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Hey docs, hope everyone is doing well. Buckle up, this will be a long post.
I wrote this out for the D3s at my school and thought it was worth sharing for all of SDN.
It is about now when you should start thinking about your future plans with 1.5 years left of school.
The first thing to decide is whether you will pursue specialty training or not. For those of you that will, refer to the bottom of this post.
Since the vast majority are going to be general dentists, I would like to clarify a few things. There are essentially a handful of paths to go as a GP: private practice associate, private practice owner, DSOs, academics, public health (IHS, prisons, NHSC etc), and the military. The benefits are better in terms of retirements, insurance, time off etc outside of private practice. However, the income levels are significantly higher (2-3x if not more) as a private practice owner. The easiest way to pay off debt is to increase your income. I think owning a private practice is the right move for most docs with 300k+ in student loans. How do you find a private practice job as a new grad? or how do you find a practice you want to buy? Firstly, look at your life plans and decide where you and your family want to live long-term. Professional success is not very meaningful with a turbulent home life (also divorce is very expensive.)
If you are certain where you would like to live already, excellent. Drive around the area during your break time and visit the dental offices there. just show up during business hours and chat with the docs and give them your resume and phone number. Look up the older ones that are close to retirement especially. The goal is to have them hire you for a bit and eventually buy out their practice. The best deals are not the ones that are listed by a broker, but rather ones you seek out yourself. Buying straight out of school can work for a select few, but it is very difficult and many banks will not give you any money.
Life no longer works on school years once you graduate, so you can associate for 6 months and then buy. Or longer. If you cannot visit the area, look up all the dentists on google and make a little card with your info and mail it to them. yes, physical mail. You may need to do this 2-3 times in an area to get responses and account for your letter being junked. Wait at least 6 weeks apart between mailing cards. For those of you that are unsure of where to live or can’t find jobs, you can definitely work at a DSO, or in public health. The jobs are definitely available. The reality is that most private practice associateships do not work out beyond a year, which is why I am suggesting you work at an office with the intention of buying it. Working at a DSO/public health has its own set of problems depending on which one, however, you can almost certainly get a job somewhere. May not be your ideal location, so start looking a few months in advance at least. Willamette, Pacific, and Aspen are the big ones in the area I am in amongst others.
I have heard the best things about Heartland dental amidst all the DSOs in terms of supporting new grads with CE and other courses. Heartland is all over the US, but more in the midwest than here. If you work at a DSO, pay specific attention to how they manage their systems as it is usually far superior in business organization to many private practices. Ask the front desk what they do, and how they do it. Figure out insurances. Don’t just show up, drill and leave. Then you can translate their systems into your own practice when you are the owner, or learn what system not to implement and avoid.
Clinic experience: A very legitimate concern that I have heard from many of you is that you will not have very much clinical experience on graduating. What I can tell you is that every new grad dentist has said that for the past century. Is there a huge difference between completing 5 and 10 crowns? I’m not so sure. Of course I encourage all of you to do the maximum you can do in clinic.
What I personally believe is more important is learning how to think like a dentist i.e. tx planning and then having the humility to learn and be mentored by elders. This is a career involving life long learning. You will be constantly updating your education with CE and study clubs your whole life. Personally, I show my cases with radiographs, photos, models etc to three gray haired instructors at our school who are all experienced practitioners and wonderful mentors. I also have several mentors outside of school (some wonderful grads from from my school amongst many others) that I try to do the same thing with to see how they would do things.
It is absolutely essential to find mentorship to succeed in this career. Find instructors right now in school that you can get along with and pick their brains. Yes even if they are not in your clinic group and you have to stay through lunch to hear them talk. Go to study clubs and find people there and also look for mentors online. Most people remember the challenges of dental school and their early career and are willing to help the younger generation.
How can you grow clinically without doing more in clinic? I am a huge believer in self-directed learning. Here are some resources for all of you:
Do not even think about implants till you are comfortable extracting any tooth in the mouth. Do not screw around with ortho at the start of your career, you can cause TMD and significant problems if you don’t know what you are doing. Bottom line, not many people are willing to pay 50k for a FMR even if you trained at the Kois Center.
