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Periodontics

Inside Dentistry

September 2010, Volume 6, Issue 8
Published by AEGIS Communications

A Conversation with Dr. Michael Alfano

The executive vice president of New York University discusses trends in higher education and its effects on dental schools and the delivery of dental healthcare.

Inside Dentistry’s newest board member, James B. Bramson, DDS, president of Bramson&Company, holds an in-depth conversation with Michael C. Alfano, DMD, PhD, executive vice president of New York University, discussing a wide range of topics that reveal the width and depth of these leaders’ many years of experience and wisdom in the clinical profession as well as academia.

Inside Dentistry (ID): Mike, you have a long and varied history in the dental world. Tell our readers a little about your background and experiences and how they have shaped your perspective over the years.

MA: My education has been a terrific asset in achieving a varied and fulfilling career. After completing my dental degree from UMDNJ, I received a PhD in nutrition from MIT and training in periodontics at Harvard. During my training in Massachusetts, I practiced general dentistry part time, then I spent 8 years teaching, doing research, consulting, and managing my own periodontal practice in New Jersey. In 1982, I became the vice president for dental research at the Block Drug Company (now a unit of GSK), ultimately becoming senior vice president for global research, technology and quality assurance, and a member of the Board of Directors at Block.

I wanted to be working in academia at the end of my career, so in 1998 I rejoined the academy and became dean of the College of Dentistry at New York University. In 2006, I assumed my present position as executive vice president of NYU.

ID: What kind of lessons did you learn in industry that you use in your administrative work in education?

MA: Going back to academia was intimidating—I didn’t know if my corporate world skills would translate or be valuable to an educational institution. It turns out that they were enormously helpful, because more than anything, I had learned the value of administrative efficiency, goal setting, team building, and prudent budgeting. Indeed, as I think back on my time as dean, my most important observation—which I now hold as an axiom—was that: Great economics builds great academics, not the other way around. A corollary to this axiom (for any deans who might be reading this) is: A dean with money to spend has a perceived IQ that is 75 points higher than a dean who is broke!

ID: I thought your response about the lessons you learned in industry that you use in education was interesting. Can you expand on that?

MA: I fundamentally enjoy the academic side, and I thought the freedom of academics would allow me to create a career that would provide more self-fulfillment. In the corporate world, you have to follow a prescribed direction that comes from the very highest levels of the company. However, the corporate world can be more like academia. It’s not nearly as autocratic as most people on the outside think, and you can move much more quickly. I remember once interviewing for a position, but I was a little hesitant to give up writing grants in areas of interest to me. Then the CEO asked me, “So how long does it take for you to get one of those grants?” When I explained that 18 months would be considered fast, he responded, “Well, if you come down here and convince me of a great idea, you could be spending that money in 18 minutes.” So that was fairly compelling—and the truth of the matter is that it did happen. If they were good ideas, you could move on them fairly quickly.

ID: What’s the best piece of advice you ever received?

MA: I have been blessed by many mentors along the way, but the best advice came from my father when I was a child: Education is the only thing that can’t be taken from you. Use it wisely. Always tell the truth, and have the courage of your conviction to stand on the principles you value.

This question leads me to reflect a bit on leadership. There are thousands of leadership programs available today that teach administrative and management skills, and help people to build a network. However, they do not teach key leadership traits like integrity, vision, charisma, passion, and, perhaps most importantly, courage. These critical attributes cannot be taught, they can only be modeled for others to see—and my father was an amazing role model.

ID: Speaking some more about leadership, do you think the dental schools could do a better job of teaching leadership—emphasizing ethics, integrity, and those kinds of traits?

MA: I feel very strongly that you can teach administrative and managerial skills. But some of the core elements of leadership are traits that I don’t think can be taught—like courage and passion. They can be modeled, and we have all seen people who are really passionate about issues. However, I think these leadership institutes, as they are frequently called, misrepresent their product. By all means, they can be extraordinarily valuable. But I just don’t think you can teach passion, integrity, charisma, and the like.

