Probe&Mirror www.ao.org/chapter/montreal
Newsletter • Summer 2019
This Month:
• Article: Lucky to be Alive • Ometz Report: Giddy-Up • Article: Corporate Dentistry… or, Is Winter Coming? • Scientific Report • Student Report • Social Report
PRESIDENT’S MESSAGE Dear Fellow Fraters,
has made everything run so smoothly. Unfortunately for us (but fortunately for him) he will be stepping down as Treasurer for next year but we have a great replacement in Michael Wiseman. I know Elliot will show him the ropes and make sure that everything runs as smoothly as it always has.
As my second and final term as president winds down, I would like to take this opportunity to thank everyone for their support and effort over the years. I could not have done this without the help of the wonderful mainline and executive committees. You have all made my job easier and I cannot thank you enough for all the time and dedication that you put in to making this chapter, AO-MRDS, run so smoothly.
Finally, none of these articles, excerpts, reports, clinical pearls, or other various writings would be possible without the continuous efforts of Dr. Harry Wise. As the editor of the Probe and Mirror, he works very hard to compile everyone’s reports and edit them into this exceptional journal. Without his hard work, we wouldn’t have a Probe and Mirror of this quality. Thank you, Harry. Your dedication is very much appreciated.
Michelle and Jeremy did an incredible job with planning all the social events this year including the president’s cocktail and annual closing dinner. How they were able to continue to put together these beautiful events and stay within budget is truly amazing. Lesley was fantastic again as our VP communications. She is always on top of everything and getting out information as soon as we get it.
I also want to mention the community initiatives that Alpha Omega is involved with. The Ometz clinic is a program in which dentists provide free basic care to those in need in the Jewish community. As of late, we have a shortage of volunteers; so if anyone is interested, please contact Marty Wise. (drmarty@hotmail.ca). Even if you would like to help out for just one clinic, it would be greatly appreciated. There is also the Holocaust Survivor Oral Health Care program. It is a joint initiative between Alpha Omega and Henry Schein with the aim of enhancing the quality of life of Holocaust survivors and their oral health care needs. I would also like to thank Dr. Jeffrey Tenser for his involvement as the ambassador of this initiative, and I encourage other AO members to get involved.
A very special thank you goes out to both Michelle and Lesley for attending most meetings and staying current of everything, even while working and raising very young children. Thank you so much for staying on to finish your mandate while I was president. Our scientific program this year was excellent and I have no doubt that next year will be just as good, if not better! Dr. Jon Werbitt did a fantastic job lining up a great group of lecturers and he will continue to run the program for the upcoming year. Sam continues to play a very large role as our student liaison. He helps to organize events with the students and does a great job recruiting young people to our fraternity every year.
I would like to conclude by saying that I feel very honoured and humbled to have been the president of such a strong Alpha Omega chapter. I have had so many wonderful memories and have made so many great relationships over the past 2 years. I am truly sad to say good-bye to my role as president.
I want to thank Mel for always being there for me and guiding and supporting me throughout my presidency. I’m not sure if many of you realize this, but he is one of the main reasons that AO MRDS still is what it is today.
Dr. Marcelo Bercovici will be succeeding me as our next president. He will also have the ongoing support of the mainline that was so helpful to me and I wish him all the success in his new role. I know that we are a strong chapter and we have a wonderful future ahead of us.
Elliot, a very special thank you goes out to you not only for what you have done for the past two years, but what you have done for the past 10 plus years for AO. Elliot as treasurer has balanced the books and kept us within budget over the last decade. Performing a job that goes mostly unnoticed to people outside the mainline and executive committee, he has been the guy that
Fraternally,
David Baker
1
P&M SUMMER 2019
LE
A RT IC
EDITOR’S MESSAGE; OR LUCKY TO BE ALIVE Dear Fraters,
On other occasions I have had various cycling experiences, such as learning to fly. On a very hot and dry day in late August about ten years ago, I found myself in Cap-St-Jacques Park, following one of the dirt trails that double as ski-trails in the winter. To paint an image, the trails actually interlace several farm fields where various crops grow during the summer. Since the harvest had already passed, the fields were left to winter and only the dried chaff and straw remained, covering the furrows like a blanket where the crop had been.
