The Hazard Chronicles

A couple of weeks ago I finished up my last patient, went back to my desk, and took off my jacket. I sat there for a while thinking about the last 15 years of my career. I thought of this building, this team, and these patients- of how small we were in the beginning, the excitement of growth, and all the twists and turns along the way. It’s been a wild ride. Then I stood up and walked past all the empty rooms to the back door where I usually leave at the end of the day. I paused for a second, looked back, and then looked out into the town and community surrounding me. I took a deep breath, and stepped over the threshold out of my old office as the door closed behind me.

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A lot has led up to this moment, and the last year was one of the busiest and most transformative times of my life. It is impossible to include all the small details, or the conversations, or the multiple difficult decisions that have taken place along the way- partly because of narrative convenience, and partly because things have evolved so much and so quickly that I don’t know if I even could. Here is a very brief and overly-linear storyline that fills in most of the questions that people might have.

In 2014-2021 I worked at one of the very few offices in town that accepted Medicaid patients- most of that time as the lead doctor in a small satellite office as part of a larger organization. We worked hard, and we were very good at what we did, and people liked us, and we grew. As this happened, I got a real sense that we were an important part of the community, and it was extremely rewarding to see my patients in the grocery stores or at my kids’ school events. This was a regular occurrence, and almost universally they would come up and thank me for how they had been treated. They would tell their stories, share their excitement and frustration over small life events, and then introduce their friends and family. At our office, we were providing something for them that they couldn’t receive in many other places- and a lot of times this went beyond great dentistry. For some, in a very real way, we were giving them dignity.

In the early 2020s our area experienced extreme growth, largely accelerated by the covid pandemic. The Wall Street Journal did a piece about how we were among the fastest growing communities in the nation, and the median income skyrocketed to nearly double what it was before. There was a twelve-month period during this time where an average of twenty new residents per day were moving in from surrounding states! To say that this influx caused some growing pains in our little community would be a huge understatement, and it fundamentally changed the economy- mostly for the better.

But not for everyone. While a lot of industries and business thrived in this new atmosphere, there were still large cohorts of people who were left out of this growth and were increasingly being left behind. To a great extent, the growth was happening because of the hard work of these people, and yet their wages couldn’t keep up with the rapidly rising cost of living. Dentists were hit by this as well, and seeing Medicaid or otherwise marginalized groups became unfeasible for many private practices in order to keep up with the economic and political realities of the area.

As for us- we flourished. Our patient-focused philosophy, new ownership, and the addition of new procedures made it so that we, as a practice, were doing better than ever. But as market forces shifted, like almost every other practice in the area, it became increasingly difficult to sustain our traditional patient base. We expanded our team, and eventually built a new location with more space and better facilities for a growing demographic of patients seeking quality high-end dentistry. My own skillset grew, and I was able to see and do things, clinically, that I never dreamed of being a part of when I was in dental school. It’s been cool. My past patients though- those who were already falling through the cracks, didn’t have anywhere else to go.

These changes were largely responsible for my decision to go back to school and get my master’s degree in public health. Seeing, in real time, how much external factors could affect the health and welfare of individual people and families was both fascinating and a little bit troubling to me, and I wanted to understand it better. Since entering the field last fall, I’ve spent almost a year immersing myself in the intersection of social science, politics, data analysis, and medicine, and I'm more intrigued than ever by how these distinct forces can be intentionally leveraged to impact communities at scale.

I also wanted to continue to provide, as a clinician, for people who didn’t have access to the expansive offerings of private practice in the area. On my days off, I started moonlighting at a public health clinic in Spokane to dip my toes into the world of large, public health administration. Like with the education, I was immediately taken by the multiple moving parts of the operation, as well as by the difficult philosophical decisions that went into its management. Health care, as I saw it, was increasingly being defined more and more by decisions in boardrooms and political committees than those made in the operatory. Working in this world required a specialized skillset, but instead of steady hands and clinical knowledge, the toolbox consisted of analytics, systems thinking, and the ability to communicate across and between groups and cultures.

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Last spring, Heritage Health, the third largest community health center in the state of Idaho, was looking for a new director for their dental program. They were undergoing a massive expansion, bringing dental into a large new facility called The Center For Healthy Living, where it would be integrated with multiple other health services as a hub of public health for all of North Idaho. From there, dental clinics could expand even further into neighboring counties, either with mobile units, or by expanding the offerings of existing brick-and-mortar offices within the organization. In doing this, people who have found themselves without a medical home would increasingly have access to services that are desperately needed.

So yeah- They needed someone to help guide the organization through this next chapter, and despite my relative inexperience with large-scale operations, they asked if I’d be willing to step into that role.

I said yes, and joined their amazing team a couple of months ago. At that time, my world started spinning, and has not stopped since.

Suddenly, I find myself sitting on a statewide political committee for the Idaho State Dental Association. Suddenly, I am enrolled not only at Boston University for my master’s, but at Harvard Medical School as well for executive leadership training. Suddenly I am setting up lunches and coffee meet-ups with other stakeholders in our community, or giving PowerPoint presentations to a room full of executives, or sitting around a table with other physicians, behavioral specialists, and administrators. Suddenly, I’m applying what I learn in class in real time, earning a seat at the table in 'the room where it happens.' It is exciting, but deeply daunting. The technical requirements don't intimidate me, but the responsibility does- the commitment that I have to my patients (who I still treat), to my organization, and mostly to the entire region that has, in a very real way, become my new workplace.

So, back to this last week…I finished up my last patient, went back to my desk, and took off my jacket. I sat there for a while thinking about the last 15 years of my career. It’s been a wild ride. Then I stood up and walked past all the empty rooms to the back door where I usually leave at the end of the day. I paused for a second, looked back, and then looked out into the town and community surrounding me. I took a deep breath, and stepped over the threshold into my new office as the door closed behind me.

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A quick note to my patients at Syringa: While my primary mission is shifting toward expanding public health across North Idaho, I am not disappearing! I will still look forward to seeing patients at Syringa Dental and Implants for the foreseeable future, though my hours might look a little different. I look forward to continuing to care for each of you while also helping build something that is desperately needed for our entire community.

A quick note from Rachel: There are very few times in life when you go through a shift, and everything changes. Since September, life has been a pretty wild ride. Things have changed fast, and it has been incredible watching Logan take on these new challenges with gusto. It must be said that Syringa dental is family. I consider myself a de facto member of this family, and I am not sure I will ever experience that again with future practices (this has been tough for both of us). I love you guys- and we are not going anywhere. I am looking forward to football parties, monthly Bunco nights, fantasy football trash talk, ladies nights, and group dates. Family sticks together, and we will see you soon! 💜