Looking to the Military for a Few Good Educators

In this month’s letter, Dr. Rick Valachovic looks at how military service can prepare dentists for encore careers as dental educators.

About 10 years ago, I had the honor of participating in a national educators’ tour sponsored by the U.S. Army Medical Field Service School at Fort Sam Houston in San Antonio, TX. I met uniformed health professionals of all kinds and came to more fully appreciate their commitment to the needs of both healthy soldiers and those who had returned from conflicts with injuries. Impressively, all the dentists with whom I interacted were either already board certified or on the path to board certification in general dentistry or a dental specialty program. But what struck me most was how the entire health care team was focused on its mission: keeping service personnel healthy and ready to deploy.

Oral health is rarely the first thing that comes to mind when people think about national readiness, but dental conditions, including not having enough teeth, have been among the most common medical reasons for deferment from military service since the Civil War. In fact, the label “4-F” to denote a medical deferment originated back in the days when recruits needed (and often lacked) four front teeth with which to bite down on a gun powder cartridge so they could tear it open with one hand.

Loading today’s weapons no longer relies on the users’ dentition, yet even in the 21st century, dental readiness remains a concern. When the army called up members of the National Guard and Army Reserve to deploy to Iraq in the early- to mid-2000s, roughly 50% of these citizen soldiers had dental problems that made them unfit to serve overseas. Like many other Americans, guardsmen often lacked dental insurance or the means to pay for routine dental care. A change in Army regulations in 2010 reminded reserve troops that they are responsible for their own dental readiness and charged commanders with ensuring the dental readiness of the troops they lead, incentivizing everyone to promote and maintain better oral health.

In contrast, active-duty service personnel can receive dental care at little or no cost, thanks to a robust corps of military dental officers. ADEA Senior Scholar in Residence Leo Rouse, D.D.S., FACD, was one of them, and he ultimately served as Commander of the U.S. Army Dental Command.

“When you have a unit with poor dental readiness, you can’t deploy,” Leo told me, or as he likes to say, “If your troops can’t eat, they can’t fight.” When Leo was stationed in Germany, he made this case with Norman Schwarzkopf, who was then a one-star general. “Just imagine,” he told him, “if one of the folks who operate these tanks has an acute episode of dental pain. It could affect how they operate the equipment.”

If the name Schwarzkopf is not familiar to you, he became a four-star general and then a household name when he commanded coalition forces during the Persian Gulf War. Fortunately, he and others in the military shared Leo’s views, and over the decades, the services have established a series of dental centers and postgraduate programs where service members can receive excellent care.

The Dean of the Boston University (BU) Henry M. Goldman School of Dental Medicine, Jeffrey W. Hutter, D.M.D., M.Ed., attended one of these programs at the National Naval Dental Center (now the Navy Postgraduate Dental School) in Bethesda, MD. Before graduating from the University of Pennsylvania School of Dental Medicine, he sought a commission as a lieutenant in the U.S. Navy Dental Corps. The position came with a two-year service obligation, and he and his wife soon discovered that they liked the military lifestyle and the educational opportunities the Navy offered. “You were a naval officer first, then you were a Dental Corps officer,” he recalls, which was a far cry from the private practice existence he envisioned for himself while still in dental school.

Jeff was eager to specialize in endodontics, but before he could apply for an advanced education program, he needed to complete a shipboard or foreign duty tour. Choosing to “go to sea,” he served on a destroyer tender that maintained naval vessels in the Mediterranean. “We were fixing the sailors’ teeth while the tender was fixing the ships themselves,” he told me, and there was plenty of care to be provided. “It didn’t take long to realize that our mission was to keep the sailors, marines and soldiers ready to deploy or go to war at any time.”

Following his specialty training, Jeff was sent to the Naval Dental Center in Pearl Harbor, HI, where he says working with junior dental officers gave him his first taste of what being an educator might be like. He asked to serve next at the National Naval Dental Center in Norfolk, VA, home of the world’s largest naval base. There he ran the endodontics department and developed a one-year fellowship program in endodontics. After four years at that duty station, Jeff began to see himself as an educator, a reality that was confirmed by his next posting as chair of the department of endodontics and director of the Advanced Specialty Education Program in Endodontics at the National Naval Dental Center in Bethesda. “I went from being a resident in the program to now running the program itself,” he recalls happily.

By the time Jeff retired in the summer of 1996, he knew he wanted to stay in education, and his rise through the ranks at BU confirms that academia has been an excellent fit for this retired military officer. That comes as no surprise to Leo Rouse, who made the same transition himself and eventually served as the Dean of Howard University College of Dentistry.

“If you want an outstanding faculty member, you can’t do better than someone from the military,” Leo believes. Why? To have a successful military career, you must be a good officer as well as a good dentist, he says, and the qualities that officers possess work well in an academic environment. Collegiality, strategic thinking and the ability to plan, evaluate, manage and budget can be especially valuable as faculty members rise through the ranks. Leo began his academic career as a faculty member in the Dental Science Division at the Army Medical Department Center and School (AMEDDCS) at Fort Sam Houston. When he retired from the Army in 1997 and transitioned to an academic position at Howard University, he was able to advance to the roles of Associate Dean for Clinical Affairs and Chair of the Department of Clinical Dentistry. As Leo put it, “People saw I could walk and chew gum at the same time.”

John Valenza, D.D.S., Dean at the University of Texas School of Dentistry at Houston (UTSD), sees something similar in the military veterans who make up as much as 10% of UTSD’s faculty. “Military veterans have a unique experience that prepares them well for an academic environment,” he told me. “It’s not just how they lead as faculty. It’s also how they work with students. They bring insight to helping others learn and advance, an ability that translates well in teaching roles.”

As John points out, retired military dentists also understand structure, learning curves and advancement processes, knowledge that prepares them well for the rigors of promotion and tenure. And because the military attracts a diverse cross-section of Americans, recruiting faculty from the veteran population also helps make dental schools more diverse. That’s important at a public institution such as UTSD, John says, that wants faculty, students and staff to reflect the population of the state.

During my visit to the Medical Field Service School at Fort Sam Houston, and more recently through my service on the Veterans Administration National Academic Affiliations Council, I’ve also come to appreciate that veterans bring another invaluable asset to academic dental institutions: knowing how to function as part of a team. Military health professionals are focused on the mission, and that focus is key to their ability to dismantle the barriers that have traditionally stood in the way of interprofessional education and collaborative care. What better group could we look to for future faculty than these board-certified dentists for whom interprofessional collaboration is the norm?

The challenge is making the connection between military service and academic dental careers. Most military dentists have only worked in military environments. We need to provide them with opportunities to become acquainted with civilian academic culture, so they can see how easily they might fit in.

As Jeff Hutter’s experience illustrates, military service is imbued with educational opportunities that provide an excellent foundation for future academic careers, and officer training provides leadership experiences that would be hard to come by in the civilian dental world. “The Navy gave me the tools to be a leader and to work with students, residents, faculty and staff as a team,” Jeff told me. He is grateful for that experience, and we should be, too. It’s a privilege to welcome retired military dentists to our academic institutions, and I hope we will be welcoming more of them soon.