Feeling overwhelmed starting out in private practice :/

[dentaldoc1515]

I'm a recent grad 2015 (post 1 year GPR) had great experience in residency, but now as I start private practice I feel completely overwhelmed. Overwhelmed with the amount of patients, time limitations...Overall I'm just not feeling confident. I sometimes feel that my standards are so high that everything I do I feel slightly disappointed or think if I only had more time..

I know it just takes practice and experience to get better...but it's dealing with the uneasiness of doing things you haven't done before and going out of your comfort zone that kill me..

Any thoughts or suggestions? I guess I'm just feeling a little down about my career choice..the speed, the doing what's best for the patient, and feeling good at the end of the day (major priority for me) with the work I do make me feel like it's gonna be hard to do well enough to live a decent life and pay back my massive loans.

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[Tooth]

Specialize in something easier like orthodontics

 

[johnhancock1]

I felt the same way my first year out. That is why when people ask me if I recommend a GPR, I generally say no because the way you are expected to practice in real life is way different than in an academic setting. Speed is what makes you money in GP and clinically acceptable work (not A work) is all that is expected.

I almost never felt good at the end of the day. But what starts to happen is you begin to rationalize and start thinking like people you are surrounded with. You are unhappy at this time because your perspective of what is right/wrong is shaped by academics (which I believe in the right perspective) and you received validation when you did it the right way. Now you are in a setting where the people do not think like academics and you are being criticized for being unrealistic and slow (making you feel like you are wrong and thus unhappy). Overtime you will start subscribing to the dogma that is out in the private practice world and your perspective will be shaped by them (and you will begin to forget the principles that your mentors in an academic setting taught you). One of the things I can think of is "Well this tooth has no ferrule but it is December and her benefits are about to expire so why not just RCT, Post, and Crown it so she has something for the short term. Who cares about long term prognosis." Or "studies have shown that we don't need to worry about the biologic width because the bone will remodel over the years and create the biologic width. So we don't need to crown lengthen!" Over time after you hear this so many times, you begin to question if what you were taught is wrong in school and you will become happier as your perspective changes. Unfortunately for me, I read the literature everyday and until this very day, I still read the literature.

So my advice to you is if you truly will not be happy with just money and a good lifestyle (GP's can make just as much as specialists these days), then either go into an academic setting or specialize. If you really like restorative, specialize in prosthodontics. You will receive more time to do excellent work and be compensated more for each procedure (so it is realistic to spend time to be a perfectionist). And you will be a making a huge difference in a patient's life. But you won't make as much money as a GP so make sure you know what makes you happy and your motivation in life.

And before GP's kill me, there are great GP's out there that I refer to. But they are definitely not the ones making the most money.

 

[dentaldoc1515]

Johnhancock1--I think you are spot on about the perspective aspect of dentistry and I feel like that is a big reason why I feel the way I do.
Like I said before I'm looking to make a decent salary and have a good lifestyle while feeling good about the work I do. I know speed with come with more experience..I just wanted some reassurance that the way I feel isn't something so abnormal. I'm the first dentist in my family and don't know many people in the field so it's hard to get advice and ask/see what to expect. I considered specializing thinking I might feel more comfortable in one specific aspect then doing a variety of things, but I honestly don't know 100% if thats what I want and it's a big commitment.
To be honest I don't feel the urge to only want to do a certain specialty Another huge factor is taking on more debt. I already have over 300k from dental school and I'm in my early 30's looking to start a family sometime in the next few years. So I'd like to get my feet wet, make money, and work hard a couple years before having kids.

 

[Apramana]

Have you considered community health clinics? With the potential for loan forgiveness incentives, and I would think their reduced potential to overtreat their patients, that seems like it would be an option for you to explore.

I believe @lemoncurry has had a great time as a community health clinic dentist, and he just recently had a thread about his experiences after dental school:
http://forums.studentdoctor.net/threads/ask-me-anything-sdn-oldbie-and-dental-grad-edition.1223544/

 

[shendo]

Have you considered community health clinics? With the potential for loan forgiveness incentives, and I would think their reduced potential to overtreat their patients, that seems like it would be an option for you to explore.

