At the past president’s breakfast held in Orlando this past April, then president, Dr. Louis E. Rossman, and the Board shared some good news about ending our contractual relationship with Edelman, the Chicago advertising firm that the AAE hired in 2005 to run our Public Awareness Campaign. As some of you may recall, I wrote an editorial in February of 2009 questioning the metrics of this campaign and its effectiveness in raising public awareness in regards to our specialty (Please go to the website to see this editorial.…www.njendo.org/). Now even though we are no longer committed to a professional public relations firm at the moment, we are still paying an additional $125 to Chicago for a future public awareness campaign (the RFP ((request for proposal)) is due sometime in 2010). The first and foremost question I have for our present leadership is ….How does the AAE justify this supplemental charge when they raised our dues last year and continually raise annual session fees during a time of significant economic hardship to all endodontists? The recovery may well be a few years in the making. Secondly, what type of program does the Public and Professional Affairs Committee (PPAC) and the AAE Board of Directors plan to implement that would produce the impact and traction necessary to be successful in light of the past 4 years? Edelman, in my opinion, failed to show any metrics that could justify giving them over $2,000,000 dollars of your hard earned money? Most of you don’t realize that the American Association of Oral and Maxillofacial Surgeons and the American Association of Orthodontists separately funded over $10,000,000 collectively in public relations campaigns of their own. What lessons should we have learned from them? Perhaps our Executive Director, Mr. James M. Drinan, could enlighten us. He worked for the AAOMS and the AAO before he came to the AAE in 2001.

The $125 we are required to give the AAE as a supplement to this year’s dues begs the question….should not the collection of this assessment involve accountability and transparency too? Do we have the right to know if this mandatory assessment is dedicated to a viable and carefully organized public awareness campaign or are these monies quietly earmarked as “TARP” funds for shortfalls in the AAE’s 2008 & 2009 budget? Do we really have a budget surplus or the illusion of one created with an accountant’s version of smoking mirrors. Why won’t or can’t the AAE’s Board of Directors and our staff give the membership a full and un-sanitized account of these monies? One only has to take a look at the current meltdown of the ADA and almost every one of its divisions that is being caused by the failure in transparency not only to the members at large but to those responsible for the governance of the organization. The ADA’s audit committee has now hired its own independent auditor to act as a checks and balance for the membership. Their foundation is currently under audit and it is well known what happened to ADABEI and the millions of dollars spent and lost by the Association due to the failure of systems and the lack of transparency.

It is now January 2010 and 6 months have passed since the collection of this mandatory supplement. On the AAE’s website (AAE.org) in the Members Section the yearly Annual Reports are provided going back to 1995-1996. Look into the 2008-2009 Annual Report and go to page 10. It gives a less than comprehensive budget report showing cursory revenue and expenditure lists. The fiscal year (2008/2009) shows a surplus of $303,626. As of June 30, 2009 the Membership Demographics census shows there are 4,165 active members (page 9). If my calculations are correct those members paid $520,625 to the AAE for a dormant program.

If you look at the line item designated PA Campaign (Public Awareness Campaign) in the chart below you will see the column marked YTD (Year to Date) Actual (9/30/2009) with $38,270 in expenses in contrast to the column marked YTD in Prior Year with expenses of $40,425. That explains the expenses based on the quarter ending 9/30/2009 and 9/30/2008. Now don’t forget this is an Annual Report. Yet the AAE Board of Directors, the executive committee and our executive director for reasons known only to them haven’t given you any information about the other three quarters in 2008 or 2009. Something puzzles me with their financial calculations. Conservatively, they have probably taken in close to a $1,000,000 over the last two years (2008 & 2009). Yet according to their own annual report they spent about $800,000 for the campaign in the last two years. That leaves the AAE with an estimated $200,000 surplus collectively for the past two years. Again, please remember, the Public Awareness Campaign ended in April of 2009. Admittedly, this is an estimate at best but since the AAE does not provide detailed financial reports to its members I have no way of providing you with comprehensive line item revenue and expense spread sheet for the PA Campaign assessment.

