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FALL 2018
T H E D E N TA L S O C I E T Y O F G R E AT E R O R L A N D O
THE FLORIDA DENTAL SAFETY NET
Commentary
TRIBUTE TO A PATRIOT:GEORGE WILEY STARKS
Up Close
Editor’s Message
DIGNITY & RESPECT
THE CONS & PROS OF DSOs
Opinion
JournalFlorida’s New
LAWSOPIOID
& What You Need to Know
T A B L E O F C O N T E N T S
4MEMBERSHIP UPDATES• Welcome New Members• Calendar of Events• Back to School Bash
5PRESIDENT’S MESSAGEGreetings!
7EDITOR’S MESSAGEDignity and respect
10TECHNOLOGYHow to read a Cone Beam CT
11COMMUNITY OUTREACHTake Time to Give Back
13SINK YOUR TEETH INTO THIS2:00 a.m. Thoughts
14OPINIONThe Cons and Pros of DSOs
17FEATURE ARTICLEFlorida’s New Law on Controlled Substance Prescribing
22UP CLOSETribute to a Patriot:George Wiley Starks
24COMMENTARYThe Florida Dental Safety Net
What’s Inside
Editorial and advertising copy are carefully reviewed, but publication in this “Journal” does not necessarily imply that the Dental Society of Greater Orlando endorses any products or services that are advertised, unless the advertisement specifically says so. Similarly, views and conclusions expressed in editorials, commentaries and/or news columns or articles that are published in the ”Journal” are those of the authors and not necessarily those of the editors, staff, Board of Directors or members of the Dental Society of Greater Orlando.
PRESIDENTJason Battle407-381-3335
Jbattle [email protected]
PRESIDENT ELECTCharlie Bertot407-628-2286
SECRETARYSundeep Rawal
TREASURERKim Carlyle-Clark
IMMEDIATE PAST PRESIDENTJames Flatley407-302-7774
MEMBERSHIP CHAIRScott Cohen407-644-4404
PUBLIC RELATIONSCaroline Gordy-McHugh
EDITORMary Isaacs407-696-5210
DIRECTORSDavid Blue
Joey Bongiorno407-849-1020
Tom Holehouse407-654-1296
Bernie Kahn407-629-4220
Lucien Johnson407-282-0002
Clay Miller407-834-0330
Diane Tran407-282-3232
Tony Wong863-956-2700
IMPORTANT CHANGES TO MEMBERSHIP MEETINGS IN 2018
AN AFFILIATE OF THE CENTRAL FLORIDA DISTRICT, AMERICAN & FLORIDA DENTAL ASSOCIATIONS
D E N T A L S O C I E T Y O F
GREATER ORLANDO
SERVING ORANGE, OSCEOLA AND SEMINOLE COUNTIES
ASSOCIATE AND LIFE MEMBERS:
• You have different privileges than Ac-tive members - you do not pay yearly dues, which is a nice perk! Just as a reminder, the DSGO bylaws state that Life and Associate members must pay the minimal dinner fee for meals at quarterly membership meetings ($35). It’s the only way to keep food costs in line with the budget. Our next meeting: November 12, 2018.
• If you are not sure of your status, please call the DSGO office at (407) 894-9798.
ALL MEMBERS:
• 4 days prior to our Monday member-ship meetings (the Thursday before), we must give George a guaranteed headcount of how many people will be attending. If you RSVP to come, but then don’t attend the meeting, we still have to pay for your meal.
• Just like broken appointments, if you don’t show up, then there will be a charge of $35. Staying within our austere budget means eliminating unnecessary expenses- it’s just good business.
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M E M B E R S H I P U P D A T E S
WELCOME NEW MEMBERSACTIVEDr. Atila C. Miranda499 E. Central Pkwy, Ste 220Altamonte Springs, FL 32701(407) 831-4008
Dr. Brian Weinert1460 E Red Bug Rd #1000Oviedo, FL 32765(407) 971-1116
Dr. Sandra Wasif100 Burnsed Place, Ste 1000Oviedo, FL 32765(407) 366-9090
Dr. Ana Garcia14500 Gatorland Dr. Orlando, FL 32837(407) 857-0800
Dr. Sara Shah707 Pennsylvania Ave Ste 1200Altamonte Springs, FL 32701(407) 478-5002
CALENDAR OF EVENTS
BACK TO SCHOOL BASH
OCTOBER 18-22, 2018 ADA meeting-Honolulu
MONDAY, NOVEMBER 5, 2018 Board of Directors-Dental Society office 800 North Mills Avenue Orlando, 32803. 6:00 p.m. Nominations for the 2019-2020 Board ofDirectors.
FRIDAY, NOVEMBER 9, 2018 HIPAA, OSHA & CPR-Winter Park CommunityCenter 721 W New England Ave, Winter Park, FL 32789 10:00 a.m.-3:30 p.m.
MONDAY, NOVEMBER 12, 2018 Membership Meeting-Winter Park CommunityCenter 721 W New England Ave, Winter Park, FL 32789 Nominations for Board of Directors 2019-2020 from the floor. Speaker Dr. Don Tillery. Guest-Dr. Dan Crofton-Central Florida District Dental Association President.
THURSDAY, JANUARY 17, 2019 CFDDA Caucus and House of Delegates.
FRIDAY, JANUARY 25, 2019 Florida House of Delegates-Tampa
MONDAY, FEBRUARY 4, 2019 Board of Directors-Dental Society office 800 North Mills Ave. 6:00 p.m.
