The Group Dentistry Now Show: The Voice Of The DSO Industry

Kyle Guerin, Director, Pacific Dental Services Foundation and Corporate Social Responsibility and Shreekrishna Akilesh, DMD, MPH, Senior Associate Program Director Advanced Education in Pediatric Dentistry NYU Langone Dental Medicine Postdoctoral Residency Programs, join the podcast to discuss the PDS Foundation Dentists for Special Needs newly launched residency program for pediatric residents from New York University Langone Dental Medicine. This new program will offer four second-year residents and four first-year residents with one-on-one guidance focused on special needs advocacy and training.

Our podcast series brings you dental support and emerging dental group practice analysis, conversation, trends, news and events. Listen to leaders in the DSO and emerging dental group space talk about their challenges, successes, and the future of group dentistry.

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FULL TRANSCRIPT

Hello and welcome to The Group Dentistry Now Show. The voice of the DSO industry. I’m Kim Larson, and this is Bill Neumann. Today we’re talking about The Pacific Dental Services Foundation, dentists for special needs clinic and NYU Langone Pediatric Residency Program.

Bill Neumann:

Thanks Kim. We have two special guests here today. One, Kyle Guerin actually was on this show, I think about this time last year. Welcome back, Kyle.

Kyle Guerin:

Great to be back. Thanks for having me again.

Bill Neumann:

Yeah, absolutely. We also have Dr. Akilesh, welcome to The Group Dentistry Now Show. I’ll give you a little bit of background on both gentlemen that we have here. Kyle, who I mentioned was already on the show last year. Kyle is currently the director for Pacific Dental Services Foundation and corporate social responsibility.

Bill Neumann:

His background is in marketing and events and some really interesting background here, Kyle. He worked executing large scale experiential events for Chrysler, Jeep, Dodge and the Detroit Pistons. He worked with the legendary former UCLA basketball coach, John Wooden. That’s pretty cool. But found his niche in the field of corporate social responsibility at PDS, that was about 10 years ago, it looks like, and that’s how he got into healthcare.

Bill Neumann:

He’s led over 25 international dental service trips to places like Ethiopia, Fiji, Guatemala. He’s built 15 playgrounds with some help with the KABOOM! program and helped provide clean drinking water for over 175,000 people in need. Great accomplishments. So again, welcome Kyle.

Bill Neumann:

I’ll give you a little bit of background on Dr. Akilesh. He is the senior associate program director of advanced education and pediatric dentistry at NYU Langone, dental medicine in their post-doctoral residency program. It’s a mouthful. He is based out of Phoenix, Arizona and prior to moving to Phoenix, he was the associate program director at NYU Langone’s Providence, Rhode Island site.

Bill Neumann:

Dr. Akilesh is currently oversees program sites in Arizona, Missouri and Washington State. Education wise, he has his dental degree from Harvard School of Dental Medicine. He also has his master’s in public health from Harvard and his certificate in pediatric dentistry from the University of Connecticut. So again, gentlemen, thanks for being here today. Welcome to The Group Dentistry Now Show.

Kim Larson:

Thanks for joining us, guys. Kyle, what’s changed since we last spoke about the PDS foundation about a year ago?

Kyle Guerin:

Man, what hasn’t changed. It has been a whirlwind. It’s funny, our chairman of the board and CEO, Steve Thorne said, “Getting it built was going to be the easy part and now trying to run it, figure this out, solve this issue. It really would be the challenging part.” And he’s absolutely right.

Kyle Guerin:

Last time when we were on, we kicked the clinic off with Dr. Dent. Dr. Dent was leading us from Houston, just really getting us started, coming in to Arizona and all of a sudden he gets diagnosed with cancer and goes through this incredible health journey. Thankfully he’s doing fine. He’s in remission, just absolutely doing fine, which is great.

Kyle Guerin:

We bring in another clinician, spend about a year with him. Much like this whole issue of just trying to find the right fit to serve this patient population. We’ve struggled, we continued to try to implement new things and have finally landed with this.

Kyle Guerin:

I’m going to gush over him a little bit. Dr. David [Durapshee 00:11:16] , Who is a pediatric dentist that sees adult patients with special needs. It’s been, gosh, I think 19 months since we’ve opened and it’s been, a whirlwind is the best way to describe it.

Kyle Guerin:

It’s each patient that comes in, you get these stories and you get these experiences and you meet these parents and you see these smiles. When you’re able to get a patient to get them to open their mouth or get x-rays or to get a prophy for the first time, it’s so amazing to see that and the joy and the relief on a caretaker’s face. It has been exciting, challenging, tears, sweat, exuberance, all those things. It’s really been an incredible journey.

