Transcription
Welcome to the Paul podcast, where we take a deep dive into all things dentistry and non-dentistry. I'm joined today with my co-hosts, Dr. Annie Kot, and Dr. Parsa Shahidi.
An and Parsa, we have a very special guest today that we do. We're really excited about having Dr. Rick Valovic here with us today on the Paul podcast. He is the Professor and Executive Director at the Center for Oral Health Policy and Management at the great New York University College of Dentistry. He began his career on the faculty of Harvard School of Dental Medicine and served for 22 years as the President and CEO of the American Dental Education Association, which is something we're all very, very fond of and love. He received his DMD degree from the University of Connecticut and then he completed his Advanced Education Programs in Pediatrics and Dental Public Health at Harvard School of Dental Medicine, the Children's Hospital Medical Center here in Boston, and the Harvard School for Public Health. His current research at NYU focuses on leadership development, workforce issues, and access to care. He serves with Dr. Naso on the Job Special Advisory Group at Harvard School of Dental Medicine and, among other things, he is an incredible leader, and we're grateful to have you here today. Thank you. Welcome.
Thank you. Well, having introduced Rick properly, Parsa, Rick, let me ask you kind of the first question, maybe to get the ball rolling. I think I'm coming from a perspective. I've been in dentistry more than 50 years, as you know. And so, when Annie asked me about joining the podcast, just like yourself, I've had a number of opportunities through the years, but I've never been so inclined. But the thing that makes this really interesting to me, Rick, is that it's three generations. As you know, Annie was one of my residents at Harvard, and now we've got Parsa. And you know, this is really terrific because you have, you know, two bright young men there looking at things through a very different set of spectacles, looking through different spectacles than I see things. But I think one thing that can unite all of us is the following question. You and I have seen many, many shifts in dental education through our 50 years. What do you see as the one of the most, or one of the most significant shifts that you see in dental dental education occurring over the next seven to 10 years?
Thanks, Annie. So, I think that what we're going to be seeing is the impact of this new, new generation, and the changes that they bring to, to, to not just practice, but to, to life in general. And so, you know, we talked about over the past 20 years or so, the, the, the transition from Baby Boomers and the introduction of digital, you know, excellence, that, that maybe we didn't have. But I think that what this next generation is going to bring, they're digital natives. They're comfortable with emerging technology.
Yes, and that's where things are going to happen. Right, right. You know, look at what's just happened in the last two years around the introduction of artificial intelligence and how dramatically it has changed things. It has created jobs and it's taking jobs away. We, we're re-instituting Three Mile Island to provide enough electricity for these data, for a data center in, in central Pennsylvania. The technology issues are going to just explode, right? And these, this next generation is ready for it. And I, I think that as we now are accumulating what has been the development of digital dentistry, the use of, uh, scanners, the, the use of 3D printing, the use of CBCT, the use of, uh, of, um, of same-day, uh, crown preparation and placement, whatever that, now with AI, we're going to be able to put all of that together. Get better diagnosis, earlier diagnosis, much more minimally invasive procedures. And, and I think that this next generation is just ready for that. They're more attuned to work-life integration, things that, that many of us, it didn't work. You, you, either you had your work or you had your life. And, and I think that, that this next generation, um, is, is able to, to have that integration. And, and that's why DSOs are going to, to, to grow. And with the resources that the DSOs have, as opposed to these small boutique practices that we've had, that, that, um, that the integration of technology is just going to be what's going to drive everything.
I'm, I'm particularly intrigued by the work-life integration because I'm a person who, I, I think endodontics, particularly for women, could be one of the greatest specialties in either medicine or dentistry. But one of the things also, and I was really, uh, one time brought up at a board meeting at, at a school that I'm a board member of, was about the gender equality. And that in some of the dental schools now, the ratio is more than five to one female to male students. And when I went to dental school in the '70s, uh, this was at Penn, we had 152 students in the class. With all the capitation in those years, we only had nine women. So that was extremely skewed to the male student. Now it's kind of going to the other way. Do you see any issues with gender equality in terms of dental applicants and dental acceptances?
Well, I, I think that what, what we're, what we're seeing. So when I was at a, you know, I was at, that's where the common application service, ADAS, right? And so it was to 2016 that we saw the change that, that women became, um, majority applicants and majority acceptances. So now, as we look around the country, it's really headed, as you said, towards 60, 65% overall, right, um, women. And, you know, in the work that I do here at NYU, where we had 65% women in, in the class, um, they do bring a different perspective, um, to, to everything. And then they're going to bring a different, they're bringing a different perspective to practice as well. Yes. And not just that, that, um, they, they're, they're forced in many situations, um, to take care of, of family issues more than, than men have. But I think there's a balance happening now, as, as this next generation is starting to have families, a balance of, it's not just, you know, the, the, the responsibility dominated on for the, for the woman is not as, as it was, um, when, when we were getting V. So I, I think that, I think that, yeah, it, it is. And, and, um, you know, not only are they less likely to, to, um, get into an, an equity position in a, in a practice, so they, you know, DSOs and large practices work better for them, but they're also more likely to take care of Medicaid patients. They're more likely to, to provide care, um, in situations where, um, the patient may need financial resources or may need other kinds of approaches for their disabilities. Um, and so I think that women are bringing a whole new, um, dimension, yeah, uh, to, to dental education and to dental practice, and that's all for the good. Absolutely.
Annie and Parsa, you better get a question in because I can speak for two hours non-stop. Of course, we're, we're just enjoying it. It's, uh, it's great information. So, um, Rick, what, what, in terms of the, this, what Annie mentioned in terms of the some of the, um, shifts in the gender, uh, and potential lifestyle choices and things that people may end up making, is that then all feel like it's driving things to a different economic models? Is it, is the future of the economic models that are used in dentistry, um, going to evolve, and how's it going to evolve regarding, for example, you know, the, the effect of student debt, the use of the DSOs? Are more women going to be working for DSOs, possibly, or the demographic changes as a whole? And how is all of that going to affect just the overall financial picture of dentistry?
I, I think that, you know, the practices that, that we've traditionally thought of, and, and, you know, it was into the 1990s that still 92% of practices in the United States were one or two-person practices, right? And it was those, and then, uh, the, the dentist, um, devoting 35% of his or her time to administrative, um, issues. I think that as we move towards the DSOs and, and large group practices that are not necessarily DSO related, with these large group practices, multi-site, um, multi-practitioner, large staff, that they can better, they're better able to work with insurance companies to, to maximize reimbursement, um, through very specific standard operating procedures that, that maybe, um, a small practice isn't able to do. So I think that as we, it's clear we're moving away from the small boutique practices, um, that had, you know, what many of them only open four days a week, for only eight hours. Think of the capacity of the all of that equipment, um, just sitting there. That, the, the large group practices, DSOs are able to take advantage of and be more profitable. Um, and, and given the, the types of practice approaches that this younger generation, um, is looking for, and as we talk about work-life balance or whatever words you want to use. I have to tell you that, that as I go around to meetings, and I was just at a meeting in, in Dubai earlier, ADC, as, as you, what I kept hearing was dentists wanted continuing education about meditation, about yoga, about kinds of things at the conference in the future, that really dealing not just with work-life balance, but really finding ways, um, to, to enhance their lives, um, through the use of these kinds of things. So, you know, I just think we're, we're moving clearly to, to large practices. The one or two-person private practice will go away as our, any, my generation goes away, um, and we're going to be replaced by, by a very different, um, culture.