After writing editorials for all but one issue when I was president in 2008-2009, I figured that I would break tradition and skip this issue’s editorial. Instead, I thought that I would entertain you with an article that some of you can relate to if they ride a bike. Not a Harley, but a real bike that you actually have to pedal! As some of you already know, I have a passion with biking that I live for from April to October and I’m sure that I am not alone with this, since I have exchanged many stories with other members over the years. For this reason, I think that I might even get other fraters to come forward and share some of their bike-worthy, camp-worthy, hike-worthy, fishingworthy, canoe/kayak-worthy and other worthy bedtime stories that they can relate to their grandkids and also share with us. However, no golf-worthy, hockey-worthy tennisworthy, or anything to do with team sports will be considered. So ends my intro.
As I continued along, enjoying the ride, I happened to notice a group of bee-hives along the trail and I decided that a detour would be my strategy. My new route would take me at right angles to my current trajectory, across the middle of the field, to another trail that was parallel to mine and I would safely continue on my way. So, on my mountain bike, I began to pedal across, perpendicular to the furrows; up and down, up and down, wending my way, until I happened upon one of the furrows that was not really a furrow, but a much deeper irrigation ditch. This was my unofficial introduction to flight school. The flight was awesome! The incredible sensation of weightlessness was wonderful and I felt as if I was a bird, soaring above the earth. However, the landing, which is always compulsory, turned out to be rather rough, as I soared over my handlebars and did a mean tuck-and-roll, one-point landing in front of my bike.
Anyone who has ever straddled a bike, knows that they never forget their first experience of actually balancing on two wheels as your parent or older sibling are running beside you, screaming “Pedal!” when they let go and pray that you don’t crash. I started cycling on a 24” hand-me-down that I shared with my brother, Martin at age 8. How we didn’t kill each other competing for it, I don’t know, but by the following year, we had each earned our first real bike; a 28” Raleigh “racer” with 3-speed Sturmy Archer gears and hand-brakes. We went everywhere with them and rode them fearlessly without a helmet or any other riding gear. When we turned ten, (Parents, think about how times have changed) we each received as a birthday gift from our parents, a dynamo, headlight and taillight set for our bikes, so that we could ride with the cars, trucks and busses “safely” at night. What were they thinking? I remember that when we were around that age, Marty and I had a crazy dog that we could not keep, so our parents found a home for it in Rosemere. We lived on Mountain Sights near Van Horne and we desperately wanted to visit our dog, so we set out with only our memories to guide us. Two hours or so later, sharing the road with the usual traffic and bridges, we saw our dog. He was ok and didn’t really miss us as much as we had missed him. But we did it!
After checking that I was still in one piece, save for a cut above my sock that served as a sponge to absorb my blood, the only damage to my bike was my tail light lens that got lost in the grass. On another occasion, I was with a small group, again pedalling through The Cap, in early spring. There was a cabane-a-sucre and horse-drawn wagons that were transporting visitors. It was a spectacular spring day, where shorts and tees were the dress. The dirt roads were too muddy to negotiate, so we followed one of the several paved roads that lead to the beach area and on to the western exit towards the St. Anne area. As if I don’t learn, I found myself ploughing my bike through the many remaining fingers of snow that crossed perpendicular to the otherwise, bare road. I had the surprise of the day when one of those fingers turned out to be a “thumb”, a big one, of thick, dense snow that caught my front wheel like a bear trap. And so, I had my second flight lesson over the handlebars.
2
P&M SUMMER 2019
part that I could reach and dragged it and myself to safety on the grass. The seat was abraded down to the frame and the bar-ends scraped, but otherwise, ride-able, so we reattached it more securely and went on to our ride. One last story I would like to relate involves another mishap, where I didn’t actually fly, but it was more like falling like a rock. On a return-ride along the Solanges canal bike path, which runs about 62k from St-Zotique to Pointe-Aux-Cascades, we were about ¼ k from the approaching parking lot where my car was. While moving at a moderate 20k pace, I was distracted by reading my bike odometer and inadvertently went on to the grass beside the paved trail. Without thinking out the physics involved, I tried to return to the path at a very shallow angle and my front wheel, rather than rolling up onto the pavement, sort of glided along the edge. Bike and all, I went down on my left side, scraping my shoulder, hip, knee and ankle, also shredding the back of my glove. I heard my helmet crash against the unforgiving pavement and just to punctuate that I would never again be as careless, my seat gave me a hammer-blow to my groin that resonated right up to the top of my head. Thankfully, the bike was ok without even a scratch.
