Bill Klaproth (Host): This is an AAOMS On the Go Podcast. I'm Bill Klaproth, and I'm pleased to welcome with me today two OMSs who currently serve on state dental boards. We have Dr. Angie Rake from Minnesota and Dr. Bobby McNeill from Texas. Dr. Rake and Dr. McNeill, welcome to the podcast.

Dr. Bobby McNeill: Thank you so much, Bill. I appreciate the opportunity.

Dr. Angie Rake: Yeah, thank you. And hello, Bobby. And Bill, thank you for covering this important topic.

Host: It definitely is an important topic, and I just want to first clarify that neither of you are here in a professional capacity as members of your state dental boards and any comments made here are your own. So, that being said, you both have an interesting perspective on today's discussion topic, which is substance use disorders and the need for destigmatization.

So first off, Dr. Rake, let's start with you. Can you share your perspective on how substance use disorders and mental health issues impact the dental profession, both from the patient and practitioner viewpoints?

Dr. Angie Rake: Sure. So I just want to start by recognizing that health professionals, including us in dentistry and oral and maxillofacial surgery, like anyone else, are susceptible to substance, psychiatric, and other potentially impairing medical conditions. And as we all know, if this is left untreated, even the best surgeon, best clinician can become impaired placing patients at risk.

And many providers or professionals do not seek help due to stigma, the fear of exposure, the lack of awareness or even, more importantly, concerns over ability to continue to practice. So, I think it's really great and important that the biggest way of addressing the efforts to reduce substance use disorder and the overdose crisis in the United States is to take action with destigmatization. 

Dr. Bobby McNeill: Angie, I love what you said there. From my perspective, I was a chief resident and one of my faculty members was impaired and patient harm happened. And frankly, I think that's probably what pushed me into the regulatory environment and made me so passionate about the well-being of our colleagues.

Host: Yeah. That's interesting that you had firsthand knowledge or experience that, Dr. McNeill. So, Dr. McNeill, let me stay with you for a minute. So, how have your experience as an OMS and a state dental board regulator shaped your understanding then of substance use disorders within the dental community? 

Dr. Bobby McNeill: I'm not sure if Angie would share this, but I think from my perspective, my personal experience, some of the most difficult things I deal with as a state board member is when we have a dentist come before the board and it's a substance use disorder issue and patient care issues, and you just see how their lives just absolutely fell apart. And there were likely many, many points along that journey that the person could have gotten help, but for many reasons that was not successful. And so, I would just see example after example of that and just know that we had to do better as a profession. And we had to do better as regulators, you know, we're fairly retroactive with what we do as regulators instead of trying to be proactive. So, I'm hoping we can make a change.

Dr. Angie Rake: Yeah, I totally agree with that sentiment, exactly. It's really heart-wrenching when you see somebody that has substance use disorder, which I think, you know, we need to be reminded and part of the destigmatization is just be reminded that this is a chronic remediating disease. Addiction is not a personal choice that reflects any lack of willpower and it is not a character flaw, and it's not an optional thing these people can just choose to do and not to do, but it is something that is defined as a disease by the Diagnostic and Statistical Manual, we're on the DSM-5 now. And just keeping that in mind, I think, is important for all of us, whether dealing with colleagues or situations like Bob and I deal with on the State Board or when we're talking to patients.

Host: Yeah, it's good to have that perspective, right? It's good to always remember those things, Dr. Rake. So, thank you for sharing that. Dr. McNeill, you mentioned in your experience you saw where this did cause patient harm. Can you talk a little bit more how substance use disorders affect patient care and potentially what safeguards can be implemented to ensure patient safety?

