 Aloha and welcome to today's show the state of the state of Hawaii is today's show and it's on Think Tech Hawaii's live streaming network series Think Tech Hawaii broadcasts from our downtown studio at 1164 Bishop Street at the core of downtown Honolulu and it also operates remotely. I am your host Stephanie Stall Dalton and given our social distancing practices these days I am broadcasting remotely. Our guest today is Dr. Andrea Braun who practices general dentistry and serves as an executive dental coach for a fortune company to improve dental practices and services across the islands for Hawaii residents. Welcome Dr. Braun. Well thank you my pleasure being here I appreciate it. Great well and Dr. Braun may I call you Andy in this conversation having known you. Absolutely yes please call me Andy. My nickname is Dr. Andy. Andy's fine that's good. Great okay so for today's show titled Hawaii's dental community during COVID-19 Andy will tell us about the pandemics effects on the small business community of dentistry and according to the national data Hawaii is one of the hardest hit states under our circumstances of the pandemic and it ranks as number 15 in impacts particularly for small businesses there are major concerns about operations shutdown and the ensuing unemployment claims which in Hawaii have increased 4,000 percent since 2019. At the federal level the generosity of Congress's two million dollar cares act is a gift and also a problem particularly for small businesses to choose how to manage the funding as loans and grants in their best interests and often as the only means to their survival. Dr. Braun Andy tell us how your small business community Hawaii dentists and their staffs are managing COVID-19 challenges. What are the major issues affecting the small business community? Well I can honestly tell you it's it's been a whirlwind really since the middle of March and when the American Dental Association came out with their guidelines of just good social distancing and limiting your care to emergent care our dentists here really had to scramble to make plans and make plans fast and you know it's been a scrolling changing landscape that we've really had to keep up with on every level and we've been working with our close to two dozen businesses here that represent our health care community and dental providers all you know general dentists all the way to specialists and it has been just unprecedented and just really really intense so our first focus was really about our people because the teams that we work with are just like our family and so when we have to make really big important decisions that affect and trickle down all the way to you know our extended family of our co-workers that we spend more time with sometimes and we do our own families it's it's quite wrenching I would say is the best word I can I can describe how you know how the doctors have been feeling about all of this. Yeah go ahead sorry I don't want to step on it. I know you're allowed to take a breath there and I hope I didn't jump in too fast I was just wanting to pursue that and find out what are the major effects on these people and how are the employees feeling about the circumstances. Yes you know it's a two double-edged sword because we need to protect the business the owner and we need to protect the people and not have anybody get you know damaged too badly in any of this and so now that the CARES Act has really straightened out and we really understand it and we know what the provisions are going to be and how the government is working so hard and fast and furious to get the funds to the small businesses it's given a little bit more certainty to the teams so we you know a majority of the people are have taken laid off due to lack of work so they're on full unemployment or they're on temporary partial layoff at zero hours and our doctors have had to really work on identifying who their essential team members are because there's still business at hand there's still emergency patients that need to be seen there's all kinds of work to do behind the scenes of rescheduling and just you know on all the different levels of a small business and a small health care provider business you know between inventory and the financial engine we work around five financial engine five business engines and so all of those engines have to be have to be kept at a good idle a good strong idle in order for the practice to remain viable when they do open their doors so it's a lot gave that detail because that was one of my questions I know in some of the writings about this they mentioned how disadvantageous this is for other than law firms and other kinds of businesses where there's no issue with working from home you can do just as much from home as you can from the office and I wanted to ask you specifically and you did mention all of that how that and you clarified that actually there is still a lot to do in the office but not for all the employees so the ranch is who who are these essential workers who can maintain that position and then the question is do does the end do the income levels of the earning levels of the employees of dental practices are they high enough to compete with the unemployment offering that we have for people and so is that an issue for the employee as to whether they will take the unemployment because it will provide them with a little more income versus staying with you all so that they can assure they are kept on and return when you come back up what about that complexity the words how how do they are we back up yeah is that okay okay can you okay yeah something something froze up on us but anyway we yes we've been looking at that because there is a point at which it tips where the person would be better off or they extend the length of time on the full unemployment with given the fact of the you know the formulas that state of Hawaii has applied and how they figure out what the weekly unemployment is on a full unemployment and then you add the