Leadership in Dentistry During Times of Uncertainty





By Lexi Marino April 3, 2020

Rolando Mia, from Zyris, hosts a video series focused on the latest news, topics, and conversations happening in dentistry featuring dentists across the nation. In this episode we interviewed Dr. Ana Vazquez, from Fisher Pediatric Dentistry, to give her advice on empowering her team with strong leadership in dentistry during uncertain times. 

Watch this video to learn the following:

  • Focusing on a “WIN” concept – what’s important now?
  • How to lead a practice of 70 or more employees during a crisis
  • How to get ahead of the curve by changing protocols and adapting to new measures of safety
  • What is a true dental emergency?
  • Minimization of aerosols and spatter, especially with sick patients, using continuous HVE

Transcription

Rolando Mia:

There we go. So good afternoon everybody. This is Rolando with Zyris. I’m here with Dr. Anna Vasquez another one of our guests who’s going to share insights perspective and also kind of all of the things that she’s doing and how she’s dealing with that with regard to everything that’s going on.

As this goes on, if you have any questions or if there are any, please feel free to send them through put a note there and as we can, we will answer them going through this. So first of all, Dr. Anna Vasquez, it’s a pleasure seeing you as always. Great to see you.

Dr. Ana Vazquez:

Well, hi Ro. It’s nice seeing you. I know we’re both at home. We’re deferring, practicing staying home. At least you look very professional. I have a sweatshirt so…

Leadership in Dentistry

Rolando Mia:

So, what’s happening seems unprecedented right now. How many, just what’s going on, and how many things are happening in the world and wanted to spend some time to get your perspective on that.

And specifically, as it relates to, you know, your practice dentistry and everything you’re doing. So could you just kind of give a general summary of what your practice is all about and how you’re, how you’re kind of navigating through that right now?

Dr. Ana Vazquez:

Absolutely. Well, absolutely. You know that we are going through a stage that the world has never seen. So this is completely new. There’s absolutely no books that you can read.

There’s no protocol in any of our offices to say, “Hey, this is what you have to do.” I have a philosophy in life that nothing happens to you, things happen for you. So even though obviously all practitioners will extremely worry, I can only imagine new practitioners that are getting out of school with loans, with staff that they have never managed.

And then everybody’s looking at you like, okay, you’re my leader. What are we going to do? So…it’s hard. It’s a lot of pressure on ’em and we as the owners I know, you know, but obviously people that are listening, we have a pretty large office.

It’s one location about 70 employees. So everybody looks at me like, “okay, Dr. Ana, what are we going to do? What is this going to be about? What’s going to happen next week?”

Well, if I knew all the answers, I would  not be here talking to you. However, one thing that I can control as the leader of my practice is my attitude and I, how do I react to the news? I, like I said, I think that things happen for you, not to you.

Things happen for our nation. There’s something behind this that he’s going to get us more together. So in our practice, let me tell you one of the things that we have been doing since obviously we are close, we are seeing though emergency patients because as a pediatric practice we have about 26,000 active patients.

So there’s always emergencies that happen. And I don’t want these patients to end up obviously in the emergency room. So we are treating those patients. But as an office, we have taken this moment to do other things that we usually don’t have time to do. For instance, we are reviewing protocols. So that’s something that is a new practition.

You have not been able to establish protocols. What’s going to happen with this, what are we doing this, this might be a good moment to do it. We’re also reviewing for all our new employees. We like to do a training and we like to have obviously everything ready for them.

So that’s something we’re doing right now. We are doing videos on everything that we do in our practice. Some of them are actually with our computer system software.

So any new employee that comes to our practice can see them. And that’s something that obviously we can have either one employee from home doing it explaining it. I have a management team that have been actively working on it.

There’s other things that we can do, but most important is our reaction. One thing that I told our staff when all this happened, “it’s like at this moment we have to work with the WIN rule.” And I was mentioning to you “W I N” – what’s important now?

What’s important right now obviously is this the health of our patients and our staff. So we’re working on that.

Rolando Mia:

I love the WIN concept because of the perspective is going forward as opposed to, “Oh no, we’ll figure this out.” When, when you look at, how you’re working with your staff right now, I mean over 70 members of your team, is your practice open?

How are you managing that right now and especially when you’re treating some of your some of these emergency procedures?

