“WHY YOU SHOULDN’T BE A DENTIST”Lecture #9

9.1 Years of schooling and debt

– Debt– Difficulty in getting in

• Number of Applicants• Number of Positions

– Difficulty level of dental school

Interesting web site on dental education issues

• http://www.adea.org/publications/tde/Pages/Students.aspx

Average debt of Graduating dental students

“If you live like a dentist while you’re

a student, expect to live like a

dental student when you become a

Dentist”

First Year dental courses

• BiochemistryHistology/EmbryologyIntroduction to MedicineDental MaterialsGross AnatomyRadiological AnatomyMicrobiologyOcclusionRestorative Dentistry LectureRestorative Dentistry LaboratoryRadiologyAnatomy DissectionPhysiologyPreclinical Periodontics

Possible Solutions:

• Prepare yourself emotionally for a long educational process. Realize that even though your friends will be financially ahead of you when you finish, you will probably catch up with time

• Get really good grades and DAT scores so that you can go to a less expensive school

• Learn frugal habits while in school so you don’t go so far in debt

• Take a full schedule at BYU and learn to manage you time well

9.2 Difficulty in setting up practice cost of Setup and

Operating Expense

– Finding an associate position– Lack of business training in dental school

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Cost of setup, operating expenses are high

– Average cost to buy a dental practice• http://www.promed-financial.com/listings/dental.

php3• ½ of one year gross for “good will” or practice

reputation plus records• Cost is higher for orthodontic practices

– Operating expenses are on the rise, currently at 65-70%, up 5% in last 5 years

Possible solutions• Be very picky about the associateship you enter. Carefully screen

the office. Make it a matter of careful thought and prayer. Watch how the owning doctor treats his staff. He will likely treat you the same. Is the owner doctor absolutely honest, does he provide top quality care?

• Find a way to have school paid for such as military scholarships, service scholarships where you practice in an underserved area etc.

• If opening your own practice, be frugal in your purchases. Remember that bells and whistles don’t bring patients, treating people with kindness does.

• Take business continuing ed. courses or hire a consultant to help you set up and run your practice.

• Operate your practice within a budget. Watch the overall expenditures in your office. Act proactively to manage them.

9.3 Repetition in the job, Inability to Relocate or

Change Jobs Easily

– Copy of the schedule– How do you maintain a sense of excitement

for something you do over and over

Inability to move or change jobs without serious repercussions – Numbers of jobs

• http://www.bls.gov/oes/current/oes291021.htm

– Nature of a dental practice precludes relocation

Possible solutions:• Don’t let yourself become trapped into “doing procedures”. Everyone you

treat is a person, the procedure may be redundant but the person is not. Take the time to talk to your patient. People are infinitely variable. The fillings may all be nearly the same but the people receiving it are not. All of the time I hear dehumanization in dental offices, “you have a root canal in room #2”. Don’t fall into that trap. You have a person who needs a root canal treatment in room #2.

• Go to continuing education courses and expand your horizons. Learn to do orthodontics or implants.

• You should always look for ways to do simple things like fillings in a better way. I change how I do things on a regular basis, nearly after every course I take. Always look for ways to improve

• Choose your career carefully and be happy you don’t have to change so often. Staying with one job has its blessings. You will be very secure and don’t have to always be out there looking for a new job. Being between jobs or unemployed is a huge stress in the life of a family. Be grateful you probably won’t have to go through this often.

9.4 Growth of managed care in dentistry

– http://www.managedcaremag.com/archives/9806/9806.outlook.shtml

– Managed care overlays

• Traditional Insurance– UCR

• PPO– Reduced fee

• HMO– Base fee

Possible solutions:

• Don’t enroll in any managed care plans. Decide at the first that you don’t want that kind of practice and then don’t let patients talk you into it and don’t be tempted to take this shortcut to becoming busy.

• Educate your patients about why these plans are not the best idea.

• If you have to enroll in managed care, first ask yourself do you really have to and then if the answer is yes, at least don’t do capitation. Nobody should be that desperate.

9.5 Physical and emotional demands of the job

• Repetitive stress disorders• Emotional demands of working in a

stressful environment

Article on Physical stress of Dentistry

• http://www.ineedce.com/coursereview.aspx?url=1742%2fPDF%2fDentistryShouldntbe_ergo.pdf&scid=14118&cmpid=EnlCEMarch172010

Possible solutions:• Exercise and stay in good shape, it will help your body deal with the

demands. Becoming overweight greatly amplifies the physical demands of dentistry. Regular exercise will increase your back strength.

• Use magnification that forces you to sit up straight and lessens you fatigue

• Get a good assistant so you don’t have to lean over as much• Learn to manage your schedule, don’t let it manage you• Become involved in cosmetic dentistry, it is always more emotionally

rewarding to provide something that patients are excited to receive than something that they have to receive.

• Don’t take short cuts like managed care. It will get you busy fast but you will have to work five times as hard to make a living. Soon you will be burned out emotionally and physically.

9.6 Demands of managing a business

– Hire and fire– Money

• Patients• Insurance• bills

– Last one to get paid– High demands with minimal instruction

• Tax strategies, hiring techniques, employee reviews etc

Possible solutions:• Associate with a dentist who runs his/her business well and learn

from him• Bring in a consultant to mentor you. They are expensive but a good

on is worth it.• Read your dental periodicals, there are tons of good articles on

business management• Surround yourself with capable people who can learn and share the

burden• Visit with your friends that are dentists, share ideas and learn from

each other.• Realize that the first five years of practice are not going to earn you

a lot of money, after that you will do better. Have realistic expectations.

• Make goals and reach them

9.7 Inflexible schedule, No Benefits

– Dentists work more than you may think• http://www.bls.gov/oco/ocos072.htm

– You can take time off but you often have to plan a long time in advance

– Can’t just leave to go watch your kids soccer game.

– When you are gone everyone quits getting paid. When you take time off all your employees become temporarily unemployed.

No benefits

• Health, retirement, paid holidays, paid sick, paid vacation

Possible solutions:

• Have realistic expectations. You are not going to have as flexible of a schedule as you have been led to believe.

• Plan way in advance so that you can have time off with your family.

• Put your staff on salary so they don’t begrudge your time off as much.

• Plan your retirement early and make regular contributions.

9.8 Relative isolation from peers

• Even though you are with people all day there are limited opportunities to talk to dental peers about your daily challenges

• Join a study group where you can associate with other dentists

• Join a small group practice• Treat your staff as peers. Take them to

continuing education courses and let them learn the lingo. It is very satisfying to have staff members who are very well trained with whom I can discuss cases and get their input. Staff members seem to appreciate this also.