benefit of the $600 on top of that per week and so there is a there is a point in the hourly wage which are a lot of our workers fall into where they're going to be you know our doctors are are ready to have that conversation with the team members and so there's a lot of opportunity in this whole thing it's it's really making us think on a lot of different different levels and so when we when we do come back on board whenever that is you know it's going to be a kind of a titration effect because it's going to take a little while for us to be back we're back to the business levels that we were when we close down and so I mean in a lot of ways it's great that all that is there to support the team members that aren't going to be able to come right back the administrative team members the ones that are working the financial engines and the scheduling coordinators and and the people that are doing all the inventory and ordering and stocking are the ones that are you know we're going to be the busiest in the early phases and so and as we get close closer to a point in time where we don't have as many new cases or zero new cases for four or five six weeks then you know it's going to be it's it's going to be a different picture well in your case in the case of these small business practices are they going to have our dental practice is going to have the the good fortune to come right back up to a hundred percent or will there be and of course this depends on the state again too right if they're going to be regular rules or guidance on how to come back up but assuming you could do what you wanted to do would you be able to get right back up to a hundred percent therefore be able to rehire and just get on with business can you tell us a little bit about what your future there might be that's a really broad topic because a lot of this has to do with the education and the understanding levels of our patients so the communication about this and the safety that is going to be available for the patients and for the team is of the utmost concern and you know main main priority of all the business owners is to really understand this virus understand the working environment how can we protect the patients how do we screen the patients I mean the nature of this virus is so kind of betwixting because you know we have to assume everybody has it until we just don't have any more new cases pop up it's it's presenting opportunities in the clinical arena dentistry has always been practicing to keep everyone safe because we deal with aerosols all the time and because we're deal with blood-borne pathogens and we have to assume and all of our standards are based around people assuming they all have tuberculosis or hep C or HIV we can't assume anybody walking in the door has nothing we always have to understand all the health precautions and and apply them universally no matter who our patient is and so that way we kept everybody safe and so dentistry will rise to this occasion I have no doubt we have you know we have been really great at that in in all the industries we've been top notch in that and so I don't see this going to be any different except it may look different and feel different to the patient experience well I was wondering is this a factor that people will be afraid to come back I mean I don't think anybody's going to be afraid to go back to the lawyer or the CPA or the whoever's office they've got to get into but do you think that there's a factor of fear that people will have about in fact that you do all of that and will they be safe and is the community doing anything about that or is it an issue yeah right well I think it layers on top of all the other fears having to do with going to the dentist however I think this is a time for really clear and open communication with your practice if you do have concerns about how safe will I be you know that's the time to pick up the phone and ask and our practices are all over communicating at this point that's what leadership is we over communicate in times of crisis and so every doctor is reaching out to their patients and helping them understand you know when we come back it's going to be a very safe environment for you just like it always has been we might look different we might have different some different gowns on some different PPE masks you know our dentists have always you know you go to the dentist and everyone's wearing the masks and gloves and goggles and glasses and so they might be a little different style or a little little different standard or have different you know guardianship so or levels of protection for the people that wear them and and then turning rooms over will be you know probably something that you'll be more aware of and so that you know all of these all of these universal precautions that we're all going to be taken or based on CDC guidelines and all with this virus in mind and how we can protect each other from this I think what's really been missing I mean I think maybe they don't they don't have all the information yet but I am really excited about the public understanding more about this virus and how how can we keep healthy and so what will come I think in the coming weeks when the researchers really understand more and then they educate all of us we'll all have a better understanding of this well I'd like to probe into some of those precautions so what has this this what they call the novel a novel virus what has this forced other practices into doing I mean that it adds expense to the small business consideration and I'm sure we'll have to go on but I mean assuming that that the fact that this is so virulently transferred and infectious what what is it that you all are having to do from the inside here we've lived with coronaviruses in our world forever and they're pretty benign when they you know they they're they're the cause of most of our colds and flus and what not the one that makes this one so tough is that it you know it was a it was a benign virus in the animal