Life after dental school

[Geco17]

Hello guys, I am a currently a D2 and have started getting my feet wet on real patients doing minor restorative procedures. I gotta say, I am so happy with my career choice so far! I love so many things about it already. However, there is one thing that has become increasingly frustrating. The more I learn about "the real world" the more
I realize the insane amount of possibilities available out of dental school. I have found this range of possibilities to be a little bit overwhelming. During my time here so far I have gone through the natural progression that most students go through- from the desire to specialize to being hot for general dentistry etc, etc... My latest thoughts are on the realities of being a GP. Up to this point what I have understood/hears about GP's is that they can do "whatever they want" so long as they feel comfortable. As i am progressing through my classes and picking up knowledge i am realizing that there is no way a GP can do "all things" with acceptable quality. For example, implants vs pedo vs crowns and bridges vs rct's vs occlusal guard fabrication.. the list can go on and on and the closer you get to a discipline you realize how different the driving philosophies behind each of them really is. So I guess my question is, for those of you who pursued general dentistry how have you "personalized" your practice? is there really standard procedures that you have cut out of your daily practice and refer to other general dentists? Sorry for the rant... I know its kind of early to concern myself with these types of things, but its kind of fun for me to look to the future and think about what kind of practitioner I want to be! at least it beats studying for my perio quiz tomorrow 😉

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[UncUndergrad1]

losing*

Be a doctor, write like an educated person. This is genuinely difficult to read, so I quit.

 

[Saddleshoes]

The kind of patient pool you are working with will help define what area of dentistry you emphasize and what area of dentistry to forget.

For an extreme example, working in a welfare clinic you may get good at extractions but never come close to doing an implant.

 

[ProspectivePostPreDent]

losing*

Be a doctor, write like an educated person. This is genuinely difficult to read, so I quit.

First, this is a juvenile post. Second, your writing here isn't technically correct, so you committed the one fatal mistake of the writing snob. You couldn't keep it together for two sentences.

 

[2TH MVR]

I like your optimism about your future options. As you said .... as a GP you have many types of procedures at your disposal. You mentioned doing "anything you want" as long as you feel comfortable. I would add to this that you must also be proficient at those procedures. Like another poster mentioned ....depends on where you practice (young families, boomers, high earners, low income, etc. etc.). It also depends on what you like to do. As you will find out .... there are procedures that are profitable and others less so. Lots of variables.

 

[UncUndergrad1]

First, this is a juvenile post. Second, your writing here isn't technically correct, so you committed the one fatal mistake of the writing snob. You couldn't keep it together for two sentences.

Juvenile? You have lots of children coming up to you and correcting your text? No. No you don't.
No one is asking for perfect grammar or impeccable English, but it's reasonable for a doctor to write in a manner that is legible. This is genuinely difficult to read---it's a mess, and **** like this reflects poorly on dentists. I realize this is a relatively private board, but have some self respect. He/she wants advice after dental school? Present yourself like a highly educated adult, because you're supposed to be.

 

[oralcare123]

GP CAN do "all things" with acceptable quality, if he/she wants to

 

[Geco17]

@oralcare123 I agree that a GP can do most things with an acceptable degree of quality ... BUT how realistic really is it? I am wanting to look at it from a real life perspective. Like @2TH MVR mentioned, it isn't just a matter of being able to do it well, but rather a matter of being proficient at it at the same time. I understand that your location will (to some degree) determine the type of dentistry that you practice, but what about your personal appeal for certain types of procedures? I have two particular examples - I recently heard about this GP that practices down the road from my school that has apparently abandoned most areas of general dentistry and dedicated himself almost exclusively to endo. He has been successful enough that other general dentists refer some of their work to him. Another thing that promoted me to start thinking about this, is the discrepancy in procedures performed by GP's in my school. It seems that older professors stay far away from most non-traditional restorative and prosthetic work, while younger faculty are trained in a variety of "niche" fields. I know that regardless of what you like or dislike, GP's will often have very similar day to day lives. However, I was just wondering what are some small or big steps that you (practicing dentist) have taken in order to make your career unique while maintaining acceptable proficiency and quality and at the same time satisfying your own desire to perform or not perform certain type of work.

