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Ethics

OSHA updates workplace poster

Are you an employee dentist? Do you know your rights?

The federal Occupational Safety and Health Administration unveiled a new version of the employee-rights poster OSHA-covered dentists and other employers must display in a conspicuous place where employees can see it but said employers need not replace previous versions of the posted notice.

OSHAThe new version of the poster “Job Safety and Health – It’s The Law!” is available without charge and in English and other languages at osha.gov or by phone at OSHA’s toll-free number 1-800-321-6742 or the OSHA publications office (202) 693-1888.

The poster is available in Chinese, Korean, Nepali, Polish, Portuguese and Spanish. The Polish and Portuguese versions are available online only. OSHA regulations do not specify or require employers to display the OSHA poster in a foreign language. However, OSHA encourages employers with Spanish-speaking employees to also display the Spanish language version.

For employers in a state with an OSHA-approved state plan, there may be a state version of the OSHA poster. Federal government agencies must use the Federal Agency Poster.

The poster informs workers of their rights and employers of their responsibilities under the Occupational Safety and Health Act. The poster was updated to include new reporting obligations for employers, who must now report every fatality and every hospitalization, amputation and loss of an eye. It also informs employers of their responsibilities to train all employees in a language and vocabulary they can understand, comply with OSHA standards and post citations at or near the place of an alleged violation.

The last poster update was published in 2007.

A question of ethics

Some issues that a new dentist might face may include:

It is my first time doing a procedure that I want to incorporate into my practice: how can I do that ethically on my first cases?

When should I refer? Are there ethical considerations if I don’t refer?

At what point should I send the patient to a specialist? When and how do I tell a patient their treatment should continue with a specialist without losing the patient’s confi dence or trust? As an ADA member, what is my ethical obligation to my patients?

Dr. Ishkanian

Dr. Ishkanian

We invited Dr. Emily Ishkanian to share perspectives relevant to clinical experience. is the ADA New Dentist 14th District representative and representative on ADA’s Council Ethics, Bylaws and Judicial Affairs. The ADA Principles of Ethics and Code of Professional Conduct (the ADA Code) can offer guidance to help new dentists answer ethical questions, Dr. Ishkanian said.

“My reputation, my name and my license are too valuable to risk,” Dr. Ishkanian said in describing several real world practice situations she encountered. Dentists are faced with challenging ethical dilemmas in day-to-day practice. However, new dentists are placed in especially precarious positions when faced with what seem to be a choice between acting as defined by the ADA Principles Professional Responsibility and possibly losing their job.

Some ethical situations include the following:

Advanced procedures
When you are asked to complete procedures and your gut tells you this isn’t a treatment you feel comfortable performing, you have the option to refer to another practitioner who is more skilled in the procedure. Not only should this be an option, but it may actually be an ethical obligation. Ultimately, as the dentist, you make that call, because only you know your capabilities and you are responsible for making sure you do no harm to your patients. Recognize that referrals don’t make you a weak clinician, but rather show that you value the patient’s best interests. No one should expect you to do anything you don’t feel comfortable doing.

Ratios
Crown-to-filling ratios may sound absurd, but some new dentists have actually been faced with this expectation. If a dentist hasn’t met the adequate ratio, he or she may have been reprimanded or in some instances his or her employment may actually have been at risk. At the end of the day, as a dentist you have gone to school to gain the clinical knowledge to diagnose, educate and treat your patients. Yes, dentistry is a business, but you and your patients determine the best treatment, not the offi ce manager.

Continuing your education
Upon graduation from dental school, you quickly learn that you are a beginner. Is there a treatment you are looking to incorporate into your practice but you feel you don’t have quite enough experience? Take the proper steps to fulfi ll your ethical obligation to do no harm to your patients. Participate in continuing education, specifi cally hands-on CE; engage in a mentorship with a seasoned dentist by shadowing him or her while he or she is doing the procedure; reference online tutorials, textbooks, dental blogs, message boards; and most importantly know your limitations and when to refer to maintain the standard of care and to do what is best for your patient.

“After the physical, emotional and financial sacrifices I’ve made to reach this point in my career, I’ve realized that my dentistry and my work reflect the person I am and how I choose to care for my patients,” said Dr. Ishkanian.

Dr. Ishkanian suggests that if you are faced with an ethical dilemma, address it with the owner or owners of the practice. If you don’t see change on the horizon or there are too many ethical challenges that appear unlikely to be resolved, then it might be time to move on, maintain your ethics and standards and fi nd a practice that shares your philosophy. Always put your patients first, and remember this is your license and your reputation. Don’t put yourself in a position where you’re defending it.