THURSDAY, FEBRUARY 21, 2019 Membership Meeting -Country Club of Orlando-1601 Country Club Drive Orlando 32804. Election of Board of Directors 2019-2020.
MONDAY, MARCH 4, 2019 Board of DirectorsDental Society office 800 NorthMills Ave 6:00 p.m.
TUESDAY, MARCH 12, 2019 Dentist Day on the Hill-Tallahassee
FRIDAY, SATURDAY, MARCH 22-232019 FLA MOM CFDDAEdgewater High School Winter Park
MONDAY, APRIL 8, 2019 Board of Directors- Dental Society office 800 North Mills Ave. 6:00 p.m.
THURSDAY, MAY 3, 2019 American Association Orthodontics
MONDAY, MAY 13, 2019 Board of Directors-Dental Society office 800 North Mills Ave 6:00 p.m.
MONDAY, May 20, 2019 Membership Meeting-Winter Park Community Center 721 W New England Ave, Winter Park, FL 32789 Installation of officers. Speaker Dr. Ross Enfinger.
Dr. Lyudmila OnyskiDr. Cohil Dr. Cook
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P R E S I D E N T ’ S M E S S A G E
As your new DSGO president, I am excited about the up-coming year for many rea-sons. Our primary goals are to 1. make good use of your time, 2. provide valuable
benefits for our members, and 3. help our members succeed.
Dentistry and the way we prac-tice is changing so rapidly. It is truly the platinum era of dentistry if we can manage what lies ahead! We are also lucky to reside in a Central Florida community that is growing at an unprecedented rate. Some may see that as a disruption to the life and work that we have known. However, there are wonderful new opportuni-ties that will present themselves and we must be prepared for them! One of the challenges that we are finding with growth is a disconnection of our membership. Our lives are busier, and it takes longer to drive every-where. The membership meetings have become our last connection to fellow local dentists.
I highly encourage you all to use social media, like Facebook, to stay connected with one another and with dentists around the world. There is a myriad of Facebook groups where you can learn for free from your colleagues about anything in den-tistry, including a “DSGO member group.” I also challenge you all to step outside of your comfort zone and get to know members that are both older and younger than yourself.
Our last membership meeting on August 28th was a joint meeting
of the Dental Society of Greater Or-lando and the Orange County Medi-cal Society at the M Lounge. It was a fantastic event and a great chance to meet with medical professions in the area! We will have another more social membership meeting (den-tists only) on Thursday, February 22nd, 2019, at the Country Club of Orlando. The other two membership meetings, in November and May, will be traditional meetings with CE. Our CE day this year was October 12 which was an opportunity to learn from one and other by sharing den-tal pearls. Although the response was not strong with this idea, look for it again as a good way to learn from your colleagues.
An organization is only as strong as the members who support it. Please feel free to reach out to me if
you have ideas to make the DSGO stronger and more beneficial to our members. Thank you for allowing me to serve you, I am looking forward to an amazing year ahead!
All the best,
Dr. Jason BattleDSGO PRESIDENT
2018-2019407-801-1862
Greetings!
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Dignity and
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E D I T O R ’ S M E S S A G E
As the summer ends and we begin the cooler autumn months, we can reflect on all the changes that are occur-ring around us. My father on September 28, 2018, if he was
still alive, would have been 100 years old. He was my role model and men-tor in business. Although not a den-tist, he had a keen instinct, knowl-edge, and the skill to run a successful business. My father always tracked his numbers to guide his success. He sold his company and retired at 56 years old. He saw many inno-vations in his life. Growing up in the Great Depression, he knew the value of money, time, and relation-ships. It was definitely a simpler time when people had to pull together to survive. He stated that they “had enough.” There were even stories of my grandfather spending time in jail for having a still in the basement. Now we have legalized marijuana.
I attended our mandatory Opi-od Prescribing Course sponsored by the DSGO. I learned many things that I was not aware of. About ten
years ago, we had a young man in our dental practice that had had an accident and was prescribed pre-scription medication. I witnessed this young man with a bright future change, becoming belligerent and disrespectful. It was years later his father stated they had never properly thanked me for saving their son’s life by paying attention and being pres-ent. His parents were in denial and didn’t see this. He now works with teenagers with drug problems. God works in mysterious ways.
Technology changes daily. We can diagnose with more accuracy and efficiency because of Cone Beam, MRI’s, and DNA testing with genetic markers. Our success and clinical outcomes are improv-ing because of this technology. The speed of information is also increas-ing. There is often a price to pay for technology. We all have witnessed teenagers sitting around a table with their noses in their phones “relating” to their peers. Relationships are vital to the health of a dental practice, and mentoring young dentists is vital to
the future of our profession. I will be going on a pilgrimage to
Israel for fifteen days to study the life of our greatest teacher, Jesus. Mis-sion is important in our world. Our local community has been very gen-erous by providing care to the lesser served or indigent population. There are resources in our community that we should be aware of to supplement and provide that care because every-one deserves dignity and respect.
Dignity and
EDITORMary R. Isaacs, D.M.D., F.A.G.D.