ID: Did you look for some of those traits in the students you were recruiting to NYU?

MA: We certainly looked for independent thinkers when we were recruiting students. I think that’s one of the attributes of future leaders. Obviously, we looked for integrity. But it’s very hard to do this in a setting that basically allows for a single interview at best and a set of recommendations from people who are by definition favorably inclined to be positive.

ID: Can you tell us about a key challenge or turning point for you?

MA: I could go back to my childhood and talk about growing up poor, but hey, you’ve heard dozens of those stories. I think it would be better to talk about a relatively recent event, which proved to be an enormous challenge and perhaps the toughest assault ever on my integrity and courage. It began mid-decade when NYU decided to merge its College of Nursing into the College of Dentistry. We did this because of educational synergies and a recommendation by the Institute of Medicine urging healthcare providers be educated in teams. Most importantly, it was to explore the idea that if nurse practitioners were affiliated with dentists, the 30 to 40 million people who visit a dentist—BUT NOT A PHYSICIAN—each year would have access to the diagnostic skills and therapeutic intervention of a nurse practitioner.

Leading a dental school with the chance to test a very important model of healthcare intervention that could help the citizenry, reduce national healthcare costs, and position dentistry even more solidly as a primary healthcare profession was the most significant opportunity in my professional career.

Then the backlash hit. Suffice it to say that organized dentistry did not take well to this possible innovation at all. It reminded me of the way the profession tried to thwart the beginning of the dental hygiene profession in 1910 in Ohio. Yet, today there are about 300 dental hygiene programs in the United States.

In any case, the most difficult challenge for me wasn’t retaining my own beliefs that this model had to be tested, but rather the threats made against the NYU College of Dentistry. It is one thing to go down personally for your beliefs, it is quite another to risk an institution that was 140 years old at the time. However, with strong support from the University, and the encouragement of enlightened leaders in dental education, the educational model prevailed, has prospered, and has even been recognized for its innovation by some of the same organizations that balked at the outset. While it remains to be seen if this model will be adopted in private practice, it is already making substantial improvements in the quality of education for dental, dental hygiene, and nursing students at NYU.

ID: With regard to what happened with NYU and the College of Nursing, that’s not an unusual type of approach when a group is faced with something entirely new. Do you think there is a fear of the unknown that outweighs those opportunities that come from change—and that’s why people fight so strongly against change?

MA: Yes, I think that’s always the case. It’s a cliché to say that change is hard. But because everyone operates within a comfort zone, once you create some parameters that might require people to work outside that zone, there’s an uneasiness that the outcomes won’t be beneficial.

So I wasn’t surprised that the profession—particularly the New York State Dental Association—would have concerns about what we were doing. What surprised me was the almost venomous nature of their approach to understanding it—and I am being kind when I say “venomous.” They wanted to kill it sight unseen without understanding any of the implications. They saw it as an assault on the integrity of the dental profession. Truth be told, some considered the dental profession to be at a higher level than the nursing profession, and therefore any comingling of faculty or the name of the institution by definition would draw down its reputation.

It was an extraordinarily difficult time—but not because I couldn’t take the heat. I was concerned that they would also harm a venerable institution. That would damage not only the people who worked there and graduated from there, but also the profession, because I believe it’s important that private research universities continue to want dental schools in their sphere of control. Had it gone badly, one could see that NYU might back away and maybe even give up on both dentistry and nursing. That would have been a huge tragedy—all because we were inspired by what could be if people would have an open mind about letting it take its course.

ID: It seems that in a lot of these instances you have to deal with the doubt. I always hear, “We don’t know the unintended consequences of our actions here.” How do you counter that?

MA: It’s difficult because the comment is true. Unintended can also be “unknown” consequences. And it’s very difficult to play out a move all the way down the chessboard to see what other consequences might come into play. Basically, we thought we were on solid ground in terms of being consistent with both accrediting agencies’ requirements. Also with the idea that what we expect from an institution of higher education is the ability, if not the downright mission, to innovate across all that it does, including educational paradigms. At a time when costs of dental education were spiraling up—as they always do—the thought of leveraging faculty in certain effective ways was attractive, simply in terms of the academic model. As I said, that’s not what drove the university to do this—what drove the university to do this was the idea that this just might be a new way to create access to healthcare for people who don’t normally visit a physician.

