Hello. This is Cameron Cortejano with the Becker's
Dental and DSO review podcast.
I'm told to be joined today by doctor
Catherine Watkins.
Doctor Watkins, thank you so much for being
here today.
Oh, thank you for having me. To start
us off, can you just introduce yourself and
tell us a little bit about your background?
Sure. My name is doctor Catherine Watkins. I
was born, raised, and primarily educated in the
state of North Carolina.
I got my chemistry degree in 1980,
my doctorate in dental surgery in 1984,
and then I did
a one year GPR
hospital dental residency in Rochester, New York. And
I stayed for an extra year doing,
advanced general dental training and special care fellowship
at Eastman Dental Center.
And then through that, was recruited to come
back to North Carolina, although they didn't know
I was from North Carolina,
to work at, what was then Charlotte Memorial
Hospital Authority,
to work and to set up a geriatric
hospital outreach program,
and ultimately rotated UNC dental students through that
program for several years.
I then left that position
to,
go and
start to be the first cohort in a
master's degree program in geriatric dentistry at UNC,
and I stayed and completed my PhD in
oral epidemiology
and dental public health also at UNC
Chapel Hill.
And then by then, I was
married and needing a job and was recruited
to go to the University of Iowa for
eight and a half years,
and I worked there as an assistant professor
in, in preventive and community dentistry and did,
geriatric
teaching, and they have a really fabulous
geriatric,
mobile unit and education program for their students.
And I did that for eight and a
half years.
Then I returned to North Carolina,
working first at North Carolina Baptist Hospital, Hospital,
also doing a geriatric outreach program.
And then,
I had my my children were young and
my husband became ill, and,
I had to I left that position to
go into private practice.
And I worked in a large group dental
practice in Winston Salem and have been at
that practice since 02/2006.
This practice was recently purchased by a dentist
directed,
DSO,
Riccobini Family Dentistry, and I still work there
full time as a wet finger dentist.
I have been an active member of the
American Dental Association since I joined as a
student in 1982.
I was active in all three of the
state dental societies in North New York and
in Iowa and in North Carolina when I
lived there in each of those.
I think because of my background being varied
both in
academics
and in
in private practice. I was encouraged to run
for the North Carolina State Dental Board of
Examiners,
and I really didn't know that much about
the dental board, but a colleague encouraged me
to run, and I have been on the
state dental board in North Carolina. This is
my, I'm in the middle of my eighth
year.
Among my responsibilities
on the state dental board, I've been a
member of the American
Association of Dental Boards at the national level,
and I'm currently
the double ADB representative
to the American Dental Association's Council on the
Dental Education
and Licensure
Council.
And, I'm,
in starting my
fifth I'm in the middle of my fifth
year in that, six year
appointment.
I'm doing this interview because I am a
wet finger dentist. I've been doing dentistry for
forty one years, and I've had
experiences in lots of different dental settings, both
dental schools, hospitals, nursing homes, and private practice,
and now a dentist directed DSO.
So I'm willing to share my thoughts. These
are only my thoughts. I'm not representing
any
group or anything. And,
just wanted to let you know what my
experience has shaped my perspective as Catherine Watkins,
DDS MS PhD.
Awesome. Thank you so much.
What are some of the biggest issues that
you're following in the dental industry this year
so far?
Well, I know you've had some podcasts,
and I think the, the issue nationally of
this compact thing is a big issue. But
I wanna bring it up a little bit
more because for me as
a as a wet finger dentist, so to
speak,
one of the issues I'm concerned about is
loss of patient centered continuity of care.
I feel like sometimes we have dentists moving
from place to place, and we have a
problem with lack of continuity of care. And,
without continuity of care, we sometimes have questions
about
we have geographic success. Your work may not
be that good because you haven't stayed around
long enough to see. I'm also interested in
competent quality care. I think sometimes
and we see this sometimes on some of
the board complaints that I've had on the
dental board is
young dentists who go into practices
are very,
focused on trying to get their production up
and their speed up, and sometimes the competency
and the quality of care diminishes. And I
think trying to,
kind of balance
competency and good quality care with
productivity
is a is a major,
issue that I'm following.
I also think in general, and and maybe
this
fight in the compacts
is part of that, but I think
sometimes, I think we, as a dental profession,
we have done we have tried so hard
to
minimize what we do chairside. We're really a
surgical profession.
And
but we try to minimize that so that
people will are not be afraid to come
in and to be a good dental patient.
And I think we need to be very
careful that our profession is not relegated down
to the level of trade. We are a
surgical profession with lots of responsibilities,
and I want to make sure that that
stays,
high profile.