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PNC Merchant Services® and Dental Society of Greater Orlando
The Clover® suite of point-of-sale solutions,
including payments via smartphone or tablet
Cash flow management solutions
Next-day funding of card payments*
No Early Termination Fees for merchants
24/7/365 support
LEARN MORE
VISIT PNC.COM/MERCHANT, OR CALL
Dylan Floyd at 850-381-9744 or
*Next-day funding on Visa®, MasterCard®, Discover® and American Express® card transactions processed by PNC Merchant Services when deposited
into a PNC Bank business checking account. Certain restrictions may apply.
Merchant Services is provided by PNC Merchant Services Company and subject to credit approval. PNC Merchant Services is a registered trademark
of The PNC Financial Services Group, Inc.
The Clover name is owned by Clover Network, Inc., a wholly owned subsidiary of First Data corporation, and is registered or used in the U.S. and many foreign countries.
©2018 The PNC Financial Services Group, Inc. All rights reserved. PNC Bank, National Association. Member FDIC
BB PDF 1117-059-638905
Discover new member benefits
PNC Merchant Services® is excited to team with Dental Society of
Greater Orlando to bring members customized services offerings with
competitive pricing and quality services. We understand that it’s Dental
Society of Greater Orlando’s mission to provide valuable benefits to their
members to help them grow and to succeed; that’s our mission too.
As a part of this program, memberscan benefit from:
A DAY OF COMPLIANCE
HIPAA, OSHA, INFECTION CONTROL AND CPR
Friday, November 9, 2018
Winter Park Community Center
721 W. New England Ave
Winter Park, Fl 32789 10:00 a.m. -4:00 p.m.
Dentist Name_____________________________________________________
Office Address____________________________City________St____Zip_____
Telephone_____________________Fax___________________ 15% discount if entire office attends.
___________HIPAA, OSHA, INFECTION CONTROL-4 CE’s Doctors $125
___________ CPR -2 CE’s Doctors $30
Doctors Name____________________________
_HIPAA, OSHA, INFECTION CONTROL-4 CE’s $75 per team member
Dentists cannot register as a dental team member ___________ CPR -2 CE’s Team Member $30 each
Team Member Name_____________________________Designation_________________
Team Member Name_____________________________Designation_________________
RETURN FORM via fax 407-895-9712 EMAIL [email protected] to register or pay by phone 407-894-9798
Name on Credit Card______________________________________________
CC number________________________________CVV________Zip________
Email___________________________________________________________
T E C H N O L O G Y
Dates: November 16th & 17th,
2018
“How to Read a Cone Beam CT”
Dr. Dania Tamimi is pleased to offer a highly interactive 2-day course that is best described as a 3D bony dissection class. She will review the systems and anatomy viewed on a CBCT scan one structure at a time using radiographic images and graphic representations in a sys-tematic manner. Participants will be taught to use a DICOM viewing software to optimally ind the anatomy and view it for common path-ologic indings in a hands-on approach. The clinical relevance of each anatomic structure evaluated will be reviewed along with how varia-tions of these structures can affect the clinician’s diagnosis and treatment plan. Different cases that represent some of the most com-mon indications for CBCT imaging in dentistry, such as implants, im-pactions, TMD, sleep-disordered breathing and endodontics will be reviewed. This class is limited to 15 participants to ensure effective learning.
Suggested reading: DiagnosticImaging:OralandMaxillofacial by Koenig, Tamimi, et al.
Tuion: $1,895
A course designed for any dentist who is using CBCT or is thinking of using CBCT in their practice
Location: Hilton Garden Inn Lake
Buena Vista 11400 Marbella
Palm CT, Orlando FL 32836
Number of CE credits: 15 CECs
This connuing educaon acvity has been planned and implemented in accordance with the standards of the ADA CERP through joint sponsorship
between Big Sky Seminars and BeamReaders.
To register,
please visit beamreaders.com/educaon
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C O M M U N I T Y O U T R E A C H
Take time …give back! Join us in helping our community by donating your
personal dental touch!
At local elementary schools In donated clinic space In your own office
We need dentists, assistants and hygienists to volunteer locally in their private practices or in donated clinics and at events throughout the Central Florida area. Participating is easy and our community needs you! Please visit us online at www.DentalCareAccess.org , by phone 407-898-1525 or via email [email protected]
OR Complete and fax back to 407-898-1547:
Name: ___________________________________________________________
Phone: ____________________________ Cell : __________________________
Circle: Dentist / Assistant / Hygienist / General
Email: ____________________________________________________________
Volunteering Made Easy
The Dental Care Access Foundation had a wonderful year of events and serving the low-income, uninsured in Central Florida. With the help of our partners and volunteers we had our 9th Annual Central Florida Dental Outreach. Together we served 284 adults in the Greenberg Dental office located in Winter Park. Fillings, extractions, exams and x-rays were provided to adults in need of restorative and emergency dental care. Total donation in services was $375,500. The event had over 30 general volunteers, 2 computer techs, 40 dentists and specialists, 6 hygienists, 15 front desk and 50 dental assistants. We thank Andy Greenberg and Greenberg Dental and Orthodontics for their contribution of their 30 operatory dental facility, supplies and instruments. In 2013, the Foundation provided 4 quarterly children’s dental hygiene education, sealant and fluoride events in partnership with Valencia Dental Hygiene Program and provided preventative services to over 150 children accessing the free lunch programs. The Foundation was awarded a grant from Heart of Florida United Way to provided hygiene education and fluoride to the much needed area of Pine Hills, Holden Heights and Parramore. These education events will take place in the elementary and middle schools. We need hygienists and dentists who are able to join us. The next event is Wednesday, January 15, 2014 at Pinloch Elementary School from 8:30 to 1:30pm. We plan to treat and educate over 200 students and need as many volunteers as possible.
