 Good evening. My name is Sonia Saluda and as Chair of the Ontario Section, it's my pleasure to welcome all of you to our inaugural presentation of the Dr. Emo Ryjak Ethics and Professionalism Continuing Education series. Before I introduce Dr. Jones, who probably needs no introduction to most of you, I would like to invite you during the presentation to type in your questions in the chat box. At various points throughout the talk, Dr. Luanne Bisconti will read out the questions to Dr. Jones so that he can address them. Dr. Richard Jones has a long and impressive resume attesting to a distinguished career in dentistry, in dental education, and in organized dentistry. But I will highlight just a few of his many achievements. He received his DDS in 1975 and certification as a Prostadontist in 1978 from the Indiana University and worked in private practice from 1979 to 2008. He is currently the ACD Foundation President and the ACD Immediate Past President, having completed his term as ACD President in October of this year. He served as the ACD Regent for Regency IV from 2015 to 2019. He is the past Chair of the American College of Prostadontists, the IDA Task Force on Ethics and Professionalism, and the Indiana Dental Association Council on Peer Review. He has been awarded the Ethics Award by the Indiana section of the ACD and the Distinguished Alumnus Award by the Indiana University. Current projects include creating this lecture for the Ontario section and in addition to contributing to our Ontario section newsletter. He is also co-chair of the ACD Strategic Planning Initiative and the 2024 ACD Ethics Summit on Interprofessionalism. And now, without further ado, I present Dr. Richard Jones. Greetings. Can you all hear me now? Well, first I want to congratulate the Ontario section on this innovative initiative, one of several, and it's a great honor to be the first speaker in Emo Series. He's always been one of my heroes. And I should, I wanted to introduce myself, although she read quite a lengthy bio. I established the first full-time private practice of Prostadontics in Indiana in 1978. And much of my practice was involved retreating things that didn't work out too well. My back lasted about 30 years. But I've managed to be unemployed without pay on the board of the American College of Prostadontics for 12 years, chair the Indiana Council on Peer Review for 35, and served the ACD for 16 in one measure or another. Well, now my life is a bit of a jumble. Oh, he's turned himself off. How are we now? Good. I used to design complex reconstructions like, like this. And like this, that changed people's lives. But now my main job is these two characters. But I also do this. And I've managed to blend my responsibilities. These are my three daughters that came to Houston with me. So our topic should dentistry be a profession. The advantages of dentistry being considered a profession. One of the reasons I wanted to do this topic was I think most dentists really don't appreciate the value of dentistry holding that status. Is it worth the restrictions that are in place for us to be a profession? Is it out of your personal control or might you personally have some impact? Do we have a responsibility? I'm a bit of an apology because I don't completely understand the relationship and impact of the Canadian government and the Canadian dental organizations on dentistry being a profession. I think that the status of the dental profession in Canada is quite similar to that in the US. And that's my area of expertise. First dentistry back to 7000 B.C. in the Indus Valley. And then French physician Pierre Fourchard, who's considered to be the father of modern dentistry, published his influential book The Surgeon Dentist in 1723. It was a treatise on teeth, which for the very first time defined a comprehensive system for caring for teeth and treating dental ailments. Well, dentistry was barely considered a profession. Attempts to improve training were noted with the establishment of the American Journal of Dental Science in 1839. That was followed a year later when the Baltimore College of Dental Surgery, which was the first dental school in the US, opened in 1840. 200 years ago dentistry was not so technical that a barber couldn't understand much of it. There have been rapid scientific and technical advances in the past 100 years. The American Dental Association founded in 1859, followed in 1867 by the Canadian Dental Association. The infamous traveling roadshow dentist, Painless Parker, who was born in New Brunswick, but graduated from a US dental school at Temple University in 1892, has been described as a menace to the dignity of the profession. The American College of Dentists was founded in 1920, and its early leaders initiated the noble profession of dentistry with standards for education, research and journalism. In 1923, the American Association of Dental Schools was established. The following year the American Dental Assistance Association was founded. Dental schools became university based after the Carnegie Foundation issued the Geiss report, a comprehensive report that covered the state of dental education. And that was in 1926. So the noble profession of dentistry was beginning to take shape. So what is a profession. It's a vocation founded upon specialized educational training. The purpose of which is to supply disinterested council and service to others for a definite compensation, fully apart from an expectation of excess profit. And it's granted autonomy or self regulation by the government and society by virtue of committing to a code of ethics. A profession requires a high degree of technical knowledge. That knowledge is too complex for an untrained individual to completely understand. The only way that the layperson can fairly relate to a professional is if the professional commits to a professional code of conduct that protects the layperson. So for instance, if you enter a transaction to purchase a car, you have the ability to understand as much of the process as the salesperson. And trust me, when I go to buy a car. I know exactly how much that car cost that company. If you require brain surgery though you cannot fully appreciate the technicalities involved, and you must rely upon the ethical conduct of the surgeon. In fact, industry has a contract with government society to self regulate. Because we've accepted the responsibility of self governance. We've been given the privilege of self governance. So