It was fortunate for me that the pavement broke my fall as I once again made a perfect one-point, tuck-and-roll landing. This time, I was luckier, with not so much as a scratch. The bike was also fine. I was beginning to perfect my technique. A round of applause and cheers from my friends confirmed that it was well executed and I therefore needed no further practice. On another occasion, I went with my cousin/biking-partner in his car on a beautiful Sunday morning for a ride on a path along the Dorval-LaSalle lakeshore. We were attempting to attach my dual-suspension bike onto his rack, but my crossbar was too thick to fit in the clamps of his Sports rack, which was mounted on a trailer-hitch. So we decided to go with plan-B and mounted my bike upside-down so that it would fit in the clamps. We weren’t going far or fast, so we figured it would be ok. We set out and met up with Rte. 20 going east toward the exit at Dorval circle at about 70k. Halfway there, my cousin exclaims that he saw in the rear-view mirror, that my bike had fallen off the rack! At first, I thought he was joking, but as I turned my head around, I was horrified to see my bike bouncing and tumbling along the middle of the right lane.
I hobbled around for three weeks, using two hiking poles as crutches and found out how nice it was that strangers were holding doors open for me and drivers stopping to let me pass in front of their cars while they patiently waited for me to limp by. Foolishly, I saw my doctor after procrastinating for two weeks. He told me I was ok, since I was still standing. All my cuts and scrapes have long since healed and I still cycle regularly, although more cautiously and I always keep away from cars, trucks and busses. On a last note, I feel lucky to be alive, and at age 74, I can still keep up a very decent pace and hills or wind are no problem for me. On my bike, I can see and experience places that can be seen no other way. I have met many interesting people that have the same itch to ride. Just recently, I pedaled around the area with a friend who was at one time, confined to a wheelchair, and now he rides an electric bike; with his large parrot sitting on the handle-bars.
I screamed for him to pull over, then jumped out of the car onto the grassy shoulder and ran back parallel to where my poor bike laid in the middle of the lane. As everything seemed to happen in slow motion, my thoughts were all about some poor driver in a little Corolla, closing in on a blue mountain bike lying in the lane; or imagining a semi tractor-trailer jack-knifing and causing a horrific pile-up, trying to avoid my bike.
Feedback is always welcome and anyone who wishes to contribute an article of interest for the Probe, please contact me and you too can entertain our readers. Enjoy your summer, safely, Harry Wise, Editor wisedentistry@gmail.com
As it turned out, it was a Sunday morning and the traffic was thankfully light, so I gingerly grabbed my bike by the closest
3
P&M SUMMER 2019
SCIENTIFIC REPORT Dear Fraters,
showed a very interesting case on how important it is tg place the implants in the correct position.
With the 2018-2019 Alpha Omega lecture schedule coming to a close, it is my pleasure to present the scientific report. I would like to once again acknowledge this year’s speakers and extend our gratitude to them for putting together such great presentations. Without them, none of this would have been possible. I would also like to thank the Jewish General Hospital for continuing to provide us with a venue for our lecture series.
The 2019-2020 lecture schedule is already full. However, I am also currently working on the next group of lectures to be presented in the 2020-2021 AO scientific term. I welcome anybody who is interested to please contact me directly, either by phone or email, in order to discuss potential lecturing opportunities with AO. I am truly very excited to be a part of this fraternity and my goal as the Scientific VP is to develop a valuable, rewarding and educational lecture series. I look forward to seeing you at the next lecture!
We finished this season’s schedule with lecture’s by our past president, Dr. Jeremy Werbitt, Dr. Jonathan Albilia, and Dr. Berge Wazirian.
