1 00:00:00,510 --> 00:00:03,310 This is s Hatton with the Becker's Dental. So podcast, 2 00:00:04,250 --> 00:00:06,790 I'm thrilled to be joined today by Cyrus Lee, 3 00:00:07,510 --> 00:00:10,950 c e o of Permanente Dental Associates. Cyrus, 4 00:00:10,950 --> 00:00:12,390 thank you so much for being here today. 5 00:00:14,430 --> 00:00:16,740 Hello, Riz. Thank you so much for having me today. 6 00:00:18,380 --> 00:00:19,350 Well, thank you for joining. 7 00:00:19,440 --> 00:00:23,030 Could you start off by introducing yourself and telling us a bit about your 8 00:00:23,030 --> 00:00:23,863 background? 9 00:00:24,930 --> 00:00:25,990 Of course. Um, 10 00:00:26,330 --> 00:00:30,470 my name is Cyrus Lee and I'm the Chief Executive Officer of Permanente Dental 11 00:00:30,600 --> 00:00:32,110 Associates. Uh, 12 00:00:32,170 --> 00:00:36,110 so we are the dental group for Kaiser Permanente Dental in the Pacific 13 00:00:36,110 --> 00:00:39,470 Northwest, so that's specifically Oregon and Southwest Washington. 14 00:00:40,090 --> 00:00:44,350 So we provide dental services for Kaiser Dental members out of 21 15 00:00:44,690 --> 00:00:46,270 Dental offices. Uh, 16 00:00:46,330 --> 00:00:51,150 we are a professional corporation with most of our clinicians as shareholders of 17 00:00:51,150 --> 00:00:54,270 our group. So we are dentists owned and led. Uh, 18 00:00:54,330 --> 00:00:59,190 we have about 120 general dentists and 35 specialists who represent most of the 19 00:00:59,190 --> 00:01:02,430 major specialties, and we also have dens. Um, 20 00:01:02,490 --> 00:01:06,030 our program has been continuously accredited for over 30 years by the 21 00:01:07,000 --> 00:01:10,120 Accreditation Association for Ambulatory Healthcare. 22 00:01:10,240 --> 00:01:14,280 I think we're one of only two dental groups that's accredited by Triple hc. 23 00:01:15,060 --> 00:01:17,280 Um, and in 2022, we were named, uh, 24 00:01:17,280 --> 00:01:20,400 for our size number one healthiest employer of Oregon, 25 00:01:20,620 --> 00:01:22,920 and number one healthiest employer in Washington. 26 00:01:23,660 --> 00:01:26,400 And we're also a certified B corporation. 27 00:01:27,100 --> 00:01:31,560 So I've been practicing for about, uh, 20 years. I'm a native Oregonian. Uh, 28 00:01:31,560 --> 00:01:35,840 but I did spend several years away during my college years and in the military, 29 00:01:35,980 --> 00:01:40,640 and I've been, uh, with Kaiser Permanente Dental since 2006. Um, 30 00:01:41,050 --> 00:01:44,320 today is actually my 17th year anniversary. Um, 31 00:01:44,940 --> 00:01:48,680 so some of my highlights have been in January, 2017, uh, 32 00:01:48,720 --> 00:01:52,240 I opened our Cedar Hills Dental and Medical Office, um, 33 00:01:52,610 --> 00:01:57,600 which was the first full medical dental integrated office of its kind. Um, 34 00:01:58,300 --> 00:02:02,680 now we went to Epic as our EHR in 2016. So, 35 00:02:03,260 --> 00:02:08,240 uh, that allowed us to have the first true medical dental integrated office. 36 00:02:08,580 --> 00:02:11,680 And, uh, we had things like, we had a nurse dedicated, um, 37 00:02:12,140 --> 00:02:16,600 to our dental patients to help them close both preventative care gaps like 38 00:02:16,600 --> 00:02:20,800 vaccinations and disease management care gaps, like blood draws for, uh, 39 00:02:21,080 --> 00:02:24,080 diabetic patients to monitor their A1C levels. Um, 40 00:02:24,080 --> 00:02:27,600 and we also had a physician right there on site, uh, which allowed, um, 41 00:02:27,940 --> 00:02:32,200 me to have those in the moment, collaboration on, uh, patient care. So, 42 00:02:32,780 --> 00:02:36,640 um, I spent most of my career in the care delivery operations side of the house. 