This is s Hatton with the Becker's Dental. So podcast,
I'm thrilled to be joined today by Cyrus Lee,
c e o of Permanente Dental Associates. Cyrus,
thank you so much for being here today.
Hello, Riz. Thank you so much for having me today.
Well, thank you for joining.
Could you start off by introducing yourself and telling us a bit about your
background?
Of course. Um,
my name is Cyrus Lee and I'm the Chief Executive Officer of Permanente Dental
Associates. Uh,
so we are the dental group for Kaiser Permanente Dental in the Pacific
Northwest, so that's specifically Oregon and Southwest Washington.
So we provide dental services for Kaiser Dental members out of 21
Dental offices. Uh,
we are a professional corporation with most of our clinicians as shareholders of
our group. So we are dentists owned and led. Uh,
we have about 120 general dentists and 35 specialists who represent most of the
major specialties, and we also have dens. Um,
our program has been continuously accredited for over 30 years by the
Accreditation Association for Ambulatory Healthcare.
I think we're one of only two dental groups that's accredited by Triple hc.
Um, and in 2022, we were named, uh,
for our size number one healthiest employer of Oregon,
and number one healthiest employer in Washington.
And we're also a certified B corporation.
So I've been practicing for about, uh, 20 years. I'm a native Oregonian. Uh,
but I did spend several years away during my college years and in the military,
and I've been, uh, with Kaiser Permanente Dental since 2006. Um,
today is actually my 17th year anniversary. Um,
so some of my highlights have been in January, 2017, uh,
I opened our Cedar Hills Dental and Medical Office, um,
which was the first full medical dental integrated office of its kind. Um,
now we went to Epic as our EHR in 2016. So,
uh, that allowed us to have the first true medical dental integrated office.
And, uh, we had things like, we had a nurse dedicated, um,
to our dental patients to help them close both preventative care gaps like
vaccinations and disease management care gaps, like blood draws for, uh,
diabetic patients to monitor their A1C levels. Um,
and we also had a physician right there on site, uh, which allowed, um,
me to have those in the moment, collaboration on, uh, patient care. So,
um, I spent most of my career in the care delivery operations side of the house.
And, uh,
and then last year I was selected as the fourth executive dental director and
chief executive officer of Permanente Dental Associates.
Well, thank you. That's great to hear.
And congratulations on your 17th year anniversary.
Thank you.
So my first question for you is,
what are the biggest issues you're following in dental right now?
Wow. And how, how much time do we have ?
This could be an hour long podcast. I mean, there,
there are a lot of big issues and, um,
I think we're entering a very dynamic time in dentistry, um,
really all of healthcare, but I think, uh, really in, in dentistry. So, uh,
I tend to group the biggest issues into, um, really three buckets in my mind.
Uh, first one is around people.
The second one is around technology and care advancement. Um,
and then the third one is, uh, regulatory government policy. And then, uh,
really overarching and touching on all these areas, of course,
is the consolidation of dental practices throughout dentistry, um,
which we've seen previously in other areas of healthcare such as pharmacy and
physician practices. So, um, big issue around people. Uh,
of course right now, front and center for everyone is staffing. Um,
there aren't enough dental assistance. Uh,
there aren't enough dental hygienists and, you know, um,
riz when you look at enrollment data, uh,
comparing pre-doctoral dental students with dental hygiene and dental
assistant students. Um, over the past, um, quite a few years actually,
the number of dental students has been going up and is projected to continue
going up for another few years, uh,
with the opening of new schools and some, uh, class size increases.
Um, and meanwhile, the number of hygiene students,
and especially the number of dental assistant students, has, um,
really not been anywhere close to keeping up. Um, and in many cases, um,
maybe going down a little bit. So pretty much on, on that macro level, there's,
there's more dentists, uh, competing for fewer staff, um,
which has only been exacerbated by the years of the pandemic. Um,
here in Oregon, there's been some work on legislation for additional funds, uh,
about 20 million to expand dental assistant and hygienist training
programs. Um, so I'm hopeful that, uh,
that we'll get some of those additional funds, uh, for our state. Um,
here at Kaiser Permanente,
we've started an internal dental assistant training program, um,
which are really aimed at those people who are unable to be a full-time dental
assistant student, um, because they might be working another job at the time.
