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As a former resident, I would like to share my experience at the San Antonio VA AEGD directed by Dr. Alan Scott Douglas.
My intention is not to solely promote this one residency, but also to inform those interested in completing an AEGD/GPR of what can be accomplished in an additional year of training at a high quality residency.
To the best of my ability, this is an honest and accurate account of my experience. I also included rough number ranges for cases that are typically completed.
San Antonio VA AEGD residency:
Pros:
Dr. Douglas is an incredibly dedicated program director whose primary goal is to push his residents to be the best clinicians possible. He has been the director of the residency for the past 27 years. He is the heart and soul of the program and has dedicated his career to advancing the dental profession though education and research ---- Reason enough to look into this residency
The veteran population presents the VA dentists with a large volume of complex treatment needs. The US government pays for the treatment for the veterans seen in the residency. There is no need to work on ‘selling’ dentistry until you are actually comfortable providing the advanced procedures taught in the residency. The primary care dentists working at the VA complete most of the basic general dentistry. The complex patients are referred to the residents and specialists.
Coverage: There are typically 6 residents. Often one or two of the residents are on oral surgery, anesthesia, geriatric or pediatric rotations. The remaining residents are covered in a 2:1 or 3:1 ratio of attending instructors (General dentist, Endodontist, Periodontist, Prosthodontist, etc).
Each day of residency starts with 1 hour of lecture in the morning before clinic for the day. There are weekly lectures on perio, endo, prosth and all facets of dentistry. Towards the end of the year Dr. Douglas even lectures on investing/saving for retirement (Dr. Douglas was an accountant prior to pursuing dentistry). Before and after clinic, residents will organize/review cases with Dr. Douglas.
At the beginning of residency, there is a denture rotation with the prosthodontist to learn about the fabrication of implant-retained dentures. In the morning he lectures on the step you are about to perform. Directly after, you watch the prosthodontist perform that step on his patient. In the afternoon, you complete this same step on your own patient with him covering. The whole process occurs this way with each resident completing his or her own case. The same occurs with a one-on-one surgery to complete open flap debridement surgeries termed: Demo 0 (periodontist does surgery with everyone watching how the sedation/surgery is conducted), Demo 1 (periodontist completes the surgery with you assisting) and Demo 2 (periodontist assists you during the surgery).
Competence in various procedures should be a factor of quantity of cases competed while upholding a high level of quality. For example, when placing implants, most cases should start with diagnostic casts, wax-ups, surgical/radiographic stents, CBCT studies and final treatment plan/discussion with restoratively driven implant placement.
The following facets of dentistry listed below are taught to a high level of competence:
Implant Dentistry: diagnosis and treatment planning of dental implants; fabrication of surgical guides; utilizing interpretation of cone beam images and Simplant CBCT guided implant stents; surgical placement (immediate, delayed immediate, edentulous) and restoration of dental implants; use of custom abutments; fixed and removable implant retained over-dentures and partial dentures.
30-80 implants. Typically around 50 implants
Esthetic Dentistry: diagnosis and treatment of altered passive eruption, dento-alveolar extrusion, and vertical maxillary excess; restoration with porcelain veneers and Emax crowns; CEREC Omnicam inlays/onlays; internal and external bleaching (in-office and at home trays).
Many large veneer cases
Periodontics: esthetic and functional crown lengthening; bone grafts (including use of Sonic Weld technology); open flap debridement; osteotome sinus lift; ridge split; Alloderm connective tissue grafting. Socket preservation/Guided bone regeneration: using materials such as Bio-Oss, Bio-Gide, GEM21S, Emdogain.
Extensive surgical experience in of the above procedures. 1-2 sedation surgeries each week, however surgery can be done most days under local anesthesia.
Endodontics: rotary instrumentation (Profile, Protaper and GT files); cold lateral/hybrid warm vertical obturation; experience with endodontic treatment of molars; non-surgical endodontic retreatment, apical surgery. Many calcified cases due to aging veteran population.
Approximately 40-60 cases. Typically 10-20 molars. A few re-treatments/apicos.
Oral Surgery: simple and surgical extractions; soft tissue biopsies; operating room experience
Tons of surgical extractions/bone grafting
Prosthodontics: full mouth rehabilitation; re-establishing occlusal vertical dimension; advanced crown and bridge
Extensive experience with full mouth and single arch rehabilitations. Typically around 3-6 FMRs on average.
The VA has an on-site lab which is great for delivering big cases. The tech with often come in the room to evaluate/change contours/stain etc.
Obstructive Sleep Apnea: treatment with Thorton Adjustable Positioner (TAP) appliance.
TMD: occlusal guard therapy, management of acute TMD conditions
Orthodontics: Invisalign; using fixed orthodontics to aid in complex restorative treatment plans. Orthodontist present for 2 days every other week.
