Neal Johnson, DDS, PhD, MBA - Pediatric Dental Anesthesiologist in California

Eva Sheie (00:01):
Whether you're visiting a dentist for the first time or considering a new one, the more you know about who's behind the chair, the better your experience will be. I'm your host Eva Sheie and on Meet the Dentist, we feature professionals sharing their expertise so you can feel confident about who you trust with your smile. Welcome to Meet the Dentist. I'm honored and privileged today to bring you Dr. Neal Johnson. He is quite an interesting character and he's both a dentist. He has his PhD and his MBA and he's currently practicing in all over California, sometimes from his car, I understand. Welcome to the podcast. Nice to meet you.

Dr. Johnson (00:42):
Nice to meet you as well.

Eva Sheie (00:44):
So tell us a little bit about where you're working today and how you're spending your time.

Dr. Johnson (00:50):
Yeah, happy to do that. So as you mentioned in your intro, I happen to be working mostly in California, specifically Southern and the Central Valley. So that would incorporate the Inland Empire, Riverside, San Bernardino, Victorville, and then moving on up to Bakersfield, Visalia, Oxnard. Those areas I practice in specifically dental offices offering general anesthesia services to them for their pediatric patients. Mostly I do also service adults, but that is usually not as common as the kids. I prefer working with kids actually because again, so totally. They're much more fun to deal with and they're a lot of special needs kids, autism, ADHD and otherwise that need the help and I'm happy to provide that service for the dentist who contract with me for my services.

Eva Sheie (01:47):
It sounds like you like challenges to me.

Dr. Johnson (01:50):
I do. I like challenges, I like problems, I like solving problems. That's my thing. So anything that has to do with that, I'm happy to be a part of.

Eva Sheie (02:00):
When you are out helping general dentists see these kinds of kids, what treatments or procedures or situations are you finding yourself in that those kids need help getting through?

Dr. Johnson (02:14):
They usually require extensive dental work and in most times to be able to do that, it would have to happen normally in several visits to the office. And we've found, and dentists have found out really quickly that a kid may start off for the first two visits, you do a few here and there, and then the third visit they're like, no, you're not touching me anymore. And then where do you go from there? So to avoid that when there's a lot of extensive treatment, we tend to recommend that the kids, as long as they meet the criteria for in-office general anesthesia, they'd be sedated or put to sleep for their procedure. So it's quite extensive or in the case of special needs kids who would not cooperate in the office at all to do anything with them but do need the help. We also make sure we provide those services for you to be able to get the work done for the children.

(03:08):
And again, this is when we're talking about general anesthesia and offering services, it's more than offering services to the child. It is more about doing that for the parent as well because imagine a parent who's very anxious, the kid is in pain, they recognize that there are a lot of cavities that need to be addressed and they're like, how do we get this done? They probably don't have all the time to take off work in the normal circumstance, but if we said to them, you know what, we can do this all at one time safely with your kid asleep. You come in one day, you get it all done and you go home and it's done. That is music to their ears. Most patients that I encounter, their parents are very happy to hear that.

Eva Sheie (03:49):
I imagine that for dentists that these kinds of cases are really challenging too and that you might seem a bit like a superhero to everybody, both the parents and the dentist who you're helping.

Dr. Johnson (04:02):
Yeah, I think for most of us that do this, that is how we are seen, right? Because we are providing a service that would not be able to be done otherwise because here are the other choices. Number one, you don't do it, which is really not a choice because it has to be done. Two, you do it in the hospital and the waiting list for that is usually about two years, in which case the disease progresses and worsens. The third option is to a surgery center, but that also comes with a time crunch. You may not be able to get into the surgery center at the time you would want. So there's a delay there. And then the other option is the dental office. As long as the office itself, the practitioner all fit the criteria because we can't go into every single office. Some offices are not conducive to safe treatment.

(04:58):
We just can't do it right. We have to make sure they all fit a certain criteria and I mean, I love going to work because I love being able to see the look on the parent's face when the dentist does good work and solving that problem. And we have taken a big load off of them where they're like, okay, I don't need to come back again. This is all done. We just probably have to come back for checkups on whatever the case is. But they're really, really happy because somebody has decided to work on their child. I've had situations where parents, I don't know where to go. I dunno what to do. Nobody wants to see my child because he's autistic and he doesn't sit and they say, we don't see special needs. Then you are the last resort. So when they come to that particular office and then I agree to do the case, you could see how they would respond to something like that.