Um, and then another issue around people, and this is really, uh,
more on the dentist side of things, is the cost of dental ed education. Um,
the amount of debt these graduates are coming out with is really,
really incredible. Um, for me, uh, 20 years ago,
the thought of having a six figure debt load was, was really unfathomable,
um, which led me to look at the, uh, military scholarship option for me, which,
which I, I think is a great way to go,
and it was such a great experience for me. But, you know, when we have, um,
new dentists, uh, starting out their career, uh,
250 to $400,000 or more, um, in the whole,
um, there's some big implications, um, to having those kind of, uh,
financial pressures. And then, uh, the second, uh,
area is really around technology and care advancement. Um,
and I think the one that, uh, probably jumps out immediately right now is,
uh, that around generative ai, artificial intelligence. Um,
so of course this is gonna have major implications everywhere in society, um,
including dentistry. So, uh, a couple initial areas, um,
in dentistry would be in, uh, radiology such as augmentation,
uh, to, um, clinicians', uh, radiographic exam.
And then on the payer side of things, um,
really using AI technology for utilization and claims review.
And I don't know if these things are, you know, necessarily
a bad thing or a good thing. Uh,
I think what's important in is that there's transparency into what's going into
these models, uh, into these models. It's like with, uh,
uh, dental lab, uh, cases, you know, uh, junk in, junk out.
So we gotta make sure that, uh,
the things going in are really appropriate. And then, uh,
how much actual, um, human use do we have to,
uh, really help inform on how these technologies are gonna be used, um, and,
and where is the clinician's voice, um, in that process. Um,
another technology care advancement issue, uh,
since I'm with Kaiser Permanent Permanente Dental, um,
is medical dental integration. Uh, that's a big one.
So we've been doing things around medical, dental integration for decades. Um,
and, you know,
the challenges in healthcare are so big that I don't think we can continue to
have these silos between medical and dental.
Dental for a lot of people might be their only regular touchpoint in the
healthcare system. So, uh,
really the question is how can we work as extenders of primary care and continue
to elevate our profession as an integrated part of our healthcare system? Uh,
and then that kind of brings me that third area, and that's around, uh,
government regulatory and, uh, policy.
So we know not enough Americans have access to dental care. Uh,
there's so much unmet oral health needs.
The 2021 Surgeon General's report on oral health in America, um,
advances in challenges.
It says that while our understanding of oral disease continues to grow, um,
too many Americans still suffer from diseases of the mouth, uh,
the majority of which are related to oral health disparities.
And that really does underscore the intersectionality of social and systemic
determinants that can, um,
create both advantages and disadvantages with respect to oral health and
therefore overall health, um, across a person's lifespan. So,
um, getting back to the government regulatory and, uh,
policy aspect, the question is, you know, are are there any levers, um,
that there's gonna be a, uh, pressures to pull? So, um,
some of those things to keep an eye on would be, um, uh,
Medicare expansion in the dental. Uh, you know, in, in medical,
Medicare is a single biggest payer, um,
and that's had a massive effect in the, um, medical space. So if there's ever,
uh, any expansion of, uh, this program into dental,
those long-term effects would, would really, really, um,
be significant over time. Um, and then that around, uh,
mid-level providers, you know, I'm, I'm here in Oregon,
and so we are a state that just recently, um, has authorized, uh,
dental therapists.
So there's about a dozen states with at least some level dental, uh,
therapies, uh, in some settings. Um, some are more broad and others are more,
uh, narrow. So those are all things, uh, definitely worth keeping an eye on,
um, from that government regulatory, uh, policy standpoint.
Very interesting. Thank you for sharing. My next question for you is,
what are you most excited about and what makes you nervous?
