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great job blog. i look forward to reading more.
MY FIRST JOB: A retrospective blog
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New DDS on the Block: Private Practice Blogumentary 2
Time for a one month update (already?).
So at this point, I am actually happier than I expected I would have been. Which is why I think I am happy. Its all about expectations. DO NOT SET YOURSELF UP FOR DISAPPOINTMENT BY HAVING UNREALISTIC EXPECTATIONS COMING OUT OF SCHOOL. This is setting yourself up for stress, hardship, anxiety, emotional anguish and potentially even depression. All of which would make your life miserable. You know what thats just a good rule to have for almost anything in life. Learn how to tame your expectations, without hampering your ambitions.
Re-asses your expectations, and align them with reality. Dont start your marathon with a spirnt, and burn yourself out midway by chasing money and over-expansion. This is a life-long career, and its about endurance. Slowly but surely. Making the big bucks is not as an associate out of school. Making the big bucks is owning your practice and having 1 associate/partner, 2 hygienists and a 3 day weekend. Thats the life. As an associate, you can expect to make a decent living, but certainly no where near your potential.
I digress. Back to the posting. So I am happy to be where I am right now. I think I have picked up even more speed, have become slightly more efficient, and am less intimidated by it all. In general, I handle myself pretty well, but being the only Dentist at the office right out of school/residency can test ones character at times, and Im sure it is not for everyone. It gets especially challenging when youre already running late, and find out that a couple of emergencies have been added on to the schedule, and the hygienist has been waiting for an exam for the past 10 minutes. And youre patient is not getting numb ! Yup, if you ever run into difficulties (and you will) getting a patient numb (redhead or not), it will happen when you are running behind at least that has been my luck
Production is probably a good topic to discuss now, now that Ive been at it for roughly a month. Take into account that my numbers might be on the lower end, since Im still building steam, seeing new patients for exams (unproductive time in the short term), and just not nearly as efficient as I can become with more practice.
When it comes to productions, there are really three numbers you need to know:
Office fee schedule productions
What you charge for certain procedures in your office. Mostly, you can only charge this to private pay patients, ie, you charge $1250 for a PFM crown.
Insurance fee schedule productions
What you agree to accept from the respective insurance company as a fair compensation for your work, ie, Aetna reimburses you $700 for that very same crown you would otherwise charge private pay patients $1250 for.
Collections
What you actually take to the bank, after denied claims, disputed coverages, re-dos, write offs, copayments and what not, ie, your staff never collected your patients $10 copayment for the fluoride treatment your hygienist did a couple of months ago.
Im not paying close attention to my numbers at this point to be honest with you, but I think Im doing ok. I sometimes like to add up just roughly what I produced on certain given days, just out of curiosity. The practice manager thinks Im a workhorse, which I take to be a good sign. But then again, the last dentist was 8 months pregnant and left for maternity, which to me was a pretty easy act to follow. No 20-minutes-late morning sickness here.
Production goes in cycles. There are no 2 days alike. I dont think anyone can expect to consistently produce any given number every day, so you need to talk about averages (monthly, quarterly, ). Some days are big, others are duds. Some days I produce $1000, others I may produce $5000 or even more. Some days Im web surfing or reading most of my time, while others Im just trying to keep my head above water. Some days I feel like I am not even earning my paycheck, others I feel like I am being taken advantage of ! Im still on my 3 months daily guarantee period, no production bonuses. Oh, and by the way, 35% taxes is a bit too much Connecticut. Seriously
Case acceptance for me has been at a good rate so far. Patients are returning for recommended treatment, keeping me busy, which is good.
Take the time to talk to your patients ! Education is the key to case acceptance. If you present a big treatment plan, and the patients does not see the value of it, then what is the urgency ? If you take the time however to educate your patient on why they need a crown on that MODB amalgam on #3 with 2 cracks on it, you get their attention. I can not tell you how many times (well actually I can, about 6 so far), Ive explained to a patient that a specific tooth is at risk of fracturing, and recommend full coverage, when there immediate response was Thats what happened with this tooth, pulling their cheeks back with an index finger to show me their other crown. I bit down on a piece of bread, and broke the tooth. It hurt like hell !. Crown now or root canal and crown later ?
One of the most frustrating things was (and actually still is, but to a much lesser extent), when you start at a new job, every single patient you encounter is a new patient. I dont now about you, but Im not taking responsibility for someone elses treatment plan. You can be a drill/fill dentist, working off a work order, or you can approach your patients comprehensively. I stay after being done with patients almost every day, review the next days schedule and charts, and go line by line through the treatment plans and radiographs, making sure I agreed with whatever was on there. I then make notes on my schedule so I know exactly what Im doing for that particular patient. Update bitewings, caries control, discuss medications whatever just be prepared. Its also the best way to keep yourself busy. When reviewing treatment plans, I occasionally catch interproximal lesions needing treatment, but since the last dentist never had time for an exam after the patients last cleaning, no one ever noted them in the chart. Other patients never got previous treatment completed, but are still coming back for cleanings. That is exactly what you dont want. A DO diagnosed in 2007 will turn into endo, given enough time. Simple things like that. They all add up.
Now that I am getting some of my own treatment plans back, things are going much smoother, and the anxiety level has been dropping ever since.