Kim Larson:

It’s impressive and heartwarming. Just watching the video of the clinic. It does bring a tear to your eye. There is a real need for this. Tell us about the need for dentists to serve special needs patients.

Kyle Guerin:

The numbers range. Different studies but we estimate there’s between 52 and 60 million Americans with intellectual developmental disability. The numbers say that only 10% of dentists are really prepared or willing to see this patient population. What we’re seeing all the time is just the desperation for a place to come and to be seen and define this dental home.

Kyle Guerin:

I mean, we’re getting people that are driving hundreds of miles from different states that are just like, you can feel the weight come off their shoulders when they’re able to find a dental home and a dentist that can see them and work with them and provide the level of care that they deserve. And whether that’s the know-how, the knowledge, the empathy, the insurance. Acceptance of their insurance. All the challenges that go into, that this audience has to face that we’ve been able to overcome.

Kim Larson:

Why do you think more dentists don’t see patients with special needs?

Kyle Guerin:

I know this is only about a half hour show Kim, so I won’t go into to… We could go on for hours and hours and hours of this. There’s so much work being done across the country and thought leaders and discussions but I think it’s a real simple one.

Kyle Guerin:

I mean, really the biggest one we see and that’s… A lot of this, why we’re so excited to be partnering with Dr. Akilesh, is just the lack of education and training. Pediatric dentists get more of this training as part of their programs but so many dentists, they don’t get anything. Maybe it’s one week or… For a lot of the universities, more and more are having some sort of rotation. A lot of them have their own special needs clinic.

Kyle Guerin:

You’re seeing more and more and we’re slowly seeing a very slow charging movement towards more education. Towards more of that dental school curriculum. But it just is this fear, I mean, of not getting in a place where you don’t… Starting it without being able to complete or able to just… It’s a little bit challenging and there’s that just unwillingness to try to tackle that.

Dr. Shreekrishna Akilesh:

I’d like to add to what Kyle said, with treating the special needs patients. Their treatment can be extremely complex and even a seasoned practitioner can feel like they’re in over their head because there’s considerations that are coming from every aspect of the patient’s life that are going to impact the treatment that you can do and how successful the treatment is going to be both short-term and long-term.

Dr. Shreekrishna Akilesh:

Touching on another point that Kyle mentioned. Education is a big part of it. Whether it’s the medical field or it’s the dental profession, it has been shown that if residents or students are not exposed to information or techniques or procedures as part of their initial training, they are much less likely to engage in them once they graduate and during practice.

Dr. Shreekrishna Akilesh:

For special needs patients, for dental students and also for residency programs to have that exposure, it’s critical. Because you can’t really expect a graduate from a program to then go out and do something that they haven’t been trained to do. They’re not going to feel comfortable doing that.

Kim Larson:

Absolutely. It seems like new dentists do want to give back to the community. So Dr. Akilesh, tell us about the Pediatric Residency Program.

Dr. Shreekrishna Akilesh:

As Belle said, our program is NYU Langone, Dental Medicines, Pediatric Dentistry Residency Program. It is a very long name. We have been in Phoenix, Arizona since 2014. Our program has 14 sites nationwide, spanning the continental US. We even have a site in Hawaii and another site in Alaska. We’re across pretty much all the time zones.

Dr. Shreekrishna Akilesh:

Our program has thus far graduated 533 pediatric dentists since it began in 1994. Our Phoenix site alone has graduated 20 pediatric dentists since 2014, which I think is pretty impressive. Our program is unique because it’s based out of community clinics across the country. We’re affiliated with local hospitals for the medical rotations, which are a requirement of the specialty training for our residents. In Phoenix, we’re also affiliated with several institutions and our most recent partnership has been with the PDS foundation, so our residents could actually rotate to the dentists for special needs clinic and get more exposure to treating patients with special needs.

Kim Larson:

Why did you partner with PDS on this residency program?

Dr. Shreekrishna Akilesh:

That’s a good question. Our program is a hospital-based residency program. I think being located in Phoenix, many people may not remember that our hospital is actually based out of Brooklyn. Our home site, our hospital is in Brooklyn, New York.

Dr. Shreekrishna Akilesh:

We have always believed that the best way to train our residents to have a productive career in the specialty of pediatric dentistry would be to expose them to environments where they’re actually going to get real world experience. Real world experience is really something that applicants to our program are looking for. They could have the opportunity to go to a university based program but they’re choosing to apply and to come to our program because they want that real world experience.

Dr. Shreekrishna Akilesh:

I think for us, PDS was a natural choice because PDS’s core set of values. I mean, one of them, I think is it’s almost like a version of ours, clinicians leading clinicians in clinical excellence. I think that’s just another real way of saying that you need to have real world experience, and you need to be mentored by people who are doing what you aspire to be doing and if you can have that as part of your training, then I don’t think your education can get any more thorough and any more well… A solid foundation than that.

