By Timothy Hyland
John P. Bitting says he'll never forget his first day on the job with DOCS Education.
That's mostly because, after that first day, he was fairly certain the position wasn’t a good fit for him.
The year was 2006, and Bitting had just settled in the Seattle area and passed the Washington bar exam. He had his law degree and, via a temp agency, a steady job — until one day, he didn’t.
Because of a billing dispute between the temp agency and his then-employer, Bitting found out that he was summarily out of work. Having hopped in the elevator after getting the bad news from his boss — and feeling, well, not so pleased with the situation — Bitting called his contact at the agency with a straightforward declaration: "You owe me a job."
The next day, Bitting's phone rang and the news was what he had been hoping for: a new job was available, and immediately. It was for a small educational and advocacy organization in the world of dentistry. And though Bitting had no previous experience (or interest, really) in the world of dental law, he accepted.
Thanks, But No Thanks
So, it came to pass that he walked into the Lake City (Seattle) offices of DOCS Education, where he met Coni Fadigan, a principal administrator who had been with the organization since its founding in 1999. It was Fadigan who gave Bitting the first explanation of what his job would entail.
Suffice to say, her description didn’t exactly knock his socks off.
"I remember Coni pointing to a big bank of filing cabinets and saying, 'Your job is basically to memorize all of those — all of those regulations,'" Bitting recalls. “And I was like, 'This isn't going to work.’ I called the agency back and told them it wasn't a good match and that I wanted them to find me something else."
Fortunately for Bitting — and DOCS Education — he didn't ultimately get his wish.
Before he could move on to his next gig, Bitting had the opportunity to sit down with Dr. Michael D. Silverman, the co-founder and president of the organization. It was Dr. Silverman who ultimately was able to explain not only the nuance of the job but also the importance of it. While serving as the organization’s regulatory attorney does demand that he memorize cabinets full of state regulations. Dr. Silverman was the one who sold him on why the job mattered.
"Dr. Silverman is just a master of explaining things," Bitting says. "He's a master of explaining even very complicated or esoteric things. I mean, he might as well have been a lawyer (and his father was one!). So, when Dr. Silverman explained the organization and the role, it was like the light bulb came on for me. I remember I called the agency again, saying, ‘I just met with the boss — I totally get it now.’ And I’ve been there ever since.”
Indeed, for the past 13 years, Bitting has played a central role in the ongoing development and growth of DOCS Education, not to mention the broader sedation dentistry movement. As the organization's regulatory and general counsel, Bitting works diligently to track regulatory changes in all 50 U.S. states, as well as the District of Columbia and 10 Canadian provinces. In other words, yes, that daunting bank of filing cabinets is still a central part of Bitting’s job — it’s just that the contents of those cabinets keep on changing, and it’s Bitting’s responsibility to stay on top of it.
“My job is to keep our doctors out of trouble with the dental boards before they get into it,” Bitting explains. “I liaise with the boards, so they don’t have to.”
It may sound rather straightforward, but it’s not. The reality, says Bitting, is that regulations governing the same general practice of sedation dentistry can vary widely from state to state and province to province. Beyond that, even in cases where two states may have regulatory language that on the face looks the same, how those words are interpreted can vary widely.
Methodically and diligently, then, it is Bitting who does the work of making sure that the dentists providing care via sedation dentistry know precisely what they can do, and how they need to do it, no matter where they may be practicing.
On the Front Lines
“The company was based in Philadelphia until 2006, and then moved to Seattle, and of course Washington is completely different in terms of regulation than Pennsylvania, and very different from Oregon, too,” says Bitting, who now lives in Portland.
“California is by far our biggest membership state and attendee base, which is why we focus so much time there, but of course California is entirely different than those other states, as well. It’s just the fact of the matter that you really need to have one human being who can serve as the repository of all of this information. It’s all public information, yes. But somebody has to understand it. …That’s basically why I have a job.”
The essential nature of Bitting’s role became clearer than ever in late 2016 when sedation dentists around the country learned of proposed regulatory changes — pushed forward by some members of the American Dentistry Association — that figured to present them with a significant challenge.
The controversial new guidelines, known as Resolution 37, proposed substantially expanded education requirements for dentists practicing sedation dentistry. For some general dentists, that meant that after years of successful practice they would no longer be able to use sedation until they completed an onerous batch of newly required courses.
Not all states adopted the language, but a few have. And now, more than two years later, the battle over Resolution 37 continues.
Bitting is on the front lines.
“In 2016, the ADA guidelines really became far more restrictive in the realm of oral sedation,” Bitting says. “All of a sudden we had a bunch of doctors who have been doing oral sedation for years, and now they are being required to take an IV course. The challenge for us in the future, I think, is to continue working to prevent any additional states from adopting these unnecessary regulations. I’ve got about four to six state dental boards that I’m dealing with right now — trying to get them to stop it.”
Bitting admits the work he does is often a grind.
But like everyone else with DOCS Education, he is devoted to his charge — because he says it’s essential that sedation dentists continue their work. Simply put, Bitting says, sedation dentistry helps keep people healthier. It gives them happier, fuller lives.
And that’s something worth defending.
“Access to care is a safety issue,” Bitting affirms. “The point of what we’re trying to do is help people get the care they need. The reality is that somewhere between 30 and 33 percent of the population is so frightened of going to the dentist that they don’t even bother picking up the phone. That’s where sedation comes in. That’s why DOCS Education was founded.”
[Editor’s Note: The time, cost, and aggravation of regulatory entanglements often create severe hardships for dentists and their practices. Having a seasoned regulatory attorney who will respond to your questions promptly–and prevent problems before they arise–is priceless, as many DOCS Education members have discovered since Bitting first began representing their interests in 2006. Since 2019, DOCS Regulatory Counsel is Kate Marcus. You can contact her at: Kathleen.Marcus@DOCSEducation.com."
If you’re not yet a DOCS Education member, you’re invited to join our community of dentists at the forefront of the profession. Click here. As your regulatory ‘safety net,’ John P. Bitting, Esq., alone, more than justifies the modest annual membership fee.]
Author: Contributing writer Timothy Hyland has more than 20 years’ experience as a writer, reporter, and editor. His work has also appeared in Fast Company, Roll Call, Philadelphia Business Journal, and the Washington Times.