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Dr. Luisa Schuldt (LS): Welcome to the latest edition of Brush Up, brought to you by Oral Health. I am Dr. Luisa Schuldt, your host for today. I am a dual specialist certified in both prosthodontics and periodontics, based out of Font Hill, Ontario. Welcome to our guest today, Dr. James Yacyshyn. Thank you for joining our audience today. James has served as Clinical Director at the University of Alberta as well as staying active in clinical practice, being the owner and practicing at Empire Dental Associates, where he practices as a general dentist. Empire Dental is a group of multiple general dentists and a prosthodontist. Welcome James. Thank you.
Dr. James Yacyshyn (JY): Hi, thanks for having me. As far as background, I have been at the continued education part of the game for a number of years now and then as a practice owner as well, I love being able to apply a lot of the things that I have been able to experience over the years. So I think that varied background is giving me a different perspective certainly. I’m a U of A grad and also a U of T grad so spent some time there as well, kind of dealing with health informatics initiatives, learning from the engineering part as well. Looking forward to the conversation.
LS: So today’s conversation…leading into it we’d like to talk about technology in dentistry and how it can be integrated. What are the benefits of it? And if we’d like to start just right there, I will just let you lead into that.
JY: So benefits of incorporating tech instead of traditional methods. I think you know if we’re looking at just integrating and bringing technology into the office, there’s so many things we want to consider. You’ve got to take a bit of a pause and sit through and say: what is it that the technology is going to facilitate? It’s just another tool, really, or technique or training etc. So when we assess our environment, when we look at what it is that we’re trying to accomplish in any given day, when we look at technology or something new versus our conventional practice, you’re introducing another variable. And we want to understand what the benefits are of creating that change. So new technology – sometimes when you walk through and you’re enamored by something that catches your attention, there’s usually going to be a reason for that. And new technology, right out of the gate, essentially it can inspire us and just allow us to do something that we haven’t been able to do or do something a lot more efficiently with less headache. So when I look at new technology, I sit there and say: is there a constraint variable there? So does a new technology open other doors or opportunities? And what are the opportunity costs? Is it things like that excitement factor where now we can envision taking our practice into a different direction? Or professionally being able to develop new skills? So, you know, I love coming back to some of the current things that I see in practice like intraoral scanners and how it opens up a pathway in discovery for clinicians, depending on where they’re at and what they might want to get into. So, right out of the gate, benefits of incorporating new tech: it will open doors. You can change the way our practice is perceived, it can create new clinical opportunities, new learning opportunities. I’ve watched technology invigorate offices. Similarly, I’ve watched it become very disruptive and become a really expensive paperweight. I think we’ve all kind of experienced that, so you sit there say: what are the variables? Why is it that, on one hand, the benefits that we can foresee or try to realize, why is that not always realized? Why is it that sometimes that you sit there and go: well, it was a great idea at the time and, unfortunately, I spent a little bit of money, but it never really came to be. I mean those are fascinating questions for me, both as a practice owner and as somebody who’s involved with continuing education.
LS: So I think what you mentioned in the beginning, is that what’s really valuable is that this is a tool. So our final outcome of providing wonderful care, in a way that is as easy as possible, as minimally time consuming as possible, is as comfortable to the patient and ourselves as possible. And this is a tool that can help us to do that if it’s done well.
JY: Absolutely.
LS: And that would lead into my next question, which is how can we get this into our practice in a way that is easy and fluid? With minimal onboarding necessary for this technology. What recommendations would you have for this?