 

[ProspectivePostPreDent]

Juvenile? You have lots of children coming up to you and correcting your text? No. No you don't.
No one is asking for perfect grammar or impeccable English, but it's reasonable for a doctor to write in a manner that is legible. This is genuinely difficult to read---it's a mess, and **** like this reflects poorly on dentists. I realize this is a relatively private board, but have some self respect. He/she wants advice after dental school? Present yourself like a highly educated adult, because you're supposed to be.

I guess I just don't understand how the OP's spastic writing style is so much less dignified than you connecting two independent clauses with nothing more than a comma.

And if you've never witnessed the unbearable pedantry of immature people in large groups, then you're missing out on half the fun of the internet.

 

[UncUndergrad1]

I guess I just don't understand how the OP's spastic writing style is so much less dignified than you connecting two independent clauses with nothing more than a comma.

And if you've never witnessed the unbearable pedantry of immature people in large groups, then you're missing out on half the fun of the internet.

First sentence: Oh please, shut up.
Second sentence: That's reddit /iamverysmart material.

 

[yappy]

The real life perspective is that a single GP patient pool isn't large enough to warrant investing in the CE, capital, and time necessary to do most specialty procedures. GP differ from specialists in that specialists pull from many offices to build a schedule.
It is difficult to learn advanced procedures without formal training. Indeed, no one is going to pull you aside, shield you from liability, and show you how to do things when they have their own schedule/office. Brass tacks - most insurance companies pay specialists more for the same procedure.
Instead of spending a lot of money on specialty CE, capital, and staff training to do specialty procedures it is usually more lucrative to fill your schedule with bread and butter.

You don't want to be that GP that invested 100k into an implant system just to complete a few a year. Yes, this happens a lot. Beware of people selling shovels.

 

[2TH MVR]

I recently heard about this GP that practices down the road from my school that has apparently abandoned most areas of general dentistry and dedicated himself almost exclusively to endo. He has been successful enough that other general dentists refer some of their work to him. .

Here's the problem with that scenario. We live in a litigious society. When you refer a patient to another doctor for treatment .... you are now part of the liability track. That patient depends on your professionalism and knowledge to direct that patient to the appropriate provider. GPs can do everything as another poster mentioned, but they will be held to the SAME standards as a specialist who has 2-3 years of additional training and is recognized as a specialist for that procedure. Do you want to take the chance of referring a patient to a GP who happens to do a lot of those procedures well ..... or an ADA recognized specialist specifically trained to do those procedures?

I spoke to a GP the other day regarding his referrals. He told me that he gives his patients 3 referral cards and lets the patient DECIDE which specialist to see. This further shields him from possible future liability.

 

[321931]

Here's the problem with that scenario. We live in a litigious society. When you refer a patient to another doctor for treatment .... you are now part of the liability track. That patient depends on your professionalism and knowledge to direct that patient to the appropriate provider. GPs can do everything as another poster mentioned, but they will be held to the SAME standards as a specialist who has 2-3 years of additional training and is recognized as a specialist for that procedure. Do you want to take the chance of referring a patient to a GP who happens to do a lot of those procedures well ..... or an ADA recognized specialist specifically trained to do those procedures?

I spoke to a GP the other day regarding his referrals. He told me that he gives his patients 3 referral cards and lets the patient DECIDE which specialist to see. This further shields him from possible future liability.

I agree with the litigious part, but specialists are trained to handle tough cases. Tough endo, tough pedo, tough surgicals/impacted teeth. I still do on occasion the easy RCT, the easy surgical, the OK pedo patient. You can't be scared to practice, and the reality is that you won't get sued unless you royally **** up which is hard to do...but if you sever the lingual nerve during an impacted wisdom teeth- that's different. The other reality is that your bedside manner will get you sued more often then screwing up a case. If you are an extremely competant GP but do a short endo but terrible bedside manner and that tooth blows up, you can get sued. If you are meh GP but do a short endo and break a file and that tooth blows up and you refer out...but you are nice guy...they most likely won't sue. That's the reality. It's more about bedside manner then anything.

Your GP the other day about 3 referrals is absolutely paranoid. Dentists in general tend to be just paranoid in general. I think your GP with the three cards thing is a bit nonsensical but I understand how he trying to shield himself but at the same time....ridiculous.

