July 8, 2011
One year into operations, and they’re just about up to speed at the UW’s Center for Pediatric Dentistry, a joint operation between the UWSoD and Seattle Children’s hospital, located in the old Navy base at Magnuson Park. The Center has the potential do great things for a surprising mix of populations: children in need, of course — but also for dental students and residents, and the families of staff from both the University and Children’s. And the research potential of the facility is out of this world — literally. Think: Star Trek-style scanners and more. At the helm is Dr. Joel Berg, the visionary pediatric dentist who worked doggedly to make it all happen. Perhaps surprisingly, Berg’s business acumen was a key factor in making it all happen.
The road to Seattle
Berg always envisioned himself as a pediatric dentist in academia, but took a nine-year detour into private industry after his first job at the University of Texas, cutting his teeth with two major dental companies — ESPE in Germany, and later, Philips Oral Health Care here in Washington. The business skills he learned in those positions served him well in developing the Center for Pediatric Dentistry, where communication, vision and persistence were keys to pulling the project together. At ESPE, what started as a consulting position to help with clinical trials of a middle ear device using glass ionomers became much more, says Berg “I had experience with clinical studies at the university and was able to facilitate their needs. I was then asked to head up their American scientific presence in the US.” Obviously impressed with his work, ESPE later tapped Berg to helm their worldwide scientific presence in Germany — the only American among 1,000 Germans, heading a department with 30 PhD scientists. While still at ESPE, Berg got a call from a indefatigable headhunter for a position very similar to the one at ESPE, only this was in the US. Her persistence paid off, and Berg spoke with the company’s CEO — David Guiliani, founder of Sonicare — who convinced him to come back to the states as the Chief Clinical Officer for Philips Oral Health Care in Snoqualmie, Wash.
The Philips gig required Berg to develop and flex new muscles — he was managing their clinical studies, professional relations and interactions with dentists – but because it was a consumer product, he also had to understand and develop ways to reach consumers with oral health messages through various media, like television. Those skills would be invaluable when he came to the UW, according to Berg, “When I think of my experiences in the industrial sector, perhaps most valuable were the connections I made – with chairs of departments and deans from all over the world, most of whom I am still in contact with today. I also learned how to reach consumers with oral health messages through the power of advertising and promotion — the things that we struggle with in trying to get patients to change their behaviors every day. I learned that by cooperating with partners we could accomplish a lot more.” Case in point: the Center for Pediatric Dentistry, where relationships between the university, Children’s Hospital and major donors had to be carefully orchestrated.
In 2003, Berg left Phillips to become the chair of pediatric dentistry at the UW — a position so compelling, he says, he would have moved anywhere to take it. Then in 2006, he added the title of Dental Director for Children’s Hospital to his CV — that model, holding two positions simultaneously, is fairly common nationally where the chair of an academic department at a university is the dental director at the hospital. Children’s is private, but all of the physicians and dentists are appointed at the UW academically. Once at Children’s, Berg began to identify common needs of the two entities, saying “We knew we needed a place for a faculty practice, someplace to merge those patients who were historically seen at Children’s, along with the otherwise healthy patients at the UW. We needed a larger training center – the one we had was not adequate to meet our training objectives, and it was outdated. And, we needed better technology and a better way to do research, too.” The devil was in the details, however, and one factor played a surprisingly important role in determining the facility’s location — parking. Berg explains “In pediatrics, parents often come with whole families in tow, making parking essential — moms with babes in arms need to be able to easily make their way to the clinic, so parking must be plentiful, easily accessible and cheap, or free — coming up with the money to pay for parking can be a challenge for poor families.”
The vision for the center evolved as a solution for all of these separate issues, but before anything could happen, there were scores of points that needed to be addressed — among them, who would be the primary manager of the facility, what business model would be used and where they would house such a center. Of course, the challenges of bringing two big organizations together were many. First and foremost, however, was finding the location. Berg remembers the first time they showed him the formerly dilapidated building, “When we first pulled up, the place was pretty beat up – most people thought it would be impossible to have a pediatric dental center here. And to be honest, I wasn’t looking at the building too much – I was focused on 1,100 free parking spaces a block away. I said ‘We’ll take it…’ and then I looked at the building.” It was a mess — unoccupied for 19 years, it was rife with asbestos, had water dripping from the ceiling, and looked terrible. But, it had the space that they needed, and though there were some constraints (the building is historically protected, meaning the outside could not be changed), Berg knew it would work for them. With a lead gift of $5 million, they were able to move ahead with the project. Not that they were out of the woods entirely — there were challenges convincing all parties that it was economically feasible — at $21 million, the renovations were very expensive. In the end, the finished under budget and increased the size of the school of dentistry by 17 percent in one fell swoop.
Not quite a year later, Berg is enthusiastic about the Center’s progress to date. Their goal of a 30,000 patient/year rate (120 patients/day) will be achieved in September, and surpassed next year. “We’ve been very careful, “ says Berg, “We could have seen that number two months ago, but we wanted to build up our infrastructure and systems before doing it. We have all of the same logistical issues a big practice would have — so we ran lean in the beginning, staving off the expenses until we had the revenue stream to support it. Then the wave of calls started, up to 120-130 calls a day, from people wanting to bring their children in. Unfortunately, we didn’t really have the infrastructure to manage the deluge, so we had to titrate the flow to make sure that phones could get answered and people could get care. Every dental office in the world experiences this; we just had it in a much bigger way.” It was a teachable moment for residents and students, too, and gave Berg and staff the opportunity to show students and residents how to be more. Berg explains, “ I think if you were to survey dentists everywhere and ask them what they most wish they had more training in dental school, practice management is always number one and two. We’re great at teaching these people how to be excellent dentists, but we don’t always incorporate the management piece into that experience as well. If we just focus on what is best for the patient from a customer service standpoint — efficient, productive, high quality care and a great experience — that’s the best education, instead of focusing on the education and then back-filling with the patient care. We’re trying to create a dental home for people here – and good practice management is part of that experience.”