In person CEs I would take if you can afford the time and money to do so. Inquire about student discounts at all of them and any other courses:
Should you do a residency?
Frankly I think the vast majority of people can benefit immensely from the right residency program. But for those of you that truly feel unconfident in yourself or your skill levels I would say it is essential to do one. You know yourself the best, just be honest. It is better to spend one year under supervision than have a high level of anxiety about performance on routine dentistry in your practice life. A good 1 yr GPR/AEGD can help you gain 5+ yr experience. However, you need to do the right one. a few off the top of my head are San Antonio, Idaho Pocatello AEGD, UBuffalo AEGD, AT Still AEGD, UNLV, and a few others. What is most important is talking to current residents and asking what they do in terms of procedures there as some are less useful than others. Things change from year to year as well so you must ask recent grads or preferably current residents. Reach out via groups like dental nachos, student doctor network, and alumni of your school.
Should you specialize?
If you plan to be a lifelong associate, you are absolutely better off as a specialist. As I mentioned previously many private practice single docs do not know much on how to hire associates and don’t have the pt flow to support it. for this reason many associates do 2 days a week here and there at multiple offices. You can produce what a GP does in a week in a day as a specialist. The jobs at a DSO are significantly better for specialists as compared to GPs. Also bottom line you usually make more money. A business minded GP will do better than a specialist, but the average specialist does better than the average GP. Also your day to day clinical life is easier as a specialist compared to a GP as you are simply better trained at one thing.
If you are concerned that perhaps your grades are not the best, do not worry too much. I personally believe, almost anyone can get into any residency program, it just may not be on the first time (or second). Many programs (esp endo) pretty much require you to do an AEGD/GPR year initially before applying for the specialty. That will strengthen your resume even if your grades are not the best. If you haven’t done any ECs, I’d suggest starting with a research project. the vast majority are online now and are really not that hard to do. you will not be doing bench research in a lab. Try to strategically pick a professor who will also write a recommendation letter for you.
Speaking of rec letters, those of you looking to apply for residencies need to start thinking about who could write your LORs. If applying for a specialty, make every effort to have the program director here at your school write your letter. If your school does not have residencies, start chatting with the specialist that is there and making connections through them. Having a letter from a PD makes an immense difference. Then start thinking about who will write your other letters - you can have a total of 5 letters. Application cycle opens June 1, plan to submit your app as early as you can. Start drafting your PS ideally around now so you have time to give a copy to your letter writers and have a nicely made copy of your resume as well.
These are just some of my brief thoughts as a fellow student. I am looking forward to hearing thoughts from real dentists, and my fellow students so we can all learn and grow to be successful in our future careers.
TL;DR: you can have a great career, but you gotta have a plan. getting mentorship is the single most important thing to a successful career imo
I wrote this out for the D3s at my school and thought it was worth sharing for all of SDN.
It is about now when you should start thinking about your future plans with 1.5 years left of school.
The first thing to decide is whether you will pursue specialty training or not. For those of you that will, refer to the bottom of this post.
Since the vast majority are going to be general dentists, I would like to clarify a few things. There are essentially a handful of paths to go as a GP: private practice associate, private practice owner, DSOs, academics, public health (IHS, prisons, NHSC etc), and the military. The benefits are better in terms of retirements, insurance, time off etc outside of private practice. However, the income levels are significantly higher (2-3x if not more) as a private practice owner. The easiest way to pay off debt is to increase your income. I think owning a private practice is the right move for most docs with 300k+ in student loans. How do you find a private practice job as a new grad? or how do you find a practice you want to buy? Firstly, look at your life plans and decide where you and your family want to live long-term. Professional success is not very meaningful with a turbulent home life (also divorce is very expensive.)
If you are certain where you would like to live already, excellent. Drive around the area during your break time and visit the dental offices there. just show up during business hours and chat with the docs and give them your resume and phone number. Look up the older ones that are close to retirement especially. The goal is to have them hire you for a bit and eventually buy out their practice. The best deals are not the ones that are listed by a broker, but rather ones you seek out yourself. Buying straight out of school can work for a select few, but it is very difficult and many banks will not give you any money.