We do know there are millions of people with these chronic diseases who could benefit from earlier diagnosis. The thought of being able to intercept before the disease becomes more difficult to manage was the compelling idea that we wanted to evaluate.

ID: Higher education is under some assault these days—lack of affordability, questions about value, decreased outside funding, and the list goes on. What do you see as the major challenges in higher education in general?

MA: This is a very timely question. Higher education is under significant assault these days. With costs escalating at near double the inflation rate for the past 40 years, Americans have had about all they can take. As we say at NYU, the higher education reset button has been pressed.

Getting into specifics on this would try the patience of your readers. Suffice it to say that institutions of higher education in the United States have already begun to employ many of the techniques of the corporate world using tools like re-engineering, re-structuring, outsourcing, right-sizing, and the like. So far, the efficiencies at most institutions have come behind the scenes, but change is likely to come to the academic components soon. Indeed, in some state systems, and smaller private colleges, academic changes replete with faculty furloughs, partnerships with “for profit” educational entities, and increased teaching loads have already begun. Perhaps most importantly, the days of tuition increases at twice the rate of inflation are over.

ID: Well, if it’s about the need to learn more about new skills and efficiencies and business modeling, can you tell me what’s at the root of that? Is it lack of incentive? Is it tenure? What are the for-profit universities doing, and are they building a better business model to educate people?

MA: I think one of the signature problems for higher education is that it often doesn’t recognize who its stakeholders are. So if you ask a group of academics who the stakeholders of the universities are, the most common answer would be “the faculty.” I’ve asked that question, so I can say this with some experience. There are some members of the faculty who would say “the students.” That’s a pretty darned good answer, and I think that’s the level at which the for-profits are operating—and I believe that’s an appropriate level to be operating at.

The bigger picture for the not-for-profits is that the stakeholders, I believe, are the citizens. There are about a half dozen substantial tax breaks that are offered to not-for-profits. And the expectation by society is that it derives value by allowing those institutions to prosper just a little bit more than if they have to pay taxes. For a few hundred years now, that model has delivered excellent value for the American citizenry.

In more recent years (which I would define as the last four or five decades), the cost has been escalating at rates that—to use a popular buzzword—are not sustainable. Increasingly, the attitude of the American people is that this is just out of control. At the institutional level, in some ways higher education looks a bit like healthcare. What do I mean by that? It’s very hard for individuals to assess the value of what they have just purchased. You know if you like your physician or not; you know if he or she is personable. You don’t know for sure if they are proffering the best kind of care for you or if they are doing this surgical procedure at the highest skill level. But they believe that they are, and you have to trust them.

So too with education. You are going on reputation. For example, do you like the geography? Do you like how the tour guide functioned? And so forth. Not every reputation is important, but that’s part of it.

Then you factor in the way these services are paid for. For the vast majority of Americans, healthcare is paid for by third party payers, typically supported by the corporations that create the payrolls. In higher education, it’s also largely subsidized by third parties in the form of grants directly from the university or various scholarship programs, along with highly subsidized loans that are made available through the federal government with some state participation, as well. Therefore, it’s very hard to judge the quality of the product or the service that is being purchased while you are receiving it. Also, there is less concern about the typical spending habits of individuals because you are not writing a check or opening your wallet to pay for it.

When you have scenarios like that—and you throw in some of the other issues, like the expense and constant change of technology on which they are highly dependent—it’s a recipe for very rapid escalation of cost.

There’s also a bit of star power involved—medical centers strive to get the biggest, best names in surgery onto their faculties. So too with universities. And that tends to escalate salaries.

ID: Would you agree that the ongoing economic climate is not going to support those kinds of subsidies?