Fraternally, Dr. Jonathan Werbitt jwerbitt@gmail.com 514-567-5105
Dr. Werbitt presented a very interesting lecture titled “Socket Preservation: A systematic Review.” He reviewed the advantages and disadvantages to grafting following extractions. He showed some very interesting cases that drew many questions from the audience. The next lecture was an amazing one by Dr. Jonathan Albilia entitled “TMJ instability and Malocclusions.” Dr. Albilia did an extensive review of the pertinent literature. He also condensed the finding into easy to use flow charts. Our last lecture was done by Wazirian, titled “Biological, Complications.” Dr. Wazirian complications that occur after
the super-talented Dr. Berge Mechanical and Aesthetic lectured to us on the many implants are placed. He also
Dr. Jeremy Werbitt
Dr. Jonathan Albilia
GRADUATES Montreal’s Chapter of Alpha Omega would like to extend hearty congratulations to the following graduating members of Alpha Pi:
We wish you all the best of luck in your future endeavours, and hope that you will remain involved in Alpha Omega as alumni members. Our future depends on you, and we look forward to welcoming you into our ranks as the young leaders of tomorrow.
Shalom Benzaquen - McGill University, Class of 2019 Matthew Stotland - McGill University, Class of 2019 Bianca Saban - McGill University, Class of 2019 Peter (Panayiotis) Servinis - McGill University, Class of 2019 Emmanuel Suissa - Université de Montréal, Class of 2019 Ezequiel Wendichansky - Université de Montréal, Class of 2019
החלצהב- to your success! Sam Malkinson Alumni-Student Liaison Montreal Chapter - Alpha Omega
4
P&M SUMMER 2019
STUDENT REPORT
Hi Fellow Fraternity Members,
catered event was a tremendous success and was attended by over 20 of our student members. I would like to extend a special thank you to the Korman family (Ronnie Korman and Natalie Levy for opening their home to host the event). Special thanks to Rachel Korman, Stephanie Wiseman, and Gabriel Kakon for their great contributions and time-commitments to help put this event together and make it the success it was! We have heard great feedback about the experience and we hope to continue having the event in future years.
We have had a great year in the student chapter. From the President’s Cocktail dinner, to a successful student opening event and the well-attended Shabbat dinner, I can comfortably say this year brought some new-found strength within the student membership. From the beginning of the year, we made a strong recruitment effort to notify incoming students about the benefits of joining Alpha Omega, either within McGill University, or Université de Montréal student chapters. We were able to significantly increase student involvement from approximately 20 members in the previous year to 32 student members in the current year. In fact, 7 students joined from DMD1 Class at McGill University and we ended the year with 21 McGill and 11 U de M members. The President’s Cocktail was very well attended, introducing students to the membership at large and the opportunities for networking. Students were able to learn about the initiatives and opportunities, as well as the continuing education courses offered by Alpha Omega Montreal and how they could continue their involvement in the future.
On a closing note, this year has been one of renewed membership, involvement, and engagement within our student chapter. I have thoroughly enjoyed my executive role and I am very optimistic about the future of our student chapter, given the great responses of student interest and desire for involvement in leadership roles. This would not have been possible without all the hard work of our executive members. I want to thank my fellow Alpha Omega student executive members for all the work they have committed to this year. They are: Matthew Stotland, Naomi KadochSebbag, Emmanuel Suissa, and Bianca Saban. I wish everyone the best of success in their studies, residencies, and whatever the future has in store. It has been a pleasure.
We began our student opening event with a new concept of introducing students to general dentist members of Alpha Omega and specialists in a more informal, social setting. Students had the opportunity to socialize with specialists who might become their mentors in the future. The event was geared towards encouraging students to intermingle with our professional members and have the opportunity to learn about what they do on a daily basis through shadowing opportunities. By the end of the year I have personally heard of quite a number of students taking advantage of those opportunities to visit practices of the dentists present at this event to a level more than any of us would have expected.
Thank you, Shalom Benzaquen President, Alpha Omega Montreal Student Chapter McGill University D.M.D., Class of 2019
Through an active communication via social media, information from the Alpha Omega Montreal Chapter was easily relayed to students. For example, students were informed of the opportunities they had to apply for international internship/externship opportunities through Alpha Omega International and of organized humanitarian trip opportunities held this year in the Dominican Republic through AO’s Midwestern University College of Dental Medicine-Illinois chapter. We decided to hold a student Shabbat dinner event, a popular event which had not been held in many years. This fully
5
P&M SUMMER 2019
SOCIAL REPORT Dear Fraters,
We thank Dr. David Baker for his hard work and commend his dedication towards AO, as well as for being the amazing president he was! We hope to see you all at the President’s cocktail in September to celebrate together with Dr. Marcelo Bercovici !