Dr. Bobby McNeill: Boy, I tell you, we've seen examples throughout our own specialty with anesthesia complications thatperipheral or central to those issues was substance use disorder and other mental health issues. As far as figuring out how do we address the situation? What's the solution? I think there's so many different components. And as regulators, Angie and I can sit here and give one opinion and we can only do so much, that's where AAOMS coming on board, state dental societies and practitioners, and taking care of colleagues and friends. We got in this profession of dentistry and oral and maxillofacial surgery. We're here to care for others, and we need to take care of ourselves if we're going to help others, whether that's our patients or staff or even our families. So, we just got to get ourselves in a good position. And a big part of that is destigmatizing people taking care of themselves, people getting help when they need to get help.

Host: Dr. McNeill, do you think that's one of the biggest challenges that you've encountered in addressing substance use disorders among dental professionals, is the stigmatization of this?

Dr. Bobby McNeill: Oh, for sure. For sure. And in Texas, one of the things we've done recently is sort of change the questions that we ask on licensing applications, including renewal applications. We used to ask these have-you-ever questions and we have about 70,000 people that we give licenses to in Texas between hygienists and dentists and dental assistants. And have-you-ever questions – boy oh boy and it was a very broad question – it almost seemed like, “Have you ever felt sad? Have you ever been anxious? Have you ever had a substance use disorder?” And most people, you know, we had like maybe 10 people would answer the question to the affirmative out of 70,000. So, people weren't answering this stigmatizing question. But more than that, the research was showing, and this is some research from the Federation of State Medical Boards, that just by asking that question prevents people from getting help. And after we changed things in Texas, one of the benefits was we were able to talk about it and share the changes and work with our Texas Dental Association to help to spread the message. And I had a very good friend call me, and he's a dentist, and he said, "Is this legitimate, these changes you're talking about?" I said, "Yeah, I was heavily involved in it. It's legitimate." And he goes, "Well, I got to tell you, I wanted to take my life and I had a substance use disorder and I was in a bad spot. And I'm changing, I'm getting help based on you guys changing and doing what you did." So, there's things we can do, and need to do. 

Host: Wow, that is quite a story. 

Dr. Bobby McNeill: It was powerful, powerful. You never know what your message can do to help somebody else.

Host: So, that certainly makes you feel you're on the right track then for destigmatizing substance use disorders?

Dr. Bobby McNeill: I would say we're on the right track, but then, and Angie may have this as well, since we're in this space, you also hear the unsuccessful outcomes. And it makes you question, "Are we doing enough?" And as I sort of alluded to at the onset, I think there's so many factors that contribute to the mental health space, including substance use disorder, because that's certainly one element of mental health. There's so many factors that contribute to it, and it makes sense that there's going to be so many different things that are going to come into play as far as being part of the solution.

Host: Angie, any thoughts on that?

Dr. Angie Rake: Yes, totally. I think Minnesota, our changes in our questions when we ask for license renewal or initial applications have changed just like it has in Texas. And we certainly hope that this continues a wave across the entire United States. And similar story to Bobby, but I think just this discussion and Bobby's commentary really highlights the three common misconceptions with either addiction and recovery or mental health issues is that we need to keep in mind that addiction and the recovery or mental health issues and dealing with that is not the same for everybody. Everybody's journey looks different and how it presents looks different. And as I mentioned earlier, just keeping in mind that both of these things, it's not a character flaw. It's not a personal choice and is not optional for these people. And it is both of these, both mental health, psychiatric issues and substance use issues are remediating issues, and it's an ongoing, lifelong disease that people have to deal with, and this needs to be kept in mind, especially with the compassion that we need to be able to show to our colleagues or patients afflicted with these entities.

Host: Yeah. And I know that some state boards have taken action to address substance use disorders among practitioners, such as coming up with physician help networks. Can you talk about that and how effective these measures have been, Dr. Rake?