I believe the operative question we should ask the AAE’s Executive Director and our Board of Directors is…..”Why haven’t you provided us with a comprehensive line item spread sheet for the PA Campaign? What was done with the other approximately $200,000 collected in the past 2 years? Isn’t it time the membership had a full accounting of this project with Edelman from beginning to end?” Should the BOD’s fiduciary responsibility to its members be veiled in unfathomable accounting jargon like a credit card disclosure statement or can we finally have a clear and unambiguous explanation of the AAE’s annual budget? Before anyone jumps to any conclusions on my queries please unequivocally understand I am not accusing anyone of financial malfeasance or impropriety.

However, I respectfully ask, and so should you, for more accountability and transparency. How did the Board of Directors and our executive director spend this extra revenue over the last two years and what are their future plans for the campaign monies generated this fiscal year? Were these monies placed in our General Operating Expenses/Revenues to bolster our bottom line or are they clearly earmarked as dedicated funds to be spent only by the PPAC for the Public Awareness Campaign. I believe these are legitimate questions that deserve to be answered by those who have the “real” information to assuage the concerns voiced by many.

Is this continuing mandatory dues assessment providing a meaningful “bang for the buck” for our membership or is this a convenient windfall used to shore up depleted financial resources? I don’t know what the answers are to the questions I have posed. At this point the only thing I know is the AAE is short on disclosure and accountability. If the AAE were not a 501c 3/Non-Profit organization and had to submit to more stringent government disclosure requirements they would never be allowed give a public financial statement that was so scantily clad. However, should the AAE leadership and the executive director wish to respond to this editorial and give us their side of the ledger, so to speak, I will be happy to publish their response on our website. As members of the AAE we have the right to a comprehensive and full financial disclosure. It is time for the leadership and staff of our organization to give us a detailed accounting of the financial position of the AAE. Looking at the present format of our annual financial report is like reading the Monarch or Cliff Notes” to Chaucer’s Canterbury Tales. Transparency is a much abused term but in this instance I believe it to be an appropriate and accurate expression to employ. The top of the financial position report suggests that if you have any questions about the financial position of the AAE you should call our Treasurer, Dr. Robert S. Roda, the AAE Budget & Finance Committee (who are its members?), the Executive Director James M. Drinan or the Chief Financial Officer Jerry McDonald at headquarters for further explanation. That offer doesn’t really do it for me. How about you? Has the leadership ever thought that anything less than full financial disclosure to our membership just might engender some legitimate distrust in the way our organization runs our business? Perhaps it is one of the markers that have precipitated the fractionalization of our membership. This concern has been voiced by me and many of my colleagues across the country including past presidents and current members of our Board. It’s time for the AAE to acknowledge meaningful and constructive dissent and not treat everyone with a dichotomous opinion on an issue as a threat to the leadership and staff of the AAE. The Board of Directors should be reminded occasionally that the privilege and honor of leading this organization also carries the responsibility of transparency and accountability. The JOE should be a conduit for members to express themselves and voice their opinions. Scientific exploration and political dissent or agreement can and should coexist in our journal.

“It does not require a majority to prevail, but rather an irate, tireless minority keen to set brush fires in people’s minds.” Samuel Adams

“We have met the enemy, and he is us”

____ Walt Kelly

“It is a well-known phenomenon that we do not notice anything happening in our surroundings while being absorbed in the inspection of something; focusing our attention on a certain object may happen to such an extent that we cannot perceive other objects placed in the peripheral parts of our visual field, although the light rays they emit arrive completely at the visual sphere of the cerebral cortex”

Rezsö Bálint 1907 (translated in Husain and Stein 1988, page 91)

This quote was taken from an article from Perception (1999) authored by Daniel J. Simons and Christopher F. Chabris. The article’s title is “Gorillas in our midst: sustained inattententional blindness for dynamic events”. Why I am quoting from a journal dealing with psychology? That’s a good question and even if you didn’t ask I’m going to tell you why because that’s what editors do. With the ascendency of titanium implants into the dental armamentaria over a decade ago endodontists have felt threatened and marginalized. We have been totally focused and disquietingly absorbed by the perceived menace of implantology to our specialty. Just as Sauron, the Dark Lord of Mordor (from The Lord Of The Rings), with his piercing eye looking elsewhere failed to see the Hobbits come to destroy the “One ring that rules them all”, our specialty fails to acknowledge the threats to us from within.