On a bizarrely related topic, a couple of Fridays ago was probably the weirdest day Ive seen in practice yet. Im not even sure how to explain it, but Id say that I was almost 90% certain my office was being Punkd. I kid you not. We had 6 emergencies (all new patients) on the same day all nut jobs, straight off their meds. It was u-n-b-e-l-i-e-v-a-b-l-e !!! I was in total disbelief ! What was even more shocking, is when I called the practice owner to give him a few good laughs, her shrugged the whole thing off as it happens a lot, its a full moon. What ? When did we start accepting Aetna HMO for werewolfs ?
Its normally not that crazy though. I barely see enough interesting patients to make my commute worthwhile. Every now and then youll get the occasional know-it-all or weird patient, which come to think of it now, makes for good stories later.
I like to discuss my findings directly with the parent whenever possible following pedo exams (not through the assistant or hygienist). So, as usual I was going through my findings and recommendations with one of the parents, and you know recommended sealants. And that was it. I saw the most horrible facial expression known to man, drawn on the moms face, followed by the punch line of the day; Well, my sister is an ophthalmologist, and she told me that sealants cause cancer. Why would ever recommend them?. (assistant giggles, stumbles out of the room). I calmly dispel that idea, and refer mom to none other than google for more info. Next stop, pedodontist (sorry guys, but yeah that was me).
Another dad (notice how it is usually overbearing parents of helpless sweet little shy kids) was a little worked up after hearing that his little girl has 6 cavities, citing that she has great teeth, 6 is way too many. In her defense, two of them were buccal pits, and the four others were interproximals on baby teeth (mo/do, mo/do). But heres when it gets interesting I love this part dad was obviously concerned and asks to see the x-rays. Wow. As he looks at the radiographs, he explains to me that he is recovering from knee surgery, and had the opportunity to look at most of his x-rays, so he has been trained in this. I dont see anything, he exclaims, which is when I had the tough job of gently breaking the sad news to him you dont know how to read x-rays ******* ! Needless to say, he asked for his daughter to see a different provider at the practice for a second opinion. And to that I say, good riddens (the other dentist decided to watch one buccal pit, but treated the other 5).
I never totally believed my professors in dental school, when they would say that in practice you would hardly ever worry about the clinical aspects of the actual dentistry (the prepping/temping/endo accessing/drilling) and how it would become second nature, but I am starting to see that now. Its more about managing a frighteningly diverse mix of patients, each with their own individual needs and expectations to be met. Its about doing a good job, quick and getting it right. All the time. Its about hiring, firing, ordering supplies, med consults and yes its about money. Your bottom line.
And thats the bottom line.
More to come
Time for a one month update (already?).
So at this point, I am actually happier than I expected I would have been. Which is why I think I am happy. Its all about expectations. DO NOT SET YOURSELF UP FOR DISAPPOINTMENT BY HAVING UNREALISTIC EXPECTATIONS COMING OUT OF SCHOOL. This is setting yourself up for stress, hardship, anxiety, emotional anguish and potentially even depression. All of which would make your life miserable. You know what thats just a good rule to have for almost anything in life. Learn how to tame your expectations, without hampering your ambitions.
Re-asses your expectations, and align them with reality. Dont start your marathon with a spirnt, and burn yourself out midway by chasing money and over-expansion. This is a life-long career, and its about endurance. Slowly but surely. Making the big bucks is not as an associate out of school. Making the big bucks is owning your practice and having 1 associate/partner, 2 hygienists and a 3 day weekend. Thats the life. As an associate, you can expect to make a decent living, but certainly no where near your potential.
I digress. Back to the posting. So I am happy to be where I am right now. I think I have picked up even more speed, have become slightly more efficient, and am less intimidated by it all. In general, I handle myself pretty well, but being the only Dentist at the office right out of school/residency can test ones character at times, and Im sure it is not for everyone. It gets especially challenging when youre already running late, and find out that a couple of emergencies have been added on to the schedule, and the hygienist has been waiting for an exam for the past 10 minutes. And youre patient is not getting numb ! Yup, if you ever run into difficulties (and you will) getting a patient numb (redhead or not), it will happen when you are running behind at least that has been my luck
Production is probably a good topic to discuss now, now that Ive been at it for roughly a month. Take into account that my numbers might be on the lower end, since Im still building steam, seeing new patients for exams (unproductive time in the short term), and just not nearly as efficient as I can become with more practice.
When it comes to productions, there are really three numbers you need to know:
Office fee schedule productions
What you charge for certain procedures in your office. Mostly, you can only charge this to private pay patients, ie, you charge $1250 for a PFM crown.
Insurance fee schedule productions
What you agree to accept from the respective insurance company as a fair compensation for your work, ie, Aetna reimburses you $700 for that very same crown you would otherwise charge private pay patients $1250 for.
Collections
What you actually take to the bank, after denied claims, disputed coverages, re-dos, write offs, copayments and what not, ie, your staff never collected your patients $10 copayment for the fluoride treatment your hygienist did a couple of months ago.
Im not paying close attention to my numbers at this point to be honest with you, but I think Im doing ok. I sometimes like to add up just roughly what I produced on certain given days, just out of curiosity. The practice manager thinks Im a workhorse, which I take to be a good sign. But then again, the last dentist was 8 months pregnant and left for maternity, which to me was a pretty easy act to follow. No 20-minutes-late morning sickness here.
