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A conversation with the president-elect

Dr. Charles Norman seeks 'seamless transition between the levels of the tripartite' for the ADA


2013-14 leader: Dr. Norman will be installed as the 150th ADA president Nov. 5 in New Orleans.
Whether it's student debt, dental reimbursement, access to care, government regulation or building membership, the incoming president of the American Dental Association always faces a full plate of issues.

Dr. Charles H. Norman III, who will be installed as the 150th president of the American Dental Association Nov. 5 before the House of Delegates in New Orleans, is well versed in the issues facing the profession. The Greensboro, N.C., general practitioner has worked his way through every level of volunteer leadership in organized dentistry, believing that being involved was and is the way to make a difference.

"Early on in my career, I realized that to be successful, you have to invest in more than just going to the office and working from 8 to 5," he says in recalling what motivated him to reach out beyond his practice. "I felt there was much more to a career in dentistry than the traditional clinical practice. Whether you might be interested in teaching, volunteering in your community or taking a leadership role in organized dentistry, you must avail yourself of the opportunities and resources that will help you succeed. For me, organized dentistry provided the avenue to pursue my interest in giving back to my profession.

His life lessons started in Cary, N.C., when it was a small town of about 1,200 people. Located between Raleigh and the Research Triangle, it now numbers 135,000, but Dr. Norman recalls the small town days of his youth.

"There were only two dentists. They were leaders in our community and well respected.

"My dentist, Dr. Hubert Hatcher, encouraged me to consider a career in dentistry due to my interest in science. I was intrigued by the clinical skills required, as well as the opportunity to help people. When I was in high school, people would ask me what I wanted to do in life, and I said, be a dentist."

Dr. Norman attended the University of North Carolina, Chapel Hill, where he enrolled in a predental program that fast-tracked into dental school. During his senior year of school, a part-time instructor, Dr. James Osborne, asked Dr. Norman to join him in starting a practice in Greensboro, N.C. They began their dental practice together in 1977, and by 1989 they had outgrown their initial office and decided to build a new facility. Due to the logistics of managing their large staff, they designed the space for two separate offices with a communicating door so they could maintain their close working relationship.

Early on in the life of the practice, they found the local dentists welcoming and often received referrals. More importantly, said  Dr. Norman, "we were treated like colleagues and our neighboring dentists served as mentors and offered support and advice on running a private practice. All the local dentists belonged to the local society and we were encouraged to become involved as well. The help we received didn't surprise me because I had seen it in my own community growing up, where the only two dentists in town had offices right next to each other and were on call for each other." That kind of collegiality was the strength of organized dentistry then and it continues to be a strength today.

His first experience in dental leadership was chairing his local society regional educational seminar. He had to secure meeting space and  speakers as well as take care of other planning details.

From there, he assumed more and more responsibility at different levels in the local and state dental organizations.

"The profession has been great to me and my family. I was so proud when my son, [Matt] chose dentistry as his career, and I am fortunate that we can practice together."

The other aspect of organized dentistry that attracted Dr. Norman was the fact it was the easiest avenue for accessing continuing education. University CE was available, but it meant travel and time out of the office. In your own community, the local dental society was able to fill that void by hosting CE in the evenings and on weekends. "I really think it doesn't matter whether it was 1977 or today in 2013, our profession is about lifelong learning," he said, "because knowledge changes so quickly. Dental school is just the first step in your professional education. It's a process that will continue until the day you retire. Fortunately for me, the dental society could fill that niche at the time."


The Normans: Dr. Norman poses with his wife, Sharon. The couple have two married children and one granddaughter.
Dr. Norman is past ADA 16th District trustee (representing North Carolina, South Carolina and Virginia) and past president of the North Carolina Dental Society, and served on the boards of the ADA Foundation and the North Carolina Dental Health Fund. He is a past chair of the ADA Council on Dental Practice, served as an ADA delegate from 1994-2008, and was on the boards of directors of the Dental Foundation of North Carolina, the UNC School of Dentistry and the North Carolina Services for Dentistry. He is a member of the Academy of General Dentistry and he is also a fellow of the International College of Dentists, the Pierre Fauchard Academy and the American College of Dentists. He is a past member of the N.C. State Healthcare Commission and a past volunteer coordinator for Missions of Mercy free dental clinics in the state.