Available ADA resources to help new dentists facing ethical situations include the ADA Code of Ethics, the Ethics Hotline and the archive of ethical scenarios that can be found at ADA.org.

When professional conduct is the question, the ADA Code may have answers.

The ADA Principles of Ethics and Code of Professional Conduct amplifies Dr. Ishkanian’s advice. “The American Dental Association calls upon dentists to follow high ethical standards which have the benefi t of the patient as their primary goal,” says the preamble to the Code.

“The ethical dentist strives to do that which is right and good. The ADA Code is an instrument to help the dentist in this quest.”

Student ethics video contest deadline July 31

The ADA Council on Ethics, Bylaws and Judicial Affairs is accepting entries for the 2015 Student Ethics Video Contest. The deadline to submit entries is July 31.

Since 2010, CEBJA has annually sponsored the contest to draw student attention to the ethical dilemmas that dental students and professional dentists may encounter and to provide an exercise focusing on appropriate responses based on the ADA Principles of Ethics and Code of Professional Conduct. This year, the contest will include a second competitive category, created for videos that promote patient safety through ethical treatment. A grand prize and an honorable mention award will be available for each category.

The new category is the result of the participation and support of CNA in this year’s Student Ethics Video Contest.

The contest is open to degree-seeking students at, or new graduates of, any ADA-accredited dental school who are 18 or older and U.S. citizens.  Entrants must also be ADA student members or members in good standing of the American Student Dental Association.

To qualify, videos should be no more than four and a half minutes and must portray the application of one or more principle, code or advisory opinion contained in the ADA Principles of Ethics and Code of Professional Conduct. To be eligible in the new category, the video should focus on ethical treatment promoting or enhancing patient safety and treatment outcomes.

CEBJA will announce the winners at the ADA 2015 — America’s Dental Meeting in Washington, D.C. For more information, contest rules and entry forms, contact Earl Sewell at sewelle@ada.org.

To view previous years’ winning videos, click here.

CPS offers resources to help dentists navigate Medicare decision

The deadline for opting in or out of Medicare is looming for dentists, and the ADA Center for Professional Success has a number of online resources that can help them make sense of the regulation and what to do, according to ADA News.

Center for Professional SuccessAny dentist who prescribes Part D covered drugs to Medicare beneficiaries has three choices. They must enroll in the program either as a provider of Medicare services or as an ordering/referring provider or opt out in order for prescriptions they write to be reimbursed by Medicare, according to the federal government. Dentists who fit this requirement must take action by Dec. 1.

The Centers for Medicare and Medicaid Services has several options for enrolling that apply to dentists. Opting out of the program, by signing an affidavit and entering into private contracts with patients as appropriate, means dentists are out of Medicare for two years and cannot receive any direct or indirect Medicare payment for services provided to Medicare patients. Regardless of the choice, a full explanation and links to the appropriate form, as well as sample affidavits, are available through the Center for Professional success.

The Center for Professional Success has a number of other resources that can help with this sometimes complicated and confusing process:

  • Medicare tutorial video
  • Frequently asked questions about the Part D regulation
  • Resources for enrolling as a Medicare provider
  • Resources to opt-in as a Medicare ordering/referring provider
  • Resources to opt out

The Medicare tutorial video, along with the FAQs, is designed to help dentists make a decision on which option is right for them.  To access these resources and more, visit Success.ADA.org.

Addiction webinar set for April 22

An upcoming webinar aims to educate dentists on how to prescribe medication for patients with a history of addiction.

prescription drugsSafe Prescribing for Patients With a History of Substance Abuse Disorders is scheduled for April 22 from 2-3 p.m. Central time. Michael O’Neil, professor of pharmacy practice at South College in Knoxville, Tennessee, will discuss how dentists can implement treatment strategies that guide safe practices while performing procedures on patients with a history of substance abuse disorder. Dentists will also learn how to develop a safe and effective plan for acute pain management for patients receiving opioid maintenance treatment for addiction.

Those who participate in the webinar are eligible to earn one hour of continuing education credit. To register, contact Alison Siwek, manager of dentist health and wellness for the Council on Dental Practice, at siweka@ada.org or 1-312-440-2622.

Last day of registration is April 20.

UIC dental student receives MLK scholarship

Mr. Dante Brown

Mr. Dante Brown

The University of Illinois at Chicago College of Dentistry announced it awarded third-year UIC dental student Dante Brown a Dr. Martin Luther King Jr. scholarship.

The Dr. Martin Luther King Jr. Scholarship program was established at UIC in 1985 to recognize outstanding minority UIC students, such as African Americans, Latinos, and Native Americans, who have demonstrated high academic achievement in fields in which they are underrepresented and who have shown strong commitment to community and campus service.