Dr. Ana Vazquez:

Yeah, that actually, that’s a very good question. Right now with everything that’s going on, obviously in our world we are changing protocols, so nothing is going to be the same as it was three weeks ago.

So changing protocols like for instance today I was seeing patients this morning because we are in a moment that we have to be extremely careful. So there were things that we would do. For instance, the patient stays in the car, in the parking lot, they text us that they’re there.

And I have a member of this staff that goes escorts the patient, we check their temperature and then they go into a private room. And then that way we can definitely treat the emergency. Also we check the temperature and every single one of our employees to make sure that we’re in compliance.

One of the good things about our profession is that we have been using PPE for a thousand years. So this is not something new that now suddenly it’s like, “Oh my gosh, we have to wear a mask? We have to wear glasses?” We have been doing that for a while. So obviously we don’t, three weeks ago we were not taking temperature for our patients or our staff, which we’re doing right now. But I think that from all the professions then it’s something that for us is not going to be a big change because we have been doing it. We have been doing PPE. We have been cleaning our units, we have been so it’s just to make sure that the public knows that that as a professional together we do it. We have been doing it. I think that communication will be awesome.

Social media for some of the new dentists that are struggling are thinking, “Oh my gosh, all my patient is going to come back? What’s going to happen?” I think the public needs to know that we have been doing all this, that this is not now because of COVID-19. Suddenly we’re going to start cleaning after each patient. It’s something that we have been, we have been doing. “How many utensils do we have in the office that are disposable?” So it’s something that obviously the patient never care about, but this is the moment to communicate with them.

Communicating With Patients in Times of Uncertainty

Rolando Mia:

That’s so cool. So from a, from a parent perspective, who is sitting here and happens to run into this or you know, what advice or what message are you giving out to the parents who are, you know, concerned about it, you know, my child is in pain or whatever. What is it that you would tell them?

Dr. Ana Vazquez:

Well first of all, the emphasis, we all should be available for emergencies. The majority of the, the emergencies if we can treat obviously with antibiotics or pain control, but there’s some emergencies that happen. Kids now that they’re at home they are more active. They start getting into each other and siblings. And that happens. That’s the beauty of kids. So we have seen trauma on trauma patients. There’s some trauma that you can wait, but there’s some trauma that they cannot wait. If it’s obviously if it’s something cosmetic it can wait. But if it’s a pulp exposure, you have to see these patients immediately.

So as dentists we are available every single one that I know they are available for emergencies. All we want to make sure is that our patients don’t have to end up in an emergency room where those beds are needed for something else. So it’s for as a parent first of all I want to reassure you that there will be a dentist or a pediatric dentist in a community that will be on call to be able to see your child. And I wish I could tell you that you can bubble wrap your child but that’s not allowed. So we just have to manage and let them be.

Rolando Mia:

Thank you for that. It’s reassuring because there are people who are not quite sure how, and I love the message about how you have been, in dentistry and the practices, you have been dealing with infection control and cleaning, all that type of stuff. So I think that’s, that’s awesome.

Dr. Ana Vazquez:

I know the years of practice we, that I have been, we have gone through other moments that people were questioning like, “Oh my gosh, are you protecting for this?” We have been. We have been in it, even at dental schools, obviously we’re so particular about infection control and cross-contamination. So for, for us as dentists, even more than in all other medical professions, we are extremely worried about this. I mean it’s something that we have been practicing. But once again, it’s communication, parents don’t know that.

Empower Your Dental Practice

Rolando Mia:

Yeah, that’s good. That’s really good to know. Now you have a massive practice and you’ve been around how many years?

Dr. Ana Vazquez:

I wish I could tell you that it was 10. But the truth is that it’s been 25 years.

Rolando Mia:

25 years in looking at what you’re doing, you’re hunkering down with your team and you are working with them to figure out how to get through this. What advice would you give, especially someone who’s just starting out or who doesn’t have as large a base or is sitting there thinking to themselves, “Oh my goodness, I’ve got, I just started, I’ve got all this debt and then now I’m being forced effectively to close for the next, who knows?” There’s a lot of uncertainty. What advice would you give people like that?