The AAE’s underfunded public relations effort has failed to produce the palpable results we had hoped it would. The American Association of Orthodontists spent millions of dollars and had little data or metrics to show their public relations campaign was cost effective or beneficial .They were perceptive enough to pull the plug when they realized enough is enough. Are you satisfied with the public relations campaign now in place and funded annually by a $125 assessment to you? This camapign has had no meaningful oversite. Where are the metrics that demonstrate any measurable success associated with this program? This campaign should have been discontinued after 4 years of spending almost $2,000,000 dollars on an ineffective and wastefull effort. Are our leaders being fiscally responsible to the membership in view of the global economic downturn? I believe this unwarranted largess begs that question. These monies could have been better spent improving the infrastructure of our post graduate endodontic programs and bolstering a faculty shortage that will reach irreversibly catastrophic proportions in the next ten years or less. As baby boomers continue to retire in ever increasingly large numbers an already acute faculty shortage will metastasize into an educational nuclear winter. The AAE could have been decidedly more pro-active in fostering distance learning programs to help support our overworked and underpaid post graduate faculty. How much longer does our leadership expect us to pay $125 per annum as an additional tithe to our annual dues?

I have said for a long time now that implants are not the enemy. Rather, it is the practice of using implants as an insurance policy for poorly treated root canals that has us repeatedly complaining and or bemoaning our loss of stature in the dental community. Regrettably, this is a self inflicted wound. It’s really not important who delivers the implant. I don’t care whether the implant is placed by a GP, endodontist, oral surgeon or periodontist . That is inconsequential. However, the major problem occurs when we, as endodontists, are left out of the diagnostic loop and perfectly healthy teeth are condemned for extraction. When a diagnosis is made predicated on inappropriate dental algorithms, ignorance, greed and limited or no understanding of the culture of referral we lose authority and relevence as a specialty. We should be training our endodontic postgraduates to be proficient in endodontics and single tooth implant placement. The specialty of endodontics is in the unique position to provide our patients with an unbiased treatment plan best suited for their needs. Periodontists, Oral Surgeons and Prosthodontists are not prepared to provide endodontic services nor should they. We can do both expeditiously and ethically too.

The only way your voice will ever have any consequence to the rest of your dental colleagues who place implants is when you start placing them as specialty also. The AAE’s decision to promote endodontic treatment through the all too transparent and somewhat banal effort to cast doubt about implants does not help our cause. Lower maintenance on endodontically treated teeth is never going to be a prime concern for those with missing or hopeless teeth. How many of our colleagues will be concerned about the long-term effects of maintaining an implant when deciding whether to extract or treat a tooth endodontically? The endodontic/implant algorithm requires significant clinical and academic dialogue with a healthy amount of research and interdisciplinary collaboration mixed in. Ataractic articles that only endodontists read are self-serving and only promote collegial dissonance.

What is our mission and are we doing everything we can as a dental specialty to instruct and inform our referrers and the public? I think if we look in the mirror, we will be able to find the answer.

The Man in the Glass

By Dale Wimbrow, (c) 1934

When you get what you want in your struggle for self,

And the world makes you King for a day,

Then go to the mirror and look at yourself,

And see what that guy has to say.

For it isn’t your Father, or Mother, or Wife,

Whose judgment upon you must pass.

The feller whose verdict counts most in your life

Is the guy staring back from the glass.

This is the first in a series of editorials from the editor of the New Jersey Association of Endodontists (NJAE) website. The opinions expressed in these editorials are solely those of the editor and do not represent the views of the American Association of Endodontists, the AAE’s Executive Committee, Board of Directors , or members of NJAE. Comments to the editor are welcomed. Letters to the editor will be added as they are received. We also encourage guest editorials. Please submit your editorials or comments by email to guttadoc@msn.com.
Marc Balson, DDS, FACD, Editor of the NJAE Website

Author: Dr. Marc Balson

Financial Transparency and Other Musings

We have met the enemy, and he is us

“We have met the enemy, and he is us”