Pedodontics: Pulpotomy, Stainless Steel crowns, Space maintenance. (Rotation at Santa Rosa childrens hospital has been temporarily discontinued, but may start back up soon)
IV Sedation approximately 40-50 cases
Extensive experience treating medically compromised patients
Clinical Photography - Each resident is given their own SLR camera and is expected to take high quality photos. At the end of the year, each resident gives a 1 hour case presentation illustrating all of the exciting cases they have completed throughout the year.
Throughout the year, each resident presents 2 treatment planning presentations on complex cases they have worked up as well as a research presentation on a topic of their choice.
Opportunities for community dentistry: Community dental clinics (ie. Haven for Hope), Free dental days (Dentistry from the Heart) etc
Compared to most other residencies there is a generous stipend
San Antonio is a great place to live. It’s an inexpensive city, favorable tax situation, lots activities, good food options. Also near Austin, which is a whole another experience in itself.
Cons:
Limited pediatric experience, however there are plans to re-start the pediatric residency rotation soon.
Limited third molar experience, however some impacted cases can be completed on the oral surgery rotation. Some younger veterans (early 20’s are being discharged and still need their 3rd molars removed).
Time consuming. Expect to put in a lot of time after hours and possibly on weekends to get the most out of the residency experience (this is actually a benefit to the residency). Residents who complete this residency are highly motivated and typically opt to stay late after treating patient to allow for treatment planning, lectures and lab work. Also, the residents are never ‘on call’
Some more info:
In addition to Dr. Douglas, there are multiple highly trained general dentists with 1 or 2 year AEGD experience on staff.
There are many full time specialists on staff: 2 prosthodontists, 1 endodontist, 2 oral surgeons, 1 periodontist, 1 TMD/oral path/oral radiologist/geriatric dentist.
1 part-time orthodontist.
As you can see, this residency will put you many, many years beyond your dental school experience. There is an optional second year of residency, but it is not common for residents to feel the need to say an additional year due to the condensation and intensity of the residency training. There was never a day that didn’t feel like I learned a ton.
The residents and instructors typically have very good relationships. The instructors are always open to discussing cases during and after hours. The residents are known to bond during the residency and often spend time together outside of the residency.
D3 and D4 dental students often visit the residency to shadow for just 1 day or up to 1 week. This is a great way to get a taste of what the residency is like.
I am happy to answer any questions about the residency. I also had learned about other residencies during the application process, but I obviously feel most comfortable discussing this program due to my experience there. There are a lot of other programs out there, but I felt like this one offered the highest volume of high quality experiences. The 6 resident typically produce around 5 million dollars of dentistry (based on old fee scales from the 90s, so it’s probably a lot more in todays dollars).
If you would like to shadow the residency or have any questions, please contact Dr. Douglas at [email protected]
My intention is not to solely promote this one residency, but also to inform those interested in completing an AEGD/GPR of what can be accomplished in an additional year of training at a high quality residency.
To the best of my ability, this is an honest and accurate account of my experience. I also included rough number ranges for cases that are typically completed.
San Antonio VA AEGD residency:
Pros:
Dr. Douglas is an incredibly dedicated program director whose primary goal is to push his residents to be the best clinicians possible. He has been the director of the residency for the past 27 years. He is the heart and soul of the program and has dedicated his career to advancing the dental profession though education and research ---- Reason enough to look into this residency
The veteran population presents the VA dentists with a large volume of complex treatment needs. The US government pays for the treatment for the veterans seen in the residency. There is no need to work on ‘selling’ dentistry until you are actually comfortable providing the advanced procedures taught in the residency. The primary care dentists working at the VA complete most of the basic general dentistry. The complex patients are referred to the residents and specialists.
Coverage: There are typically 6 residents. Often one or two of the residents are on oral surgery, anesthesia, geriatric or pediatric rotations. The remaining residents are covered in a 2:1 or 3:1 ratio of attending instructors (General dentist, Endodontist, Periodontist, Prosthodontist, etc).
Each day of residency starts with 1 hour of lecture in the morning before clinic for the day. There are weekly lectures on perio, endo, prosth and all facets of dentistry. Towards the end of the year Dr. Douglas even lectures on investing/saving for retirement (Dr. Douglas was an accountant prior to pursuing dentistry). Before and after clinic, residents will organize/review cases with Dr. Douglas.
At the beginning of residency, there is a denture rotation with the prosthodontist to learn about the fabrication of implant-retained dentures. In the morning he lectures on the step you are about to perform. Directly after, you watch the prosthodontist perform that step on his patient. In the afternoon, you complete this same step on your own patient with him covering. The whole process occurs this way with each resident completing his or her own case. The same occurs with a one-on-one surgery to complete open flap debridement surgeries termed: Demo 0 (periodontist does surgery with everyone watching how the sedation/surgery is conducted), Demo 1 (periodontist completes the surgery with you assisting) and Demo 2 (periodontist assists you during the surgery).
Competence in various procedures should be a factor of quantity of cases competed while upholding a high level of quality. For example, when placing implants, most cases should start with diagnostic casts, wax-ups, surgical/radiographic stents, CBCT studies and final treatment plan/discussion with restoratively driven implant placement.
