Dentistry Uncensored with Howard Farran
Dentistry Uncensored with Howard Farran
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705 The Importance of Dental Politics with Kevin Earle : Dentistry Uncensored with Howard Farran

705 The Importance of Dental Politics with Kevin Earle : Dentistry Uncensored with Howard Farran

5/11/2017 3:23:00 PM   |   Comments: 0   |   Views: 169

705 The Importance of Dental Politics with Kevin Earle : Dentistry Uncensored with Howard Farran

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705 The Importance of Dental Politics with Kevin Earle : Dentistry Uncensored with Howard Farran

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VIDEO - DUwHF #705 - Kevin Earle

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AUDIO - DUwHF #705 - Kevin Earle

Kevin Earle has been the executive director of the Arizona Dental Association since 2008. In that role, he serves as the principal lobbyist for dentistry and better oral health care at the State Legislature. 

He is the former executive director of the Arizona Board of Dental Examiners.  Before his move to Arizona, he spent twenty years regulating professionals in the New Jersey Division of Consumer Affairs.  He was the Executive Director of the New Jersey Board of Dentistry for many years, and  in the past regulated  several other categories of health care professionals, including the Board of Medical Examiners. 

He holds a BA in Public Affairs from George Washington University, an MBA from Rutgers University and an MPH with a concentration in health policy from Columbia University. 

Howard Farran: It is just a huge honor, how lucky can I get to have the executive director of the Arizona Dental Association come over to my house for a podcast. I've been a big fan of yours. You've been sitting at the helm for what, nine years? 

Kevin Earle: Coming up nine years in September. 

Howard Farran: Let me read your bio. Kevin Earle has been the executive director of the Arizona Dental Association since 2008. In that role, he serves as a principle lobbyist for dentistry and better oral healthcare as a state legislator. He is the former executive director of the Arizona Board of Dental Examiners. Before his move to Arizona, he spent 20 years regulating professionals in the New Jersey Division of Consumer Affairs. He was the executive director of the New Jersey Board of Dentistry for many years and in the past regulated several other categories of healthcare professionals including the Board of Medical Examiners. He holds a BA in Public Affairs from George Washington University, an MBA from Rutgers University, and a master's in Public Health with a concentration in health policy from Columbia University. Damn, you're an amazing man. 

Kevin Earle: I try. 

Howard Farran: I want to start back when I first, I graduated 30 years ago this May 11. When is May 11, Ryan? 

Ryan: That's in two days. 

Kevin Earle: That's right, coming up. 

Howard Farran: That's in two days? Thursday will mark 30 years. I remember when I got here 30 years ago, back then it was called the Arizona State Dental Association. The Arizona Board of Examiners, I mean those guys were at it 24 hours a day. Is it kind of like you worked for one side of the coin and now you went to the dark side. 

Kevin Earle: I was viewed with suspicion and then some people say I came to the light and some people say I came to the dark side. But I think that experience, having worked with the profession and always had a good relationship with the profession, really helped me in my role in regulating the profession. It gave me a deep understanding of dentistry and it really allowed me to make an easy transition. I also worked on Capitol Hill when I first got out of college so lobbying and the regulatory environment was something that I'd always worked within. I think that's really helped as well. I've had a decent relationship with the Board of Dental Examiners.

This year we've had some challenges here in Arizona, one which we found that the governor wants to move all the regulated boards under the Department of Health Services and in that process last year when the governor wanted to do that, we found out that the Dental Board was sitting on five million dollars of extra money that they have collected over the last several years and we went back to the board and said, you need to lower license fees. We went with Dental Hygiene Association and the board agreed and so now we've got lower license fees coming up this year.

Then the question came up as to what they were going to do with the extra money that they still had in the bank. They had the idea that they were going to give it way to charity. We said, oh no, no, no. You've taken it from your regulated profession. It was given to you to regulate the profession, not to give it away to charity and asked the board whether or not they wanted to be accepting grant applications and then deciding Solomon-like how they were going to split this money up. They abandoned that idea but they were down that pathway for about four months. Luckily, we've gone to the legislature and we've removed language that will help to have further reduction in license fees and the board will have to live on its savings for the next three years because everybody who renews in the next three years is going to pay no renewal fee. 

Howard Farran: Mine is next month. 

Kevin Earle: Next month, well you're going to pay only $510. It used to be $650. 

Howard Farran: Nice. Another thing going back to journey, when I got here in '87, there were no dental schools. I've seen two dental schools get going. That was rocky too because a lot of dentists didn't want the competition. A lot of older dentists said, who am I going to sell my practice to? What do you think about the rise of private schools. I think we're probably graduating 1,000 more dentists a year now than we were 10 years ago. 

Kevin Earle: This is a challenge and the expense of dental education has really become a challenge because they're coming out, the average is $262,000. The dentists that are graduating from our two schools, it's more like $500,000 to $600,000. 

Howard Farran: Because they're both private. 

Kevin Earle: They're both private. It's relatively expensive. It's not to say that they aren't doing a very credible job of graduating good quality dentists. We work very closely with the two dental schools, we have great relationships with our students. In fact, this year we got our students involved in the legislative initiative because again, going back to figuring out the things that were happening, we discovered that there was something that when they first developed licensure by credential here and allowed people to come from other states, they put a $2,000 fee on a credentialing application. 

What was happening is that a young dentist who was coming here that may not take REB exam, perhaps took the CERTA exam or the credits exam, the board would accept that exam result but then they would charge then $2,000. Our students were very active in lobbying for the legislation. We had them come and testify before the legislature. It was a great opportunity to get them involved and interested in what's happening at the legislature. This is something that's going to affect their colleagues from across the country because if someone wants to come to Arizona and they're less than five years out of school, they would have had to pay a $2,000 fee. We've gotten rid of that fee. We've done, I think a lot toward license portability. 

Howard Farran: They always say that you never want to see sausage or laws made. 

Kevin Earle: Yeah, it's not a pretty site. 

Howard Farran: You said when you got out of college, you were working on Capitol Hill. A lot of people always ask me, why are you a member of the ADA? First of all, the ADA has two-thirds, 65% market share. If you look at the Fortune 500, almost no company has 65% market share. Maybe Intel on a microprocessor. When people say the market share is low, I'm like, dude 65%? I'll take 65% of any market. I'll take 65% of the bottled water market. I think it's a huge market share. But a lot of people ask me, they always say, why do you do it? I said, because you have no idea what they're ... I see it as number one, political. These kids have no idea. They've invested $500,000 into their sovereign profession and it's the ADA in DC and 50 state societies keeping it a sovereign profession. If you took all that away, like a big issue here is dental therapists in Arizona. If I graduate from dental school and I'm $500,000 in debt and they say, well a dental therapist can do all the fillings and stuff like that, that's ... 

Kevin Earle: Yeah, there's a serious flaw in the thinking behind this movement to create dental therapists and it's taken a different tack here in Arizona. A lot of the questions were on whether the training was adequate and whether they could operate safely. First of all, we know that they've existed in other states. The only state where they've actually functioned is Minnesota and Minnesota has 57 that they've graduated of which only seven are working in rural areas. If this is the answer to the access to care problem for people who are in remote areas, there isn't a lot of evidence to suggest that folks are going there. 

The other thing too is they come and I think they come in with the wrong diagnosis. They believe that there's a workforce problem here, that we don't have enough dentists. We do have enough dentists. They'll say well, only 38% of the dentists in Arizona will "accept" Medicaid. The flaw in that argument is you can't just raise your hand and say, I want to be a Medicaid provider and work for one of the access plans. It's controlled by the managed care organizations that run access, they have certain network requirements, they're not going to make their network bigger than they need it to be. Access says you need to have geographic coverage and that's the way the market is controlled for Medicaid. 