Eva Sheie (05:50):
Can a lot of these places are fairly rural, are they not?

Dr. Johnson (05:56):
Some are and some are not. Early on in my career, I worked in LA and a lot of urban places. It was like dentists everywhere as a years has passed, I found I was going to more rural areas and underserved areas where there were just a few dentists or there were dentists, but not many who would offer in-office general anesthesia. Now remember that the dentist, a lot of the time, they also may have their reservations about anesthesia or the myths involved in safe administration of general anesthesia. So that also presents a barrier to care. There's a lot that goes into this whole thing about offering this service to parents. I find that the offices that embrace it, who understand it, and we're able to show them why this is a benefit to them, and the parents and the child, they do decide, okay, let's go ahead with this and see how it works. And you can't stop 'em after that because now they're able to keep their patients in the office and take care of them right there and then.

Eva Sheie (07:05):
I have seen this in social media like mom groups where there's a lot of judgment and stigma around having anesthesia just for dental work. Why would you put your child through that? Well, there's always going to be a trade off between your teeth falling out or having serious dental problems, which can affect your whole life or going under to get those taken care of. But I'm curious, what do you see people really misunderstand about having anesthesia just to go for a dental procedure?

Dr. Johnson (07:42):
Okay, let's look at it this way. The first thing they're going to tell you is this. Why is this not being done in a hospital? How can you do this in the office? And again, I understand that in some of these mom groups, they can be for good and not so good. Mostly not because you get a lot of rumors and myths flowing around there. They say, oh, well, I heard this, I saw this on the news, and my friend went here and this is what happened, or whatever the case is. And in most cases, they don't talk to anybody who provides the care to be able to get answers from them. So first thing they're going to say, it's not safe. You can die. Well, there a lot of things that are not safe flying in airplanes. You can die that way. And as a matter of fact, the prevalence of that is more than if it were in office general anesthesia.

(08:34):
But the providers are well-trained. Many of us are, especially those who went through a specific dental anesthesia residency, do this thousands of general anesthetics every single day in the dental office without any incident. In the unfortunate event where you've had a problem, it is often because of some underlying medical condition that was not disclosed or because of some type of negligence, which is also rare. And it's just a matter of educating these individuals about what anesthesia is, how it's safe, how we make it safe, and the fact that we do this all the time. And I have been asked to speak at certain places to give those talks and that training. And I also created several videos, training videos, animated videos that children and parents can watch that also provides explanation of how it works. I take 'em through the entire process from the beginning to the end, and it is meant for them to watch with their child. And since I've been doing stuff like that, I've had a lot more acceptance from parents as a result of having that information.

Eva Sheie (09:49):
Are those videos we can find on YouTube?

Dr. Johnson (09:52):
So for my patients, when I send them information, I send one or two of the videos along because I created them, but usually I have it available for dentists to be able to subscribe to so that they can send to their patients for them to watch them as well. So there's a series of six animated videos and that's how we get that information out. So yes, you can find them online, but it's a subscription that people typically would have to employ. But there are a couple of free ones that I use right now that people can find on YouTube.

Eva Sheie (10:26):
If it's okay with you, I'll put them in the show notes so we can at least see, get a preview.

Dr. Johnson (10:31):
Absolutely.

Eva Sheie (10:32):
Yeah, I wish I'd had those. I told you before we started recording that my daughter had a tooth pulled and it was a lot of conversation with her. She's not special needs, she's just typical, but kids have never had surgery before. And for most kids I would think that going to the dentist is that's really the first thing where that might come up.

Dr. Johnson (10:58):
Absolutely. And I'll share one with you at the end of the session, so you'll see what they look like and then you can kind of see how we created those to be able to help the parent and the child. And also they work just to help the dentist as well because it helps educate them as the entire process.

Eva Sheie (11:23):
Sometimes I think hearing doctors' resumes can make you want to go to sleep, but your training in particular is really different and really interesting. And so is there maybe a concise way you can kind of take us through that special path that you took to get here?

Dr. Johnson (11:42):
So first of all, I immigrated from Barbados to the United States about 25 or more years ago. And I came here and I did a PhD in microbiology and that degree I was focusing on some dental bacteria and one thing led to another, ended up in dental school, it was teaching for them for several years and then decided to go back to school to do dental anesthesia. Worked for them for a little bit more after that. And then when I decided to leave Loma Linda University and go it on my own, I wanted to make sure that I am pretty entrepreneurial. So I decided, look, I want to get a business degree. So I decided to do a business degree at UC Berkeley, and that has helped me with my current consultancy as well. So that's pretty much it in a nutshell. So from basic science to a clinical degree to a specialty, and then business and taking all of those learnings that go into how I think about consulting, how I think about helping other dentists and organizations be able to function a lot better than they are right now.