Kim Larson:

The hands-on experience is critical and I think all dental students and residents would agree with that. Kyle, do you have any thoughts about?

Kyle Guerin:

Yeah. I just wanted to say Kim, it was funny. We invited… Not funny but we invited Dr. Akilesh to our ribbon cutting and this is the first time I’d ever met Dr. Akilesh. He came up right away and he’s like, “Kyle, we’ve got to do this Pediatric Residency Program. It would be amazing.” And he had so much enthusiasm and just really was… I loved his heart and I had to almost like… We just needed to get our ducks in a row and get things in order. He waited patiently and would check in with me all the time but once we were finally able to launch it and get going, it’s been just really cool to get started and really expose more of the residents to this patient population.

Kim Larson:

This sounds like an incredible program. What are you hoping, Dr. Akilesh, that the residents are going to take away from this program?

Dr. Shreekrishna Akilesh:

As I mentioned before, the real-world experience, I think is really critical for the residents. The candidates who apply to our program to be residents with us in Phoenix are hands-on learners, just like you touched on. Many of them are, they’re all already dentists so they’ve all graduated from dental school successfully. Many of them have state licenses.

Dr. Shreekrishna Akilesh:

Most of our residents have also had a few years of practice experience as general dentists before deciding to come back, realizing that they actually need additional training in order to specialize in pediatric dentistry. I think, for our residents, they understand that their education is not confined just to the walls of an academic institution and my hope with really partnering with PDS foundation was that my residents also get exposure to DSOs as well.

Dr. Shreekrishna Akilesh:

And understand that the role of DSOs today in dentistry and the role that they play in providing access to care, especially for some of them, I mean the most persistent problem that our profession faces is access to care. If the residents, again, going back to what I was saying about treating special needs patients, even just the model of a DSO and the model of a community clinic. If that’s something that they’re exposed to during their residency, it will be a consideration for potential career path when they graduate from the program and decide [crosstalk 00:21:04]. I think this is, so they get exposure to really all of those things, all in one setting and that would be the PDS foundations clinic. I think it’s great.

Bill Neumann:

I wanted to throw a quick question out there to either one or both of you. What’s the length of time somebody would spend with PDS in this residency program. Maybe take us through a little bit about that journey, what that looks like.

Dr. Shreekrishna Akilesh:

We started rotating our residents… They have been rotating for probably about five weeks now and we’re working… So, we’re in the middle of the academic year currently. We’re slowly phasing our residents in. We’re also making sure that Dr. [Durapshee 00:21:49] is able to supervise the residents adequately. And he’s comfortable with where the residents are in terms of the experience that they bring to the clinic in working with him.

Dr. Shreekrishna Akilesh:

Our hope is really that our residents would be… We would probably have at least a couple of residents rotating to the PDS foundation clinic for at least two to three days a week. That’s our hope. That’s something that I think both Kyle and I are open to changing that, and hopefully increasing that based on the feedback that we get from both sides.

Bill Neumann:

Excellent.

Kim Larson:

Dr. Akilesh shared his goals for the program. Kyle, what are your goals for the program?

Kyle Guerin:

Our big goals are really just to increase the overall scope. Our whole dream and vision when we kicked this off was to big dreams right of increased access to care across the United States. Even within this model of… One of the things PDS does so well is as a DSO is just scale, right? With 855 offices across the United States, we’ve been able to just grow and scale.

Kyle Guerin:

Now we don’t plan to have 855 special needs clinics. I have a little bit of hair left but I don’t think I’d have any after that point-

Kyle Guerin:

But we would, at some point, could we have 10 of them? And we want these to be just hubs, and where we’re able to bring people into learn and grow and spend time with us and serve this patient population and really take away some of those stigma. With us, it’s just continuing to get more people learning, more people involved, more people aware of what we’re doing, and by having these residents in, it allows us to see more patients on our day-to-day, every day. We’re just super blessed to have them involved and so far it’s been great.

Kim Larson:

Yeah. It’s such a win-win because dentists want to give back to the communities, they want to be philanthropic. There is such an incredible demand for this, like you were saying, “People come to the clinic and a weight has been lifted off their shoulders just to know that finally they can get the access to care that they need or your child needs are there. ”

Kyle Guerin:

Yes. With the dental schools or the community clinics, I mean, the wait list is just a mile long because they just can’t get everyone in. We’re trying to narrow that and get the treatment that people need.

Kim Larson:

How can others get involved in helping the special needs community receive the dental care that they need?