The following facets of dentistry listed below are taught to a high level of competence:
Implant Dentistry: diagnosis and treatment planning of dental implants; fabrication of surgical guides; utilizing interpretation of cone beam images and Simplant CBCT guided implant stents; surgical placement (immediate, delayed immediate, edentulous) and restoration of dental implants; use of custom abutments; fixed and removable implant retained over-dentures and partial dentures.
30-80 implants. Typically around 50 implants
Esthetic Dentistry: diagnosis and treatment of altered passive eruption, dento-alveolar extrusion, and vertical maxillary excess; restoration with porcelain veneers and Emax crowns; CEREC Omnicam inlays/onlays; internal and external bleaching (in-office and at home trays).
Many large veneer cases
Periodontics: esthetic and functional crown lengthening; bone grafts (including use of Sonic Weld technology); open flap debridement; osteotome sinus lift; ridge split; Alloderm connective tissue grafting. Socket preservation/Guided bone regeneration: using materials such as Bio-Oss, Bio-Gide, GEM21S, Emdogain.
Extensive surgical experience in of the above procedures. 1-2 sedation surgeries each week, however surgery can be done most days under local anesthesia.
Endodontics: rotary instrumentation (Profile, Protaper and GT files); cold lateral/hybrid warm vertical obturation; experience with endodontic treatment of molars; non-surgical endodontic retreatment, apical surgery. Many calcified cases due to aging veteran population.
Approximately 40-60 cases. Typically 10-20 molars. A few re-treatments/apicos.
Oral Surgery: simple and surgical extractions; soft tissue biopsies; operating room experience
Tons of surgical extractions/bone grafting
Prosthodontics: full mouth rehabilitation; re-establishing occlusal vertical dimension; advanced crown and bridge
Extensive experience with full mouth and single arch rehabilitations. Typically around 3-6 FMRs on average.
The VA has an on-site lab which is great for delivering big cases. The tech with often come in the room to evaluate/change contours/stain etc.
Obstructive Sleep Apnea: treatment with Thorton Adjustable Positioner (TAP) appliance.
TMD: occlusal guard therapy, management of acute TMD conditions
Orthodontics: Invisalign; using fixed orthodontics to aid in complex restorative treatment plans. Orthodontist present for 2 days every other week.
Pedodontics: Pulpotomy, Stainless Steel crowns, Space maintenance. (Rotation at Santa Rosa childrens hospital has been temporarily discontinued, but may start back up soon)
IV Sedation approximately 40-50 cases
Extensive experience treating medically compromised patients
Clinical Photography - Each resident is given their own SLR camera and is expected to take high quality photos. At the end of the year, each resident gives a 1 hour case presentation illustrating all of the exciting cases they have completed throughout the year.
Throughout the year, each resident presents 2 treatment planning presentations on complex cases they have worked up as well as a research presentation on a topic of their choice.
Opportunities for community dentistry: Community dental clinics (ie. Haven for Hope), Free dental days (Dentistry from the Heart) etc
Compared to most other residencies there is a generous stipend
San Antonio is a great place to live. It’s an inexpensive city, favorable tax situation, lots activities, good food options. Also near Austin, which is a whole another experience in itself.
Cons:
Limited pediatric experience, however there are plans to re-start the pediatric residency rotation soon.
Limited third molar experience, however some impacted cases can be completed on the oral surgery rotation. Some younger veterans (early 20’s are being discharged and still need their 3rd molars removed).
Time consuming. Expect to put in a lot of time after hours and possibly on weekends to get the most out of the residency experience (this is actually a benefit to the residency). Residents who complete this residency are highly motivated and typically opt to stay late after treating patient to allow for treatment planning, lectures and lab work. Also, the residents are never ‘on call’
Some more info:
In addition to Dr. Douglas, there are multiple highly trained general dentists with 1 or 2 year AEGD experience on staff.
There are many full time specialists on staff: 2 prosthodontists, 1 endodontist, 2 oral surgeons, 1 periodontist, 1 TMD/oral path/oral radiologist/geriatric dentist.
1 part-time orthodontist.
As you can see, this residency will put you many, many years beyond your dental school experience. There is an optional second year of residency, but it is not common for residents to feel the need to say an additional year due to the condensation and intensity of the residency training. There was never a day that didn’t feel like I learned a ton.
The residents and instructors typically have very good relationships. The instructors are always open to discussing cases during and after hours. The residents are known to bond during the residency and often spend time together outside of the residency.
D3 and D4 dental students often visit the residency to shadow for just 1 day or up to 1 week. This is a great way to get a taste of what the residency is like.
I am happy to answer any questions about the residency. I also had learned about other residencies during the application process, but I obviously feel most comfortable discussing this program due to my experience there. There are a lot of other programs out there, but I felt like this one offered the highest volume of high quality experiences. The 6 resident typically produce around 5 million dollars of dentistry (based on old fee scales from the 90s, so it’s probably a lot more in todays dollars).
If you would like to shadow the residency or have any questions, please contact Dr. Douglas at [email protected]
