527 Practicing With Purpose: Lessons From the Wind River Reservation

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Now that I've been up on the reservation, I think a lot of it.

I love going to work.

There's not a day that I'm like, oh, I have to go to work today.

I'd rather stay home.

And I think that's the patient population.

I think it's staff I work with.

I think it's a full wind river cares as a unit in the people that work there.

As a dentist working with a hygienist.

Where other staff will be asking them, well, what do you think?

How does this look?

What do you see?

Because I think that helps overall, because we are a team.

It's not just the dentist separate over here.

The hygienist is here.

The assistants are here.

We're all a team that are working together to take patients.

The best we can and provide the best care.

Whether that's prevention, whether that's treating cavities,

the oral diseases, and things like that.

And welcome back listeners to episode five, two, seven, with Dr. Johnson.

We are here with my amazing co-host Jessica Acacin.

Hello, Dave and I are really excited to have Dave Johnson back.

We were just talking about the name Dave and how it's set on a pedestal of excellence.

And we're really grateful that you decided to come back in our first episode.

Afterwards, we were talking a little bit about not a little bit, but a lot about

dentistry and everything.

And it came up that you do work on the wind reservoir.

And we wanted to know more about that.

So welcome back, Dr. Johnson.

I would say my guru, my sensei, and pediatric dentistry,

that's where I started really loving prevention, like preventive dentistry.

If I think back on that, I would say that you were the start of that.

So thank you.

And I want to hear more about this professional shift from going from your private practice

into working on the reservation.

So take us through that a little bit.

Okay.

I'm happy to be back.

I love talking to you guys.

This is a fantastic podcast.

Oh, thanks.

So I'll try to be as concise as you don't have to be.

That sounds great about the podcast is you don't have to be concise.

Well, I don't want to drag on to bore your listeners, but so yes, Jessica and I work together

in my private practice six or seven years, six, six, seven, as all the kids say today,

six, seven, oh, good, good, you're so good.

But I think it's fallen out of favor that term, six, seven.

But the kids still say, yeah, so I had my practice and I'm trying to remember on the last

episode, I practiced for in ironically, Riverton, Utah for about 22 years in private practice.

And then I sold it to a group and worked for this group in Utah.

It's kind of an all encompassing pediatric health group.

So they started in pediatric medicine and now they have mental health and they had dentistry,

pediatric dentistry and orthodontics.

And then they moved us to Bluffdale, Utah, and I worked for them for a year.

I love my time in private practice.

I learned a lot.

I think the most.

Yeah, oh yeah, I mean, I don't know if I caught you, but I did teach it primary children's

hospital for 10 plus years in their pediatric residency.

I didn't, when we moved, when the group bought it, I kind of didn't like the direction and

there's nothing against that company.

I didn't like the direction, how DSOs kind of push you, if that makes sense.

It wasn't a good fit for you.

It wasn't a good fit.

Yeah, I mean, I'm, I'm old and slowing down in the days of seeing getty to 60 plus kids

a day.

I, I just couldn't do it.

And so they didn't kick me out.

I kind of just left the company after my contract and I was offered a position on the Windriver

Reservation up in Wyoming and how are you offered that position?

Like, how did that come about?

How would you, well, for me, it was kind of, you know, like, you know, like, you know,

it was kind of a different, yeah, it was a different, uh, and I'll explain in a minute.

Traditionally, Indian Health Service has postings for, in this their website.

It's a government agency for Dennis Hygenist, nurses, positions, et cetera.

And you, and they have all the listings for IHS positions and then tribal positions where

the tribes are managing their own health care.

And those are called a 638 and that, and that stems from a 2010 legislation.

It was called the Indian Self Determination and Education Assistance Act that allowed

tribes to kind of take over their health care because traditionally, for IHS, I hate

to say it.

It was kind of services were kind of a first-come, first-served basis.

And, you know, I, I think for me, prevention is the key.

And so when tribes will start taking over their health care, what, what I've experienced

in my current situation is they are all about prevention.

And they have so many services, not only in dentistry, but in all the, you know, medical

fields, the mental health field, maternity, child care.

And so we, we really push prevention.

Anyway, back to my story.

So I knew the director up there, the dental director.

He was a little bit older than I am.

He actually trained me in my residency.

And so I was hired to replace him as a pediatric dentist.

I'm not the director when he passed away last year.

We have an interim director, but to be honest, I kind of just wanted to work with the kids

in the club.

But that's how I ended up there and I've been up there over two years now.

That's fantastic.

You mentioned being able to work with the kids and being able to have a say when it comes

to prevent a dentistry.

