Sue Keller AB '90

The Story

Going into Dentistry from Harvard

I’m originally from outside Erie, Pennsylvania. When I came to Harvard, I played double bass  in the orchestra and also played trumpet in the band. Freshman year, I also learned to row crew (which was something I just wanted to try), and I’m now rowing crew again as an adult, over 30 years later! I was a history major during undergrad, which means I used up all of my elective courses with basic science courses as I was mapping my route for dental school.

I had wanted to be a dentist since I was about six years old, and I knew the importance of comfortable treatment and having a beautiful smile from my own early dental experiences. 

I went to the University of Connecticut Dental School. Dental school was a combination of boot camp and kindergarten-not the greatest experience, particularly after Harvard. I was lucky to go to the University of Connecticut as we actually had the medical and dental students together for the first two years, so I took the same basic science courses as medical students, including full body dissection in anatomy. It was pretty awesome because it was a nice broad exposure to all things medical.  I did a one year general practice residency at Hartford Hospital, which was a major trauma center. Residencies aren’t required for dentists, so it was an extra year of experience working in a clinic setting with local dentists as attendings during the week.  I was also in-house, on-call every fourth night with the Oral and Maxillofacial Surgery trauma team. They didn’t call the dental residents down to the ER for a toothache; they would call us down when a motorcyclist without a helmet launched themselves headfirst into a telephone pole and cracked their skull open and needed the scalp stapled closed. As a first-year resident, my job was to go down to the ER, assess the situation, and do what I could in terms of facial lacerations and care, and call a higher resident for backup. It was a nice process of teamwork, and we got to see amazing things and have great training experiences. As a result, I have a very strong medical background, and can speak with physicians and medical people very comfortably. 

Opening a Practice

In 1995,  I bought a family practice in Greenfield, MA, three miles up the road from where my husband and I lived in Deerfield. In 2000-2001, I went out to Seattle and got some very advanced training on comprehensive treatment, and additional training in oral conscious sedation because I had so many patients who were afraid of being at the dentist. I also did oral wellness talks. I used to give talks at the hospital after my two kids were born on infant tooth care, called “Brushing for Babies,” and this was really fun because I was teaching parents that there were things they could do from Day One to have a healthy mouth. Most people weren’t doing these things.  

With my extra training, I transformed my family practice to make a niche providing comprehensive care for dentally anxious adult patients, building out a space outside Northampton, MA. It was an absolutely gorgeous space, an old mill building with 14-foot ceilings, wooden floors, and huge windows that looked west. It was just an amazing space I built out from a vanilla box. I decorated it so people would feel comfortable. I built the treatment rooms so that all the equipment was behind the patients so really they were just looking out the window. I got rid of the overhead lights and only used a headlamp so they didn’t feel like they were surrounded by equipment.

I made the reception room extra large and I used to have jazz jam get-togethers with my musical friends, lending it out to local music boosters so that they could meet there and created a space that could be used for presentations and as a community space. 

The Great Recession and Industry Changes

I moved into the new office in 2007, just before the major economic recession in 2008. That turned out not to be a great time to take on an incredible amount of debt and move my practice 25 minutes south. I lost two-thirds of my regular patients in the move, so I had to rebuild in the new area. I had gone from taking a couple of main insurances to being insurance-free as well, and it was a real economic struggle. I kind of hit everything wrong with timing for the business aspect of things. Clinically, what I was actually doing as a dentist, was great. 

The medical industry has changed so much in the past 25 years, especially in the areas of marketing, technology, and dental benefit plans (aka “insurance”). When I first established my practice in Greenfield, the main ways of reaching new patients and for them to know that you existed were two things - the sign on your street and the fact that you were in the Yellow Pages. Right around the late 1990’s, multiple dental software companies were competing and buying each other out, and you don’t know which product line was going to survive. In 2001, when websites started coming up, I had one of the first websites in my area. When I moved my practice, my IT guy forgot to quote me $40,000 for the labor cost of the installation process (he had only quoted for the hardware). So from Day One, I was $40,000 more in the hole that I didn’t prepare for and didn’t have a loan for. And I was also in this new building with a tiny little plate on a group sign, across the street from a dentist who owns a building and has a 10 by 14 foot sign, and who has been there for two generations. I don’t think I realized the impact of not having clearly visible signage until many years later, when I learned that many people simply didn’t know my office existed. 

