Emerging Advocacy Groups Support Small Business Dentistry

Michael W. Davis, DDS


Small business dentistry is increasingly establishing advocacy groups designed to address specific issues. Areas of concern range from protecting the doctor/patient relationship against the intrusion of the insurance industry and corporate dentistry to honest evaluation and solutions for the public’s “access to care.”

These associations are springing up in a variety of different states. Because of their distinctive smaller sizes, they are highly attuned to specific predicaments unique to a given state. Larger national groups may have multiple and conflicting agendas, which too often grind effectiveness to a standstill. These smaller spearhead organizations often serve as the initial testing ground for addressing and solving challenges. Many times, state dental associations will later pick up the banner and carry forth with their added weight and power of membership.

Three organizations that exemplify this movement are the Concerned Dentists of Texas (CDoT), the Concerned Dentists of Washington State (CDWS), and the Massachusetts Dentists Alliance for Quality Care (MDAQC). Each of these relatively small associations is free to examine problems unique to its specific state and discover optimal mechanisms for local problem solving. They aren’t handicapped by the political or economic motivations of a faraway distanced leadership. They aren’t bogged down by neverending and do-nothing committee meetings. And, they lack multiple layers of leadership hierarchy, which often hinders effective action.

Leaders in these advocacy groups are almost always involved directly as small business dentists or as retired small business dentists. One common thread enjoyed by these associations is the wealth of knowledge volunteered by affiliated retired dentists, practicing doctors, dental school faculty, and students. One can’t underestimate the valuable insights generated by these individuals. They are generally well-grounded in deep caring of the dental profession and a genuine respect for the public welfare.

Massachusetts Dentists Alliance for Quality Care

“Our fear is that when the trends of dentistry move towards a more corporate model, the priority can be more focused on the business success of a corporation or a board of directors and less on the needs of the patient and quality of care from the dentist. Our group will stand up for quality of oral health care and the needs of Massachusetts patients,” said Jill Tanzi, DDS, a general practitioner from Hopkinton, Mass, and an officer with MDAQC.

“Dental students are the future of our profession and the key to the long-term success of private practice. We have plans to link students to private practice owners for mentorship while they are still in school to give them a view of what private practice is all about,” Tanzi continued. “The DSOs seem to be recruiting significantly in the dental schools, and we would like students to be aware of opportunities outside of corporate dentistry. It is our belief that we do not want the dental profession to be controlled by business people who have no knowledge or interest in patient care, but rather by dentists themselves who care deeply for their patients.”

MDAQC is quite proud of its efforts with legislation in its commonwealth to oppose alleged abuses from the insurance industry.

“We were able to hire an attorney when we initially formed and formally petition the Attorney General (Maura Healey) in our state against insurance abuses. We believe it was effective, although our legislature is still deciding our fate,” Tanzi said. “We also have been taking calls from dentists from all over Massachusetts and the United States. Some just need some moral support and a place to report their insurance dilemmas. We plan to act on these reports in the future, so please keep them coming!”

MDAQC also has conducted an access to care survey and shared its results with Massachusetts legislators and the dental community at large (see attached). The group concluded there is little need for mid-level dental providers, as the underserved currently have ready access to both adult and pediatric dental care even in the state’s most underserved county.

Concerned Dentists of Washington State

“Organized dentistry has allegiances and responsibilities across the broad spectrum of dentistry. Our focus is limited to the concerns of solo and small group practices, which we consider to be the backbone of quality dental care,” said William E. Hooe, DDS, MS, an oral and maxillofacial surgeon practicing in Shoreline, Wash, who is very active in CDWS.

According to Hooe, the group’s members are not risk averse. They speak freely and unconstrained from organized dentistry’s politics, he said. When Delta Dental implied that the group could be held liable for anti-trust issues for its advocacy, Hooe explained, organized dentistry became nervous and encouraged the group to back down. Instead, CDWS continued its efforts.

“We fanned the flames of enthusiasm for solo and small group practices. We framed a simple question: To whom does dentistry belong? Delta Dental and corporate franchises, or solo and small group practices?” Hooe said.