This year we have had an excellent social program, with enthusiastic attendance. The Chanukah party was a great success! AO members and their families joined us at Pizza Pita, where we all enjoyed good food, arts and crafts and Chanukah- themed games. Join us next year for a repeat!!
Fraternally,
Michelle Diamond and Jeremie Abikhzer
The closing dinner celebrated both Dr. David Baker’s end of two terms of President and welcomed our new President, Dr. Marcelo Bercovici. It was combined with the Israel bonds Men of the Year event, honouring Drs. Harry and Martin Wise for their dedication to Alpha Omega and in support of Israel Bonds. Over 100 members attended this important cause at the Chabad of CSL. Barbara Kay was the key-note speaker of the evening and presented an interesting speech discussing antiSemitism, concealed as anti-Zionism.
6
P&M SUMMER 2019
SOCIAL REPORT (CONTINUED)
Dr. Elliot Goldenberg was presented with the Alpha Omega International Certificate of Merit at the annual international convention in December. Pictured at our executive meeting are, Left to right, Drs. William Steinman, Elliot Goldenberg, Michael Tenenbaum and David Baker.
7
P&M SUMMER 2019
SOCIAL REPORT (CONTINUED)
CHANUKAH PARTY!
HOW MANY DENTISTS DOES IT TAKE TO CHANGE A TIRE?
Fraternalism at it’s best. Pictured are Drs. Marcelo Bercovici, Elliot Goldenberg, Harry Wise (in red jacket) and Mel Schwartz. Picture compliments of Michael Bybelezer
NEW PROGRAM TO IMPROVE THE ORAL HEALTH OF SENIORS IN LONG TERM CARE INSTITUTIONS The Quebec government recently announced the introduction of a new program to improve the oral health of seniors residing in long term care institutions (CHSLDs).
residents have retained much of their natural dentition and also have dental prostheses, either fixed or removable. Of course some also have implant supported prostheses.
This is welcome news for all health care providers who care for residents in the CHSLDs within our health care network (CCOMTL). These institutions include Maimonides Hospital, Jewish Elder Care, Mount Sinai, Henri Bradet as well as 3 Catholic institutions, Father Dowd, St Margaret and St Andrew’s. The objective of this program is to focus on prevention and early intervention in order to improve each individual’s comfort and masticatory function. This is an important recognition that oral health is an essential part of overall health.
Significant funding will be available to hire a full time dental hygienist, train personnel and pay for the professional services of dentists and denturologists who provide care on site at the institutions. As Chief of the Department of Dentistry of our health care network I am very pleased to have the opportunity to coordinate our efforts in implementing this new government initiative and improve the oral health care status of our seniors.
Mel Schwartz
The program aims to educate nurses and nursing assistants on how to assist seniors in daily oral hygiene. Many elderly
8
P&M SUMMER 2019
LE
A RT IC
OMETZ REPORT
to the stable, my wife asked me to go back to the car and get some packets of sugar to give to Widow-maker, to thank him for such a good time. I gave him the sugar and we headed back to the car. A few moments later, I felt hot horse-breath on my neck and then a horse head on my shoulder. He had broken away from his post and came to find me. I’m not sure whether he wanted to come home with us or he was trying to apologize for throwing me, or merely wanted more sugar. My wife and I were in Waterton-Glacier National Park (also known at the International Peace Park because it is the only national park in the world that is situated in two countries - the U.S. and Canada), the heart of western Canada and Montana, the “horse-ville” of the world. This is the one place on the planet that if you hear the name, you think…horse. You have to go horseback riding in those rugged, pristine mountains, or you haven’t lived. We went. It started out very nicely, seven riders following Roy Rogers and Dale Evans through the forest. I will mention in passing, that this park has the highest population of grizzly bears in the world. The forest was magnificent and being on a trail in the Rockies on horseback provided a magical perspective. All was good in the world, until we heard the sound of my horse grunting, whinnying and then rising on his hind legs with his front legs kicking in the air. Something obviously spooked him - maybe the sight of a grey jay flitting in the trees. Hi-ho Silver! Nine calm horses and my horse is trying to throw me into the pine trees. It was very hard for my wife to convince me to go riding again. She had a problem when I was interested in getting a motorcycle, but… “Horseback riding”, she maintained, “can be done safely”. The next occasion was in Virginia, in Smoky Mountain National Park. The name of the park conjures up cowboys chewing tobacco, and of course, horses. After a good deal of begging and pleading by her, I hesitantly agreed to once again get up in the saddle. The trail was easy to ride on, flat and even. There was, however, a shallow stream to cross. We followed the horses in front of us, and though the stream had a rocky bottom that could cause a horse to stumble, they all managed to cross effortlessly. I attributed this to the fact that these horses were quite used to navigating this obstacle. I was relieved that my only worry had passed. Wrong. What goes up must come down, or whatever stream you cross, you have to cross the other way to get back. This time as we were crossing, my horse stumbled and sat down in the water, soaking my sneakers, my socks, my underwear, and my jeans up to my waist.
