September 6, 2012
When we caught up with Dr. Joel Berg this past June, the dust was just beginning to settle on the announcement that he’d been selected as the new Dean at the University of Washington School of Dentistry (UWSoD). Berg, who was likely chosen for his mix of business and academic cred (see sidebar), as well as his ability to take a massive project from start to finish with partners both in- and outside of dentistry (he was the driving force behind the The Center for Pediatric Dentistry), will undoubtedly operate differently than Dean Somerman, whom he replaces.
Well-liked and congenial, we found no shortage of people willing to express enthusiasm at his selection — Eric Olendorf, Class President, UWSoD 2014, called Berg “Exceptionally energetic and dynamic in the classroom,” and said that Berg will “…usher in a new era of excellence at UWSoD.” Dr. Ashley Tercero, a former student of Dr. Berg’s says, “Dr. Berg has been a great ambassador of pediatric dentistry for Washington State. He inspired me, and many other dental students, to pursue pediatric dentistry. His work on the Yakima Residency Program enabled me to get the residency training I needed, and sparked my desire to work with a high-need population. I highly admire, respect, and appreciate Joel Berg and am thrilled to see the great things he will continue to do for pediatric dentistry and the University of Washington School of Dentistry.”
Once in place as the Dean, Berg will rely on foot soldiers in the department, saying, “I operate differently than perhaps the former Dean did — I clearly look to the team around me — operations people, the collective body of associate and assistant deans — they run the place; I’m here to help them. My job is to serve as the face of the UWSoD — to talk about what we’re doing, get support, make connections, and also reach out to alumni, graduating classes and organized dentistry.”
To that end, Berg plans to be very customer-centric, saying, “Both alumni and practitioners are our customers. They’re a proud and loyal group, and one of our biggest assets. I need three things to make the job exciting to me — a history of clinical excellence and education, a strong research infrastructure, and a loyal, proud and dedicated alumni — at the UWSoD, we have all three.” And while organized dentistry might have felt left out of the huddle lately, Berg sees outreach as one of his primary functions, along with management/operations, and lastly, the overall strategy and vision for the future of the school. In a wide-ranging conversation with Dr. Berg, he talked openly about his vision, changes he sees in the future, and his connection with WDS and others in the community.
Defining the product
If you ask Berg, he’ll tell you he was also chosen as Dean because of his bent for change — noting that while the University continues to produce excellent restorative dentists, nearly every aspect of the SoD needs attention. And while he’s clearly been knocking around ideas of how to improve the venerable institution for some time, it’s not his style, or intention, to storm the school and make sweeping changes. Before implementing any change, he’ll first hear what the other stakeholders — in this case the faculty — think, at a retreat he’s planned for December. Saying that nothing will be sacred, their first order will be to define their product and determine its specifications using sound business principles. For Berg, the product is the dentist of 2025, and he notes that what they’ve done in the past may no longer be relevant to that dentist. “It’s like having an old house with failing electrical work,” he says, “You can patch the system to keep it running, but you still end up with failing fuses when you should have something more forward thinking and modern.”
Though some might find it unorthodox when he describes dentists as a “product of a manufacturing process,” it’s a sound business model that should serve the school, and the students, well. Berg, and his crew will discuss what skill set the 2025 dentist will need, and what they’ll require to work cohesively in their communities — leaving curriculum and clinic systems out of the conversation until they’ve polished up their definition. But what if they can’t agree on specifics? “Truthfully,” Berg says, “Consensus is not always desirable or possible — but at least we’ve had a discussion, and can decide what we want to create. Then we can build a machine to make the product. This machine — as in any business — is made up of parts that form the product you want. Dentistry is no different, really. I think in our case the machine consists of the curriculum, clinic, research and residency.”
