October 2008
Volume 4, Issue 9

The Santa Fe Group’s First Annual Meskin Symposium New York City, New York

On June 4th and 5th, the Santa Fe Group, oral health’s leading-edge think tank, met at the New York University (NYU) College of Dentistry to convene the First Annual Meskin Symposium. Named for Santa Fe Group founding member and former president Dr. Lawrence Meskin (1936-2007), the symposium investigated “Expanding Access to Primary Care: New Oral Health Workforce Models.”

Santa Fe Group president Dr. Linda Niessen, along with NYU senior vice president for health Dr. Robert Berne and dean Dr. Charles Bertolami welcomed participants. “I think if the Santa Fe group had a meeting and put the smartest minds together and said ‘Design the most complex health care system you could,’ it wouldn’t be as complex as the one we currently have—and that’s why the challenge for you today is significant,” said Dr. Berne. “We have all of these institutions, small and large, that need to survive. We have public policy that needs to be served. We have the patient base—obviously the most important thing that we’re all here for. We have regulations in and out. We have 50 states and some local government concerns in large urban areas. It makes it very, very difficult to provide the quality of healthcare that we do and very, very tough to address all the public policy around the professions.”

Nonetheless, Dr. Berne and Dr. Bertolami remained confident that the group would rise to the occasion. “I can’t think of a more congenial environment for the kind of bigger disciplinary thinking that I hope will take place here the next two days,” said Dr. Bertolami.

Keynote Address

Keynote speaker Jo Ivey Boufford, MD, president of the New York Academy of Medicine, challenged participants to “act local but think global” in her assessment of health systems and the health work force. “At the global level, we’re facing the realization that while we have an unprecedented ability to prevent and cure disease and significant political will and I believe unprecedented financial investment in health at the global level, the weakness of health systems and problems in the health work force are a major factor holding back progress in the more highly visible and heavily politically supported, so called vertical programs,” she said.

“Now oral health, as you know, is clearly an integral part of general health and well being, and oral health professionals can play a critical role in providing needed preventive and curative health services that can have quite significant impact on overall health in the world. Yet, I would say that your voice is not as prominent at the global table as it might be, and thus the contributions of the oral health professions could make to global health system strengthening and work force planning is not what it could, or in my view, should be.”

Dr. Boufford went on to give some background of recent developments in the health work force and health systems and brought the gauntlet back to the oral health profession and its role in the provision of care. “Primary care and prevention strategies should be a priority area of emphasis due to the ability to enhance access and mobilize community resources and potentially reduce costs by early detection and treatment,” she said. “Obviously, cost is one of the major challenges in our healthcare system.”

Logistics are also an issue. “Due to the long pipeline of production of traditional professionals, like physicians, dentists, and nurses, and the expense of that education, there is, I would call it a return to serious consideration of a more functional approach to work force development—trying to match population health needs with work force competencies.

“The professions need to take an active role in shaping this functional approach. This work really has to be informed by a much closer connection between our educators and our service providers and health policy advocates.” In her international work, Dr. Boufford related, “this was a classic story in every country. The educators and academics were really complaining—and I think with good reason—that they were not invited to the table, were not involved in the conversation. How can you expect us to produce what you need? Now, we all know there are other reasons why that isn’t happening, but I think it is a legitimate issue to look at for policymakers.

“There is a special challenge for this functional planning in the United States due to, what I would call, a history of academic arms race in the health professions preparation,” she continued. “You really almost have to have a baccalaureate degree to do anything in the United States these days. Masters and doctoral preparation is a baseline for entry, again, for anything that really relates to other human beings. So I think we have to revisit this and I think all of the professions really have to do this in a serious way. We may decide we like it the way it is, but it really can’t go unexamined in this kind of environment.”

Finally, “I do think it is a special challenge for oral health professionals. Many dentists—and I think this is a worldwide situation, having talked with a lot of dentists—many of them feel that they are sort of apart from the broader health system and I think one of the issues is that they like it there,” she said. “But what I sense from a group like this is, is that the profession, or a segment of the profession, which obviously has an enormous contribution to make, is really prepared to step up to the plate and really begin to help take on some of these enormous global challenges and also deal with the disparities in this country. I commend you for taking on the challenge and I really look forward to seeing what you come up with.”

Continuing the Conversation

Dr. Boufford’s keynote address was followed by Dr. Edward O’Neil’s presentation on “New Models for Health Care De-livery in Dental Practices” and Dr. Frank Catalanotto’s discussion “Ethical (and other) Issues Related to Improvement of Access to Oral Health Care.” Shelly Gehshan closed the first day of the symposium with a presentation on “The States’ Role in Workforce Policy.”

Day Two began with a pair of facilitated discussions. The first featured Dr. Jay Gershen and Dr. Catalanotto engaging “The Need and Demand for New Work Force to Improve Health and Expand Access to Care.” The second showcased Drs. Kathleen O’Loughlin and Ronald Inge on “Barriers and Solutions—Impediments to Workforce Development.”

Afterwards, a panel discussion on workforce models brought Drs. Amid Ismail, Ronald Nagel, and Terry Fulmer, as well as Ms. Jean Connor to the table under the moderation of Dr. Arthur Dugoni. Dr. Ismail presented the American Dental Association model, Ms. Connor the American Dental Hygiene Association model, Dr. Nagel the Alaska Dental Therapist model, and Dr. Fulmer the Nursing model.

Following lunch, the plenary session featured Dr. Michael Alfano and Dr. Bertolami presenting recommendations and action plans. “The question that I have for you is this: Is anybody going to leave here and do anything?” Dr. Bertolami said. 

Dr. Bertolami and Dr. Alfano led the group in a discussion of the major themes addressed over the two days, and “how can we formulate these into a tangible recommendation and is it plausible that some of us can do something, either organize this as a Santa Fe Group or perhaps more individualized to provoke change?”

Several hours of lively discussion elicited over 40 recommendations. The Santa Fe Group members agreed to survey the participants after the Symposium to assess their priorities for these recommendations. The recommendations fell into the following categories: legislative and regulatory issues; public relations; health professions educational systems; health professionals collaboration; novel service delivery models; innovative financing mechanisms.

The Meskin Symposium closed with Dr. Dominick DePaola speaking on behalf of the Santa Fe Group. “I want to thank everyone in the room for an unbelievable and great couple of days. I can assure you that Santa Fe takes this thing seriously. We plan to keep moving forward and one of the things that we are willing to really focus on is sustaining the kind of momentum that you get out of a meeting like this. We have been fortunate in the past to get some real leverage out of these wonderful kinds of discussions, and we heard everything you said.”

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