Dr. Angie Rake: Yeah. So, I can speak to what happens in Minnesota. We have – our Board of Dentistry – works with the Health Professional Services Program. And this program helps monitor and assist licensees, and this is any health care licensee in the state with physical, psychological, substance use disorders so they can still practice as long as they are accountable and compliant with the program. So, we really rely on this health professional services program to guide us, the board, into telling us what is the safest and best for the clinician that they're treating and also the patients. So, we really are deterring away from going down what used to be the discipline pathway with licensed professionals. And, you know, our goal is to keep access to care and people safely providing care. So, that's what's being done in this state. We kind of turn it over to the healthcare professionals.

Host: Dr. McNeill, how about you in Texas? 

Dr. Bobby McNeill: We have a similar program in Texas and just hearing Angie talk, you know, mental health is certainly on a continuum. And I think we're always kind of looking for opportunities to have a pivot where people can get help and get better before it gets to the state board level. There’s just…that's where it gets back to taking care of yourself and well-being.

Host: Dr. McNeill, for an OMS that is struggling with this, is coming forward and admitting they have a problem one of the biggest challenges, is that one of the things that really are obstructing people coming forward and getting help is they just don't want to admit it? They think, "Hey, I can do this. I can get through this. I can fix this on my own." Is that part of the problem, and is just getting people to first admit that they need help?

Dr. Bobby McNeill: I think that likely is part of the problem. I'm sure there's many others. And a lot of us surgeons we’re type A personalities and we're fixers. We can fix all sorts of things until we can't. I was glad to see the AAOMS Cares Program develop when you've lost hope and just see no way, it's a program that can offer some help or support. Or if you're concerned you're heading in a direction where you don't want to go, I know our former AAOMS President, Paul Schwartz, was pretty helpful at getting that program set up.

Host: Yeah, that's really important. So, let's talk about the support systems that are available for dental professionals who are struggling. You mentioned AAOMS Cares, another one is PHN. Can you talk a little bit more about these resources for our members that may be struggling? 

Dr. Bobby McNeill: We had the AAOMS Cares Program director speak at the national and state AAOMS Leadership Conference a couple months ago. And kudos to AAOMS to introducing the concept, getting it going, talking about well-being, and they have information on their website that's pretty handy, and you can call the phone. And the director of the program is in recovery himself. He has a powerful story and he understands where things are at. It's just moving to hear stories of people in recovery. And you got this. You can do it, but sometimes you got to take the first step. Sometimes it's reaching out to your friends and colleagues for their support as well. But there's many things out there, but you've got to reach out and get the help.

Host: Yeah, absolutely. So, Dr. Rake, let me ask you then, reaching out, getting help. There are a lot of people that are ready to support someone that is struggling. Can you speak to the importance of collaboration between different stakeholders, such as dental boards, professional associations, and mental health experts in addressing substance use disorders and mental health issues?

Dr. Angie Rake: Yeah. So, my involvement is more currently from the regulatory perspective. And I think it has been just a critical thing and trying to get the word out that if you seek help, you're not going to lose your license or ability to practice and make money and provide for your family. So I think that is of utmost importance and just the collaboration between the health professional services program that we have in Minnesota, the program that Bobby described in Texas, the AAOMS Cares. And I think Bobby is very much involved with ADA initiatives that I'll let him speak on as well.

So, just with the marked increase that has really come about I think in just the past several years, hopefully, will show people with these types of issues that there is help out there, supportive help that is not going to be punitive, where a lot of people that didn't seek care or receive treatment seek it. It is estimated by the CDC that only 10 percent of Americans that meet the criteria for having substance use disorder actually seek and receive treatment. So we would assume that this would transcend to healthcare professionals as well.

Dr. Bobby McNeill: Angie, I love your comments there. And I think collaboration is critical. And for people that are listening to this that are in the AAOMS leadership pipeline, kudos again to you. I have the opportunity, I'm part of the American Dental Association's Dental Team Wellness Advisory Council, and we had an ADA Health and well-being Summit, the very first one, and AAOMS was the only specialty that showed up. Different state dental associations were there, the Federation of State Medical Boards, the American Medical Association. And so, AAOMS is playing a critical role. We want to take care of the members, we want to take care of our colleagues, we want to take care of patients. And if you need help, we really, really need you to get that help.