And then the last thing, which is very
politically
positive, but a very difficult thing to assess
is, access to care.
And this has been an issue since I,
was in my, first geriatric fellowship up in
Rochester, New York. I was told,
oh, we've got all the baby boomers are
getting old, and they're gonna need good geriatric
dentists to take care of them. But
over the last forty one years, I have
not seen a great growth in the access
to care for special needs populations.
I think we do a pretty good job
of taking care of what I call the
walk talk, open on command, pay as you
leave patients.
But if you've got anyone who fails in
any of these areas, if they have physical
problems, mental problems, or financial issues, I don't
think we as a profession are very good
at access to care. And I think it's
kind of funny that
both the compact that are going upstate legislators
talk about
the compact and the mobility
of the practice addressing access to care, but
I think that's I think that's,
small minded. I don't think access access to
care is gonna have anything to do with
increasing the numbers of dentists in the area.
It has everything to do with getting people
to rural areas and getting them trained to
take care of more compromised and special needs
people in a productive way, in a way
that can be financially remunerated, and we are
not there. And I don't think being a
member of either compact is gonna make that
happen any better.
So,
those are the issues that
I'm looking at, but I'm looking at it
from a dentist's
perspective
and,
and then we can talk about how the
other issues affect that going forward.
Yeah. Definitely. I think those those all make
a lot of sense, and those are some
great points.
Something that I'm curious to to get your
thoughts on are, what are you most excited
about when it comes to dentistry right now,
and and what are some things throughout the
industry that are making you a little bit
nervous or or concerned?
Well, I mean,
when you think about the fact that
when I was in Rochester, New York at
Genesee Hospital, I was in the OR with
doctor Brandon Marks who started dental implants, and
I got to watch him actually work
with my mentor, Bijan Aramkore,
in showing him how to do dental implants.
There was no such thing as a dental
implant education when I was in dental school,
and now I regularly restore dental implants with
my surgeon friends who placed them. So
I think the technology and,
and things that the few that we do
now and that we've done since I've been
in dentistry and that the future holds is
very exciting. I mean, we've got scanning. We've
got three d printing.
I mean, we're doing lots of interesting things
and maybe actually growing teeth and tooth buds
and that type of thing.
The practice that I'm in, they're experimenting with
AI, especially in reading radiographs right now.
It's about fifty fifty. I think 50% of
the time it identifies it on the X-ray,
and 50% of the time it doesn't. But
I think these are exciting areas, and I
think
I think we shouldn't be afraid of the
technology. We should embrace the technology.
But in terms of embracing the technology,
we also have to my concern is we
have to bring up the education
for that technology, and we have to do
it in a
responsible way. And I don't mean just for
educating
the the licensed
practitioners, the dentist, and the dental hygienist. In
in North Carolina, we do not license our
dental assistants.
But, also, we need to do professional support
and education for our dental assistants
and for, our lab technology.
I mean, we're doing all this technology here,
but we're not
we're not embracing
the,
lab techs, which are integral to good quality
care.
A lot of people are afraid of robots
and stuff. I mean,
I've sat here and since COVID,
when I did my test for my dental
licensure, but if I took the Northeast Regional
boards in Rochester and I took the North
Carolina boards, and we were doing testing on
live people.
And, of course, since COVID,
we do not do that. We have developed
really pretty impressive technology for mannequin use on
hand skills test with the ADEX test that
I'm a examiner for. But there's no good
substitute for anything other than having a live
patient and and
and having a you can do a technical
test, but have it you have to have
a patient
and
a human dentist doing dentistry. I don't think
we're gonna get to robots actually being able
to do dentistry in human mouths at least
at least not, I think, for another
hundred years or so. But,
anyway,
I think
that's what I'm excited about, and then education
I'm concerned about. And, also, you know, we've
mentioned a little bit before, but I'm concerned
about the,
the fact that there's not a whole lot
of recognition among non dentists that
among the general population that dentistry is really
a surgical based profession.
We're not a trade,
and therefore, the license
to practice has to be held to the
highest standard
whatsoever,
very similar to the the standard that we
do for our medical surgical
professionals.
And,
we all should all want
confident practitioners, and we should all want them
to be
vetted at the very highest level. And I
think that's
my biggest concern when I'm looking at this
compact issue and
any other issues where my understanding is the
the compact that they call EDH compact, the
one that was put forth by the council
state government.
That was basically,
modeled after the compact for estheticians,
which in my opinion is a is a
trade, not really a profession.
But the,
compact that was put forth by double ADB,
and I don't know, they've got a different
acronym, interstate
dentist and dental hygiene,
testing exam or compact,
It was modeled after the expedited medical licensure
profile, and I think that's the most appropriate
way to do it.
