Monday, April 14, 2014

Insurance for Life

Just when I thought life as a dentist could not get any more exciting, I began to face some serious decisions about disability, retirement, and death at a very young age. As much as I like to plan ahead (vacations, parties, outfits, etc.), thinking about at what age I will retire, when I will die, and how to make sure my family is financially secure when I am gone can get pretty depressing.

Like many recent graduates these days, I signed up for disability insurance when I was in my general practice residency. I was making some cash (finally!) and knew that it was better to lock in a policy when I was still young and healthy. I am only now starting to decide if I would like to increase this policy. Unlike malpractice insurance, disability insurance is optional and many dentists cancel their policy or do not sign up at all if they never lock in a reasonable rate. The premiums can go up so high that it does not make sense for them financially. On the other hand, when you are a recent graduate and you are making (hopefully) a fraction of your income potential, you do not want to spend the extra money every month on something that seems so far away (retirement) and unlikely to happen (long-term disability).

Long-term disability indicates that you will be disabled and unable to work for a period longer than three months; you should have three months worth of savings in your bank account to get you through any period where you would not be able to work before your benefits kick in. How many 30-year-old young professionals are responsible enough to have taken this precaution? My own informal research has indicated not too many. When I was in dental school, I was afraid of going skiing. I knew one unfortunate accident and I could face the horror of missing clinic, resulting in delayed graduation date. These days, the possibility of losing a few months of income, which your insurance will not cover if you are out of commission for less than three months, is equally as terrifying.

You can become disabled at any age. But for most of us, retirement and death are hopefully far on the horizon. Why do I need to think about this now? How prepared can you be for all of life’s unpredictability and not drive yourself crazy in the process? While dentistry is a relatively stable profession, I cannot help but notice tons of recent articles in the media about how tough it is out there in the job market. Many individuals that were successful for years in various fields have lost their jobs later in life and are having the hardest time of all finding employment, faced with fierce competition from recent graduates. Having a sense of security for those later years in life can be priceless. How many dentists between the ages of 30 and 35 have already started saving for retirement? Does it make sense to increase your policy to have you covered for life in case something unfortunate occurs, or to use that extra money for savings and/or investment purposes? There are many options, and they should be carefully evaluated based on your individual needs.

In addition, you have financial advisors and/or insurance brokers trying to reach out to you constantly via email, LinkedIn and other forms of social media. Everyone has a different plan and they try hard to get some one-on one-face time. I try to avoid this sales tactic since it is time-consuming and dealing with salespeople is not my favorite activity. However, it is important to talk to a few different sources, get your facts straight and ultimately make an informed decision about your financial future, rather than pushing it off until you are older. As for more seasoned dentists reading this blog, what advice do you have for the younger generation? Is there something you would have done differently if you could go back and change things? Please share your thoughts in the comments.

Have a great week!

Lilya Horowitz, DDS

Monday, April 7, 2014

What Does AGD Membership Mean to You?

According to the AGD, “Membership in the AGD provides general dentists, students, and dental team members with the education, advocacy, and information they need to advance themselves in the dental profession while providing their patients with the best care possible. AGD membership represents a dedication to lifelong learning and overall oral health for the public.”

I have now been in private practice for 11 years, and can appreciate what my fellowship and membership in the AGD truly mean. I have begun to participate in more AGD-affiliated CE events, and have quickly realized that the caliber and level of education is superior to many that I have enrolled in previously. More importantly though, my membership is morphing into many new and exciting opportunities I hadn’t realized existed. What began as a goal to become an AGD Fellow has now become much more.

We have all, at times, set our mind to accomplishing a goal. I have a tendency to become consumed by the goal. Upon receiving my FAGD, I simultaneously researched mastership. With that, I discovered that the road I was preparing to embark on would be challenging and a test on my personal stamina- particularly because at the time, my state did not have an established MasterTrack program. Using the AGD website, I searched for constituents that had an existing MasterTrack program (one that wouldn’t cost too much in time out of the office and additional travel expenses). Fortunately, with a little prodding, less than 12 months after receiving my Fellowship, I will be attending Session 1 of the reactivated Wolverine III MasterTrack series here in Michigan. #CEjunkie in full force!

My AGD membership is more than the obvious dedication to lifelong learning. It is becoming an opportunity for my own personal growth and advancement as a person. I would have never imagined myself stepping up to blog here, for example, but my experiences with the AGD are overwhelmingly positive and I can’t imagine not sharing or inspiring other colleagues to join and become active in such a worthwhile organization. Additionally, there are many opportunities at the local, state and national level. That being said, I couldn’t have foreseen the whirlwind my last 12 months have been. My involvement in the AGD Fellowship program has extended to becoming a board member and a course manager for the 2014 AGD Annual Meeting & Exhibits in Detroit.