In 2009, I started re-taking a couple of the major insurances, chalking up the write-offs as a marketing cost to build up the patient base after the move and the Recession. Then, about a year later, one of the major insurance companies decided they were going to cut all of the reimbursements by 30 or more percent. My whole practice is based on adults who haven’t been to the dentist for 10, 20, 30 years. They’re anxious and require a lot more time. When I charge for that time with my normal fees “fee-for-service”, I am compensated for the extra training, care, and time I give.  However, to be “in-network” with insurance contracts, I have to accept the fees from the company I’ve signed a contract for, even if these patients are more complex and take much longer to work with than an average patient. I felt that conflict when the insurance company comes in and dictates fees, resulting in the people without insurance subsidizing the reduced fees paid by the patients with insurance.

I was always very ethical, wanting to do my absolute best for the patients and not cut corners with quality, but that left me as the one taking the hit. With reduced fees, all I could do was try to increase the volume of patients seen, which was not going to work for my model of care.   

One of the realities of focusing on anxious patients is that when people wait so long to take care of their health and don’t establish healthy habits, half of the ones that we do the care for disappear again, while the other half become extremely loyal patients. A lot of them had mouths that were so badly broken down, they couldn’t tolerate or afford treatment. So a lot of them, we patched up and went through basic disease control like large fillings to get rid of cavities and periodontal therapy, but they were never able to complete their treatment and go through the reconstruction because they’re such challenging patients and because they weren’t prepared for the cost of their neglect. They come in not just with dental anxiety, but also generalized anxiety. Dental anxiety is easier to deal with because once people have a good experience, they do well. But generalized anxiety was not at all easy to deal with. 

The impact of social media was growing during this time, especially starting around 2012. Some of my colleagues who were not cutting-edge, had established practices and weren’t worried at all about social media or trying to advertise because they had a patient base for the past 30 years. Meanwhile, I was trying to attract people from an hour away. Dentistry is easy. I know how to do it. Treating patients is easy. All this entrepreneurship was much more challenging, and I rarely had staff who could keep up with that level of computer ability, social media savvy, and be able to help me grow the practice. 

I tried to get out of the insurance programs and started doing fee-for-service again. But then there was the cost of having only one doctor producing, with all my costs going up. I just wasn’t prepared to be an entrepreneurial business owner on top of being the primary producer. I learned a heck of a lot about business and marketing, because I was trying to build my own practice in a recession and rapidly changing times. We were just not getting enough profit to make it worthwhile, and I actually closed my practice in December of 2018.

I went from having a successful family practice in a small office in Greenfield to having a beautiful practice that took great care of patients, but was getting hit with every whammy from the recession to technology to social media.

I practice for a year as an associate in a local family practice, taking my patients with me. As a second generation family practice, they had all the patients they needed and didn’t bother much with marketing. I was shocked at how little effort they put into marketing, as their long-term patients provided adequate growth through word of mouth. And then, the COVID pandemic hit, and I was furloughed March 16, 2020. 

The COVID Crisis

COVID has been a living nightmare for dentists. All we do is produce aerosol, for every cleaning visit, drilling, water spray: everything. You have patients coming in, you have no idea whether they have COVID or not, and at the beginning, there was no PPE for dentists, but they were still expecting dentists to take care of emergencies. It was dangerous. 

Meanwhile, it was my 30th Reunion year for Harvard last year, and we went from in February planning a Reunion at Harvard to in March, continuing our planning for the first-ever online reunion, which we accomplished! We had Zoom meetings of all sorts, and within a few months, I realized that I did not want to go back into clinical dentistry. 

Connecting Medicine and Dentistry

When reimagining my career, trying to figure out where I could create the greatest impact in preventing the advanced problems that I saw every day in my private practice, I realized that physicians, pediatricians and family docs, who see infants and toddlers from ages 0 to 3 do not communicate in any regular way with general dentists and pediatric dentists.

Medicine and dentistry don’t talk to each other, because they’re in separate silos. They don’t have an agreement on who’s going to see children and at what age and for what care. Now I’m looking for an opportunity after taking a COVID pause and thinking about the second half of my life career. How can I increase the communication between physicians on the medical side to dentists?