Production goes in cycles. There are no 2 days alike. I dont think anyone can expect to consistently produce any given number every day, so you need to talk about averages (monthly, quarterly, ). Some days are big, others are duds. Some days I produce $1000, others I may produce $5000 or even more. Some days Im web surfing or reading most of my time, while others Im just trying to keep my head above water. Some days I feel like I am not even earning my paycheck, others I feel like I am being taken advantage of ! Im still on my 3 months daily guarantee period, no production bonuses. Oh, and by the way, 35% taxes is a bit too much Connecticut. Seriously
Case acceptance for me has been at a good rate so far. Patients are returning for recommended treatment, keeping me busy, which is good.
Take the time to talk to your patients ! Education is the key to case acceptance. If you present a big treatment plan, and the patients does not see the value of it, then what is the urgency ? If you take the time however to educate your patient on why they need a crown on that MODB amalgam on #3 with 2 cracks on it, you get their attention. I can not tell you how many times (well actually I can, about 6 so far), Ive explained to a patient that a specific tooth is at risk of fracturing, and recommend full coverage, when there immediate response was Thats what happened with this tooth, pulling their cheeks back with an index finger to show me their other crown. I bit down on a piece of bread, and broke the tooth. It hurt like hell !. Crown now or root canal and crown later ?
One of the most frustrating things was (and actually still is, but to a much lesser extent), when you start at a new job, every single patient you encounter is a new patient. I dont now about you, but Im not taking responsibility for someone elses treatment plan. You can be a drill/fill dentist, working off a work order, or you can approach your patients comprehensively. I stay after being done with patients almost every day, review the next days schedule and charts, and go line by line through the treatment plans and radiographs, making sure I agreed with whatever was on there. I then make notes on my schedule so I know exactly what Im doing for that particular patient. Update bitewings, caries control, discuss medications whatever just be prepared. Its also the best way to keep yourself busy. When reviewing treatment plans, I occasionally catch interproximal lesions needing treatment, but since the last dentist never had time for an exam after the patients last cleaning, no one ever noted them in the chart. Other patients never got previous treatment completed, but are still coming back for cleanings. That is exactly what you dont want. A DO diagnosed in 2007 will turn into endo, given enough time. Simple things like that. They all add up.
Now that I am getting some of my own treatment plans back, things are going much smoother, and the anxiety level has been dropping ever since.
On a bizarrely related topic, a couple of Fridays ago was probably the weirdest day Ive seen in practice yet. Im not even sure how to explain it, but Id say that I was almost 90% certain my office was being Punkd. I kid you not. We had 6 emergencies (all new patients) on the same day all nut jobs, straight off their meds. It was u-n-b-e-l-i-e-v-a-b-l-e !!! I was in total disbelief ! What was even more shocking, is when I called the practice owner to give him a few good laughs, her shrugged the whole thing off as it happens a lot, its a full moon. What ? When did we start accepting Aetna HMO for werewolfs ?
Its normally not that crazy though. I barely see enough interesting patients to make my commute worthwhile. Every now and then youll get the occasional know-it-all or weird patient, which come to think of it now, makes for good stories later.
I like to discuss my findings directly with the parent whenever possible following pedo exams (not through the assistant or hygienist). So, as usual I was going through my findings and recommendations with one of the parents, and you know recommended sealants. And that was it. I saw the most horrible facial expression known to man, drawn on the moms face, followed by the punch line of the day; Well, my sister is an ophthalmologist, and she told me that sealants cause cancer. Why would ever recommend them?. (assistant giggles, stumbles out of the room). I calmly dispel that idea, and refer mom to none other than google for more info. Next stop, pedodontist (sorry guys, but yeah that was me).
Another dad (notice how it is usually overbearing parents of helpless sweet little shy kids) was a little worked up after hearing that his little girl has 6 cavities, citing that she has great teeth, 6 is way too many. In her defense, two of them were buccal pits, and the four others were interproximals on baby teeth (mo/do, mo/do). But heres when it gets interesting I love this part dad was obviously concerned and asks to see the x-rays. Wow. As he looks at the radiographs, he explains to me that he is recovering from knee surgery, and had the opportunity to look at most of his x-rays, so he has been trained in this. I dont see anything, he exclaims, which is when I had the tough job of gently breaking the sad news to him you dont know how to read x-rays ******* ! Needless to say, he asked for his daughter to see a different provider at the practice for a second opinion. And to that I say, good riddens (the other dentist decided to watch one buccal pit, but treated the other 5).
I never totally believed my professors in dental school, when they would say that in practice you would hardly ever worry about the clinical aspects of the actual dentistry (the prepping/temping/endo accessing/drilling) and how it would become second nature, but I am starting to see that now. Its more about managing a frighteningly diverse mix of patients, each with their own individual needs and expectations to be met. Its about doing a good job, quick and getting it right. All the time. Its about hiring, firing, ordering supplies, med consults and yes its about money. Your bottom line.
And thats the bottom line.
More to come
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added my thoughts and I love this blog, there is some great info on here
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I dread those situations......I might just lose it. Nothing like people claiming to be trained in that which they are not.