In November 2013, the Foundation partnered with Dr. St. Matthew Daniel for All About Beautiful Smiles in Orlando to treat 40 adults in her practice providing donated fillings, extractions and hygiene services through Dentistry from the Heart. In total we provided over $25,000 in care. This year, we are gearing up for our annual Give Kids A Smile and Kid’s Smiles events for February’s National Dental Health Month. These events are provided in partnership with private practices such as Drs. Lane, Curley and Zak to treat foster children and other kids without access to preventative and restorative dental care. If you are interested in participating or starting your own event, contact the Foundation at 407-898-1525. We coordinated the treatment of over 1600 individuals in 2013 with a tremendous impact to the Central Florida Community. We appreciate the volunteers who make these events successful. We could not do it without caring individuals willing to give back to their community. We hope you will consider giving some of your time. Clinics and events are held on evenings and
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STARTING A PRACTICE IS A BIG LEAP.TRANSITIONING SHOULDN’T BE.
DENTAL PRACTICE SALES | PARTNERSHIPS | APPRAISALS | BUY-INS & BUY-OUTS | MULTI-DOCTOR TRANSITIONS | ASSOCIATESHIPS
You’ve done it all—built a patient base, trained your staff, invested in your practice. So, when it’s time to think about your next chapter, let us help you get the most out of your career’s investment.
Talk with the experts, we’re ready when you are. Call or email Paul directly.
PAUL RANG, [email protected]
(407) 412-7619
A D S F L O R I D A . C O M
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S I N K Y O U R T E E T H I N T O T H I S
2:00 AM ThoughtsA recent article in the Wall Street
Journal highlighted the plight of Mike Meru, a Utah ortho-dontist who accumulated $1,000,000 in student loan debts. At this time, his debt, ac-
cumulated from seven years of study, stands at $1,060,945 dollars. He makes $6589.97 a month in payments, which does not even cover interest. He falls $130 further in debt each day. At this rate, in twenty years the debt will double. He currently earns $255,000 per year, owns a $400,000 home, and drives a Tesla. After twenty-five years, the debt will be forgiven.
There are some cautionary tales in this story. First and most obvious is the cost of a dental-specialty educa-tion and the subsequent inability to pay it back. This will ultimately have a detrimental effect on attracting quality recruits into the profession.
Second, and I guess not surpris-ingly, the general public is completely unsympathetic to the situation. After all, doctors are wealthy. A million dol-lars in debt is nothing.
When visiting with University of Florida dental students last year, many of them expressed student loan debts of over $300,000. Unlike the good old days, interest begins accruing the day they sign on the dotted line. Let me tell you, $300,000 is a monster when you have no practice, no job, and no clue what you are going to do, as is the case with many of them. This debt serves to increase the chances of new dentists attempting procedures they are not qualified to perform. All of this because of economic pressure.
Speaking of DSO’s, it seems that an unintentionally developing chokepoint will hamper their prolif-eration. That chokepoint being the inability to attract enough qualified and capable staff to manage and run dental offices. My own experience lately involved a two-year search to fill two positions. I now have the best team I have ever been blessed with, the core of which have been with me forever. The search has been brutal. Perhaps it is a result of the economy, but there are just not an abundance
of skilled professionals available.There is some positive economic
news.Disney has now agreed to pay
union employees $15 per hour. Even better news is that middle class in-come has reached an all-time high of $61,372 in the last year, according to the U.S. Census Bureau.
The mid-term elections are afoot. I mention this only because, well, it’s important. You saw the economic numbers, right? Talk to your staff. Give them time off to vote.
I have got to get some sleep.
Jeff Sevor
COLUMNISTJeff Sevor
DMD MS
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O P I N I O N
In recent years, the concept of dental support organizations (DSOs) has continued to evolve and enlarge in the United States despite controver-sy. It is estimated that there are at least 1,000 DSOs, emerging DSOs
and large-group practices in the USA with many others planning to start. The largest three DSOs are Aspen, Heartland and Pacific.
There is no firm definition for DSOs, and each varies significantly in how they deal with the practices with-in their individual organizations.
The Association of Dental Sup-port Organizations states that:
“Dental Service Organizations (DSOs) contract with dental prac-tices to provide critical business management and support including non-clinical operations. The creation of DSOs has allowed dentists to max-imize their practice with the support
of professional office management. The DSO model enables dentists to focus on the patient while delivering excellent dental care.”
Whatever the definition, and whether or not you agree with it, the facts are that DSOs are definitely here and growing rapidly. They ap-pear to be filling a need for practicing dentists, or their enormous growth would not be present.
This article includes an overall view of the apparent advantages and limitations of DSOs, and the reasons why some practitioners find DSO growth to be objectionable while oth-ers promote them.
The major advantage of dental support organizations
It is well known that the vast ma-jority of dentists love dentistry and dental practice. However, most den-
tists do not enjoy the business side of dentistry. One of the major goals of DSOs is to reduce or eliminate the business and administrative aspects of practice. That appears to be the sin-gular, most-important advantage of DSOs for many dentists.
Some readers will disagree with the specific DSO advantages I list be-low. I concede that not all DSOs pro-vide every advantage, but the leading organizations are providing most of them.