Mr. Brown, who noted he was mentored by his own dentist, Dr. Edward Ruiz, a 1987 graduate of the dental school, applied for the scholarship in 2014.

To qualify for the scholarship an undergraduate must have a minimum 4.0 GPA. Graduate and professional students must also show a record of high academic achievement. Brown was awarded the professional level scholarship of $5,000.

When not in class, Mr. Brown provides free dental services at Community Health-West Town, Goldie’s Place and to homeless individuals in the community. In addition to his community service, Mr. Brown serves as treasurer of the UIC chapter of the Student National Dental Association, and is an active member of the UIC chapter of the American Association of Public Health Dentistry.  He also works to help others in his spare time.

“I tutor on campus and am one of the teachers for the post-baccalaureate Dental Anatomy course,” he noted.
After his graduation in May of 2016, Mr. Brown has well defined goals.

“I plan to practice general dentistry for a few years, complete my Masters’ in Public Health, and then consider residency programs in dental public health,” he said.

I’m a new associate dentist…what does the ADA do for me?

From supplying life insurance, advice on which board to take, and resources to make your CV shine; the ADA has many benefits to offer. In this blog post, I’ll be focusing on what the ADA can do for the recent graduate as well as a dentist entering an associate or partnership position. This was myself a few years ago. Unfortunately I was unaware of these items below that the ADA offered; however, I would have utilized almost all of them. Hopefully the resources that I go over in this issue will be useful to you — the new dentist!

Dr. Sinclair

Dr. Sinclair

Classifieds

Finding a job after graduation was much harder than I originally anticipated. During dental school I consistently heard about the rapid retiring rate of general dentists and the lack of new dentists entering the job scene creating a huge demand.

Well if you add in a recession and a few more dental schools opening up in the US, let’s just say jobs weren’t as plentiful as I initially believed.  Besides even if there were jobs out there, where was I supposed to look?  I had never seen a job posting for a dentist on the pages of monster.com or Craigslist.

Did you know that many state dental associations have their own classified section for dental jobs? While writing this article, I paused to take a moment to check out the listings. With the help of the Virginia Dental Association, I was able to view over 25 postings for general dentist jobs in almost every part of the state. This consolidated area of postings is a great way to see what positions are available as well as a fantastic resource for posting that CV you worked so hard on. Visit the VDA classifieds here. The ADA classifieds can be found here.

Contract resources

Congratulations! You’ve been offered a job, or maybe two or three. Well how do you know this contract agreement you are getting ready to sign is fair? Do you have a 5, 10, 20 mile non-compete, and do you know what that entails?

Just imagine if there was a non-compete clause in your contract that made and job locations in a 20-mile radius around your current employment location off limits. If this was the case, you could find yourself having a 30-45 minute commute for any future employment opportunities. How will you be paid on production, collections or salary? Are you going to be an employee or an independent contractor?  Are you or your employer responsible for paying lab fees? These are just some of the questions I had to answer looking over my initial contracts, and I was unfamiliar with almost all of these terms. Each one of these choices listed above has its own pros and cons, and that is where the ADA comes in.

The ADA has a free resource for members, “Dentist Employment Agreements: A Guide to Key Legal Provisions.” This document explains many of the terms and provisions common to dental employment agreements. The material is presented in a manner to help you consider and review a contract employment. You can also contact the ADA legal department for help understanding the language in your contract. However, remember this is not a substitute for legal advice or a lawyer’s review of your contract. That scenario above about a 20-mile non-compete creating a long commute happened to a fellow dentist.  I think that makes this one service by itself worth every penny of your ADA membership — at least from all the gas money you would save.

Ethics Hotline

Chances are after you have signed your employment contract you will end up working with at least one other dentist.  Many of these dentists have gone through very similar, if not the exact, training that you went through. What happens though if you start seeing shared patients, and you disagree with the recommended treatment plan? The first step would be to discuss the plan with the other dentist(s), but afterwards if you still feel as is if it excessive or unnecessary treatment where do you turn? The ADA created their Ethics Hotline (1.800.621.8099) for instances like this. The ethics hotline is place to discuss questionable issues that may arise in the day to day happening of a dental office in an anonymous environment. Personally I have never needed this, but I find it very comforting that the ADA offers this resource to its members.

Reduced Dues

One of the most common talked about items as a new dentist is the amount of debt that has been incurred. I, like many of you, had to take out student loans to cover the cost of my education as well as my living expenses. I read just the other day where the average dental student debt upon graduating is around $240,000. The ADA and its components understand this as well.  As a new dentist, the memberships rates are drastically reduced the first 5 years of practice and are even free the first year of practice. For more information, click here.