Have you noticed that there's a difference between travel dentistry, corporate dentistry

as you mentioned in private dentistry, being able to have more of an impact and promoting

that preventive dentistry?

Yeah.

So private practice, you know, I'm just going off my personal experience.

You get pretty busy and you're seeing multiple families, you know, one right in sequence.

And so you do talk about it.

You do rely on assistance.

Unfortunately, most pediatric dentists in myself included, we didn't have hygienists.

And looking back, I wish I had a hygienist in my private practice.

I think that's the one thing that one regret that I never had one because I didn't think

I needed one, low and behold, now that I'm up on the reservation, the hygienists, you

know, they clean adults, but they clean the kids and they go over hygiene.

And honestly, I think the patients listen to the hygienists more than they do to the dentists.

I'll be honest.

And I wish that I would have had that in private practice.

In my current situation on the reservation, I feel like I have more time with the patients

because it is a community health center setting and in private practice and even in the

corporate dentistry, they want you to see as, you know, especially in corporate dentists.

You want to see as many patients as you can because it comes down to the bottom, you know,

the bottom line.

And with how the structure set in a community health center, you're really focused on the

patient and what their best needs are.

So I don't know if that answers your question.

Often the bottom line is money when you're in a situation now where the bottom line is

patient care.

And I look back on my time when I was your assistant and I thinking I was doing the best

work I had at, you know, like I am, I can profit so well.

And I didn't even know, actually, this is an interesting situation is I didn't understand

what the word, the word profument.

And it was really difficult for me in school because what I understood, what profy was,

was polishing.

And what profy actually is is what a dental hygienist can provide.

And listening to you say, I wish I would have had a dental hygienist just really makes

my heart grow.

And because I hear that you've seen a difference and you're seeing that difference as me as

one of your assistants and now seeing what I became as reflected from the hygienist

that went through school and became and what they are able to do.

And I appreciate you being able to see the difference in what can be offered when education

is available.

And there is a standard of, you know, a standard of that care and when we're able to give

that time and that preventive education to our patients is really can really make

a difference.

And if I had a magic wand, man, if I had a magic wand, well, and to be fair, Jess, I don't

laugh.

I don't know everything.

I didn't know that a profy wasn't a polishing.

My whole career in, you know, and I finished my residency in 2001.

So I'm kind of want to, you know, I'm now becoming the old timer in the profession.

And you know, we were like, okay, you know, your assistants just do the profies, profies,

profies.

And unfortunately, I never really dove into the difference.

And I have learned that on the reservation, the hygienist set me straight and they're

like, well, technically, it's not a profy and I'm like, it's not.

It's not.

And then I'm like, you know, it's really not.

And it's no disrespect for the assistants out there.

And I don't know if we talked about in the first episode and the idea of training assistants

to be hygienists on the job is a big mistake, in my opinion.

Now that, you know, I've worked with three fantastic hygienists up there.

I can't even clean as well as the hygienists.

And so I think it's a better service for the patients in the end.

That's really what it is and what it's about.

And, you know, that's, I don't know why everyone goes into the profession.

You know, it is, it's a, it's a nice lifestyle.

I didn't go in it for the money.

I just, you know, and now as I practice over the years, I really went into it to work

with the patients and, you know, make their experience great so they don't hate dentists.

And to treat them the best that I can and take care, you know, they're decay because

decay is a disease.

And so, yeah.

I'm sensing that you went into the profession wanting to serve a population, your patient

population, and that you found more purpose in serving that population on the reservation

versus what you were able to do or the constraints that were put upon you as a provider in other

your private practice or being corporate dentistry.

And I'd like to dive into that a little bit on what, what changes there were and, and why

you feel such a difference and how that impacted you as a professional.

Yeah, I, you know, it's interesting.

I, when I started my private practice, I was young, you know, 31 years old, full of energy.

And there's a drive, so I'm going to get philosophical, sorry, about that.

But, you know, when you're in my 30s, it was all about establishing this career, this,

my practice.

And it's like an accumulation stage, right?

And then I got into my 40s, early 40s, I don't know if it was a midlife crisis or what,

but it's like, wait a minute, you know, what am I doing, right?

And I think it started shifting.

I mean, I always felt like I worked well with patients.

I think personally, I'm a solid dentist clinically, but I could manage kids very well.

And that's what I enjoy the most is that interaction with patients and parents.

And anyway, in my 40s, you know, I kind of like, okay, I don't want to see 60 kids a day.

That's not what I'm, what I'm here for.

But it got to the point, especially the last year and again, no disrespect for the corporate

groups about my practice, but it wasn't like, oh, I'm excited to go to work.

