Watching YOUR Cost of Doing Business

The 1998 American Dental Association House of Delegates (HOD) left this long-time observer of ADA programs and services with some decidedly positive impressions.

The House of Delegates decision-making process has always been democratic and thorough in its efforts to address the needs and wants of the majority of the approximately 107,000 active dues paying members. None the less, over the years there have been instances where California delegates have questioned whether the design and costs of ADA programs approved by the HOD have effectively met the needs and program preferences of California members. It isn't difficult to conclude that the needs of a California Dental Association member in Los Angeles are significantly different than those of a member of organized dentistry in rural Maine or in any of the many vastly different environs that comprise this country. We are learning that the needs and preferences of dentists from the many ethnic origins that populate California may make it difficult for CDA or a component society to make decisions about programs and services for members that are acceptable to the majority of their respective membership bases as we move ever closer to the end of the twentieth century.

Thus, it is easy to recognize that a national organization formed to represent and serve the interests of a unified profession that is becoming increasingly divergent in its demographic composition, will face increasing difficulty in meeting its goals unless it is able to successfully readjust its traditional mode of operation. In recent years, California delegates have been concerned about some ADA HOD proposals that have added to an increasing tripartite membership dues total. These programs were perceived to not have the same value here as they purportedly had in other districts of the American Dental Association.

The potential for a significant increase in ADA dues this year was particularly worrisome to CDA delegates as they convened in San Francisco for the 1998 HOD. As most colleagues who read this know, the 1997 ADA HOD had directed that the American Dental Association undertake extensive efforts this past year to educate the membership to the purpose, goals, content, and cost of a proposed ADA National Public Awareness Campaign. If the proposal was approved this year, a dues increase of $304 per year per member for three years was expected.

In addition, increases in dues to build up the financial reserves of the ADA, and to cover renovations to the Chicago headquarters building had been expected to add another $80 to the 1999 dues bill. Also, it has been customary at each recent ADA HOD meeting to add the cost of all approved programs at the current session to the dues base which was established the previous year and has been used to frame the projected budget for the coming year. It was therefore anticipated that proceedings at the 1998 HOD could add as much as $400 plus the costs of any other new program or task approved by the HOD. As a matter of record, the 1998 HOD approved new or continuing programs with a total cost anticipated to be slightly in excess of $1.8 million for 1999.

Given the knowledge that CDA and some component dental societies had proposals that could also increase the tripartite dues package, California delegates were even more sensitive to economic issues than in the recent past. A recent ADA random membership survey on the impact of the $300 tab for the Public Awareness Campaign left little doubt that membership losses to CDA and its component societies could be significant if that campaign was approved. The stage was set for lively debate on the one hundred plus resolutions before the HOD, the most significant ones having been identified above.

Reference committee testimony prior to the first HOD business session conveyed a clear message that many members across the country believe that the profession must undertake continuous efforts to strengthen its public image in the effort to increase dental awareness and demand for care. Increasingly, member dentists believe that any public awareness activity should be a function of their membership dues, which led 1998-99 ADA President Timothy Rose to comment during his address to the HOD that the ADA dues should really be considered "...a cost of doing business." rather than membership dues.

Given the strong member preference for the public awareness campaign and the recommendations from the ADA Board of Trustees that favored the strengthening of association reserves and the renovation of the headquarters building, it is remarkable that the 1998 House of Delegates was able to minimize dues increases for 1999 and 2000, thus keeping "your costs of doing business" under reasonable control.

The HOD did not reject public awareness activity, preferring a more conservative, gradual approach to implementation of materials developed to date in five states in the coming year. It will also allow for some development of new materials and their associated cost. Most important, it will enable evaluation and further development of the program components in order that the programs can be kept vital and relevant in the states in which they will operate.

We believe it is important to the future health of the American Dental Association that programs are designed for implementation in states where they are needed and wanted, rather than on the massive global basis on which the public awareness program was originally designed. This method of implementation or adoption of new programs, should be of significant merit to the profession. Given the fact that it is difficult to design association-wide programs that will meet the special needs of every state or group within the ADA membership, core programs initiated by the ADA can be customized by the individual constituencies at their expense, to meet their particular needs.

The major cost of the program will be borne by those who will use it and modify it to their specific use. The basic costs of this program and all of the remaining programs, reports, or services approved or requested by the 1998 HOD amounted to a more modest ADA dues increase of $17 in 1999. Other examples of the cost consciousness of the 1998 HOD were actions reducing the level of association reserves from the 45% recommended by an independent study, to "a goal of 30%," and the denial of the funding request for the headquarters renovation.

Finally, the HOD took the unprecedented action of reducing the budget figure used for calculating ADA dues for the year 2000 to $343, demonstrating again during this session, its intent on keeping spending under control, keeping dues and services they fund attractive to the membership. The future of the profession, based upon these proceedings could not be projected to be more positive. The process of deliberation, while democratic, was not constrained by tradition, and was guided for the first time by the recognition that needs and preferences differed in the states and districts that make up the ADA. The decisions of the 1998 HOD were more equitable to all individual constituencies than they had been in the recent past.