Being an associate can be very challenging and rewarding at the same time.  It will give you the opportunity to develop your speed and skills as a dentist while in many cases working with a mentor. Associateship will introduce you to the fellowship of dentistry that the ADA embodies.  I had the privilege of working alongside several great dentists in varying office environments during my associateships and call many of those dentists’ great friends today.

This blog post, reprinted with permission, originally appeared in the Virginia Dental Association journal. Dr. Cappy Sinclair is a New Dentist Now guest blogger and a 2009 graduate of Virginia Commonwealth University. Dr. Sinclair currently serves on the Board of Trustees at the Academy of Cosmetic Dentistry, as member of 3M’s Council for Innovative Dentistry, and as an ambassador for the Dawson Academy. He started his own practice Coastal Cosmetic Dentistry 3 years ago from the ground up and is more than happy to share his success and failures with fellow new dentists. He is a member of the American Dental Association and the Virginia Dental Association. To contact Dr. Sinclair, email him csinclair@smilevabeach.com.

Learn how to help law enforcement through dental coding workshop

Registration is open for FBI-sponsored National Crime Information Center Dental Coding workshop in Sacramento, California, March 28-29.

The FBI’s Criminal Justice Information Services Division organizes these weekend workshops across the country. The training sessions are designed to provide NCIC dental coding and National Dental Image Repository instruction to forensic odontologists and licensed dentists who wish to provide assistance to law enforcement in identifying missing and unidentified persons cases.

The workshop is set for 8 a.m.-6 p.m. at the Embassy Suites Sacramento Riverfront Promenade. Participants will receive a certification for 16 hours of training at the end of the course, but they should also check the continuing education unit requirements for their organization or association to determine whether the credit is accepted.

The FBI will conduct a criminal history background check on everyone who registers, and a felony conviction will disqualify a person from participating. The FBI also asks that those who have attended a workshop before not register to allow others to participate.

The training is free, but attendees must pay for their own travel and lodging. Those who choose to stay at the Embassy Suites should reference “dental coding workshop” when booking their reservation.

There are 50 slots available, and registrations will be accepted first-come, first-served. Registrants must be licensed dentists. For a registration form, email Kathleen Oldaker at kathleen.oldaker@leo.gov.

Learn how to identify drug-seeking patients in upcoming webinar

An upcoming webinar aims to educate dentists on how to interview patients with addiction problems and identify those who are just seeking drugs.

prescription drugsInterviewing and Counseling Patients with Substance Use Disorders and Drug-Seeking Patients is scheduled for Feb. 18 from 2-3 p.m. Central time. Michael O’Neil, Pharm.D., professor of pharmacy practice at South College in Knoxville, Tennessee, will lead the webinar and review basic interview and counseling skills that help optimize patient care and protect dentists from patients who may have criminal intent.

Dentists may find themselves the targets of prescription drug diversion scams and schemes and the webinar will provide tips on how to talk to patients about their intentions and counseling that will help minimize risks to the patient and dentist.

To register, contact Alison Siwek at siweka@ada.org. Registration closes Feb. 16.

Know anyone who has volunteered internationally?

Do you know a dentist who has generously given their time, talents and skills by volunteering internationally?

Int'l Volunteer Svc LogoApplications are due April for the Certificate for International Volunteer Service, a program that recognizes ADA members who have volunteered in developing countries to improve the oral health and overall health of individuals.

Criteria for applying for and receiving the certificate include:

  • Be an active, life, student or retired member of the American Dental Association.
  • Have served in an international location with a program sponsored by a dental school or recognized nonprofit organization for a minimum of 14 days, either in one period or in several visits, in any 24-month period.
  • Have provided clinical dental service and/or taught local dental personnel or assisted in training initiatives to improve the local oral healthcare infrastructure.
  • Supply evidence of the dates of the service with a comprehensive, detailed breakdown of activities and the value of the contribution by means of a letter or testimonial from the director of the program or other appropriate official (for student members working in a dental school program this requirement shall be the responsibility of the dean or director of the outreach program).
  • Be nominated by a component or constituent society, federal dental service or dental school.
  • Be verified in writing to be a member in good standing by the component society, if such exists, or by the constituent society, commanding officer or dean of the dental school as appropriate.

Nominations are reviewed by the ADA Board of Trustees at the June meeting. Recipients will be announced within 30 days of the meeting and the certificates will be distributed to the recipient, or to the nominating component or constituent societies upon request. A certificate may be awarded to the same individual more than once.

For more information on the Certificate for International Volunteer Service or to submit a nomination, click here.