So that's
that's what I'm excited about and concerned about.
Definitely. Thanks so much for that. In your
view, what will the most effective health care
leaders need
in order to be successful over the next
two to three years? I know we've talked
about the compact and robotics and AI tech.
What do you think health care leaders kinda
need
to to bring success to to themselves and
their organizations?
Well, I don't know. I mean,
do we want to go into more
details about the I don't know. I mean,
for me as a practitioner,
patient care is what brings me joy,
and
that's
what that's what I think we need to
remember is that the dental profession is
is a health care profession,
and we are challenged
to
treat oral disease. We are challenged to restore
health.
We are challenged to restore function for people
who
need to be able to chew and to
speak. A lot of people don't even think
about how dentistry is important for your speech
and phonetics.
We need to everybody gets focused on their
white smile, but also just having a smile
and being able to function and
giving that kind of confidence. And I think
we need to maintain our quality patient centered
care. The biggest thing that I'm
the thing that I I think is gonna
be important I mean, DSOs are
growing and they're everywhere, and I have had
a lot of people say, oh, well, I'm
against DSOs. No. I practice in a DSO.
But I practice in a dentist driven DSO,
which means that
the one of the owners of the practice
has been a wet finger dentist. And if
I have a problem as a wet finger
dentist, I have another dentist to go to.
I can I can sit here and say,
no? We can't do
what your
production administrator is saying because it can't be
done that way and done safely.
I'm not so sure that all
DSOs that are not dentist driven
do that. We've seen some cases
in
in North Carolina where we have had some,
young dentist be put into a situation where
there's not an older dentist mentor,
and so they are expected to perform
procedures in a shorter amount of time than
they're capable of, and the person who suffers
is the patient.
And sometimes, we don't find out that that
suffering has occurred
until that dentist has already been moved on
to another
place, and then the complaint rest at the
state dental boards.
And
I'm not sure, and I don't know what
if you've had any discussions
about
what the function of a state board is.
And I'm not sure they're all
I know all state boards are they're they're
required to protect the public. That's the main
thing. And they have to regulate dental practice
and licensure.
And they need to establish that each state
is responsible for establishing that the practitioners in
their state are,
fit to practice.
And,
and we do background checks in North Carolina,
and we are we vet people with, both
the double AABB clearing house and the National
Practitioners Act. And in North Carolina, we actually
use the FBI and do fingerprinting,
to make sure that the licensees that we
have in our state have a character and
fitness
are are prepared for being a good character
and fitness to practice
in our state.
And but other responsibilities
that some
I didn't know until I mean, the only
when I joined the North Carolina State Dental
Board,
I really my only experience with the dental
board before has been being my getting my
license to practice and doing the test.
But, actually, it's so much more because we
in addition to doing the granting of licensing
and renewals,
we also,
have to,
adjudicate
any cases that go on. So if a
pay a person in the public complains about
a procedure that's been done for them or
against a dentist or a dental hygienist,
then we have to investigate it and make
sure and see if there has been any,
problems that fell below the standard of practice
in our state.
And then
we also have to enforce that state general
practice act has happened. A lot of people
think that
state boards and part of the reason that
we're having this problem with the with the
compact is I was involved in in some
of the early history of it, and there's
a lot of disingenuous
information that's out out there between the two
compacts. And
one of them is
most state boards that I know of, they
are prohibited by state law to be able
to lobby.
We have to stay totally ethically free and
separate.
Any legislative
efforts that happen
in most states have to happen through the
dental society at that state level,
and that's the reason why I have been
so
so concerned
about the
different roles that I'm I'm seeing happen between
the American Dental Association
that is behind the
DDH compact
and what's happening at some state dental society
levels, which where they do not support that
compact, but they instead support the one that
the double ADB has put out. And mainly
because the double ADB compact keeps
the licensure and the vetting
and the,
re the fitness to practice at the state
level
and doesn't
pull it away and put it at a
government level that's not even adjudicated by dentists.
I don't know if I'm not trying to
ramble, but I I want to make
make it clear to
you since you're not a dental person how
very important that role is
because
we have we've had people who I mean,
dentists are people just like in every other
profession, and we've had people who've had issues
with substance abuse that
and,
other issues of criminal record,
And we need to be able to follow
that through. And many of those tenders, they
go through,
substance abuse
treatment, and they can go back and get
into practice, but
they do not have a clear record. Now
if you're in medicine
and you want to be a member of
of their expedited licensure process, you have to
be
totally
free of any blocks on your history, and
many of them have to have to have
some kind of extra credentialing or crediting before
you can get an expedited license.