The other thing I will comment on GP's doing everything. Do what makes you money. I can bet you that buying a CBCT and placing 2 implants a month is going to bankrupt you. It's better to keep your practice lean and simple rather then spend money on technology. To many people tout technology as a ways to make more money. That isn't the case. You will be contracted with insurance and through insurance you can only charge 800$ for a crown regardless if you did it with a digital impression machine versus a conventional impression.

When you are young and have big bills to pay like your education and practice loan and house, it absolutely makes no sense to buy big money items to "do everything." Keep a lean practice, pay off your debts, and practice 5-10 years and figure out what you like and don't like and what your practice can afford. After 10 years when everything is paid off, then put some money into technology that will make you more money and that you enjoy.

Sales people are ALWAYS willing to sell nonsense because it's their JOB. They rub your ego a lil bit, call you superman, and sign on the dotted line. Now its a paperweight and you have a 10 year note on it. Don't go bankrupt.

 

[321931]

The real life perspective is that a single GP patient pool isn't large enough to warrant investing in the CE, capital, and time necessary to do most specialty procedures. GP differ from specialists in that specialists pull from many offices to build a schedule.
It is difficult to learn advanced procedures without formal training. Indeed, no one is going to pull you aside, shield you from liability, and show you how to do things when they have their own schedule/office. Brass tacks - most insurance companies pay specialists more for the same procedure.
Instead of spending a lot of money on specialty CE, capital, and staff training to do specialty procedures it is usually more lucrative to fill your schedule with bread and butter.

You don't want to be that GP that invested 100k into an implant system just to complete a few a year. Yes, this happens a lot. Beware of people selling shovels.

Yup happens alot more then people think.

 

[ProspectivePostPreDent]

First sentence: Oh please, shut up.
Second sentence: That's reddit /iamverysmart material.

Let me get this right.

First, you call the OP out for not upholding the lofty literary standards of your esteemed profession, and you do so using poor grammar.

Then, you accuse me of acting pompous. Really? Out of anyone in the thread, that's who you'd pick?

I think I'm seeing a pattern here. Sometimes the ol' self-awareness-ometer 3000 needs a little kick to start running again. Give it a try; it's an especially useful tool for "highly educated adults" like yourself.

 

[UncUndergrad1]

Let me get this right.

First, you call the OP out for not upholding the lofty literary standards of your esteemed profession, and you do so using poor grammar.

Then, you accuse me of acting pompous. Really? Out of anyone in the thread, that's who you'd pick?

I think I'm seeing a pattern here. Sometimes the ol' self-awareness-ometer 3000 needs a little kick to start running again. Give it a try; it's an especially useful tool for "highly educated adults" like yourself.

I realize that the concepts of spectrum and significance can be difficult to grasp. There is a difference between word diarrhea, childish mistakes like loose vs lose, and the proper separation of clauses in terms of commas vs semicolons vs new sentences. You're also aware of this, but you wanted to swoop in and be the "look at me, I'm so smart" guy, letting me know my grammar wasn't PERFECT, then using unnecessarily superfluous and bombastic language like a neckbeard wearing a fedora. Everyone look at this guy! He's the smartest in the thread! There's no self awareness that needs to be retuned. My original point stands-- the OP was a mess and not fitting of someone who knows/should be capable of better, let alone reflects on the field we share (because if he/she doesn't care how we perceive her here, she likely doesn't care elsewhere). My second point is that anyone who writes, "witnessed the unbearable pedantry of immature people" in conversation probably owns a fedora and a copy of Atlas Shrugged. That, or you're just young and haven't quite figured out what matters. Probably fresh off 4chan, reddit, or some forum where you love to be a board warrior, but this isn't that. Internet high five!

 

[schmoob]

Let’s get back on topic.

 

[ProspectivePostPreDent]

Let’s get back on topic.

Yep, no problem.

I would mention to the OP that there are a bunch of dental podcasts that dive into this exact topic pretty extensively.

 

[DenTalFluoride]

I’ve been very lucky to have worked with seven dentists at three different offices as an assistant during my gap year. One of the most unethical, arrogant, and even sociopathic dentist I’ve ever met never referred any of his patients. I’ve witnessed him break a thermafil due to frustration and recklessness, garbage and unsupervised orthodontic system for anyone who pays no matter how severe their malocclusion, controversial beliefs such as accepting perforations of the maxillary sinus with implants and shameful disregard to conserving tissue and bone during IV sedated extraction. Of course, this guy is banking with several satellite branches who heavily markets toward the lower income population. First quote that comes to mind from this dentist, “Goddamnit why are all these patient’s mouth ****ed up”.