Eva Sheie (12:56):
It's fascinating. When you decided to get that MBA, had you already been in private practice at that point?

Dr. Johnson (13:02):
Yes. I had already been in private practice. So there was a period between the dental degree and anesthesia of about five years where I practiced general dentistry for about five years, seeing mostly adult patients and most of that I was doing a lot of surgeries and sedation because I had my sedation permit at the time as well. So I had been in private practice understanding how that works, but not my own private practice. We were in a faculty practice at Loma Linda. I was shielded somewhat from some of the business part of it. I was just working, but I've always, I can't help it. I go any place I go, I look at how things work and I like, ah, that could work better. So I always see stuff and want to fix it. So when I decided to get my MBA, the plan was I am going to go into industry and solve some problems and then realize, you know what? They need to go into industry. They were right here in dentistry, so I will stay here and fix 'em in dentistry. So that's why I decided to do and blend the clinical and the business side, and that has worked out really, really well, to be quite honest with you.

Eva Sheie (14:13):
We are like-minded in that problem solving. I love tackling something and getting to the other side of it. And I'm curious, I'm sure you've solved thousands of problems, but do you have any favorites?

Dr. Johnson (14:28):
Yes. Well, most of the time one of the major problems that I see everywhere I go, I don't think I've been anywhere where it's perfect or even close to. Let's take something for example as scheduling for general anesthesia as one of the things I think that most places don't know how to do it and to be efficient, those days can be long days. Some of the cases, granted, you don't know exactly how long they're going to be because if the child never cooperated for x-rays in the beginning, how do you know? So you are diagnosing while they're asleep. So the case could be an hour, it could be two hours, it could be 30 minutes, who knows? So scheduling becomes a little bit of a nightmare, but I've shown many offices that I go to how to schedule better and how to be more efficient in their time. And if I am there, I can guarantee them that I can turn the room over and be ready really quickly to see the number of patients we have, which allows them also to be efficient in the way that they provide care. And also because it's the parents' time as well. And we want to be always respectful of everybody's time. So because lateness is one of my pet peeves, tackling, scheduling and being late and on time, those are things that I care about. So that is my favorite thing to do. Solve the problem when it comes to scheduling and make sure using different parameters to be able to solve that problem.

Eva Sheie (15:57):
Is most of the software that does scheduling in dentists agnostic to a problem like that. Does that make sense?

Dr. Johnson (16:05):
I know exactly what you're asking and that Yes, and that is correct. Most of it is agnostic to a problem like that because they all just are fundamental scheduling. It doesn't matter what they are, they all do the same thing.

Eva Sheie (16:20):
So it's a strategy that you're bringing.

Dr. Johnson (16:22):
Correct. It's a strategy. And also with the current advent of artificial intelligence, there are opportunities to be able to use that to augment the way how people schedule based on the case complexity, historical data about certain patients or patient populations or whatever. Those are helpful to help give you a statistical understanding of who is likely to show or not show. There are several ways that we have determined over time collecting data what we can use that goes into scheduling. So for most of the software, we can plug in our own software into that to help people understand how scheduling can be much better because it's still a perennial problem. It's still a problem that people are still fighting with and trying to figure out how to solve, and we think we've figured it out.

Eva Sheie (17:18):
You took your own experiences and then built software around solving that problem?

Dr. Johnson (17:22):
Correct? That is correct.

Eva Sheie (17:23):
How long did that take?

Dr. Johnson (17:25):
Over the last couple of years I would say, so we are just in beta testing of it now, but it took about a year and a half or so to be able to kind of put that together, especially collecting all the data that we needed to collect the different interviews we've done. And of course, because I traveled to multiple offices, I see so many different things that I can use that information. I get to be able to inform us of how we need to create a solution for that problem.

Eva Sheie (17:56):
Along with the scheduling problem are there any other opportunities where you see AI being able to actually have a positive impact?

Dr. Johnson (18:06):
Oh, a hundred percent. So especially when it comes to, let's say for example, here is a typical scenario. A typical scenario is that a scheduler will reach out to me, send me by email, mostly health history form to say, Dr. Johnson, is this case to be scheduled? Please, can you take a look at the information and whatever the case is. So as if I'm not busy enough, I have to go through all of this stuff. And like I said,

Eva Sheie (18:38):
Is it PDF usually?

