Specializing: Wait a Couple Years?

[devin_62]

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I'm not trying to jump the gun here (I haven't even applied to Dental School yet), but I love to be prepared for anything to come toward me. I, of course, have thought about the possibility of specializing. I've shadowed a periodontist and loved it, and this summer I will be given more exposure to the other specialties. I understand that a specialist cannot do "general dentistry" procedures to his patients once he has completed his residency. This being the case, would it be smart for a graduate to work as a general dentist for a couple years to see for sure if general dentistry is the best fit for him? This way, they will know for sure that a specialty is for them.

This might all change once I get to dental school, because I would think students are given enough exposure to each aspect of the dental profession to know whether or not a specialty is best for them.

 

[ktcook83]

This might all change once I get to dental school, because I would think students are given enough exposure to each aspect of the dental profession to know whether or not a specialty is best for them.

This may or may not be true... depending upon whether you seek out certain procedures... for example, you might not do much RCT before you graduate... not enough to really know you want to limit your practice to endo all day.

 

[toofache32]

You can do any procedures you want to, regardless of specialty. Specialists can do general dental procedures and GPs can do specialists procedures.

Some states have "Specialty laws" which keep a specialist from doing general practice if they advertise theirself as a specialist. One of my friends is a board-certified orthodontist, but practices in a small town in Tennessee where there isn't enough ortho to keep him busy. So he advertises himself as a general dentist who also does ortho...this way he can do general dentistry also.

Also, a generalist can perform a "specialist" procedure, but the generalist is held to the standard of care of the specialist if complications occur. In other words, if the procedure goes bad, it's not a valid excuse to say "but I haven't had the training of a specialist so you can't expect me to do as well" because you should have referred it if you don't have the training.

 

[adamlc18]

Also, a generalist can perform a "specialist" procedure, but the generalist is held to the standard of care of the specialist if complications occur. In other words, if the procedure goes bad, it's not a valid excuse to say "but I haven't had the training of a specialist so you can't expect me to do as well" because you should have referred it if you don't have the training.

If this is true, and I am not doubting you on this, I wonder if any general dentist out there has ever been foolish enough to try something like a Lefort I? Funny thought, yet scary for the patient.

 

[toofache32]

If this is true, and I am not doubting you on this, I wonder if any general dentist out there has ever been foolish enough to try something like a Lefort I? Funny thought, yet scary for the patient.

I doubt it, but anything is possible. The same principles exist on the MD side. A medical license will let a Family Medicine doc place breast implants (there's a guy in Oklahoma doing it) but they won't have much of a leg to stand on in court if things go wrong.

 

[mdub]

Also, a generalist can perform a "specialist" procedure, but the generalist is held to the standard of care of the specialist if complications occur. In other words, if the procedure goes bad, it's not a valid excuse to say "but I haven't had the training of a specialist so you can't expect me to do as well" because you should have referred it if you don't have the training.

That's also the general rule in tort law for pretty much every field. It applies to doctors, engineers, etc. The basic rule is that if you hold yourself out to be an X, you're held to the standard of conduct for an X. So be carefule what you say you are and what you do whether it's in dentistry or any other field. (And the standard of care usually "rachets." So if you're doing something in a related or overlapping field, you'll usually be held to the higher standard.)

 

[NUKE]

Many specialists still do General Dentistry!!!! Ever heard of Wife, Mom, Dad, Brother, Cousin, Friend, etc. The farther away from home you practice the less general dentistry you will have to do.

 

[ItsGavinC]

Specialists may be able to do GP work, but most don't for a couple of reasons.

1) They aren't good at general dentistry so they actually lose money on procedures. Financially it doesn't make any sense and only causes problems down the road.

2) Most patients aren't going to have a specialist do work outside their specialty area.

3) The ADA code of Ethics states that specialists that do general dentistry are in violation of the code.

 

[ItsGavinC]

Many specialists still do General Dentistry!!!! Ever heard of Wife, Mom, Dad, Brother, Cousin, Friend, etc.

But in all seriousness, the smart specialist will hook those family members up with a fellow GP colleague. Most specialists aren't even equipped to do general work, and it certainly causes more headaches than it saves.

 

[I'mFillingFine]

On a slightly different note than doing both at once, is it ever hazardous to do a few years as a GP before even applying to specialty school? I know that endo especially likes some additional clinical experience, but does going away from academia for a few years hurt your competitiveness versus a GPR/AEGD?

What if it's not a matter of trying out general dentistry to make sure that you want a specialty, but if you just want to start working/get some money/not be in school anymore, but have every intention of applying to a specialty in a few years? I wasn't sure if it was like college after high school, where it's so rare to go after you take a certain amount of time off.