I believe @lemoncurry has had a great time as a community health clinic dentist, and he just recently had a thread about his experiences after dental school:
http://forums.studentdoctor.net/threads/ask-me-anything-sdn-oldbie-and-dental-grad-edition.1223544/

One thing to keep in mind about community health clinics is that in many of them, providers usually will be expected to see between 20-30 patients and if the original poster is feeling overwhelmed with the number of patients to be seen in private practice, then working in a community clinic setting might not be the best option. reading about lemoncurry experience with community clinic, he had already worked in a corporate setting for a few years prior so coming from that type of background, he is already used to seeing a greater volume of patients.
Ladnaania- during your GPR program, on average how many patients were you able to see each day? How many patients are you expected to see at the private practice you are working at currently? One option might be to consider finding another private practice where you are not expected to see as many patients, and also where the owner is willing to take the time to mentor you.

 

[privatedds]

Exact reason why GPR is such a joke.

OP how long have you practiced in PP? You will get used to it within a month or two. I felt like a useless person after my first few weeks in PP as well.

 

[oralcare123]

It will pass. Watch the main dentist and ask for some advice/help from the assistant on how to treat patients faster. Everyone is slow in the beginning

 

[lemoncurry]

I worked at the CHC before I worked corporate. It was my first job outside of school.

To the OP, things will get better. Fresh out of school, I was really pushing to do all my appointments within an hour. I remember I had an a-ha moment when I had about 15 minutes before lunch to do an MO on a kid, and everything just was going perfectly and I was able to get it done. That gave me lots of confidence to start shortening my appointments and really focusing on the process and routine instead of just making a new decision for every step of the procedure.

You start to learn which burs you need and which you don't. I pretty much do all fillings with no more than four burs: a diamond pear, a round slow speed, a football finishing bur and a flame carbide.

As your assistant gets used to you and you to them, you can get on the same brainwave and anticipate each other and you will get faster. But the biggest thing is that you have to learn to trust yourself and trust your training. Sure, your class 2 composite prep may look more like an amalgam prep, but as long as you are confident that the caries are removed and the prep isn't likely to fracture due to undercuts, then move on. Fill that sucker. It comes with time and sometimes you need a kick in the butt to make that next step, but it will happen if you let it.

 

[dentaldoc1515]

My GPR wasn't very high pressure in terms of volume. I did it at a very busy hospital for veterans..it was great in a sense that I did a lot of crown and bridge/restoring implants/ ideal to because finances weren't an issue... but that's not realistic in the real world. Dealing with finances and not ideal situations is reality. I'm working at two very different offices (one I was lucky enough to have somewhat of a mentor) and the other I'm the only doc there on the days I work. It's a good mix, but I guess because I'm so new (only been on pp for 1 month) I find myself so anxious. Anticipating what's next, what's coming in, what if it doesn't go right, do patients like me etc... I'm hoping with time that this will pass? I just worry that I'll always feel this way and not enjoy what I'm doing.. but it's not like I have a choice. I have over 300k in Loans to repay and like i said I'd like to start a family in the next 1-2 years.

I think the other thing that discourages me is the area I'm in heavy populated big city NYC area.. seems very hard to make it here. The plan is to move out of this region within the next year or so...but my question is does it get any better? I almost feel like my whole perception of what dentistry would be has been flipped upside down.

