Harrell Tells Graduates ‘the Sky Is the Limit,’ Encourages Them to Give Back in Their Careers

Following is the commencement address, given by Dr. Sharon Nicholson Harrell at the UNC-Chapel Hill School of Dentistry’s 54th Honors Convocation on May 13, 2007.

Harrell is dental director for FirstHealth of the Carolinas, a not-for-profit hospital system based in Pinehurst. She received her DDS degree from the School of Dentistry in 1987 and her master’s degree in public health training at the UNC-Chapel Hill School of Public Health in 1990.

To Dean Williams, Vice Dean [Ken] May, faculty, distinguished platform guests, family, friends and the Class of 2007, good afternoon!

It is especially meaningful to me to be asked to give your commencement address because:

Twenty years ago to the day, I was sitting where you are, and it was the culmination of a dream – the dream of my father who never finished high school, the dream of a man who worked in factories all of his life, but who had a vision for his three little girls: Tammy, Wanda and me, Sharon. (I’m the oldest.) He told us, he said, “For the first time in history, unlike me, you can go to any college you want and achieve anything you desire. The sky is the limit.”

So on the wings of a father’s dream, I graduated from the UNC School of Dentistry in 1987 and became a dentist. My middle sister, because of that same dream, is an ob/gyn, and my youngest sister is a lawyer – all of us, UNC alumni. America is a wonderful country, and UNC is a wonderful university. The sky truly is the limit.

I want to follow up on that theme of “the sky is the limit” and tell you that my commencement topic this afternoon is “You Can Have it All.” You can have it all.

Twenty years ago, when I graduated, we were in the aftermath of the feminist movement. In fact, at that time, our entering class of 26 women was the largest number of women in a class who had ever matriculated at the UNC School of Dentistry. Twenty years ago, “you can have it all” meant that women could have a career and a family.  In fact, there was a popular song out in 1972 by Helen Reddy, which was number one on the Billboard chart entitled “I Am Woman, Hear Me Roar”! There was another popular commercial for Enjoli perfume in which a mother belted out the lyrics: “I can bring home the bacon, fry it up in a pan…” and you know the rest. So, “you can have it all” meant something different then.

So, just what do I mean in 2007 when I say you can have it all? I mean that you can have it all in that you can have a successful practice and still give back to your community.  You can have a successful practice and still provide dental health care to underserved populations. “You can have it all.”

Dentistry is a wonderful profession. However, the true love of the profession comes through finding your calling – finding your niche. For some of you, it might be cosmetic dentistry, for others, prosth, for still others it might be academics. For me, it has been public health. Find your niche in dentistry, and you will be happy forever.

As I said, dentistry is a wonderful profession, and I consider it a privilege to have been called to do it. And I do believe it is a calling. Everyone can’t do what we do. So it is incumbent upon us, by virtue of being able to have the opportunity to practice in such a great profession, to say thank you by “giving back.”

You can have it all. You can have a successful practice and still give back to your community.

Your class made history by being the first dental school nationwide to “give back.” I applaud [Class of 2007 DDS graduate] Jennifer Bell and your entire class for signing a pledge that affirms your commitment to provide dental health care to underserved populations for at least four hours per month.

Let me share a story with you about one underserved person. This is an excerpt from The Washington Post dated February 28, 2007:

“Twelve-year-old Deamonte Driver died of a toothache Sunday.”

“… The bacteria from the abscess had spread to his brain, doctors said. After two operations and more than six weeks of hospital care, the Prince George’s County boy died.”

“A routine, $80 tooth extraction might have saved him.

“If his mother had been insured.

“If his family had not lost its Medicaid.

“If Medicaid dentists weren’t so hard to find.”

Just how bad is this access-to-care issue for the poor and underserved?

The North Carolina Medical Journal reports that out of the 100 counties in North Carolina, there are many as 40 counties where there is no dentist willing to serve a Medicaid patient.

Dental Medicaid, as you know, is the dental insurance program designed by the state and federal government to pay for dental treatment for low-income individuals.

Fewer than one in three Medicaid recipients sees a dentist each year.

Why don’t more dentists sign up for Medicaid? One of the reasons that dentists don’t sign up for Medicaid is because of the low reimbursement rates, which range from 35 percent to 85 percent of what the dentist charges based on the 2007 National Dental Advisory Service median.

An active Medicaid dentist (as defined by the Division of Medicaid Assistance) is one who receives at least $10,000 in Medicaid reimbursements per year.

Jennifer Bell charged you to give four hours per month to serve communities with limited access to care. I have even a bolder charge this afternoon. Before I give you my charge, let me tailor it a bit. I know that many of you will be in associateships where your owner dentist decides your patient make-up. I know that many of you will be in specialty programs and residencies. But when the time comes that you are the decision-maker, I boldly charge you to consider providing at least $10,000 per year in care to Medicaid recipients in the state of North Carolina.

What a wonderful way to say thank you to the citizens of North Carolina who have made it possible for you to receive the most premier dental education in the nation.

In the examples that follow, I’ve using the DDS class. However, I would also challenge specialists who are graduating to do the same, because if patients have trouble accessing a general dentist, they really have problems accessing a specialist. For the dental hygiene and dental assisting graduates, consider joining a practice which allows you to give back to the community.

Well, just imagine what happens if you accept my charge! That means that this class alone would provide over $800,000 worth of care to Medicaid recipients in a year’s time.

Since the average Medicaid patient receives about of $467 worth of dental treatment each year, your class would increase access to care for over 1,700 additional persons.  Assuming the classes below you did the same, you would increase access to dental care for almost 7,000 more Medicaid patients. What a wonderful legacy to leave.

You can have it all.  You can have a successful practice and still give back to your community.

I can hear you saying: “Dr. Harrell, this all sounds good and altruistic, and it’s giving me warm fuzzies, but you must be going bonkers! How can I make my annual production goals if I see any Medicaid patients? How would I combat the no-show problem? I can’t do it, I have too much debt.”

And I know, I know, some of your mentors have warned you against taking Medicaid, but if the tide against providing access to care is to change, it must change with you!

According to the 2005 American Dental Association Survey of Dental Practice, the average U.S. dental office has almost $600,000 in gross billings per year. Providing $10,000 in Medicaid care would come to less than 2 percent of gross charges per year.

You can have it all and still give back to your community!

I want to close with a poem entitled “A Dentist’s Prayer”:

Thank you, O God, for the privilege of being a dentist.

For letting me serve as your instrument in ministering to the sick and afflicted,

May I always treat with reverence the human life which you have brought into being and which I serve,

Deepen my love for people so that I will always give myself gladly and generously to those stricken with illness and pain,

Help me to listen patiently, diagnose carefully, prescribe conscientiously and treat gently,

Teach me to blend gentleness with skill,

To be a dentist with a heart as well as a mind.