Now, do we have some areas where we have difficulty getting dentists to work in those remote areas? The question is, is there enough population to support a dental practice there? Clearly, there isn't. As my former president, Dr. Brian Poley says, you don't build donut shops where there ain't no cops. If there's not a significant enough population to support a dental practice, whether a dental therapist is working there, the brick and mortar and overhead associated with a dental practice has to have significant enough income to be able to support it and make it viable. It also basically has to be heavily subsidized. The government basically has to subsidize the delivery of care. 

I think that we can be more creative with our existing dental team. We have the tools available in the law to take our most trusted folks that work in our dental office, connect us virtually through tele-dentistry technology, be able to send an affiliated practice hygienist into a remote area to a senior center or a WIC center or a Headstart center to be able to screen folks, take integral photographs, populate a patient record, take x-rays, transmit them to a dentist and let the dentist preliminarily treatment plan them and have that person that sees that patient get them started, get them cleaned up, educate them about their oral health and then try and work on ways in which we can get them into a dental home. I see you've written the word EFTA. 

Howard Farran: You're very good, you read that upside down. 

Kevin Earle: That's right I can see it upside down. That's another thing we've done, expanded function dental assistance. We've created them in the law two years ago. I'm a little frustrated right now because I haven't seen any educational programs cropping up because there is a strong demand for it. There are a number of people that know that by having an expanded function dental assistant working at your side will make you far more efficient, you can deliver more care because you can move to the next patient, finish them up, go back and check the filling and make sure that it's appropriately done. Most people who have worked with expanded function dental assistants, tell us that they become more expert than the dentist. We don't have to do much, but we've got to really figure more creative ways. 

Howard Farran: Back to that ESTA, I thought I heard that the next step was when it got past that you had to set up an education forum. 

Kevin Earle: We're waiting for the community colleges. As a matter of fact, I have a meeting with Dean at Midwestern University tomorrow to talk about having them set up an EFTA training program. 

Howard Farran: It's a new dean, isn't it? 

Kevin Earle: No, Dr. Smith has been there awhile, maybe three years. 

Howard Farran: Yeah, I mean new from when it was started. Right now, there's no ESTAs in Arizona. It's legal but there's no training for them. 

Kevin Earle: One of the things that we did in this legislation this year was to allow the board to recognize someone who has an EFTA credential in another state. 

Howard Farran: Nice. I got my assistant licensed in EFTA, I bought it on Ebay. It was nine dollars.

Kevin Earle: Really? 

Howard Farran: There's where I got my eagle scout and my black belt. 

Kevin Earle: Was it a COTA approved online program. 

Howard Farran: Another issue, the hygienist. Some of the states, the hygienist had independent licensure. I believe it was Colorado but it didn't seem like it was very significant. It seemed like everything I would hear was like there were only not even a dozen. 

Kevin Earle: That has really not caught on. We've worked very closely with the Dental Hygiene Association. This legislation that we got through this year and the legislation that did some work on affiliated practice model a couple of years ago, which included that tele-dentistry and the EFTA. That was done in collaboration with the Dental Hygiene Association. That's another thing from the past. It used to be that the Dental Hygiene Association and the Dental Association were at odds with each other. We found that if we want to do something to improve the oral health of Arizonans, that we need to work together to try to find more creative ways to do that. 

Howard Farran: Could you send a memo to the Democrats and Republicans that they should try that?

Kevin Earle: You get far more accomplished by working together. 

Howard Farran: It's just crazy times we live in, isn't it? 

Kevin Earle: It is, it is. 

Howard Farran: I want to ask you another question about water fluoridation. We don't put public health policies up for a vote for putting Vitamin D in milk, iodizing salt, preventing all these additives to breads. Why do you think of all the public health policies, I mean we don't vote on whether or not we should vaccinate our kids for polio or like I said, iodize salt. We have a whole generation of Americans who don't what goiter is. Ever since they iodized salt, you haven't seen it. Why do you think that is an election? 

Kevin Earle: I think it goes back to the '50s and '60s when everybody thought that fluoridation was a communist plot and I guess it developed a history back then. We've still seen challenges to fluoridation just this past year again. We saw it crop back up in Bisbee. I think you'd be amused at the last lady that testified at the hearing in Bisbee said that she was a clairvoyant in town and that she was concerned that the pineal gland was calcified because of fluoridation and that was the gland through which you communicate the afterlife. We were going to have her go from town to town to testify with that information because I think it would really move people in the direction of fluoridation. 

Howard Farran: I worked a lot on the first campaign back in '89. In fact, your association worked that. We just had to do again just a couple of years ago. It's very interesting because when I'm out there at those debates and things, there are a lot of crazy people in America and I think it might as many as 20% of Americans might just be bat shit crazy. 

Kevin Earle: As a matter of fact, I think we've had some success on fluoridation initiatives across the country. I think there were at least six communities that had elections in the last six months. 

Howard Farran: One thing I sympathize with those people is like when you show them studies from the CDC or whatever or the American Dental Association, they just don't trust it. The ADA is just a shill for dentists and we want to put it in the water because it'll make all the teeth bad and then we've got to do more dentistry. I would say there's now less trust among Americans than there was when I was growing up. 

Kevin Earle: It's so counterintuitive that dentists would be in favor of something that's going to lead to less decay and less work. 

Howard Farran: But it seems like Americans believed more in America when I was 20 than when I'm now 54. It seems like there's a lot of ... 

Kevin Earle: A lot of skepticism. 

Howard Farran: A lot of skepticism. If you're talking to them and start with the deal that I don't even trust you, you're buying this stuff from a fertilizer company and you're pouring it in the water, and you're doing it to ruin teeth. Once you have no trust ... Also, I want to ask you about amalgam because it seems like the anti-mercury people, is that filling going to go away. Do you think that legally, politically that it's ... 

Kevin Earle: I don't think as a filling material it'll go away. I think given the fact that our Medicaid program is very much geared toward and will only pay for amalgam fillings in a lot of cases. I don't think it's going to entirely go away. I believe, however, as new dentists come on board who are less familiar with amalgam materials and as technology develops where there are materials that are more durable, I think we're going to probably see a movement away from amalgam. But I don't think it's going to go away entirely. I don't think it's going to be banned. I think the EPA just in the last year maintains that it's a safe filing material. 

Howard Farran: But do you know where it's not safe? Is the cremation of humans. 

Kevin Earle: Then you take it out. 

Howard Farran: I came reading that burning coal is 50% of atmospheric mercury. But they say dental fillings are 6% of atmospheric mercury because of just cremation. There are 7.5 billion humans, so how many die each year, how many get cremated, and how many had a bunch of fillings? I think one of the next steps that dentists should do in all 50 states is get a law passed so you can't cremate someone until a dentist or a hygienist, someone's got to go in there and extract. It's kind of creepy but someone's got to go in there, they do. 

Kevin Earle: I've had the question with respect to gold but not with respect to amalgam fillings. 

Howard Farran: All 50 states and the ADA, they really need to address that because so much of the anti-mercury stuff is just laughable science, it's just laughable science. But when you look at the cremating of amalgam, I don't think you should cremate amalgam. 

Kevin Earle: Interesting, I hadn't thought about that. 

Howard Farran: You haven't thought about it. I got one you haven't thought about? 

Kevin Earle: You see that. 

Howard Farran: My gosh, that's pretty cool. 