I, you know, it's like, I got to go to work.

I have a full load today.

Now that I've been up on the reservation, I think a lot of it, I love going to work.

There's not a day that I'm like, oh, I have to go to work today at a rather stay home.

And I think that's the patient population.

I think it's the staff I work with.

I think it's the whole Wind River cares as a unit in the people that work there.

And I think honestly looking, I'm just talking about myself, I just think I've developed

a lot of empathy working with these patients that I've worked with in the relationships

that I've built.

And so it has given me purpose.

And when I got, this was a personal story.

When I got hired on, I was talking to the CEO of the reservation and I said, hey, I just

want to thank you for hiring me on here because it kind of changed my life professionally.

And he goes, it's giving you purpose.

And I said, yeah, absolutely.

So I just got the chills.

So anyway, but yeah, that, I love it up there.

I love working there.

I don't plan on leaving.

And you know, as long as they like me and still have me up there, I plan to stay up there

for, for, it's all I finish my career.

So Dr. J, not, I mean, I think everybody who's listening out there definitely got the

goosebumps, right?

Like we all got that excitement of like, hey, I would love to kind of recreate that.

What are some of the things that you notice that is a pattern when you go to work as the

team members?

The patience, is it you being in this season alive?

Do you think that's something that a 30 year old, 40 year old could very much have is that

excitement to go to work because I feel the same about when I get to do this podcast with

Jessica, right?

I get that excitement that purpose.

Yeah.

And okay.

And I can only speak for myself, honestly, I feel very lucky, hashtag lucky, right?

And I'm in this situation.

I think for me, personally, it is the staff, we have fantastic staff.

We're all human.

We all get on each other's nerves.

But overall, the staff is fantastic.

I think that's part of it.

It is the, the patience that we work with.

And for me, personally, there's nothing better than, you know, a patient, reduce a procedure

and myself in the hygienist, I know, feel the same way.

You get something done, the patient's happy, the guardian's happy, the child's not afraid

of going to the dental clinic.

And that, you know, adds to the whole, I guess, essence of where I'm at.

And, you know, there, and there's a need up there.

And, you know, the group, Wind River repairs, we're making a difference.

We have a mobile bus unit, we go out to the schools, we're screening the kids, we're

playing fluoride, we're, we're on top of it as much as we can be.

And I've noticed since I've been up to the last two years, I mean, it's, it's, it's making

a difference.

And so it's kudos to the organization, to the staff, all the workers, it's, it's great.

And that in and of itself, again, gives you that purpose and a, and my small piece of

accomplishment in what the mission of the group is.

Well, I have to imagine that it's also the type of dentistry too, right?

I mean, you said it yourself being able to have that preventive dentistry, being able

to do the right thing for the patient creates that foundation to be able to say, yeah,

I'm going to work because I believe in the type of dentistry that I'm doing.

Nobody's forcing me to do things that I don't want to do.

Therefore, you create that camaraderie with your team, with your patients to say, hey,

I'm taking care of them.

And this is coming to fruition.

So that's, that's pretty impactful for no, absolutely, sorry, I didn't mean to cut your

off.

But it's like, um, and I'll be honest, I'd rather prevent a cavity than having to fix it,

hands down.

It's so much easier.

But, you know, I look at whoever I'm working with because we, we do rotate assistants

up there.

We're a team.

And Jessica, probably, I don't know if you remember from my office, but before I even

walk in the room to say hi, to start something, this, the staff already has the patient

manning.

And, and that's the key in how it's set up.

And, you know, in my office, my office was set up for kids, you know, up there, we see

adults and kids.

So it's not as like kid-friendly in the sense of, you know, we don't have murals on

the walls like I did and, and, and things like that.

But that's where I give credit to the staff.

And I tell them, you know, we're a team, you know, when I told an assistant last week,

I'm like, well, we're a team.

It's not just me.

It's both of us.

And you already have the patient manage before I get in the chair and they're happy.

And that's, you know, that's what it's about.

But again, prevention, if I can prevent it so much easier.

So yeah.

Absolutely.

Well, prevent decay and also prevent people from having poor experiences.

So later in life, they're not as concerned about going to the dentist.

And that doesn't progress the disease, whether that be carries or parodal disease.

And they're coming to the dentist and having those things caught, educated about, prevented

or restored before they become life altering.

Yes.

Exactly.

Because our, our smiles are life altering.

A disease that goes undetected for years and without people really realizing it.

I mean, that's what's so insidious about oral disease is it's not as blatant as other

diseases can be or as quick as other diseases are.

And so you go a really long time before once it's caught and it's you're in stage three

perio or you have multiple extractions.