Specific advantages of DSOs• Enhancement of work-life bal-
ance. Running a dental practice is a major responsibility! The numerous aspects of administering a practice, dealing with the needs and wants of patients, purchasing equipment and supplies, hiring and firing, dealing with staff challenges, working with
By Gordon J. Christensen, DDS, MSD
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O P I N I O N
third-party payers, and myriad other responsibilities take time, energy, constant thought, effort and money. These responsibilities often take pre-cious time away from family, home, religious affiliations, civic respon-sibilities and yourself. DSOs may enhance the work-life balance of a practitioner in the following ways:
• Reduction in administrative re-sponsibilities. Very few dentists enjoy administrative responsibility such as employee challenges, hiring, firing, payroll, and identification of products and purchasing them. Such responsibilities are greatly reduced in DSOs.
• Ensuring compliance with regula-tions. Dentists generally do not like OSHA, HIPAA and other regulatory groups that make time and effort de-mands on practitioners. DSOs can take over much of this responsibility.
• Providing less involvement with insurance companies. Do you like dealing with dental benefit plans? They tell you what to do, when and how to do, and how much to charge. They own you! How about having a DSO be your voice in negotiations with these companies? A large DSO that has scale and may be able to ne-gotiate better fees.
• Having significant help with man-agement. A DSO can help you with most of the management tasks that burden you down mentally and sap time from your life.
• Providing legal support. Do you know or even want to know the legal implications of treating patients? For many dentists, this is also a disgust-ing and time-involving part of prac-tice that can be reduced by being in a DSO. Also, help will be available for you if and when you have a legal challenge.
• Negotiating with dental suppli-ers. DSOs can reduce the cost of practicing by negotiating with dis-
tributors and obtaining price reduc-tions.
• Reducing many other frustrating business situations. The responsibil-ities previously mentioned are great-ly reduced for practitioners when they have DSOs handling much of the actual work to accomplish what-ever needs to be done. However, there are myriad other day-to-day time-consuming tasks that can be reduced by being in a DSO.
• Creates a professional communi-ty. Not all dentists need or desire a so-called “community” with which to associate. Many are involved with their dental societies or study clubs to satisfy this need. However, DSOs can provide a community for you.
• Provides mentors. Within the DSO community, there is the opportunity to find mentors in almost any area of dentistry.
• Allows greater focus on patient care. By removing the administra-tive tasks already noted in this arti-cle, practitioners are able to concen-trate their time and efforts on actual patient care.
• Provide access to state-of-the-art technology. You know the high cost of the many types of technology available for dentists. Some of the DSOs provide up-to-date, high-cost technology that most private practi-tioners would hesitate to purchase.
• Assists you with keeping up with change and innovations in the pro-fession. With significant help re-ducing administrative tasks comes also an emphasis of DSO owners on keeping their practices up-to-date on materials, devices, techniques, con-cepts and political activities.
• Provides a jump-start to a new practice. New dentists often have a difficult time jumping into the re-sponsibilities associated with start-ing a practice. DSOs can offer signifi-cant help to bridge the gap between
dental school and the “real world” of practice.
• Facilitates easier exit from prac-tice. Not only can DSOs help to start a practice, they can also facilitate exit from practice. A dentist can “retire” without retiring by slowing down and working fewer days. Some den-tists can also sell their practice to a DSO when the time comes to retire.
• Provides significant help to new dentists. Young dentists have enor-mous education debt. Working in a DSO at a time when running a prac-tice is a formidable task for a new dentist helps pay off school debt, builds practice speed, increases pro-cedure diversity and builds self-con-fidence.
• Encourages and provides continu-ing education. Some DSOs provide continuing education for their den-tists. This is an essential need that some private practicing dentists postpone.
• Offers greater ability to serve income-challenged patients. The DSO concept has helped to improve access to care for low-income pa-tients.
Limitations and dentist frustrations with DSOs• You may not be your own boss. One
of the significant reasons some den-tists elect dentistry as their career is to be their own boss. If being an employee instead of a small business owner is a negative for you, some DSOs may not be the logical or best type of practice for you.
• Lack of independence. As with any organization, each DSO has their own rules and regulations. You may want to make your own rules and not have someone telling you what to do. If so, a DSO practice may not be for you.
• Bad reputation. Not all DSOs have a great reputation. Some have earned
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O P I N I O N
a bad reputation because of alleged strong money orientation, accusa-tions of quotas for treatment, and questionable business policies. Many dentists still have a negative opinion of the entire concept. It is a common complaint I hear as I am speaking throughout the country.
• Getting out of a bad contract. Try-ing to leave some DSO contracts can be like a bad divorce. I have heard complaints from some practitioners who have had difficulty getting out of contracts that they felt were unfair. DSOs similarly feel that the docs are being unfair. There may be need for some negotiation.
• You may feel ostracized by some fellow private practitioners be-cause they feel your corporate practice puts strain on their pri-vate practices in the geographic area. Some private practitioners are upset with DSOs because they often come into communities and develop what the private practitioners feel is unfair competition. The DSOs may have lower costs on equipment and supplies and some or all of the ad-vantages listed above that the private practitioner does not have.
Why are many participants in DSOs young dentists?