Kevin Earle: A new initiative next year. 

Howard Farran: Where do think dental therapists, where do you think that's going to end up? 

Kevin Earle: Well, Pugh Foundation submitted a sunrise application last year. In Arizona, if you're going to expand the scope of practice or if you're going to create a new regulated healthcare professional, you have to go through a process and there has to an application filed by September and then there's a hearing before what's called the Health Committee of Reference. We went through that process this past year and the hearing was two-and-a-half hours long. We presented our case, they presented their case. There was competing testimony and it didn't move forward because there was only one vote in favor of it and eight votes against it and so a bill wasn't introduced. There was some movement during the course of this legislative session of someone trying to sneak in a bill by a legislative process called a strike everything amendment. That was quashed but we know that the Pugh Foundation is still pouring money, that they've had a press conference recently to advance the dental therapists again. We're going to see another sunrise application. 

They've been trying to enlist the support of a number of other groups, one group called Goldwater Institute, which is a conservative and libertarian kind of a think tank here in Arizona. What they're position is that they believe that this "free market solution" to the access to care problem to which I respond, hey wait a minute. We're the free market. If we thought that this was going to lower the cost of dental care, then dentistry would have embraced. We clearly know that the cost of the person that is providing the service isn't going to materially change the cost curve on dental procedures. It is certainly not something that's going to significant effect the cost of it. There's no evidence to suggest in any place where dental therapists have been prominent that the cost of dental care has gone down. 

Howard Farran: A lot of these kids might not even know anything about the Pugh Foundation. How would you describe the Pugh Foundation. 

Kevin Earle: There's a lot of good things that happen with the Pugh Foundation. They do a lot of research on public policy, on health policy. We don't know where their money comes from. 

Howard Farran: You don't know where the money comes from? 

Kevin Earle: No, we don't know where their money comes from. As a matter of fact, if you pull up their 990 form, you'll find out that the sources of their income are blanked out so we don't know. For example, it could be the insurance industry that's funded this in an effort to ... 

Howard Farran: Oh, you're not going to go with George Soros. 

Kevin Earle: Could be. 

Howard Farran: Isn't he the funder of every conspiracy known to man? 

Kevin Earle: Well, he could be. You never know, you never know. We really don't know. The Pugh has taken on this as a cause celebre and they're in like 20 states fighting this battle. The other challenge that we talk about is the fact that dental therapy is different in any state that has adopted it. It's one form in Minnesota. They've gotten a bill passed in Maine but the bill says that we have a new dental school here in Maine and we're not going to do any dental therapy until we know what we impact of the new dental school is and let's see whether or not the dentists that come out from the University of New England are going to be significantly solving the access to care problem by working in remote areas. It's not proceeded in Maine. 

A bill has passed in Vermont, it's not operational yet. It has an entirely different model. The model that's in Alaska is an entirely different model. We don't have any consistency into what the scope of training is. There are COTA standards for education only because the state of Minnesota said there should be standards. That's what they're proposing here that the educational model would be an 18-month training program and it's got to include certain components. The two dental schools I think have been approached. We're hopeful they won't adopt the dental therapy thing. 

Howard Farran: Do you see these private schools ramping up even higher than they are now? Ten years from now, how many more dental schools do you think there will be? 

Kevin Earle: I think they're going to hit the point of no return. It's so expensive to set up a new dental school and it's very capital intensive. The faculty is expensive. There's a new one now opening out in El Pase, I believe that is allegedly chartered to deal with access to care issues so we'll see whether or not that means that dentists will be produced that will work in remote areas in New Mexico.

Howard Farran: Little known trivia about El Pase, being a dentist here 30 years. For the last few years, I've had several patients that they were territory manager for Texas and Arizona. I'd say, why Texas and Arizona? They go, it's half the distance from El Paso to Phoenix as it is from El Paso to Houston. Can you imagine how they got the biggest? They go, it's six hours for me to drive from El Paso to Phoenix. It's 12 hours to drive from El Paso to Houston. That is really a big deal. 

Is this overly simplistic? Some people say that the access to care problem would be solved instantly if dental schools would only accept kids from rural America. You can't bring in a kid from San Fran, LA, and Miami and tell them to go to Bumblebutt, Iowa. But if you only accept a class of kids from the rural, they'll go back to rural. 

Kevin Earle: I think A.T. Still University here in Arizona operates on that philosophy because a lot of the folks that have come into dental school for example, they have the largest percentage of Native American students of any dental school in the country. I asked Dean Dellenberg how many of those dental students have gone back to their communities, he said every one of them. I think that works. I've done a lot of work with the tribes here and we've encouraged them to identify promising students and there are programs that can help to mainstream them, to help them get into dental school and support them throughout that process. We clearly want to try to encourage folks who are committed to their homes to be able to come back and provide services there. Part of the frustration within the Indian Health Service and even with the tribally run facilities is that they will bring people in there on a loan forgiveness program but as soon as they're done with the program, they're gone so there's no continuity of care there. 

Howard Farran: It's so obvious, who else would be more likely to go practice on an Indian reservation than someone born there. 

Kevin Earle: That makes absolute sense.

Howard Farran: Who would be born and raised in Phoenix and go live in Eloy? 

Kevin Earle: I completely understand that. There are some other interesting things that we're working on. In the Navajo Nation, for example, we've gotten a greater understanding of prevention and overlaid in the Navajo Nation or in most tribal communities are what are called community health workers that are embedded in their diabetes programs, their smoking cessation programs, cancer, cardiac programs but there's an oral health piece to all of that. We are currently, the ADA is funding a group of members of the community health worker program in the Navajo Nation are training them as community dental health coordinators at Central New Mexico Community College. 

That way they become effectively oral health social workers and they work very closely, side-by-side with all the folks that are working in those programs to help them understand to take better control of their oral health, to be more focused on prevention, to understand the important of nutrition, the passing of bacteria from mother to child. All those things that they need to have a better understanding of, I think ultimately will start to change the burden of disease among our tribal folks because we really need to have very robust prevention activities. It's not all about drilling and filling. It's about reducing disease. 

Howard Farran: Do you know what I think had the biggest, in the 30 years of what I've seen, do you know what I think has had the biggest effect on those reservations in reducing disease? 

Kevin Earle: Is? 

Howard Farran: The success of the LDS church in the Navajo community. I think they've recruited a third of the Navajos into their religion. 

Kevin Earle: Really? Okay. 

Howard Farran: Every dentist I talk to and whenever I'm up in there in Tuba City they say, you can just drive down the street and say, LDS, LDS, LDS because if you just get them to quit drinking, so much disease goes away. You can't drink and be an LDS member.

Kevin Earle: The diabetes levels are sky high. 

Howard Farran: But diabetes, if you're drinking a fifth of vodka every day. 

Kevin Earle: Well, it turns to sugar. 

Howard Farran: I actually think the LDS have just had more impact on the nation than anything. 

Kevin Earle: We do know, however, that the decay rates among the Navajo children are the highest in the country. Working closely with them, it's not all about the delivery system. The delivery system is between you, me, and the lamppost is particularly dysfunctional. When you have to make an appointment to make an appointment, then you know we have a dysfunctional delivery system. At Phoenix Indian Medical Center, you have to be on a line, not online, on the first Tuesday of the month to get an appointment for dental care that could be weeks and weeks and weeks away.

Howard Farran: Wasn't Arizona home of the first Native American Indian dentist? 

Kevin Earle: Yes, Dr. George Bluespruce. 

Howard Farran: I want to get him on the show so bad. Do you have contact information for him? 