MA: Absolutely. As I mentioned before, the reset button has been pressed. The state of Massachusetts, for example, introduced a bill that begins to tax all the endowments over $1 billion (and there are 11 of these across the state). They’re not happy with the way the institutions are returning the growth on those endowments, and also they need tax revenue. The city of Pittsburgh proffered a tax on tuition for all the universities in the city to pay as one vehicle to solve its budget problems. And the US Senate directed the IRS to investigate institutions of higher education to ensure they are not abusing their tax-free privileges.

From these examples, you can get a sense there is a pretty high level of dissatisfaction with that aspect. If you were to survey American voters on how they feel about US higher education, they would say: it’s the best in the world, we’re so happy we have it, we’re a better country for it. So they’re not really assaulting the universities for what they have done, but for how they have done it. And how they have paid for it.

We just took the lowest tuition increase in 23 years—so we’re adjusting to that. We’re putting pressure on faculty salaries, trying to operate the institution at a smaller spread between the tuition increase and the salary increase. Traditionally at NYU, there has been a two points’ difference. If tuition goes up 7%, salaries can go up 5%. Now with tuition going up 3.5%, where can salaries go? Well, they can’t increase more than 3.5%. But clearly, if they go up only 1.5%, you run the risk of not being able to recruit or retain faculty. So you need to compress that difference. We have tried to do that by making the business part of the university more efficient.

ID: Based on your experiences and outreach, and the major challenges to dental education and dentistry, how do you see the profession responding?

MA: When I left the dental deanship and NYU recruited Charles Bertolami, a very talented leader, to replace me, I deliberately tried to remove myself, not only from the NYU dental school, but also from active participation in the profession—although I retain membership in the ADA. However, while things have gone very well at the school, that is not the case with the profession, and I have been slowly drawn back to observe and comment, because I care too deeply about the profession that has afforded me such a fulfilling career. Troubling trends are developing in both the educational and the practice arms of the profession of dentistry.

If you were to assess how dentists moved from barber surgeon tradesmen to highly respected professionals, most would conclude that the signature change came when the educational component moved from apprenticeship, through proprietary schools, to university-affiliated dental schools—especially affiliations with research universities. Since the early 20th century, there has been a healthy mix of dental schools affiliated with research universities and those sited at less research-intensive parent institutions.

The balance in the numbers of research intensive and non-research intensive dental schools is shifting, with essentially all of the new schools affiliated with institutions that are not research-intensive. To be sure, these new schools usually have distinguished leaders, and they all endeavor to bring something important to the table: community-based learning and service, education in collaboration with other health professionals, sharp focus on recruiting particular types of dentists, and so forth. However, I believe that the last dental school to open within a research-intensive university was the University of Florida in 1972—almost 40 years ago. Thus, while good outcomes can come from establishing new dental schools at non-research intensive institutions, these 20 or so newly opened or planned schools are creating an imbalance between those based at research-oriented parent institutions and those sited at other types of institutions.

To make matters worse, the research-oriented schools are concerned that they will be at a competitive economic disadvantage because sustaining a research enterprise comes with significant associated costs. They are also concerned about maintaining growth in the science base of dentistry and sustaining the esteem of the profession. Thus, they recently convened a group of some 27 schools in the Midwest to ponder the situation. While the concerns of the leaders of such schools are understandable, the discussions that took place would have been better at a national meeting with all dental schools in attendance. Dividing the small enterprise of dental education into subgroups of schools would be a huge mistake. This is a time for more dialogue, collaboration, and understanding—not less.

The American Dental education Association showed great leadership a few years ago when it invited all components of dental health education to the table for membership. In contrast, the risk of creating multiple “affinity” groups of dental schools is high, and dental education in the United States will not be well served by such divisiveness.

Finally, we should all consider why such great institutions as Harvard, Columbia, and Michigan were pleased to welcome dental schools onto their campuses more than 100 years ago, but Stanford, Chicago, and Yale would be unwilling to do so today.

ID: Why wouldn’t a Stanford or Chicago or Yale want to have a dental school?