only a trained dentist can understand dental treatment well enough to fairly evaluate the standard of care for that treatment. It's just an accurate to be judged by peers. Professional regulation typically comes in two forms. The professional organization develops interprets and enforces ethical and clinical standards of practice. In the US that's American dental association in their tripartite the state dental associations in the local dental societies. And the other component in the US is that professionals working for governmental licensing agency help develop interpret and enforce the law that defines the practice. But that's not really self governance, because it's a branch of the government of the government. So back to our chronology, the 1950s and 60s might be considered a golden age for the profession. By the 1950s dental knowledge and ability had advanced to a high technical level. In dentists had achieved high income, respect and community leadership opportunities. Professionalism was ingrained as a peer expectation. By the 1970s, dental insurance had become widely available. Access to care increased with an average annual insurance benefit of $1,000. It's interesting that 50 years later, that's still the average annual insurance benefit. Since the 1970s dental health insurers responding to the demands of their policy holders have attempted to contain the cost of dental treatment by among other devices limiting payment of benefits to the cost of the least expensive yet adequate treatment suitable to the needs of individual patients. Nevertheless, more families could go to the dentist. Dentists got busier and made more money. The number of dentists increased. PPO's came into being and peaked in 2011 with a 65% market share. As benefits decreased dentists dropped out as they were unable to run profitable practice. The Federal Trade Commission became more powerful in 1970 and began looking at professional associations for restraint of trade violations. Pressure from the FTC led to diminished professionalism and impaired regulation by state agencies and professional associations. This increased commercialism and dentistry. The door open for misleading and unprofessional advertising with claims of fake specialization and promotion of unnecessary and non dental treatments. One of my favorites are the certified weight loss dentists. They take a day long course. They use insurance codes and the technique to decrease the oral compartment by fabricating a false palate, which makes chewing slower, and that in turn, theory results in a loss of weight. There's at least two state boards in the US that have lost litigation and they now must allow hobbyists in non ADA accredited areas to claim specialty status. The ADA code has been altered for those states. Professional regulation has been undermined. The door open for over treatment and lower quality. Federal Trade Commission actions have contributed to making self regulation in enforcement of the ADA principles of ethics and code of professional conduct difficult to enforce. In the early 2000s, society had entered the age of untruth. Brassity was no longer an expectation. PSOs increased dramatically. In 1999, 65% of dentists were in private practice. By 2021, that percentage declined to 46. No doubt educational debt and cost of practice have contributed to the transition from traditional solo practice. This practice does provide economy of scale and cost sharing. Available hours for clinical care increase as does doctor efficiency cost of care and access to care or benefits. The commercial aspect of dentistry is stimulated by profit opportunities and by non dentist ownership. Generational differences impact solo practice is the priority of life balance increases. In the last century has seen an historic evolution in clinical dentistry. Evidence based practice expansion of duties for non dentists. Scientific knowledge. Technical developments like implants bone grafting digital dentistry imaging computer assisted design, just to name a few. Unfortunately, those same advances, advances can also be corrupted for personal gain. In 2030, an obituary was headlined. It read, it was a tragic day for nearly 170,000 North American dentists, their families, and the three quarters of a billion dental patients that they had treated. It was announced today that the profession of dentistry had died. It was an unexpected shock. The dentistry had long been revered as one of the most respected of all professions and was considered by business analysts as a healthy and profitable industry. Investigators have determined that dentistry had been suffering from a cancer like disease that had gone undiagnosed for four decades. And frankly the central profession was created after a long battle with huxterism false advertisers, uncredentialed training, fake degrees, and a plethora of dental treatment gadgets. It took many decades to establish accredited dental schools and the ADA and door specialties and for practitioners to incorporate evidence based materials and techniques into their everyday practice. The dentistry enjoyed the highest standard in the world. It took less than 40 years to undermine those efforts and revert back to the roots of barber dentistry. The autopsy report points the finger at the suit between the AMA and the Federal Trade Commission and the subsequent agreement with the American Dental Association. That agreement eventually had the effect of redefining dentistry as a business and emasculating the powers of self regulation. Misleading the public opened many opportunities. A small group of entrepreneurs discovered that by changing their mission from health care to profit, they could increase their personal income from the top 2% to the top 0.5%. This involved false advertising, over treatment and violation of clinical standards. Soon, corporate investor groups exploited the opportunity. In even established dental schools to control the curriculum. Naturally, other dentists gradually jumped on the profit bandwagon with the feeling that everyone else is was doing it. So should I threats of litigation cause state appointed regulators to back down from regulation. The professional organizations missed the opportunity to proactively defend dentistry from national trends and influences. National self regulation, declined to a state of virtual inactivity. The public was exposed to billboards, advertising painless dentistry, infomercials to crying the use of