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Forget dread, how do you keep yourself from bursting out laughing?
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Great blog/ thread.........
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Lol. I got a kick out of this one...
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I have to say that i've spent the past hour reading through this thread and it has been very interesting and informative. The last time I logged into SND was in 2006 when I started dental school and now i'm in my last year. I'm looking into GPR's out in California. I also have a prospective job offer in my hometown and I'm torn between what path would suit me best. I've decided that if I don't get into a GPR that suits my needs then I will look into the associateship. Any comments or helpful guidance would help. Thanks everyone for this post!😀
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[ I never totally believed my professors in dental school, when they would say that in practice you would hardly ever worry about the clinical aspects of the actual dentistry (the prepping/temping/endo accessing/drilling) and how it would become second nature, but I am starting to see that now. Its more about managing a frighteningly diverse mix of patients, each with their own individual needs and expectations to be met. Its about doing a good job, quick and getting it right. All the time. Its about hiring, firing, ordering supplies, med consults and yes
its about money. Your bottom line
[/QUOTE]
Hey NILEBDS!
I totally agree with what you said above...and your experiences are nothing but similar to mine when I started working last year...But anyway, you got me hooked up again in SDN🙂
Looking forward for BLOG#3.
Hey NILEBDS!
I totally agree with what you said above...and your experiences are nothing but similar to mine when I started working last year...But anyway, you got me hooked up again in SDN🙂
Looking forward for BLOG#3.
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Hey NILEBDS!
I totally agree with what you said above...and your experiences are nothing but similar to mine when I started working last year...But anyway, you got me hooked up again in SDN🙂
Looking forward for BLOG#3.[/QUOTE]
Maybe you could contribute a blog part 1 😀
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Great thread. Thanks a bunch.
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New DDS on the Block: Private Practice Blogumentary 3
Three month update !
It seems like a long way looking back ... it feels like a year, but apparently it's been only 3 months. 🙂 Im happy to post this update, but it actually took me a little over two hours to write and edit ! This is a lot of work guys Still, glad to do it 🙂
I'm still feeling pretty good about private practice. Things are progressing at a pretty decent pace. I'm learning, growing, making mistakes ... well, mostly learning and growing. Last week for instance I did an endo (2 canals)/post/core/prep/temp/impression for #13 in 3 hours flat. Im not sure what I did most of learning, growing or if the whole thing was one big mistake ! LoL It felt really good though, and the patient was just soo grateful to have had it done at once so he didnt have to take more time off work. It was a vital tooth (MOD resin + Buccal cusp fractured), so I was pretty comfortable one-stepping the endo. Its the little things
So lets see what to talk about ? Ill just try and tackle random thoughts as they come to me, reflecting on my past 3 months, so I hope I dont loose your attention. Grab some coffee if you need to
So I guess the most significant development since posting here last would be the addition of another full time associate at my office. This can be, and should be, analyzed from several different angles:
- Are there enough patients (especially unique new patients, not just one time emergencies) to keep us both busy
- What will his/her impact be on my schedule/production
- Where did they go to school (YES, as it turns out, it does matter)
- How much/little do our practice philosophies overlap
- Are they making much more than I am ! 😛 I mean come on, you dont take your first paycheck to the BMW dealer and buy a 5 series apparently, some people do!
So in brief, I would say that it has been working out OK for the both of us so far, but in part due to the fact that we are both salaried (first 3 months), and neither one of us has to worry about production yet. For example, if a 2 hour root canal patient cancelled on short notice, in an arrangement where you are salaried/daily guarantee, you would not worry that much about the front desk filling that hole in your schedule. On the other hand if your production counted on it, it would certainly make you nervous at the very least.
This has been exactly the case with me I am indifferent for now, but worried about how this will impact me later.
Another issue of concern with associateship arrangements, and with practices in general is how good is your front desk ? A good front office team always has backup list of patients called in to fill these last minute cancellation bombs. Patients needing or willing to come in on short notice, or in need to finish their work before they switch jobs/insurance, or whatever reason it may be if your front desk is not proactive in aggressively managing your schedule, you will end up with unproductive or down time. There should be at least one person whose full time responsibility is watching the schedule like a hawk, and always planning and preparing for such catastrophes. Im not a big fan of double booking, but Im sure it has been working for some offices.
Another great way to fill unexpected mini-crashes on your schedule is to do lots of hygiene checks. If the patient is right there, theyve taken time off work anyways, and need work to be done, just ask if they would like to get it out of the way now. Most times patients agree, since it is obviously more convenient, but also saves them the anguish of having to worry about going to the dentist all over again. Im already here, so lets just beat it to the ground doc ! I like that
Three months also happens to be a minor milestone for my position now, being the time I am open to renegotiate my guaranteed salary VS pure production percentage compensation. I thought I had everything planned out, and knew how I wanted to do it, but was thrown the curve ball of a new associate in the office. Dont get me wrong, we get along very well, and were actually becoming good friends. But numbers are numbers the new associate threw off all my calculations, in a sense that my production will most certainly take a hit, and it will obviously become much harder for the front office to keep me as busy as I have been lately. So you probably see where Im going with this I never thought I would do this, but at this point, with the cards I have been dealt, Im thinking that staying on my salary guarantee is not such a bad idea anymore. I will with no doubt though ask for a higher number though.