world amongst the the bat population and then it somehow mutated and got to really like like human beings and it has really created I think all this havoc because it's so hard to know when someone's actually has the virus and so and it's and it's infectiousness because it I guess it you know it persists on surfaces or if you're in close relationship to a person then you know there's there's a bigger likelihood that it'll be transmitted so well what it's going to mean to dentistry is we've always been huge on surface disinfection whether it's the chairs and the handles you've seen all the plastic on the sterilization that we do and everything and so 10 tending now more in these interim phases I don't know how long this is going to have to go on but just working more with the aerosol and so there are techniques that we have will be putting in place much as what's come off of like the cruise ship industry where they've gone and disinfected all the surfaces and sprayed rooms and what not so all we need to do is aerosol eyes a room after it's been used or an aerosol has been created in it and missed the room so that whatever that that missed in the little chemistry inside the mist it's kind of likened to a saline aromatized aerosol eyes saline solution that just missed the room and pulls all of those any particles that are in the air down make some heavy and then the floor is cleaned so as far as there's going to be extra steps and then the PPE that is required is going to be a little bit more expensive for the doctors with the you know the different kind of coats and maybe even covering the hair the hair gear there's going to be you know hair covers that will you you wouldn't necessarily see you know 10 months ago on a dentist so it'll just I think you'll see that there were taking the extra precautions and yes there is going to be an added expense for all the owners and you know that likely will be passed on to the patient in some form just like you know in many other industries that have to take extra extra precautions whether it's hotel industry or restaurant industry we don't you know we don't really know how that's going to look well I know you the medical professions like at Queens or at the hospitals that aerosol that's a new notion anyway for me but that sounds very helpful that you can mystify or miss the room and have it actually take care of the particles and then you only have the floor that it needs to be antiseptically clean so what about your PPEs your all of your paraphernalia that you wear and the protective gear and everything has have the dental communities been asked to donate those to the hospitals here in Hawaii what's been the situation and why they had enough yeah part of the ADA guidelines that came out and said that you know basic general dental practices that are that are doing anything other than emergent care really that was the effort behind that was really to help flatten the curve and help keep PPE available to the hospitals and not be such a burden and not take you know that supply chain management of the PPEs whether it's your basic surgical mask and gloves and gowns and whatnot but you know there's going to be ongoing screening of the patients and so there's really great kind of protocols for you know if a patient really gets screened and there's absolutely no no risk based on their sheltering in place recently they haven't been traveling they don't have any kind of upper respiratory cough they don't have a fever and they pass all of this you know all those checkboxes are often it's going to look very normal for that patient in the dental practice versus someone who may have been a dental emergency but they think that they've had you know they've been exposed or been in close contact with someone who they know is positive or they've been tested and they have positive but they can't shelter in place right now because they have a bad toothache there's there's protocols in place to take care of those patients in a timely manner without creating you know without having to reinvent our wheel it's it's it's very manageable. Well I'm thinking that about seventy seven seventy seven percent of the Hawaii GDP the domestic the gross domestic product comes from local local business. So with the dentistry down and the this dental community this small business community down what portion do you have any notion of what section of depletion or how short Hawaii is going to be because of this industry being out because as I'm understanding it's pretty much out right. Is there recommending that yeah we're recommending our doctors start ordering now and honestly the dental supply houses and that supply chain that brings those to dentistry have been very great at communicating what's happening on their end and how what kind of expectations we can have on this end for finding those kind of equipment and the more time that goes on I think the easier that's going to be and so our our organization is working on that as well for our family of doctors that are being coached by us they are you know there they'll be different supply lines that'll funnel practice PPE to those practices as well so that everybody can open up and be safe and I you know I think the patients also when they're when they're experienced when they come back to the office they might ask be asked to do things like simple rinses they'll be they might have their temperature taken they might be asked to wash their hands they might be asked to bring their own blankets and their own pillows and their own headsets those kinds of things or their own you know just for their own personal comfort which really helps reduce you know the cross-contamination so but as far as the supply is we're gonna have what we need otherwise we'll postpone what we need to do until we have that have that well I think that everybody would love to be able to bring their own binky to come to the dentist and the comfort level would be marvelous but anyway I know you all are very good at doing that now