43 00:02:36,820 --> 00:02:37,653 And, uh, 44 00:02:37,660 --> 00:02:42,040 and then last year I was selected as the fourth executive dental director and 45 00:02:42,490 --> 00:02:45,640 chief executive officer of Permanente Dental Associates. 46 00:02:46,970 --> 00:02:48,420 Well, thank you. That's great to hear. 47 00:02:48,440 --> 00:02:50,900 And congratulations on your 17th year anniversary. 48 00:02:51,390 --> 00:02:52,223 Thank you. 49 00:02:53,410 --> 00:02:55,310 So my first question for you is, 50 00:02:55,620 --> 00:02:58,630 what are the biggest issues you're following in dental right now? 51 00:03:00,820 --> 00:03:02,920 Wow. And how, how much time do we have ? 52 00:03:03,110 --> 00:03:05,840 This could be an hour long podcast. I mean, there, 53 00:03:06,090 --> 00:03:08,320 there are a lot of big issues and, um, 54 00:03:09,230 --> 00:03:11,910 I think we're entering a very dynamic time in dentistry, um, 55 00:03:12,090 --> 00:03:16,630 really all of healthcare, but I think, uh, really in, in dentistry. So, uh, 56 00:03:16,670 --> 00:03:21,390 I tend to group the biggest issues into, um, really three buckets in my mind. 57 00:03:22,170 --> 00:03:24,310 Uh, first one is around people. 58 00:03:24,650 --> 00:03:28,110 The second one is around technology and care advancement. Um, 59 00:03:28,530 --> 00:03:33,070 and then the third one is, uh, regulatory government policy. And then, uh, 60 00:03:33,210 --> 00:03:36,470 really overarching and touching on all these areas, of course, 61 00:03:36,490 --> 00:03:40,510 is the consolidation of dental practices throughout dentistry, um, 62 00:03:40,510 --> 00:03:45,040 which we've seen previously in other areas of healthcare such as pharmacy and 63 00:03:45,040 --> 00:03:49,560 physician practices. So, um, big issue around people. Uh, 64 00:03:49,580 --> 00:03:53,720 of course right now, front and center for everyone is staffing. Um, 65 00:03:53,890 --> 00:03:56,080 there aren't enough dental assistance. Uh, 66 00:03:56,320 --> 00:04:00,800 there aren't enough dental hygienists and, you know, um, 67 00:04:01,220 --> 00:04:03,760 riz when you look at enrollment data, uh, 68 00:04:03,760 --> 00:04:08,320 comparing pre-doctoral dental students with dental hygiene and dental 69 00:04:08,320 --> 00:04:12,960 assistant students. Um, over the past, um, quite a few years actually, 70 00:04:13,380 --> 00:04:18,240 the number of dental students has been going up and is projected to continue 71 00:04:18,240 --> 00:04:20,760 going up for another few years, uh, 72 00:04:20,760 --> 00:04:25,640 with the opening of new schools and some, uh, class size increases. 73 00:04:26,420 --> 00:04:28,640 Um, and meanwhile, the number of hygiene students, 74 00:04:28,640 --> 00:04:32,040 and especially the number of dental assistant students, has, um, 75 00:04:32,040 --> 00:04:36,920 really not been anywhere close to keeping up. Um, and in many cases, um, 76 00:04:36,920 --> 00:04:41,640 maybe going down a little bit. So pretty much on, on that macro level, there's, 77 00:04:41,870 --> 00:04:45,760 there's more dentists, uh, competing for fewer staff, um, 78 00:04:45,760 --> 00:04:49,640 which has only been exacerbated by the years of the pandemic. Um, 79 00:04:49,640 --> 00:04:54,200 here in Oregon, there's been some work on legislation for additional funds, uh, 80 00:04:54,200 --> 00:04:59,080 about 20 million to expand dental assistant and hygienist training 81 00:04:59,160 --> 00:05:03,280 programs. Um, so I'm hopeful that, uh, 82 00:05:03,550 --> 00:05:07,640 that we'll get some of those additional funds, uh, for our state. Um, 83 00:05:07,640 --> 00:05:08,920 here at Kaiser Permanente, 84 00:05:08,920 --> 00:05:12,880 we've started an internal dental assistant training program, um, 85 00:05:12,880 --> 00:05:17,640 which are