Giddy-Up Dear Fraters, When I was a teenager, two of my cousins, my brother and me spent a weekend at a dude ranch, which was my first exposure to horseback riding. It was a memorable experience, and I was gently introduced to the equestrian sport. As I remember, aside from coming home smelling like a stable, I also developed an iconic Texas drawl which took several weeks to disappear. Horseback riding never had the chance to become more than an occasional activity for me due to its limited availability. However, it came to be that I developed a complex - whereby I actually began to believe that horses communicated with each other to make it their life’s work to track me down, and at any opportunity, try to kill me. My wife has always loved horses, and she finally coerced (i.e. forced) me into riding with her. We went to a stable not far from home, and she asked for the gentlest, most surefooted beast that they had for me to ride. I remember his name… Widow-maker! We started out on an unpaved country road, and on my insistence there was to be no trotting or galloping - only gentle walking. All went well until we reached the top of a small hill, and as we started to make our way back down, my horse tried to live up to his name, stumbled, went down on his knees and sent me over his head with me hanging onto his neck so as not to dive headfirst onto the road. We were eye to eye- the terror on my face clearly evident to him. I think he actually smiled at me (if horses can smile). When we returned
9
P&M SUMMER 2019
OMETZ REPORT (CONTINUED) I don’t know if it counts, but does riding on a camel up Mount Sinai count? After all, it’s almost a horse! On our backpacking trip to Israel in 2005, we took a side trip into the Sinai desert and arranged a ride up that biblical mountain on camel-back. These beasts are strong and agile, but can also be mean and temperamental. That is why, when a greenhorn like me rides one, the guide holds onto the reins to control it. We began the climb at 3:00 in the morning, as to attempt this during the heat of the day is foolhardy and even the camels don’t like it. It would also enable us to witness the magnificent sunrise from the summit. Except for our headlamps, it was pitch black, and we rode the switchback trail up the mountain, my wife on her camel behind me. My camel, of course, had a death-wish. He wanted to see if he could walk as close to the edge of the trail as he could without falling off the mountain. As we climbed, he moved closer and closer to the edge, each time the guide fighting him to move away from it. Riding a camel tends to force you forward into the saddle, and for a guy this can be “uncomfortable”. This ride was good for me because I was focused on something much more than a mere pain in my “groin”. My wife on the camel behind me felt my anguish, as each time my camel drifted to the edge, she wondered if going on foot up the mountain would have been a better option. Horses are still a big part in my wife’s life. She is an active volunteer at a horse rescue shelter in Hudson called A Horse Tale. This organization rescues horses that would otherwise end up in the “glue factory”. Some of them are old; some of them can no longer be cared for by their owners and some of them have been abused or neglected, or are no longer considered to be “useful”. They range from huge wagon-pulling giants, to miniature pets. She goes there several times a week, feeding them, administrating medication, “mucking” their paddocks (that’s shoveling manure), grooming them and loving them. The money to care for these animals is raised through their many
fundraising events. I go with her on occasion to help out, but I still look over my shoulder to see if one of them is out to get me. It is important to give back in your life, regardless of your choice of what to give back to. All my life I have been on the receiving end, not of charity, but of people helping me: life itself having been good to me; and of family and friends that have been there for me when I needed it. I have coordinated the Ometz clinic, and it has been a way to channel my desire to give back. If any of you feel that giving back is something you would like to do, contact me and I will be delighted to help you get involved in a wonderful way of giving back.