amalgam, unrecognized specialties, such as cosmetics, sleep apnea implants, non credentialed certifications and fellowships, free exams, dental ones, product sales, kickback, rewards to refers claims of superiority, prioritization of smiles and partial treatment over dental health and on and on. Painless Parker would be pleased with the dental retail industry of 2030. Professionalism was so gradual that the upper echelon of ethical dentists didn't notice at first. Even the guardian professional associations didn't notice. Later they feared litigation and did not want to lose members. Some councils on judicial affairs were disbanded for your relevancy. Then it was too late. The state for profit grew fake centers of higher learning spring up, and even for profit dental schools. The institutes charged high fees, but the presentations were glitzy, and the participants were given certificates, master ships and marketing packages, national television campaigns, and the promise of large profit centers. The bastion of professionalism had always been pure standard. But ironically, as organized industry didn't notice the tens of thousands were being taught to perform below the standard of care. Those practitioners increased in mass enough to actually redefine the peer standard. Eventually, all areas of oral health care focused on profit overpatient that included purveyors of continuing education, some dental manufacturers, some dental supply companies, some dental laboratories and some ancillary providers. It became increasingly difficult for honest practitioners to compete on an uneven playing field. They became disgruntled, retired early and encouraged quality young people to study other fields. Now that solo private practices become archaic, there's talk of replacing the current private provider system with a national health service. Society realizes that since they're getting ripped off with high fees and low service and the dental associations aren't protecting them, then low fee service might be okay. The professional associations will soon become small groups that commiserate about the past membership will shrink to study club size, because there will be no compelling reason to belong. Dentist income will shrink considerably as income will become standardized nationally, and they will compete with the lesser trained technicians in mid level providers. A lower standard of dental care will become acceptable. Respect for dentistry will decline, as it is no longer considered an ethical and learned profession. That's the end of the obituary and I'd like to know what you think about that future. So I'll open the floor for questions or comments. Dr Jones we do have a question, given the obituary do you see a way back for the dental profession and following on that. What key elements need to be present to bring us back as a profession. Well that's actually the crux of the rest of the presentation. So thanks for asking that question, but I won't answer it the second, but I will answer it. Do you have anything else. Not at the moment. Okay, so then back to 20. Yes. Oh, sorry, okay I don't know how to do this because I'm a computer Luddite so am I supposed to type in a question or can I just speak to you directly. At this point you can speak to me directly. Okay. Personally, I think one thing that one doesn't consider is people in general in this whole thing patients patients are not widgets. They start to realize when they're being handed something. And the other thing I also want to mention is the corporations tried on failed. I don't know what's happening with dental corp right now but it's headed down that I think it's headed down a rocky road it's $1.3 billion in debt. It's living in its business model that it has designed for itself, which now with interest rates going up. It's starting to run into problems. I also think that in general I don't think that these corporations will last very long, because people health care and business somehow does not seem to mix very well. Yeah, you're correct there are a number of indications that these DSOs have peaked that they kind of exhausted their plan. But I am going to address some of those points in a few minutes. Okay, thank you. Thank you. So back to 2022 dentistry is at a fork in the road of professionalism versus commercialism. There's always been a marriage of clinical care and business management, much like two lanes of a highway each headed in the same direction, but diverging and converging at various times into varying degrees. As a respected profession the emphasis has been on patient care. The economic changes have favored the business side of dentistry in the last 40 years. During that period the lanes have diverged, and I think have become an actual fork in the road. Different dentists have favored one lane or the other, since painless Parker. Certainly the 20th century saw prevalence for the lane of professionalism. I don't think so much in the 21st century. I do think there will always be a patient type for every doctor type. So if you're highly professional. I think you'll always have patients in your practice. We have only to look at the United Kingdom with some dentists working solely under the national health system, but the vast majority are in private practice, some of those mixed their private practice with the National Health Service. So there'll always be dentists who choose to serve as professionals, and they'll be discriminating patients that choose those dentists. I think we'll always observe an ebb and flow of three populations of practicing dentists. The upper echelon of professionals. And I think that's who's on tonight will focus on patient care and professionalism, the lowest and most commercially focused group, and then the largest middle population. The dentists that enjoy the protective aspects of belonging to a profession, but are focused on economic realities. So the big question isn't this most noticeable low group. The big question is what happens to this largest population of dentists when professional status is lost. Unfortunately, commercialism is here. Dental aesthetics is an important consideration and all dental treatment, but it's not acceptable to isolate aesthetics from the other aspects of professional treatment form is intimately related to function and longevity. And it's the dental professionals responsibility to maintain that relationship cosmetic cosmetic dentistry risks, the mockery of dentistry as a profession. It's about a