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Taking on Pro-bono Cases by Dr. Michael Scoles

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A few years ago, I got this e-mail from a complete stranger. His words made me pause and reflect on what I was doing with my career. When I was an associate, I spent one day a month at a free clinic in Seattle. Fast-forward to two practice purchases, the neverending CE chase and a new baby - volunteering was the last thing to eat on my very full plate.

I'm not sure how he got my e-mail address; I'm assuming from my website where it mentions volunteer work. Here you have someone who appears to be truly down on his luck and saw in the media that someone died from a tooth infection. He was scared and couldn't find anyone to help him.

Dear Dr. Scoles,

I am writing to you very much in desperation. I called the Union Gospel Mission many ti mes to make a dental appointment. I t is the only place that mentions about dental surgery and teeth restoration and not only routine procedures. I left messages mentioning that I am suffering. H owever, nobody ever called me. Today I read about a man who died of dental infection and I am afraid.

After some research today, I am finding out that you are one of the doctors w ho volunteers at the Missi on. Could you please help me get an appointment? I can't help feeling a bit asha med of my situation and even to show my teeth. But I can't keep on l i ving like this.

I do look forward to hearing from you.
Sincerely,
Chip

It took one e-mail to get him an appointment; thirty seconds to make a profound difference in someone's life. As dentists, we have a unique ability that not many others possess: we can remedy acute pain for another person in minutes. We do it every day. People pay us to do it. It becomes routine. I will leave it up to the philosophers as to whether we have an obligation to do work for free.

I still have a very full plate, but I am down to four days a week and I am finding a bit more balance in life. I'm going to start volunteering at the clinic again. Sometimes, it is too easy to get caught up in your own life and stress over truly insignificant things, when just down the road, there is someone who has a legitimate fear of dying from a toothache. I am glad this person e-mailed me. It definitely made me do an inventory on my life priorities.

A few weeks later, I received this e-mail:

Hi Dr. Scoles,

Just wanted to let you know Dr. Paul took care of me last Friday. He is great! His hands are so light! He extracted two upper teeth. I still have many teeth left to be extracted but those were the worst and most painful ones.

I was a bit sad not to see you at the Mission. I am sure I'll meet you one day. I have your website bookmarked. When things get a little better for me, I want to volunteer my time at/donate to the Mission. I've learned quite a bit through my hardships.

I just want to thank you again from the bottom of my heart.
Kind regards,
Chip

Obviously, volunteer work benefits a lot of people, but it can also be a very gratifying personal experience. Unfortunately, it is not without its pit falls. I will give my perspective on volunteer dentistry and things you should look out for when deciding to give back.

There are several avenues to do volunteer dentistry overseas. It is a very virtuous thing to do. If you are at the place in your career where you can shut your office down for a week or two, this is definitely something to consider. For me, there is so much unmet need within 10 miles of my office that I have never seriously considered these trips.

There are all kinds of ways to find people who are in legitimate need of services who don't have the means to come see us. Most state dental associations have a donated dentistry program. There are numerous types of free clinic settings, religious groups and even mobile dental vans that rely on dentists and auxiliaries volunteering to complete their mission.

With the donated dentistry program, you are seeing the patient through all their treatment, and in some cases, you may elect to do their recall as well. It is cost effective in that specialists are on board, as well as the local dental labs. Once on the provider list, they will send you a candidate who has already been screened and you determine whether you would like to treat him or her. On paper, it's a good system and we have treated several very appreciative patients over the years. The down side is no-shows. In the vein of "no good deed going unpunished," nothing sours you more than to block out two hours of your schedule for a probono case and have the person not show up. This has happened on a consistent basis. Now, in our initial meeting with the patient, we stress that one cancellation will result in their dismissal. We have had patients demand certain procedures and they show little gratitude, and we have had patients bring us cookies and are an absolute joy to have in the office. Guess which ones we allowed to stay on for recall care?

My wife and I were leaving a restaurant in our town and a homeless woman came up to us asking for change so she could go to the University of Washington Dental School to get a tooth extracted. We gave her a few dollars and walked away. After about 20 steps I stopped, went back, gave her my card and told her she could come to my office and I would help her. She was there the next morning and we extracted two severely decayed molars. I think the staff got as much out of it as the woman did. Bottom line, it feels good to help people and it's great for office morale. Most patients will see you in an altruistic light when they find out you are helping others this way. Unfortunately, having a homeless person in your lobby during normal business hours might put off some of your other patients.

While volunteering in the clinic setting, there is usually no shortage of patients and you can really make great use of your time. I've heard it from the dentists who do mission trips; they are working 12- 14 hour days just trying to keep up. I don't think you need to kill yourself, but if you spend eight hours at a clinic, you are going to get a workout. At the clinic where I volunteer, most of the people we see are physically living in the building and are a phone call and a few minutes from coming down. We also have a high volume of walk-in patients who will sit in the waiting room all day to be seen. This is hard work with dated equipment and materials. If you establish a track record with particular clinics, they might be able to order specific things you can't live without. The clinic is the first place I call when we are upgrading or cleaning things out since most clinics are on a shoestring budget. Things that have fallen out of favor for us are wonderful additions for them.

