NMDA Journal Winter 2020-21

nmdental.org 25 of their staff and almost lost their associate. All of the practices received a loan to help keep their practices going. The newer dental office stated, “Without the PPP loan, it would have set me back three years or bankrupted me. It was horrible financially, logistically, emo- tionally, and clinically.” Many of the offices used the loan to pay rent, payroll, and items to make their offices safe, like a washer/dryer, UV lights, air purification, and PPE. One office improved their online por- tal so patients would have a touchless check-in and checkout. All but one of the dentists surveyed stated that if there were another shut down, they would most definitely need financial assistance again. It was recommended that grants be considered, loans that have to be repaid will be difficult due to diminished revenue. Income is strained since personal protective equipment i.e. gloves, surgical masks, N95 masks, gowns, and faceshields are costing more and most of the time are somewhat difficult to acquire. Disinfectant mate- rials are also more expensive and sometimes not as readily available. Additional expenses include purchasing equipment to filtrate the air, disinfect spaces, extraoral vacuum, iodine water filters, and/or create room isolation. Dentists have also started purchasing pre-rinses for patients and more rubber dammaterials. Operations in the office have also slowed down since offices are taking time to screen patients, having them wait in their cars instead of a waiting room, and minimal use of the Cavitron. A couple of the offices reported that their hygienists are temporarily cut. One dentist stated, “Recall is the lifeblood of any dental office. Without recall, the schedule will not exist, and not enough revenue will then be created to pay for fixed and variable overhead.” Most of the dentists have not increased their fees. The newest dentist owner reported that a PPE fee was needed at their office, they are charging $4.30 per appointment and they have mixed reactions from the patients. This dentist in particular felt that there is no support from third party payers and more needs to be discussed in gaining the insurance companies’ support in covering this expense. Another contributing factor to revenue is when patients reschedule or cancel their appointments. Most of the offices are experiencing more than five patients per week. One dentist noticed that each time the Governor reported increasing COVID cases on TV, the patients would start calling to cancel or reschedule, most stating that they will not be making appointments until there is a vaccine. Another dentist expressed the need for the state to understand that dental care is essential for the community’s health. “We are essential, when I was closed for eight weeks, emergent issues built to a point that I was busy full-time, with a limited staff, taking care of emerging dental problems.” About 50–90 percent of patients across the surveyed practices were highly anxious about their exposure to COVID. However, almost all of the dentists are relatively comfortable providing dental treatment during the pandemic. It seems like all of the dentists are taking the right precautions and doing their best to provide a safe environment for their patients. As a fellow, practicing dentist to the individuals surveyed, I would like to share my own experiences. Being in the trenches with my col- leagues, it seems like there were two chapters to this pandemic. The first, shorter chapter was when we were partly or entirely closed down in the Spring months. The second, long, and arduous chapter was slowly reopening and attempting to remain open, while endur- ing and navigating the constant challenges and changes in taking care of our patients and business. The Paycheck Protection Program (PPP) loan was vital to all of our practices and keeps us afloat. Without it, we would not have been able to pay our staff or our fixed overhead during a period of shut- down or loss of revenue. For our practice, like most of the respon- dents, we had to temporarily furlough or cut our employees, especially hygienists. Encouragingly, it seems that most of us were able to respond in saying that these layoffs were only temporary and do not expect to permanently cut staff. The shutdown seemed acute and drastic and now we continue to take on the many different problems that constantly drain our prac- tices and energy. Large equipment to disinfect and purify the air and additional PPE are added expenses that are taken on at a loss. Addi- tionally, we are all on average reporting about five patients per week who have to cancel or be turned away, either due to failed screenings, symptoms, or self-imposed travel quarantines. My own experience is about 95 percent of our canceled/rescheduled appointments are due to the travel quarantine rules set by our state. For the patients that do keep their appointments, many patients have added anxiety and concerns about fear of exposure. And I will say they are right to have those thoughts and concerns. There is defi- nitely a wide range of opinions between all of our patients on this, but we all have to deal with it to some degree. Constantly spending time to answer and reassure patients that they are safe in the dental office may sound innocuous, but it can be mentally draining for the dentist and dental staff. The constant loss of patient flow and staff hours is the most signifi- cant ongoing problem. Some patients are no longer able to pay for treatment from either losing income or their dental insurance. Other patients don’t want to come in due to fear of possible exposure. This prevents us from treating dental issues that can become urgent in a matter of months. The last and most frustrating problem, at least for me, is the constant juggling of staff schedules. Dentists and staff have “sick days” that are unpredictable. Outside of the office setting, we still have possibil- ity of exposure and if we start to feel possible early symptoms of COVID we take caution and stay home. Of course, we are then tested and wait and wait (and wait) for test results to be obtained so we can return to work. Filling in the missing teammembers is hard on the practice and also hard on the staff member that must stay home. They are losing hours of pay that they can’t make up and, most of the time, won’t qualify for any unemployment benefits for such a short period of time. Lastly, from a new dentist’s standpoint, I will say this briefly. Dental school definitely did not prepare you for this! I say this to point out the obvious, but to also allude to what I believe is the obvious remedy. The remedy for all of these problems has been the dental community. The collaboration of ideas and resources between dental offices has been the utmost help. I am lucky in that I am in a small group prac- tice, so I have not had to navigate these waters alone. Tough deci- sions were discussed, everyone’s input considered, and a collective answer obtained. Even with three dentists in the group, we have still reached out to other colleagues and the NMDA for guidance. In these uncharted waters and unprecedented times, no one had a master contingency plan, and for a new solo dentist I’m sure it was a very dif- ficult situation. Whether you are newly practicing, just started your dental practice, or have been in practice for a while, I sincerely hope you know the power of your surrounding dental community and associations. When you need to reach out, our colleagues and asso- ciation are ready to help.