I proposed a 20% increase in current salary with no bonus and they said YES on condition that they would not discuss any further increases until my first year was up and we complete a thorough annual review. Works for me ! Its all about negotiations. In life, you only get what you ask for (or some of it).
As awesome as that sounds, it makes me wonder how much money there really is out there to be made ? I wont lie, Im getting a little impatient with being an associate already not because it doesnt pay enough, or because I dont like my job, but just because I know I will be buying or starting my own practice anyways, so why not sooner than later ? I do not think I am ready to set out on my own yet besides another year or two as an associate would not hurt at all, but I can see that Ill be pretty antsy during that time. Im thinking to myself Ill stay as an associate not because I want to, but because I know it is the right thing to do in the long run. And just when I was feeling content with that mentality, I get an email from a practice broker whom I was in touch during my initial job search last summer about an excellent opportunity with a great practice in New Haven looking for add an energetic and dedicated partner, to overtake the office within a few years ! Ugh decisions decisions decisions !
I guess my dreams are outpacing my patience. Well see not sure what Im going to do about that yet.
Some weeks are good, others are bad. Some days are great, others are regrettable. I actually brought back copies of my schedule in order to actually give you accurate representations of my days:
Example day 1 (normal)
08:00 FREE
09:00 New patient denture consult/imprerssions
10:00 Post/Core/Crown #9
11:00 Post/Core/Crown #9
12:00 #19-MO, #20-DO
01:00 LUNCH
02:00 #30, #31 Build-up/Prep/Temp/Impression
03:00 #30, #31 Build-up/Prep/Temp/Impression
04:00 #15-O, #18-O
Example day 2 (monster day)
08:00 #19-MOL, #20-B
09:00 #7-DLF, #21-B (Build-up/PFM?)
10:00 #19-Build-up
11:00 #14-DOL, #15-OL
12:00 #20-RCT
01:00 LUNCH
02:00 #19-B, #18-Build-up
03:00 #30-RCT Obturation + Build-up
04:00 #30-RCT Obturation + Build-up
05:00 #14-O, #15-O, #18-O
06:00 #3-OL, #31-O
06:30 #3-MOB
Example day 3 (unproductive)
08:00 #3,14,19,30 Sealants
09:00 Denture post-op
10:00 FREE
11:00 LR quad pain
12:00 #18-OB
01:00 LUNCH
02:00 Emergency (Patient of record, lost crown placed in 2004)
03:00 #31-MOB, #30-DO
04:00 UR quad pain (#3-Endo access)
Keep in mind also that throughout these days you need to accommodate late patients (within reason of course), hygiene checks and sometimes even add-on emergencies.
Moving on so, this one day, the senior dentist came to me and asked a favor, since I did not have a patient at the time. His first time ever to get some insight into how good (or not) I was. Remember, hes only there a half day every week, and has heard good things, so at this point has lots of confidence in me ! He has absolutely no doubt when asking, you did a GPR, right ? You should be able to do this for me. I dont want the oral surgeon to mess this one up.. Basically the situation was one where he wanted to retain the distal root of #31, and extract the mesial one only due to furcation involvement ? His plan (which I really did not agree with) was to use that distal root of #31 as an abutment, pontic # 30 and abutment #29. Hmmm anyway, in this situation it is really not wise to criticize his treatment plan, and just act as a referral dentist. What do you want me to do for you, in order to make your treatment plan work ? Whether your treatment works or fails is really of little concern to me. So I respond with all confidence that this should be a simple task for me to do. I get in there, and guess what. The distal root (proposed abutment) is also mobile grade I ! The mesial root is not luxated to a point where you can just grab it with a forcep, which means some sort of elevation is needed. Every time I try and luxate or elevate the mesial root, the distal root moves ! (Yes, they are completely separated at the furcation, and at this point he had already crown-prepped his distal abutment). Long story short, I decided to put my tail between my legs, and at the risk of making myself look bad told him I could not do it. It was really frustrating, because I obviously could have done it, but was at a risk of luxating the distal root too. So even though I could have done it, I thought it would be more prudent to say no ! It was the smart thing to do in my opinion
The days go by A very good patient of his comes in with a fractured #18 Buccal cusp is no where to be found, broken down to the gum level. Non-vital, history of RCT, but no full coverage restoration (is anyone here surprised). Patient is in a lot of pain. Im guessing there is subgingival separation somewhere, since every time he puts his tongue on that area, it is unbearable. Its Friday 2:00pm, and theres no way the oral surgeon will get him in before Monday. He asks me if I can do anything, since he is very timid when it comes to extractions. And here it comes REDEMPTION ! It feels great ! IA block, Long buccal, PDL and the patient feels much better already ! 15 minutes into the surgical extraction, and I get the mesial root out, elevate the distal and bam ! DONE ! Patient is happy, the senior dentist looks at me like Im some sort of wiz, and I can finally exhale. Not to sound dramatic, but it was a lot of pressure, even though Ive done this sort of surgical extraction tens of times before in residency its the little victories like this one that make for good days at work.