quick smile enhancement with the subrogation of the other aspects of dental health. It's the antithesis of holistic dentistry. The uninformed and professionally unsophisticated dentist is being preyed upon by national forces in a dramatic and pervasive manner. It must be true or they wouldn't allow it to get away with it. This space implant company had its mission changed corporate greed level in an effort to create more demand for sales. They designed a system devices techniques and marketing strategy, so that an oral surgeon who's a non restorative dentist furthest removed from occlusal concepts and restorative treatment planning than any other dentist should diagnose the need for treatment and place the implants capture the impression and send it to the laboratory for fabrication. The dental laboratory is placed in the position of making it work without seeing the patient of being trained in the multitude of biologic factors. The family dentist who may well be an implant novice discovers that he can make money by allowing a non restorative surgeon to supervise restorative reconstruction on his patients. Then, another example is the all in one place implant ads that you see on TV with the attractive actors with natural teeth pretending to have replacements. And if it wasn't okay, the implant company and the dental organizations wouldn't allow it. Please don't get me started on the ethics of selling all on four systems at great profit without offering overdentures at a fraction of the cost. Commercialism is here and implant dentistry and cosmetic dentistry and group practice dental manufacturing companies and dental supply companies and purveyors of continuing education and throw away journalism and social media as the new source for clinical guidance. Can ethics or science maintain the balance. Is it too late. If the world outside of dentistry ever suspects that dentistry is not a profession will external factors control the balance. Society has changed from the loyal trusting public. The doctors with awe and respect to a suspicious and litigious group that expects someone else to be responsible for their problems. Society has become commercial and greedy. Some have come to accept baloney advertising is credible. Some know that it is buyer beware, and they're on guard. Of course, that makes it difficult for a true professional to motivate for a needed complex service. Society is subject to fads like cosmetics and believes them to be more important than comprehensive care. Society's already discovered that they can tell the dentist what to do. The dentist respond favorably to that opportunity to make a quick buck. In other words, you give the patient what they're asking for instead of what their health requires. Society is susceptible to direct marketing of products and techniques. Society has begun to notice the change from a selfless profession to a production based retail industry. This change is understandable, but it does make it difficult to provide quality care in a reputable manner. Government helped redefine marketing in dentistry or perhaps open the floodgates when they decided to redefine self regulation as restraint of trade. That new interpretation of dentistry as a business may be the similar event that will result in the death of the profession. Professional practice has little need for marketing beyond correct announcements, patient satisfaction, and word of mouth. Government intervention has encouraged commercialism and business competition, which in turn have spawned misrepresentation. There's great financial incentive to mislead the public into believing that the fake initials after your name or the fabricated certificate on your wall are legitimately recognized by the professional association. There's a financial advantage in the deceptive practice of marketing superior skills, exaggerated training, fake specialty status, and painless dentistry. People will believe that you are the only one or the best specialist in implants or sleep or TMJ or cosmetics, if it's in writing on a billboard or on TV. They will assume that it's true or the dental association and the government wouldn't allow it. It is unfortunate that government doesn't understand dentistry or appreciate its importance to not only oral health, but critically systemic systemic health and the productivity of the citizenry. The learned professions are too complex and sophisticated for legislators and bureaucrats to micromanage and expect the public to benefit. When the government considers that a profession is a trade in undermined self regulation, the profession eventually becomes a trade in the public suffers. Government society have begun to notice the changes in dentistry. Dentists have dropped from number two to number five in the Gallup opinion poll of public trust on professions. They see the emergence of the retail model, and they see the decrease in self regulation. They never understood the profession of dentistry. They trusted us to understand and control. Now they realize that the government society must exert influence in increasing control over the business of dentistry. Treatment services have been unitized and standardized and priced accordingly. At least two state agencies have defined dental specialty with a total disregard for academic or American dental association standards. Generational changes in society and in dentistry has significant impact. There's less loyalty towards institutions in greater cynicism. Lifestyle balance and tolerance for delayed gratification is different. Communication styles may be different enough to impact collegiality mentorship. In the past the dental association provided a formal bond between dentists. And now that collegiality, or back then that collegiality was a powerful informal bond that facilitated mentorship and peer pressure. As dental peers become less similar in more distant conformity to previous paradigms diminishes. Mentorship is a powerful tool for learning clinical dentistry, practice management and dental professionalism. Mentorship has traditionally been a key component of a professional dentistry. It was hardly spoken of and often taken for granted. Mentorship has suffered greatly for a complex array of reasons. Generational differences in communication, loyalty to institution life balance, work goals, etc. Have compromised relationships between the old fogies and the young brats. New practitioners with huge debt and feeling underprepared for the dental world