MA: I have an answer, but it’s difficult to state. I think that in the eyes of Stanford, the profession of dentistry has lost esteem. Maybe 100 years ago, had the opportunity availed itself to Stanford, it would have had a dental school. But I think it’s extraordinarily unlikely that they would today. I just had a discussion with the president of a very prestigious university who said they’re not sure that dental schools can contribute to the kind of academic dialogue that they would like to have on their campuses.

This is very disturbing when it looks like the nation needs 20 more dental schools, and not one of them is going to be sited at what most would agree is a reasonably intensive research institution. I know of two research-orientated institutions who have danced with the possibility of creating a dental school. One was Rochester, which is a fine institution that would have loved to have started a dental school, and the other was Texas Tech, which is less well-known but growing in research stature. If we can get just a few of these places to agree that it is appropriate to initiate a dental school, then my concerns are mitigated substantially. The fact that there have been none, I find to be a very worrisome trend.

ID: Since you are concerned about whether this movement is going to retard the advancement into scientific frontiers in dentistry—will there still be that drive in research? With that assumption, why hasn’t industry stepped in to replace what goes on in research institutions?

MA: I think it’s fair to say there are many other ways that dental science can be advanced other than a dental school doing the research. In fact, I think 50% of the NIDCR budget goes to nondental institutions. So there is no question that the science can continue to advance.

But the worry is: where will the passion for the value of research to the profession come from, if not from dental professionals who have been schooled in the value of research and who have the potential to contribute? You could argue that a school with no research capacity can teach the value of research. But if there are no schools actually doing that research, it can become a very shallow exercise, particularly over the profession as a whole.

ID: Should we be concerned about conflicts of interest in industry-sponsored research?

MA: One obligation of dental education is to teach how to properly read and understand the literature. And part of evaluating the literature is to understand the origin and design of a particular study. So corporate research per se can be every bit as valuable as—or sometimes more valuable than—research funded by foundations, private philanthropists, or the federal government.

However, sometimes research becomes very product-specific and is not as valuable in terms of advancing the profession. I think there’s good and bad research, regardless of the sponsor—that’s the way I would look at it.

As a recipient of public grants, I would look someone squarely in the eye and defy them to show that I used a lesser standard in those studies than I did with NIH support. But there’s no question, the reason we disclose the source of the monies is so people can assign a value to it and be appropriately suspicious (or not) about whether there is any inherent bias.

ID: When you put your ear to the ground, what are you hearing these days?

MA: My network isn’t quite what it used to be, but what I do hear troubles me. In addition to the problems in education that I just mentioned, I understand that divisiveness is in the air within organized dentistry. Having failed to learn a lesson from the way the dental therapist issue in Alaska was managed, it seems unable to craft a workable solution to address the public cry for better access to dental care. Indeed, as we talk, there are at least two groups of state dental societies meeting separately to discuss alternative approaches to access. One group seems to be focusing on how best to deploy a so-called “mid-level dental practitioner” within the context of the current dental healthcare delivery system. I have had the opportunity to speak to this group, and they seem to be taking a responsible approach to a very difficult problem. The other newly formed group may be taking more of a position to preserve the status quo. This approach did not work in Alaska, did not prevail in Minnesota (which seems to be moving forward in a progressive manner), and it typically fails to offer a viable alternative to increasing access to care.

I understand the ADA has scheduled a meeting on this topic this summer, and I hope that it can catalyze healthy discussion that will not simply create a legal or a PR strategy, but a more broad-based approach that actually begins to deal with the problem of access. It is difficult to be optimistic, but I have my hopes for this to be successful.

ID: One of the duties of that leadership is to make sure that people see, hear, and understand both sides. Now, regarding lack of access to dental care, it seems that there are new players, new parties—specifically, organized patient advocacy groups—who are somewhat changing the debate. They are increasingly vocal. How do you see the new players beginning to change the debate or maybe the strategy?