Millennials, generally classified as being born from 1980 to 2000, are rapidly becoming the major factor in the workforce. Estimates are that there are about 83 million millen-nials in the USA out of roughly 240 million adults over 18 years of age (U.S. Census Bureau). The Pew Re-search Center stated that millenni-
als have surpassed baby boomers to become the largest current genera-tion in the United States. Millennials are considered to have the following characteristics that directly relate to why DSOs are so attractive to the in-coming generation of dentists. Mil-lennials want a better work-life ex-perience in their vocation, they are technologically savvy, they feel that they are global citizens, they are au-thentic and transparent, they are lib-eral and progressive, team oriented, and civic oriented. It is my opinion that the same DSO characteristics that irritate and frustrate most older dentists are attractive to the younger millennials entering the profession.
ConclusionsDental support organizations
(DSOs) are here. They and group practices are now a significant part of dental practice. The growth of DSOs is inevitable, as has already happened in other health professions. So, are DSOs good or bad? To put it simply, it de-pends on your perspective.
I suggest that private dental prac-titioners accept the fact that DSOs are here and learn to work with them for the overall betterment of service to patients. I predict that the typical solo practice will exist for many years but that it will quickly become a much less prominent part of dental practice in the future.
FMA Opioid Article reprinted with permission from the Florida Medical Association and the Florida Dental Association
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FMA Opioid Article reprinted with permission from the Florida Medical Association and the Florida Dental Association
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George Wiley Starks, kneeling left, and his “Coffin
Corner Boys” crew during World War II.
(Regnery Publishing)
TRIBUTE TO A PATRIOT:George Wiley StarksBy Carole Engle Avriett
On Sunday, July 29, around noon, another American hero from the Greatest Generation “slipped the surly bonds of Earth” one final time. World War II B-17 pilot George Wi-
ley Starks, who pinned on his airman’s wings when he was just 19 years old, passed away at age 94 at his home in Orlando surrounded by many from his abundant family and friends. The quietness of the hour belied the amaz-ing and “full-throttled” life he led.
I heard about George Starks four years ago after my husband returned from a fishing trip. Between casts, fish-ing buddy Lou Pesce had related how he heard their mutual friend, George, share his WWII experiences at a local dental meeting. All three men knew
each other since they had practiced dentistry in and around the Orlan-do area for many years. Aware I was searching for my next military writing project, my husband suggested I check out this story.
I called George, and we arranged to meet for breakfast the next morn-ing. Within five minutes, I was spell-bound. The events were some of the most amazing stories I had ever heard. So began the research for this project — and a cherished friendship with one of the most incredible people I’ve ever met.
Raised in Live Oak, George was known throughout the small north-ern Florida town as one of the most personable and charming teens in the county. Drum major, president of the
drama club … he was a natural-born leader in so many ways. Days after the bombing of Pearl Harbor, George hitchhiked a ride to Orlando to join the fight. Within a few months, the young man found himself in Pyote, Texas, training with the Army Air Corps to fly a B-17.
By late 1943, he and his assigned crew of nine men — average age 22 — were flying training missions out of Podington, England. During their first bombing mission, George’s plane was shot down by a German FW-190. So began a terrifying segment in the lives of each of the crew. George and all the others parachuted into Nazi-occupied France and spent the next several har-rowing weeks dodging Germans, aid-ed by French villagers.
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Finally, George met a mem-ber of the French Resistance, who helped him during the final weeks of his 300-mile trek into Switzerland. This journey was filled with terri-fying moments, including passage through five German roadblocks while George was hidden on the rear floorboard of a car.
His innate sense of honor and commitment motivated him to pledge two things after his narrow escape: First, he would do whatever he could to keep in touch with his crew members as long as he lived; second, if at all possible, he would one day return to Europe to locate as many brave souls as he could to thank them for risking their lives to save his. George lived long enough to accomplish both goals.
But George’s life did not slow down when he returned stateside after VE-Day. He went to dental school, yet stayed in the Reserves. Four years later, he was called to active duty once more and headed to Korea, where he served as chief of Dental Services for the 121st evacuation hospital. For the next 21 months, he operated on facial wounds in areas of highest casualties during the Korean War.
Back home, his wife gave birth to their first child, whom George did not see until nearly two years later.
Upon returning to Orlando from duty in his second war, George established a private dental practice that lasted 28 years. After retiring, he taught at the University of Flor-ida College of Dentistry for another 16 years, and then served on the State Board of Dental Examiners for eight years.
Along the way he made good on the commitment to himself af-ter returning home from WWII. He kept in touch with his crew through the years, even hosting reunions at
his home where the “Coffin Corner Boys” — his crew’s nickname — pored over old European maps and shared stories.
Perhaps most memorable of all, he returned to France five times to locate nearly every brave soul who had helped him and his crew during those tumultuous times of evade and escape. With the help of Orlando’s then-mayor Carl Langford, these French heroes were given keys to the city and made honorary citizens of Orlando.
George had traveled the world, in times of war and times of peace. His life was filled with remarkable events of historic proportions.
Several years ago, I made a com-mitment of my own — to spend my days recording as many of these veterans’ stories as possible. But it didn’t occur to me then that there would be such a bittersweet part of the process.
It is hard to put into words how much I will miss George — his hu-mor, his courage, his charm, but per-
haps most of all, his clarity of vision about the world around him. He was a gentleman and a patriot, a true American treasure.
Carole Engle Avriett of Winter Garden is author of the recently released book “Coffin Corner Boys: One Bomber, Ten Men, and Their Harrowing Escape from Nazi-Occupied France,” in which she records those spell-binding stories her friend shared around his dining-room table. The book is available at Amazon and Barnes and Nobel.
