A Vision of the Future

Members of the California Dental Association who regularly read the CDA Update, participate in leadership activities in their local component societies, or serve on CDA committees have been well-exposed to many discussions and reports relating to the strategic planning efforts under way at the association. However, until the results of these planning efforts conclude and leadership approves the course of future activity, very little can be predicted with confidence about the direction that current and future programs will take and what kinds of issues the association will value as inherent to its purpose.

In mid-April of this year, Executive Director Tim Comstock addressed a group made up primarily of current and former association leaders. While Tim has been communicating regularly with membership via the pages of the Update, we found his remarks on this occasion to provide an insightful perspective on some of the directions the association will probably embark upon once the planning and approval processes are complete. What we found particularly valuable about Tim’s remarks is that he has developed a firm understanding of some important trends that have been influencing the association and the future of the dental profession. They are trends that must be dealt with; and Tim, the person at our helm, showed that he understands the Big Picture -- his vision of the future CDA is coming into focus. He understands some of the major changes in course that must be considered if the association is to achieve the mission and purpose established for it in the current strategic planning process.

I felt that Mr. Comstock’s presentation should be shared with all members with access to these pages. It should be helpful to long-time members in understanding some of the reasons for change. Newer and younger members, who have been concerned that membership in organized dentistry has not been fully addressing their professional needs, can take comfort that their concerns will be addressed with new energy in the future.

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CDA -- 2000 and Beyond

Tim Comstock, executive director

It is a rubric of life, of war, of corporate America, and even of nonprofit professional associations, that structure follows strategy. It cannot be the other way around if you want to build and maintain anything that is responsive, creative, competitive, and capable of change.

I spent 20 years in the world of higher education. Despite its generally left-leaning politics and the individual dynamism and cutting edge pose of many of its members -- there is nothing in the world so conservative as a faculty governance group. Their structural model is specifically designed to ensure that only an act of God or a political cataclysm has even a slight possibility of nudging the enterprise in a different direction.

The CDA/ADA system isn’t quite as entrenched as is that of academe, but we’ve only been at it a bit over a century -- academia has a thousand years on us.

So, why do we need to change? We’re strong, and our programs and advocacy serve our members and the profession with skill and honor. We have somehow wound ourselves into the ownership of two class A office buildings within a hundred yards of the State Capitol, and we own an insurance company with reserves in excess of $100 million. So, what’s the rush to change?

Here are a few reasons:

* Because we are still operating on a model and with a system that is finely tuned for professional and cultural realities that existed in the 1950s and ’60s.

* Because we’ve piled programs upon services, upon unfunded mandates, onto a staff that is exhausted trying to do it all. We’ve done this over the years without assigning any relative priorities. Therefore, we do a thousand things -- we are, or try to be, all things to all dentists -- and we aren’t really sure that we’re doing any of these things really well.

* Because the world has changed and is changing dramatically. John Welch, the innovative leader of General Electric, observed, "When the rate of change outside exceeds the rate of change inside, the end is in sight."

* Because 40 percent of our membership is over the age of 50. Within 10 to 12 years, they won’t be paying dues; and we’re not capturing sufficient numbers of new, younger members through our present mechanisms to even stay even.

* Because the ranks of new dental grads look and act so very differently from our present membership. What do they care about the advertising canons that compelled us to lay out hundreds of thousands of dollars in a fight with the Federal Trade Commission? How turned on do they get over our never-ending battle to bring fluoridation to California’s water supply?

These things are, at most, abstract holograms to new dental grads and young practitioners. We’re like the kindly old grandpa to these people. They acknowledge us -- they might even enjoy having us around. But, are we worth $1,500 or more a year out of their pockets -- just to keep around?

I don’t think so. If we’re going to engage them in our enterprise, we have to show them how and why we are relevant to them and how their being with us is a benefit to them.

Art Dugoni, past CDA and ADA president, and present pre-eminent dental dean, is one of the most respected voices in the country whenever the dental biz is discussed. And Art Dugoni is worried, deeply, about the future of dental education and, therefore, about the future of the profession of dentistry, organized and otherwise, in California and throughout the rest of the country.

Those who are now matriculating from school to the practice are different. They are not boosters and joiners like we were. The pressures on them are far greater and different. The debt they face at an early age, as they take their first steps into practice, is staggering. The rallying cry, our rallying cry, of fee for service only is but another abstraction to them. They’ve got to live, to eat, to pay off massive loans. Few among them have the capital to buy a practice or start up an office from scratch.

What can we do for them that is relevant and will inspire their trust and enthusiasm? What can we do to address the fact that our dental schools have hundreds of faculty positions unfilled and not fillable because they can’t pay enough to attract qualified teachers?

I don’t have all the answers -- none of us has all the answers. But, CDA has embarked upon a major program of self-examination in an effort to discover the answers and to become a relevant leader in addressing a multitude of problems that weren’t even anticipated 20, 30, or 40 years ago.

Right now, we are at least looking to the future, although we’re firmly set in the past and present. To get to the future, we have to be able and willing to drop the baggage from the past. Picture yourself running for a departing train while carrying a 200-pound suitcase. Your odds aren’t good. I’m not saying there aren’t some things in our suitcase that are valuable -- there are. But we need to judge with great care exactly what have to take with us on the trip we must take.

I see us four or five years down the road -- still solid and sound. I hope we’ll be a bit larger and a whole lot more varied in our makeup. We’ll likely have fewer programs and maybe fewer total staff in Sacramento. But, we’ll do a better job on the programs we’ll have. We will be a better partner to our component societies and to the ADA in what I hope is a better-defined and more cohesive tripartite than the rather loosely drawn confederation we see today. I see us, too, as a better teammate to the dental academic enterprise. Finally, I see a leaner, more responsive, and more proactive governance and council structure that will propel CDA into a leadership role in public health forums up and down the state of California.

The road from here to there won’t all be smooth. Change upsets a lot of us; that’s only human. But we must move on. And, there’s a chance that we all won’t be there at the end, or at least we all might not arrive there at the same time. I do know that it’s a trip we have to take if we are to be a viable, key player in the affairs of our profession five, 10, and 20 years down the road.

As Dan Quayle once said, "If we don’t succeed, then we run the risk of failure." Maybe John Kennedy said it a little better when he observed 40 years ago, "The United States has to move very fast even to stand still." His comment rings true for CDA. Now we stand ready to fashion our accommodation with the future.

pull quotes

We are still operating on a model and with a system that is finely tuned for professional and cultural realities that existed in the 1950s and ’60s.

CDA has embarked upon a major program of self-examination in an effort to become a relevant leader.