Kevin Earle: I do, Dr. Bluespruce is a good friend.

Howard Farran: Really? 

Kevin Earle: Yeah, yeah. 

Howard Farran: He was the first Native American Indian dentist in America. 

Kevin Earle: Yes, he was. 

Howard Farran: Oh, I so want to talk to him. 

Kevin Earle: He has so many stories. 

Howard Farran: I know, and I've seen him. He's always speaking at these different functions and he's quite a great speaker. 

Kevin Earle: He's amazing. Dr. Dillenberg is retiring too so you may want to talk to him before he disappears. 

Howard Farran: I did a podcast with him. 

Kevin Earle: Did you? 

Howard Farran: I did. Very well received. I want to ask you, I did another podcast with Regina Cobb, who is a dentist in Arizona.

Kevin Earle: Who is my good friend who hired me. 

Howard Farran: Really? I wanted to tell you that because again, you people that come out with half a million dollars in student loans by not investing in your profession in the ADA membership is a really bad idea because if you just all these legal battles, you're not going to be holding much 30 years down the line. Then people will say, they don't agree with something like this. Dude, what percent of the stuff do you not agree with your mom and dad? They're still your mom and dad. They're you're only mom and dad and the ADA is your only mom and dad. If you don't like it, get involved but I want to ask you, because a lot of these people may not realize but there are a lot of dentists who just get involved in politics. Regina Cobb was amazing. In fact, we never had a dentist president or in the senate but we have four in the congress right now and one of them is from Arizona, Paul Gosar. Do you know all four of those guys?   

Kevin Earle: Paul I know quite well. The other members, as a matter of fact, one of the other dentist members was presiding over the American Health Care Act vote the other day, Dr. Mike Simpson from Idaho. I noticed that he was up on the dais pounding the gavel. 

Howard Farran: He's the longest serving dentist, right? 

Kevin Earle: Yes. 

Howard Farran: From Idaho? 

Kevin Earle: Yes. He's been there for quite a while. Then there's a new guy from Texas named Babbet and a guy named Mike Ferguson from Georgia who was just elected. 

Howard Farran: I actually weight to Creighton with Paul, we both lived in Swanson Hall. 

Kevin Earle: Did you?

Howard Farran: I was on the ninth floor, he was on the eighth floor. Tell the story, like Regina Cobb, what makes one of your ... Okay, so you said Arizona has 4,000 licensed dentists, 3,200 of them are active, two-thirds of them are ADA members. What is the journey for some dentists to get involved politically? 

Kevin Earle: Well, you know Regina was first of all, she was president of the association but she was always involved in our Council in Government Affairs. She was the chair of our Council in Government Affairs during our most successful run of legislative victories in the state legislature. That's really what gave her the bug. She was a member of the board of education in Kingman and was very active in her community and had a wonderful reputation. She is well loved at the capitol. She is the vice chair of the health committee. She is the chair of the health subcommittee and the appropriations committee. She is the one that led the restoration of Kids Care in the Arizona budget last year with a lot of political repercussions. 

Howard Farran: What percentage of this is volunteerism versus making money doing this? 

Kevin Earle: You don't make money doing this. 

Howard Farran: I know. 

Kevin Earle: The salary of a state legislator is $24,000 a year. You do it at considerable sacrifice. 

Howard Farran: It's their drive and passion? 

Kevin Earle: It is, it is. 

Howard Farran: Because I was wondering about Paul Gosar, he was a successful dentist in Flagstaff, Arizona. 

Kevin Earle: He was. 

Howard Farran: Now he's got to consider himself living in crazy times. 

Kevin Earle: His first interest in legislative activity happened when the dental therapy started in Alaska and the American Dental Association and Paul was on the Council of Government Affairs at ADA and that's really gave him the bug. He's had considerable success this year, actually. One of the things that he's been pushing for, for quite a while, is the repeal of the McCarran-Ferguson Act. 

Howard Farran: Right, I wanted him to come on the show and talk about it. Do you have an email for him? 

Kevin Earle: Sure. We got it out. It has passed the House of Representatives. 

Howard Farran: But I don't think 90% of the dentists even understand.

Kevin Earle: Well, see the McCarran-Ferguson Act is an interesting thing because there are only two industries that are exempt from antitrust laws. One is major league baseball and the other one is health insurance. This goes back to the 1940s when they tried to create health insurance companies. They said, well, they're going to need to work together so we're not going to worry about antitrust laws with respect to health insurance companies. Even though two dentists can't talk about what fees they're going to charge, insurance companies can talk about what fees, what reimbursement they have. The repeat of the McCarran-Ferguson Act will put some transparency. 

Howard Farran: Is it done? Is it a done deal? 

Kevin Earle: It has passed the House of Representatives and it's got to get through the Senate now. 

Howard Farran: But will it? 

Kevin Earle: We are hoping and praying. It may be incorporated into this change in the healthcare. 

Howard Farran: The healthcare industry has a lot of weird stuff. Take Delta, it's a nonprofit. I've never seen so much money, sales, and profit than a nonprofit. Would you say there's a lot of profit in that nonprofit? 

Kevin Earle: You know, it's funny. We don't really talk about dental insurance because I don't call it insurance. I call it a payment health assistance program. It's really not insurance and it depends upon the nature of their book of business. It used to be, I think more profitable. It depends on how their networks are functioning. There's been some challenges here with our own Delta. There was a recent issue that just happened in California, I'm sure you may have read about it. The California Dental Association participated in a lawsuit against their Delta because they had unilaterally canceled all the contracts of all their premier providers and made them PPO dentists and it cost the California Dental Association three million dollars to pursue that but they ultimately prevailed. 

Howard Farran: That money, did that come from the tooth fairy, a unicorn, or members paying dues.

Kevin Earle: The California Dental Association now owns a malpractice insurance company and they're a lot more well healed than we are. 

Howard Farran: They also own that 22-story building, right? 

Kevin Earle: They do, it's the tallest building in Sacramento. 

Howard Farran: That was a smart move. 

Kevin Earle: Yeah, I would think so. 

Howard Farran: Utah dentists to have their own dental malpractice. 

Kevin Earle: I don't know. 

Howard Farran: It's like 90% of all the dentists in Utah have the same dental malpractice and they only cover Utah. 

Kevin Earle: I think that the financial resources to be able to pursue this kind of litigation, ultimately they're going to get back 1.5 dollars of it from Delta and that will be returned back to the members they were suing for. That was a big win but insurance is differently regulated in California. It's not regulated like it is here. Here it's essentially unregulated, I should say. 

Howard Farran: I was wondering with regard to Delta, I just wonder, everything in life has a trade off. I wonder what the trade off would be if all the nonprofits were publicly traded. I'll bet there's good and bad in both systems. 

Kevin Earle: If you're a not-for-profit corporation, again it depends on his they're regulated. In California, there is a minimum minimal loss ratio, medical loss ratio that they are required to have. They've got to maintain a medical loss ratio of about 80-85%. Here, that's not regulated. You can have an insurance company that would be here that could have a medical loss ratio of 60%, which means they're spending 40% on infrastructure and salaries and 60% of the premium dollar is going to benefits. But medical loss ratios aren't regulated in Arizona the way they are in California. We're seeing a movement in a lot of states, the move toward legislation that would mandate medical loss ratios. 

Howard Farran: Another thing I noticed in California, they were complaining that a lot of people weren't participating in their state Medicaid program for dentistry but they raised the fee schedule and it attracted a lot more dentists. 