Yeah, from what I gather, er, do you think that the overall, this, this kind of corporatization of the process would be by and large positive? Is that what your view is?
I think done right. And there, there are DSOs and large group practices who are doing it right, with the right incentives. But it's a, it's got, we've got to go through this transition of, you know, moving away from, um, these small practices to the large practices, providing the incentives, um, to, to, to dentists, um, and staff, um, to, to be, um, productive in a, in a way that, that maybe didn't necessarily have to happen before. And remember that, from, when we talk about corporatization, you know, we got to remember that, I, I think there are very few practices in the United States, no matter how small they are, that don't have LLC or PC after them. I, they're already, I mean, everything is really corporate, corporatized in a way already. It's just, make, but I think that, yes, the, that for dentistry, as opposed to, to medicine, I think dentistry has an opportunity to, to really be successful, um, in these DSOs and large practices as, as we move forward.
Dr. Valovic, I, um, I appreciate it because I, I think you bring a lot of expertise and unique insight into this conversation. But I, but I'd love to push back or ask you a question here. I think the big debate has been, uh, for, um, these DSOs, has been, do the providers, the doctors, lose autonomy and decision-making power? And I have to say, you know, it's speaking to colleagues through the job search process, interviewing with these different, whether that's DSOs or private practices, you know, the allure of the private practice, you know, model is that you get more decision-making power, you probably have more control of your schedule and your treatment protocols, your treatment plans. Yeah. What would you say to people who would say, I lose a lot of autonomy working for a big DSO as a provider?
I would say that, that you do, naturally, you do lose some autonomy. But it depends on the DSO. It depends on, on the practice that you're joining, and you, you need to go into that practice, um, either contractually or otherwise, that, that you maintain whatever autonomy you can. Now, if you're coming into a practice, they're going to have certain, um, policies and procedures, but they don't necessarily take away that autonomy. Yes, there are some bad apples out there, everyone agrees to that. But if you look at the work that the Association of, of Dental Support Organizations, ADSO, has done, they're really trying to bring an ethical perspective to that maintains the independence of, of the dentist, um, but provides for some standardization, um, so that as patients come through, it becomes more efficient, um, and therefore the, the productivity enhances, and as a consequence, um, dentists can be successful financially as well. That's how I see it.
And Parsa, let me add something because Rick, before, I mentioned when we were talking about P, kind of like the life integration thing, work-life integration, and the gender issue, where he mentioned that it's like 65% women, but they're generally not looking to be equity owners on their own corner practice. So the fact that now we've had this change in terms of the gender distribution, we have more women. Unlike most guys, gentlemen, women have a life or want to have a life, okay? And have a family. So the idea that they can have a lot of that kind of corporate business stuff that you have when you're running any small business, be it dental or otherwise, they're not doing that. They can concentrate elsewhere. So the graduation of so many female dentists, Rick, I think is a perfect match with the increase in DSOs.
Yeah. And Annie, make a great point. But let, let me just remind us of something. So, Annie, when you and I graduated from, from dental school, um, there were 6,300 graduates, right? At the late '70s, early, early, 6,300 graduates. So then in the '80s and, and early '90s, seven dental schools closed, and another seven almost closed. The ones that closed were private. The ones that didn't close were, were public. So that by 1990, just 10 years later, we went from 6,300 graduates down to 3,900. 6,300 down to 3,900. Now we've, um, opened, you know, almost 20, almost 20 new schools in a way, but we're only graduating this year, 7,000. We're only graduating 7,000 new dentists this year. So, um, you know, the, the, the, when you just look at supply and demand, you know, we, we, the, the population, when you and I graduated, was 240 million. It's now 340, right? And we're just, we have only the same number of.
The access, access to care issue for me is a big thing. We'll talk about that a little bit later. But one of the things, um, uh, just talking here in terms of the graduates, are you including advanced standing graduates as well in that number?
Yeah, yeah. Wow. Yeah. So, so there's all, there's, whatever, when you include, I mean, there's like 7,300 new licenses, right? And I, I have another question because I've never quite understood this. I've heard people, and these are, you know, the dentists, the dent, people in the dental world talking about for-profit dental schools. I mean, what is the difference between a quote, regular dental school and a quote, for-profit dental school? What's the difference?
So, there is a for-profit, there is a for-profit dental school in California. Um, and so they, they have investors that they have to return to, right? And, and whether or not those, those investors were looking just for financial gain or were willing to socially invest in this kind of thing. Um, but all the others are not-for-profit, um, and are, you know, and are subject to the rules, um, you know, and, and a third of them are, are, are state-supported. So, you know, that has to. So, um, I think there, there is this perception out there that some of these new schools are for-profit. They're not. They're all, except for one, they're all, they're all not-for-profit. Okay. All right. Uh, um, but, you know, they, they don't, they don't have post-grad advanced education programs necessarily. They're not doing a lot of research. They're really just putting out practitioners, um, for the area.
I, I think that's a really great answer because you hear people talk about for-profit dental schools with an S, and you're saying there's like one. That's a big difference. Thank you. Well, Rick, there are a few coming up as well, a few new programs and new dental schools, right? Are there? Yes, yes. There's so, yeah, I, there, I think it's like there's 74, uh, CODA-approved dental schools in the United States, um, and there's, there's another seven, um, that universities that have plans for dental schools, um, most of whom, most of which have, uh, have founding PS.
I had a quick question for you, Rick. Obviously, you're President Emeritus of ADEA. Dr. Valovic, and I was looking through some of the data that ADEA published, and, um, in the year 2000, the mean academic average DAT score, the Dental Admission Test, because we have a lot of viewers who are, you know, already in this profession but looking to get into this profession, and I think this is going to be really interesting for all those people and all those folks. So, in the year 2000, the mean DAT score was 17.8 out of 30. For those who don't know, and in 2024, it was 19.3. The average GPA in the year 2000 was 3.2 for accepted applicants, and, uh, in 2024, it was 3.53. The average GPA for first-year enrolled students in dental school in 2000 was 3.35. 2024 was 3.67. So obviously a large gain, you know, in terms of performance across DAT and GPA scores. So this might be a tough question, but I think the audience really wants to know, based on this data, do you think it's too difficult, or do you think it's not difficult enough to be accepted nowadays into dental school, given this data we have, uh, you know, talked about here today?
I, I think so. I'm, I'm chair of the admissions committee at NYU. They, they let me just tell you that, that the students who come, the applicants who come in, we, we interview everybody that, that gets accepted, a personal interview at the, at school. Um, and I can just tell you that the applicant pool is just phenomenal. The, the, the decisions are very difficult because if you, you look at, at, as you said, overall GPA, science GPA, DAT scores, their essays, the, the quality of their interview. And I, I have to tell you, they, they come in, this, this group comes in, they are dressed impeccably, um, men and women are just really wanting to make an impression. Um, and it's, it's, it's amazing. So, yes, um, you know, we're going through a period here where, um, you have, if you're going to, if you're going to get into dental school, you have to do well in college. Yeah, yeah.