 

[toofache32]

On a slightly different note than doing both at once, is it ever hazardous to do a few years as a GP before even applying to specialty school? I know that endo especially likes some additional clinical experience, but does going away from academia for a few years hurt your competitiveness versus a GPR/AEGD?

What if it's not a matter of trying out general dentistry to make sure that you want a specialty, but if you just want to start working/get some money/not be in school anymore, but have every intention of applying to a specialty in a few years? I wasn't sure if it was like college after high school, where it's so rare to go after you take a certain amount of time off.

I don't think it necessarily makes you less competitive, but it is extremely rare to go this route. After about 5 years as a GP, you will be making $100-200 Gs, will own part of (or a whole) practice, ownership in a building, your kids are in school, your hours are regular, your spouse is used to having you home every night, and you are the boss at work.

That's a good deal to begin with and most people cringe at the idea of getting rid of all those investments, ripping your kids out of school to move across the country, telling your wife you'll be sleeping in a hospital every 3rd night for the next 4-6 years, will spend 80-100 hours a week at work, and working for attendings in a military-style arrangement. Oh yeah...and you also take a pay cut down to about $40G a year.

In other words, private practice is a trap which will keep you from ever going back.

 

[I'mFillingFine]

I don't think it necessarily makes you less competitive, but it is extremely rare to go this route. After about 5 years as a GP, you will be making $100-200 Gs, will own part of (or a whole) practice, ownership in a building, your kids are in school, your hours are regular, your spouse is used to having you home every night, and you are the boss at work.

That's a good deal to begin with and most people cringe at the idea of getting rid of all those investments, ripping your kids out of school to move across the country, telling your wife you'll be sleeping in a hospital every 3rd night for the next 4-6 years, will spend 80-100 hours a week at work, and working for attendings in a military-style arrangement. Oh yeah...and you also take a pay cut down to about $40G a year.

In other words, private practice is a trap which will keep you from ever going back.

That does make quite a bit of sense! Is this an accurate lifestyle for all specialties? It seems like it fits more the OMFS route....?

 

[aphistis]

That does make quite a bit of sense! Is this an accurate lifestyle for all specialties? It seems like it fits more the OMFS route....?

Wait, there are specialties other than OMS?

 

[JavadiCavity]

But in all seriousness, the smart specialist will hook those family members up with a fellow GP colleague. Most specialists aren't even equipped to do general work, and it certainly causes more headaches than it saves.

Additionally, people who specialize choose to do so because they DON'T want to do general dentistry. And, GPs would be pretty angry with the orthodontist they referred their class II case to, and while the patient was at the ortho office, the orthodontist noticed a crown that was failing and replaced it.

 

[EuroOMFS]

I'm not trying to jump the gun here (I haven't even applied to Dental School yet), but I love to be prepared for anything to come toward me. I, of course, have thought about the possibility of specializing. I've shadowed a periodontist and loved it, and this summer I will be given more exposure to the other specialties. I understand that a specialist cannot do "general dentistry" procedures to his patients once he has completed his residency. This being the case, would it be smart for a graduate to work as a general dentist for a couple years to see for sure if general dentistry is the best fit for him? This way, they will know for sure that a specialty is for them.

This might all change once I get to dental school, because I would think students are given enough exposure to each aspect of the dental profession to know whether or not a specialty is best for them.

I´m not in the US, and I guess there are different views/custums, but I can tell you I worked as a GP for 5 years before going into OMS. I was pretty sure by the time I finished dental school that I wanted to go into OMS, but I was broke, in debt and I wanted to try working as a GP, to see if it was for me. Another thing is that most European dental residency programs, don´t accept anyone fresh out of dental school.

I quickly found out that GP work was not for me. I found myself more and more drawn by the surgical side of dentistry. I had my own office, started placing implants and some simple dentoalveolar stuff, and by the end of my fourth year as a GP I realized I that OMS was what I really wanted, so I started applying. I accepted the paycut, the hours, the moving etc. and I haven't regretted it for a moment.

Hope this helps.

 

[I'mFillingFine]

That's a good deal to begin with and most people cringe at the idea of getting rid of all those investments, ripping your kids out of school to move across the country, telling your wife you'll be sleeping in a hospital every 3rd night for the next 4-6 years, will spend 80-100 hours a week at work, and working for attendings in a military-style arrangement. Oh yeah...and you also take a pay cut down to about $40G a year.

Aah, but what if you work for a few years, don't have kids yet, and your spouse takes over as the prime breadwinner for two years while you get endo-fied?

It just sounds so ominous to be stuck one way or another...I know people have done it both ways, but I didn't realize how significant your immediate postdoc decisions are for the long run...