That is life altering.

And if we can alter life in the prevention stages, that would be much better.

And I think often the four letter word comes to play in that word as time.

I heard you earlier say that now that you are on the reservation, you have a little bit

more time.

And I think to bridge, maybe those who are listening that feel that they're caught in

a time warp at work, they come to work, they're seeing 50 50.

You said 60 patients, but whether that number is the correct number of how many patients

you saw, they may feel that they are caught in this time warp of seeing more patients than

they can accommodate with feeling that purpose in their profession.

I think an ask I have to our professional world is maybe reassess, reassess what's happening

in your own office, reassess what is the purpose and sometimes and that is a balance.

I'm not saying this is an easy decision.

I'm not saying that, you know, it's going to be, yeah, let's give everybody two hours

for a procedure that would be great if we had two hours, but can be done well and can

be done to a standard of care, maybe in an hour and a half or let's let's look at that

and also look at the personalities of your team, since as a team approach, maybe,

maybe Dave Torres can do something in a half an hour that's going to take me an hour to do.

And I wonder if we would stop making it so, so predictive and less personal.

Maybe we could find more of that purpose in our profession when we're in those,

the years of 30s, really establishing a career or establishing a practice.

And yes, there is a rent that needs to be paid.

I don't think those are always opposing things.

And when we look at the most opposing, we end up setting ourselves up for failure.

Yeah, and it's a balance for sure.

And I think it can be done, you know, I'm in a different part of my career than someone coming

right out of a residency that's, you know, and again, it goes back to what I said,

again, personally, is that 30s of accumulation, that's what I would call it, where you just,

you know, you want to make money, you want to accumulate stuff.

And then I think that's like I said, whether it was a midlife process or what, but there's a

shift, right? And in me, there was a shift and I was kind of reassessing a lot of different things.

And so honestly, like towards my private practice and even in that corporate group, I'm like,

I don't want to see more than 40 kids a day. That's enough. And, you know, with kids, it is,

you do have a window, you know, like it is, I have more time, but a kid who's only going to sit

there, there are attention spans short. So you get it done quick, you do it correctly, words,

clinically sound, the kiddo, and the kids happy, is if they're there too long, they will lose it.

I mean, it happens. Visitor. Yeah. Yeah. So my question for you, Dr. Johnson, is I wouldn't wish

your 30 year old self a preemptive midlife crisis. That's not what I'm wishing. I have what I'm

curious about is me having worked with you, I think we provided a great service. And I, I think

your dentistry was a plus and looking back at my own life arc and seeing what I provided as an

assistant versus what I can now provide as a hygienist, what would you say to that 30 year old without

preempting this midlife crisis that would make a difference to preserve maybe some of that purpose

in the midst of the accumulation or the, but not even the, the necessary establishment of a practice.

Yeah. Honestly, what I would say is go try to find work on a reservation. I'm, I'm the

dead serious. That's great. And hire a hygienist, right? And hire a hygienist. And I would hire

two hygienists like I love hygienists. And I have all the respect and I've said this in the

last one. You guys are specialists. You guys are fantastic. And you know, it would be one like if I

had a hygienist, I wouldn't say, Hey, we go and I'm up for this for your old that, you know, because

I know there are general dentists say, Hey, well, you blocked this patient for me. Because again,

I think that is like not that you can't, but you have your own specialty. But it again,

we're feeding into the idea of I want to see as many patients and packing and do as much

procedures as I can in the day. I think it also depends on your team, right? Like I remember the

very first time I was asked to anesthetize a four year old. It's make a really long story short.

You'll hear that story in another episode. But I ended up watching someone else do it. And that

was the right decision for that time. And I think that there are some hygienists that when, when

mentored well, that might become part of their flow in the office that works. And, and I don't know

if it's a time thing or if it's a continuity thing. I mean, that I think that can be a number of

different things. But I think that mentorship is really important. And also letting people play

to their strengths. I would prefer if there is somebody that needs preventive care, I would

rather be in the seat of preventive care. If there's someone else who can do the anesthetizing that's

going to see them for a restorative procedure. But if it's prevention and I can get them them for

prevention or if I have some time, somebody didn't show up in my schedule and you're running behind

and I feel confident giving an eight year old a block, I can do that too. But letting people play

their strengths and having a, this is, I mean, this is a hill I'm going to die on. There needs to be

a competency for people in those areas playing to their strengths. There needs to be education

and competency and accountability. So if I'm going to get a kid on them, that's going to, that

falls on me. I chose at the very first time I was like, this is not going to be safe for me,

snack and be safe for the patient. I'm opting out because I have an accountability to my profession,