Molar endo --- or not. What is your comfort level ? Dont push yourself too far beyond it. You obviously need to test it every once in a while, just to know your limits, but dont go too far. I personally shy away from them. I need to perfect my technique on single canals first, before tackling multiple ones at a time. At first, I wouldnt mind doing them, but upon reflecting on my work, I was not satisfied. I stopped doing them ever since. I will gladly do endo access on molars, which is a win win. I get the training on the access and locating the canals, do all the leg work pretty much, and refer it to the senior doc to finish it up, and get production (and accountability) for it. Why not ? I will only complete anterior and premolar endo for now. My experience has been that once you let your guard down, especially in endo, you will start running into problems. Never get cocky about stuff be it molar endo, extractions, complex restorative or whatever it may be. One of the most frustrating clinical situations (for me at least), is being blocked out of a canal, or not being able to get down to length.
On the other hand, a buddy of mine in practice feels more gung ho about molar endo, but has so far cut a patients lip (patient not thoroughly numb and flinched during access), broken a few files, perforated a couple of times because of calcified canals all without loupes !
Ive also run into a couple of intimidating esthetic cases (to me at least) so far. They may seem simple on the surface, but turned out to be far from it. It is a lot of pressure on a new practitioner like myself, to receive a referral letter for an implant restoration, signed:
Vice President, American College of Oral and Maxillofacial Surgery (ACOMS)
Vice President, The AmericanAcademy of Implant Dentistry (AAID)
It doesnt help either when the patient is female 17 years old and in need of an implant restoration for a congenitally missing #10 !
The second case was for a very attractive young female flight attendant, on a budget, and interested in an esthetic restoration for her central incisor which had been treated with a resin veneer a few years ago. The patients main concern is that she is getting married next month, and needs to look perfect for her wedding album. (Gulp!). Im thinking to myself, ok, screw this one up, and you have yourself a prett-tty unhappy patient for life ! We agreed to do prep veneers #8/#9 (which may not be ideal, but was a much as she was willing to do, and should be a significant improvement over her current situation).
They both worked out ok, but man, were they part of my learning curve. No screw-ups, but I made sure that I took my due diligence in treatment planning Preliminary models, wax-up, esthetic try-in and lab communication ! Key for any esthetic case to be successful, I think.
Heres a rant for you It is incredible to me the amount of bad dentistry that is out there walking and living in peoples mouths ! Boy, is it overwhelming ! Its not unusual to see short endo fills, leaky resins, open margins on crowns, and hideous periodontal care all which have been supervised and watched for years by previous dentists. On a related note, one of our most loyal sources of referral has not been our orthodontist . not our endodontist not even marketing. It has to be Aspen dental. Wow. I see at least a couple of unhappy Aspen patients each week, FMX in hand, asking for a second opinion, because they were treated so badly there. Believe me, Aspen is only part of the story. The worst part is that the poor patient hasnt a clue of what sort of mumbo jumbo has been going on in his/her mouth. In my experience, they are more than not very trusting and accepting to consequences which could have otherwise been avoidable.
It still is incredible to me how much of dentistry and quality control is left to self restraint and personal criticism. This is the real world where there are no prep checks only reality checks and they just keep coming.
More to come
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bravo. i look forward to reading more
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could you please elaborate further? i'd love to hear what you've learned about this. thanks!
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awesome thread! if you don't mind me asking - approx how much is your salary and how much is your debt? is it manageable to pay off the debt in a 10 yr period and still live a comfortable (im not talkin a 10 stories mansion and a 40 car garage - just comfortable) life? any response would be appreciated!
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Thanks for taking your free time to write this. Much appreciated!
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This really doesn't surprise me a bit. While teaching one of my DAT courses, I get this guy who hasn't gone to dental school (an ex assistant) who OWNS 3 practices. He goes on and on about how dentistry is "all about being a salesman" and "all about the money" (yes, I quote), yet he has never been to dental school and can barely understand DAT material.
He kept talking about how "dentistry is easy" and anyone can do the procedures. My first thought was, "of course anyone can do them, but can they do them properly?"
This was plain scary for me but opened my eyes to a lot of things that I frankly didn't know existed.
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wait, are you telling me someone can own a dental practice without having a dental license?.....
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as long as they don't see/treat patients...i don't see what the problem is.
healthcare is a business and many people out there treat it like one.
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Well, I say "own", but on paper, you can "manage" an office only.
We talked about this in one of my courses. In TX law, you cannot own a practice or do dentistry without a DDS. You can, however, sign contracts to be a "consultant" for a dentist who agrees to work for you. You bought the office, you supply them with work, you arrange the pay, but they do the work. In the contract somewhere you place clauses that the dentist will be released if they make decisions against your will.
Essentially, it is a loophole to allow these sorts of things to occur.
He may be lying about some things, but I do know that this sort of thing happens frequently. It is very unfortunate.
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Reply in Bold.
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Holy. Easily afford an X6M?!
Awesomeness. 😀
Awesomeness. 😀
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NilesBDS,
How much more prepare were you for private practice after a GPR residency?
How much more prepare were you for private practice after a GPR residency?
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I'll do my best ...
Some schools are just better than other in preparing their graduates for professional success in the real world. Thats what it boils down to. Granted, each one of us may define and quantify success differently, be it matching to a post graduate program of choice, getting into certain specialty programs, successful associateships or startup practices, but the premise remains. Not all schools are created equal. Not all schools are equal in a sense that each school offers its graduates different sets of tools and skills in preparation for a dental career and professional advancement in the real world. Whether those tools become relevant to your definition of success is what makes for either an excellent school experience, or a poor one, which will ultimately be reflected upon and will directly affect your patients, staff and yes partners, associates and co-workers.
