From the Ground Up: Interim UWSoD Dean Dr. Gary Chiodo Talks Strategy

Dr. Gary Chiodo recently came on board at the University of Washington School of Dentistry as its Iterim Dean. Chiodo inherited a morass of problems at the UWSoD, and along with it, a group of stakeholders anxious for answers and fixes to problems that have been percolating to the surface for the better part of a decade, as well as a looming $36 million deficit. Chiodo knows that he won’t erase that in his two-year tenure, but he has a plan that he used before at Oregon Health & Science University, where he was asked to perform a similar resuscitation. We spoke with Chiodo on his third day on the job, and came away impressed with his calm determination and direct style. The situation seems like familiar territory to him, and while that alone might not guarantee success, it’s comforting to know he has a framework and a plan.

From 2012 to 2014, you were Interim Dean at OHSU. How were their issues similar and different to those at the UWSoD? 

At OHSU, I was asked by the Provost to step in as the Interim Dean. The current Dean wasn’t leaving, but he was stepping down from his position. So what I came into was similar to the situation at the UW. They had a budget deficit which had accumulated over several years, and it was continuing to accumulate. The amount of deficit there was probably about 10 percent of what they have here, so it was a lower amount of operational deficit, but we were trying to finish up raising money for the new dental school. We had raised quite a lot of money toward that, but fundraising had slowed, and we had about $12 million left to go. So I had an operations budget deficit to get in front of, and I had a capital development campaign to re-energize. Because of the operating deficit, the faculty had not received a raise, not even a cost of living increase, in several years. It’s safe to say that morale was an issue. That is similar at the UW, in that the faculty is aware of the fiscal challenges we have, and I think it’s concerning to faculty and affects morale. Everyone has a different idea about what caused it, and how best to fix it. So all of that is similar. 

How will that experience inform the work you do to make changes at the UW?

My approach to dealing with it at OHSU is substantially similar to the approach that I intend to use here. When you have a budget deficit of the UW’s magnitude, there’s no way you can cut your way out of it. You have to grow your way out of it. I know that some cuts were made shortly before I arrived here, but that has minimal effect on our budget. And then you get to the point where if you continue cutting, you’re actually going to decrease your productivity, so my focus is on the revenue side of the ledger, and driving those numbers up. Which is not to say that I won’t be looking very strategically and carefully at the expense side of the ledger to make sure that what we have there makes sense, is the right size, and supports the mission and goals of the school. But my laser focus will definitely be on the revenue side. What I did at OHSU, and what I intend to do here, is build the faculty practice with enthusiasm and a vengeance, because that really helped make up the difference in the budget deficit. Some of the positions that were laid off shortly before I arrived may turn out to be counterproductive, and we may need to hire some of them back in order to have a robust, thriving faculty practice. 

Another similarity is that at OHSU, we didn’t market our faculty practice off the campus. We marketed it to our faculty and students, and in fact, we only needed a portion of them before our schedules were completely full. I hired four dentists, put them half time in the teaching clinic and half time in the faculty practice, and made sure that we staffed-up with hygienists and assistants. The other thing we did at the same time was reach out to people about the undergrad clinic. We found that students were very interested in getting into that clinic because they didn’t have a lot of money, and being treated in the pre-doc clinic made their insurance dollars go much farther. It had a nice effect on those schedules, as well.

Does the UW have the facilities for those practice models?

The facility that we have here in the main dental school building is actually larger and nicer than the one I inherited at OHSU in the old dental school. We do have a nice-sized facility. It needs a little polish and fine-tuning to make it look like a regular practice, but nothing major. The other facility we have is the Center for Pediatric Dentistry in Sandpoint. It is a very nice facility. We have the option there of having faculty access the facility in the early morning hours, early evening hours, and Saturday. And there’s parking. So we can market that to students and employees. 

What are the challenges of being an Interim Dean? What are the benefits? How is this kind of work satisfying? 

There are advantages and disadvantages of being an interim anything. One of the advantages is that you are here for a limited engagement, and you have some very specific goals to accomplish, which frees you up to go flat out, be aggressive and assertive, and do what it is you know you need to do to fix things, recognizing that along the way you may lose some friends. But it’s not like you’re worried about people getting mad at you and firing you. I’m only going to be here for a short period of time. I need to move assertively and rapidly, but also strategically and cautiously. I’ve been brought in to fix some things and achieve some reasonable stability and a solid foundation. Part of what I’m doing is making this job look very attractive to a future applicant for the permanent position as Dean. Right now, if they did a recruitment for a permanent Dean, there may not be enough interest in that because of the issues that need to be fixed. I think I can do that. 