Besides his son Matt (wife, Chandler), who is in practice with him, he and his wife, Sharon, have a daughter, Emily, who is married (Brian Richards) and the mother of the Normans' only grandchild, Claire.

With his son in the practice, devoting himself to ADA business has been an easy transition for the president-elect. Before his immersion at the leadership levels of the ADA, Dr. Norman recalls fondly that he had time for golf, tennis and other sports. He is also a season ticket holder for Carolina football and basketball, but admits this passion, too, is pretty much on hold while he serves at the ADA national level. He was a part-time clinical instructor in the department of fixed prosthodontics at Chapel Hill before he became an ADA trustee. "I enjoyed the experience of working with the students and would love to do so again when I'm finished with my Association duties."

During the past 20 years, Dr. Norman has also volunteered his talents at a free dental clinic in Greensboro, as well as being involved in the state's many Missions of Mercy events. He serves as the dental volunteer coordinator for the annual clinic held in Greensboro that serves about 1,000 patients each year.

Another personal interest is mentoring potential dental students. "I would regularly have students spend time in our office just to observe and ask questions about the application process. It is rewarding to know that in some small way I have been able to encourage young people to pursue a career in dentistry just as Dr. Hatcher encouraged me many years ago. In fact, I am proud to call six former patients colleagues."

This is the first of two parts of an interview with Dr. Norman by Judy Jakush, ADA News editor, about his thoughts on the profession and the year to come.

ADA News: In talking about your early career, the camaraderie of interacting with other dentists is something you highlight. You've mentioned that starting a practice with another dentist instead of going solo was somewhat unusual in 1977. How does your experience compare to what dentists graduating today are facing?

Dr. Norman: The concept of working in an office by myself never really appealed to me. I think my partner and I were a little ahead of our time by starting a practice together as general practitioners. Based on conversations with my son, I think students now are trained together collaboratively. They anticipate working in that way, so it is more common now to see partnerships or group practices.

Having an opportunity to practice with another dentist who could act as a sounding board for treatment plans and clinical questions was a real advantage. Our relationship helped me grow as a clinician and allowed me to pursue other interests since one of us was always available for call. Having two dentists from different educational backgrounds and different perspectives improved our ability to deliver the best, most appropriate care to our family of patients.

ADA News: Did you have any trouble securing a loan when you graduated?

Dr. Norman: At the time, there was a bank in our community that was courting professional business, and I didn't have to borrow a huge sum to start a practice compared to today's standards. Jim and I were able to reduce the cost of operating the practice by sharing space, equipment and staff. I was also fortunate that I didn't have a large educational debt from dental school. Having the two of us co-sign the note helped because interest rates were ridiculously high, anywhere from 15 percent to 20 percent. A professional, like a dentist, was considered a low risk and most institutions were willing to write unsecured loans. We obviously have a much different environment today. Graduating students have a much higher debt proportional to their net incomes and they are entering practice during an extended sluggish economy.

ADA News: While your involvement at the local and state levels eventually led you to become 16th District trustee, what made you seek the office of president-elect last year?

Dr. Norman: It's an interesting transition. I didn't go on the Board thinking I'd run for the office; I thought I'd do my job as a trustee and that would be it. As a more senior trustee, you are asked to take on greater responsibilities and you gain expertise in a variety of disciplines. At that point, you have to make a decision whether you have something else to offer and whether you have the potential to lead the Association successfully. Ultimately, I felt I could help facilitate the work of the Board and be able to articulate the policies of the Association.

ADA News: What has the ADA accomplished in your years on the Board and as president-elect? What are the priorities now?

Dr. Norman: As a member of the budget and finance and strategic planning committees of the Board, I became engrossed in improving our financial position and our budgeting process. Over the last four years, we made significant improvements in the financial health of the Association that allows us to concentrate on the things that are most important to our organization, providing goods and services to our members. During a period of transition, we lost focus on the value of membership, and now we are at a place where we can focus on members, their needs and those things that really bring us together as an Association and deliver real member value. All of the volunteers and staff are asked to evaluate all of our programs based on whether they add to member value. If we are successful, our members can be proud to say they are members of the American Dental Association.