to my license and to me, to the patient, to the patient, not me, to the patient. And so I think

that that's something to consider. Well said. Yeah. It goes back to knowing yourself and your team,

right? Like, I think we all are noticing this pattern of being able to say, we got to advocate

for ourselves, right? Like if you close your eyes and you're afraid of going to work or intimidated

or excited to go to work, if you forecast your career for the next 10 years, chances are you're

probably going to go in that season of your life where you're saying, I don't like going to work

every day because I'm doing things that I'm not certain. Or I love going to work because my team

always has my back and I have their back as well. So being able to kind of advocate for yourself

for your career, for your patient goes a really long way. Dr. Johnson, what advice? And I know we

could go into to the whole advice team here is just because again, you know, that beard, that

beard is really, so you guys, for the listeners, he's got a very wise beard. So this next advice is

coming from a wise soul. What advice other than hygienous keeping you in check, which by the way,

if we come back track a little bit, I would love to, I would love for you to set up the tone on how

that happened because not a lot of dentists are receptive, right? So maybe like, hey, hey, hey,

like, you know, stay in your, in your scope, but I'm thinking of the dentist that I've worked before

and it just goes back to that synergy and that conversation to be able to have that that ability

to have a conversation and say, hey, how can I, how can I help you today? What are some of the things

that you can do to help me have an easier schedule or a patient flow? But yeah, what advice do

you have for that dentist listening or hygienous listening that they don't have that synergy with

their team and be able to kind of communicate to each other in the spirit of advocating for their

career and their patient? Well, I think definitely if you're not comfortable with something speak up,

that's one thing for sure. And I tell, I get corrected by one of the hygienists all the time.

So I just tell her I'm coachable because, you know, we, I don't know everything. I mean, I,

I know what works, yeah, I know what works for me. And, you know, I'm glad that our hygienists,

like I really value their input and opinions. And so I think as a dentist,

working with a hygienist or other staff, I'll be, you know, asking them, well, what do you think?

How does this look? You know, what do you see? Because I think that helps overall because we are a

team. It's not just the dentist separate, you know, over here, the hygienists is here, the

assistants are here. We're all a team that are working together to treat the patients the best

who can and and provide the best care, whether that's prevention, whether that's treating

cavities or oral disease and things like that. I think for coming, I'm going to speak to the dentist.

I mean, we don't know everything. Far from it, you may think you do. Once you think you know

everything, then I think that's where problems can arise. It's time to go. Yeah, I think

work on a reservation and then you'll be, yeah, I just think be coachable. I mean, we're all adults

and I think open communication and communicating is the key. Like if someone, for me personally,

if I'm doing a front filling, okay, and I'm, I'll always ask my assistant, how does it look to you?

Because I want their input, right? And if they say, no, that looks like I won't swear, but I'll say

that looks terrible, right? That's chicken. Yeah. And so I value that input. It's not an ego thing

for me. I just want to do the best work like Dan and have a positive experience. So Dennis,

get rid of your ego's, Dennis. That's what I'm trying to say. I think that's a really great

way to end this is it's not about ego. It's about having the best experience for the patient.

And in turn, like that helps you as a professional as well, that feedback. I am a much better

clinician because I hang around with people who in my esteem are better than me. And Dr. Johnson,

thanks for letting me hang around you. I'm honored to be here and thanks for working with me.

Yeah. I have a respect for you, Jess. And thanks. I do have to tell a funny story though,

when you used to do the polishing, not curfews. I know exactly where this is going. And you know,

I think you had curfew in your hair and your scrubs. I did. I was telling you to hide

yourness up there. And they were kind of laughing. And like, she's awesome. You know, but she,

but I haven't always been. Yeah. Yeah. And I still have I still have room to grow for there.

I am still learning new things to this day. And yes, my name is Jessica. So they used to say,

you're making a mess, Jess, I would have profy like all over it. It was it was definitely a learning

curve. And I'm grateful for your patients. And I have come a long way. Wait a minute, Jess,

you mean to tell me that your secret to your beautiful curls is probably paste? That's why routine,

that's why routine. That's how I get the volume. That's how I get the volume.

Minty fresh. Oh, thanks for being here. And the ending note is no that there's always room to grow.

Yep. Thank you, Dr. Johnson. Thank you. Thanks for having me.

That's a wrap on today's episode of a tale of two hygienist podcasts. If this conversation

made you feel seen, inspired or even just a little fired up, share it with a fellow hygienist or

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and Jessica. And until next time, keep learning, keep laughing and keep showing up for yourself

and for each other. This has been a production of Endeavor Business Media, a division of Endeavor

B2B2B.