of 2022 desire mentorship. They are often being mentored, but often by self proclaimed institutes, emporiums of continuing education and dental businesses that offer employment and systems. They are also mentored by manufacturers and dental supply companies that promise personal wealth, but actually seek corporate wealth. They are mentored by slightly older dentists that have themselves been seduced into thinking that dentistry is a business and not a profession. It seems that the classic mentoring pattern of young dentist, old dentist is changing to a pattern of new dentist financially successful young dentist, or new dentist promises of wealth, or new dentist corporate management. Mentorship may well hold the key to the future of dentistry. Young dentists might well question the origins in virtues of the profession of dentistry. They might go back to the roots of a great profession to discover why they have a great opportunity and what they need to do to preserve that treasure for themselves in the future and for patients. Associations provide great service, but the larger they are, the slower they adjust to change. Associations do not want to lose members, and they choose litigation issues very carefully. The ADA relies on their state and local dental tripart organizations to self regulate, but the local society seem to rely on the larger group to take the lead. There's little proactivity. Change is so gradual that by the time it's recognized, the new status quo becomes acceptable, and perhaps becomes a new standard. Now is the time to make clear statements of standard of care. Continuing education used to be a proud system of disseminating valuable knowledge. It involved teaching and learning. CE has become big business with orientation toward profit. The employers of CE have discovered huge profits with policy presentations that promise big profit for the practitioner. But too often the expensive products that are sold at the emporiums of CE have the same level of value and integrity for the practitioner, as the new procedure has for the patient being overpriced, overutilized and underneath it. They really need a cheaply made and expensive false pallet to lose weight. Well the practitioner now has a fake certificate, initials to use unethically after their name in a marketing package, and a promise of a great profit soon. It would be helpful to the busy practitioner. If the dental association were able to endorse certain educational programs as representative of a standard of care, and based upon the evidence. They would be able to use the technology in gadgets or display displacing diagnostic and technical skill. There's no question that technological advances like anesthetics implants advanced restorative materials and digital dentistry have made measurable contributions to dental health care. There is a risk that the person purchase of an expensive gadget obliges its use and might even drive the treatment. There's also a risk of believing that if the technology is high tech enough and expensive enough, it will compensate for operator shortcomings. Technology is no better than proper diagnosis treatment planning and accurate appropriate implementation dental manufacturers and supply companies used to be the oral health care team with a mission to advance dental care for the patient. But some have been seduced by commercialism and greater profit. Why sell you an inexpensive scalpel and support proper training when the profit from an expensive gadget is so much greater. Your dental supply rep, used to provide evidence based support for clinical care. Some now pressure you to borrow money for the purchase of the device to your in order to make more profit and keep up with the race for the million dollar net practice. The dental trades have a great opportunity to help the young dentist and establish a career long partnership that benefits all, including the patient. They can be the first line source of evidence based dentistry corporate dentistry and group practice with remote business owners is a new concept. The traditional paradigm of the solo practitioner generated a compensation for effort and investment in education and practice, equal to 40 to 60% of production. We mistakenly call that compensation profit in the business world that level of profit is incredible. Understandably, greed drew attention to dentistry in the business world sought a piece of the action. It's not unusual for the young dentist to now receive a compensation equal to 20% of their production, and that hardly compensates for effort and education. The dental business model can enhance corporate profit by controlling quantity and quality of treatment and adjusting the doctor and auxiliary compensation. There is financial incentive for the dentist to manipulate the dental system in order to increase profit. When that manipulation occurs, dental ethics suffer and the system spirals down further. The development of an assembly line production quota model makes sense to a non dentist treatment may not be planned by the treating doctor. A specific time may be a lot of for a certain class of restoration, which is expected to produce a certain profit in a specific time. The due pressure incentives may be placed upon the dentist worker. The doctor may be treating a patient that they have not examined and will never see again. Does this system makes sense to a professional health care provider, a learned doctor or a trusting patient. And does this dental worker still fit the definition of a professional group practice can be a good system for the patient and for the dentist. The dental association, the ethical concepts in the legal and regulatory paradigms had not kept pace with the evolving paradigms of practice, and they must be restructured. Academia has always been part of the learned professions, but it's now been tainted by commercialism. In the past, the state dental college received adequate funding to fulfill an altruistic mission of training the best health care professionals for the citizenry. Legislators, legislators in universities have reduced dental school investment. The mission of educational institutions to operate at a profit pervades the system from the top down. The mission to create profit affects curriculum and teaching methods dental education squeezes an influx of technical developments into the same four years. Another knowledge is displaced with a financial pressure to minimize costs. Case can be made that because of curriculum changes. This is more desperate for information to be more successful, but is actually less equipped to evaluate sources of information. So clinical guidance sometimes comes from social media sites and picks up they pick out the ones with the most hits, instead of the peer reviewed literature. Young dentists are beginning their professional business careers with unprecedented school debt, unprecedented setup costs and unprecedented expectation of earnings. Do they have the luxury of preferencing ethics over money. 