Article appeared reprinted with permission from Carole Avriettt.
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C O M M E N T A R Y
THE FLORIDA DENTAL SAFETY NET Our Commitment to AccessBy Matthew B. Hall, DDS
The U.S. does not have universal health care coverage, but instead a patchwork of different insur-ance plans, and many people are without insurance because they either do not qualify, or do not
have the ability to afford coverage or to pay out-of-pocket for care. Medicaid and Medicare payments do not always cover the cost of delivering care. Med-icaid will cover dental care for children and Medicare only for oral surgery where trauma or pathology involves structures beyond the teeth and gums. The present reality is that a segment of the population will be poor and unin-sured or underinsured for many rea-sons. Some people move in and out of poverty for many factors including loss of a job due to chronic illness or other socioeconomic factors. For many, life is like a high wire or trapeze act, if they fall they will die or be seriously injured un-less there is a safety net to catch them. The Institute of Medicine defined the safety net as consisting of health care providers who adopt a mission of hav-ing an open door policy, offering pa-tients access to services regardless of their ability to pay, and providers who have a substantial portion of their pa-tient mix consist of uninsured, Medic-aid and other vulnerable patients.
With a population now over 21 million, Florida has 15.3% without in-
surance and 16.5% at the poverty level. Those on Medicaid, Medicare and VA benefits are included among those in-sured. Many on Medicare are the poor elderly with very low Social Security payments. Florida elected not to ex-pand Medicaid under the Afford-able Care Act (ACA), leaving about 600,000 people uninsured. These people are too poor to qualify for sub-sidized plans because under the ACA they are supposed to be covered by the expanded Medicaid. For the age group 18-34, the uninsured rate in the tri-county area of the DSGO is: Osceola 26%, Orange 23% and Seminole 18%. A great many of the uninsured are the working-poor with part-time employ-ment, and those with no access to em-ployer offered insurance.
Who Qualifies as Poor?The federal government has pov-
erty guidelines that change periodically depending on calculations of the cost of living and consumer price index. This is called the federal poverty level (FPL). For example, in 2018 the FPL for an in-dividual is $12,140 earnings in a year before taxes and for a family of four it is $25,000.
Safety net providers set a poverty level threshold that typically ranges from the actual FPL or some percent-age above the FLP, for example 133% or
150% of the FPL. Persons who qualify for Medicaid are by definition poor, but able-bodied, non-elderly adults without dependents, are not eligible regardless of how low the income.
What is the Florida Dental Safety net?
The Florida Dental Association (FDA) is committed to helping access for all Floridians. In its 2016-2017 re-port on donated dental care statewide, a total of $5,514,625 worth of treatment was performed for free to the poor un-insured. This likely is a low figure be-cause a lot of free and low fee care is delivered by member dentists and does not get reported.
The FDA is actively engaged in helping to coordinate, support and en-courage Florida dentists to help with the dental needs of low-income and unin-sured fellow Floridians. These efforts in 2016-2017 include:
1. The FDA Foundation providing $493,472 to charitable programs.
2. Donated Dental Services (DDS) arranging care via 210 volunteer dental labs and 421 volunteer dentists in the network.
3. Project: Dentists Care (PDC), the safety net of local dental access pro-grams around the state, that includes 289 teams with at least 728 volunteer dentists.
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4. Florida Mission of Mercy that last year did 12,058 procedures in two days with total volunteers of 1,556 in Pensacola. In 2018 this event was in Fort Myers and in 2019 it will be in Orlando.
What is the Dental Safety Net in the DSGO area of Central Florida?
We are very fortunate to have many dedicated administrators, professionals, donors and government support for our safety net in Orange, Osceola, and Sem-inole counties. Dentistry is a part of the overall medical safety net. There is a Pri-mary Care Access Network (PCAN) in our area of Central Florida that is com-posed of all health care providers who make up the safety net, and providing for dental needs is part of this network. There is a PCAN Board of Directors that coordinates the safety net, and The Dental Care Access Foundation Ex-ecutive Director is on this Board. This Board includes the directors of the state and county supported health care facili-ties with dental clinics, and the private nonprofit community health facilities with dental clinics.
Below is a list of access to care resources in our DSGO community:
1. The Dental Care Access Founda-tion, Inc. (DCAF) is a 501(c)(3) non-profit that screens and refers patients, who qualify as low-income and unin-sured with urgent dental needs, to den-tal events coordinated by DCAF, to De-partment of Health clinics, or to private offices, where the patients are treated by dentists who volunteer to provide free care. DCAF also coordinates volunteer dentists to provide oral hygiene instruc-tion and hygiene kits to students in local elementary schools.
The Executive Director is Julie Mi-chael Grimm and email is: www.den-talcareaccess.org.
2. Florida Hospital Dental Care Access Program’s Mobile Dental Unit, for East Orlando/Bithlo children and
adults, was started in 2013. The mobile unit is staffed by volunteer dentists, hy-gienists, and assistants and provides free restorative and extractions procedures.
Michelle Lawton is the Dental Coordinator, email: [email protected]; and Dr. Pearl Burns is the volunteer Dental Director.
3. Orange Blossom Family Health (www.orangeblossomfamilyhealth.org) offers medical, dental and behavioral health programs. It offers services to low-income housed and homeless resi-dents of Orange, Osceola and Seminole Counties. The dental services include pediatric care, emergency care, restor-ative and low cost removable full and partial dentures.