Yes. It's an interesting question. I mean, I'm curious, Dr. Naso, what do you think about this topic? I mean, I know this is more of an admissions type of conversation, but I guess it has to do with the quality of applicants that go into the post-grad programs, into the workforce. We talked about that number, 7,000. What is your take on all this?
Well, I mean, there is, as, as Rick also said, as the population is increasing, as the, uh, you know, we're opening up more to the global market, the number, the sheer number of applicants are going to go higher, and therefore competition is going to get greater. So the more competition, you're going to get generally a better, um, cream of the crop. You could also make an argument that there might be some grade inflation going on. That's right, because that is certainly something that is out there as well. But, you know, that's, that's, I guess, is for the better, I guess in many ways. Why? If there's more competition, the better, which, um, will improve the quality of care, the quality of.
Let me chime in here, if I may also, um, because yes, obviously through the years, and what I was telling them, Rick, before we started the podcast, I don't think Gia Aosa had ever heard the term "gentleman's C," and I was talking about in the '50s and '60s, a C was a very good grade. And then through the years, they obviously, grade inflation has occurred. And as I mentioned, Ali and Parsa, before, now you have, you know, all kinds of preparatory courses for things. Thank God for standardized tests. So I think it's very, very difficult comparing a B at at school A or school B and C, then comparing it from the '60s to the '70s. That's difficult. But one of the things that Dr. Valovic mentioned that I think is a very, very key thing, and I, I mentioned this, that anybody wants to get into the endodontic program because they're not in the match. Rick mentioned everybody has a personal interview. And I think when you're a person who is looking for dentistry as a career, medicine as a career, actually anything, I think having a personal interview is a huge separator. And, you know, it's really funny, Rick, when I was at Harvard, you know, there's multiple people you have to go through. And having spent, uh, many years in Asia, 10 years in Asia, I was always kind of a warm-up for many, uh, Asian applicants because they would relax with me. And, you know, because, I mean, it's intimidating when you go into a school and a series of, of interviews. And I would be able generally to relax them. But I think, Rick, for me, I think a personal interview is a big deal.
And, you know, when I was at, uh, ADEA, we did a, a really comprehensive survey of advanced education program directors. And when we were asking, what, what is it that you really want in your, um, the applicants? And then the people who are going to, you know, join your program. You know, there's this perception out there in many ways that, oh, we need the person who is graduating at the top of their class, that has the highest GPA from dental school and so on. But yet, when you ask, what is it that you, what is a successful resident or post-doc in your program? And it's, you know, a commitment, right? An ability to be part of a team, a willingness during the time that they're there to, um, to, to collaborate with others, to be available for emergencies when needed, right? You know, very being a very bright person isn't necessarily what is most desired, right? But yet, we keep saying, oh, I want to get the, you know, either you're number one or two in your class, or I'm not going to, you're not going to. Well, but then you get people who can take tests well, yes, don't aren't necessarily contributors to the program, right? So we, we've got to get away from this concept that, that just having a high GPA is going to, is going to. And so that's why again, as you said, in personal interviews, and, and Parsa, what I used to do, um, and, and Annie, I think you remember how I used to do this, uh, I would get to the point of all the application pool, I would personally meet 15 to 20 people, right? But when I started doing interviews, it was like playoffs in a professional sport. Everybody started equal, okay? So whether you were the first person I wanted to make sure I asked, or the last one who kind of snuck under the wire, all that was off. Everything was about you as an individual, selling me why I needed to take you into, into the program. And I think that's a very good way of doing it because what happens, as Rick said, almost always is never based on academic performance. There's other things that. And what's crazy, and I don't mean to scare you, Parsa, as a young person, many times it's the first three minutes. Yes. And what I, I used to do, secret be known now, uh, because it was a small program and endodontics with four people, I used to use the concept, Rick, that's actually Japanese. It's called "Wa." And "Wa" in Japanese means harmony. So I would always concentrate on the first person who I thought would be the first person. Number two was the person who could work with number one. Number three was the person who could work with one and two. And four was the person. And what was crazy, you understand, uh, for people who don't know, but the dental school is part of the medical school at Harvard. I had people from the medical school asking me, how did you pick your residents? They're like attached at the hip. But it makes for a much more, there's always an exception, do not. But, but, but it was really a wonderful way because what you had is, you had synchronous, you had a uniform approach. And I, and I think that's really, it works really well, that technique with a smaller group.
So, Rick, let me ask you this, because I've had this idea for a while, and I think it kind of comes down to the crux of what we're discussing here, and you as the Director of Admissions there at NYU, which is the largest dental school in the country. I feel like the real question here is, what are the standards for the, what makes the best dental student, and consequently the best dentist? And I think these are the problems when it ends up being a part of the interview ends up having the bias and so on. But I feel like if all, if these criteria could be boiled down to specific values that could have weighted, then it could easily be programmed into an AI program in which the role of bias would then be entirely removed. And clearly, an interview with the human could certainly be included in there, but maybe that could also be weighted a certain amount based on that. Because I feel like what we want in a student is not just someone who's book smart, but somebody who's also wise, can make good decisions, has the ability to work with a team, and at the end of the day, also has the hand skills, which is the part that is entirely missed in the whole admissions process. So what do you think about the potential role of AI in replacing some of the admission bias?
Well, let me, let me tell you about how we, we do the admissions process at NYU now. That, that is, I think, ready to be, um, to be integrated into an AI kind of approach. So there's a, a platform out there called Kira Talent. K-I-R-A Talent. So within, when, when the student, um, the applicant, um, submits the final application to us, which is usually in June or July, um, we offer them, require them, to be interviewed through this platform, um, that is done, you know, they, within two weeks, they have to be prepared to, to have this interview, um, which is, um, virtual. We ask the questions, and the, the, uh, the applicant responds, you know, usually like a two-minute kind of response, um, and then their responses are graded by, by, uh, trained evaluators, two of them, um, about their responses. And the questions relate to the things that you just talked about: grit, leadership, um, ability to, to interact with others, communication skills, nothing really related to, to their cognitive skills, but really related to all of the other things. Yeah, empathy is one of them as well. And, and so then they get a score based on that, um, from zero to four, um, and we use that as one of the other profiles that, that, that we use to select from. So that can easily be put into an AI system, um, that, that puts all of that together. But again, related, yes, we, we want to have people that have, uh, that, that can handle the rigor of a dental curriculum, that, um, you know, within four years, we need to produce an independent practitioner, right? And, and Annie, I mean, compare what our curriculum was, you know, compared to what, what students have to have to do in dental school now within four years. And so, you know, often we, we hear from, uh, dentists of our generation and saying, you know, these students just aren't prepared when they come out. Well, when you think of everything: implants and, and periodontal disease, uh, uh, care, perio care, endodontic care, um, robotics, everything, um, that, that there's expected of them now, besides the science. I mean, and, and, you know, there were, there were whatever, maybe 2,000 drugs in the formulary, you know, 40 years ago. There's now tens of thousands of them in the formula, and, and changing every day. So, um, I, I think that, that, uh, yes, we, we need to have people that, that can handle all of that, the rigor, but also have all the grit, the empathy, the leadership, the collaboration.
