In a Predicament - Endo or Pedo

[Endo or Pedo]

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Hi All,

I have been an active reader for some time of this forum and am grateful to you all for the wealth of information you share with the community. I have been practicing general dentistry for about 4 years now and am preparing to apply for my residency this year. I asked myself a series of questions (including the passion, living with the rest of the life., etc) but could not arrive at a single outcome (I admire those of you who could bottom out to one single passion). I am equally passionate about both Endo as well as Pedo as both of them have their own merits that interest me. I really do not know what I would choose if I were given both the residencies. I am sure some of you might have gone through the journey and would seek your inputs to streamline my thinking and make my choice. Here is my current thinking

What I like about Endo:
- Ability to save natural tooth
- Ability to significantly help patients from pain and other root issues
- Constantly Evolving Field with many technological advancements and a lot to learn
- Requires significant skill and passion to be good at it
- I already perform many of the RCTs (except the most complex multi-rooted molars) and enjoy doing it with precision (although I take about 70-80 min on an average)

What I do not like about Endo:
- Some people make me believe that the field is getting generic with Rotary and other commonplace advancements for the general dentist
- that the number of female residents are few and far in between (dont know why this bias - you might have realized by now that I am a female)

What I like about Pedo:
- Kids..Kids..Kids. Although some of them are challenging (which I like) I like working with kids for most part
- Ability to perform all kinds of kids dentistry including some ortho part
- Ability to master and advance in anasthesia
- Equal number of female dentists given the opportunity by admission committee

What I do not like about Pedo:
- Limit to perform basic dentistry for most of the day
- competing with general dentists for the patient pool

Just for reference, here is my profile. I am a female dentist with 4+ years experience. Part 1 - 90. Part 2 - 87. GPA about 3.8 with Dean's Honor list in many of the trimesters. lots of volunteer work in the field of dentistry.

I seek your help on the following:
- Please read and correct me if my thinking above regards the two fields is accurate. Please feel to differ, add or update with the future of these specialties. Also I would like you to tell me if there are any best known methods (like keeping touch with the key faculty members, associating with the school..) that may help in improving my chances while I go through the application process.

I truly appreciate any guidance.

Regards,
Katt

 

[senpai]

Flip a coin 😉 Just kidding, but really you can't go wrong with either one, they are both great specialties and my only advice would be to talk to people in each field and in residency and try and decide which specialty you would be the happiest doing. I wouldn't worry about any sort of supposed gender bias, I think it's more personal/personality preference as to why perhaps more women go into pedo and less go into endo. I know atleast at the endo program at my school and the 2 other programs nearby that there are several female residents. Your obviousely qualified so any sort of prejudice demonstrated by the program you could always just sue the hell out of 'em and make your money that way 😉 jk... I only know of a few programs in OMFS that haven't had a female resident in a number of years, but that is mostly do to the fact that the atmosphere at those programs is such that no decent woman would ever want to go there, i.e. a bunch of big, shaved-head brutes who love to fart, tell dirty jokes, and hit on the nurses in the OR. My kind of program👍

 

[smogdodger]

Katt, I can see where you are coming from. I was also interested in two specialties. It sounds like you have pretty even likes/dislikes about both endo and pedo PROCEDURALLY. So, I would have to guess that your tie-breaker lies elsewhere. An endo office IS NOT a real social environment (usually). Most patients are one-time basis so there is not a strong staff-pt relationship. Endo staff is generally very small because you are limited to 1-2 patients at a time so you don't need a big team to keep things rolling. Such offices are more quiet. Pedo offices are fun, social, and require great relationships with patient families. You've got a large list of patients each day and parents who want to ask you how to help their children. Its an environment for dentists who likes educating people.

So, from my viewpoint, it looks like you are down to acknowledging your personality type. Are you a social person who likes interaction with lots of people (larger staff, patient families, etc) or would you rather escape people (i.e. more introverted) to the point you just want to focus on a task in a quiet environment? It seems that these kind of differences make the difference between clinicians who are excited to go to the office on Monday and the ones who are dreading the week ahead, particularly for dentists who have been at it for 15-20 yrs. And by the way, the endo program at my school had about 50% female residents (if that's a real hang-up).

