, didn't it?
Howard: Absolutely! And Gary, seriously, dude, thank you so much for all that you've done for dentistry in your own practice but that you do for the American Dental Association. I mean, the amount of time you've served and I know it's a thankless job. Whenever you're in politics it's a thankless job. But there're so many people listening right now saying, "But why don't they do this? Why don't they do that?" And let me tell you something, you can't bitch if you're not a member. So if you want to bitch, pay your dues, get involved or shut up. And on that note, Gary, thank you so much for coming on the show.
Gary: Thank you, Howard, it's been my pleasure.