Kevin Earle: There have been some major reforms I think that have happened in California. They were operating basically, the Southern California and Northern California were separate. One was a capitation plan, the other one was a fee for service plan. The reimbursement levels were low. There have been some recent studies from ADA that basically are looking at what Medicaid reimbursement rates are and also overlaying the supply of dentists and whether or not they've got high utilization. Here our published rate is 54% of UCR but in reality that's what called the fee for service fee. Those dollars go to these nine different managed care organizations and the fees, the reimbursement levels are about 38% of UCR so it's relative low. It's challenging to be a Medicaid participant here. 

We have challenges with access although they've worked with us in the last year. We've gone to them and said, you've got to alleviate some of the burdens of extra paperwork and pre-authorizations that you're requiring and they've worked to try to adopt a uniform practice matrix so that the rules are the same from one plan to another. We had some issues involving credentialing. With some plans it was talking up to 120 days to credential a new dentist. If you extend an offer to a new grad and it's taking 120 days, that was entirely unreasonable. We've gotten them to change some of the credentialing and actually create a fast track process for a new grad to be credentialed within 15 days. It's not rocket science to credential someone with an insurance company. 

Howard Farran: A lot of kids when they come out of school don't know the difference between the Medicaid and Medicare. Medicare is the federal thing like your grandma's Medicare for her health insurance whereas Medicaid is state by state. It's one of the things they found out with Obama care. In Arizona everybody calls their Medicaid Access and they had no idea that was part of Obamacare. They had a lot of money and subsidies from Obamacare. I don't want to get political, you should never talk about religion, sex, politics, or violence but right now the congress is trying to repeat Obamacare, which is 50 state different Medicaids. Does that really have a dental impact? 

Kevin Earle: Yes, it does. First of all, in the Medicaid program, children are the only ones that are mandated to be covered under Medicaid. In Arizona, we only cover kids. We had no coverage for adults. We did many years ago. In 2009, the state decided that they were looking for quarters in the sofa cushions and decided to eliminate the adult dental benefit. That's an optional benefit. You're not required by the federal government to cover adults under Medicaid. There's also an enhanced match. The Medicaid is a partnership between the federal government and the state government. Usually the match is about a three to one match. For every dollar that Arizona comes up with, the feds come up with three. When the Affordable Care Act was passed, there were inducements to and a big fight in the legislature to expand Medicaid to people that were under 138% of the federal poverty level. If the state would move forward with that, they would cover 90% of the cost so we went into this expansion mode.

The fear is now with this American Healthcare Act that they'll significantly clamp down on the dollars that come in to cover our Medicaid population, which means that the folks that are in that expansion category are probably going to be the first ones that have challenges obtaining coverage. I don't know where these folks are going to go to get health insurance. Many of them have significant preexisting conditions that are now covered under Medicaid that if they try to obtain insurance in the private market, that's going to be a challenge. Those adults that were covered under that thing have no adult dental coverage. 

However, we were successful this year getting the governor to request the legislature to put our adult emergency dental benefit back. We just got that through the state budget last week. Starting on October 1, adults will now have under Medicaid will have a limited adult emergency benefit that will cover root canals on their 14 interior teeth or extractions and it's up to an annual cap of $1,000. But at least they'll have something and they won't have to go to an emergency room where they're just going to become antibiotic resistant and opioid dependent. Hopefully, we're going to see that movement out of emergency rooms and back into dental clinics and dental offices where they can get coverage. 

Howard Farran: You know, Kevin you're still a young spring chicken but you've been in this business for years. You used to be executive director of the New Jersey Board of Dentistry including the Board of Medical Examiners. You have a BA in Public Health. How long have you been in like healthcare government space? 

Kevin Earle: My first switch to the healthcare space was when I went to the Board of Medical Examiners in 1994. 

Howard Farran: 1994, see I wasn't even born yet. 

Kevin Earle: Right. 

Howard Farran: That's how long you've been in it. The question I wanted to ask you is, when I lecture around to all these advanced countries, why is healthcare always such a controversial issue in America. It's just not in Canada, Australia, New Zealand, England, Germany, France, Sweden, Switzerland, Ireland, I mean you could just go on and on and on. All these single payer countries do it for half the cost. We do it for not only twice the cost but eight times the controversy. What is about the American journey that why it's such a ... 

Kevin Earle: This is a constant challenge. When you go to other countries, I spent some time in Denmark a few years back, and I was in Norway and I said do you mind paying so much in taxes. They said, no we don't mind paying so much in taxes because if we lose our jobs, we know we're going to have coverage, we're not going to lose our home, we're always going to be able to get healthcare, and the government will help us find a job and get ourselves back on our feet again. We don't mind spending that because we know that we're going to be safe. We're also very happy. Denmark for example, is the happiest country on earth. I don't know why we're so afraid of being happy. If we didn't have these concerns and these challenges ... 

Howard Farran: Where does it come from? Is it because Americans for some reason don't like their government or government period? 

Kevin Earle: There's a whole suspicion about government. I think we have, allegedly, the greatest government in the world and most democratic but we're so afraid to move forward and to be more progressive. 

Howard Farran: I also think the high tax thing is ... 

Kevin Earle: That's a big issue here in Arizona. 

Howard Farran: Actually, it's a joke really because in Scandinavia, they'll pay half in taxes but most people are working for $40 an hour, so they'll net $20. You come to America and most people are working $10-15 an hour and you might only have to pay 25% taxes but you're only netting $10. I'd rather pay twice as much taxes and net $20 than half as much taxes and net $10. It's net, net, net, net. Who cares what your gross is? These employees don't even live on their gross. I paid my employees for 30 years and if you ever ask them how much they make, they only say the net number. They never look at the gross, the FICA matching. 

Kevin Earle: Or the cost of their employee benefits and all that other stuff. I see with my own employees. I run an organization where we have 18 employees. 

Howard Farran: Who has 18 employees? 

Kevin Earle: The Dental Association. 

Howard Farran: You guys have 18 employees? 

Kevin Earle: Our Dental Foundation and our clinic downtown. 

Howard Farran: Is Terry Zalowski your favorite employee of all of them? 

Kevin Earle: He is. 

Howard Farran: He's an amazing man, I love that guy. I love Terry. 

Kevin Earle: You know he's going to listen to this podcast. 

Howard Farran: Is he? Terry, big shout out, Terry is an amazing man. Let me say this, you have two-thirds membership, you have 65% for national, state, which I give an A. Like I said, in the Fortune 500, I mean American Airlines, the number one airline in America is Southwest Airlines. They have 27% market share. What would Southwest Airlines do to get 65% market share. Some of these kids come out of school they say, Kevin, I'm half a million dollars in debt, I can't join these things. What would you say to that kid? 

Kevin Earle: You know, I would say that you're coming out of school and you're alone. You shouldn't have to go and face the challenges that you're going to be seeing in the rest of your career alone. That's the concept of a dental association that you have a cadre of folks around you, you get to understand more, you become a better dentist, you have relationships that you build with other colleagues to get to know who are the best specialists to refer to, where are the best opportunities to advance my career and to know that we're as close as your phone with whatever you need. Not to mention the fact that you're going to get discounts on your malpractice insurance and you're going to get disability insurance that's going to be with you for the rest of your career. 

Howard Farran: Don't you have a supply deal too? 

Kevin Earle: Yes, we have a dental supply company where you can save $16,000 a year on your dental supplies for your practice. 

Howard Farran: Who is that from? 

Kevin Earle: It's a company called Source One, which is based here in Arizona. 

Howard Farran: Run by my buddy, Ahmad Shams. 