 

[omaralt]

Well why dont you remain a general dentist and limit yourself to mostly (or all) only pedo and endo? Why specialize? Keep in mind the lost income and then only limiting yourself to one speciality. You seem to Have a passion for both so keep doing both.

 

[senpai]

Well why dont you remain a general dentist and limit yourself to mostly (or all) only pedo and endo? Why specialize? Keep in mind the lost income and then only limiting yourself to one speciality. You seem to Have a passion for both so keep doing both.

I've never really understood this argument... Wouldn't you be losing a ton of income by limiting yourself to just certain procedures as a general dentist? The whole idea of specializing in regards to finances is that it's an investment to recieve extra training to then recieve REFERRALS form GP's who don't have the SPECIALIZED training in certain procedures, which = more of the green.
I just can't see a general dentist telling all of their patients to get lost, except for the kids and the ones who need a root canal and expect to survive. If it's a simple root canal or an easy going kid, why would any GP refer that patient to a GP who has the same amount of training when they can do it themselves? And if it's something beyond what the GP can do, what makes you think that a GP with the same amount of training would be able to do it?
I know that there are some GP's that get extra training in certain procedures (CE, etc.) or are just good at certain things, but the egos of the GP's must kick in somewhere and say: "I'm the best d*** GP in town, if I can't do it, no other GP can and there's no way I'm referring to this clown who thinks he/she's some sort of pseudo-specialist..."

 

[Blue Panther]

I've never really understood this argument... Wouldn't you be losing a ton of income by limiting yourself to just certain procedures as a general dentist? The whole idea of specializing in regards to finances is that it's an investment to recieve extra training to then recieve REFERRALS form GP's who don't have the SPECIALIZED training in certain procedures, which = more of the green.

"I'm the best d*** GP in town, if I can't do it, no other GP can and there's no way I'm referring to this clown who thinks he/she's some sort of pseudo-specialist..."

Hire an associate, and cherry pick the pedo and endo cases for yourself. Do those cases in house which would normally get referred out. While completing those cases to the standard of care of a specialist... which goes without saying.

 

[senpai]

Hire an associate, and cherry pick the pedo and endo cases for yourself. Do those cases in house which would normally get referred out. While completing those cases to the standard of care of a specialist... which goes without saying.

The first part of your post makes sense and addresses the dilemma of building up a patient pool, however, I would argue that you would probably need to hire multiple associates to keep busy.
But what makes you think that a GP with no training beyond 4 years of dental school would be able to complete those cases that normally get referred out with the same standard of care as a specialist?
A highly disagree with the philosophy of "why specialize when you can do everything a specialist can do as a GP?" It's just simply not true...
I don't think we should underestimate the benefit of extra training/education. After 4 years of dental school you are very limited to basic/routine procedures w/o additional training. I even have friends in GPRs/AEGDs who claim that they've learned more & enhanced there skills more within 6 months of doing that than they learned in 4 years of dental school.

 

[omaralt]

I've never really understood this argument... Wouldn't you be losing a ton of income by limiting yourself to just certain procedures as a general dentist? The whole idea of specializing in regards to finances is that it's an investment to recieve extra training to then recieve REFERRALS form GP's who don't have the SPECIALIZED training in certain procedures, which = more of the green.
I just can't see a general dentist telling all of their patients to get lost, except for the kids and the ones who need a root canal and expect to survive. If it's a simple root canal or an easy going kid, why would any GP refer that patient to a GP who has the same amount of training when they can do it themselves? And if it's something beyond what the GP can do, what makes you think that a GP with the same amount of training would be able to do it?
I know that there are some GP's that get extra training in certain procedures (CE, etc.) or are just good at certain things, but the egos of the GP's must kick in somewhere and say: "I'm the best d*** GP in town, if I can't do it, no other GP can and there's no way I'm referring to this clown who thinks he/she's some sort of pseudo-specialist..."