What has defined your AGD membership? Are you maximizing the potential that the AGD has instilled in you and your colleagues? Are you ready for the next level? The AGD invites you all to volunteer, and the payback is well worth it!

AGD membership to me means that the AGD provides me with superior education for myself and staff, opportunities to lead and inspire, and the environment to be comfortable learning and honing my skills and knowledge. Membership is an investment in me as well as my professional future.

It is your time to define your membership. What will it be?

Colleen DeLacy, DDS, FAGD

Friday, April 4, 2014

Change in Everything

I was walking by the Sony Store recently and saw an amazing 80-inch TV on display. I was amazed! My tech-envy made me want to have it in my home. I checked the price; it was only $25,000! (I say this with my tongue firmly implanted in my cheek). Reality set in. Our family room is not that large and our 52-inch TV is plenty for our home. And given what I paid for it, many years ago, it can be replaced for about $1,000.00 today. I know, given a few years (or maybe just months?) the big Sony TV will come down in price. In fact, I recently saw a Samsung 80-inch TV that was only $6,500, but it did not have the picture technology of the Sony.

My wife puts up with my geekiness and the desire to have gadgets. I think it is a requirement for being a dentist. We sure do love our gadgets. And the pace of change continues unabated. I graduated in 1987 and there is no procedure I do today, that is the same as what I did when I graduated. Everything has changed. It can be scary to stay on top of everything. But I really liked what Dr. Don Deems wrote in the January 2014 issue of AGD Impact: “You don’t need to be the first kid on the block to have the latest and greatest of everything. Instead, slow down and remember the fundamentals of providing your best dental and patient care, and your practice will do well. Simplification can have far-reaching effects.”

When I graduated, I quickly realized not how much I knew, but how much I didn’t know. Fortunately, I was in the Canadian Armed Forces and I was posted to the Army base in Calgary where I worked in a dental clinic with four other dentists, all more experienced than I was. What an amazing learning opportunity. I could practice the basic skills I learned in school with an experienced dental assistant who guided me in the non-clinical stuff that I needed to learn. I could take my time and learn how to be a good dentist. As my commanding officer said, “First you get good. Then you get fast.”

After three incredible years as a clinical dentist in the Forces, I then worked as an associate in a shopping mall practice. There I learned more skills, particularly in the business of dentistry. It was in this four year associateship period that I had the opportunity to have lunch with Dr. Gordon Christensen. He was in Calgary delivering a lecture on faster, better, higher quality dentistry. He reiterated the comment about being good before being fast. He told me that I should spend 10 percent of my time outside my envelope of comfort. If I spent less than 10 percent, I would stagnate. But more than 10 percent of my time outside of that comfort zone puts me in danger of burnout, mistakes or worse. An even 10 percent keeps us growing, learning, improving—and we all win.

Twenty years ago, I bought the practice I have operated ever since and those lessons have served me well. I am still a geek, and a gadget guy but I don’t have all of the latest gadgets. I have enough to keep me happy and wow my patients every day, and my patient care is consistently at the high level I desire and expect. I am doing the best I can. I’m pretty fast now, for some routine procedures, giving me the time to continue to develop relationships with our patients. It’s pretty fun.

So now I create lists. Each year, I start with a priority list of what I want to learn more about for continuing education (CE). Next is a list of equipment (gadgets) that I want to consider purchasing in the coming year. Because I am still hungry and still growing, the idea of no longer doing dentistry just is not part of my life equation.

Embrace the changes; we know they will continue unabated. Don’t run out and get every latest and greatest item for your practices. First you get good, and then you get fast. Slow down in everything else and enjoy the journey. The saying about stopping and smelling the roses is still valid, if not more so, today.

Thanks for reading. There’s a new Star Trek collectible series that I want to consider…

Warm regards,

Larry Stanleigh

Monday, March 31, 2014

Dentists Like to Fail

I know it sounds crazy. But the longer I practice, the more I am convinced that we, as dentists, are ready to fail at each new pursuit.

Allow me to explain.

When I try out a new dental technique, update software at the office or install new systems, I always do it on a Monday. My office is open on Fridays and closed on Mondays, so any installations or changes to are complete on Mondays. This allows me to completely focus on the task at hand. If training is involved, my staff can focus on that. It is easier when there are no patients to take care of, no hygiene checks, etc.

I recently had a friend add text/email patient reminders to his office. He had read my blog on the subject and was excited to try it out. Within a few weeks, he had failed to successfully integrate it into his office. It took him a few weeks to figure out what went wrong, but I knew the first day that he would fail.

