Closing the Gap in Risk Management

While talking with my fellow dental school classmates, I always tend to get the feeling that none of us feel well trained in “real world” risk management issues.

As a University of Southern California (USC) graduate right out of dental school, I felt comfortable diagnosing and treating a wide variety of procedures within the scope of my practice. My graduating dental class also had the pleasure of going through a newly implemented curriculum for behavioral dentistry, which has helped me tremendously in communicating with my patients from a wide variety of different backgrounds and cultures. Risk management, however, is a different story.

I am licensed to practice dentistry in the state of California as well as Arizona. I have found myself calling the state boards and my malpractice carrier with simple questions. I have attended numerous continuing education (CE) courses that have helped me paint a better picture in regards to simple issues from clinical note charting to more sophisticated situations such as What happens when an associate dentist stops working at a practice and does not cement a crown on a case that was in progress? Who is responsible, the practice owner or the associate?

These might sound very childish to practicing dentists with years of experience, but the reality is, for us recent grads, it’s scary not knowing right versus wrong in regards to risk management. If the issue is something clinical, and we feel like it’s outside of the scope of our practice, we are taught to refer the patient to a specialty dental provider. However, we cannot simply refer out when it comes to risk management issues.

With the high cost of dental education, the last thing young graduates need is to get into issues with the dental boards. Our licenses cost us a fortune, and we would like to protect them in any way that we can.

I love teaching. Adding information to someone else’s knowledge database is one of my passions in life. During my time at USC, I taught a course to our interested pre-dent undergraduates. Immediately after graduation, I relocated to Arizona to practice full time 4 days a week and teach as an adjunct faculty at the College of Dental Medicine-Arizona one day a week. I try to do my share of giving (as far as real-world clinical issues go) to my students. However, I teach the first-year class, and it is hard for me to get their attention in regards to risk management when they are worried about their next pharmacology exam or their next Class I preparation practical.

WHAT CAN WE DO?
Ultimately, it is our professional responsibility as licensed dentists to treat each patient with dignity, utmost ethics, and integrity, and to provide them the best treatment possible. Furthermore, it is our sole responsibility to obey by the rules and regulations set forth by each state’s dental board.

Although I believe there should be a higher level of collaboration among dental schools, insurance carriers, experienced practicing dentists, regional dental boards, and—last but not least—regional dental organizations and associations, it is also my opinion that the core of this issue lies within our profession itself. We, as dentists, need to take the first step and initiate in asking for more courses, more information, and looking for more guidance. They’re out there!

The first and most important change can begin by implementing risk management curricula into the last one to 2 years of dental school. That would be great, but let’s be honest; for such changes to occur, it could take many years!

We can also ask malpractice insurance carriers to provide such courses on a quarterly basis before they sell us the insurance binder. It is a win-win situation for all (less risk for us = less risk for our insurers). The Dentist Insurance Company, for example, has implemented what it calls the “Risk Management Advice Line.” Once you become insured through them, you are given a phone number for insured persons to call with questions in regards to risk management. I have personally used this service, and it’s great. I believe every single recent graduate should be able to utilize such a service during the first few years of practice. Although each state’s dental board has its own rules and regulations, and some states may have different positions in a specific situation, it’s very helpful to have a hotline readily available to contact to get general information in regards to risk management. I am sure that there are other insurance companies that have systems in place, which would make sense in reality. (Again, less risk for us equals less risk for them!)

THINGS TO CONSIDER
A majority of risk management issues fall into the following categories: (1) patient care, (2) informed consent, (3) employment, (4) financials, (5) general liability, (6) record-keeping, (7) property, and (8) scope of practice. Notice that risk management isn’t only concerned about your relationship with your patients, but also with your employees and em­ployers.

WHERE TO LOOK FOR ANSWERS

  • Your insurance carrier. Ask a representative if the company has a PDF that can be sent to you with information. Also ask the representative if the carrier has a hotline you can contact, such as The Dentist Insurance Company’s, mentioned previously.
  • Your own state dental board. (Note: rules and regulations differ from state to state.)
  • An experienced mentor dentist. You don’t necessarily have to work for him or her. Invite the dentist to lunch and ask questions.
  • Share your knowledge with other professionals and learn from each other. I have a number of friends from my graduating class with whom I frequently speak, giving us a chance to compare notes on important professional topics.

Closing Comments
The information is out there. Should the schools and insurance carriers do more? Sure! It’s always good to do more to be protected. However, in reality, it is ultimately up to each of us to reach out for information. It might be difficult at first. It might take a phone call or 2 (or 3). It might take a few days to a few weeks for us to find the actual and accurate answer. How­ever, the information is out there, and if your license is as important to you as mine is to me, then you’ll find a way to get the answers.

Last but not least, this is directed to the practicing dentists with extensive experience in the profession: Help us! When you hire us, please make a commitment to teach and to mentor us. I have looked at hundreds and hundreds of ads for “associate dentist” positions. I never saw a one that included, “Owner dentist is willing to mentor.” If I had, I would have jumped on it immediately and would have considered it as an important part of the “compensation” package.


Dr. Sadehkhou graduated from the University of Southern California (USC) School of Dentistry in Los Angeles. He has sat on board as faculty at College of Dental Medicine-Arizona and is currently a faculty member at the Ostrow School of Den­tistry of USC, in its division of restorative sciences. He can be reached at This email address is being protected from spambots. You need JavaScript enabled to view it..

Disclosure: Dr. Sadehkhou reports no disclosures.



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