Marty Wise, coordinator, Ometz clinic. drmarty@hotmail.ca
10
P&M SUMMER 2019
LE
A RT IC
CORPORATE DENTISTRY…. OR, IS WINTER COMING?
You may have seen the movie The Founder, in which hustler Ray Kroc shrewdly wrestles away control of the privately owned restaurant brand from the founding McDonald brothers. Kroc went on to develop the franchise into one of the world’s leading corporations, providing a satisfying experience for its customers. So why not McDentists? Well simply put, dentists are not hamburgers.
Written by Dr. Mark Grossman
dentist without any substantial change. I have no problem with this scenario. My concern is what happens after the 5 years.
CONSISTENCY
What is the key to McDonald’s success? Consistency. A Big Mac will deliver the same predictable product whether in Montreal, New York or at the Port de Nord on the way up to Tremblant. There are no surprises for customers who trust and have confidence in what they are being served. But not so with dentistry, for as we know, not all dentists are created equal. The patient experience can vary greatly in the hands of different dentists, and here lies the primary challenge facing corporate dentistry.
TURNOVER
Undoubtedly, some owners opt to continue working as associates following the 5 year period, typically on a part-time basis. Gradually, more and more of their patients are assigned to younger associate dentists, working at a percentage. So what’s the problem? Given the perfect scenario, committed associates remain with the practice, providing continuity and quality of patient care. However, this arrangement begs certain questions.
RELATIONSHIPS
For the majority of people a visit to the dentist, while likely not a favoured activity, is an accepted and important part of their overall healthcare. Given the often invasive nature of our profession, confidence and familiarity are essential components in allowing patients to feel comfortable during treatment. The classic owner/ operator model ensures the continuity essential in cultivating a trusting Dr./Patient relationship. Can the corporate model afford this imperative to the population? I think not. Here’s why.
1) WILL ASSOCIATES REMAIN LONG TERM?
Unlike an owner/operator, an associate is essentially an employee of the corporation working on a percentage basis, frequently significantly less than the traditional 40%. With high income being a primary motivation to choosing dentistry as a career, how many will remain satisfied with this financial arrangement long term? Furthermore, as an associate, little or no equity is built up in the practice, which remains primarily within the corporation. It seems unlikely that an associate can have the same level of commitment and dedication to a corporate owned facility as would an owner/operator. Retaining individual dentists long term could become challenging.
THE MODEL
In a nutshell, here’s my understanding of the corporate model. A group of investors, including at least one dentist, purchase existing clinics from owner/operators,(typically $1-2 million annual gross minimum), paying them up front for a predetermined value. The owner commits to continue working as an associate at percentage for 5 years, obligated to keep revenues at presale levels during that period. Most of the income generated by hygienists stays with the corporation. While incentives for exceeding production can exist, failure to meet billing requirements can result in clawbacks against the purchase payment, mitigating risk for the corporation, while motivating dentists to keep up production. Following the 5 years, if agreed upon by the corporation, Drs. can continue to work as associates with no minimal requirements.
2) EXPERIENCE
We were all at one time young dentists so this is not to knock them, however nothing replaces experience when it comes to treating patients. With more limited employment opportunities for recent graduates in the major cities, younger dentists will be drawn to corporate owned clinics. Patients accustomed to a long held relationship with a seasoned clinician may not accept having much younger, less experienced dentists assume their care.
