Why 1 dentist decided to get a medical degree

Although Lisa Simon, MD, DMD, serves as an associate physician at Brigham and Women's Hospital in Boston, she is also deeply involved in the oral health of patients.

Dr. Simon recently joined three other doctors in testifying before the U.S. Senate Committee on Health, Education, Labor and Pensions about how to improve dental care affordability and accessibility.

Dr. Simon recently spoke with Becker's about her support of medical-dental integration and how progress can continue in these fields.

Editor's note: Responses were lightly edited for clarity and length. 

Question: What inspired you to earn your medical degree after becoming a dentist?

Dr. Lisa Simon: I went to dental school and then was working at a federally qualified health center as a dentist, and all of the ways in which the separation of medicine and dentistry and how it failed my patients and made it so much harder for them to get the care they needed and really impossible for me as a dentist to take care of them made me realize that I might want to be a generalist and become a physician. [It also made me] think about ways  being a dual citizen of both worlds might actually implement some changes, which have been so hard to make within the ways we deliver dental care in America. 

There are so many ways to do this, and arguably going to medical school is the least direct or longest way to do it. For me, a big part of it was that being a proceduralist, a dentist who can put your hands on someone and make a change in their bodies was really valuable, but I also wanted to have space within my clinical life to address and acknowledge all these things that were coming up along the margins that dentistry wasn't equipped to handle.  Patients told me they were having a really difficult experience at home, or if their blood sugar was really high, or if their blood pressure was really high, I wanted to think about those things too. So from a personal perspective, maybe I learned that as much as I loved practicing dentistry, I really wanted to be somebody's primary care provider too. 

The other piece of this is that we talk a lot about ways we can integrate these two systems, and we need all sorts of people with all sorts of skills working on this, but understanding from a bone-deep perspective how the systems work and how they feel as a provider, both on the dental side and the medical side, was something that was really important to me when I thought about what it might mean to make change. I'm an academic, I'm a nerd, I want to know everything about something before I make an opinion and this kind of felt like learning as much as I could about something. 

Q: What do you think about the progress that has been made with medical-dental integration?

LS: If I could wave my magic wand I'm sure I'd make it advance more quickly, but I think we've actually seen a huge amount of change just in the last five years. Ten years ago, when I first decided I was going to go to medical school, people were confused. They thought it was a weird, strange thing to do. Even just over the course of my medical training, I started getting a sense of people being like, "Oh, that makes sense. The two things are connected. I can see why you might want to have both degrees." That was also a sign of progress within our field and within medicine to understand the ways oral health and our overall health are connected. More recently, we've seen some really exciting policy changes that have never happened before. For example, the new, very limited dental benefit for medically necessary dental care seems like a small thing, but it's also the first time Medicare's ever offered dental treatment to people, so that's amazing. There are ways to go, but it's been exciting just to see how much progress we've been able to make with our fields shining a spotlight on some of these issues. 

Q: Why are dental benefits seen as more optional compared to medical benefits?

LS: There are a couple of reasons, but it all comes back to history. The idea of medical insurance comes out of this idea that if something really big and bad happens to you, you won't spend all of your money paying for it. It's this idea that you have minimal risk, whereas dental insurance isn't really insurance. If you have to have a big expense, you're more likely to have to pay for more of it. Dental insurance is kind of like a discount plan. You can get coverage for your cleaning and not pay anything, but if you need an implant, you're gonna pay 100% of it. That's the opposite of how health insurance works. So I think by working in an opposite way, it makes it really difficult to connect those things together because the idea that you'd have dental insurance that would only pay if you had a big, bad thing happen to your oral health doesn't exist. So I think that's been a big part of it. The other reason I think dental benefits are often seen as optional is because people who have the privilege to access dental care are often the ones who are making decisions. For them, the separation isn't that hard. So I think it's really difficult to continue to keep in mind that for millions of Americans, that's not the way it is, and we need to advocate for them and we need to listen to them.  

Q: What are the missing pieces of the puzzle that could keep integration from advancing further? 

LS: A big part of it is how few people are actually able to afford dental care, which is why big changes like Medicare and Medicaid coverage can make such a difference for so many people so quickly — these things we can't change at an individual level, but that if the government changed, it would affect millions. The other barrier is that we continue to be trained and practice in systems that are pretty separate. I went to medical school. I can tell you how little oral health training we got. When my physician friends don't know something about oral health, they just text me, but you shouldn't have to be a doctor who has a dentist friend in order to help your patient. On the flip side, I meet a lot of dentists in private practice who are amazing clinicians and care so much about their patients, but also don't really know how to be connected to their patients' physicians. What are they going to do, get them on the phone? These doctors are so busy, they're never able to. So some of these things are just structural barriers we need to address, like having electronic health records that talk to each other and having an awareness of how other people work or how the health system functions. Those are harder issues to fix, even with the wave of my magic wand. 

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