I have an idea of creating a little menu of possibilities, ideas for medical-dental integration for infant/toddler prevention that might work in their community, and to get them talking on Zoom, community by community. Zoom is a silver lining of the pandemic. It has given us the technology to allow diverse groups to meet because they can actually Zoom much easier than actually getting together. 

Pediatricians probably see infants at least 10 times between the ages of 0 and 3 and dentists often don’t see them at all. Pediatricians are seeing these patients and are in a position to get them referred to a happy dental home. We can even teach them to apply fluoride varnish as prevention, or silver diamine fluoride as a stop-gap treatment of cavities. But many medical providers barely look in the mouth, or they look right past the teeth.  But with training and creating a very clear pathway for infant oral health, it’s just a win-win-win for the patients,  the parents, the medical and dental folks, and for society when this connection and collaboration happens. 

Many kids need specialized care, treating kids is not easy, and the impact of a difficult visit can be literally life-long.  I was treating 60-year-olds who were crying in my chair, because of something that happened at a dental visit when they were six. They never healed that psychological trauma, and traumatic things that happen to kids can carry on for a long time, and impact their health care seeking behavior.

Providers need to limit their treatment to within their realm of comfort and competence, and be willing to refer for specialty care when it is in the best interest of the patient.

I don’t expect all general dentists to see kids or treat children; we have pediatric dentists who can do this. But most general dentists can at least see infants for an exam, then keep them for preventive care if they are cooperative, or refer them to a pediatric dentist, with specialty training for managing and treating infants, toddlers, and children of all ages. Dental offices need to be clear about who they can treat and know when and where to refer younger patients. 

The Importance of Prevention

I had been called into a local children's theatre because they needed a dentist to do a cameo appearance for their production of “How I Became a Pirate.” The pirates had green teeth and there was a dentist involved. I had taken a few improv classes, and I’m a musician, so they picked the right person for stage presence! I basically wrote out a two and half minute segment where I wrote a rhyme to match the pirates, who spoke in rhyme:  

Are you brushing after each meal and snack,

Drinking water in between?

Do you floss all the sides/scrape the germs off your tongue?

Wonderful, let’s see how clean!

After I did those shows, people came up to me afterwards and thanked me. Kids found me on the streets and said, “I know you, you’re the dentist from the pirate show! Are you REALLY a dentist?” It was hilarious, it was fun and easy, and I was making a difference. People were listening. That reminded me of Schoolhouse Rock from my 1970’s Saturday morning cartoon-watching days. So now I realized that we needed to do something with social media, and to make a difference I would have to go to the national stage. Now Tik Tok is taking off, so I’m doing a 60 second Tik Tok based on brushing for babies, based off of the Baby Shark song. It’s going to be an earworm, and people are going to remember it because it’s cute with me and all my puppets with little toothbrushes, matching the music to get that preventative care message out.

I realized that younger people are getting all of their information online. So I realized I had to build this space where I can give some information that would be helpful to community health. I treated all these anxious adults who were in their 30s, 40s, 50s, and 60s. Their disease is huge.

I’m trying to get my preventive care message to all pregnant women. The prevention of disease is cheap - it’s just a toothbrush and toothpaste and floss and knowing that you have to use it after meals and drinking water in between. Anyone can do that, you need no money to do that. If you go to any dental office and tell them you can’t afford these items, you will leave with a bag of them all. I was talking to a pediatrician, and she realized she could have toothbrushes at her office. Nobody should go without, or share, a toothbrush. Kids should be able to brush their teeth in school, but now kids barely have the time to go to the bathroom. This preventative care message will make it so that we spend less money on treatment, and more on people who fall through the cracks and can help more people. 

Women in Leadership

Our (Covid-cancelled) Thursday night 30th Reunion event about the history of Women’s Suffrage turned into every Thursday lunchtime Zoom that we now call the Radcliffe Circle. My colleagues and my classmates, we talk about everything from the history of women’s voting to Black Lives Matter to other social justice issues. During these times, I am able to talk with colleagues who are in business, law, doing non-profit work, breaking down so many silos with interdisciplinary connections. I also realized I love working with intelligent, diverse, engaged women.