In contrast, I’m currently working part-time for a dentist in his late 50’s who does everything from quality orthodontics with corticotomy to radiographically beautiful endodontics. He rarely refers out, and mostly to oral surgeons and endodontists for the purely difficult. This guy just simply love dentistry who took several CE seminars in his younger days. He runs one humble clinic with most new patients from referrals. He’s always saying, “Treat your patients such as the way you would want to treat your own mother or brother”.

In the other days, I work at another clinic that just opened July 2017. This dentist focuses only on the bread and butter of general dentistry. She periodically has a periodontist who comes in and another general dentist who does surgical extractions once a month. She’s five years fresh out of dental school, and when I questioned her why she keeps her scope limited, her explanation, “Life is short, difficult and risky procedures are not worth the stress and headaches”. Also, this practice is located at an affluent neighborhood so we get a lot of cleanings and cosmetic only patients.

 

[2TH MVR]

I’ve been very lucky to have worked with seven dentists at three different offices as an assistant during my gap year. One of the most unethical, arrogant, and even sociopathic dentist I’ve ever met never referred any of his patients. I’ve witnessed him break a thermafil due to frustration and recklessness, garbage and unsupervised orthodontic system for anyone who pays no matter how severe their malocclusion, controversial beliefs such as accepting perforations of the maxillary sinus with implants and shameful disregard to conserving tissue and bone during IV sedated extraction. Of course, this guy is banking with several satellite branches who heavily markets toward the lower income population. First quote that comes to mind from this dentist, “Goddamnit why are all these patient’s mouth ****ed up”.

In contrast, I’m currently working part-time for a dentist in his late 50’s who does everything from quality orthodontics with corticotomy to radiographically beautiful endodontics. He rarely refers out, and mostly to oral surgeons and endodontists for the purely difficult. This guy just simply love dentistry who took several CE seminars in his younger days. He runs one humble clinic with most new patients from referrals. He’s always saying, “Treat your patients such as the way you would want to treat your own mother or brother”.

In the other days, I work at another clinic that just opened July 2017. This dentist focuses only on the bread and butter of general dentistry. She periodically has a periodontist who comes in and another general dentist who does surgical extractions once a month. She’s five years fresh out of dental school, and when I questioned her why she keeps her scope limited, her explanation, “Life is short, difficult and risky procedures are not worth the stress and headaches”. Also, this practice is located at an affluent neighborhood so we get a lot of cleanings and cosmetic only patients.

I guess this is what makes dentistry appealing. So many different ways to practice. Not suggesting any one way is better than the next. Example A above is an individual who obviously is motivated by money more so than quality dentistry. The late 50's guy probably has worked hard all his life. Made some good financial decisions early on and can now practice quality dentistry at his pace. Example 3 may have a SO who contributes to the family financial needs therefore allowing her to practice as she wants.

As you can see ..... choices seem to revolve around $$$$$$$$$$$$. Financial freedom gives you the opportunity to practice dentistry how you want to.

 

[yappy]

I guess this is what makes dentistry appealing. So many different ways to practice. Not suggesting any one way is better than the next. Example A above is an individual who obviously is motivated by money more so than quality dentistry. The late 50's guy probably has worked hard all his life. Made some good financial decisions early on and can now practice quality dentistry at his pace. Example 3 may have a SO who contributes to the family financial needs therefore allowing her to practice as she wants.

As you can see ..... choices seem to revolve around $$$$$$$$$$$$. Financial freedom gives you the opportunity to practice dentistry how you want to.

How can you not suggest that method A is inferior to method B? I would never aspire to that. If I knew of a colleague who practiced like that I would have no problem alerting the dental board.

 

[charlestweed]

How can you not suggest that method A is inferior to method B? I would never aspire to that. If I knew of a colleague who practiced like that I would have no problem alerting the dental board.

I wouldn’t jump to a conclusion when I only hear a one-sided story from one former employee, who may not like his boss very much. And the doctor, whom the employee accused of doing poor dentistry, cannot come here to present his side of the story. I don’t think he would be able to attract a lot of patients and have a successful practice like what he has right now, if he consistently performed poor dentistry…no matter how low his fees are. For a dental practice to stay successful long term, the doctor needs to provide good dentistry, which will help him get a lot more word-of-mouth referrals and stay busy. Poor dentistry = loss of patients = no money.