“We engaged in a lot of fact finding. Our colleagues stepped up and contributed time, energy, and money. Over time, we could feel a spotlight being focused on the corrupt nature of Delta Dental of Washington. Delta subscribers began voicing their displeasure, adding to the voices of Delta member dentists,” he continued.

“Another important advance is seeing dental students adopting the spirit our organization. At the University of Washington Dental School, dozens of students have organized and are demanding transparency and accountability with their tuition dollars,” Hooe said.

The school is in dire financial straits, Hooe said. Its former dean, Joel Berg, DDS, MS, is a business partner of recently announced retiring Delta Dental of Washington president and CEO Jim Dwyer.1-3 Plus, the interim administration has enacted serious cutbacks. A public records request from a student unearthed and publicized more radical cutbacks.

“These young dentists have wrestled significant influence on future decisions at the dental school. They have created a spotlight on the admin’s decisions and are not staying quiet in the background. Many are speaking out against the strong influence of Delta Dental of Washington and corporate franchise dentistry within their educational system,” Hooe said.

Goals for CDWS include dealings with an allegedly abusive insurance industry.4

“Delta has committed a lot of time, energy, and money towards enacting unilateral polices that benefit their company at great cost to their policy holders and the dentists trying to deliver quality dental care to them,” said Hooe.

“We will continue to call into question the ridiculous income going to Delta’s CEO and board members. Continue to make clear the gross inadequacies of Delta’s policies, which prevent delivery of quality dental care in many instances. We would like to uncouple the delivery of high-quality dentistry from the constraints of the near monopoly of Delta Dental of Washington,” Hooe said.

Concerned Dentists of Texas

CDoT has three main goals. First is building membership and statewide support. Second is enforcement of state statutes relating to illegal ownership by hedge funds, pension funds, insurance companies, and absentee dentist owners. Third is the preservation of the education and testing integrity of the state’s future dentists.

“We are most proud of the network we have built to communicate and build on our understanding of the difficult issues facing the profession of dentistry and our patients’ true access to care,” said Jackie Stanfield, DDS, a general dentist from Flower Mound, Texas, and a CDoT director.

“It is our belief that if hedge/equity funds and insurance companies own dental practices and employee dentists, many with $450k in debt and working under pressures of company demands for performance, how can we ever preserve the right of our children and grandchildren the freedom to choose their dentist and their right to great dental care?” she asked.

“As much as we would like it not to be, most issues are political in nature and, as such, must be addressed with an understanding of the political landscape. We communicate with legislators locally and in Austin as well as various state agencies. We have found they do not hear our perspective regarding the practice of dentistry if it wasn’t for CDoT,” Stanfield said.


Small advocacy groups consisting of passionate dentists are impacting the future of dental healthcare in ways that other organizations have been less successful in using. These entities interact with their states’ policymakers, legislators, attorneys general, state regulators, and dental school faculties as well as with concerned dentists and dental students. A common theme between all of these associations is a deep love for the dental profession and genuine concern for the public interest.


  1. Long K. Amid $36 Million Deficit, UW Dental-School Dean Resigns. The Seattle Times Oct 26, 2017; https://www.seattletimes.com/seattle-news/education/amid-36-million-deficit-uw-dental-school-dean-resigns/
  2. Washington State Dental Association. WDS Announces CEO Jim Dwyer’s Retirement. WSDA blog Mar 13, 2018; http://www.wsda.org/news/blog/2018/03/13/wds-announces-ceo-jim-dwyer’s-retirement
  3. SpringRock Ventures. Team 2 (Venture Partners, Strategic Board Directors). SpringRock Ventures, Seattle, WA, copyright 2018; http://springrockventures.com/team2/
  4. Davis MW. Dentists File Formal Complaint against Delta Dental of Washington. Dentistry Today News Jan 24, 2018; http://www.dentistrytoday.com/news/todays-dental-news/item/2853-dentists-file-formal-complaint-against-delta-dental-of-washington

Dr. Davis practices general dentistry in Santa Fe, NM. He assists as an expert witness in dental fraud and malpractice legal cases. He currently chairs the Santa Fe District Dental Society Peer-Review Committee and serves as a state dental association member to its house of delegates. He extensively writes and lectures on related matters. He may be reached at mwdavisdds@comcast.net or smilesofsantafe.com.

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