Dr. Ana Vazquez:

First of all, breathe, breathe. Take a moment. You’re not here alone. We are all on this. It’s not just that, “Oh my gosh, Dr. such and such has a half a million dollars in between student loans, plus the practice.” We’re all in this together. Everything is gonna work out. Absolutely everything. Do what’s ethical and do, what’s the moral thing. Now most of the dentists are going to be like, “Oh my gosh, what if I lose a patient?” Well, you know what? Just be who you are. Just do what’s the right thing to do.

The patients will follow us. The patients will come back. They’re not gonna stop only because we had to close for four weeks and go to go to a practice down the street. Any of the truth is if they went down the street, then they were not your patients to start with.

So it’s easy for me to say because I have a very established practice. But I, when I started practicing I, one lady that I was working with, she was my mentor. She said, I know don’t do anything for money. The money will come. And I know that we all have student loans. We then suddenly we have a mortgage, we have it favorable to cover do, what’s the moral thing to do? What do, what’s ethical, do what you do well and everything is going to work out, but breathe, don’t do it. And when you bring in anixety to the plate is just going to be, it’s definitely going to be an disaster.

Rolando Mia:

Thank you for that.

Dr. Ana Vazquez:

And another thing is like, I’m talking about obviously a pediatric population, but we do not want to add to the anxiety of the parents of the child plus the dental procedure itself. So it’s part of what we have to do. Even as a general dentist, your patients don’t like you, let’s be honest. They don’t want to be there and to have a crown done, they know they need it. So if you are anxious on top of all, this is definitely going to be a worse experience for them. So as hard as it is just this in the moment just to calm down.

Rolando Mia:

Thank you. So earlier on you mentioned something about the emergency room. Now I understand you also work in the emergency room at your local hospital. Is that correct?

Dr. Ana Vazquez:

That is correct. I do a big number of cases in the hospital right now. Where the only patients that I can bring to the hospital are true emergencies. Now as a parent also, I understand that if I come to you Ro and I say, “Hey, I can take your child for a case at this hospital, immediately you’re going to be thinking, but aren’t you seeing other patients that are COVID-19 positive?” And that’s true. So one of the things that, at least in my practice we are doing, we are doing some sedations in office to prevent and to allow the hospital to use those beds for what’s really important at this moment.

In the hospital, like I said, I’m do close to a thousand cases just last year. And it’s great for me. I mean, I think it’s one of the most wonderful things that we can do in dentistry, especially in pediatric dentistry. But what’s important now is that we don’t allow this child to have a, we don’t allow this child to be in pain. So even though it might not be the most wonderful idea to have to do an oral sedation at the office as that’s the only thing that I have available at this moment.

Rolando Mia:

So what is, what is the definition of true emergency? If you were to define that, you know, as a parent, what would that be?

Dr. Ana Vazquez:

Well, actually the ADA did an awesome job last week on sending a review of what then a true dental emergency is and a true dental emergency will be cellulitis. When you have an abscess, when you have any infection, when you have a pulp exposure, when you have obviously some other fractures.

So all of us that are members of the ADA, we received some specific guidelines that helped us whenever we gave that call to differentiate. “Okay, is this the it crown for an adult, is this a crown that is out of occlusion, that is something that we need to do because it can get worse?” So the, the ADA did an awesome job just giving us that guideline. So obviously as a pediatric dentist, I mean if parents, sometimes they call us say, “well there’s a baby tooth that is still there and the permanent tooth is coming in behind.”

Well that’s not a true emergency. So I have in my office, I am blessed that I have an awesome team that I have one lady right now on call and she has been with me for years, so she understands and she’s my protocol lady, so she knows when it’s a true dental emergency or not. And she can schedule and obviously right now since there’s the uncertainty of or being on the schedule right now we’re doing is definitely putting the patients at a certain time. So there’s no, there’s nobody waiting in the waiting room or in the reception area. There’s two patients at a time. That’s the maximum.

Emergency Procedures

Rolando Mia:

That is awesome. So, you know, you’ve been a friend with Zyris for a very long time and we so appreciate, you know, the support that you’ve given us. We so appreciate the, the advice you’ve given as far as your procedures right now, if I understand correctly, you use our system both in your office and in the emergency room. How is it effective? Is it something that other dentist should consider for, for the emergency procedures or, or as it relates to that?