compared to many years ago when tennis weren't so good with this chair side manner which has changed quite a bit but anyway I wanted to kind of go back to this gross domestic product thing so I mean with dentistry with with the dental business community going down and people are not coming in they're not they're not having the procedures you're not billing nothing's happening now I mean this is gonna be at least two months right I mean of that entire community in Hawaii that is a huge chunk isn't it of a huge chunk of money plus then you get to pay your taxes to the state and then they don't get those for probably these two months and so I wonder I was just wondering what cut if that was not really on anybody's mind probably that they're not gonna be paying their state taxes but I think the realization of how it is that a small business community is important to the state's economy and that this could but yeah you think about everything the impact of this not I mean we're just a small little emblem of a bigger picture and the trickle-down effect into this is just so critical because you know even yeah all these I mean the workers in dentistry are primarily women and a lot of them have children and they're in a two-income household and they have they must work and so now we're gonna have you know what's gonna be happening with all the you know with the childcare and all of those needs for for those you know for those young people and so we're just getting we're starting to think really outside the rail outside the box so that our community of dentistry can support our workers and get everybody back on board as quickly as possible in unique ways that that we're really we're really excited about and proud about and having really great conversations about so you know what the trite saying is out of every crisis comes opportunity but that is really really really true and that you know for patients too I mean the general public are gonna be there they're also not working and so well a great deal of them you look at the different sectors the hotel and restaurant business and the tourism business and people are gonna really they're gonna postpone postpone things probably in dentistry is one of those things they might also yeah we're coming back up to a hundred percent because this is something that people are not to offend our do we'll put off we'll put off going to the deficit unless they're in an emergency situation so so this could be a fact that way but alright so I wanted to ask about the the the effect on actually as you say primarily women who are you're not saying primarily there are women dentists because it's probably about even now right but the staff you know the hygiene I want to talk about the dental hygiene community because they have been extremely hit hard in this because even when the dentist if they open their doors again when they open their doors again it could be that they open their doors for restorative and they're they're triaging their patients as too well you put this off for now two months and now it's starting to hurt and and you you're screening really well so you're very low-risk you haven't got you know so you're basically just come back in and get get your treatment that you needed the hygiene department we're gonna be working hard at communicating with patients the importance of that full-body health and if they go without you know people that have chronic other chronic illnesses like diabetes or high blood pressure and the elderly or they have dry mouth and they're getting cavities I mean this this whole thing I think sometimes dentistry and the oral health takes a backseat to medicine it's just we see so much before any medical doctor does that we're really the sentinel for many for many people to you know raise the red flag and we really need to go get this checked out so I would just urge people listening to this to you know don't don't put off that that dental cleaning as soon as you're able to support your oral care and that way you know postponing a dental cleaning may sound minimal it's just there's a lot of things that can go wrong in a short amount of time so don't put a very tight community and describe it in familiar terms that people are really affiliated over it and so does that remove any issues about the unemployment so I mean if although it may be that your salaries are adequate or high enough level to keep people tanging on so to speak or waiting or willing to support the practice in that way with some sacrifice but if there is an unemployment check that would be more are the dentists concerned about that and would they check with them yeah definitely not you know with associate doctors on board and also dental hygienists being more highly compensated no way is the unemployment going to help is going to sustain them in the way that their own full-time salary would have or their full-time wages so it's really the more middle yeah it's more that maybe that 15 to 18 dollar range of worker that it would be the dental assistants or the receptionist and that category of worker that might have second thoughts about that and you know what this is a great time for people that might not be that happy at their job to go you know there's this is like I said yeah but it does seem like the dental community is is po that small business is a double disadvantage is that people are enduring but it's not but it's kind of balance it's not all all that is balance for the employer and the employee definitely yeah well it's it's been pleasure and very informative and we're out of time so we'll have to wrap it up like you said yeah I'm 70s still Dalton whenever so thank you yeah yeah I'm good I'm 70s still Dalton and this is the state of the state of Hawaii on think tech think tech live streaming network series and we've been talking remotely with Dr. Andrea Braun about Hawaii's dental community during COVID-19 I'll see you again in two weeks on the next state of the state of Hawaii Mahalo for your attention and aloha everyone