JY: First thing, right out of the gate, is just establish a plan. It doesn’t matter what the technology is, but when I look at it, our basic needs analysis is something that we don’t do very well. Sometimes it’s just gut, it’s instinctual, it’s excitement, its availability, it’s a rep showing up with the new something shiny going “hey you gotta have this!” But we don’t always spend enough time thinking about it – just saying, okay as a tool, what is this going to facilitate change in? So, like we said, is it is it going to be some new delivery of some means for the patient that we’re not currently doing? Or is it the efficiency with regards to how we’re currently practicing? For example, let’s go back to the intraoral scanners. What is it that you want to change? Why do you want to change? When you think about some of the challenges that some of the new original scanners had, right out of the gate, it’s that they couldn’t do everything really, really well, so you’d still see conventional impressions and you almost get a duplication in work. And you have to sit there and say: well, is it speed? So we’re bringing this in but it’s going to make certain steps faster for us. But is the quality proposition still there? So, again, it can be too early with certain technology. At the same time, you don’t want to be too late. And you want to sit there and say: well, how and when do you modify your work process as a function of this tool? So, for me, there’s lots of organizational development schools of thought, different assessments you can do, but it doesn’t have to be that complex. I think, if as clinicians, if we just take a little bit of time setting goals – what do we want to change? – create those objectives, set some timelines and then measure those things…Because when things are reactionary, and its purchase, and it’s like “you gotta buy it right now, before year end, and you’re going to get all these discounts,” you kinda sit there are go: well, think in terms of you as a clinician. How are you going to use that tool? And then, more importantly, think about how your team is going to use it as well. So, if you think in terms of the CAD/CAM dentistry that’s happened in the past, and how many times has the evolution of the technology been far in advance to where the teams at? So, for instance, you as a clinician, where do you value your time in that equation? What do you want to be doing? If you’re already really efficient at it, then the second part is: where are your staff in that equation? There were so many dental assistance that were introduced to CAD/CAM where all of a sudden they were becoming a tech. That’s not what they went to school. Their interest may not of lied there. All of a sudden, you’re watching the deliverables just not being what you would thought they would be. It’s okay to be passionate and interested and gung ho, but at the same time, you gotta make sure your team’s on board with it as well. Back when I was spending my time at University of Toronto, one of my research projects looked at the efficiency of integration of technology in the dental office and we used an analytical approach that was similar to looking at the efficiencies of bank branches. And we tried to use comparators and we did this through some of the production and financial measures that came in that were made available on practices that introduced technology, but the account is shared with us. So, again, I look at this in the thesis work and all the rest of it, but do you know, when you boil that thesis down, one of the most impactful measures that came from all of the analysis of different technologies being introduced in office, you know what the number one common thing was?
LS: I would love to hear it.
JY: The amount of time and effort put into training staff. So the more you invested is a function of staff training, and the more you invested in their background with the new technology, the faster the adoption curve was for the technology, the quicker it was brought in without disruption to workflow, the more successful that change initiative was. So it’s kind of interesting, really, when we think about bringing new technology in. If we actually just look at basic needs analysis, as a clinician, why are we doing this? Who’s involved? What are we hoping to accomplish? Set those goals, get those objectives outlined, and then actually hold people accountable to timelines, because when you actually think about these teams that we have, they’re complex. It’s more than just us and the resources that are involved as well. And if you don’t actually reflect on it and pull people into the conversation, it just gets to be a little more muddied, to be a little bit more of a challenge and then all of a sudden you get very expensive paperweight sitting there.
LS: I’ve seen our teams overall struggle so much with adapting to COVID, adapting to new rules and new regulations, and then if you add adapting to new technology on top of that, without the basis that they need, it can add a lot of stress to the work environment. So that integration and trying to get that “wow” moment, when the team member sees how useful it is within a few weeks of integration, can be really valuable. And when, as clinicians, whether it’s the dentist or any one of their team members, six months later or a year after integrating this technology, they’re like “Oh yeah, wow, it can do this. This is made it so much easier.” But when that happens so far down the line, there’s usually been a lot of struggles and things that could have been learned earlier on. The investment in time with the team is very valuable.