Kevin Earle: He's a good friend of ours and he's moved into many other states. We want to provide those opportunities that are going to be able to save people money and know that you're going to have a support network around you and we're going to be the ones that are defending you when you get a threat from the dental therapy group or when there is something that's a challenge that we're dealing with. We've got the power to go down to the legislature just like we did with the students legislation this year with changing that $2,000 credentialing feel. We saved them $2,000 right up in the front. Then even what we're doing with dental board fees for the next three years. People aren't going to have to pay a renewal fee for the next three years because we were vigilant and stayed on top of the fact that the dental board was collecting too much money. 

Howard Farran: I can never remember the ADA economist's name, Marko ... 

Kevin Earle: Vujicic. 

Howard Farran: Marko, M-A-R-K-O?

Kevin Earle: Marko Vujicic, he's our chief economist. 

Howard Farran: What is that, Marko? Is that? 

Kevin Earle: I don't know what country he's from but he is brilliant. 

Howard Farran: He is freakishly overqualified. He comes from the World Health Organization, the United Nations. How did the ADA get one of the smartest economists, I mean the most credentialed? But anyway, I was wondered, I just sent you an email. I was wondering, there's a bit threat on Dental Town and it's called an Open Letter to the ADA. Basically, this guy is saying that in August 2008, President Bush signed this long-term reauthorization of the Higher Education Act. This provision of the federal student load rules ensuring dentists ... Anyway, what he's saying is that when physicians have half a million dollars in student loans, there's all these programs for repayment all the stuff like that. 

When it was done, dentists were not real doctors, we're more like Dr. Pepper and Dr. Seuss and Dr. Dre and we weren't included in this but I was wondering, I've read it several times and I'm not smart enough to know the details. I just emailed to you but do you think you or Marko could read that thread on dentistry because it's exploding? There's like thousands of views and comments. It's so funny because dentists, Americans are so anti-government, some of the kids with half a million dollars in debt don't even want the government to help them because it's the government. Anyway, is there any way someone intelligent could way in on that?

Kevin Earle: This is one of the big issues that we fought for in Washington. This year the American Student Dental Association and the American Dental Association were there together for the first time and lobbying congress to deal with student debt and student loan issues. One of the weird things that is in federal law is that you can only refinance your student loan debt one time. That's ridiculous. If there's an opportunity to take advantage of lower interest rates, there is no way that there should be a restriction on refinancing your student debt. As a matter of a fact, the ADA has a great program to allow students to do that, consolidate their debt, save significantly on their interest rate and it's only available to members. 

The other thing that we're dealing with is the fact that there are two kinds of loans, a subsidized loan and an unsubsidized loan. When you go into dental school, you can't get subsidized loan, which means you're accruing interest all the time you're in dental school. There's no reason why you shouldn't be able to have a subsidized loan that would allow you to defer your interest payments until you graduate because you end up with an extra $100,000 of interest on top of the money that you borrowed. 

Howard Farran: But Kevin, how many countries have you been to that you really liked vacationing in? You said you went to Denmark. 

Kevin Earle: Yes. 

Howard Farran: How many countries do you think you've been to? 

Kevin Earle: I've been to Denmark, I've been to Greece, I've to Italy, I've been to France. 

Howard Farran: I'm not kidding about something, I know everybody thinks I'm kidding but aren't we getting close to where a kid walks out of school a half million dollars in debt and can't pay for everything. I think I'm just going to move to Greece or Auckland, New Zealand. Then sometimes they'll marry their sweetie in the class and these guys are 24 and a million dollars in debt. At that point, doesn't it just look nice and say, I'm going to move to Copenhagen. 

Kevin Earle: Just walk away from this, right. 

Howard Farran: Has anybody done that or do I just have a very criminal mindset. 

Kevin Earle: I'm also fearful for these young folks who may get induced into working into scenarios where they are over diagnosing and they're engaging in activity just because they've got a bill to pay at the end of the month. I think we're seeing a propensity of folks who engage in things and try to induce patients to do things because they've got a huge nut to make at the end of the month. We pride on dentistry to be the only profession that has a strong code of ethics but yet we're building a scenario here where it's just putting people into untenable positions that's going to move them into the direction of doing things that are not patient centric and not good for the profession. People will go to another dentist down the street and they say well this guy says I've got 10 fillings that need fixing and in reality that's not the case. 

Howard Farran: Are you getting more feedback from some of these corporate centers that a lot members are doing second opinions on they're told they have a big treatment plan and they don't? Are you kind of referring to that or do think [crosstalk 00:55:47].

Kevin Earle: I think even in someone in a private practice where they have that economic pressure and they talk to some practice guru that gives them the idea that they can go ahead and do this and it's all focused on making money but it's not focused on doing the best thing for their patients. 

Howard Farran: You've been in this '94 so how many years from '94 to 2017? 

Kevin Earle: I don't know, I can't do math in my head. 

Howard Farran: I take geometry. You've been in this 23 years. You remember when Orthodontic Centers of America was publicly traded and it was NASDAQ. They all imploded, they went away. Corporate is back now. They've been fine for 10 years. A lot of people say they're about 12%. It's how you define corporate. A lot of dentists are incorporated but they have one office. I'm talking about the 35 chains that have more than 50 locations. They're 12% of the market. Do you think in 20 years or 10 years, they'll double that? 

Kevin Earle: I think it's absolutely growing. I think we also see a dynamic where dentists are coming out of school in debt and they want to make sure that they make a good salary but they don't want to be bothered with the business aspects of their practice and this was a good answer for them. Somebody else takes care of those issues. They take care of the billing and the administrative and the personnel. 

Howard Farran: But when you dig deeper though, it seems like their main problem is dentist turnover. Some of these corporate chains, some of those guys could hire 20 dentists. 

Kevin Earle: I think the models are changing. I think the models are providing better opportunities for equity investment on the part of the dentists that are working there. I think that leads to a little more long-term stability. We're seeing a lot of market penetration of a lot of these larger organizations, particularly here in Arizona where it's okay for someone, a non-dentist to own a practice as long as they're registered with the Board of Dental Examiners. But Marko Vujicic has some statistics recently that he's talked about as to where the marketplace is and where folks are being employed. We're seeing that among the younger demographic, particularly among women who may be only working part-time that these are good options for them because they can have that work/life balance and be able to work together. 

Howard Farran: If you haven't had a kid yet, just don't do it. Just don't do it, 27% of baby boomers have no children and every time I look at my four boys I just think, why wasn't I in that, just kidding. I want to ask another really, really hot topic. In Texas, an implantologist was declaring that he was a specialist and the Texas Dental Association, your equivalent in Texas, I guess they went to court and the court ... 

Kevin Earle: It was the Texas Board actually. 

Howard Farran: Oh, it was not the Texas Dental Association but the Texas Board of Dental Examiners and it looks like, is it too overly simplistic to say that specialties have been thrown out of court. 

Kevin Earle: Yeah, I think it is a little over simplistic. There has been a movement of some groups to form a separate certifying body to certify specialists. There's been a lot of talk about this at the ADA level. There's been a lot of movement toward rethinking the process for declaring a specialty. Right now, it requires a vote of the house of delegates, which makes it a political process and it really should be, the decision should be made on the merits of whether or not someone has had an academic program and training of sufficient rigor in order to call themselves a specialist. 

There's wide variation in terms of what education criteria people use. Some people say it's only 400 hours of CE and other people they have to go into a residency program for several years and have so much patient experiences and go through an accreditation process. There's, I think, a vast difference between what people might call a specialist. I think the question is how someone is perceived by the public to be a specialist. I think the public needs to understand the difference. I think there is rigor to the process that ADA employs but it is undergoing some reform and some consideration at the ADA level. 