Dr. Ana Vazquez:

Absolutely. I and you know, my feeling about your product. I use the Isolite in the office, we have 19 rooms and every single one is equipped with with your unit. We use it as a pediatric dentists. I love the fact that in the office, even though I might have a child that is moving around, I know that I have airway protection, which for me is like the number one. I can have isolation on the area, I can work two quadrants at a time – high vacuum.

Tell me a dentists that doesn’t want that, to be able to work on a dry area? Now obviously, you know, that my passion is hospital dentistry and I don’t know if I’m supposed to say, but I have been working with your company on an appliance that is it will be exactly the same as we’re using in the office.

The Isolite but in the operating room it’s the best thing in the world. Being able to work on an area when the patient obviously is asleep. So we have a bite block, so it’s open. I have a constant suction. I would not work without that appliance and I have been using it since I think that pretty much since you started. And I have seen the changes seeing that some materials. But I know not only I like it, I know that my staff adores working with it. My hygienists would not do a sealant if I cannot place the Isolite.

Rolando Mia:

Is it, do you see it as something? Thank you for that. You see it as something that’s also helpful.

Dr. Ana Vazquez:

Oh, by the way, you’re not paying me for that.

Rolando Mia:

So with regard to things like spatter or aerosols, do you see it helping out in kinda helping minimize that? 

Dr. Ana Vazquez:

Oh, absolutely. Obviously in the office, I cannot imagine a dentist that has not at least seen the product. It helps obviously because of the constant suction. There are other pediatric dentists that use it. Sometimes we have these patients that get sick. And even as an adult, I mean, you have those patients where that suction comes in so handy. So, so handy in the operating room for me is an even though obviously I have a very important control in terms of the environment, being able to protect the air way, keep everything dry and not on my face or my mask or on my glasses when I’m with a patient, it’s priceless, priceless.

And the fact that it’s disposal, I know that we have talked about doing certain things that you can autoclave. I personally, I like the fact that it’s a disposable product that you don’t have to worry about it. It comes in so many different sizes. As a pediatric dentist I don’t use the large, but I know you have one. It’s for us has been a miracle and you can talk to any of my staff members that we use a lot of expanded duties in the state of Indiana where I practice and they would not touch a child if we don’t have the Isodry.

Rolando Mia:

Oh, thank you for that. Thank you. So your, your practice, is it open right now or have you, have you really pulled back?

Dr. Ana Vazquez:

No, we were really pulled back. We have been closed. This is our second week closed. Like I said, I mean I see emergencies. We have other doctors in the practice. So we have been – my partner was on call this weekend. I was on call today and I’m on call tomorrow, but are we only for true emergencies. I’m just following the guidelines from the ADA.

Rolando Mia:

And from a planning perspective, how are you attacking kind of now and then how are you kind of setting yourself up for when we’re through all of this?

Dr. Ana Vazquez:

And that’s an awesome question. That’s a very, very good question. And as all of us are on this uncertainty, what’s going to happen, when are we going to be able to open? First thing is, once again, breathe and be positive. Obviously we’re going to go back to maybe a new norm, but we’re going to go back. We’re going to be seeing these patients in my office. What I have decided is that we’re extending certain hours.

If I as a parent, and you probably know that, “Hey, I have my kids, I’m not gonna go back to school probably until next August, next September.” So you have more flexibility in terms of the times that you have that you’re offering. So we’re gonna be offering, we’re gonna start an hour earlier. We’re working through lunch and so it’s just extending those times that might be available for parents to come and bring the child and that it’s easier for some parents that have to take their kids to a daycare.

Well then come a little bit earlier – this is temporary. We’re going to go back, we’re going to go and we’re going to be able to do the same things that we were doing. It’s just this time. And I think t’s good to a point to understand as somebody that has a large practice sometimes we get a little bit with that feeling of entitlement that, “I deserve this and I need this and I need that.” Sometimes you don’t have to pull back and say, “You know what? First of all, thank you God, because I love my profession. Number two, thank you God that I have people that are working with me that love what they do. And number three thank that we have a job, thanks that we get to go to some place and work.”

If you put things in perspective, I mean these are first world to a point. We are not worried that a lot of other things could happen. We’re safe, we have a roof. We have family that we love. So let’s be thankful instead of just being on the negative part.