Along with getting the facility up to speed, Berg is most excited about the Center’s formidible research goals, specifically, in two areas: caries management including risk assessment, and restorative techniques. Berg elaborates, “We have a role in educating not only pediatric dentists, but also general dentists – they provide 70 percent of the care for children in the country. Patient management is critical, and the need for isolation with rubber dams is greater. In primary teeth, we have the advantage of choosing treatments that you might not choose for a permanent tooth that might be more beneficial – like fluoride releasing, glass ionomer. We also do things you wouldn’t even do in a permanent tooth, like stainless steel crowns. It’s a very different approach to restorative dentistry, and we have the growth and development issues thrown in there, too.”
On the risk assessment side, Berg sees emergent scanning technology as the Holy Grail, “We’re working on developing technology that will enable either a physician or a dentist to scan a child’s teeth and determine if sub surface demineralization is present. The technology is available in various forms, but we’re researching how we can apply it to a device that is inexpensive, efficient and reliable.” To that end, Berg is working with UW inventors, including Eric Seibel, a mechanical engineer. Seibel is a photonics expert who has developed a fiber optic laser scanner about .8 mm in diameter. With it, doctors are able to perform an endoscopy with no sedation — the patient is even able to talk during the procedure. After discussing children’s caries’ issues and Seibel’s research, Berg realized it could be used in the discovery process with kids teeth. Seibel went on to receive a $150,000 grant from the Life Sciences Discovery Fund and is currently assessing how to bring a device to market with a team of developers that includes a PhD student, a couple of retired UW faculty members, and a former Boeing engineer. That research will include the establishment of an outside company, product development, and testing at the Center. It’s cutting-edge, space-age stuff that could have a huge impact on the way pediatric dentists treat children. Berg explains “I’m excited about early caries detection — one of the most important things we can do in pediatric dentistry is reliably and specifically identify which children are at risk for early childhood caries and then aggressively intervene on those instead of the whole population.”
Bringing education to many
Part of that education effort Berg and his team of ten pediatric dentists are doing at the Center includes messaging about age one visits and early intervention. Berg is a big proponent of the age one visit program, saying “We’re starting to see some traction with it. For most, having a cavity is a nuisance, but for these kids that we see at risk for early childhood caries, it’s a life-altering event. To have to go to the hospital under general anesthesia at age two or three creates a long-lasting, negative association with dentistry as painful, and they may grow to be a difficult patient later in life. So it becomes not just about managing their teeth and health, but educating them and making them a good patient, too. Dentistry and oral health needs to be seen in a positive light.” Perhaps more importantly, the Center also functions as an educational facility for the faculty. Berg is unequivocal: without a practice, keeping faculty at the university would be very difficult. He explains “This is a challenging era for recruiting and retaining faculty in academics, given the disparity of income and other attractive reasons for being in private practice. It’s not realistic to think that we can compete 100 percent from a compensation standpoint, but we can provide some kind of middle ground that blends together a higher compensation along with the benefit of being in the rich, academic environment. We wanted to build this center because there is a real opportunity for us to grow our practice component, make it interesting to our faculty, and allow us to retain more staff. That’s critical – without faculty, you can’t have a residency program or a dental school. And, by keeping the practice active we can grow from within, as well as from the general population of the area – the UW has 36,000 employees, many with children, and Children’s has another 5,000 employees.”
With the large population of children seen at the facility, they have more than adequate base to combine education and research from other disciplines to study some of the thorny problems in pediatric dentistry, like oral hygiene education. Berg sees another educational opportunity here, saying, “I’m not an expert on communication and education, but I can get a psychologist and epidemiologist or someone from the school of public health who has developed ways to reach families for other diseases — to prevent smoking or early childhood pregnancy, say — and apply some of those techniques here, we might be able to have an effect on early childhood caries.” At the Center, one of those efforts involves a partnership with a group from the autism center at Children’s, where they have a large patient base with autism spectrum disorder. “Getting dental care for a child with autism can be a challenge,” says Berg, “We’re in discussions to put a dental chair in the autism center so that they can do some desensitization work with the children to enhance their experience here. I think we have a lot of opportunities like this to provide a bridge between dentistry and other entities.”
Since pediatric dentistry is the only specialty in dentistry that refers to a population as opposed to a set of procedures or treatments, Berg has assembled an expert team, which includes Surgeons Mark Egbert and Libby Kutcipal. The two handle everything from orthognathic surgery to supernumerary and complex extractions, to the repair/extraction of broken teeth, as well as the extraction of wisdom teeth in older children. Berg effuses, “They’re highly specialized surgeons who really enjoy complex cases — we get a lot of referrals from pediatric dentists and surgeons because Mark and Libby are experts at managing medical issues.” The Center’s endodontist, Nestor Cohenca, could probably be busy full time at the Center, but currently is there a few days a week. Berg says, “Pediatric dentists love treating kids, but if a child needs a root canal at ten on a permanent molar – the expertise resides with specialists like Nestor.”
Berg is already looking to the future of the Center, proactively planning for the time when expansion will be necessary. At the same time, he’s confident of the Center’s ability to meet the needs of the area’s burgeoning population of children at risk — by creating their dental home in Magnuson Park. He says, “We want to interface with the community and be accessible to them, and we also want to be accessible to the community of practitioners for education purposes and research on restorative techniques, and I think we’re well on our way to accomplishing that.”