As I have a question for you, Rick. There was a point a number of years ago where there were some serious discussions, at least to an outsider, it seemed like a serious conversation about, should dental school actually be five years? And having the fifth year as kind of almost like a GPR? Has there been any thoughts about that? Or was that a program that was going to be based totally on federal funding, and federal funding is becoming a nightmare? So where is that? Is there, is there a feeling that maybe dental school should be a fifth year, a non-tuition-based fifth year?
I mean, as, as you said, there, there was, it was a trend for a while, and it really has gone away, right? It, you know, and, and what, what's interesting is, um, you know, early, you know, I'm, hate to keep going back to, to our generation, but, you know, almost everybody went into the military, right? Right. And had, and had a two-year experience, you know, caring for healthy, mostly men, right? Um, young and great patients, right? And you could, you could really gain your skills. And, and so I think that, um, you know, we're, we're the fifth year. In New York, you have to have a, you have to have, in order to get licensed, GPR. Yes. You, you have to have some post-grad education. Um, but the problem here has been that that's reduced the number of, of, uh, first-time applicants for licensure, right? Because not a, right? You know, you, if you haven't done it, you, you can't apply. So, you know, I think that all those issues are, are, are going to continue to, and to, to grow. But, you know, it's, it's, it's a way to gain.
I'm going to ask Parsa a question now. Now, Parsa, as, as a dental student, do you have enough time in the day to do what you want to do in terms of dental requirements, outside activities? I'm not talking about right, but in terms of what's needed, uh, in terms of what you think you need to do, the time you need to spend with your dental demands from school? Do you have enough time in a day, or how does that work out? How do you balance the time?
Yeah, it's a good question, and something that I, that I was thinking about, uh, bringing up today with Dr. Valovic here. You know, a lot of people in dental school, their medical school friends, we spent a lot of time together. And, you think about the trajectory of those four years and how the requirements are set up from a national perspective and a school perspective, um, individually. And I think the schools that are not set up in a pass-fail system really, really put a lot of pressure on the students. You know, I went to a dental school that was not pass-fail, and I absolutely loved it. I learned a lot. I felt very clinically competent. But there were times where you really think about your next two weeks, and you look at the schedule of exams and submission of clinical requirements. And for those listening who are trying to get into this, to dental school, I think time management is so important. And it became stressful. Was, and I think that were those were the moments, those stretches of one, two, three months where things were so chaotic, where you separate the wheat from the chaff. And perhaps the people that knew how to separate and manage their time, you know, are you able to study? Are you able to prepare clinically? Are you able to prepare for your patients? Are you able to pursue your own personal social agendas? I mean, these are things that are important. And then you look at our medical school friends, and obviously such a hard curriculum, but the P/F system that they've, you know, universally adopted is interesting because you focus on learning. You focus on, you know, the grade doesn't matter as much as the actual takeaway of the information. And I think adopting that nationally could be a huge shift in, in, in the system of how dental school works, and probably for performance of clinical competence. We talked about that, it's not just about the test scores. And, you know, Dr. Naso said, we've spoken about this, Dr. Kotch, how do you evaluate candidates? It has to be more well-rounded. And, you know, this is a question I have for Dr. Valovic, because the audience really wants to know this: What are the secrets to get into dental school, at least to NYU?
Yeah. Well, I think, well, you know, during my time, that I did well to every dental school in the United States and Canada, and foreign as well. Um, I, I think that the, the secret of getting in is really, first of all, be successful at, at your college academic program, the grades. But then identify by two or three things that help to differentiate you from everybody else. Be a leader in a club, be a, a leader in a sport. But what is it that, that makes you different than the others? Um, and I, I think that what I would focus on are differentiators. Things that you did and pursued and made clear that you had the commitment, and that there was a success at the end. Now, success may be, we tried this and it didn't work, but that was a success because you tried it, even though it didn't, it, you've learned from it. So I, I, I think that being successful in, in your college, being, being able to, to do some outside activities that, that, that show your, your commitment, and particularly leadership, um, to, to also have the, the exposure that, that gives you something that's just that little bit different. And, and so, um, something in the community becomes very important. Um, and I think, uh, you know, the, the DAT is important, but yet, um, we know that it's not as, as, um, as, uh, likely to, to show success beyond the first year of dental school, right? So I think you need to be able to show that, that you can handle the rigor of a scientific program, um, that you can show a commitment and some leadership, community activity, um, and, and those are the kinds of. Being prepared for the interview, um, spending the time to, to put together an essay that doesn't look like it's AI generated, that it is very, you know, uh, I, I think that's a killer. Yeah. Um, people, people who have, you know, something that is clearly AI generated and don't, you know, your application will be set aside.
So those are powerful words. And yeah, Parsa, let me add a couple of things to you also. I think one of the things for perspective students is try to get to know something about the school. Maybe make a visit. See if there's a couple of people that you can speak to. Okay? That adds an enormous amount because what happens, uh, a lot of times with young people when you're going for interviews, whether it's college or professional school, they want to be kind of cool and composed. As Rick will tell you, and I will tell you, enthusiasm goes longer than you guys realize. Like, I really want to come here. It's, it's big. And you don't overdo it. But if you know a little bit about the school beforehand, if you've spoken to some of the students who are at that institution, you go in with a lot more confidence about having a conversation. And to follow that up, um, you know, I think, you know, many people have personalities that are more introverted and, and so on. And be, be prepared, um, to, to come in, and you need to be able to, to define yourself, um, beyond your application. And the interview really is usually very critical, and, and showing enthusiasm and, and getting out, you know, all right. So if you are an introvert, then that means that you need to think about, um, what you're going to say before you go in. Well, you know, you can find out what the kinds of questions are in general that are going to be asked. ADEA has these Go Dental events, both at the annual session every year, this year in outside of Washington DC, and, and beyond. Many of the dental schools have, uh, recruitment programs that come around. Just do anything that you can, um, to gain more knowledge, to, to put yourself in a better position.
Well, you mentioned Rick also about the adding, I mean, Annie mentioned the potential for adding a fifth year. That kind of leads up to the question. Although you mentioned that it may have been tuition-free, to the reality that in the US, dental school is four years of undergraduate plus four years of dental school, and then potentially turning into five years. That means nine years to become a dentist, aside from the rigorous academic work involved, plus the, you know, all of the additional stuff to do. I think, me, the greatest structural problem we currently have in our educational system, vis-a-vis now the presence of DSOs and corporate dentistry that is coming in, that is essentially designed for cost-cutting, is the reality that dental education costs up to a million dollars in terms of student loans and so on for these graduates to leave. And then as they leave, they're facing issues with, you know, student loan payback, insurance companies trying to cut down fees. Now, soon enough, you know, once the DSOs gain enough momentum, it's not going to be quite the, you know, the distribution generally tends to trickle up in these types of large corporate entities. So how do you think economically speaking, this rising cost of tuition now with potentially adding more time and so on, will square out for the average practitioner coming out to try to, to, to make dentistry something that you would want to recommend to your kids as a profession down the line?