Life no longer works on school years once you graduate, so you can associate for 6 months and then buy. Or longer. If you cannot visit the area, look up all the dentists on google and make a little card with your info and mail it to them. yes, physical mail. You may need to do this 2-3 times in an area to get responses and account for your letter being junked. Wait at least 6 weeks apart between mailing cards. For those of you that are unsure of where to live or can’t find jobs, you can definitely work at a DSO, or in public health. The jobs are definitely available. The reality is that most private practice associateships do not work out beyond a year, which is why I am suggesting you work at an office with the intention of buying it. Working at a DSO/public health has its own set of problems depending on which one, however, you can almost certainly get a job somewhere. May not be your ideal location, so start looking a few months in advance at least. Willamette, Pacific, and Aspen are the big ones in the area I am in amongst others.
I have heard the best things about Heartland dental amidst all the DSOs in terms of supporting new grads with CE and other courses. Heartland is all over the US, but more in the midwest than here. If you work at a DSO, pay specific attention to how they manage their systems as it is usually far superior in business organization to many private practices. Ask the front desk what they do, and how they do it. Figure out insurances. Don’t just show up, drill and leave. Then you can translate their systems into your own practice when you are the owner, or learn what system not to implement and avoid.
Clinic experience: A very legitimate concern that I have heard from many of you is that you will not have very much clinical experience on graduating. What I can tell you is that every new grad dentist has said that for the past century. Is there a huge difference between completing 5 and 10 crowns? I’m not so sure. Of course I encourage all of you to do the maximum you can do in clinic.
What I personally believe is more important is learning how to think like a dentist i.e. tx planning and then having the humility to learn and be mentored by elders. This is a career involving life long learning. You will be constantly updating your education with CE and study clubs your whole life. Personally, I show my cases with radiographs, photos, models etc to three gray haired instructors at our school who are all experienced practitioners and wonderful mentors. I also have several mentors outside of school (some wonderful grads from from my school amongst many others) that I try to do the same thing with to see how they would do things.
It is absolutely essential to find mentorship to succeed in this career. Find instructors right now in school that you can get along with and pick their brains. Yes even if they are not in your clinic group and you have to stay through lunch to hear them talk. Go to study clubs and find people there and also look for mentors online. Most people remember the challenges of dental school and their early career and are willing to help the younger generation.
How can you grow clinically without doing more in clinic? I am a huge believer in self-directed learning. Here are some resources for all of you:
- Make an account on dentaltown.com. this is an excellent resource that I have learned tons from. Look at their clinical cases and threads like I want to extract teeth. Look up Scott Perkins 15 minute molar endo. John kanca, lane ochi, Michael melkers, Cory Glenn lots and lots of other stuff that you can learn so much from on here. all students also have free online CE on here, I strongly recommend you look at these, they are very helpful.
- Join the dental Facebook groups and look at their cases. by looking at thousands of cases and asking questions from the treating doctors you will start to develop your tx planning ‘muscle.’ These are just a few that I like, there are many more.
- Keep CERECing
- Strupp and Brumm Dental Protocols
- Dental Nachos
- RIPE global
- Articles and solved Clinical Cases - styleitaliano.org great website for learning more on esthetic dentistry.
- Podcast: Shared practices is an excellent way to start. Start with season 1 and work your way through. These episodes are absolutely game changing.
- Again go to dentaltown.com and read everything by Scott Leune. He is an absolute genius. Read every start-up thread on there.
- Sign up for email list serve Helpful Dentist – Best Dental Tips
- Facebook groups again there are many others but start here:
- Practice biopsy
- The business of dentistry
- Mastering Patient Communication
- Dental Practice Start-up
- Again find actual mentors. You don’t need to look very far. Most of our grey haired instructors have owned their own practices and are very happy to chat about it, so just ask them. I have had extensive and wonderful conversations with former practice owners that are faculty at our school in retirement. especially chat with the part timers that come in once a week.
Do not even think about implants till you are comfortable extracting any tooth in the mouth. Do not screw around with ortho at the start of your career, you can cause TMD and significant problems if you don’t know what you are doing. Bottom line, not many people are willing to pay 50k for a FMR even if you trained at the Kois Center.