He had scheduled his computers to be updated and his staff trained on a regular work day. Yes, his staff was supposed to learn new software in between making hygiene recall appointments and setting up for crown preps. He was supposed to be on the phone with the software company in between recall exams. Do you think he and his staff saw the new software recall system as a benefit or a hindrance?

The introduction to a new piece of equipment, software, etc. is important. You and the staff must see it as a positive experience. How positive do you feel about constant interruptions? That is how my friend rolled out the new system. When I called to see how it was going, he told me that his staff had never really taken to it so he discontinued the service. We’ve all been there. We go to a continuing education course and are excited about a new concept. We think about how great this will work in our office, but the idea falls flat.

Where does this pattern start? I blame dental school. Remember the first time you tried prepping a tooth for a crown in lab? Or your first cavity prep? Were you encouraged by the faculty or discouraged? Did anyone ever congratulate you on a great first try? Or were you just told you would need to try again? It seems that every time we tried something new, we were trained to fail the first time around.

I overcame this in dental school by trying to learn to succeed. In lab, I noticed very quickly that nothing ever got signed off before 5 p.m. They wanted you working away in lab despite your best initial effort. But when the professors wanted to go home, everything was suddenly good enough to sign off on.

So a buddy and I (who shall remain nameless) would sneak out of lab, go grab a drink, and go bowling on campus. We’d return at 4:45, just in time to hear our instructors explain how much our work had improved! I learned that sometimes it is okay to get things right the first time around.

Do yourself a favor. Set yourself up for success. Dedicate the time necessary to introduce new products or techniques into your office. Nothing is more is more disappointing than having YOUR idea, which YOU are paying for, fail because YOU sabotaged it.

Andy Alas, DDS

Thursday, March 27, 2014

This Just In: Dentistry in the Media

If you haven’t seen this commercial, you should watch it now. Courtesy of the Food and Drug Administration, it emphasizes the consequences smoking can have on your teeth, gums and mouth. When this guy doesn’t have enough money to buy his cigarettes, he removes pliers from his pocket and extracts his own tooth.

We’ve all seen it. A patient sits down in the chair, opens their mouth, and we find all sorts of staining, calculus, pockets, recession, attachment loss, bone loss, inflamed and angry gingival, and overall very poor oral health. We ask if they smoke or use tobacco, and they say yes. What I’ve been pleasantly surprised about is the education these patients have already received. They are on board with the consequences tobacco use has had on their teeth, and they admit they already thought it is a major contributing factor. I always ask if they have thought of quitting and ask what I can do to help. I’m happy to say I’ve even gotten a few to quit and have enjoyed being their cheerleader in the process at our dental appointments.

Now, let me turn to a different announcement I’ve read recently regarding periodontal disease and the risk factor of smoking. Delta Dental’s new plan for employees’ limits their cleanings for ‘healthy adults’ to one per year. Employees in Michigan, Indiana and Ohio can complete an online risk assessment survey and may qualify for additional cleanings if they have certain risk factors and/or a history of periodontal disease. The issue that the American Dental Association and American Academy of Periodontology have with the risk assessment is that it “does not include several known risk factors that would possibly warrant additional cleaning benefits, especially smoking.” Delta sent a letter to network dentists announcing the change and recognizing smoking as a risk factor, but “excluded smoking as a risk factor because it did not want to reward employees for ‘bad behaviors.’” Needless to say, dentists and patients are upset by this change.

Another interesting approach by Delta is the option to include a genetic test looking for the Interleukin-1 gene. A positive test would make employees eligible for additional cleanings in the year. Dr. Vorrasi, chair of ADA Council on Dental Benefit Programs, questions this move by saying, “If Delta honestly wanted to assess risk of periodontal disease, why would they exclude the most recognized factors in favor of a genetic test that is unproven?”

Katie Divine, DDS

Monday, March 24, 2014

For the Last Time, I am NOT the Hygienist!

Let's get one thing straight. I have NOTHING against dental hygienists. As a student, I happily shared classroom space, clinic floors, and celebrations of academic and personal milestones with hygiene students. Now that I’m in private practice, hygienists are an essential part of my success in the dental office. They are my friends, colleagues, and teammates in our shared goal of helping our patients achieve the best dental health possible. I need them. I love them. I respect them.

That said, if one more new patient shakes my hand and asks when the doctor is coming in, I'm going to stab myself in the eye with a discoid-cleoid.