Well, first of all, I think that what we're seeing is that there, in spite of what we may think from inside, there is this perception out there, and I think appropriate, um, that, that dentistry is a very attractive profession compared to other health professions and, and other opportunities, um, in law or business or, or anything else. Though it is an attractive, but I think that, that we were, what we need to do is, first of all, within the current structure, do everything that we can to make sure that students come in understanding the cost, um, of, of the, of the program, um, and how to get credit, how to get good credit, how to be careful about your spending. Um, you don't need to start the, the doctor's life, um, in your third year of dental school. That you, you need to be careful about expenditures, and, and because you're just going to have to be paying that up. But I, I think that there's other things that we need to be thinking about. Do we really need to have four years of preparation in college to get the DATs? And then we repeat biochemistry, physiology, anatomy? And so, could we go, could we go back to, if you have fulfilled the prerequisites and have demonstrated your, your capacity, why not a three-year? You know, apply after three years, you may not get your bachelor's degree, um, or, you know, programs like, like NYU, we have a seven-year program from the students that are, that are at the College of Arts and Sciences and then come to the dental school at the, at the end of their third year of college. How else can we reduce the, the, the time in seats? So we need to also look at competency-based education, right? If we all know that there are students who have completed all of their requirements and are ready to, to take the, the board exams, um, by the end of the first semester of their senior year, right? So why, if they, if they're completed, why do we need to make them stay till May when, when they really could could graduate and, and move on and either take the boards and start practicing or be prepared, better prepared for, or their, or their advanced education program, instead of making them stay in the seat till they complete it? Now, we also know that there's students who are not ready in May of their fourth year, and, and some of them need to continue to, to finish things, to gain that the skills that they have to have. But I think we, I mean, I actually just wrote a guest editorial in the Journal of General Education, was published in November of last year, that we, we, if we're going to, to put out, um, students, graduates who are ready for independent practice, using all the, the, the, the requirements of practice now, it's a, it's a full four-year program, or, you know, a couple of schools for at three years. But how can we reduce the time so that not only do they not have to potentially pay as much tuition, perhaps, but then they also gain more, uh, life earnings, lifetime earnings? You know, not, you, you mentioned that about your medical school colleagues. You know, medical schools, first of all, what are their expenses? You know, maybe an anatomy lab, a histology lab, but otherwise, it's lectures. Then they send the students out to clerkships and hospitals. And they, there, what you can't do anything with an MD, right? You have to do three years of residency, really learn how to be a physician, right? And, and that for the most, so, you know, the medical students have a certain luxury of being able to spend the time, right, outside of class. And, and there isn't an expectation, um, uh, that you're going to be ready for independent practice at the end when you get your MD degree. That is a challenge. I mean, to be honest, speaking of medicine, most of my friends, physician friends, are not recommending their kids to go into medical school.
Exactly, exactly. But, you know, you know, that also brings up another point about early graduation and early graduation is that if we actually were to assign the cost to a degree, then as opposed to, you know, charging per year or per semester, the students, then it would allow these accelerated formats to move forward for the education to be more efficient. And also, in some ways, to be honest with you, I feel that the advanced standing programs in many schools, where many students are getting degrees abroad with, you know, no to no college costs and so on, that then come and only do two years and get their bachelor's, their dental degree, whereas these other students have had to go through eight years of tuition. It creates a competitive advantage for the advanced standing students graduating that then makes them, you know, more amenable in the market to go into positions in which there's a lower pay, possibly. I'm, I'm not generalizing. I'm just going to say that it's a potential possibility, just, you know, where the incentives are. And that creates a change in the dynamics and the balance of the market, vis-a-vis the employment, um, between those who've had an eight-year degree versus those who've just gotten the two-year tuition degree. Do you, do you find that to be a challenge? And do you think potentially a charge per degree could solve not only that problem, but also those who want to graduate early and get out of school sooner by fulfilling the requirements faster?
It's a great point. Yes. Um, the, I.
I think that that that is and that that feeds into if we talk about doing Competency Based education, that you know, as long as you can demonstrate that you have these skills, um, and that you can move on, as opposed to making everybody go through the exact same program. That, if an argument that you're going to hear, of course, from the DSO schools is, "Well, what, what if they leave, uh, at the end of the first semester of their fourth year? We lose that tuition." Well, as you said, if you say, "Here's the price of the degree," and and and even said it at the beginning of, you know, "If you're coming in, here's the tuition that's going to you're going to be charged for the next four, whatever, until you get your degree," and that's that's the price that I think people can then prepare, um, financially for it. As well as then that the dental schools and universities can say, "Well, fine, I we graduated competent, um, dentists, um, but we also, we're financially sound and doing it."
Rick, you make good points. That brings me to another point. Uh, does, uh, does the dental school at NYU have a proactive relationship with Stern, which, which guys, is the business school at NYU? Yeah, yeah. Um, not that that, not yet. That's one of the things I'm working on. Um, you know, the demand for MBAs in New York City is just so intense that it, you know, they're trying to figure out how to be in a collaborative. But as, and you make a good point, as I, you know, leaving after after 22 years, if if I was asked, "What is the most compelling issue facing, um, the dental profession?" It's leadership. Who's going to follow us? And who's, who's got the financial and business skills to be able to run these, um, right, big DSOs? And large, now, we we know that many of the DSOs have, you know, still have founding leaders in there, right? So when those founding leaders move on, either because of just generation changes or that that they sold the the businesses, who's going to take their place? And we don't have a leadership ladder, uh, for dental education, for the military, for the corporate side of of of dentistry, for organized dentistry. Who's going to be, you know, who's going to be? We we know the changes that are going on, um, in in both the ADA and and specialty associations, uh, who's going to be the leaders that are going to follow us? And so, uh, that's why we're so focused on developing leadership programs here at NYU, um, that that, uh, that are like the programs that that many of us experienced at Harvard, where, you know, if if when I was, uh, at at at Harvard, uh, teaching and on the promotions committee, you know, we, we everybody was going to graduate into and move into some position that would lead them to leadership in the future, right? And it, we had one, I remember we had one student who went directly into private practice, and for a year, we convened about how did we fail that student that he thought could just go in a private practice. So, um, but I, I think that that's what, and the business acumen, uh, as you talk about with Stern, is our business school. You know, the B school at Harvard, um, we really need to have those a cadre of dentists who have those that level of of sophistication in finance, finance modeling, um, you know, the the entire side of of entrepreneurism to make it work