In person CEs I would take if you can afford the time and money to do so. Inquire about student discounts at all of them and any other courses:
- Bioclear in Tacoma, WA. This is an excellent course on composite restorations, they have their own matrix system which they do try to sell but it is an excellent course. Bioclear Live Learning Center - Bioclear
- Strupp and Brumm Protocols: course on prosth Continuing Education Seminars - William C. Strupp DDS and Michael W. Brumm DMD | Clearwater FL
- We Teach Extractions. This course is a week long and pretty expensive course in Guatemala but I have heard wonderful things about it. Hands On Extraction Class | Dental Development Seminars Again endo/exo should be priority skills for all GPs.
- Breakaway. This is a business course. Take it if you have any interest in owning. Breakaway Dentist Seminars | The Best Dental Practice Management Seminars
- Endo unsponsored in Vancouver, BC. This has a waiting list for a long time and the borders are closed for now but I wish I could have gone to this if I was becoming a GP. Endodontics Unsponsored – Endodontics Unsponsored with Dr. Mark Olesen This course goes through all the major endo systems and allows you to utilize all of them. Many endo CEs are them trying to sell you their files and rotary system. endo should be a high priority for all GPs to learn. Go up to grad endo as much as you can and see how they utilize things as residents can use whatever system they want. Being a referrodontist can significantly limit your production abilities. If you are in a small town, you will not have specialists support anyways and will need to do things yourself.
Should you do a residency?
Frankly I think the vast majority of people can benefit immensely from the right residency program. But for those of you that truly feel unconfident in yourself or your skill levels I would say it is essential to do one. You know yourself the best, just be honest. It is better to spend one year under supervision than have a high level of anxiety about performance on routine dentistry in your practice life. A good 1 yr GPR/AEGD can help you gain 5+ yr experience. However, you need to do the right one. a few off the top of my head are San Antonio, Idaho Pocatello AEGD, UBuffalo AEGD, AT Still AEGD, UNLV, and a few others. What is most important is talking to current residents and asking what they do in terms of procedures there as some are less useful than others. Things change from year to year as well so you must ask recent grads or preferably current residents. Reach out via groups like dental nachos, student doctor network, and alumni of your school.
Should you specialize?
If you plan to be a lifelong associate, you are absolutely better off as a specialist. As I mentioned previously many private practice single docs do not know much on how to hire associates and don’t have the pt flow to support it. for this reason many associates do 2 days a week here and there at multiple offices. You can produce what a GP does in a week in a day as a specialist. The jobs at a DSO are significantly better for specialists as compared to GPs. Also bottom line you usually make more money. A business minded GP will do better than a specialist, but the average specialist does better than the average GP. Also your day to day clinical life is easier as a specialist compared to a GP as you are simply better trained at one thing.
If you are concerned that perhaps your grades are not the best, do not worry too much. I personally believe, almost anyone can get into any residency program, it just may not be on the first time (or second). Many programs (esp endo) pretty much require you to do an AEGD/GPR year initially before applying for the specialty. That will strengthen your resume even if your grades are not the best. If you haven’t done any ECs, I’d suggest starting with a research project. the vast majority are online now and are really not that hard to do. you will not be doing bench research in a lab. Try to strategically pick a professor who will also write a recommendation letter for you.
Speaking of rec letters, those of you looking to apply for residencies need to start thinking about who could write your LORs. If applying for a specialty, make every effort to have the program director here at your school write your letter. If your school does not have residencies, start chatting with the specialist that is there and making connections through them. Having a letter from a PD makes an immense difference. Then start thinking about who will write your other letters - you can have a total of 5 letters. Application cycle opens June 1, plan to submit your app as early as you can. Start drafting your PS ideally around now so you have time to give a copy to your letter writers and have a nicely made copy of your resume as well.
These are just some of my brief thoughts as a fellow student. I am looking forward to hearing thoughts from real dentists, and my fellow students so we can all learn and grow to be successful in our future careers.
TL;DR: you can have a great career, but you gotta have a plan. getting mentorship is the single most important thing to a successful career imo