Host: For someone listening to this podcast that is potentially struggling, what would the first step be to getting help? Where should they turn to first? Dr. McNeill, let me direct that to you. 

Dr. Bobby McNeill: It's hard to give a blanket answer just because there is a continuum there. There's so many things – you can talk to your physician. That's what my friend who I said called me up. That was his first reach out, was to talk to his physician that got him to a therapist and on some medications.

There's so many different options out there, as we talked about the AAOMS Cares program. You just need to make the call, you know, the president-elect of the American Dental Association, Dr. Brett Kessler, has been in recovery for about 25 years and is quite passionate about talking about his story. And he, like many, many others was just in a really bad place and thought there was no hope and no one to turn to. And there's always people to turn to and just make the call, get online. There's so many things out there that can help. 

Host: Good points for sure. Dr. Rake, anything to add to that?

Dr. Angie Rake: No, I agree. It's like anything else. The first step and usually, once someone takes a first step, there's so many avenues and thankfully now so many supportive avenues that people can seek help through.

Host: Yeah, take that first step. That's so important. Let me both ask you this question. Let me start with you, Dr. Rake. What are your hopes for the future in terms of how the dental profession addresses substance use disorders and supports those that are affected? 

Dr. Angie Rake: Yeah. I talk about first steps. I think just really over the past – definitely within the last five years – that we have gone from taking baby steps to running a marathon in terms of addressing misconceptions, the stigma, learning how to ask appropriate questions and use appropriate words when talking to patients. We're on a path that I think is great, and I hope it just really continues. You know, we're starting to talk about this topic at our national meetings and locally. And it's really been just a pleasant eye-opener for me to see this transformation from these things being taboo to "We need to talk about it" and really addressing it for what it is as disease processes.

Dr. Bobby McNeill: Angie, I love your analogy that you gave there and that sort of sums it up. We've gone from no one talking about it to now lots of people are talking about it. Part of the ADA, they have this well-being index that they are utilizing through the Mayo Clinic and it's specific to dentists. And the latest data as of today that I found out in our meeting, 56 percent of dentists are distressed or struggling. And when you have those sorts of numbers, which are consistent with others within healthcare certainly, you need to take care of yourself.

If you don't have a substance use disorder, it makes sense to take care of yourself so you don't get a substance use disorder. And if you're in that spot where drugs and alcohol, if you need help, as we've talked about this whole time, you got it. You just got to make the call, reach out. As Angie said, you know, this is a disease process and we want you to be in the best shape as you can be so you can take care of yourself, take care of others. That's what we do as professionals and as colleagues.

Host: Yeah, very, very well said. Well, I want to thank you both for being on the podcast today. Before we wrap up, one last question as we talk about substance use disorders and the need for destigmatization. Dr. Rake, anything else you want to add? 

Dr. Angie Rake: No. I am just so grateful to AAOMS for continuing to cover this topic and really be on the forefront and addressing the issue.

Host: Absolutely. And how about you, Dr. McNeill? Final thoughts?

Dr. Bobby McNeill: I love what Angie said. AAOMS is taking the lead here. It's a leadership opportunity that we need to embrace. We need to help our colleagues. We need to take care of ourselves. Be well, friends.

Host: And again, very well said. Well, Dr. Rake and Dr. McNeill, thank you so much for your time today. I appreciate it.

Dr. Bobby McNeill: Thank you. Appreciate it, Bill.

Dr. Angie Rake: Thank you.

Host: You bet. And once again, that's Dr. Angie Rake and Dr. Bobby McNeill. To learn more about AAOMS Cares, which we were just talking about, please visit AAOMS.org/AAOMScares. So please, if you're struggling, you need help, please go there and learn more about that program. And if you enjoyed this podcast, please share it on your social media and make sure you subscribe so you don't miss an episode. Thanks for listening.