The Radcliffe Circle has provided a wonderful, safe, on-going learning environment.  I like that collegiality, the collaboration, working with other smart and caring people. In my next career, I want to work with peers, not employees or patients, and talk to them on a collegial  level.  

I also belong to the Mommy Dentists in Business Facebook group, with over 8500 women nationwide. It’s just so nice to see that people are in a similar situation as you, so that we can bring people together and talk about cases or what awful thing happened at the office or with employees and how to get support for it. Sometimes, the best support is just knowing you are not alone. I wish this group had existed when I was starting my practice. FB groups have definitely allowed for national/international professional groups that are an incredible support to practitioners. Younger colleagues are so stressed out trying to raise a family and own their own practices, especially during Covid times, which have been devastating to dentistry (since everything we do produces an aerosol).  These women went into dentistry so they could help people have good health, have some control over hours and make a good living. Now, they’re finding this pressure that they have to buy a private practice - like that’s the gold standard. I say, no, no, no. It’s just not that easy owning a practice, especially as a solo practitioner as the times are changing.

Because I have shared my experience of leaving clinical dentistry, I’ve had many women reach out to me on Messenger or call me on the phone to just talk through why they’re hating dentistry, or how things are not going the way they should. I give them advice to help them decide the next step. It’s been very rewarding for me to show women that they have choices, that they aren’t stuck, and if their situation isn’t working out for them, they have options, including walking away. Sadly, several women dentists died of suicide during the pandemic. I never want someone to feel so trapped professionally that they would rather die than walk away. Too often, we become our careers, and that’s not healthy. There are always options, different directions to go. 

I think there will be huge benefits over the next 5 to 15 years, when more of dentistry moves out of the single dentist practice model and moves to small group practices where ethical dentists are in charge, not big corporations--those are dangerous for patients and providers alike. Medical providers went down a different path. There are almost no independent physicians anymore: almost all are affiliated with hospitals. Yes, hospitals do provide support, training and marketing, but I don’t like the competitive systems. If I’m in a hospital system, and I want to go to the best specialist overall, they might not be in my system. As a provider, I would be prohibited from referring outside the system. I consider that restriction on referrals out of network to be unethical. 

When I first moved to western MA, I wanted to get involved in the local dental societies. There was a Franklin County society, a Hampshire County Society, and the larger regional Valley District society. Attending my first Hampshire meeting, I was the only woman at the meeting. I happened to be wearing a white blouse and blue navy slacks. At the end of the presentation, one of the older male dentists actually turned to me and asked me to get him his coffee. He thought I was a server. That just goes to show how underrepresented women were at the time in those meetings, and even though I was the only woman in attendance and new, he didn’t take the time to meet me or even notice me, and assumed that any woman in the room was a working for the restaurant. Locally, we also had a women’s group of dentists (about 70 women strong now), which is awesome and something I’ve really enjoyed being part of for many years.  When I first started around 1995, I didn’t see many women dentists owning their own practice, although that number has increased over the last 25 years. When I first went to a women’s group dinner meeting, a woman dentist about 20 years older than me attended. Towards the end of the meeting, she admitted that she had come to the meeting to object to their being a separate women’s group. Her generation had worked so hard to be ncluded at the men’s meetings, she wanted to tell us that we were taking a step backwards for women in the profession. Then she apologized.

She said that she had had such a wonderful time getting together with the other women dentists and feeling supported and heard, she realized that a separate women’s group was exactly what was needed, in addition to the larger regional and more localized county groups.

Shortly thereafter, I went to one of the Executive meetings at the larger regional dental society, and I was one of two women there (I knew the other woman, an oral surgeon, from our women’s meeting).

One of my male colleagues, a specialist on the fast-track to leadership positions in organized dentistry, started talking with me, asking why we needed a separate women’s group, asking “Don’t you feel welcome at this meeting?” As I was about to answer, one of his male buddies walked by, punched him in the arm, and asked him, “How about those Holy Cross Crusaders?”  My colleague turned away from me, talked with his friend about college sports for a few moments, and then turned back to me. At which point I said, “And that is why we need a separate women's dental group.” He looked a bit sheepish and nodded.