Since I first started seeing patients as a third-year dental student, getting mistaken for an assistant or hygienist has been almost a weekly occurrence. Why is the concept of a female dentist still so hard for some people to grasp in this day and age? Our profession has changed in so many ways since Lucy Hobbs became the first American woman to graduate from dental school in 1866. What used to be a stodgy old boys' club is now an equal-opportunity playing field where smart, talented, and business-savvy women are successful practice owners, powerful policymakers, and active leaders in their communities.

Yet, that hasn’t stopped many a patient (both male AND female) from sharing obtuse comments with me as. “Really? I didn’t know girls could be dentists!” Or, “Oh, when they said ‘Dr. Nguyen’ would be doing the surgery, I just expected you to be a man.”

And then there’s my personal favorite: “I don’t understand why a woman would waste her time and money with all that school and training.”

Over the years, I’ve devoted considerable effort to defending my choice to pursue dentistry as a career. Unfortunately, I think most of my audience tunes out 95% of what I say, choosing instead to come to their own wildly inaccurate conclusions. Despite all my attempts to enlighten them by citing current statistics on women in dentistry and my own personal experiences as a student and clinician, I’ve found that there are many who cling to one or all of the following impressions about female dentists:

1. Women choose dentistry because it is an easier alternative to a career in medicine.
2. Women who go to dental school ultimately just want to practice part-time or become stay-at-home moms, live off their husbands' income, and never have to work hard.

I’m not going to sit here and pretend like there has never been ONE female dentist who entered this profession after failing to gain entrance to medical school and deciding to change gears. I can’t say that no woman has ever been attracted to dentistry because it has demonstrated high earning potential. And I certainly can’t say that there aren’t any girls out there who make it a goal to pick up an MRS while they’re working towards their DDS. But I firmly believe that, for the vast majority of women dentists, the decision to pursue a career in dentistry is a highly personal one motivated by a multitude of complex factors that are unique to our own individual upbringings, personalities, and life ambitions. There’s a lot more to it—and us—than we’re given credit for.

Growing up, I got to witness firsthand what life is really like for a medical doctor. My father is a senior attending in anesthesiology at a large hospital in New York. Though his job literally gives him the opportunity to save lives on a daily basis and afforded our family a relatively comfortable lifestyle, it has not come without major personal sacrifices.

Because of the demands of his occupation, he routinely missed holidays, recitals, soccer games, and many other events that make raising children and having a family of your own so wonderful. When he WAS home, he was typically exhausted and/or unable to do anything that he couldn’t leave at a moment’s notice in case his pager went off. My mother went to so many parent-teacher conferences alone that it was years before my school realized that my folks had been together and living in the same house all along.

As much as I respected my father for his incredible work, I knew that I didn’t want that kind of professional life for myself. I wanted a job that was equal parts science, creativity, and service to others. I wanted more flexibility, more work-life balance, and more face time with my family, friends, and community. I felt that ,as a dentist, I would be more likely to have better control over my schedule and a greater ability to construct the career and life I wanted.

That didn’t mean that attaining my goal was going to be any less challenging. Dental school is by no means an "easy" alternative to medical school. The admissions process for both medicine and dentistry is similarly rigorous, cutthroat, and expensive. The same anxiety levels, constant fear of failure, and lack of sleep that haunt physicians during their years of school and residency as they struggle to memorize a seemingly endless deluge of information, train their hands to expertly wield surgical instruments, and pass their board exams also plague dentists in an equally daunting and unforgiving fashion.

Both paths require a thick skin for criticism, the ability to persevere in the face of adversity, and the mental clarity to make decisions quickly and adapt to change under duress. In practice, both physicians and dentists deal with stress, fatigue, and the multitude of pressures that come with being responsible for another person's well-being. Whether you are male or female, no doctor has it easy.

You would think that by the time I graduated from dental school and began a residency program at a level 1 trauma center, people would have no problem recognizing that I had achieved full-fledged tooth doctor status, and thus would be privy to all the rights, privileges, and respect that my male counterparts enjoy, right? WRONG! A few months into my GPR, an attending at the hospital commented, “It’s a shame that women like you who’ll eventually want to work part-time or give up their jobs so they can have kids take up spots in dental school classes that could go to men who’d work full-time and be more productive members of this profession.”

Yeah. That happened.

Without downplaying the truly archaic and sexist attributes of his flippant remarks, let’s address the part of that statement that really burns me. I deeply resent the notion that a woman who chooses to make adjustments to her professional life that may allow her to commit more time and energy to a family or other personal interests could ever be considered unproductive and/or not working to her full potential. I also have a huge problem with our culture’s perception that a stay-at-home mother does not work hard or have the ability to make valuable contributions to society.