JY: I look at it and I start to appreciate some of the experiences that I’ve had as a clinician and going from conventional film, years ago, to digital. And, not just digital, but all of a sudden, 3D. The imaging sides of it, the complexity. It’s like watching the cottage industry evolve into a lot more of a complicated existence, and the cottage industry…it’s just the costs that go with it as well. We have to appreciate the overhead, the challenges that go with these investments and the burden for the entire team, but hands down, people are the single biggest part of it. I think we just have to be more organized than we were in the past. We could bring something in no problem – bang –you’re off and running. Now, if your capital outlay is 1/4 of $1,000,000, you gotta go in with a pretty strategic plan because not only is it that capital outlay, but it’s the fact that you gotta get a return on investment given how fast things become obsolete. How short their life expectancy is. It’s gotten a little bit more challenging with regards to that having good conversations with regards to how are we going to use this, where are we going to use this, what’s the impact. When I look at that conventional film change to digital, one of the ones that I found really fascinating is early practice management software, which is wonderful. But explaining to team members who were well versed in one platform and explaining why we needed to change because now we’ve got CBCT, and how we’re going to bridge that information into the equation as well, and unless they see the bigger picture as well, you’re creating change that’s very stressful for some people. And not all of us handle change as well. Again, it’s focusing on buy-in at all of those levels in order to see that new tech to its fruition, in essence.
LS: You’re mentioning the return on investment and it’s two completely different concepts: this is integrated well, or this is really bumpy along the way. And I think our reps will talk to us about return on investment when they’re selling our technology, but they won’t give us the full scape of “this is worst case scenario” and “this is best case scenario” or “it’s integrated well” and “if it’s integrated poorly.”
JY: Yeah, it’s a highly variable term. As I’m using it, I’m using it in in terms of the financial component and certainly the advantages of bringing it in. But you have to talk in terms of workflow as well and disruption. And there’s a price to be paid on that. But similarly, ROI might be something where you may not get the financial benefit of it, but some of that new technology maybe a differentiator for your practice. You’re viewed as being one of the most up to date, one of the technologically more intensive practices, that may build you a following with regards to patients and clientele that you might not have otherwise. So ROI is just one of those broad terms, in essence. And how are reps going to present it to? Of course, they may be motivated to give you the rosiest picture ever, but at the same time, let’s face it, even the reps will tell you about those situations where something is purchased, and why is it that it’s sitting in that cupboard six months from now. And the really good reps, the industry partners in essence, they’re motivated for your success as well. What they will do is try to work out some of the challenges that you faced and look at additional training opportunities or give advice that way. So I can’t paint them all in one brush but sometimes do I get a rosier picture? Absolutely. Sometimes, do we see pretty negative outcomes when it comes to some new tech? Certainly, that could happen as well. But I think everybody should be motivated to figure out: how do we make this work and when? What are the missing pieces? Obviously, the more experience is that you can translate from other practices, other environments, then there’s that group learning as well.
LS: Then how do we make this work and how do we make this work well can have a huge impact on even staff retention, keeping them happy in the workplace or adding stress to their day-to-day, which would be great to avoid. So, nice, smooth integration is so important. Do you have any practical tips or specific guidelines as to how this integration – you already mentioned good planning, early training on this, making sure the team knows the value of it – are there any other tips you can give us on how to integrate this smoothly?
JY: Again, the most practical and the most common tip is just good communication. It starts with training, starts with people being aware in regard to what you want to do with this. Those are classics with regards to vision. Where are we? Who are we as an office? Why is this important? Our mission. Now you’re driving down to the detail level of how are we going to get there? How are we bringing this in? Who needs to spend time with this? And how much time? Because practice is so busy, and everybody watching and listening kind of knows that. Now you sit there and say: okay, but realistically, if we’re going to make some of these changes, we gotta give ourselves a little bit of a buffer. I’m going to spend some time to get right with it because, otherwise, it’s a recipe for frustration and so many of these other things that can derail a team. So the most practical advice is, again, noting that thesis, is invest in your people and that that time. So 100% that’s the one gold nugget I can share.
LS: James, you were mentioning a few minutes ago, the integration of new technologies and that conventional radiography has progressed into digital radiography, and now 3D technologies such as CBCT. What other valuable technologies have come onto the marketplace and have come to improve our practice over the last two to three years?