really aimed at those people who are unable to be a full-time dental 86 00:05:17,670 --> 00:05:22,200 assistant student, um, because they might be working another job at the time. 87 00:05:22,620 --> 00:05:26,680 Um, and then another issue around people, and this is really, uh, 88 00:05:26,680 --> 00:05:31,160 more on the dentist side of things, is the cost of dental ed education. Um, 89 00:05:31,420 --> 00:05:34,800 the amount of debt these graduates are coming out with is really, 90 00:05:34,800 --> 00:05:38,560 really incredible. Um, for me, uh, 20 years ago, 91 00:05:38,560 --> 00:05:43,030 the thought of having a six figure debt load was, was really unfathomable, 92 00:05:43,450 --> 00:05:47,750 um, which led me to look at the, uh, military scholarship option for me, which, 93 00:05:48,160 --> 00:05:50,390 which I, I think is a great way to go, 94 00:05:50,890 --> 00:05:54,750 and it was such a great experience for me. But, you know, when we have, um, 95 00:05:55,010 --> 00:05:58,040 new dentists, uh, starting out their career, uh, 96 00:05:58,040 --> 00:06:02,640 250 to $400,000 or more, um, in the whole, 97 00:06:03,260 --> 00:06:07,360 um, there's some big implications, um, to having those kind of, uh, 98 00:06:07,360 --> 00:06:11,120 financial pressures. And then, uh, the second, uh, 99 00:06:11,150 --> 00:06:14,720 area is really around technology and care advancement. Um, 100 00:06:14,900 --> 00:06:19,640 and I think the one that, uh, probably jumps out immediately right now is, 101 00:06:19,740 --> 00:06:23,960 uh, that around generative ai, artificial intelligence. Um, 102 00:06:24,180 --> 00:06:28,200 so of course this is gonna have major implications everywhere in society, um, 103 00:06:28,200 --> 00:06:32,440 including dentistry. So, uh, a couple initial areas, um, 104 00:06:32,660 --> 00:06:37,040 in dentistry would be in, uh, radiology such as augmentation, 105 00:06:37,780 --> 00:06:41,760 uh, to, um, clinicians', uh, radiographic exam. 106 00:06:42,140 --> 00:06:44,720 And then on the payer side of things, um, 107 00:06:44,860 --> 00:06:48,440 really using AI technology for utilization and claims review. 108 00:06:49,140 --> 00:06:51,720 And I don't know if these things are, you know, necessarily 109 00:06:53,320 --> 00:06:56,040 a bad thing or a good thing. Uh, 110 00:06:56,080 --> 00:07:01,040 I think what's important in is that there's transparency into what's going into 111 00:07:01,040 --> 00:07:05,520 these models, uh, into these models. It's like with, uh, 112 00:07:06,100 --> 00:07:09,600 uh, dental lab, uh, cases, you know, uh, junk in, junk out. 113 00:07:09,700 --> 00:07:12,080 So we gotta make sure that, uh, 114 00:07:12,140 --> 00:07:16,320 the things going in are really appropriate. And then, uh, 115 00:07:16,340 --> 00:07:21,040 how much actual, um, human use do we have to, 116 00:07:21,300 --> 00:07:26,240 uh, really help inform on how these technologies are gonna be used, um, and, 117 00:07:26,240 --> 00:07:30,960 and where is the clinician's voice, um, in that process. Um, 118 00:07:30,960 --> 00:07:33,880 another technology care advancement issue, uh, 119 00:07:33,880 --> 00:07:36,800 since I'm with Kaiser Permanent Permanente Dental, um, 120 00:07:37,180 --> 00:07:39,640 is medical dental integration. Uh, that's a big one. 121 00:07:40,180 --> 00:07:43,680 So we've been doing things around medical, dental integration for decades. Um, 122 00:07:44,700 --> 00:07:45,440 and, you know, 123 00:07:45,440 --> 00:07:49,720 the challenges in healthcare are so big that I don't think we can continue to 124 00:07:49,720 --> 00:07:52,040 have these silos between medical and dental. 