20 years ago the Enron scandal made it clear that conventional professional standards can be compromised by financial pressures. There is societal pressure that places financial success over all else that's important $200,000 is not enough. I must make 2 million. It has traditionally been based upon the paradigm of the solo or small practice group the small group practice. It's wonderful to personalize your practice to fit your mission and vision and personal values. It's a great privilege to independently make decisions about the best treatment for your patient and the best environment for your team and still earn a comfortable that's in the top 5% with the highest respect in your community, a $300,000 school burden with a million dollar buy in might well discourage the traditional dream of private practice. It's easy to make the case that financial pressure forces the dentist to be commercial. The dentistry is at a fork in the road. Some manufacturers, some supply houses, some purveyors of CE and some publishers of non period literature are becoming wealthy at the fork in the road. The face of dentistry is changing rapidly. Maybe boomer population is retiring. It's being replaced by a generation with different financial realities, different stress factors, different communication styles, different core values, different motivational factors. The professional memory is being lost. The bodies of evidence and professional standards are becoming less relevant. They are oblivious to the envelope of professional standards being changed. The younger dentist may not have the historical perspective to notice the fork in the road. The new peer standard will redefine the practice of dentistry. Soon, it will be too difficult to turn around. Eventually, the government and consumer groups will discover that dentistry has changed, and they won't like it. They don't have a convention for right fork versus wrong fork. So I'll stick with the left fork for dentistry as a retail industry void of required professional principles of conduct, ethics and rigid standards of care. So what is the appeal of dentistry as a business and not a profession? Is it just money? Well, there are certainly benefits of autonomy of practice. You can practice any way you want. There's no intervention by those with peer knowledge. So you won't be judged by people that understand what you're doing and have expectations. The universe of advertising is opened up to you, misleading advertising. There will be an increased spectrum of treatment options with little need to invest in evidence-based dentistry or continuing education. There's the ability to emphasize business efficiency and profitability over optimum clinical care. Excuse me. And of course, there's a benefit with the anticipation of increased income, at least initially. It's kind of established that a young dentist signing on to a DSO will make more money initially, but over his career they'll make less. But what will be sacrificed if dentistry is no longer a profession? There will be increased regulation by government, and the government won't understand what dentistry is about. There will be a loss of a political action and lobbying representative with government. You'll be on your own. Judgment by those without technical understanding, loss of technical competence and respect, loss of the personal doctor and patient relationship, increased litigation, loss of collegiality, loss of protection from unscrupulous dental manufacturers, suppliers and providers of continuing education, increased competition, eventual decline in income as patients become more wary. The right fork of dentistry as a profession provides substantive and altruistic benefits. The income brackets for almost all dentists in the top 10% of the population, with a majority in the top 5%, in many reaching the 2022 U.S. 99 percentile of $400,000. Dentistry being a profession provides opportunity for great clinical care, vast and intentional academic and research support, professional organizational guidelines and support, professional organizational representation with the government, less governmental intervention than in the wild west of the retail marketplace, control of competitive stresses, enhanced personal doctor-patient relationships, respect in the community, community leadership opportunities. It also provides the opportunity to feel really good about the service that you provide and how you enhance the lives of others. And also to treat generations of the same family and to even get Christmas cards. And I have to tell you anecdotally, I haven't practiced since 2007. Every year I get a Christmas card from a patient I have not seen since 1985. The shortcomings of being a member of a noble profession are quite similar to the benefits of not laboring under the structure of a profession. I think a good illustration is the dynamics of children and a divorced family with one parent providing structure support and guidance. The other parent provides freedom and access to a broad base of social options. The latter provides immediate gratification, but the maturing child comes to realize the nurturing and promise of a successful future comes from the value-based parent with structure and consistency. Structure is an essential attribute of a healthy community. We are in a new normal caused by socioeconomic factors, which we don't control, but we can impact them. What doesn't kill us makes us stronger. There's always a new normal and often accompanied by an uncomfortable transition. It was great when my parents transitioned from a telephone party line to a private service. It was easy to adjust to air conditioning. Xylokane is much nicer than Novocaine, but TikTok and the need for preteens to have $1,000 iPhones has been painful for me. I understand what my parents went through, and I must remember what I was thinking when they were shocked by change. Dentistry has always been a marriage of clinical