 

[deebog01]

Ladnaania: Your situation sounds a lot like what I (and many, many other dentists) went thru after dental school. I went straight into community dentistry after dental school in a small community in South Texas. I loved the job, but I hated the small city life. It wasn't even a year before I got stir crazy and needed to get back to the big city. Going into private practice was such a shock! I felt overworked, overwhelmed, and over pressured to make what I needed to pay my loans and support myself. 5 years and 4 jobs later in Austin TX (private practice / corporate), I realized that the only job that didn't make me hate dentistry was that first one when I was working for a non-profit. Now, I'm back in community dentistry working in a bigger town and I have never been happier. I discovered that you don't have to move into the boonies to get a job with a non-profit. Go to the HRSA Jobs center, and I'm sure you'll be surprised at what's available in your area. I'm making a little less than I was when I was working for corporate dental, but I get $25,000 / year extra (tax free) to pay off my federal / private student loans, 3.5 weeks of paid vacation per year (goes up to 4.5 next year), 10 days of paid holiday, great benefits, and oh yeah... a 4-day work week M-Th. In a lot of places, after you factor in 401k contribution, health plans/benefits, and loan repayment, you can make the equivalent of $200,000 / yr. Another misconception about public health is that it's only primary care (fillings and extractions). I do root canals, dentures, crowns, fillings... everything. Liability insurance is great too. You don't need to pay for a policy because you're covered by federal tort. That's like the bullet-proof vest of liability insurances btw.

More importantly tho... I have absolutely nobody breathing down my neck, telling me that I need to do more crowns, work faster, see more patients, compromise my ethics. If my schedule is getting too packed, I ask my manager is ease it up. I have no demoralizing yelp reviews, no pressure when the patient flow is low... and in the entire time I've been working here, not a single upset patient. With public health, work stops when I leave the office. My off time is about my wife, travelling, and eating sushi. When patients are getting a filling, extraction, root canal or denture for cheap to nothing, they're grateful instead of picky. There's no better feeling than seeing a patient cry tears of joy over seeing a treatment plan that they can actually afford. If you truly aren't happy with private practice... consider giving public health a try. I hope this helps!

 

[dentaldoc1515]

Ladnaania: Your situation sounds a lot like what I (and many, many other dentists) went thru after dental school. I went straight into community dentistry after dental school in a small community in South Texas. I loved the job, but I hated the small city life. It wasn't even a year before I got stir crazy and needed to get back to the big city. Going into private practice was such a shock! I felt overworked, overwhelmed, and over pressured to make what I needed to pay my loans and support myself. 5 years and 4 jobs later in Austin TX (private practice / corporate), I realized that the only job that didn't make me hate dentistry was that first one when I was working for a non-profit. Now, I'm back in community dentistry working in a bigger town and I have never been happier. I discovered that you don't have to move into the boonies to get a job with a non-profit. Go to the HRSA Jobs center, and I'm sure you'll be surprised at what's available in your area. I'm making a little less than I was when I was working for corporate dental, but I get $25,000 / year extra (tax free) to pay off my federal / private student loans, 3.5 weeks of paid vacation per year (goes up to 4.5 next year), 10 days of paid holiday, great benefits, and oh yeah... a 4-day work week M-Th. In a lot of places, after you factor in 401k contribution, health plans/benefits, and loan repayment, you can make the equivalent of $200,000 / yr. Another misconception about public health is that it's only primary care (fillings and extractions). I do root canals, dentures, crowns, fillings... everything. Liability insurance is great too. You don't need to pay for a policy because you're covered by federal tort. That's like the bullet-proof vest of liability insurances btw.

More importantly tho... I have absolutely nobody breathing down my neck, telling me that I need to do more crowns, work faster, see more patients, compromise my ethics. If my schedule is getting too packed, I ask my manager is ease it up. I have no demoralizing yelp reviews, no pressure when the patient flow is low... and in the entire time I've been working here, not a single upset patient. With public health, work stops when I leave the office. My off time is about my wife, travelling, and eating sushi. When patients are getting a filling, extraction, root canal or denture for cheap to nothing, they're grateful instead of picky. There's no better feeling than seeing a patient cry tears of joy over seeing a treatment plan that they can actually afford. If you truly aren't happy with private practice... consider giving public health a try. I hope this helps!

Thank you so much for the advice! I've always imagined myself in private practice and still kind of do, but this isn't a bad option. I'll have to look into it. Thanks for taking the time out to offer some insight