Dr. Johnson (18:39):
Yes.

Eva Sheie (18:40):
Yeah.

Dr. Johnson (18:41):
And I see this, I mean, I'm seeing 12 patients a day on average, so I have to go through a lot of these things. So I have over time have said to them, have given them documentation about what qualifies as okay and what, for example, qualifies as not okay. And what questions should be asked to follow up on before you contact me. Some people listen, some people don't. So we created something where AI is able now to help triage a lot of the data that comes in and gives you a score, a risk score of whether or not this case should go forward or not. So it's still ultimately the decision of the anesthesiologist. Every anesthesiologist has different risk tolerances, but it at least informs the scheduler about whether or not they should even bother to contact you versus whether or not they should. So it helps them to, because it's really quick.

(19:40):
So sometimes if you send me an email, it may take me a day or two to get back to you, but if you upload this information, we are able to make you get the answer right away and automatically it can put stuff into a queue and you know what you need to get, what the information needs to be obtained before you can send to me. So it does help move things along much faster, way better for efficiency into a central platform that we don't have to worry about security with emails and all those kinds of things, because I hate going through email chains. I dunno about you, but just annoys me. So having something centralized where you can see exactly what the next step is and it's very clear and makes a whole lot better than the current system, and that happens most places.

Eva Sheie (20:26):
That's really exciting to hear about and it has an impact on everyone around all the humans are benefiting from this.

Dr. Johnson (20:34):
Yes, yes.

Eva Sheie (20:35):
You've put together quite a fascinating career, and I think as long as there's problems for you to solve, you're going to keep being very forward about tackling and moving through them. It's very unusual, and I talk to lots of people and I don't usually see anyone doing what you're doing.

Dr. Johnson (20:58):
For me, look, life would be boring if there weren't problems. Nobody really likes problems, but I see them as opportunities for solutions, and if I feel I have a good idea, I like to tackle it. And so I go to work all day and come home and work again because there's always something to do. So my days are quite full from sun up to sundown and beyond, so they're quite full where I'm always tackling something, working with developers on solving this problem and that problem. So we're working on some really big things at the moment, and hopefully we'll come to market within the next month or so. So yeah, I spend a lot of time on those things and I just feel life is a lot more interesting that way.

Eva Sheie (21:54):
Is there anything that you do when you're not at work that you can share with us?

Dr. Johnson (21:58):
Good. Yeah, sure. So I play around a lot online with different AI software. That is what is fun to me. I like to see what it can do, and before it always have gone by and I'm still doing that, but it's fun to me. It doesn't feel like it's not work, it's fun. Apart from that, I always find the opportunity to try a different vegan restaurant wherever I can find it. So I look for those, whether I'm traveling or in the area, I always look for different vegan places or spots or whatever. I do that. That's for fun. I travel a lot as well, so I work really hard for three weeks and then take the last week to travel mostly to Barbados, but if I need to go somewhere else, I go somewhere else. So those are things I do to kind of clear my mind and find something else to do apart from working, but I'm still going to set, have to say work wins. Most of the time it shouldn't be that way, but I, I'm looking to make some changes because I think that it's time you can feel, it's time to shift yourself away from work to something a lot more fun.

Eva Sheie (23:04):
There's a question that I like to ask doctors on this podcast, and you're free to say, I don't want to answer that if it's not for you, but if you're on an airplane and they get on and they say, is there a doctor on the plane? What do you do?

Dr. Johnson (23:19):
Oh, I always respond. Well, I not right away wait first to see if any of the other physicians respond, and if not, and they ask twice. I do because the last time, and I've been on airplanes where there've been emergencies all the time, and I was involved the last time a guy, two rows in front of me collapsed his wife next to him, he screamed out, and so they didn't have to call anybody. I just unbuckled my seatbelt and I got up and another guy also got up as well. So the guy came to eventually, we asked her some questions. We got some information on what we likely thought was happening, and we were on our way to Barbados at the time, and I think we were probably about an hour away from landing. The other guy who responded, he asked, so what do you do?