125 00:07:52,500 --> 00:07:56,960 Dental for a lot of people might be their only regular touchpoint in the 126 00:07:56,960 --> 00:07:58,880 healthcare system. So, uh, 127 00:07:58,880 --> 00:08:03,040 really the question is how can we work as extenders of primary care and continue 128 00:08:03,040 --> 00:08:07,920 to elevate our profession as an integrated part of our healthcare system? Uh, 129 00:08:08,160 --> 00:08:11,440 and then that kind of brings me that third area, and that's around, uh, 130 00:08:11,440 --> 00:08:14,480 government regulatory and, uh, policy. 131 00:08:15,420 --> 00:08:19,400 So we know not enough Americans have access to dental care. Uh, 132 00:08:19,870 --> 00:08:21,920 there's so much unmet oral health needs. 133 00:08:23,190 --> 00:08:27,610 The 2021 Surgeon General's report on oral health in America, um, 134 00:08:27,650 --> 00:08:28,890 advances in challenges. 135 00:08:28,990 --> 00:08:33,770 It says that while our understanding of oral disease continues to grow, um, 136 00:08:34,510 --> 00:08:38,370 too many Americans still suffer from diseases of the mouth, uh, 137 00:08:38,370 --> 00:08:41,650 the majority of which are related to oral health disparities. 138 00:08:41,710 --> 00:08:46,450 And that really does underscore the intersectionality of social and systemic 139 00:08:46,850 --> 00:08:48,610 determinants that can, um, 140 00:08:48,790 --> 00:08:53,410 create both advantages and disadvantages with respect to oral health and 141 00:08:53,410 --> 00:08:58,240 therefore overall health, um, across a person's lifespan. So, 142 00:08:58,420 --> 00:09:02,080 um, getting back to the government regulatory and, uh, 143 00:09:02,080 --> 00:09:07,080 policy aspect, the question is, you know, are are there any levers, um, 144 00:09:07,350 --> 00:09:11,840 that there's gonna be a, uh, pressures to pull? So, um, 145 00:09:11,840 --> 00:09:15,640 some of those things to keep an eye on would be, um, uh, 146 00:09:15,920 --> 00:09:19,120 Medicare expansion in the dental. Uh, you know, in, in medical, 147 00:09:19,560 --> 00:09:22,200 Medicare is a single biggest payer, um, 148 00:09:22,200 --> 00:09:26,800 and that's had a massive effect in the, um, medical space. So if there's ever, 149 00:09:27,460 --> 00:09:30,520 uh, any expansion of, uh, this program into dental, 150 00:09:30,530 --> 00:09:34,200 those long-term effects would, would really, really, um, 151 00:09:34,500 --> 00:09:38,280 be significant over time. Um, and then that around, uh, 152 00:09:38,590 --> 00:09:41,040 mid-level providers, you know, I'm, I'm here in Oregon, 153 00:09:41,460 --> 00:09:46,080 and so we are a state that just recently, um, has authorized, uh, 154 00:09:46,080 --> 00:09:47,040 dental therapists. 155 00:09:47,100 --> 00:09:51,990 So there's about a dozen states with at least some level dental, uh, 156 00:09:51,990 --> 00:09:56,550 therapies, uh, in some settings. Um, some are more broad and others are more, 157 00:09:57,210 --> 00:10:02,190 uh, narrow. So those are all things, uh, definitely worth keeping an eye on, 158 00:10:02,410 --> 00:10:06,110 um, from that government regulatory, uh, policy standpoint. 159 00:10:07,220 --> 00:10:11,390 Very interesting. Thank you for sharing. My next question for you is, 160 00:10:11,820 --> 00:10:14,710 what are you most excited about and what makes you nervous? 