Public Health Advocate Balances Quality of Life While Treating the Underserved

"I knew my real love in clinical dentistry was at the population level,” said Randi Tillman, DMD, MBA.

Managing the work/life balance was important to Randi Tillman even at a young age. And she had an excellent role model: her father, a well-respected dentist in Springfield, Massachusetts who enjoyed many interests beyond the office. From playing the piano to riding a moped and reading voraciously, Tillman’s father embraced the quality of life many people strive for but never achieve.

“I was very fond of my father and had a great deal of respect for him, both intellectually and professionally,” said Tillman, DMD, MBA, who today is the assistant vice president and chief dental officer at The Guardian Life Insurance Company of America. His influence, she added, was what motivated her toward a career in dentistry, “because I perceived it as giving me an opportunity to really balance career and family life.”

Tillman took that opportunity and ran with it.

EARLY INFLUENCES

Tillman recalls having the good fortune to do an internship for three summers while in dental school within public health services. One of those stints was in the Alaska Native Medical Center in Point Barrow, Alaska, located north of the Arctic Circle. Early exposure to public health, she said, enabled her to think about dentistry in terms other than just private practice.

“We didn’t have a term for it, but it really made me aware of population health,” she said. “How can we affect more than just the individual patients who come into our office?”

Tillman began thinking more about minorities and healthcare; about underserved communities and about the poor distribution of dentists. She acknowledges it was the first time she became aware there were people who didn’t have access to the services she had taken for granted her entire life. And it set the stage for much of the future work she would do on the business side of dentistry.

“I think that as I evolved as a practitioner, I knew my real love in clinical dentistry was at the population level,” Tillman said.

That interest grew during her tenure as an associate professor at the Columbia University School of Dentistry. Tillman received a grant from the National Institutes of Health to establish a curriculum in geriatric dentistry. At the time, there was very little discussion about how to treat older patients. The assumption, she recalls, was that older people would lose their teeth, and there was nothing more to it.

“In fact, that has proven not to be the case,” she said.

That experience laid the groundwork for what would become a lifelong interest in treating the underserved.

CRUISING ALONG

In the 1980s, Tillman had an interesting opportunity to work part-time as the dental director for Holland America Cruises, a post she held for seven years. She was responsible for placing dentists on cruise ships and writing policy for the care of crew members and officers. She was compensated with a salary, and sometimes with free cruises.

But that doesn’t mean it was all smooth sailing.

Tillman recalls that the majority of the crew on Holland America cruises at that time were Indonesian, Filipino and Dutch.

“From an epidemiologic perspective, it was very interesting,” she said.

For example, while she often saw the same level of neglect among the different populations, she would see—due in part to their different diets—dissimilar patterns of disease. For Filipinos who had a high sugar diet, Tillman witnessed a lot of tooth decay. For Indonesian populations, however, there was greater incidence of periodontal disease.

“I always felt somebody should do a study of the different populations on a cruise ship,” she said.

BRIDGING THE GAP

Over the course of her career, Tillman has become adept at bridging the gap between clinicians and payers. That is challenging, because there is historical friction between the payer community and providers.

For example, she explained that the clinician side is focused primarily on what is happening with one patient, as he or she should be. The business side is responsible for balancing the needs of multiple stakeholders: the employer (who usually purchases the benefit package), the patient, and the corporation (the insurance carrier). In order to keep the cost of dental insurance affordable, carriers, like Guardian, develop cost containment policies. These policies are contractual agreements.

“There may be times when a dentist recommends a procedure which is not covered by the insurance carrier; however, it may be in the best interest of the patient to have the procedure done nonetheless,” Tillman explained.

Dental insurance, she added, would be too expensive if there were no plan limitations.

“For me, this is why choosing the right insurance carrier to work for was so important, and why I’ve enjoyed my time at Guardian,” Tillman said. “The company is truly committed to doing the right thing and applies this mindset to help inform our decision-making on how to best serve our customers.”

FOCUSED ON PREVENTION

Tillman said the interesting thing about dentistry is so many of the problems people have are preventable.

“Dentistry is really two diseases,” she says. “It’s dental decay, and periodontal disease. And both of those can be prevented with proper home care and seeing your dentist on a regular basis.”

Sounds simple, yet people still make poor choices.

“People haven’t changed,” Tillman said. “People still, for whatever reason, don’t want to brush or floss regularly, or partake in good oral hygiene habits. It just seems to be our nature.”

And that’s why Tillman is so thankful that she has had the opportunity to make a difference in patients’ lives, especially in terms of education about oral health and its relationship to overall health.

“That’s where I’ve had the biggest impact.”

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