Kyle Guerin:

Yeah. There’s so many ways. I’d say a couple of the easy ones, there’s some big ones and there some easy ones. The first one is there are so many great CE classes out there of just continuing to get more and more educated. A lot of times for clinicians, they’ve been out of school a long time and maybe they didn’t get that training. But finding some of those CEs, continuing to learn and grow in the space and even taking some time… There’s an amazing program. One of the people we work really close with Dr. Steve Perlman, who has been connected to Special Olympics for a long time. I like to call him the godfather of special needs dentistry, but there’s such great opportunities to even dip your toe in some of the Special Smiles events that Special Olympics puts on.

Kyle Guerin:

In these weird times where, they’re not doing as many events. When life gets back to normal, really getting involved and doing some of the screenings and if nothing else come check us out, come get involved at… If you want to come and volunteer or spend the day with us or just see how things are doing, we’d love to have you, I mean, that was part of this.

Kyle Guerin:

One of the reasons, we put it in Arizona is because they do have a volunteer license that you can get in Arizona. Come on in and spend a day and learn and see patients and help this out because we’d love to have volunteers come be a part of this.

Bill Neumann:

Excellent. It sounds like you both are doing some wonderful things and we hope that next year when we have you on, you can talk about either opening up another clinic or we can talk about all the residents that have been through the program and a little bit about that journey.

Bill Neumann:

Hopefully they’re able to take those skills back to whether they open their own pediatric practice or their own practice or whether they go work for PDS or another DSO. But they can help serve those special needs patients at the practices that they end up participating in or owning or what have you.

Kyle Guerin:

Yeah. That’s a great point. Just find a way. Open your doors and be a resource for it and just give it a shot. You can do it.

Kim Larson:

It’s such a great way for residents like, Dr. Akilesh was saying to see the DSOs really… What they really are all about and of course, PDS is phenomenal DSO. So, they get a taste of what a DSO is and it might just be the right fit for them. Then they can tell other people about it too. It’s just a wonderful program.

Kyle Guerin:

As I take off my foundation and just put on my CSR PDS hat, one of the areas that I love as a DSO is just challenging within the market of all of us. It’s not a competitive edge. The more we all give back and serve and the more we can all be trying to out serve one another, all it does is raise up the goodness of it all. I love to, when we’re out there and all of us are competitive in this space but if there’s one thing that I would love to see, it’s like, who can outgive the other because that’s ultimately just shows more of what we’re all about as DSOs.

Kim Larson:

Dr. Akilesh, Did you want to add anything to that?

Dr. Shreekrishna Akilesh:

Yeah. Just wanted to mention that I feel really privileged to have a site in Phoenix where our residents can rotate specifically to get experience with patients with special needs. We do not have a site like that with any of our other sites across the country where they have one clinic that’s just dedicated to special needs patients.

Dr. Shreekrishna Akilesh:

I think our residents in Phoenix are extremely excited and extremely grateful to have that experience. I think it does a wonder for the curriculum. I just heard from our second year residents that they’re studying for boards now and all of the conditions and syndromes that they’re studying, they’re actually getting to see patients that have those conditions at the special needs clinic. And ones that they haven’t studied yet, they’re actually looking them up while they’re at the clinic. I think that there really is no better way to learn when you’re not just memorizing a condition, you actually remember the patient that had that condition and how you took care of them. I think it’s just an amazing experience.

Kim Larson:

Just to clarify, the dentist for special needs clinic, they see adults and pediatric patients, correct?

Kyle Guerin:

Yeah. One of the things that we do, we see from, I think our youngest patient has been two up to… We had this very sweet, I think they were 96, and everywhere in between. One of the things we’re really trying to do is make it friends and family. We had a story the other day where a mom brought in both her son with autism and then her neuro-typical daughter. It was amazing to see as we have a… One of our rooms, we have two chairs next to each other and it was amazing to see the difference in the behavior when the sister modeled how, sitting in the chair, listening to the dentist, opening up and how much better that situation went when the one patient was able to see that, “This is safe, this is okay. Sister’s doing a great job.” One of the areas of just being in that place, the dental home for the whole family. We’re trying to make it… There’s nothing… Both inclusive and a dental home for it for everybody.

Bill Neumann:

Excellent. So Dr. Akilesh and Kyle. Thank you both for joining us. I really appreciate it and let’s check in maybe in six months or a year and find out how things are going?

Kyle Guerin:

Oh, I’d love it.

Dr. Shreekrishna Akilesh:

That would be great.

Kim Larson:

Thanks for joining the show.

Bill Neumann:

Thanks again, Kyle, Dr. Akilesh-

Dr. Shreekrishna Akilesh:

Thanks for having us.

Bill Neumann:

We appreciate it. This is Bill Neumann and Kim Larson and this is The Group Dentistry Now Show. Until next time.

Kim Larson:

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