care and business management. The good and the bad are maybe the necessary. Painless Parker conjures terrible images, but if you read his biography, it was not all bad. Some of his unpopular initiatives are now mainstream, like patient advocacy, increased access to care and advertising. The new normal includes advances in communication, expanded access to care, cost sharing, volume purchasing, decreased fees, increased salaries and profits, enhanced auxiliary support and access to expensive technology. Of course, there are some painful aspects to the new normal. And those painful aspects can be managed by confidence in the mission and belief in dentistry as a noble profession. Why are we here? Why are you here? My paradigm of professionalism is so strong that I have difficulty imagining dentistry as a purely retail industry. But my observations of some practices in my logic, logic paint a dismal picture, as foretold by that mythical obituary that I read. Provision centers, all natural care, cosmetic care, Botox, cellulite removal from anybody part, nail spa, ambulance chasing, hucksterism, quack treatments and over treatments, reverting back to a painless Parker concept in the high tech world. The little concern for the patient is more than an opportunity. In no thought of ethics or professional behavior, cutthroat competition, went a trip to Cancun or go to Cancun for your implant treatment. What can be done? What are our options? Perhaps we could get angry, resign ourselves to the inevitable, walk away, or go to the other side, play for the other team. We could respond with value based intention and focus. We may not be able to impact the most noticeable lower commercial population. But we can empower the upper echelon and we can engage the largest middle group. The CCD can guide us toward the right work and salvage the profession and dentistry for patients and those who follow us. The college executive organization, the section leadership, and the individual fellows are the disciples of the profession that do have the ability to enhance excellence, ethics, professionalism and leadership. The college provides publications, the ethics handbooks, scholarships for ethics and leadership training, support for the sections, strategic guidance with initiatives regarding diversity, relevance, communication, group practice, professionalism, interprofessionalism, ASD, the American Society for Dental Ethics, AADJ, the American Association for Dental Editors and Journalists, and SPIA, the Student Professional, Professionalism and Ethics Association. And also the college provides outreach to other organizations. A strategic plan for an unknown future of the profession has already begun. The report should be in in July. The college also provides connections, connections to regencies and to sections, but also connection to other entities in healthcare. In fact, we have a history of identifying problems and activating the appropriate groups to action. What can SPIA do? The Student Professionalism and Ethics Association is the discipleship of the future. They are tri-lingual with digital and social as native languages. They understand their peers, the pressures, motivations, communication styles and values. SPIA connects with the college. We engage and empower one another. SPIA members can do what disciples do to create positive change. Remember I talked about the three populations. SPIA leaders are the upper echelon. Do not focus on the loud extremes of the low population. We can't do anything about them. But we can engage the large middle population. Educate your peers as to the advantage of dentistry as a profession. Engage and empower because you can make a difference for the middle group. You need confidence and mission and purpose. So what can we do as individuals? First, begin with yourself. You might be familiar with the six expectations of the professional from Ruel and Babu. First, acquire the knowledge and skills of the profession to the standard set by the profession. Second, continue learning as new advances in technology emerge. Third, put oral health interests of patients before self. Four, abide by the profession's code of ethics. Five, serve society, not just those who can afford your care. Six, participate in personal self-regulation. The monitoring of the profession and participate in professional associations. Next, look to the future by nurturing professionalism and others. The responsibility of mentorship should be number seven on the list of expectations of the profession. Let your association, join your associations and study clubs and let them know that you value professionalism. Educate your patients about our code of ethics and professional conduct. And encourage them to walk away from dentists who do not measure up. Know that you can have impact. Know your core values. Know to which of the three populations you belong. The upper echelon, the largest middle group, or the low. Understand the significance of dentistry being or not being a profession. Acknowledge your role, potential for impact, and also the butterfly effect. Live in practice as an exemplar. Engage your dental community. Start a study club or a lunch group. Engage other communities. Engage another generation through support and mentorship. All of us choose and have the ability to act. Collectively, our choices impact the status of dentistry and society and government and allow us to enhance oral health for patients in our community. Dentistry has always been a marriage of clinical care and business management. The respected professional enjoyed a high income without optimal business practices. New systems for clinical delivery and practice management, increased quality of care, access to care, cost of care and profitability. I don't know if we're still a profession, but I'm not ready to give up. I know that it's important to be a profession. It's important that the lowest common denominator be ethics and not money. Being a profession protects the public. It satisfies the government and civic groups. It enhances the image of the professional population. Being a profession creates an environment where dentists can focus on providing good quality evidence based healthcare in a profitable way with less external infringement. Our time is limited. We use it providing good care, running a successful healthcare business, or dealing with public and governmental onslaughts as an individual. In other words, if a group abides by a code of