within a dental perspective. It was really interesting, and I'll I'll take this back to the 70s, early 70s. University of Pennsylvania was very proactive in multiple degrees, and the most proactive school with the dental school was Wharton. And and so there were numerous people coming out with a DMD MBA. But the other thing that was really very helpful, if you were running a program in the school, and you know, you wanted somebody to come in and speak to your residents or the students about how to learn with obscene debt, okay? They would send, they would send somebody over almost immediately. It was incredible. And I, and I know there's some universities where the business school is not so energized to, you know, work with the dental school. But I think having a dental school component working with either the undergraduate students or certainly the residents, how to finance things, how to learn how to live with your debt, I think it's incredibly helpful. Yeah, yeah, yeah. And and Dr. Valovic, so I think it's, it's a good point. But I have to say, as if you think about the cost of tuition, you think about the cost of tuition of dental school and business school, right? So let's just take Harvard for for example, or Harvard Business School. These are, you know, six-figure yearly tuitions. And so you have a whole cadre of students, residents that want to do that, but they're thinking, "Okay, so I have four years of dental school, I have maybe three or four years of residency or two years of residency. How am I going to fit in another two years, um, two, $300K in business school debt, plus opportunity cost of not practicing and making very, very, um, you know, attractive wages as a practitioner?" And so, so the idea becomes, how can we incorporate that into the four years? Or how can we get into the the residency programs? Uh, but all of that is to to is is okay, and and it's understandable. But Dr. Nasi, you talked about the the debt and the wages. I think to me, the question isn't so much about the time. It's about, "How do we lower this tuition? Why has it gotten so high? What can we do to tackle that head on?" I mean, we can train people to be management leaders and and financial experts as well, but how do we really tackle the problem, which is the the actual absolute value of that tuition? How do we lower that? They don't. So I don't think we can lower the tuition so that it makes all that much difference, right? You sound like you went to to the B school at Harvard. No, no, I didn't. Question? No, I didn't. Actually, I've never been to business school. It's naturally like this. Naturally. No, thank you. Guess so. I I think that what, what we, uh, so what we, I don't, I don't think we can substantially reduce tuition to a point where it would matter overall, right? So then we've got to work on the other attributes of what the the the end, um, debt is. And so, can we cut back on the number of years to the degree? For the most part, outside of North America, um, you graduate from, uh, dental school after leaving high school, right? And then five or six years after after you graduated from high school, you're you're, um, you're able to to practice as a dentist. So how can we cut that? How can we look at competency-based education? How can we do a better job at doing F at creating students during their years who have the the financial knowledge to handle the debt and to be ready to to pay it off? You know, so what we're doing at at NYU, um, we have what we call a Dental Student Leadership Institute. Um, and so we bring in about 35 students each year for a three-year program and really spend a lot of that time on business, business education, financial education. Um, that now leads to, this is the first year that we're going to have the fourth-year students and on actually Tuesday of next week, um, they'll be presenting, uh, in a shark tank format. Oh, nice. Um, presenting, uh, you know, so a couple of them are doing creating new apps for for dentistry, another one's creating a new dental school, another one is creating a new delivery model, um, that would combine, uh, dentistry, optometry, and ENT into a new business model. So we're, we're preparing this group of students, at least, um, to to have the financial acumen, business acumen to be able to to carry that forward. But again, it, it's all about developing leaders for the future, um, but yeah, I don't, I just don't think that there's a way to substantially reduce tuition. What, what would we give up to to to be able to do that, given everything that needs to have to prepare students for for for private practice?
Rick, at the medical school, your your medical school there at NYU, there is the tuition has been kind of waived for a little while, right? Based on a big grant years now. Yeah, yeah. They got a, they got a major grant that, uh, allows there's no tuition at the, at the medical school. So if you can find somebody who's willing, if we could find somebody who's willing to commit a billion dollars, um, we'd be able to to make that happen. Um, but, you know, Mayor Bloomberg has done the same thing at the John Hopkins School of Public Health. Um, you know, so again, it's another, uh, conceptually, it's another way if we can get philanthropy, um, to be more, um, a part of the the work that we're trying to do.
Rick, this comes from a a perspective of total ignorance on my behalf, but have any of the DSOs developed relationships with dental schools? Yes, um, as an example, um, in the the new dental school in North Carolina, High Point University, re, where's that going to be? In in High Point University, all right. And so Rick Workman, oh, yeah, yes, founder of Heartland, um, gave, I think, $32 million, um, and, uh, you know, as part of it, trying to establish a new dental school that better prepares students, uh, for for DSO experiences. Um, and, you know, there's others. But that that would be the most dramatic of somebody who gave, um, a substantial gift, um, to a private institution. I, I don't know eventually how that will impact tuition overall. They just started the with the first class, um, but that those are the kinds of things to see for the future as well.
Do you foresee more corporate involvement with D schools? You know, you know, and I know, and I think P and Ali as well, is that when you go overseas, many D schools have pretty close ties with different corporations. Do you see that becoming an increasing trend in North America? Any? I think that, um, overall, within the health professions and hospitals, and and you remember maybe five, six years ago, there was this real concern about conflicts of interest. Yes. And so I, we, we even, uh, uh, the bags that we had at the annual session, we had to put, we had to put the sponsor, um, on duct tape, kind, kind of equivalent, so that when they went back home, they could pull the sponsor, uh, off the bag, label off the bag, because if they came back with with the sponsor arm, they would get into trouble. Um, so I think the the pendulum is swinging. Hopefully, it's coming back. Hopefully, it's coming back. I think corporatization is going of it seems to be inevitable, not just in dentistry, medicine, but I guess across the board in our system. Um, Rick, but I think this kind of plays also along with the idea of tuition cost, uh, education, as well as access to care, right? I mean, we know that access to care is not distributed, um, equally. It's not homogeneous, very heterogeneous, at least in this country. And you see concentration. So as we were talking about the number of dentists, it is true that maybe the numbers have not, whether they have gone up or down, whatever has happened, their distribution is not equal. There are areas where there is great need, and then there's areas where there is excessive competition. So that sometimes goes along with the fact that if you are putting in eight, nine years, or in our case with the specialty, add to that, that's like another 11 years in total, with having gotten, you know, tuition and loans and costs, you don't tend to want to go to a rural area where there's a lot of need. And so there's a concentration of people in high cultural places. So you get competition in the cities and not enough in in in rural areas. So how, so don't you think that's the structural problem I'm talking about? Is that unless we can address the tuition cost and also maybe find a way to get around maybe, uh, paying back some of the loans so that we can send people to where there is need? What do you think would, I mean, as you mentioned, military was one option. What, what other, um, options do you see to address this issue of unequal care?
