Participating in an Era of Change

The year was 1944, and World War II was raging across Europe and the Pacific. As the Allies pushed toward victory, a young Charles Wilson began his push to become a dentist. Now, 54 years later, he looks back on the history of a profession that, in his own way, he has helped shape.

Wilson began his dental career as a student in the Navy. But when the war ended, he finished his dental training in 1947, using the G.I. Bill at a private dental school at the University of Kansas City, forerunner of today's University of Missouri, Kansas City.

He took his DDS degree to the far northern reaches of California, coming to rest in a small rural community just south of the Oregon border.

"Tulelake, California, was the place," Wilson said, naming one of the state's more remote towns.

There he "leased a building for $45 a month, bought some equipment, put a sign on the door, and waited for the patients to line up."

In those days, small, faraway towns boasted few dentists, so patients were easy to find and no marketing was needed. Other things were simple, too.

"We had no dental insurance to deal with, and my records at that time were on 5 by 7 cards," Wilson said.

Each card had a diagram of the patient's teeth, and cavities were marked on the diagrams. The office secretary filled in the procedures, dates and costs; and at the end of the month, she would send out a bill that presented the total cost but wasn't broken down by procedure. Then, Wilson would wait for patients to pay.

"If not," he said, "the office secretary doubled as the bill collector."

In 1950, Wilson and his wife (NAME?) moved south to the more populous Solano County town of Fairfield, then with about 5,000 people.

"My dental supply man knew business was good in Fairfield," Wilson said. "A dental office was just being built, so we moved in there. The day I opened, I was booked for two weeks solid without people even knowing who I was."

He said that getting patients without marketing or advertising was easy until the mid-1970s.

The general practitioner abandoned his solo practice in 1956 and occasionally worked with an associate over the years to share expenses.

Those expenses, Wilsons said, have changed little relative to the bottom line in intervening years. Salaries then, like today, were the highest single expense in the office budget. The relative costs of supplies and equipment are similar to today's.

To ensure overhead didn't eat into profit, Wilson simply determined what the overhead was annually and adjusted fees accordingly. He worked alone in the beginning so he only had to equip one operatory.

"The whole setup -- including chair, X-ray system, lab equipment, and the 'unit' (consisting of motor, handpiece, spittoon, water and air) -- cost about $6,000," he said.

The "unit" was the most expensive portion of the operatory. It featured an electric motor that operated the handpiece by a pulley system.

Dental assistants, then educated in a three-month school, didn't need state certification; and many offices then had one woman who doubled as the office assistant and dental assistant. The dentist performed all hygiene functions.

. In his first few years of practice, Wilson earned an annual average of $50,000 gross and kept a little more than half of that. Not bad for a well-qualified dentist who had been underprepared to operate a business.

"We had no knowledge of the business side of dentistry at all," Wilson said.

As a dental student, he didn't get any course work on practice management,

"but we were exposed to part-time faculty members who had practices. They passed along some tidbits."

The biggest challenges Wilson faced in the early years were related to areas not covered by his dental education. He took continuing education courses to learn some business practices and new clinical issues.

His practice prospered, and over the years he became active in his local dental society. In 1971, he was elected president of CDA.

As late as 1978, Wilson's staff still kept appointments in an appointment book and maintained patient's records on cards. Then, after he began a 12-year run as CDA speaker of the house in 1978, a sea of change was poised to sweep over practice management. The computer age for the dental profession loomed on the horizon.

In about 1980, Wilson bought one of the first computer systems to appear in a dental office in Solano County. After he and his staff overcame the initial learning curve, they immediately put their training to work tracking patient accounts and insurance and procedure codes.

"It cost $20,000 and printed statements at the end of each month, already inside their envelopes and sealed," Wilson said. "After we used it for a while, we didn't know how we ever got along without it," he said.

Managed care didn't exist in the early years of Wilson's practice. In later years, he was barraged with almost daily requests to sign up with plans, but stayed with fee-for-service and indemnity insurance plans until his retirement in 1992.

After Wilson retired, he started another career in which he seeks to incrementally lower a number which signifies success. His golf handicap is 18.