Feel free to disagree with me, but my personal belief is that if a woman makes the very personal decision to have children, the greatest contribution she can make to the future is to raise her children to be kind souls who understand the importance of education, tolerance, and fairness for all people. If this is her goal as a parent, then she deserves the respect and support of others, no matter how she sets out to accomplish it and what she does or does not choose to give up in the process.

Lastly, anyone who thinks that being a dentist means that I spend my days off swimming in piles of money, à la Scrooge McDuck, should speak to my accountant, who had an exceptionally good laugh doing my taxes last week.

Reality television has a tendency to portray the lives of doctors and their families as a frothy whirlwind of walk-in closets, designer accessories, and sprawling real estate. While this may be a true reflection of life for some very successful healthcare professionals, for many others, it’s a mere droplet in a vast pool of existence that has far greater depth than those wading only in the shallow end can appreciate. For every doctor who frequents glitzy charity functions in the name of self-promotion and elevating social status, there are a hundred more who are making tremendous contributions to our world by participating in research, shaping healthcare reform, advocating for patient rights, teaching at the predoctoral or postdoctoral level, and performing pro bono treatment without expecting any compensation or recognition in return.

But back to the plight of women in dentistry. It seems that the overarching problem that arises with having to constantly correct those who automatically assume that I must be playing a supporting role in the practice is that it reflects a culture that is still not accustomed to seeing women take the lead. There are still a lot of people who are uncomfortable with the idea of a female in charge, and I suspect that this is because there still aren’t enough people out there telling young girls that they can and deserve to be.

A woman who chooses to enter the dental profession is declaring to the world that she has the drive, intellect, and confidence to handle the formidable task of charting the course of her professional destiny. She can suffer the slings and arrows of outrageous criticism and ignorance while setting her sights on success and achieving her personal definition of what it means to have it all. She can aim unapologetically high.

Honestly, what woman WOULDN’T want that?

Diana Nguyen, DDS

Wednesday, March 12, 2014

Humor in the Dental Office

Let’s face it: going to the dentist isn’t usually very funny. In fact, for many (maybe most), it’s downright scary. It doesn’t help that the media has traditionally played on the public’s fear of going to the dentist. There are movies that feed into this fear-inducing perception. Think “Little Shop of Horrors,” “Marathon Man,” and my all-time least favorite, “The Dentist.”

Conversely, there are comedy skits that poke fun at the vulnerability one experiences going to the dentist. Remember the Dudley Moore/Bo Derek movie “10?” In the “Carol Burnett Show,” there were skits with the hilarious Tim Conway and Harvey Korman. Even Jimmy Fallon did a skit that hashtagged its way through Justin Timberlake’s visit to the dentist. #dentalcare

Then, there are the dentists themselves. We are often the source of humor in the dental office. Perhaps it is a valiant effort on our part to make the patient feel more comfortable and allay their fears. Or perhaps it is a subliminal desire on our part to be stand-up comics and we understand the value of a captive audience (just saying).

My dad was a perfect example. Legend has it that he would fill the patient’s mouth with cotton rolls, and then begin his routine. He had a joke for every occasion and for every humor genre. This man was a walking encyclopedia of good, bad and ugly jokes. Unfortunately for him, none of his three adoring children got the joke gene. Dad tried not to show his disappointment, but I knew his disappointment was real. He clung desperately to the hope that the one (and only) joke in my repertoire would give me, joke-telling cred. With embarrassing pride in his voice, he would encourage me to tell my “wide-mouthed frog” joke to any and all of our patients. It made me feel as if I was ten years old and in a recital. My knees got weak and wobbly and my mouth went dry as I stumbled my way through the joke. (If you insist, I will regale you with my version of “the wide-mouthed frog” only if there is wine involved.) Patients laughed in a cottony polite manner and I went on about my work. It was painful for me.

But the patients? To this day, they talk about my sweet dad’s penchant for telling jokes while they were stuck in the chair. So, I guess there is something to be said about sharing humor in the dental office. If it means relieving fear and uncertainty for only a minute, it may turn out to be the best minute of the experience and what the patient will remember most. Today, I listen with delight as I hear patients laugh at the stories my dentists and hygienist are telling. The air compressor and high speed don’t sound so ominous when there is laughter in the air.

Suddenly, the dental office is a fun place to be.

Do you find that humor in the office works for you?

Claudia Anderson, DDS


PLEASE NOTE: When commenting on this blog, you are affirming that any and all statements, and parts thereof, that you post on “The Daily Grind” (the blog) are your own.

The statements expressed on this blog to include the bloggers postings do not necessarily reflect the opinions of the Academy of General Dentistry (AGD), nor do they imply endorsement by the AGD.