Okay, so, you know, there's this joke in in New York, if one more pro bono opens in Manhattan, the island will sink, right? And and, uh, you know, if you look at Utah, it, you know, which which opened the the two dental schools, you know, almost all all of the dentists really are in that, um, they Salt Lake City, Provo, the valley, right? But otherwise, Utah is a, is a dental place. Um, so I think that what, in my experience, there are many people who have rural practices that are doing very, very well. It's not like you need to be in the city to to to be successful. You, you there are rural practices that are doing, I mean, and I know two specifically, one in Oklahoma and one in Texas, that have their own landing strip for their private plane adjacent to their practice, so that, you know, they can get to another airport. Now, anyway, I think that what we're seeing is that a lot of, there are a lot of opportunities for, um, companies to, and especially foundations, um, in many states now that are looking at ways to do loan forgiveness, um, for for if you work in a, a, an area that that has an access to care issue. But I, I, I, I think that we just have to provide students with, um, really a better understanding of the options that are out there. They just, many of them think that they can just open up, um, or go into a practice in an area, as you said, you know, that that's urban and culturally, um, advantaged. But I, I just think that we, we got to find ways to incentivize, uh, students to graduates to go into these rural areas or into cities, areas of cities that that that are dental deserts, as well. There certainly is that in all the major cities, but, um, we're looking to foundations, uh, we're looking to to others. There are a couple of the DSOs that are focused only on rural areas because there are opportunities there as well. But it's, it's, it's a compelling issue. Um, you know, the, often I'm asked, "Do we have enough dental graduates? Do we have too many graduates?" Well, we have enough graduates to take care of the population that can pay for it, that has the health literacy to understand the what the role of of dental care and oral health is. Um, but there's a, boy, there's a load of people out there. And now, if we're starting to pull fluoride out of the out of water supplies, um, you know, when I started as a resident, Children's Hospital, Boston, um, the the water supply in Metropolitan Boston was not fluoridated. Um, the Christian Science Church had had been able to to prevent that from happening, and I just did quadrant dentistry all day long on the the the patients that we had from the local area. Um, and then once it was fluoridated in the early 80s, when I got to, when I was in on the faculty, we had TR and the fluoride was in the water, we had trouble finding lesions for students to practice on. Um, so I think that if, if we pull fluoride out of the water, as is seems to be happening in Florida, and now, uh, statewide, a bill is on the governor's desk to pass the Utah, that we're going to, we're going to see go back to, you know, erupting first molar, you know, first molar permanent molars that are going to need endodontic treatment or or extraction. Um, that the, the level of caries, um, both in in the primary dentition as well as the permanent dentition, is going to skyrocket again. Um, it's really a very scary time, and I think it's going to really impact, uh, the future of the practice of dentistry.
Let me, let me ask a question about that, not necessarily from the pure political angle of that, but in terms of the resistance to pulling fluoride, where is that resistance coming from? Is that coming from only the dental schools? Uh, is there a state, uh, administration in each individual state? Their level of pushback may vary from zero to 100, but where, where is that discussion taking place on the ground? So, the, the ADA, the ADA has been very public about it. Um, you know, and I, I was just interviewed two days ago by The Wall Street Journal about it. Um, you know, that I, I think that I think that, you know, we, we have gone for 75 years with fluoridation, and like it was just, 75% of Americans benefit from community water fluoridation, and it was just like, it was just accepted. Like what happened? Like almost overnight, this this this, um, political intervention that is is pushing out it. Um, I just wrote a blog, uh, post that went up yesterday about how do we deal with the vaccine hesitation issues now? Um, I, I think I think that we haven't done a good job, Annie, as public health people, right, of of countering, um, these kinds of things that we just assume that evidence is enough, right? And it's not, right? Um, with with all of the the different kinds of information out that we need to worry about. On on a much, much lower scale, Ali and I face that has ended on us was focal infection. Actually, Ali, you have a couple of videos on your your YouTube site addressing that stuff, right? Yeah, I mean, just the explosion of information through the internet and social media in the past 15 years is basically what Martin Gurri in his book, Revolt of the Public, kind of predicted, is that misinformation and, you know, malinformation, all this stuff is on the rise. So we just have to be more cognizant. And you're absolutely right that, you know, fear-mongering works far more effectively than rational evidence. So it requires people to kind of go out there and advocate properly for these things that are important. But, Pro, what do you think? Well, no, I, I, to sort of, you guys touched on it, but I, I did read that piece, um, Rick, regarding sort of the vaccines, and I think you referenced the the former FDA commissioner, Dr. Gotle, Scott Gotle, who does such a great job. Jerome Adams, a former Surgeon General, yeah. But you spoke about, you know, the spawn of, uh, polio and measles after decades of it being so quiescent. You know, I think this is a tough conversation, a tough topic, but, you know, some of these things like vaccine mandates, fluoridation, in the last couple of months, have become kind of political. And so that there's a question of science, medicine, versus politics. And it, you know, I guess a question I have for you, given all of your decades of experience dealing with this, the politics versus the the medicine, how much of an influence should politics have? And I'd love to hear everybody's answers in this healthcare decision-making process. Is, is there, is there a good spot for it? And I say that because some people argue that there's a duty for experts to engage in this political discourse to inform people, to correct the misinformation you're talking about, Dr. Nas. And some say that you should stay neutral so that you can retain that credibility as an independent source of information. How do you, how do you see all this playing out?
Well, from my perspective, is what is politics meant to do? Um, you know, sort of in the in the past, the politics was to provide the evidence, the regulation, to ensure the safety, um, and and do whatever we could to, uh, ensure the public health of the country. So, but that has now, the politics is more of, "How do, how do we move back to this perception, um, that independence and independent mindedness is more important than what the evidence might say?" So the the politics used to be, "What is the best thing for for society?" And now it's not necessarily the best thing for society. It's what's might be, is the best, um, thing for the individual. And that then within that political realm is the concept that, "Well, whatever, it doesn't matter what the science says, I want to do what I want to do." And so vaccine hesitation, um, fluoride hesitation, um, you know, all of these kinds of things are, and they're going to matter. I mean, we, we need to follow what's going on with this measles outbreak in Texas, and and, you know, we perceive, "Well, it's a, you know, it's people weren't vaccinated, and children die." Well, that's the natural course of things. No, it's not the natural course of things. And and those of us who grew up seeing, um, classmates who had polio and who were in crutches all day, those that might, I mean, I never saw anybody in an iron lung, but that, you know, I certainly knew families that had their their children in in iron lungs. It's a very, very, very scary time. And to walk away from from the WHO in the way that that we have is scary. We, we, America needs to be a leader in in the public. Go. Any, what do you think? I agree with you. And I think one of the things, and this gets into a lot of different things, and POS, you have to remember, Rick and I are from the generation. We had civil defense drills for nuclear reactions where we would hide under the desk. That's what the drill was. I'm seriously. You would go under the desk when you see a flash. Duck, right? Duck and Cover. I'll be, I'll be amalgamated with the wood from the desktop and the metal legs, right? So there's a couple of things here. One of the things to me, and I see this also not just in terms of politics, but with the influx of new technology, and where I'm going to this is, you guys have all, you heard me this at a number of dinners at Harvard. It's an honor and it's a privilege to be a healthcare provider. And whether you're a dentist, a nurse, or physician, do no harm. And I think one of the things here is like with new technology, okay, it works eight out of 10 times, but what happens to the other two times? Right? You, you've got to, you've got to make a cost-benefit analysis there. In terms of politics, I think again, as a healthcare provider, you have to be able to separate yourself. One of the things I've always said, POS, to people is this is a real provider. You treat the person who just came out of prison the same way you treat the CEO of a company on 128, okay? If you're able to treat those individuals in the same manner of compassion, you're a healthcare provider. But if you're obviously prejudicing against one of the other of those people, that doesn't meet what I consider to be a true healthcare provider. So I think what Rick's talking about is also the same thing with me. Is you have people involved in, as they say in Pat law, in the art, okay? If you're, if you're a clinician, this is dentistry and medicine, and you know what's real, I think it's incumbent upon you to share that evidence. I think it's also, I have no problem, Rick, this is so much fudged research. There's a lot of research that I don't use the term generally managed, let's say managed, okay, managed research, and you have to somehow be able to call that as it is, like, "Well, well, maybe there's some discrepancies here." Right? But I do think it's part of the honor that you take as a healthcare provider, Rick, to state what you think are the facts and the science. And we've all heard it, "Follow the science." And I, and I strongly believe in that.