I know that some people will have a free dental day and block out a whole day for treatment of local people who are in need. I think this is an outstanding idea and something I plan to do soon. Not only are you helping people, it's a great team builder and potential marketing gem. You have to advertise it to make it work, and you can get a lot of positive press at the same time. I think it's a good idea to solicit your product reps for donations to help defray some of the overhead.

Veterans are another population to reach out to - people who have served our country, might have been wounded and are now out of the military trying to find care. In some instances, VA locations are hundreds of miles away and if they can get there, they will only get basic treatment. You may have a perfect candidate in your office, or you could find someone through a local veterans support group.

I don't think there should be any shame in receiving marketing benefits from doing a good deed. If you do one day of it in your career and advertise how you are the Mother Teresa of the dental world, that's a different story. I spend a lot of time at the clinic in Seattle. I am proud of it, my staff is proud of it and we share it with our patients. I have a "giving back" page on my website, and I have received a lot of positive comments from patients about it.

As humans, I think we can all agree there is something really heartfelt, both for the receiver and the giver, when you help others directly. Writing a check cannot elicit this feeling, nor does it have the same value. As dentists, we have a unique skill set that can provide a profound impact on other people's lives. As responsibilities pile up, it is harder and harder to make time to do charitable dentistry. My suggestion is try to set some time aside. Give volunteering a shot and see how you feel about it. It is great for gaining perspective on what is truly important in life, and it is good for your soul.

The Pros and Cons of Pro-Bono Cases

The Dentaltown.com message boards are teaming with discussion about the ups and downs of offering free dentistry. Here's some of what Townies are saying.
Search: Pro Bono

pmgpenn
Posted: 9/11/2011
We do cases through donated dental each year. The patients are very appreciative and it's so easy. It costs really nothing more than your time as the lab does the work for free. If every dentist did just one case a year, it would make a huge difference. Check out www.nfdh.org for more information about Donated Dental Services.

Baltar
Posted: 10/29/2009
I recommend you only offer pro-bono work outside of your own office. You should only do free dentistry when it's on your schedule and not have clients walk into your office trying to talk you into doing work for free. Go on a dental outreach trip to a third-world country. There is a time and place to offer free care, but during business hours, you need to concentrate on your business. You do not want a packed schedule with people who can't afford any dentistry but heard you offer work for free.

velogeek
Posted: 9/11/2011
The no-shows killed treating needy patients in our office. Los Angeles is a big place and we now have the opportunity to volunteer our services, with medical services for the needy at large organized free clinics. Dentistry is the most requested service and now that we have it wired (we take two bags, one with our special setups, the other for bringing the used stuff back), we can easily see 30-40 patients per day (thank goodness for amalgam). All the patients are extremely thankful and the staff is so excited, they have even been known to drive back to the office to run instruments and return.

dr_mike
Posted: 10/20/2009
Be careful with clergy and shelters. I did work for a women's abuse shelter. Let's just say, more women needed work than I really wanted to spend time doing. Half a day a month turned into two full days, turned into late-night calls, turned into patients starting to ask for (almost demand) veneers and cosmetic work, turned into starting to affect my normal practice. I only got a thank you a handful of times for the more than 200 people I treated. I no longer offer it in my practice - best decision I could have made. Work in a county clinic. Go on a trip to a third-world nation. This will be more enjoyable, trust me. I am not saying every patient was ungrateful, just that not enough were happy.

Jordan "skibum" Pilling
Posted: 10/26/2011
I have done a few missions and love every second of them. I also do some charity case-by-case in my office. Just depends on my schedule.

wesleypipes
Posted: 12/19/2012
I had a local charity call and ask if I was willing to help out a guy who lost his job and was in pain; I said sure, send him over. He broke off an upper lateral and had severe perio. The tooth was hopeless. The guy comes in late, smells of booze, with several missing teeth. I tell him he needs an extraction and I will do it for no charge. He says he won't do it unless we replace the tooth, so now we need a full-mouth debridement in order to make the flipper. Long story short, he pretty much expected it to be free and didn't show up for his debridement and I got burned. Never again. How much is enough? We donate and support so many causes, employ people with decent jobs, work on people with transmittable diseases, give to every school fundraiser. Enough of this entitlement; learn how to say no.

factor78
Posted: 10/30/2011
We ran a free dental day out of our clinic at the start of the month. It was run on a Saturday when we normally aren't open. It was a great experience and the staff donated their time. The local paper ran an article on it and we were overwhelmed by the response. Sadly, we couldn't fit everybody. We plan to run one every three-tofour months, hopefully.

Author's Bio
Dr. Michael Scoles maintains two private practices in the Seattle area. After graduating from Oregon State University, he attended dental school at Temple and then spent three years in the U.S. Navy dental corps. He is a mentor at the Scottsdale Center for Dentistry teaching CAD/CAM technology. He is also an in-office trainer for CAD/CAM and CBCT guided implant surgery.
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