ethics, the government and civic groups can have confidence that the professional association will protect the public. It becomes a non-professional business. They lose their protective covenant with society, and that affords them the luxury of self-regulation. Weighing the advantages of being a respected professional healthcare provider with academic research and journalism support from my organization and a high income against being a wealthier retailer in a competitive marketplace without organizational enhancements leaves me with an obvious path, the right for it. I know we can do this. The ACD, SPIA, academia, our associations, the upper echelon, and the large mental populations can do what is necessary. We must be intentional and purposeful, but we can. I'm doing something about it. What will you do? Thank you. Dr. Jones, if I can figure out how to exit. Will, can you cut me off so I can take questions? Thank you. Dr. Jones, we have a question. Are you aware of any jurisdictions that are bending the curve from this prognosis and actually putting the profession back on the right path? And if so, what organizations are leading the charge in those jurisdictions? Thank you. I don't think that we're going to get very far if there's only one entity doing something. I know that there are at least a half a dozen states in the US that actually have active council on judicial affairs that review ethical violations, and they're pretty aggressive about it. Michigan, for instance, is one of them. I'm familiar with them because they were, they're in our Regency. But they actually actively evaluate ethical violations. Now, my own Indiana does not. They don't even have a committee that does that. So regrettably, that's an area that needs work. But the limiting factor has been the Federal Trade Commission, at least in the US, because when we, when the associations get a little bit too aggressive about saying your billboard is inappropriate. You will not only sue the association, but the Federal Trade Commission will accuse the association of restraining trade because they don't understand dentistry. Okay, we have another question. Do you think that mandating courses on ethics and professionalism is valuable in addressing this issue? Well, absolutely. You know, a course on ethics and professionalism isn't very sexy. A practitioner would likely prefer to take a course that's going to put money in their practice, or maybe improve the quality of their care. So there isn't a great deal of appeal for many dentists to take an ethics and professionalism course, and yet the value to the society and to citizens in systemic health is undeniable. I actually think it's best when government requires that professionals take ethics and professionalism courses every year. But do you think that if you're mandating it, it's being internalized? You know, people will take it because they're told to take it for their license, rather than putting it to practical use. Are there other ways that we can do this? Well, I think I listed some of them, and one of them is for you to realize that you can be a disciple, and you can not only live and practice as an exemplar, but you can start speaking out. You can create study clubs, join clubs, invite others to join, and create an excitement for professionalism, and talk about the benefits of practicing well. You know, you can't, the educators have learned that when they're bringing in new students, they've tried to figure out how to measure ethics, and they can't do it. You just can't do it. So to answer your question about internalism, you can't force it down someone's throat, but surely exposing them in bringing a group together that creates a certain level of peer pressure has got to be a step in the right direction. I don't see any more questions for you, Dr. Jones. Well, that's probably good because I think I've run over the hour. But I will finish in a very classic way. I want to want to make myself available to you, and you can memorize my email address the first two letters or I am the abbreviations for Indiana where I live. And the last five letters are Jones to any S because that's my name, and it's at like any email, aol because I'm old. So it's I am Jones at aol.com. So feel free to contact me anytime with concerns or ideas that I can pass on with our discipleship. And I appreciate you having me tonight. Dr. Jones is Brenda Thompson speaking here. I want to tell you that was an absolutely brilliant presentation tonight. 100 million photos of this. I'm going to go over the recording but I think the type of information you presented to us tonight is exactly what we need to present to all the faculties, and to all the young dentists and all the middle dentists and all the antiques. And I think it was brilliant and thank you very much. Thank you Brenda. Thank you. You're too kind. Thank you Dr. Jones for the very interesting and thought provoking president presentation. You've given us a lot to think about and act on. And we all want to thank you for that. I would like to thank. I did have one comment. I'm sorry. It just came in. And it was as you have to be a rep. Your presentation this evening Dr. Jones was very timely. They have dealt with some very discouraged students last week and they would benefit from your message. So available. And were there any other comments. That was interesting. Thank you. And Sonya I believe mandatory courses are a must and they must be done on a par above all. That was from our region. Terry Norris. Well, I agree. I would like to thank our corporate sponsors. Be more private wealth and Roy Corp. It's through corporate sponsorship that we're able to expand our continued education program to the benefit of our fellows and increase our financial support of SPIA student professionalism and ethics association. The dentist of our future as Dr. Jones just said. It's a three hour presentation on January 18. It's a three hour core one featuring Dr. Lino Lincoln's key speaking on bias and clinical decision making registration will commence during the holidays so please look out for that. And register early as we're limiting registration to the first 100. And continue education service certificates for tonight's presentation. They'll be emailed to you at the dress that at the address that you use for registering for the course. Thank you for your attention. I look forward to seeing you at our other presentations throughout the upcoming year. Good night, and stay safe.