This is a topic which is very hard to articulate, and you know what, probably even impossible to quantify. Which probably explains why there is no objective rank or guide to dental schools to date. All I can speak to is my experience.
Between dental school, residency and the current group practice I work for, I've worked with graduates of at least 10 different schools. I've had numerous (and at times lengthy) discussions about how to treatment plan various cases, and what an appropriate treatment should be for any given situation (which is what I absolutely loved about residency and this group practice, having other dentists to bounce ideas off of). Decisions as difficult as whether or not to open a persons bite and as simple as retaking an impression or not. As it turns out, we were not all taught the same. I dont care who tells you what, schools are schools of thought. Each will have its own. Starting with preferences for materials, approaches to dental health, biologic and physiologic concepts, restorative concepts (what is ferrule, to place a post or not to place a post, when to crown lengthen VS when to not, to crown or to MODBL). It is different.
One of the previous associates at the practice I work at has left me a lot of explaining to do. I am now left holding the bag, and having to do most of the apologizing to patients that show up with a core buildup in their temporary crown patients thinking they would finally be getting their crown today, only to find out the endo fill is 3 mm short, explaining to patients that the tooth which is now sensitive, needs a root canal, even though they were here 6 months ago and someone thought it would be a good idea to watch a hefty interproximal lesion. I could go on and on.
In fairness, I am not placing all the blame on schools, which is why I made it clear in my Blogumentary post 3 that it amazes me how much of our work is left to personal critique and restraint. Having said that, I still believe that the schools are responsible in several ways for substandard graduates, and in some instances a lack of curriculum.
One of the associates in my group practice does not etch prior to bonding, which is what he was taught in school. Almost none of the associates use rubber dams for endo which is how it was done at their schools. NONE use any magnification whatsoever. This is the real world ... there is your reality check right there.
Schools are different from one another. As nice as it is convenient to think that all schools are equal, and the notion that as long as you get your DDS/DMD then we are all somehow calibrated is just proving to be false to me day after day. Even on my interviews (residency or jobs), I have been told that they would not interview/hire graduates of certain schools, based on past experiences they've repeatedly had.
You may view this as anecdotal, and it may be ... but it's the closest we'll ever be to a true and clinically applicable assessment of some of the discrepancies in dental schools and curricula. Take it for what it's worth. 🙂
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My GPR was not your typical general practice residency, where you work at the hospital or took emergency call most of the time. It was split into 4 month rotations where we did
4 months on hospital rotations (which were not really taken that seriously)
4 months in the HSDM faculty practice
4 months at a community health center in Cambridge
A GPR will not make or break your career. It will however make your learning curve much shallower once you hit practice. In my opinion a GPR made me faster, provided me with professional maturity, made me more efficient in a wider number of procedures and more marketable for associateship positions/jobs. In one year.
I doubted my decision to do a GPR at times (so did some of my dental school instructors), knowing that I was prepared and confident to go into private practice right out of school, which I felt I was. But there is always that extra step that will make you better. Can you practice and do fine right out of school ? Sure. Will you better after a GPR ? It's what you make of it. Can you do molar endo on your own ... sure ! Will the radiograph show a radio opaque filling in the roots, certainly ! Will it be done properly ? Who knows ... Would you do a better job if you were to sign up for CE courses and practice on some extracted teeth first ?
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Eesh. Any chance it's a generation 6 self-etch bonding agent they're using?
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Hey NileBDS i definitely think this post is extremely informative, and appreciate the time you have been putting in, especially since you now know the value of your time!
I am curious as to which schools you found to produce poor dentists and of course which you felt produced dentists ready to complete procedures correctly.
I am curious as to which schools you found to produce poor dentists and of course which you felt produced dentists ready to complete procedures correctly.
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it would be imprudent to start naming specific schools and their deficiencies, but perhaps you could give us predents following your posts some things to look for when we apply/choose a school and its curricula? maybe some red-flags to watch out for (if it's possible to perceive as an applicant)?
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+1 👍
and not just NileBDS, any current dentists/dental students who have experience with this please share your thoughts. it makes a HUGE difference to find out what people think about a particular school vs. what the schools' deans try to sell us.
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Yes. That would be helpful.
Or, you could list specific schools and their deficiencies. That would be more helpful.
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One potential issue with this line of thought, is not everyone learns in the same manner and/or gets the same clinical exposure as their classmates in d-school. So whereas one person may graduate from X dental school and think that their endo curriculum is inadequate and their perio curriculum was the best, a classmate may have the exact opposite experience/thoughts.
So much of one's learning experience can end up being influenced by the luck of the draw that patient's and their needs brings them and also the simple fact that different faculty have different teaching styles and if that style does/doesn't click with your learning style.
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Hey Nile... I don't know what to say! Wow!! I am returning to SDN after a long time and I bump into this great thread. I agree with you on being tested everyday while working as a dentist, just not skill-wise but also ethically and morally. It is unbelievable. But I have to tell you that in my one month experience at a private practice, it is funny how a molar with only 1 and 1/2 of the three canals filled 5/6 years ago feels great for the patient but a good looking molar endo on the other side is always creating problems.