Howard Farran: The answer should just be, what is best for the patient. If I was going to a doctor, I would want the definition for me. If I had a rare disease and someone said I specialize in that disease or that surgery, I'd want that to be the real deal. 

Kevin Earle: Right. There's a lot of movement too with the ... The Federal Trade Commission has gotten particularly aggressive after the big case that went before the Supreme Court a few years back from North Carolina where the Dental Board went after teeth whitening kiosks with cease and desist letters. Ultimately, the case went all the way to the US Supreme court. The Federal Trade Commission prevailed and said they were acting in an anti-competitive manner. They didn't have the legal authority to go after the teeth whitening because they were market participants who were the board members and they didn't have effective state supervision. They were independent of the governor. 

What we've seen since that time is a lot of movement, state by state to create some mechanism of supervision of the regulatory boards because the regulatory boards are market participants. We're seeing some things happening here as well. Governor Ducey doesn't like the fact that they're all independent boards and they're composed of market participants. A lot of the things that he has been concerned about fall into that category. There has been some legislation this year to give them something oversight. I think the movement, the idea that they're going to bring all the licensing boards under the Department of Health Services is an effort to sort of create that shield of supervision to make sure that people don't get out of hand. There's clearly opportunity for people to crowd other people out of the market and to disqualify people who may be otherwise qualified for a license just because they don't like the way his hat is tilted. 

Howard Farran: The board knows there's no jury or appeal. 

Kevin Earle: You can to go court. 

Howard Farran: You can? 

Kevin Earle: That's your only option here. If you want to appeal a board decision, you've got to go to Superior Court. 

Howard Farran: They've got to hear the case too. 

Kevin Earle: Right, and it's a long process. If you disagree with what that court says, you've got to go to the Court of Appeals. 

Howard Farran: The last question, I can't believe we've already gone an hour and three minutes. You're so kind to do this. When I meet dentists around the world, one of the silliest terms I think is the United States of America. When you go to Europe, no one says, oh I live in the EU. No one would compare Germany to Greece, Portugal to Sweden, Norway. A lot of people say, I visited America and I always say, really, where did you go? They always say the same thing, I went to the Greater New York meeting. I'm like, did you ever leave Manhattan? They're like no. I'm like, man what a weird vision to think America is Manhattan. I always say to myself, I chuckle. 

Kevin Earle: It's really New Jersey, where I'm from. 

Howard Farran: That was my final question. You did all of this in New Jersey and now you're doing it here. Is dentistry and state politics, is it really different in New Jersey to Arizona? Is it like two different countries or is it pretty much all the same? 

Kevin Earle: It's very similar. This year I'm the president of all the executive directors in the United States. 

Howard Farran: Congratulations. How did you get that? 

Kevin Earle: I just moved up the ladder. Somebody asked and I was stupid enough to volunteer. 

Howard Farran: You're the president of all the ... 

Kevin Earle: Right, we share information all the time. The things that we face in one state are similar all across the United States and that's the function of the ADA, to keep us all abreast and to bring us together. We're all dealing with similar kinds of issues. The politics is different depending on whether you're a conservative state or a liberal state. I read all the magazines from other states and I look and see what issues they're dealing with in the legislature. They're all Democrats in California, it's a whole different world over there. Here, we've got a very strong conservative Republican legislature. That doesn't mean that we can't be successful and that we can't talk logically and that we can't stand up for what's right. We've gotten an awful lot done in the last eight or nine years. I'm pretty proud o our record, it's significant. That's why I think every dentist should be a member because we're out there fighting the good fight. 

Howard Farran: I do too. It makes me so mad when somebody will find something wrong and then quit. It's like, quit and do what? Just to run the town forever. My mom and dad cried when I graduated. That's what the profession meant to my mom and dad. I think when you retire, when kids walk out of dental school, their parents should cry too. It's a sovereign profession. It's very, very different. Last question though, what percentage of the dentists in New Jersey were part of the mob and the Sopranos and the mafia? Was it most of them? 

Kevin Earle: My own grandfather was hit over the head and thrown into the lake, which I found out when I went to Italy. 

Howard Farran: Seriously? 

Kevin Earle: Yeah, sure because all during Prohibition, he basically ran a speakeasy. I had to go all the way to Italy to find out that that happened. 

Howard Farran: Speaking of Prohibition, there's a lot of people talking on Dental Town, this medical marijuana, which is the end of prohibition of marijuana, there's a lot of dentists in Colorado and these states that legalized it that have a medical use for the marijuana but a lot of people are wondering, what does the board think about this? If you got sued like you did something wrong, and then it came out well I have pain and I'm on medical marijuana for pain for fibromyalgia or whatever and it's eventually going to open up a lot of cobwebs. 

Kevin Earle: This is going to be an interesting time to see with respect to all healthcare professionals. 

Howard Farran: If you had to have a bypass, would you want your cardiologist to smoke pot that morning? 

Kevin Earle: I think he'd be in there a for an awful long time to try and fish around in there and find the right thing. I'm not sure I would have a lot of confidence in him. 

Howard Farran: He might legally have the right. 

Kevin Earle: He could. This is I think, on the regulatory side, an issue that I'm sure people have been thinking about for quite some time. I haven't seen any issue that's occurred here in Arizona. Whether or not someone has a medical marijuana card or not, I think the board would look upon it as considering it being impaired and practicing while impaired. That's not the only way to control pain. It could also be that you could be impaired by the use of medications. Generally speaking, most of the impairment issues that come before a dental board relate to self-prescribing, self-medicating and dealing with that oftentimes starting with back issues. 

Howard Farran: Is it more opioids or is more alcohol? 

Kevin Earle: I would say that a good percentage of it is opioids.

Howard Farran: What percent would you say opioids versus alcohol. 

Kevin Earle: It would be hard to say. I haven't done any research to say what percentage is what. I would say that oftentimes folks come to the attention of the dental board because they had a driving while under the influence charge and that's generally how they get caught. 

Howard Farran: Oh, during the DUI they find out ... 

Kevin Earle: They're required by law to report it to the board. 

Howard Farran: When they do a DUI, if you flunk that then they check for opioids? 

Kevin Earle: No, I think that's oftentimes the way people get caught up into the web. Usually, someone who is self-prescribing, it may be a colleague that reports them and they can report them and maintain the confidentiality of someone. There is a confidential program now here in Arizona. When I first came here, I felt like it was hanging justice because you had to stand up in a public meeting and admit that you had a problem with drugs or alcohol. You had to come back on a periodic basis and report back to the board and the public would be there and TV cameras could be there. Luckily, in the last couple of years, we've gotten wiser. Programs like this that treat this as a disease and we want to encourage folks to get well and to recover. Programs are now confidential but there's always the stick or the hammer above your head of a potential disciplinary action and a license suspension that tends to keep folks on the straight and narrow. I think it's extraordinarily successful. It's very rare that you now see dental board issues that come up in public disciplinary orders, they're rare. 

Howard Farran: Even our music about that is clandestine, like Sade's Taboo. That was about her love for heroin. Waiting on a Friend by the Rolling Stones, Six Pence There She Goes Again. Even those songs were kind of clandestine lyrics. They didn't want to really go public with what they were singing about. 

Kevin Earle: I just think we've gotten to a better place with respect to dealing with impairment issues in the regulatory environment. When I was at the medical board in New Jersey, we moved toward a confidential program. There was eyes put on anyone that was in that program. They were masked by identity. The only person who knew who the person was, was myself as the executive director of the board so that I could double check and make sure there wasn't any issue of criminal activity or if we had a pattern of complaints about patient safety. We would bring that to the table to decide whether or not it was appropriate for someone to stay in that confidential program. 