JY: I’m really impressed with intraoral scanners. When you look at how that technology’s evolved, continues to evolve, and it’s just amazing. If you consider CBCT, on one hand, in the combined data with the intraoral scan, all the different things you can do with that. So for me, one of the really neat things being in a prostho environment where you work with a number of prosthodontics – yourself, if you consider your background – how valuable that information is. So if I can show a patient from a couple years ago where their teeth are in comparison to today, and have that level of information so readily available where they can see it, I mean that’s an incredibly powerful communication tool. That’s an incredibly powerful diagnostic tool, treatment planning tool and all those types of things. And that’s without getting into all the other things you can do once you have that intraoral scan. For me, that’s really one of those gateway tracts that starts to open up all these other opportunities. One of the ones that I talked to a lot of the new grads about is if you’re heading out into practice, and if you’re in a group where nobody is doing clear aligner therapy – ortho type stuff – go get some training in it, because now it’s pretty easy to take that that information that you gather in here and start to tie it in with some of the different clear aligner therapy that’s there. It’s a great way to differentiate in practice, in essence, and that’s without getting into all the restorative history, prostho history, that you out with this device. So then you start to consider what people are doing with regards to splint therapy, nightguards, bruxism devices. You start to look at the surgical planning, if you want to get implants. I mean, that’s what’s so cool about it is that it’s a really valuable piece of technology that now you can apply, depending on where and how you want to grow your practice, and where you want to take your practice. So for me, intraoral scan is really the thing to watch out for. It’s already been but it’s just continuing to grow and grow as far as our utilization.
LS: Yes, you mentioned earlier about the diagnostic value of it and it was designed to see changes on the dentition. I found it so valuable enough by periodontal practice, it also lets you monitor and see changes in soft tissues, to monitoring in session, for their elastic soft tissues. It’s just a really great communication tool if you want to assess what was achieved through, let’s say, a grafting procedure. You can also see how much thicker and stronger the issues were. So it’s valuable in so many different ways. Even though it was designed for hard issue, this is an extra use that many people are starting to apply it for as well. I think applying it initially for one thing, intraoral scanning, and then finding this world of other things that it can help you do, the earlier you discover this and put it into practice, a higher value you find in that investment and that integration that you’ve gone through.
JY: That’s a really interesting point because you sit there going: how many times have we been offered technology that’s going to revolutionize our practice? It’s going to change everything. You sit there and go: well hang on a second, revelations can often be very negative. Sometimes you want to sit there and say it’s about the evolution of your practice. Now you just kind of slowly grow in different directions as you have readiness, staff, their training, your level of interest, even looking at the disruption with regard to your workflow. So I get really hesitant to things that are going to change everything for me. I like to sit there and say incremental growth, incremental disruption, incremental opportunity. I’m fine with those as long as I understand, I lay out my objectives, my goals and I’m the person who likes to study that stuff. So, really, when it comes to tech adoption, it’s absolutely fascinating to see why does one thing work in one environment versus why it won’t in another. And, again, boiling down to the reasoning.
LS: I think with the intraoral scanners, and some of this technology, it’s just designed to be easy to use and incorporate. So I love that the companies have taken that importance into account, but if it’s something that’s going to be hard for the clinician or the clinician’s team to use, it will be that weight that will be sitting on our counter forever and just not being utilized. And it’s not very different to operate one of these scanners as with a tablet that we use for entertainment. It’s very user friendly and it’s easy for the team to understand as well.
JY: Human factors – there’s a whole area of research behind it. It’s a beautiful area of study. Why is it that one thing is a little more intuitive and easier than another thing? And, trust me, I myself can be one of those guys to challenge something and figure out how to break it, but, at the same time, when it just naturally comes into your processes and it works so nicely, it’s a beautiful thing.
LS: Well this has been a really great conversation, James. Thank you so much for your insights and recommendations. I think it’s really valuable information for everybody who’s listening to us today. Thank you.
JY: Thank you for the time. Look forward to carrying on in any fashion.
LS: Thank you, James.
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