Overhauling the clinic program
Once they have defined their product, Berg will be able to turn his attention to the cogs of the machine. Calling the clinic system “badly in need of repair,” Berg notes that plans will include a complete assessment and recommendation for renovation of the UWSoD’s clinic systems, but not the physical facilities, which will have to come later — “We simply don’t have the money for that now,” he remarks. Calling the production system “inefficient, with a lack of clearly defined processes,” Berg stresses that the current system doesn’t teach good quality patient care. “We have to create the best possible service and experience for our customers,” he says, “Not only because we need patients who are happy, but because it teaches the students.” With serious challenges getting patients in the door, good systems and better customer service will appeal to the public, and word of mouth will help attract new customers. Recent changes in fee schedules implemented by Interim Dean Timothy DeRouen allows patients to pay the fees they would have if adult dental Medicaid was still in effect, which should help draw adults formerly covered by the plan, but challenges remain. “They will still have to pay out of pocket,” Berg explains, “But the fees are greatly reduced, and that has helped quite a bit. But Medicaid is just one of the issues we’re facing.”
Berg also wants a massive overhaul of the way students see patients, saying, “As you know, students typically see one patient per half day, and make their own appointments. We’re teaching them to do things that are not what a dentist should be doing. They should function like a dentist as early as possible in their training, including the management of their patients and their practices. If you ask dentists graduating from any dental school what they missed in dental school, 100 percent of them will tell you practice management — because it’s an afterthought.”
Berg would like to see a system that focuses more on the patient than the tooth and mouth, saying, “We need to think about every encounter as a patient management encounter, not as a management of the tooth encounter. It’s a very different approach, but they’ll be more efficient and productive. If we teach them basic management skills, how to treat customers well, and be efficient, it will increase their level of attention to the right things.” Berg insists that practice management should include conversations about the medical necessity of dental care, why what dentists do is important to overall health, not only the mouth, and why coming to scheduled appointments is important to a patient’s health. He clarifies, saying, “These issues need to be ingrained into the souls of dentists early — that doesn’t happen until later. All of these things will be developed into an overall system that we’re looking at. We’ll try to be the role model for efficiency and productivity, while we’re teaching quality dentistry. One is not in lieu of the other, in fact, I think they make each other better.”
How far out of the box is Berg willing to look for solutions in the clinic system? Time and again he stressed that everything was negotiable, saying, “I want everybody involved, and I’m willing to look at anything — including going back to teams, a tiered structure, a medical model, or even a system like the one I had in Iowa — in the third year you have intense training for a short period of time in all the different elements — endodontics, prosthodontics, periodontics — like a boot camp. And then, in the fourth year, you get true comprehensive care, where patients come into the clinic, and students do whatever they need — just like they would in a practice. So, while I don’t know yet what the systems will look like in our clinics — we’ll have everybody take a good look at it, with the understanding that nothing is sacred.”
Once they’ve determined which clinic system the school will use, they can discuss changes to curriculum, but not before. Berg explains, “Until we understand the dentist of 2025, we’re always going to be looking at our curriculum with filters that apply to practicing today, and they may not apply in the future. We might have pushback, but our mantra must be that whatever we do, we are going to produce the best quality dentist — the best product. As long as people understand that, and I can prove it to them, I think they’ll be on board with me. And while quality may be defined differently in the future, we know that dentists will always need great restorative skills. We have to be willing to change in order to produce for the future, but we will never sacrifice quality.”
Berg advocates an aggressive timeline to the changes to the clinic system once they’re defined, but is cognizant of the importance of careful planning, saying, “We need to look at what has been done so we don’t recreate something that hasn’t worked. Seattle has differences in areas like the physical facility, so we have to make a plan that works for us.” While he favors immediate implementation if possible, he’s realistic, noting that a timeline of five to ten years is probably likely. He’s amenable to options like rolling out in phases, or deferring all change until a specific year. Regardless of the implementation plan they choose, he’s quick to say that obvious problems will be remedied whenever possible.
The facilities issue has dogged the school of dentistry for years – Berg remembers when he first visited campus some ten years ago thinking they needed to be upgraded then. WSDA President Rod Wentworth agrees, saying, “Those of us who have spent any time around the UWSoD know that the facilities are not much different then when we were in school. It is clear that we need to see the facilities in the school upgraded to reflect the times. Dr Berg shares this concern and has the vision to make it happen. His experience in growing The Center for Pediatric Dentistry from an idea to a world class facility will help him do the same with the dental school.”
Berg was able to make The Center for Pediatric Dentistry happen by partnering in the community to raise the necessary funds. But a new dental facility would cost hundreds of millions of dollars, at a time when state budgets are stretched thin, and questions remain about where the campus should be located.