4. The Orange County Dental Re-search Clinic is located in downtown Orlando. It is staffed by volunteer den-tists who teach dental assistant students, while providing free dental care to low-income uninsured patients. (*Recently closed due to contractual reasons)
5. True Health (www.mytrue-health.org) is a Federally Qualified Health Center under 42 U.S.C. 254b, re-ceiving federal funds, and has multiple sites. It has two sites for pediatric dental care and limited adult access for emer-gencies.
6. Community Health Centers, Inc. (CHC, www.chcfl.org) has multiple
locations, and is also a Federally Quali-fied Health Center. It has seven sites for pediatric dental care and limited adult access for emergencies.
7. The Orange County Hoffner Dental Clinic, is a pediatric dental clinic that treats children on Medicaid, as well as adults with emergencies.
8. The Seminole County Sanford Dental Clinic has a dental clinic that accepts Medicaid children, and adults with emergencies.
9. The emergency rooms (depart-ments) of all the area hospitals act as centers for emergency dental/alveolar trauma and infections. Both on-call dentists/oral surgeons and the emer-gency room physicians see patients regardless of ability to pay. By law (the Emergency Medical Treatment and Labor (birth) Act (EMTALA) of 1986, hospital emergency rooms must screen and stabilize all patients pre-senting with urgent problems regard-less of ability to pay.
10. Teaching Clinics of Hygiene programs at Valencia College and Daytona State College treat individu-als for $20.
11. Osceola Christian Ministry Center on Union Street in Kissimmee, operates a 1 chair clinic using volun-teers based on volunteer availability. (www.fbckissimmee.com)
ConclusionWe all have the privilege to be
dental professionals. Some of us have chosen to work in safety net dental clinics and receive a salary. For those of us who are making (or in my case, made) a good living in private prac-tice, we can afford to contribute to the safety net by volunteering through DCAF by seeing some patients in the office, and helping at dental events. It will benefit one or more persons in need every year and collectively we will be contributing greatly to dental access for all in Florida.
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Robert “Bob” Lawrence Edgerton, D.D.S., 86, passed away peace-fully and surrounded by his family on October 16, 2018. Born in Kenosha, Wisconsin, to Glenn K. and Marion (Smith) Edgerton on August 8, 1932, he attended the University of Wisconsin, completing his pre-dental curriculum studies in 1953. He received his D.D.S. degree from Northwest-ern Dental School in 1957, and remained at Northwestern for an orthodontic specialty residency, earning a Master’s Degree from the Graduate Dental School in 1959.That same year, Dr. Edgerton opened his orthodontics office in Orlando, and has served the Central Florida community with many years of work for numerous organizations, including President of the Orange County Dental Society. He developed and implemented the first smile contest for area school children during Dental Health Week, and provided twenty years of orthodontic services to the initial Cleft Palate Team in Central Florida. Early in his career Dr. Edgerton and several other area orthodontists formed the Gator Orthodontic Forum – a study club for participants throughout Florida to advance their technical and diagnostic skills by information sharing. He is a member of the prestigious, invitation only Edward H. Angle Society of Orthodontics and has presented numerous papers, lectures, clinics and case reports to this group of educators and practitioners. He became a Charter Director of the Foundation for Orthodontic Research and presided over the Florida Association of Orthodontists in 1975-1976. He was a consultant to the editor of the American Journal of Orthodontist and Dentofacial Ortho-pedics, and in 1994, served as Local Chairman for the annual session of the American Association of Orthodontists held at the Orange County Conven-tion Center. Additionally, Dr. Edgerton served on numerous boards, including
five years on the YMCA Board of Directors, and was an original member of the Committee that brought Young Life to Central Florida. He was a member of the First Presbyterian Church of Orlando where he was active in the Gath-ering of Men ministry. Most recently, Dr. Edgerton was the honored recipient
of the 2018 Florida Association of Orthodontics Distinguished Service Award, which was presented to him by Dr. Jim Wortham of Orlando. This award reflects his dedication to his many patients in Central Florida, and his life-long enthusiasm for the field of orthodontics. An avid outdoorsman, he enjoyed spending time at his working cattle ranch in Osceola County, and especially en-joyed fishing and hunting in Florida and throughout the country. Dr. Edgerton is a member of the Grand Slam Club, considered to be the most prestigious big game hunting club in the country. Dr. Edgerton is survived by two daughters, Lori Lynne Babb (Stephen C.) and Sherri Chace Focarino, (Stephen B.), granddaughters Courtney Chace Babb, Lauren
Elizabeth Babb and Sydney Chace Focarino, and grandson Tyler Robert Focarino. He is predeceased by his son, Ronald Glenn Edger-ton. He will be greatly missed by his former patients, staff, colleagues, friends and family. A memorial service will be held at 10:30 a.m. Friday, October 26, 2018, at Peace United Methodist Church, 13502 Town Loop Boulevard, Orlando, 32837. A private burial will be held at a later date. In lieu of flow-ers, please consider a donation in his honor to Young Life Heart of Orlando - FL15, PO Box 2289, Winter Park, FL 32790, (877) 438-9572, or the Na-tional Wildlife Federation at www.nfw.org (800) 822-9919.
Published in the Orlando Sentinel from Oct. 20 to Oct. 21, 2018
In Memoriam of Dr. Robert “Bob” Edgerton
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