Inside a DSO: What it was like for this dentist during the COVID-19 limitations

Ashley Keen-Ramirez, DDS, practices dentistry in Ruskin, FL, about 30 minutes south of Tampa. She started with Aspen Dental as an associate in 2013 after graduating from Louisiana State University's dental school and now has a team of 11 (including herself) in her practice.

Ashley Keen-Ramirez, DDS.

I wanted to ask her what it has been like working for a dental service organization (DSO) over the past few weeks considering the limitations that dentists around the country have faced. Of course, each practice and state are different, but I wanted to talk about the DSO mindset during and after the changes that have occurred in our industry because of COVID-19.

Q: What were things like for you and your practice when dentistry was first impacted by the pandemic?

A: We ran the gamut of emotions. At first, it was just kind of shocking trying to figure out what we were going to be doing. Everything changed pretty much daily. We were getting different requirements from the Florida Board of Dentistry and the governor and the state, so we started with emergency care only. We then realized that the demand wasn't there even for us to keep the doors open, so we actually closed for a few weeks. We were taking calls remotely, and we started doing some virtual care, including teledentistry.

As the Paycheck Protection Program (PPP) loans came through, we were able to open our doors and provide direct care to our patients again.

Q: Working with a DSO (Aspen Dental), what kind of communication were you getting from the national perspective during this time?

A: At first, with everything happening so quickly, we were having calls twice a week with all of the owners throughout the company, as well as our support system from our headquarters in Syracuse and Chicago. The focus was on what to do with our practices, what should our staffing model look like, can we afford to keep the doors open, and topics like that. As things started to settle down, we still had twice-a-week calls, but now we were talking about where do we head from here, what's next, and what are our next steps.

Once the loans were finalized, we were able to drop the calls down to once a week, because we were starting to provide patient care again. We began focusing on what can we do to keep our teams, our patients, and our ourselves safe, and our community safe at the same time.

Right now, we're still doing a once-a-week phone call. We're discussing personal protective equipment (PPE) levels, what does our demand look like, what should our scheduling guidelines and our staffing models look like, and focusing on the future, which is also really promising. We're discussing what we're going to do to help get patients back in the door.

I don't think virtual care is going away and neither does most of our team, so we're also focusing on virtual care and how we can implement that into our daily practices while we're providing direct care as well.

Q: You mentioned PPE. What has it been like for you to work on that through Aspen? Did they do most of the work, or did you have to do a lot of research and looking around for the right PPE?

A: Aspen did the majority, if not all, of the work. They were on the front lines figuring out what we needed, what were the mandates from the U.S. Centers for Disease Control and Prevention (CDC) and Occupational Safety and Health Administration (OSHA), and how do we get that PPE looking outside of our normal supply chains. We have a great relationship, but in times like this, I've been so grateful for the support that they provided. It has been invaluable. Having someone there for you, but also finding the things that we need to keep everybody safe and be able to provide the care that our patients need, has been great.

Q: How has the support system been with other Aspen dentists during this time?

A: Amazing. You know, I've always said that I've mentored doctors and I have a lot of mentors within the company, and if someone is having a problem, the chances are that someone else has had this exact same problem. Having that support system of people to just talk to and vent and bounce ideas off of is so important.

Just to validate you as a human and have someone hear you is also important right now. Mental health is a struggle right now for a lot of people, not just in dentistry but all over the world. We're going through things that we've never gone through before, and having support is critical.

Q: What's next for you and your practice?

A: We're trying to figure out what the new normal is going to be like, getting used to working wearing all this different PPE, and making sure that we can continue to get it and provide care for our patients safely. We've staggered appointments, so that we're not overbooked at any time and the contact patients have with others is minimal. They also see us wearing all of this new PPE and constantly wiping things down. Most people are very thankful. They can see what we are doing to keep them safe, and they can appreciate that. They feel safe coming into the office, and I'm very thankful for that.

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