the lost income i'm referring to is the income lost during residency. 2-3 yrs of residency = ~$400K in lost income (at least, if not more)

 

[senpai]

the lost income i'm referring to is the income lost during residency. 2-3 yrs of residency = ~$400K in lost income (at least, if not more)

Understood, although I would probably agree that it's a little more than that... But the whole idea is that it would be an investment and that in the long run you would end up making more as a specialist even taking in to account the opportunity cost of advanced training vs. continue working

 

[Pedosmakebank]

I don't blame you for looking at both specialties. For me personally, I don't think I could sit in an office and just do endo all day. Albeit, endos do make a healthy income. I hate to admit it, but like you, I thought about specializing in endo for that reason :/

However, I think pedo is catching up to endo. I know some pedos that make insane amounts of money. You will have to see a lot more patients though, which, is the only negative in my book. Just remember, if you do it for the right reasons, the money will come. I think you're making a wise decision financially though. Just my 2 cents... Good luck in your decision!

 

[Huggies]

It's interesting that you mention that one negative of pedo is that dentistry is limited to basic dentistry, yet endo is really only limited to one procedure. To me endo is more limiting in terms of procedures than pedo, but it depends if you like "basic dentistry". For me it's what I enjoy the most. I could do fillings all day long and be happy. Of course like you mentioned you do a lot of other procedures that are interesting. In pedo, the challenge is behavioural aspect of working w/ kids and knowing pathology that you don't deal w/ often as a GP. I spent a lot of time shadowing a pedo dentist and was amazed at the cases that were sent to him, staff I never saw as a GP.
Like somebody mentioned however, the atmosphere of a pedo practice is soo different from that of endo, in fact they're total opposites. I have a hard time believing that someone could honestly be interested in both.... but perhaps that's because I couldn't do endo...mostly b/c of the slow pace of practice (I do enjoy doing rct's).

I think your best bet would be to spend some time in both practices just to see what the flow of practice is like. Pedo is something you really have to love and be passionate about or it will destroy you. Most people that do it love it, but one of my friends quit after 5yrs, saying ..."I just can't deal with the brats any more"

 

[Endo or Pedo]

Hi All, Thanks a lot for all your advise and constructive feedback. I have done some soul searching based on this analysis and have decided to hold off on applying for either speciality for now. Here are the key points it came down to:

1) I have come to realize that I enjoy the gamut of procedures I perform as a GP. I could not think of myself as limiting to a particular speciality and sticking to it all day...For eg., I thought. How would the day be if all that I do from morning to evening is RCT. Or how would it be if all that I deal with is challenging kids all day. I started to immediately feel the void of not doing other procedures (OS, Restorative, Cosmetic...). Or feel the urge to interact with other age groups as I enjoy talking to all of them and am very social.

2) I may be working harder and drawing less salary/profits as a GP when compared to a speciality but I thought it is OK as it is better to work the variety of procedures that would make me happy and in the long run of life, few hundred thousands dont make that much of a difference. I wanted to look at this decision independant of financial angle.

3) I normally enjoy doing some challenging work (like Molar Endo, Surgery, Perfect occlusion, .... may be in the future Implants). Since these span across multiple areas of Dentistry I thought I will depend more on the CE path to constantly reach higher levels of competence in these procedures and offer them in my practice and refer the real complicated cases to specialists

4) Have two little kids (5 and 2) and a spouse that works in a sr management position. This leaves our hands full and may a 'status quo' may give me more time to focus on the family and a better work-life-stress balance

5) I will continue to work as a GP for one more year and see if my passion clearly drifts towards any particular specialty. Else, I will continue to enjoy the multitude of procedures as a GP and go through rigorous CE to take my skill to next level across select few advanced procedures.

Please contrinue to share your thoughts and I will keep posting from my end as things change

 

[Huggies]

Good luck with that, sounds like a wise decision... try focusing on one particular area and really growing and advancing your skills in that one specific area.
Good luck. 🙂