Michael Wilson, Class of 2005, was not exactly sure what he wanted to focus on when he entered New York University College of Dentistry in 2001.
"I thought I was signing up for a four-day workweek and golf on Wednesdays, that sort of thing," says Dr. Wilson, chuckling. "Seriously, all I knew was I didn't want to join the rat race."
Flash forward five-and-a-half years to find Dr. Wilson running an 80-hour-a-week practice that serves primarily low-income Medicaid patients in rural upstate New York. Located in Binghamton, Wilson Dental, P.C., has 15 dental operatories and a 55-person staff that includes nine general dentists, two pediatric dentists, an oral surgeon, an orthodontist, a dental anesthesiologist, and five dental hygienists. Since the office opened two-and-a-half years ago, more than 12,000 patients have received treatment.
At Wilson Dental, P.C., the hygienists provide all the sealants. The general dentists perform approximately 90 percent of the extractions, which frees up the oral surgeon to focus on impactions. This model also addresses the issue of healthcare silos, where everyone traditionally works independently of each other. "Three minds are better than one," says Dr. Wilson. "This model allows practitioners to work side-by-side. They can discuss cases and a lot of miscommunication is eliminated."
Dr. Wilson recently added a medical assistant (MA) to his team to provide basic health screenings, including blood pressure, blood glucose, and cholesterol.
"The MA slips in to see patients before the dentist sees them," says Dr. Wilson, who made the decision to add this pro bono service in order to promote better overall health in his patients. "Most important," says Dr. Wilson, "is for dentists, nurses, physicians, and other healthcare providers to work together to help ensure that the proper healthcare is being delivered."
Several people screened by the MA have exhibited very high blood pressure. In fact, one recent patient measured 200/115 and had no idea he was at such high risk for cardiovascular disease.
"Hypertension and diabetes are the top silent killers," says Dr. Wilson. "People can walk around with these conditions for years and feel fine, and meanwhile multiple organs are being damaged."
If Dr. Wilson's MA detects something suspicious, such as an elevated blood sugar level, she can then refer the patient to her/his primary care physician (PCP). If the patient doesn't have a PCP, the MA will provide other options.
"We see over a thousand patients every month and many of them don't get their general health screenings on a regular basis. So having an MA on board can have a very positive impact," says Dr. Wilson.
The MA also provides nutrition information and makes referrals for smoking cessation. "We see a lot of obesity in both adults and children up here," says Dr. Wilson.
Overall health promotion, the link between oral health and systemic disease, and expanded access to comprehensive health care are all concepts that were ingrained in Dr. Wilson at NYUCD. "They got me fired up about these ideas," says Dr. Wilson, who credits former NYUCD Dean Michael C. Alfano as one of the mentors who helped to inspire his career path.
"Dean Alfano gave several talks that definitely influenced me," says Dr. Wilson. "One was right at the beginning of 2001 at the White Coat Ceremony, and the other was at the graduation ceremony in 2005. Both times, he really implored us to think about the social implications of our career choices.
"There's nothing wrong with choosing a more traditional route, but I realized that I would be more fulfilled working with underserved folks," says Dr. Wilson.
After completing his residency at Woodhull Medical Center in Brooklyn, Dr. Wilson conducted a search on a federal Web site that lists all the US counties that accept Medicaid and are most in need of dental services. He chose to settle in Binghamton, situated in Broome County, one of the most impoverished counties in New York State.
"Surrounding counties are really in need, as well," says Dr. Wilson, who recently purchased a 15-person passenger van to bring patients to and from his dental office from Binghamton and other neighboring areas, including Elmira, Ithaca, Oneonta, Norwich, and Montour Falls. He paid $19,000 out-of-pocket to purchase the van. Medicaid does not cover the trips. By participating in social services outreach programs, including food pantries and shelters, Dr. Wilson is working to spread the word about the van.
To improve dental care access for children in the area, Dr. Wilson and his team are working with Head Start and its Dental Home Initiative. "We go right to the classrooms and do free screenings," says Dr. Wilson.
Dr. Andrew I. Spielman, Professor of Basic Science & Craniofacial Biology and Associate Dean for Academic Affairs, was another NYUCD mentor who motivated Dr. Wilson to consider building a dental practice that offers expanded access to comprehensive health care.
"Students don't always listen to ideas when it comes to moving away from traditional practice models, but Michael was receptive," says Dr. Spielman. "And it's important to note that there is theoretical evidence that this model is not only useful in improving patient care, it is also financially viable. Since many people visit their dentist more often than their physician-often every six months for cleanings-this model can be used to check individuals who might not otherwise have access to medical care and therefore can potentially prevent conditions that are life threatening or exceptionally expensive down the line."
"With this whole healthcare debate still raging on, it's clear that the only way to really lower the costs that are crippling the system is to make the US a healthier country, and the only way to do that is with effective prevention," says Dr. Wilson. "This is especially important," he notes, "because whether you're a dentist dealing with the insured or uninsured, the underserved, the middle class or the very privileged, you are often dealing with people in their 20s, 30s, and 40s, who assume they are fine unless there is something clearly wrong with them. By identifying problems sooner rather than later, you can prevent them from spiraling out of control."
"Michael is definitely a role model," says Dr. Spielman. "Slowly but steadily we are touching some lives and changing minds. It's not going to be 100 percent. But we want students to be aware that the dentist is not an end point, and you have to think about the well-being of the patient and what other healthcare practitioners can help with. Hopefully we can change the orientation of the profession."
Dr. Wilson believes that it makes sense to run either an exclusively Medicaid practice or a private insurance practice. "When you run a strictly Medicaid practice, you become proficient in learning the system and eventually iron out the kinks."
Dr. Wilson has no regrets about his practice choice and hopes other NYUCD students will also consider working with the underserved. "Just because it's not the popular thing to do, or not what most docs want to do with their career, doesn't mean it's not a good route to take."
Numerous NYUCD alumni have joined Wilson Dental, P.C., including Dr. Kien Nguyen, '98; Dr. Fayez Aziz, '89; Dr. Nassef Lancen, '92; Dr. Samy Abdel-Messih, '89; Dr. Daniel King, '05; and, most recently, Dr. Kelly Kim and Dr. Jaepil Kim, both Advanced Education in Pediatric Dentistry Program graduates of 2010.
"You can make a living as long as you do it right," says Dr. Wilson, who is just as much an entrepreneur as he is a practicing dentist. "I recommend that students read a few books on how to run a business. That can go a long way."
Indeed. With his eyes constantly focused on ways to expand access to care, Dr. Wilson is looking into the possibility of opening two more dental practices, one in Syracuse and one in Albany.