Rolando Mia:

I love your message. I love how calm you are. I love the fact that, I mean, regardless of what’s going on, you’re always looking for a way to get through that. And I love the fact that that your team, I’ve been in your practice and I see how, how not only you work with, but how, how strongly your team is together. There’s a note here and I just I want to play it here. If you look, this is from Courtney. “I’m honored and truly blessed to work alongside dr Anna. Such an amazing pediatric dentist, but more so an incredible leader.” Dang.

Dr. Ana Vazquez:

Well thank you Courtney. That one of the things, if I know we talked before, if I had any, any message or any advice for new practitioners, one thing that I can tell you is that you need your team. You need a team that is united. You need a team that will work with you and you need to expand. Don’t think that I have to supervise everybody.

I am blessed that I have a group of people that I could not work without. I know you have met all of them Ro, and I know that you know that what I say is true, but for new dentists, I know it’s hard to, we work on a space that it’s this big and then suddenly now we have so many things that we have to take care of. Find your people, find your tribe and trust them, empower them and train them. Education, we keep educating. Make sure that they keep educating and they can be good at certain things that you might not be so good at. I love everything, extremely organized, and Ro you know this is true.

I see a shiny light and I go for that shiny light. So all my team is like their turn. I come back to this, come back to this. So I have surrounded myself to people that are good at what I’m not good at.

Rolando Mia:

That is awesome. That is awesome. Are you cooking much more lately?

Dr. Ana Vazquez:

But do you know what it’s… right now is just Pearly our therapy dog and me. So I have not been cooking so much because I cook one day and then I’ll take off for like three or four days because we are supposed to be social distancing. Remember I have to be home by myself. But when, whenever we can I bring my staff  – this is the party place. I know a way to show youth that where the party is.

Rolando Mia:

Wait is Pearly with you right there?

Dr. Ana Vazquez:

Pearly is in here. You want to see her? Yeah, let’s see her. She just woke up. Really, she’s loving the fact that I’m home with her. So I’m pretty sure when we go back to the office and she has to go and see patients, she might not be so excited. Like right now is she in the morning she looks at me and said, “Hey mom, we’re staying home, aren’t we?” It’s good for the two of us. We have definitely developed a tighter bond if that is possible.

Rolando Mia:

Wow. First of all, what you say is inspiring and the kind of your demeanor, the focus and hope, I have this, I’ve heard a definition of what leadership really means and the definition that I live by is, you know, someone who exhibits behaviors that you’re willing to follow. Well, let me say I would follow you anywhere.

Dr. Ana Vazquez:

Oh, well thank you Ro. And if there’s one thing that I can leave you with is, remember that things happen for you not to you. So use this moment, use the things happen for your practice. So use it at this moment just to make sure that you’re ready for the awesome things that are going to happen in every single one of our practices. So just embrace it and be positive and think, “okay, what else can I do to serve my community, to serve my staff, to serve my patients?” And there’s going to be so many things. Just listen. Just take a moment. Just be quiet. Listen to that whisper that it’s going to come to you. It’s going to come.

Rolando Mia:

That is, that is fantastic. I don’t see any questions. If anybody has any questions here for another couple of minutes be happy to answer them. But otherwise, Dr Ana you..

Dr. Ana Vazquez:

I know Sean, I just saw him probably going to be one of the most wonderful products that you’re going to have for cases in the OR. I have been trying it and I think it’s absolutely awesome.

Rolando Mia:

That is, well, Dr. Anna Vasquez, it’s been an absolute pleasure. It’s always great to see you, your smile, like lights up, everything. Talk about making my day. I don’t have that same smile, but I do have a bigger mouth.

Dr. Ana Vazquez:

Oh, I know. Because I have to hear mouth. That is so true. That’s right. Oh my goodness gracious. I can’t wait to go to Santa Barbara. That hopefully is not going to be as gloomy as it is here in Indiana. I love your guy’s as restaurants and places to go, so can’t wait to visit guys.

Rolando Mia:

Well, thank you so much. Have a wonderful rest of your week, and please be safe. And if there’s anything that we can do very much appreciate you spending the time and sharing your insights and inspiring us today. Thank you. Stay healthy and a cyber hug. Oh, yeah. All right. Take care. All right.

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