But we've moved away from the public nature of these things and I think we're in a much better place here in Arizona. It was scary when I first got here, I said yeah, three minutes to stand before the board and state your case. Then when the ax would fall, it was the end or they would just hit the button and into the gallows you'd go. I think it's a much better place. I had a great experience when I was, I don't have much time we have here but ... 

Howard Farran: We can go 40 days, 40 nights. 

Kevin Earle: I had a great experience with a situation involving a dentist that was mixing the cherry-flavored demerol with his water bottle and had been caught by his dental assistant, dental hygienist. They went to the other partners in the practice and they ultimately confronted him and he denied use and said he had only done it once. We conducted an investigation and at the time we were able to confront him. Here in Arizona, if you have an apparent allegation, you have to go to take a urinalysis within three hours of the time you're confronted. In this case, ultimately after we interviewed the individual and found out he had been passing prescriptions, that he had been writing prescriptions in his wife's name, that he had been stealing oxycodone from his father, a number of other things. Ultimately, he was sent to the Betty Ford Center. I have a place over in Palm Springs and I was over there and I thought, I'm sending some folks over here to Betty Ford, I want to get a tour. 

Howard Farran: I thought Betty Ford was in Atlanta. 

Kevin Earle: No, it's in Palm Springs, Rancho Mirage. 

Howard Farran: Really? 

Kevin Earle: Yeah, it's affiliated with the Eisenhower Medical Center in Rancho Mirage. 

Howard Farran: Is that the only one? 

Kevin Earle: Yeah, it's the only one. 

Howard Farran: It's in Palm Springs. I always thought it was in Atlanta. 

Kevin Earle: I had a tour and I was very impressed. They have programs for healthcare professionals who have impairment problems. When we got done with it, and I was hoping to run into Lindsay Lohan when I was there but she wasn't there at the time, but this dentist said he wanted to me with me. When he came into the room, I was fearful about what he was going to say to me but he put out his hand and he shook my hand and he said, thank you. Thank you for confronting me because I couldn't accept what I was dealing with and I had no help and I didn't know where to turn. If you guys hadn't confronted me and gotten me over here to change my life, I don't know where I would be. 

Howard Farran: If you were Prince or Michael Jackson, it's sad because those guys were so rich, they were insulated from any checks and balances. 

Kevin Earle: It is and nobody wants to challenge them. 

Howard Farran: That Michael Jackson, his doctor had so many opportunities to say, this guy needs help. 

Kevin Earle: I had another situation, we got a call one morning that there was a young man practicing out in the east valley and the dental assistant said that he's drinking beer during the day. Then we got another call from a patient who said they smelled beer on his breath. We went out, got in the car and went out right there and we said, Doc, you're going to have to go pee in a cup in the next three hours, what's it going to tell us? He said that he'd had a beer at lunch. Then he explained, you know what are your drinking habits? He explained to us that at the end of the day ... Now when I walked into this place, this is in 2007, we all know what was happening here in Arizona here in 2007. 

I'm looking at this beautiful dental office with all the latest bells and whistles and I said, I know why he's drinking, he's trying to keep his head above water. This man was only a young man. He was only 28 years old, two years out of school. He had taken on this practice and he said that at the end of the day he would have a couple of beers while he was reviewing his charts. I said, well when you get to the third beer and the tenth chart, what are you remembering? I said, then you get in the car and then you drive away. I said, don't you think it's going to be an issue if you get pulled over. He had a wife and a child and a mortgage and all these extra pressures. Ultimately, we got him to admit that ... He took us into his private office and he opened the waste can, there were eight empties and this was at 2:30 in the afternoon. 

It's so important to get folks into care and to know that there is a network around them. This again is the Dental Association because other guys that have been there came back and they kept his practice operating while he was getting his inpatient treatment. 

Howard Farran: Nice. That's so nice. 

Kevin Earle: That's what it's all about. 

Howard Farran: You said that it was because it was 2007, the big recession. 

Kevin Earle: Oh, yeah. 

Howard Farran: I think it was probably the wife and the kid, don't you think? 

Kevin Earle: I don't know. 

Howard Farran: I want to make one confession on air, I'm going to run it by the head dog. Do you remember that movie Breaking Bad? 

Kevin Earle: Yes. 

Howard Farran: Did you ever see it? 

Kevin Earle: No, I haven't seen it. 

Howard Farran: It was basically a high school chemistry teacher and he was making ... 

Kevin Earle: Money to pay for his healthcare costs. 

Howard Farran: He was making medical grade meth, I guess it was the best meth ever. What I've been doing is taking the Novocaine and converting it to medical grade cocaine and selling it out the back door. I'm making a lot of money but I'm not using it. Is it all legal and good. 

Kevin Earle: Really? I had a medical board case ... 

Howard Farran: I think we should start a new Breaking Bad movie. 

Kevin Earle: This is what I aspire to Howard, what I really want to do is I want to take the stories from by board days and I want to have a reality TV show like Law and Order where you spend the first half investigating and then you spend the second half hour prosecuting because the stories from my medical board, dental board, chiropractic board days are enough to make what little hair is on your head stand up. We had, I was trying to think what the case was. 

Oh, it was a pharmacy in inner city Newark and there was a doctor in a storefront a couple of doors down and it was just a card table and a folding chair and folks would line up out the door and he would write them prescriptions and they would go down to the pharmacy and they would redeem the prescription for a controlled substance. They would bill the Medicaid system. They would then dispense the medication and the person that would dispense the medication would go back around the back of the pharmacy and they would give them cash. This was just a big cash machine. This was a whole network of folks that were going around and of course the pharmacist lost his license, the doctor lost his license too on an emergency suspension. Some folks can be pretty creative. 

Howard Farran: As you get older and older, you realize that we're all just a bunch of monkeys with clothes on. 

Kevin Earle: I want to be in Palm Springs writing scripts for my reality TV show. No one has ever used that as an idea for a TV show. 

Howard Farran: Palm Springs is four hours from here. It's about the halfway part to the beach. Would you say it's half way or two-thirds? 

Kevin Earle: It's two-thirds. 

Howard Farran: Two-thirds of the way to the beach, love that place. Kevin seriously, thank you for all that you do for dentistry. 

Kevin Earle: You're welcome. 

Howard Farran: I hope you've converted some millennials to realize that it's one of the best investments they can have to keep their profession legal in all 50 states. 

Kevin Earle: And strong. 

Howard Farran: What percent of this stuff do you think those 50 states do behind the scenes that these guys never even hear about? 

Kevin Earle: I would say it's probably about 80%. 

Howard Farran: I know, I know. Every time someone says, they don't do anything and then you can just rattle off, did you hear about this? Did you hear about that? They don't hear. I feel sorry for everyone in politics. I always think of my two older sisters who went into the Catholic nunnery straight out of high school. My older sister, I've been a dentist 30 years, she's been a nun 35 years, I could never change her mind. What could I say to her to make her a Buddhist or a Hindu? That's the tough thing about politics, it's just really hard to go and negotiate with people who aren't really ready or willing to change their mind. Thanks for doing it. I would never want to do it. To me, you're like a pediatric dentist. I'd never want to be a pediatric dentist and I would never want to run a dental board or a dental association because it's hard to get two dentists to agree that today is Tuesday. Thanks for all you do. 

Kevin Earle: You're welcome, I appreciate it. 

Howard Farran: Thank you, Ryan. 

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