Berg clarifies, “There’s a discussion going on in the health sciences about a combined health sciences entity, but no decisions have been made regarding the school of dentistry’s role in it. I’m not sure if it’s better to stay on the health sciences campus or to go off – that has to be properly vetted. I can think of advantages to both – certainly there is a contiguity advantage to being there with inter-professional education, but parking is a big problem on the health sciences campus, and unless that was dramatically changed, that’s always going to be an issue.”
Without aggressive fundraising, the school can’t move forward, and one of Berg’s relationships — his continuing partnership with the WDS and its Foundation — may rankle some. He’s sympathetic to the grumbling of the chorus, but realistic, saying, “WDS has been a good partner to both me and the school; without their gifts the Center might not have been built. We expanded the square footage of the school of dentistry by 16 percent by adding the facility. They became Presidential Laureates by giving a total of $10 million, half of which was for the center, but they’d already given $5 million to the SoD. But I understand the perception.” Berg asserts that they have to engage all segments of the community — corporations, alumni, other stakeholder practitioners who may have graduated from other schools, but are practicing in our area — and bring them on as supporters.
But the foundation is hardly Berg’s only resource, and new research is opening doors that were formerly closed. Case in point: Berg and Eric Seibel, a mechanical engineer at the UW, are developing a wand that can detect sub surface demineralization. That research, in turn, got engineering companies interested in funding the project. Berg sees all kinds of opportunities for similar cross-discipline funding, saying, “The fact that we’re working with other departments will broaden the scope of interest in oral health. In this case, engineers value what they’ve done, and companies that support engineering entities now may see value in supporting the SoD because their technologies will be employed in dental practices. The good news is, while I can’t say who they are, there is a vast landscape of corporate opportunities available to us. There’s a lot of excitement about the school, and we have many people willing to give time and money. This is in addition, of course, to the wonderful alumni donations, upon which we will continue to depend, as a core group of support.”
Beyond that, Berg has charged associate dean of research Linda LeResche with analyzing who is in research funding and who is not —with an eye towards helping those who may have gotten stuck. “Research is a business, too,” says Berg, “The best researchers have systematic approaches, are smart, capable scientists who are self-motivated. They have a strategy that includes being published, completing experiments and because of their strategy, they’re more likely to be funded, and that brings money and prestige to the UW. It’s like anything – hard workers who deliver on their promises get funded again, so we have to see what we can do to support those people, it’s very important.” At the same time, Berg will also attend to the endowment program, explaining, “If I can get another professor or two or another chair position endowed, it makes it much easier to bring in great people. It’s not just the money, it’s also the prestige — I already have my eye on areas where we need to build endowed professors and chairs, and those make a tremendous difference to what we’re able to do in research and in clinical care.”
He continues, saying, “The beauty of that is that we have a wonderful product, and amazing graduates — if you go around the world people know of the UWSoD because of the people we’ve created. It’s exciting to be able to go out and talk to alumni who are passionate about their education — even if they’re upset about something that’s happened in the school, and some are — they’re still passionate about the university.”
That passion is one reason that Berg emphatically rejects the possibility of taking the school of dentistry private, as has happened to at least one dental school. He explains, saying, “I think that pride in the UW is an equity element, and if we were to lose that it would change who we are – like a personality change. So much of what we are is because of this culture and diversity. Also, UW is the number one public university in research funding – more than $1 billion per year. I think we need to be more connected to that environment, not less. These engineering developments that I’ve mentioned are about being part of the campus – these new dental schools that have started that don’t have the rich academic infrastructure, which is a really important part of who we are.”
(Not) Politics as usual
Politically, Berg is known for being aloof and dwelling outside political circles, which has likely served him well to date. Now, though, he’s been cast center stage — how will he adjust? He’s resolute: “I’m going to do my job, and my job is to train dentists, support research and residency training. I can have an opinion about a lot of things, but that’s only important to the extent that it’s about what my job is. Sometimes people look to the Dean to give an opinion on “everything dentistry.” If it relates to my position here, and what we should be doing, then of course I’ll offer an opinion.”
Berg’s plate is stacked high — but, with his proven ability to juggle many projects and court supporters from many different arenas, the School of Dentistry is in very capable hands. We welcome the changes ahead!