MA: Excellent point. I think that brings us full circle to the comments I made earlier about who are the stakeholders of the universities. Once again, we are talking about the citizenry. If we have learned anything about the way this country works, it’s that ultimately the citizens have a great deal of power. It may take them a while to understand the issues, but once they do, they will throw people out of office. They will lobby aggressively for different kinds of legislation. I think we are seeing that happen now.

Dental care has been on the horizon for upwards of a decade as a major issue motivating the citizenry. The fact that it took some time is not surprising, it always does. But now that there have been some successes by such lobbying efforts, I think we will inevitably see more. The momentum behind this has been pent-up for so long, it’s a problem that’s going to find a solution.

ID: Specifically, how do you see the access to lack of dental care dilemma being addressed?

MA: There is no doubt that in the long run the American public will get the access to dental care that it desires—and deserves. I think that it is inevitable that a mid-level dental practitioner, or dental therapist, or an advanced dental hygiene practitioner will arise on a state-by-state basis. The only question is whether or not the dental profession will elect to embrace these new models and bring these new practitioners into the current model of dental care. A well conceived framework for the role of dental therapists can be good for the public, but also good for dentistry. The arrival of such practitioners will allow the dentist to focus more on diagnosis, the management and treatment of difficult cases, and the expansion of the role of dentistry as a primary healthcare profession.

Nurse practitioners and physician assistants have proven to be very useful in medicine, and a dental version of NPs and PAs would most likely be effective too. Indeed, such models have been successful in highly developed countries for almost 100 years. Perhaps it is time to get this right in the United States.

ID: Where do you see the next great opportunities for the dental profession? Oral–systemic associations? Medical model of care? New delivery models? Salivary diagnostics?

MA: I think each of the areas you mentioned is ripe for expansion, but at rates that are very likely to disappoint the avant-garde thought leaders in the profession. Dentistry is traditionally a late adopter of new pharmacotherapeutics. In fact, it has always struck me as a bit strange that the dental profession primarily uses stainless steel and carbides to treat its signature infectious diseases—caries and periodontal disease—while the rest of the healthcare world uses pharmacotherapy as a principle mode for infection management.

Although recent developments in salivary diagnostics are fascinating, I do not see the dental profession deploying them widely. To the extent that, for example, systemic cancer can be detected in salivary analyses, the use of such technology will bypass the dentist and be utilized directly by physicians and NPs.

ID: Is the problem with adopting some of the new technologies, deliveries, or diagnostics really the reimbursement system we have that rewards procedural-based care?

MA: That is the most significant part of the problems, although there are other reasons. It could really be how dentists view themselves. Do they view themselves as primary care providers? Do they view themselves with full authority to write prescriptions for whatever the patient’s oral health seems to warrant—smoking cessation prescriptions, for example, or to help medicate patients for a given periodontal disease? Or do they see themselves as surgeons who basically use only a handful of drugs—anesthetics, analgesics, and antibiotics—in order to effect technical treatments in the oral cavity?

Why is the dental profession disproportionately treating infection with stainless steel? Because it sees itself primarily as a surgical profession. There is nothing inherently wrong with that. But we once used surgery to eliminate ulcers, and now no one has ulcer surgery anymore. By using methods that might not be the most cost-effective or the least intrusive, dentistry will miss the opportunities to manage the diseases that we are entrusted to treat.

ID: It seems as though the medical models that are really showing promise—like Kaiser and those types of models that are designed around teams, wellness, and total care—have found ways to adopt best practices and analytics, outcome measures, and report cards that help them understand better ways for measuring what they are really doing. Do you agree?

MA: I think you’re right. The hope is that these practice-based networks can deliver that for dentistry. They are expensive to run and controversial, but I think the need is there. There are many more of them in medicine, of course, and they are designed to get real-world data on exactly the things you are talking about.

ID: NYU is very engaged in higher education on a global scale. Can you comment on the global dental environment?

MA: Dental education, like higher education in general, is going global. Twenty-five years ago, only a few US dental schools entertained the graduates of foreign dental schools for advance standing. Now, it has become commonplace. When I was dean of dentistry at NYU and had the opportunity to travel internationally, I marveled at how many dental offices displayed the NYU torch in their windows as a sign of pride (and perhaps for some competitive advantage) showing that they had been trained in the United States.