161 00:10:16,510 --> 00:10:21,240 Yeah, Riz, I think, you know, all those, um, big issues that, that we just, uh, 162 00:10:21,240 --> 00:10:24,930 spent a few minutes talking about. Um, it, 163 00:10:24,930 --> 00:10:26,490 it's all related to that because I, 164 00:10:26,690 --> 00:10:31,010 I do think that as a profession, 165 00:10:31,600 --> 00:10:34,970 that there are things that we can do to get more people, uh, 166 00:10:34,990 --> 00:10:38,610 to a better state of oral health and therefore, overall health. Um, 167 00:10:39,250 --> 00:10:41,610 I think things like true medical, dental integration, 168 00:10:42,450 --> 00:10:46,890 clinical advances and technology, um, more people interested and, 169 00:10:46,950 --> 00:10:51,650 and being exposed to dentistry as a profession, you know, for such a long time, 170 00:10:51,870 --> 00:10:56,610 uh, dentistry has been, um, largely a, a, a legacy influenced, 171 00:10:56,790 --> 00:11:00,890 um, profession for people to go into. But, um, now we're seeing, um, 172 00:11:01,520 --> 00:11:02,650 more and, uh, 173 00:11:02,840 --> 00:11:07,290 more people from all cross sections of society in our communities entering, 174 00:11:07,750 --> 00:11:09,850 uh, to profession, which, um, 175 00:11:09,990 --> 00:11:14,730 all means that all those things can help us as a profession to, um, uh, 176 00:11:15,150 --> 00:11:19,170 get Americans and our communities to that better state of oral health, um, 177 00:11:19,270 --> 00:11:23,890 and overall health and, and help, um, with health equity. Um, I also think, 178 00:11:24,710 --> 00:11:25,250 uh, 179 00:11:25,250 --> 00:11:30,210 a lot of these dynamics and challenges means that the consolidation of 180 00:11:30,410 --> 00:11:34,410 practices will continue and, and probably even accelerate a bit moving forward. 181 00:11:35,230 --> 00:11:39,410 Um, you know, we talked about the debt load and, and a lot of that, uh, 182 00:11:39,430 --> 00:11:43,810 may be driven by, you know, some of the changing demographics of our, um, uh, 183 00:11:43,810 --> 00:11:46,770 dental students. Uh, in addition to that, uh, 184 00:11:46,770 --> 00:11:48,890 means that fewer dental students are, um, 185 00:11:49,110 --> 00:11:53,520 really interested in owning their own practice than 20 or even 10 years ago. 186 00:11:54,180 --> 00:11:59,080 Um, and the challenges of owning a practice, um, uh, with the staffing dynamics, 187 00:11:59,180 --> 00:12:04,000 the technological investment, um, uh, all, all those things, 188 00:12:04,940 --> 00:12:09,200 um, mean that, uh, I, I do see more and more people, 189 00:12:09,940 --> 00:12:12,480 um, moving into, um, 190 00:12:13,040 --> 00:12:17,240 a more of a group practice model as opposed to, uh, individual, um, 191 00:12:17,240 --> 00:12:19,920 private practice model. Um, in fact, 192 00:12:19,980 --> 00:12:24,640 the most recent Ada HPI research brief, I think in 2021, 193 00:12:25,260 --> 00:12:27,160 um, it, it forecasted that, 194 00:12:27,160 --> 00:12:32,160 that the per capita supply of dentists is projected to increase through 2040. 195 00:12:32,860 --> 00:12:37,080 Um, and that's even after adjusting for changes and hours worked and patient, 196 00:12:37,460 --> 00:12:39,120 uh, visits due to, um, 197 00:12:39,380 --> 00:12:44,200 the dentist demographics in terms of age and gender composition. So, um, it, 198 00:12:44,220 --> 00:12:49,160 it should make for a, uh, uh, increasingly more, um, 199 00:12:49,700 --> 00:12:53,600 uh, competitive, uh, environment. So, you know, just like ai, 200 00:12:53,640 --> 00:12:56,240 I don't know if consolidation is good or bad, but I think there's a, 201 00:12:56,640 --> 00:13:00,600 a lot of good things about efficiency at scale. Um, but again, 202 00:13:00,600 --> 00:13:04,800 the important thing is how is that clinician voice, uh, factored into, um, 203 00:13:05,100 --> 00:13:09,720 the delivery of care, um, for patients and, um, you know, 204 00:13:10,000 --> 00:13:13,880 questions about incentive alignment and, um, how that efficiency at scale is, 205 00:13:14,340 --> 00:13:17,840 is being used and, um, whether, uh, it's, 206 00:13:17,840 --> 00:13:21,440 it's being used to enable more and more people to have access to care that will 207 00:13:21,440 --> 00:13:23,840 improve their health. Um, so those are, 208 00:13:23,970 --> 00:13:28,160 those are some of the things that are really exciting, um, that, uh, 209 00:13:28,160 --> 00:13:32,800 present really great opportunities, um, but also definitely, uh, something, uh, 210 00:13:33,100 --> 00:13:36,240 to keep an eye on, on, on how these exciting things will be used. 211 00:13:37,590 --> 00:13:40,700 Thank you. My next question for you is, 212 00:13:41,050 --> 00:13:44,860 what will the most effective healthcare leaders need to be successful in the 213 00:13:44,860 --> 00:13:46,100 next two to three years? 