One dentist's story of what it took to reopen his practice

When Andrew Bagley, DDS, owner of Bagley Family Dental in Greeley, CO, reopened the doors of his dental practice on April 27, it was more than the start of a new chapter for his business. He was blazing the trail for others in the dental industry who are trying to figure out the "new normal" following the COVID-19 pandemic.

Going back to business was not as easy as opening the doors and turning on the lights and compressor. For Dr. Bagley, there had been plenty of hard discussions with his team and plenty of labor-intensive behind-the-scenes work that had to be done to keep his business functioning and ready to reopen when he got the green light to do so.

Andrew Bagley, DDS.

"Emotionally, I will say I'm burned out," Dr. Bagley admitted. "I think I am to the point where I don't have a lot of energy left to deal with this much longer as far as keeping up with orders, keeping up with laws, and keeping up with different loans to apply for.

"There are so many things dentists have had to stay on top of and, not only that, once we would get on top of them, then it felt like the rules would change about how to apply what we just learned."

Part of those rules and subsequent changes came from Dr. Bagley's home state. Trying to understand what the ADA, the Colorado Dental Association, the state of Colorado, and his local county officials were trying to say and specify was daunting. Sometimes, the information and advice conflicted and changed at lightning speed, he said.

"There is a lot of confusion due to the conflicting directives that we are receiving. Unfortunately, a lot of the confusion comes from the fact that so many different organizations and government agencies are telling us what to do. It can be hard to know what source to trust," Dr. Bagley said. "Governor [Jared] Polis last Monday said we could start elective procedures, then on Friday we got an email stating to hold off on that because we were going to get more information in an announcement on the following Monday. Then, on Sunday, we received a directive from the state saying we were OK to proceed with elective procedures. Then on Monday, after Sunday's directive, we got another directive from the Colorado Department of Public Health [and Environment], creating more confusion."

Dr. Bagley decided to rely on the best information he could and break out the personal protective equipment (PPE) supplies that he had been buying since mid-March when he saw a closure coming.

"I spent a lot of time every day online tracking down appropriate PPE and, as a result, we have the equipment we need," he said. "I kind of saw what was coming, so I have been checking websites every day making sure to get [U.S. Food and Drug Administration]-approved face masks, face shields, gowns, and other items that we need.

"I don't think I was really caught off-guard by any of these new requirements. I had been reading about what they were probably going to be. Even though there are PPE shortages right now, if you ask my staff, 'When is the next time you'll have to order and how long are you good for?,' I think they'd say that we are good for several months before we probably need to order again."

Part of the resources for the PPE purchases came from Bagley Family Dental receiving a Paycheck Protection Program (PPP) loan.

"Having received the PPP loan helps a lot," Dr. Bagley said. "That takes some of the stress off because we now have cash flow and capital to work. It's comforting to know that if we show up to work and all of our patients cancel on us, we have that safety net."

Patient response

But, how do patients feel about coming back?

"I am from a fairly conservative county in Colorado where, bluntly, the people here don't like to be told what to do by the government," Dr. Bagley said. "And, so, I honestly think there are people that will come to the dentist and want to resume their normal lives just because the government told them to stay home for the last several weeks. Those people have been itching to show the government that it's safe. Now they don't have to stay at home, so they won't.

"We probably have had one or two people cancel on us each day. We had a gentleman who was scheduled yesterday and called and was just like, 'I can't do this. I am too nervous.' We told him that was fine with us and encouraged him to do what was best for his situation."

How does a practice accommodate patients while maintaining social distancing guidelines?

"I work in an office where I am the only doc and I have three operatories, plus hygiene," he said. "So we are actually rotating through those operatories, trying not to do back-to-back procedures in the same room. My hygienist is trying to avoid aerosols by hand scaling and limiting her use of a Cavitron."

Then, he paused for a moment.

"Now that leads us to the next question: How do we define aerosols, right? I am going to be sarcastic here, but flushing the toilet is an aerosol-producing procedure," he said. "So, do we now have to shut the bathroom down for an hour after each flush?"

At this point, Dr. Bagley laughs. Through the phone, I can almost sense that a laugh is what is needed at this moment as he starts to think about the new way of looking at his practice and what should or shouldn't be done inside it.

The money part

With the financial aspects being on everyone's minds, I asked how he was adjusting goals for the rest of the year.

"I am not sure this is a time where I am pushing too hard for any sort of financial goals," he said. "I think I have more of a 'let's see how it goes' type of attitude because, for all I know, in another two weeks, we're going to be shut back down because the virus might come back. Also, for all I know, patients might not be comfortable visiting the dentist because there might be a random news story about dentists, right?

"There are a lot of things that, six months ago, were totally within my control that are now totally out of my control. You just have to kind of take it day by day and roll with the punches a little bit."

Taking its toll

It sounds easy on paper, but all of this has had a dramatic emotional effect on Dr. Bagley, his team, and his business.

"It's definitely been emotional, and I don't think I could describe it with just one emotion because there have been so many emotions and we have had to process so much information," he said. "There have been times when I have felt totally overwhelmed. Right now, it is nice just to be back to a routine, although I don't know how long that routine is going to last."