When you’re an Interim Dean, and especially when you’re being brought in to fix various areas, a lot of the role is that of Chief Operations Officer. People often think of people at the Dean level as being above the day-to-day operations, focusing instead on strategy and long-term vision. But an Interim Dean who is brought in to achieve stability and fix things tends to be deep in the weeds of operations, and that’s fine. I’m comfortable with that. There’s nothing wrong or bad about being involved in operations, but it’s not the usual Dean role where you typically push the operations role to the next level of leadership. In this case, I am periodically the CEO and periodically the COO. That said, when you make changes with operations, not all changes are embraced. 

How do you take all of the diverse opinions into account, and can you reach consensus?

My approach has always been to try to reach consensus. I don’t do things in a vacuum. I take a very colloquial approach to gathering stakeholders and people who have a dog in the fight, involving them in discussions, and getting agreement on the problems we need to solve. First, we define the problems, then we discuss the potential approaches to solving them. I’ll listen to everybody and drive to consensus — making sure that in the process nobody misinterprets that to mean unanimity — which you will never get. But consensus you can hopefully get. And if at the end of the day you don’t, and we still need to move forward in an efficient manner, then the buck stops with me. 

How would you characterize the mood at the School?

The morale issues are substantial, more so in some areas than others. Even when I was coming up here to interview for the position, people were pretty forthright in talking to me about how they think the dental school got in this handbasket and where we’re going. But that can devolve into finger pointing, and everyone has an opinion about who or what is at fault: that clinic, or that person, or that program. And they’re coming to that conclusion based on very limited information.

There has been a lot of public attention focused on the growing dental school deficit. How will this deficit influence your immediate and intermediate goals while Dean? 

Part of the similarity of what I inherited at OHSU and the UW is that people are focused on the big picture – the consolidated budget that hits the front page of The Seattle Times. Part of my strategy and approach both at OHSU and here will be to go to the department level and see how individual department budgets are doing. When you consolidate those, you come up with a bottom line that is a number in the red. We need to go to each department and get them individually fiscally solvent, and then the consolidated budget will be solvent, as well. My plan here, which is precisely what I did at OHSU, is to meet individually with the department chairs once a month, and with my assistant dean of finance with a spreadsheet and a dashboard of line-by-line expenses. We can review if it is over or under, and review what the department chair’s plan to remedy that entails. So department chairs have the responsibility and accountability to run their departments in a fiscally responsible way. What I found at OHSU, and what I think I am starting to find here, is that department chairs absolutely want to do that. The reason that they may not have done it in the past was because they weren’t being provided with good data. As soon as you provide them with the data and you help them to think creatively about fixing the problem, they roll up their sleeves, get with the program, and do what they can to remediate it. For some, it’s the first time they’ve had the chance to really think about it. The large deficit number didn’t occur overnight. It occurred over many years. It was planted, and it sprouted, and it kept growing. There was no ‘so what?’ about it, and all of a sudden it’s a huge number. We need to fix that, but we need to start department by department in the immediate fiscal year. 

Is two years enough time?

I know at the department level we can do that, and by driving the revenue side of the ledger with increased productivity in the faculty practice, pre-doc clinics, and graduate clinics, where they have a waiting list of something like 3,000 patients waiting to get in there. Can we please open the doors and invite them in? That said, a lot of those patients are uncompensated or undercompensated (Medicaid) patients. I believe that the School of Dentistry is the provider in the state that is best situated to treat these patients in a way that makes financial sense. A private practice really can’t treat a Medicaid patient without personally subsidizing the cost of care, and I don’t think that’s a fair expectation for our alumni and other dentists in private practice, who are already paying a lot of tax dollars to support the school, and paying a lot of tax dollars that go into Medicaid. 

At the end of the two-year period, where do you hope to be? 

My hope is that all of the departments will be operating in the black in a fiscally solvent way, that we’re no longer digging the debt hole deeper, and no longer contributing to the red ink. In terms of the big number, the accumulated deficit, at the end of two years I hope to have us on a glide path with increased revenue, so that we can at least see how the debt will be paid off. It’s not going to be paid off. You can’t pay off $36 million in two years. But I can at least get us on a realistic trajectory and see that there actually is a light at the end of the tunnel. 

Our members often cite the disparity between tuition paid by dental students and the amount the dental school actually receives. Can you address how upper campus distributes the tuition paid, and why so little seems to come back to the dental school?