That doesn't mean you can't be licensed as
a doctor in a state, but you have
to go through that state's vetting process.
And I think that's one of the biggest
concerns that I have between the two compacts
that are out there and the reason that
our state in North Carolina would not support.
In fact, Bobby Fite, who's the executive director
of the North Carolina State Dental Board, he
wrote a white paper
about how
concerned he was about the,
DDH compact, and he was on the planning
committee
for that original compact. And he kept raising
some issues with some other people, and he
pulled off of that committee and wrote the
white paper against that compact
because of
the fact that if you don't have a
license, then the states don't have any
ability to vet and control
all of the
statutes that they have that are all centered
around licensed professionals. The
the legal idea of what a privilege is
doesn't make any sense in at the state
dental practice act level.
And that way, that,
keeps the state,
boards from being able to regulate
and to
vet,
licensees
and to address
the concerns of the public. If you have
a dentist who's being a bad actor or
a dental hygienist who's being a bad actor,
the state boards have the ability to control
that license. We don't know what that would
look like in the world of the,
DBH compact when it has a privilege.
And trying to do that over multiple states
without some good
criteria and laws, it it's an open ended
thing.
And then just one more thing about the
contacts.
I don't know why nobody ever talks about
this, but he is the dentist. I'm really
concerned about it. It's the fact that if
you compare the two different contacts,
let's look at the amount of money. I
don't understand
why any of the states that approves
of the, DBH contact. I think they did
it mainly because they're very comfortable with this
council state government, and that was the group
who first started this thing.
Because we in North Carolina didn't think we
needed a compact because
we already can get military licensees and their
spouses,
coverage within less than two or three days.
And we already have,
interstate agreements between people who are competent and
who have practiced for five years without any
blocks on their license. So
we didn't feel
there was a need to do a compact.
But
if you look at the details, and this
is one of the reasons,
Bobby White came out with the letter against
it, The,
the compact,
DBH compact
has an open ended way to assess
dates for paying for the compact. They don't
have any kind of vetting, digital clearing house,
or any follow-up to any people.
The,
compact that was purported by the double ADB,
they're gonna use their existing
clearing house, and they're not asking the state
to support any money. It would be supported
by whoever wants to get a compact license
just like
right now. We don't we don't get state
money in North Carolina for our board. It's
all paid for by the licensees.
And I would think
just
for that reason alone, I can't understand
states passing on it because,
of the money issue by itself. It makes
me very nervous to see something that a
governmental agency is coming in and saying they
can assess
with an open ended or open checkbook,
for something that hasn't even been written yet.
So
as a dentist, I don't even see why,
you know, people would want to do that
if they don't even know the price that
it's gonna be. I think it's really bizarre.
Yeah. Definitely. Thanks for kinda explaining and walking
through those those differences and things like that,
about those compacts.
Okay. Well, I just wanna
end with just one one last thing about
the future of ministry. I think I think
being a dent dentistry has been a really
good profession for me, and I take lots
of pride and joy in it. And I
hope that going forward
that it stays
to be dentist driven and that we keep
patients and patient care,
centered and the quality of patient care and
not the production of dentistry, but the care
of the patients as the forefront and center
of where we need to go in the
future.
Yeah. Absolutely.
One question I have for you, Cameron
Yeah. Is
what's the background of your dentist?
Do you know where the your dentist graduated?
How comfortable are you? What information do you
need? That's that's what I want to see.
I want to see you're asking about the
future, and we're looking at all of these
things. And I want to sit there and
say, my goal would be
that we could create an environment
where
any patient
would be any
family member or anybody would be comfortable being
able to go into any dental practice in
any state and be confident that their practitioner
is confident
and caring
and,
and free of any moral background, turpitude, or
substance abuse. And, I mean, I think that
should be something that we all want. I
think that that's what
DSOs would want. I think that's what the
public wants, and I think that's what you
want. So I I tell people, I say,
are you comfortable?
Why are you comfortable opening your mouth in
front of your hygienist or your dentist?
And whatever background those people have, we want
that to be uniform throughout the nation.
Yeah. Absolutely. I think that makes a ton
of sense.
And, yeah, it's definitely something that,
would be great to have, like you're saying,
across the entire country.
Right. Right.
Well, I wanna thank you for joining us
today, doctor Watkins, and and sharing
your valuable expertise and insights into the dental
industry.
It's been a pleasure speaking with you today,
and I look forward to connecting with you
again in the future. Have a good one.
I really appreciate your time today. Alright. You
have a good one too. Bye bye.