Recognizing that the United States does not have a monopoly on talent, NYU is building an interconnected network of campuses that is very different from the typical study abroad programs. In the Global Network University that NYU is becoming, people from around the world can enter at a site and receive an NYU degree—yet never set foot in New York. At the moment, this programming is primarily based in Arts and Sciences, education, Law, and the Performing Arts, but all of the professional schools at NYU, including dentistry, will definitely be a part of it going forward.

ID: As a reader I would say, okay, but what kind of implications does a global dental environment have for Joe Dentist on Main Street, if any?

MA: I think that, as in the rest of the world, there is a likelihood that they will have colleagues who were not born in the United States. And ultimately, as the world globalizes, I think that people in other countries will expect to have colleagues who were born in the United States. We’re barely at the threshold of free and easy movement of scholars and professionals around the world. I think it’s inevitable that it will happen. We certainly see it in higher education. We see it in the corporate world where talent is recruited regardless of where it might originate.

I think the profession is well behind that curve, and we don’t see that happening in a widespread way, except for the number of schools that now offer programs with advanced standing for graduates of other dental schools. There were four or five of them 20 years ago. Now there are 40 schools that offer some type of advanced standing. That has changed significantly, and I think it is helping.

ID: If you could change one thing about dentistry in the United States, what would it be?

MA: Stop killing the messenger! The dental profession has been changing slowly for 200 years. It will continue to do so. Reflexive, narrow-minded defense of the status quo will not stop change—it never has. It may slow it down, but it will not stop it. Moreover, in the effort, dentistry takes on the look of a self-serving trade group, not a public health-minded profession, and the once-high esteem of the profession will fall further in the minds of the populace.

ID: What frontiers are left for you and where are your next challenges?

MA: I hope to “retire” in the next year or two to spend more time with my six grandchildren. I also hope to be able to get more active in dentistry again, perhaps by writing, consulting, and teaching. Finally, I have joined some not-for-profit boards, and hope to make some contributions to those organizations.

ID: Any final comments?

MA: I appreciate the opportunity to participate, because the things I have been hearing are just so bothersome to me, and I don’t want us to go backwards. I wrote an article for Nexus, called “Dentistry: Circle Back, Circle the Wagons, or Circling the Moment.” The idea of circling back—which I didn’t make in this interview—is the extent that all the new dental schools are not affiliated with research institutions. By the way, the vast majority of these schools will take exception to that because they define research differently. So I understand that phrase will be controversial. But I worry that dentistry evolved from barber–surgeon to apprenticeships to proprietary (for-profit) schools to university settings. Not that there are propriety schools yet in dentistry, but you can see that almost around the corner. Once we go there, in my opinion, we are drifting back towards trends that are very, very unhealthy.

About the Interviewees

Michael C. Alfano, DMD, PhD, was named NYU’s executive vice president in June 2006. Prior to that, Dr. Alfano was dean of the NYU College of Dentistry, a post he had held since 1998; he continues as a professor of basic science and craniofacial biology at the College of Dentistry. Prior to that post, he was the senior vice president for research and technology and a member of the Board of Directors at the Block Drug Company, Inc, now a unit of GlaxoSmithKline.

Dr. Alfano practiced general dentistry in Massachusetts and periodontics in New Jersey and served as a member of the National Advisory Dental Research Council of the National Institutes of Health (NIH). He is a former chairman of the American Dental Education Association (ADEA) Council of Deans, past-president of the Student Clinicians of the American Dental Association (ADA), member of the Future of Dentistry Committee of the ADA, the ADA Foundation’s Planning Committee for the National Campaign for Dental Education, the ADEA Commission for Change and Innovation in Dental Education, and the Association of Academic Health Centers’ Advisory Committee on Health Professions Workforce Shortages. Dr. Alfano is a founding director of both the Friends of the National Institute of Dental and Craniofacial research (NIDCR) and the Santa Fe Group.