Going forward, we have identified other important challenges such as trying to improve tripartite alignment and branding for the Association. We must create an environment where any member, no matter what state or component society they belong to, recognizes that they belong to one organization, the ADA. There should be a seamless transition between the levels of the tripartite so that we can effectively and efficiently deliver goods and services as well as an opportunity to get involved. We have a long way to go on alignment and branding.

ADA News: What will the alignment accomplish in regard to member value?

Dr. Norman: If we can achieve proper alignment and branding, we have a chance to reduce redundancy and duplication of effort across the tripartite, at the same time committing to best-in-class service. To achieve this goal, we need to initiate dialogue with each level of the tripartite. The most fruitful discussion must include not only the dental leadership but also the executive directors and key staff at all three levels of the tripartite. We need to ask ourselves, what do we do well at each level of the tripartite that returns value to our members? Let's take advantage of things we do well, and let's not waste our resources by duplicating efforts—let's provide the services and programs that help the member.

I think it is very difficult sometimes to sit at 211 East Chicago and think we know what all of our members need from the ADA. We can't possibly do that. But the component and state levels of the tripartite should have a very accurate assessment of the critical issues affecting our members and the resources that are most valued. We must find a way to use our organizational structure to our advantage.

As an example, I think components have a better handle on what programs are most effective, and that is the premise behind the Membership Program for Growth. States apply for grants from the ADA to customize recruitment efforts to focus on the segment of nonmembers with the most potential for gains.

In North Carolina, they started an ambassador program that relies on volunteers willing to make a one-to-one contact with nonrenews and new graduates inviting them to become part of the NCDS. An important step is to ask nonmembers what they want from an association, or even simply, "Do you want to join?" You won't know until you ask. I think that is why the component level is so important because they have those relationships.

Another challenge that affects membership relates to the application process. Typically dentists join the Association at the component or constituent level, but the requirements vary from area to area. We should develop a uniform system that reduces barriers to joining, potentially electronically. We need to talk about how we could coordinate the membership process and make it simple.

ADA News: Speaking of membership, the ADA keeps growing in numbers, but recent years have shown a decline in total active, licensed membership market share. What is the ADA doing to increase that market share? If market share continues to erode, then what happens?

Dr. Norman: We certainly won't be able to provide the resources that we believe are so important for member support. We are heavily dues dependent at about 50 percent of operating budget, and that is an unsustainable financial model.

That same situation is true for components and constituents as well, many of which are more heavily dues dependent than the ADA.

In terms of advocacy, I think we are a lot more effective when representing a vast majority of members in our profession. In addition, a robust membership market share is essential for diversity of thought and opinion, which is important for policy development going forward. The demographics of the dental school population have changed, and the face of our profession is transforming very quickly. We must reflect diversity in our membership. The Council on Membership will present a comprehensive plan for membership growth with appropriate metrics to evaluate the effectiveness of our initiatives at the ADA.

ADA News: The ADA's Action for Dental Health Campaign features initiatives to improve the oral health of all Americans. The campaign has three key parts: provide care now to people suffering from untreated dental disease, strengthen the public health safety net and deliver education and prevention in communities. The initiatives require collaborations with other health professions, government agencies, community leaders, legislators and the public. What is the rationale for this effort?

Dr. Norman: It is clear that the barriers to access vary from state to state and sometimes within states. Any real solutions will require a variety of initiatives that can be customized to deliver specific results. With the Action for Dental Health campaign, we have developed a suite of initiatives that states can embrace to address their unique problems within their individual constituencies.

ADH was one of the initiatives that we introduced at the President-Elect's Conference this year, followed by three phone-call webinars dedicated to sharing the successes in individual states. Since its formal introduction at the Washington Leadership Conference, this campaign is gaining momentum at the state level. The feedback has been excellent and it appears that states are participating according to their local needs. I think this is the first time we have developed an organized strategy that can be utilized in any jurisdiction for addressing some of the major issues surrounding access to good oral health.