Yeah, Riz, I think, you know, all those, um, big issues that, that we just, uh,
spent a few minutes talking about. Um, it,
it's all related to that because I,
I do think that as a profession,
that there are things that we can do to get more people, uh,
to a better state of oral health and therefore, overall health. Um,
I think things like true medical, dental integration,
clinical advances and technology, um, more people interested and,
and being exposed to dentistry as a profession, you know, for such a long time,
uh, dentistry has been, um, largely a, a, a legacy influenced,
um, profession for people to go into. But, um, now we're seeing, um,
more and, uh,
more people from all cross sections of society in our communities entering,
uh, to profession, which, um,
all means that all those things can help us as a profession to, um, uh,
get Americans and our communities to that better state of oral health, um,
and overall health and, and help, um, with health equity. Um, I also think,
uh,
a lot of these dynamics and challenges means that the consolidation of
practices will continue and, and probably even accelerate a bit moving forward.
Um, you know, we talked about the debt load and, and a lot of that, uh,
may be driven by, you know, some of the changing demographics of our, um, uh,
dental students. Uh, in addition to that, uh,
means that fewer dental students are, um,
really interested in owning their own practice than 20 or even 10 years ago.
Um, and the challenges of owning a practice, um, uh, with the staffing dynamics,
the technological investment, um, uh, all, all those things,
um, mean that, uh, I, I do see more and more people,
um, moving into, um,
a more of a group practice model as opposed to, uh, individual, um,
private practice model. Um, in fact,
the most recent Ada HPI research brief, I think in 2021,
um, it, it forecasted that,
that the per capita supply of dentists is projected to increase through 2040.
Um, and that's even after adjusting for changes and hours worked and patient,
uh, visits due to, um,
the dentist demographics in terms of age and gender composition. So, um, it,
it should make for a, uh, uh, increasingly more, um,
uh, competitive, uh, environment. So, you know, just like ai,
I don't know if consolidation is good or bad, but I think there's a,
a lot of good things about efficiency at scale. Um, but again,
the important thing is how is that clinician voice, uh, factored into, um,
the delivery of care, um, for patients and, um, you know,
questions about incentive alignment and, um, how that efficiency at scale is,
is being used and, um, whether, uh, it's,
it's being used to enable more and more people to have access to care that will
improve their health. Um, so those are,
those are some of the things that are really exciting, um, that, uh,
present really great opportunities, um, but also definitely, uh, something, uh,
to keep an eye on, on, on how these exciting things will be used.
Thank you. My next question for you is,
what will the most effective healthcare leaders need to be successful in the
next two to three years?
Yeah, Riz, uh, you know, the past two to three years has been really tough. And,
um, in healthcare and, and, you know, we all know healthcare is really,
really challenging right now. And, um,
probably that will continue over the next two to three years. Um,
and so at the end of the day,
I think that the most effective healthcare leaders, um, they need to be able to,
uh, inspire and motivate their people. Uh,
because while as clinicians we center on our patients,
our most valuable resource and asset is our people.
Nothing happens without our people. Um, and, you know,
we've been asking really, uh,
really hard things of our workforce and, um, you know, I hate to say it,
but you know, there's probably gonna be more hard things over the next couple,
two, three years, um, since there really are no quick fixes to the challenges,
um, that we face, uh, in particular with staffing. Um, and, uh,
the landscape continues to change and evolve and, um, you know,
naturally most people don't like change. Um, but you know,
with dentistry being in this incredibly dynamic period, um,
changes aren't gonna happen, um, either with or without you.
So really tying your people to that bigger why, uh, you know, uh, Simon,
uh, Sinek, he, uh, it starts with why. So that common purpose.
Um, so if I had to point to one, you know,
real foundational thing that healthcare leaders will need to navigate these next
few years, um, that would be it.
Fantastic. Well, Cyrus, thank you so much for your time and your insights.
I look forward to connecting with you again in the future.
Thank you so much.
It's so important for leaders at the top of organizations to keep learning,
stay sharp, grow their networks,
help our audience better do this in a more simplified, personalized,
and meaningful way. Becker's Healthcare has launched my bhc,
it's your trusted Becker's healthcare experience and more with content,
connections, events and learning opportunities.
Join the community free of charge@www.my dot becker's hospital
review.com, and we'll see you there.