Now, the men, their idea of holding a meeting at that time was to scream at each other about whatever was on the agenda, quote Robert’s Rules of Order and argue about who was allowed to talk next, and really spent a long time not accomplishing much. I wanted to get involved, but these meetings, held 45 minutes from where I lived, were so unenjoyable that I didn’t go back for many years. It simply wasn’t worth my time to be involved and to have nothing positive happen. I stayed out of organized dentistry, with the exception of helping plan the continuing education meetings. 

Fast forward to 2019. When the President-elect of the MA Dental Society heard about our women’s group, she came out to Western Massachusetts to one of our meeting, and had a great experience. And she shared some important wisdom with us.

She explained that we should continue to come to larger group meetings, saying, “Listen, if you ladies don’t like what’s happening at these meetings, they’re not going to change if you aren’t at those meetings. You need to get a group of women to go together and sit at a table together.”

Somewhat begrudgingly, we took her advice. There had been some bad blood a few years back when the regional dental society cut ties with the women's group and the Hampshire County group. Now,  change was happening. The regional group was losing attendance at its meetings. There was a change in leadership, and that new leadership had daughters in dentistry. I do believe that is the biggest agent of change in patriarchal groups--when the older men start having their daughters join the profession, they are much more open to change. They wanted to know how to attract the members of our smaller local groups back into the main group. They invited representatives of both groups to dinner, made their ask around notifying our membership about the larger meetings and encouraging us to attend, and allowed us to make our ask about support in contacting are members utilizing the email listings of the society, creating a win-win.  Simultaneously, they changed the structures of the meetings and the committee's and began to run an extremely organized efficient meeting with good humor and much more diversity of participation. So change started happening as we came back to the regional group, and now I actually looked forward to these meetings because the current leadership was creating positive change. Membership grew as a response. And the women banded together, attended together, and sat together, and, as a result, were finally noticed and taken seriously.  We were asked to put ourselves on the ballot for leadership positions in the society, someone many of us hadn’t wanted to do before. That made a huge difference in moving many more women into leadership positions at the local and state levels. 

There is a huge lesson of positive change here. When we step away from a situation that we find unpleasant, we lose our voice. If we want to have a voice, not only do we want to stay in the situation, but we have to bring our allies with us and step in to do this together and make changes. Changing the system alone is too hard. Gathering allies and working together is hard work, but meaningful and can be fun as well, and better effect the desired change. We also learned that the existence of focus groups strengthens the larger group rather than weakening it. Giving people the opportunity to gather in groups of like interests create an engaged connected community, which can then be brought to the larger community.

A Last Few Words… 

It has now been a year in this COVID pause, since I left clinical dentistry in March of 2020. I have spent the year learning, growing, and reinventing myself, physically, socially, intellectually, and professionally. I have most recently been volunteering with the Medical Reserve Corps of Franklin and Hampshire Counties, and giving the COVID vaccine to the people in my community. I find great meaning in being of service to my community, and helping our most vulnerable populations get vaccinated. I get to work with the public health nurses, and the firefighters, paramedics, EMTs, nurses, physicians and veterinarians in my community, Working as a team to get groups of five patients vaccinated every 20-25 minutes. I love the teamwork, the collaboration, and being of service! I’m in a building with 45-60 patients, 20-30 volunteers and workers in the course of three or four hours, but I feel completely safe compared to what I would’ve felt on any given day going in to treat patients as a dentist, in a small space with aerosols created constantly. 

What comes next for me professionally? As wonderful and supportive as my Harvard Class of 1990 classmates are, I am the only dentist in my undergraduate class of 1600 people. Not very many Harvard undergrads to go on to dental school, from what I have seen. Being the class dentist did come in handy one year at our reunion planning committee meeting, when one of my classmates lost a temporary crown, and I was able to put it back in place for her at the meeting (They still talking about it at the Reunion Committee meetings!) I would love to meet up with other people who are interested in healthcare integration and getting medical and dental fields out of their silos, to join forces across the fields, and to talk with each other about how each community can great a plan for dental wellness, so that every baby can grow up to have a strong and healthy smile. 

Sue (Sisak) Keller, DMD

AB 1990 | History 

DMD 1994 | University of Connecticut School of Dental Medicine

General Practice Residency, Hartford (CT) Hospital

Dentist, founder and former President of Strong & Healthy Smiles by Dr. Sue Keller

American Dental Association Institute for DIversity in Leadership Class of 2019 - 2020

Interviewed and Compiled by Felicia Ho