What do you think, Dr. So for my, my point is, you're, I agree with both of you, of course. But, um, Rick, being also a pedodontist, you have had formal training at Children's Hospital. So you know that the importance of fluoride, especially for the younger population, in terms of caries prevention and so on. But, um, as you said, it's been in the water for 75 years. What do you say to those people who say that there are now alternatives such as, you know, external fluoride for a at-risk population as opposed to mass fluoridation of everyone, so that we could be more targeted to the people at risk as opposed to give it to everyone, even though the, you know, the parts per billion, uh, level that we have in water is entirely safe? The, the kind of the semblance of safety and so on seems to be everyone's on the edge, uh, the modern age. So what do you think about more targeted versus mass community fluoridation?
Well, it's really very consistent with all the other issues around access to care. When when we talk about targeted, we're talking about targeted the families that have an understanding of of the role of fluoride, of the role of of oral care, of the role of of regular toothbrushing, um, and flossing, and so on. That's a limited population. The value of community water fluoridation is that everybody gets access to it, no matter what. Um, and you don't have to go out. People have to make choices about buying toothpaste or about buying new toothbrushes, about buying fluoride, about, um, going to the dentist. I mean, those are all of the kinds of things that we think about in targeted approaches. Um, but it really is an overall access to care issue in a way that that having community water fluoridation, everybody in the community gets access to. And, you know, you can target the other way as well. You don't want, uh, for water, fine. I mean, there's bottled water, there's there's filters for to take fluoride out of water, you know, especially people who may be, um, pregnant or or considering pregnancy, you know, there are those filters there that that can remove it. But otherwise, um, everybody benefits from this constant washing of of, uh, fluoridated water, um, over their over teeth, um, that helps to prevent demineralization, provides for opportunities for remineralization, and in fact, um, interrupts some of the bacterial enzymes in the plaque that that that produce the acid.
Yeah, we all learned about fluoroapatite being so much better than hydroxyapatite and stronger. But it's interesting because I feel like there is a spirit in the conversation, and that's a spirit of, um, you know, the individuals who don't want it in the water versus those who really needed in the water. It's kind of the same argument as vaccination, right? It's kind of we're talking about choice, individual choice, but at the same time, it's individual versus the community. It's a fascinating conversation and topic. I guess it's, this is more on the, um, ethics and, uh, well, well, one of the things that also factors into this conversation, Ali, is that the other thing that we have in our armamentarium against caries is, of course, a dental sealant. But if you really look at dental sealants, there's a huge economic disparity. Okay? And so, you know, wait a second here, that group that doesn't have the economic means or the awareness for dental sealants, they're basically depending upon, as Rick said, fluoride. It's interesting. I guess one of the, maybe one of the last things I'll, I'll ask here, Dr. Valovic, is regarding the future of our dental education system. I mean, there's been a lot of changes, probably over your decades of experience. What can you tell us, and what can you tell the audience who's really interested to maybe play the game of, uh, predictions? What will happen in dental education that has never happened before in the next 10, 20, 30 years, that we wouldn't expect?
I think that everything that we could do, predictions of the unknown are related to technology. And we've just seen what's happened in in AI in just the last two years. I just think that that we can't predict what the role of AI is going to be in in providing care in the future, putting all this digital dentistry together, being able to to provide care, um, particularly on the diagnostic side, as well as the treatment side. But, but, um, that's where dental education has to be prepared. And I'm not sure if we're ready for that. I think we're still stuck with just introducing the individual components of new digital, uh, technology. I think that, but what, uh, is encouraging to me, certainly, is that this new generation is coming out of college and coming to dental school with, um, a better appreciation of the role that that AI and whatever other, uh, consequences of AI and and and digital. I think that what it's going to mean also is that much more of dental, dental academic experiences are going to be in the community. I think that we're going to have many more opportunities to work with FQHCs, um, other delivery models, um, private practices where students really gain an appreciation earlier on, uh, of what it's like to be in a, in a, in a private practice or a community-based practice or serving the needs of the community and being part of that. Um, and so, but predicting, um, is always difficult. But I think it's all going to be related to what happens with AI and and the digitalization. One diagnosis here. And or, let me just add something on top of what Rick, because I totally agree with what Rick says. One thing I totally feel, and I've always felt this way, every generation is bigger, brighter, smarter, faster. And the place you see that is obviously in a world of sports records. Uh, when when Rick and I were a bit younger, a four-minute mile was unheard of, and now you've got junior high school kids doing it. So again, every generation, so this gives you something up from the person sitting across from you today. Every generation is bigger, brighter, you know, quicker, faster, smarter. But one of the things I also think, I think, and it's a real concern for me, is the cost of dental education and the cost of running dental schools. And I think as a sequela of that, of that challenge, you, I think you are going to see more corporate involvement, uh, with corporations in dental schools going forward. I think some dental schools have to get away a little bit from this like sanctity of like, "Well, we don't want to be too corporate." Yes, there's a part where you, you don't want to be overly corporate, but I think if you look at some of the models in some of the other countries around the world, and I think with all this technology coming through, I think you're going to see a little bit more corporate involvement, Rick, with dental schools. I, I agree. And, you know, we've always talked about this delay between what might come out of a research lab or out of a out of a corporate research, um, laboratory. That that delay can't continue to go on. As you just said, it has to be better and faster, right? And much, much of what's going to be coming out from a from a delivery perspective, that's going to impact patient care, it's going to come out of the corporate wall, not out of what whatever NIH, IBSR, or other. And so, I, I totally agree with you that the, the collaboration, the pendulum swings always, right? And I think that that the pendulum is going to swing back, um, to, "We need to work with the corporates to get these new techniques, U, new procedures, uh, new products out much quicker." Than question. Yeah, that ADC meeting in Dubai, it was amazing. Billion dollars worth of transactions that occurred. You know, wow. Um, there's just so much, so much new, new technology and new opportunities. Unbelievable.
Well, Rick, this has been tremendous. Uh, I, this has been so thoroughly enjoyable for me, and it's, it's kind of nice to have someone, P and Ali from my generation where we can share things. And as you both are probably kind of stunned, Rick and I can talk. We, we like to use the term communicate parser, right? That's a nice term. But Rick, thank you so much for joining us. Uh, uh, for myself personally, this has been absolutely wonderful. Opportunities catching up with you all. All right. I enjoyed it as well. Thanks to all of you. Yeah, thank you, Rick, so much for joining us. And Parsa, Dr. Valovic, thank you so much. It was an excellent episode, and we hope to have you back soon, sir. Yeah, have a great weekend. Thank you. Bye-bye now. For you guys, make sure you write down below what, what you thought and what are some of your perspectives about the education, the future, and, uh, uh, any of your questions. See you in the next video. Okay, cool.
[Music]
A bright smile and wisdom spins facts and style.
Parsi dives deep with a touch of flare,
Through generations of dental care.
Root canals and life beyond the chair,
Culture and politics, we dare to share.
From molars to moments that shape our day,
We drill down deep in every way.
Turning pulp into gold with every word.