3) THE BOTTOM LINE
For established dentists looking for an exit strategy, this can be a good option provided they are committed to and capable of maintaining current production levels for the following 5 years. Given this model, patients can continue to be treated by their own
However they spin it, the main goal of corporate investors is to make a lot of money, with the big payoff coming from selling all or part to large private equity firms. This further dilutes ownership away
11
P&M SUMMER 2019
CORPORATE DENTISTRY…. OR, IS WINTER COMING? (CONTINUED)
from dentists. With profits being the main driving force in corporate boardrooms, what effect will this have on quality of patient care? Will dentists be subject to pressure to meet billing quotas, infringing on their professional autonomy? Seems inevitable.
providing they are willing to hang in there for 5 years. During that period, quality of patient care should not diminish, and ideally dedicated associates would take over once the primary dentist retires. But how likely is that to occur? Will dentists accept being employees of corporations owned by private equity firms and pension funds? In Canada, many of the clinics are still within the initial 5 yr. zone, so conclusions about what happens after are hard to draw. How will quality of patient care, professional autonomy and career satisfaction be impacted? Stay tuned. And oh yes, “Would you like fries with that?”
CONCLUSION
The dental profession can not turn a blind eye to corporate dentistry. It is already well established and will certainly continue to grow. With the current employment challenges facing recent graduates, more will find work within these organizations. For some, this may be a suitable arrangement, while others may look at these positions as short term, starter jobs. As discussed, for older dentists looking for an exit strategy, selling to a corporation may be a viable option,
Fraternally, Mark Grossman
Editor’s note. There is so much I can say about this, having had over 47 years of practice experience and thankfully, having made some good choices during mine and Martin’s careers, I feel obligated to comment on your excellent article. There has been such an enormous change in this last generation of graduates, that I am at a loss as to guessing the future of the autonomy and dignity of a new dentist emerging from dental school, or of a dentist that is facing winding down their practice, pending retirement. They become a pawn in what is becoming an industry, rather than a profession. From what I have experienced, and also what has been discussed at executive meetings regarding this subject, what you have written in your article presents an eye-opening perspective. Obviously, you have done your research on this subject.
You’re looking out for your patient’s best interest.
We’re looking out for yours. As a dentist, decisions made today will have a significant impact on your future. That’s why MNP is committed to every stage of the professional cycle.
I think that any dentist that is faced with these scenarios, should be very cautious when making this choice and to come to terms with their individual situation before making what will be a life-changing decision. They should ask all the right questions, seek independent professional advice, confer with other peers and be aware of their risks and benefits. Your article touches on a very important subject and thank you for bringing this subject to our attention.
From start up to succession, we are continually developing programs and strategies that ensure you’re always ahead of the curve. Contact Derrick Blumenthal, CPA, CA, at 514.315.3675 or derrick.blumenthal@mnp.ca
Harry Wise, Editor
12
P&M SUMMER 2019
Lewis Rosen
Senior Wealth Advisor
As heard on:
Featured in:
It is with great pride that we announce Lewis Rosen as a member of Raymond James Ltd.’s prestigious Chairman’s Council – 5 years in a row! Lewis is also recognized by the firm as a top performing wealth advisor in Canada, ranked in the Raymond James Global Top 50 out of 7,800 advisors worldwide.
To work with an Elite Advisor at Raymond James, call Lewis Rosen 514-782-6004 or www.lewisrosen.com The Global Top 50 is a two day conference attended by the top 58 Raymond James advisors globally based on annual production. The firm’s total number of advisors globally is 7,285. An advisor’s ranking may not be representative of any one client’s experience, is not indicative of the advisor’s future performance. No fee is paid in exchange for this award/rating. 13 P&M SUMMER 2019 Raymond James Ltd. Member –Canadian Investor Protection Fund.
ANNOUNCEMENTS It is with deep sadness that we announce the passing of Emma Benisti (nee Allouche), mother and mother-in-law of Patricia Benisti Dushkin and Dr. Jerry Dushkin. It is with great sadness that we announce the passing of Dr. Eli Raviv’s mother, Mm. Jamila-Yaffa Revivo on the 18th of the month of Tevet (December 25, 2018). It is with deep sadness we announce the passing of Dr. Edward Rauch, former AO-MRDS member. We also sadly announce the passing of Irene Rauch, wife of Dr. Edward Rauch. It is with deep sadness we announce the passing of Mary Libenson, mother of Dr. Howard Libenson. It is with deep sadness we announce the passing of Rosalie Harriet Altman, sister of Dr. Gerald Trager. It is with deep sadness we announce the passing of Dr. Robert Wiener, past AO President and honourary AO member. It is with deep sadness we announce the passing of Lois Vosburg, wife of Dr. Frederic Vosburg.
14
P&M SUMMER 2019