Obviously every school is going to be different. Heck, two instructors at the same school are so different!! So I think predents need to realize what they want to be and go shadow that person - a general dentist/ pedodontist/ professor or whoeever and see what they are doing, how did they reach that place in their life/ what you need to do/ learn to reach that place.
Not to hijack your thread, but I thought I'd chip in my thoughts on doing a GPR/AEGD. I am having a really tough time looking for a good associate position. To get the ideal associateship is very difficult because of the difference in practice philosophies. That is why I feel it is important to go to school in a state or location where you think you will be practicing, or I am just looking down the wrong road for an associateship. The only jobs I have had are all locum tenens type... filling in for either sick dentists/ dentists on maternity leave. Sometimes I am tempted to get into corporate dentistry to get the experience, not that there are too many CD positions out there for new grads. I wish I had followed your advice on doing a GPR/AEGD at times, but hey, my situation doesn't let me do one atleast for the next year or so. Oh well, we'll see what/ where I am a year from now. Let's now listen to more of you.
Great thread... looking forward to reading more 🙂.
Obviously every school is going to be different. Heck, two instructors at the same school are so different!! So I think predents need to realize what they want to be and go shadow that person - a general dentist/ pedodontist/ professor or whoeever and see what they are doing, how did they reach that place in their life/ what you need to do/ learn to reach that place.
Not to hijack your thread, but I thought I'd chip in my thoughts on doing a GPR/AEGD. I am having a really tough time looking for a good associate position. To get the ideal associateship is very difficult because of the difference in practice philosophies. That is why I feel it is important to go to school in a state or location where you think you will be practicing, or I am just looking down the wrong road for an associateship. The only jobs I have had are all locum tenens type... filling in for either sick dentists/ dentists on maternity leave. Sometimes I am tempted to get into corporate dentistry to get the experience, not that there are too many CD positions out there for new grads. I wish I had followed your advice on doing a GPR/AEGD at times, but hey, my situation doesn't let me do one atleast for the next year or so. Oh well, we'll see what/ where I am a year from now. Let's now listen to more of you.
Great thread... looking forward to reading more 🙂.
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Agreed. I can't believe how some dentists can get away with such crp. I was in a bad associateship. The turning point was when one of his patients came up to me and said I trust this dentist with my life (the patient has crowns on all of his three surface fillings). I wanted to yell NOOOOO!!!! I quit that day.
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Very interesting thread and I love the insight into the first job as a new dentist
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Well, I am sure you've heard most of these already, but i'll take a stab at it.
-Talk to current students. Do not talk to faculty or pay much attention to what the deans will say. Deans are always touting their own horn, explaining how their school is "the best in the nation" or has the highest board scores, incoming class GPA, post-graduate placement, research facilities ...
-Talk to recent (5 years) alumni. How big is the alumni society ? What percentage of alumni donate back to the school ? Are there any alumni practicing in your area whom you can maybe interview or shadow/take out to lunch ? You obviously would not to this with every school you apply to, but maybe if you've narrowed it down to 2 or 3 acceptances and are having a hard time making up your mind (in state VS out of state school), that may give you a tremendous amount of insight. How has that particular school prepared them for their particular career chioce ?
-What percentage of graduates stay and teach there (even part time) following graduation ? Why ?
-How do graduates feel about their own school's post graduate programs ? Do dental students rank their own school's post graduate programs higher than others ? Or would they rather go somewhere else ? Why ?
-What is the patient distribution situation ? Do students have to recruit their own patients, or is that something arranged by the school ? Do they have to fight for chairs ? How many instructors per student in the clinic ?
I think that's all for now. I'll try and maybe edit the post later if I think of other stuff.
Hope this helps ...
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No way ! Good to see you again old timer 🙂
Thanks for adding your insight here. Great post as always.
Please keep us posted. Your experiences will give us a whole new perspective, and add another dimension to this discussion. I like your unbiased and unpolished views.
Anyone else with post dental school experiences, please feel free to chime in. The more the merrier.
It's great to have you back on SDN g3k !
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Hahaha ! I hear those kinds of stories from my assistants and hygienists all the time. Previous offices they worked for and the horrific stories they have to tell. It sometimes sounds like talking to a world war II prisoner of war. Dentists throwing instruments, doing shady work, shouting obscenities at the front desk (from the opreatory) in front of patients, "inappropriate" billing measures, unsterilized instruments ... oh boy !
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In all seriousness tho, this thread is gold. I've been gaining a big sense of what to expect at the transition from dental school to being a dentist, just from reading here. Appreciate the work and effort. Thanks! 😎.
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Thanks alot 'NileBDS" !!!! Spent over an hour reading all your postings here just to wake up to the fact that I have an exam in 2 hours...😱
No, really, I totally enjoyed this thread. Looking forward to your future postings.
No, really, I totally enjoyed this thread. Looking forward to your future postings.
awesome thread. im a predent and have recently been freaking out about how i will manage a 350K debt and if im making the right decision. I've shadowed in some offices and I have been able to see the different variation based on where you go. Some dentists just don't care, while others are amazing. This thread definitely makes me feel better and that I'm making the right decision.