 

[2TH MVR]

How can you not suggest that method A is inferior to method B? I would never aspire to that. If I knew of a colleague who practiced like that I would have no problem alerting the dental board.

I was staying neutral. Not a fan of method A.

 

[TanMan]

I agree with the litigious part, but specialists are trained to handle tough cases. Tough endo, tough pedo, tough surgicals/impacted teeth. I still do on occasion the easy RCT, the easy surgical, the OK pedo patient. You can't be scared to practice, and the reality is that you won't get sued unless you royally **** up which is hard to do...but if you sever the lingual nerve during an impacted wisdom teeth- that's different. The other reality is that your bedside manner will get you sued more often then screwing up a case. If you are an extremely competant GP but do a short endo but terrible bedside manner and that tooth blows up, you can get sued. If you are meh GP but do a short endo and break a file and that tooth blows up and you refer out...but you are nice guy...they most likely won't sue. That's the reality. It's more about bedside manner then anything.

Your GP the other day about 3 referrals is absolutely paranoid. Dentists in general tend to be just paranoid in general. I think your GP with the three cards thing is a bit nonsensical but I understand how he trying to shield himself but at the same time....ridiculous.

The other thing I will comment on GP's doing everything. Do what makes you money. I can bet you that buying a CBCT and placing 2 implants a month is going to bankrupt you. It's better to keep your practice lean and simple rather then spend money on technology. To many people tout technology as a ways to make more money. That isn't the case. You will be contracted with insurance and through insurance you can only charge 800$ for a crown regardless if you did it with a digital impression machine versus a conventional impression.

When you are young and have big bills to pay like your education and practice loan and house, it absolutely makes no sense to buy big money items to "do everything." Keep a lean practice, pay off your debts, and practice 5-10 years and figure out what you like and don't like and what your practice can afford. After 10 years when everything is paid off, then put some money into technology that will make you more money and that you enjoy.

Sales people are ALWAYS willing to sell nonsense because it's their JOB. They rub your ego a lil bit, call you superman, and sign on the dotted line. Now its a paperweight and you have a 10 year note on it. Don't go bankrupt.

I'd agree with most of the points here, but I think it's important to be analytical when it comes to large equipment purchases. The main question you should always ask is: how can I make more money with this piece of equipment. It's not exactly extremes when it comes to buying large equipment, you just need to make sure that it makes you money. Probably the best pieces of equipment would be digital sensors, intraoral cameras, and CEREC. There are some savings when it comes to a digital impression machine (not having to reimpress, materials, trays, etc...), but having a DI/mill definitely makes sense (5 min prep, assistant does all the scan,design, mill, extraoral adjustments, polish, 5 min cement). I could fit in a lot more crowns with this algorithm than I ever could with traditional C&B. Less chair time, no second visits. The point is, most of the equipment out there is a useless expense, but I tend to hear out the sales reps to see if something can increase the profitability of my practice.

I don't think future dentists should be paranoid about litigation. That's why you have liability insurance and hopefully you've saved enough money that your legal team can destroy any litigation that comes your way (or have your liability insurance settle). This is another reason I prefer middle/upper middle class demographic. They tend to be less litigious and have less resources to sue you. Depending on where you practice, tort limits tend to deter a lot of lawyers from taking dental cases unless the patient has lots of time and money on their hands to spend their own funds. Some people may argue that it's bad word of mouth, but I've come to believe that like attracts like (meaning bad patients have social circles that are probably full of bad patients too).

Your chairside manner matters more than anything else. It's interesting to see a contrast of two different practices in my area. There's one guy who consistently does really bad RCT's, still has a lot of patients, and patients love him due to how he interacts with his patients; on the other hand, there's another guy a few miles down the road that does great technical work, but the patients don't like him too much because he's mean and rough with the patients. Remember that there's a person attached to the mouth and how you treat the mouth isn't as important as how you treat the patient as a whole.

tl;dr:
1. Keep an open mind with equipment, determine if it can work with your workflow to make you more money
2. Lawsuits will happen. You have more resources than the one initiating the lawsuit in most instances.
3. Most lawsuits can be prevented based on how you talk to the patients. How you talk to patients is more important than your technical skills. Your work is not going to be 100% perfect every time.