214 00:13:47,380 --> 00:13:50,910 Yeah, Riz, uh, you know, the past two to three years has been really tough. And, 215 00:13:51,330 --> 00:13:54,670 um, in healthcare and, and, you know, we all know healthcare is really, 216 00:13:54,670 --> 00:13:57,270 really challenging right now. And, um, 217 00:13:58,070 --> 00:14:01,390 probably that will continue over the next two to three years. Um, 218 00:14:02,090 --> 00:14:03,430 and so at the end of the day, 219 00:14:03,550 --> 00:14:08,350 I think that the most effective healthcare leaders, um, they need to be able to, 220 00:14:09,050 --> 00:14:11,790 uh, inspire and motivate their people. Uh, 221 00:14:11,790 --> 00:14:15,430 because while as clinicians we center on our patients, 222 00:14:16,170 --> 00:14:18,710 our most valuable resource and asset is our people. 223 00:14:19,540 --> 00:14:23,670 Nothing happens without our people. Um, and, you know, 224 00:14:23,680 --> 00:14:25,950 we've been asking really, uh, 225 00:14:25,950 --> 00:14:30,630 really hard things of our workforce and, um, you know, I hate to say it, 226 00:14:30,690 --> 00:14:34,990 but you know, there's probably gonna be more hard things over the next couple, 227 00:14:35,090 --> 00:14:39,750 two, three years, um, since there really are no quick fixes to the challenges, 228 00:14:40,010 --> 00:14:44,990 um, that we face, uh, in particular with staffing. Um, and, uh, 229 00:14:44,990 --> 00:14:48,710 the landscape continues to change and evolve and, um, you know, 230 00:14:48,780 --> 00:14:52,400 naturally most people don't like change. Um, but you know, 231 00:14:52,400 --> 00:14:56,560 with dentistry being in this incredibly dynamic period, um, 232 00:14:56,590 --> 00:14:59,640 changes aren't gonna happen, um, either with or without you. 233 00:14:59,780 --> 00:15:04,640 So really tying your people to that bigger why, uh, you know, uh, Simon, 234 00:15:04,860 --> 00:15:08,880 uh, Sinek, he, uh, it starts with why. So that common purpose. 235 00:15:10,020 --> 00:15:11,960 Um, so if I had to point to one, you know, 236 00:15:12,030 --> 00:15:15,840 real foundational thing that healthcare leaders will need to navigate these next 237 00:15:15,900 --> 00:15:18,280 few years, um, that would be it. 238 00:15:19,140 --> 00:15:23,030 Fantastic. Well, Cyrus, thank you so much for your time and your insights. 239 00:15:23,350 --> 00:15:25,310 I look forward to connecting with you again in the future. 240 00:15:25,880 --> 00:15:26,713 Thank you so much. 241 00:15:36,930 --> 00:15:40,180 It's so important for leaders at the top of organizations to keep learning, 242 00:15:40,410 --> 00:15:42,100 stay sharp, grow their networks, 243 00:15:42,450 --> 00:15:45,580 help our audience better do this in a more simplified, personalized, 244 00:15:45,680 --> 00:15:49,460 and meaningful way. Becker's Healthcare has launched my bhc, 245 00:15:49,970 --> 00:15:53,140 it's your trusted Becker's healthcare experience and more with content, 246 00:15:53,170 --> 00:15:55,380 connections, events and learning opportunities. 247 00:15:56,090 --> 00:16:01,020 Join the community free of charge@www.my dot becker's hospital 248 00:16:01,020 --> 00:16:02,940 review.com, and we'll see you there.