I don’t know enough about it yet. I know a little about the history of it. I’m still studying it and I need to get smarter about it, but my understanding about it is that five years ago, the UW went to what they call an “activity-based” budgeting process. That distributes net tuition revenue to the schools based upon a factor related to student credit hours or academic activity. It’s just one tool that universities use to allocate tuition to the various schools and colleges. It’s not the only tool, and if you looked at all of the allocation methods, there would be something to pick at with each of them. It is a tool that is fairly transparent, so you can see how the numbers are calculated. I think if you talk with any of the Deans at the UW, they are going to say that the tax on the tuition that goes back to central administration is too high. 

Part of what created some of the confusion and disgruntlement about it, at least in the dental school, is that when the process came along, both the School of Dentistry and the School of Medicine went to a four-quarter, year-round curriculum, rather than a three-quarter year. The plan is supposed to be based upon credit hours, and the school wasn’t getting credit for the fourth quarter. That complaint went back to central admin, and they fixed the problem. Then last year they gave back some of the money, and they have a system in place to fix the problem going forward. At the end of the day, the way it is calculated is the same for every school and college at the UW, so it’s no different for dentistry than it is for the others. And maybe there’s a reason that it should be different for us, but I’m not sure what that is. As I said, I need to do a deeper dive to make sure that I understand why we get what we get in comparison to other schools, and if there is a disparity, is there a reason for it, is it justified, or do we need to fix it?

There’s no way you can charge enough tuition to pay the overhead of doing the education mission of the school. Our tuition is way high enough as it is. My goal while I’m here is to not raise it any higher. This problem is not unique to UW, and is true in all dental schools. Dental education has become astronomically expensive, but even at that, tuition as costly as it is doesn’t pay the cost of the education delivered. You’re always looking for how you can supplement that. We get a variety of state funds, and depend upon philanthropy to help shore up that side of the ledger. But dental schools have the advantage of having their students in a clinical practice where they can generate revenue, which is not true of medical, nursing, or law students. We do have a bit of a unique advantage. Also, having a dental school on a campus with a medical school provides multiple opportunities for interprofessional education, and avoiding duplication of faculty teaching the same anatomy, biochemistry, physiology, microbiology, and several other foundational basic science courses. 

The new curriculum seems to be achieving its mark in terms of the quality of people graduating from the program. Do you anticipate it may be changed or scaled back, or is that off the table for the time being?

UW has one of the top-rated dental schools in the nation. No matter whose rating system you look, at we’re always in the top five. The most recent rating that came out put us at number 3 or 4, so I think if you’re looking to become a dental student, and you have lots of options and your grades are good enough to get you in anywhere, all of those things being equal, a lot of those people would choose to come here. I think that the people who were working on the curriculum before I got here deserve all of the credit, because they really did make strategic and important changes in the curriculum. We’re seeing results of that in our scores and pass rates on our board exams. We also have a very high-quality body of matriculants who come into this school, so we continue to attract the best and the brightest. But curriculum is one of those things that is continually on the table for change, and partly driven by what’s going on nationally. Two of the three big drivers of that are the CODA standards and change from the national board exam part 1 and part 2 to an integrated national exam, so we need to make sure that when our students take the integrated exam, they’re prepared for it. That doesn’t necessarily change what’s in the curriculum, as much as when the curriculum is timed, and when you place it in their four years. The third and one of the most exciting things driving curriculum change is the switch from a regional and state board licensing exam with live patients to an OSCE system. I have said so many times that I hope I live long enough to see the state board exam system go away. It’s so antiquated, ineffective, unethical, and legally perilous, and it’s really insulting. It’s an embarrassment to the profession. Going to an OSCE system is light years ahead of what we’ve been doing, and so much more meaningful and comprehensive for professional skills and judgment. We’ll have to change the curriculum to accommodate the change. We need to actively engage boards of dentistry in that effort. 

Other than fiscal solvency, what do you hope to achieve?

After being here for two and a half days, I hope to consistently be able to find my way to my office and back to the front door! On a more serious note, from what I have seen so far, we have a very impressive faculty, support staff, and student body. I’m excited to marshal all of those resources to move us forward. Part of what is on my to-do list is strategic planning, both short- and intermediate-term. Planning will help to increase the attractiveness of this job for the permanent replacement of the Dean. The strategic planning process for me involves not only our internal people — faculty, students, staff, and administrators — but it involves our community as well — the alumni association and the dental association. This dental school has a statewide impact, and all of those groups are stakeholders and need to have a seat at the table and a voice in the strategic plan. The last thing I would want to do would be to create a strategic plan that stakeholders refer to as ‘Dr. Chiodo’s Strategic Plan.’ I’m happy to drive the process and convene the people around the table to have the discussion, but the stakeholders must accept the plan as one they helped create and believe in.