(24:11):
I said, well, I'm an dental anesthesiologist. And he said, oh, he said, I'm an anesthesiologist, so well, I just retired. So he used to work at some hospital in Colorado, so we started chatting and whatnot. But I have typically always responded because most times for me, I understand it may be different for other people because I have more training in medicine than the average dentist, obviously. So I can help solve a problem, an immediate problem, or at least be able to advise a physician about what I believe the issue is and communicate with them in a way that is efficient and they understand exactly what's going on. Then most dentists probably can't. So I think there's a little bit of distinction. So for a lot of, let's say a lot of oral surgeons who are dual trained medicine and dentistry, us as dentists, anesthesiologists who went through a lot of extensive training along with physicians in the hospital doing anesthesia, you don't get any better than that, right? So we can be helpful and we do what we can to be able to assist a patient. We know, obviously, you know how to resuscitate someone and you know how to take a history, all those things, which most dentists aren't as familiar with, but probably should be. So yeah, I respond all the time as a short answer to your question.

Eva Sheie (25:42):
That's a pretty good story. I can imagine being over the ocean is not the place where you want an emergency to happen.

Dr. Johnson (25:50):
No, it is not. And I mean, what are you going to do? You're almost there, but there are some islands before Barbados that they probably could have tried to land at right away, but still, I mean, whatever was happening, I was fairly confident because I also had backup with this gentleman. The two of us were working together that whatever happened we could take care of, I was pretty confident that we could. So we asked them to bring, we said we needed the kit. I need a blood pressure cuff, a pulse oximeter, all those things, a blood glucose kit. I need all those things. Can you bring them for me? And they brought all this stuff. They had them surprise, surprise. I was quite shocked, but they had that stuff. I also walk with stuff in my bag just in case you never know, but they had that stuff and they brought it. So we were able to get the information we needed. So we were communicating with someone on the ground as well, and we did not recommend that there needed to be any emergency land, and we figured what the issue was and the problem, the guy left his medication in his check luggage, which they always tell you never to do that. Right? So, what?

Eva Sheie (27:03):
It's not the first time a patient has not followed directions.

Dr. Johnson (27:06):
Nah, probably not. So when we landed in Barbados, there was the paramedics were there and they allowed him to get off first. Obviously I gave them the information that they needed and that was it.

Eva Sheie (27:23):
Sometimes I hear that they had the equipment, but the batteries were dead or there was nothing on the plane. They didn't even have a bandaid. It's crazy.

Dr. Johnson (27:33):
It's crazy that happen, but I take stuff with me all the time. I have a little kit I take with me just in case you never know. And I remember another friend of mine who's also a dentist anesthesiologist, she had somebody collapse and she had to start an IV on the plane in the aisle. They did end up doing an emergency landing as well on that patient. But she told me, she said, could you believe there was only one IV catheter, so if I miss this, we're in trouble. Luckily for her, she was able to get it. She was pretty good at that, but she was able to get it, and so I decided, oh, I'm going to walk with a few of these just in case they didn't have what they need to have.

Eva Sheie (28:15):
Somehow it does not surprise me that that's what you learned from that was to pack your own bag from now on.

Dr. Johnson (28:23):
Yeah. Yeah. No, because you never know. Right? I would love to be helpful if I can, and if there was some of the physician on board that was taking lead, at least I would have something that I could help support him or her with. I'm happy to do that as well. I'm not in a rush to take an emergency, so if somebody else is going to handle it, fine, I'll support as much as I can, but I'm willing to do it if I'm called upon for sure.

Eva Sheie (28:53):
Well, I think you're a real superhero.

Dr. Johnson (28:57):
That's kind of you.

Eva Sheie (28:58):
Glad to know you. Dr. Johnson. Thank you for sharing so much of yourself with us.

Dr. Johnson (29:03):
Thank you.

Eva Sheie (29:03):
Tell us where we should follow you online or reach out to you if we're interested in connecting.

Dr. Johnson (29:08):
So my website is hypnos dental.com. That's for my anesthesia, and then my consultancy is theefficiencycatalyst.com.

Eva Sheie (29:18):
Wonderful. Thank you so much. It was a pleasure.

Dr. Johnson (29:22):
Same here. Thank you for inviting me. I appreciate that.

Eva Sheie (29:26):
There's no substitute for meeting in person, but we hope this comes close. If you're considering this dentist, be sure to let them know you heard them on the Meet the Dentist podcast. Check the show notes for links to this dentist's website and Instagram. To be featured on Meet the Dentist, book your free recording session at Meetthedentistpodcast.com. Meet the Dentist is Made with love in Austin, Texas and is a production of The Axis T-H-E-A-X-I-S.io.