Whistleblowing

As the time comes to write my blog, ideas swirl in my mind about what to write about. One of them was to write a blog on just funny things that happen from day to day at our office. I really could write a book on the crazy/funny things that happen inside the walls of our office. 

I decided against that blog, but I wanted to give you a taste of what that blog would have looked like. 

I had a gentleman patient who we all loved. He was in his mid-80s and he moved to Central Florida to move in with his kids. 

We got to see him quite a lot because, basically, I think he liked having something to do. 

One day he told me that our headrests did not fit his head well and that he was going to bring his own headrest. I told him to be my guest. This is what he brought—and this is real life folks; I can’t make this stuff up!

 I could go on and on.  Maybe I will give you another funny one next time.

I now will get to topic at hand. 

I have written about this in the past but it has been a couple of years. And the reason why I am writing about it again is because it keeps coming up. Overtreatment…bad treatment from another dentist and what am I suppose to do with it?

Look, I am a conservative dentist. I also am a minimalist. I feel like once you cut into a tooth, you are opening this thing up for the circle of life. You know the circle…filling, bigger filling, crown, maybe another crown, extraction, implant. (I am envisioning Rafiki holding up Simba with the music in the background.) 

I think that the longer you can put off the big stuff, the longer a tooth can go before putting on a crown and the eventual loss of that tooth.

I use composite where most people are uncomfortable using it.  I get that two ethical dentists can have two different opinions on what is the best treatment for a tooth. (Now granted, it just so happens that one treatment option that someone else thinks is “best for the patient” just happens to be a THOUSAND DOLLARS more, but I digress.)

I want to tell you a story about a patient I had.

I am a leader at my church and every week there is a prayer sheet. People write on a sheet of paper what their prayer request is and then our leadership prays for them. 

One particular prayer request was by someone who was having a bunch of teeth issues and wanted prayers for that. So I reached out to her.

She told me that she had been getting a lot of dental work done and the dentist told her she needed a bunch more work done. Then she told me she was a stay-at-home mom and her husband was presently out of work. She had money for her dental needs but the work and the costs continued to mount up.

I told her that I could take a look at what was going on in her mouth and at least give her some advice, only if she wanted.

She took me up on the offer. She came in. Here are some of her X-rays that she had sent over. 

I look at these high quality X-rays and, like you, I can see some small issues going on here. In the first X-ray, you can see some PAP associated with #19.  She was asymptomatic. I could see where they would want to do a RCT. 

I see a little decay on the distal of #12. I see a bit of decay on the distal of #13 where it looked like the enamel was nicked. I see something started on the mesial of #15. I see an E2 on the mesial of #18, probably caused by the bur during the prep of #19. (At this point, I probably would not do #18 but would do #12).

And, I am guessing that her dentist decided to the RCT first and talked to her about this. And I also am guessing that the cost of a RCT got her scared. So she went to the dentist on her insurance plan so she could save some money.

This is where things started to go wrong for her.

This is the kind of @#$% I see coming out of the corporate offices down here in Central Florida.

You see here that another dentist has taken over and did the RCT (you can tell by the quality of the x-ray).  But do you see what else he/she did?   

Yeah, they did!!! They took out the best dentistry she had in her mouth.  The crown that was PER-FECT was taken out in order to do a RCT.  Now I don’t know what you do, but what I know is that in order to do a RCT, the endodontist or general dentist puts a small hole in the crown and does a RCT and then the general dentist does an access filling. 

$950 for the RCT + $200 for the access filling, and done.

Well, not at this office. The dentist took off the perfect crown to do the RCT and, after the RCT, he/she put on this brand new piece of poop on her tooth. 

And, if you look at the pre-op X-ray, you will see the decay on the mesial of #18. Now, at my office, if I am taking off a crown and I see decay on the mesial or distal of an adjacent tooth, I take out the decay and restore it right then. This way you don’t have to do a two-surface filling that blows out the marginal ridge.

Well, not at this place. 

This dentist decided to wait and then do a MO amalgam. But it looked like the decided to shoot this amalgam in with a shotgun.

I am not bashing corporate dentistry or corporate dentists or insurance practices or insurance dentists and I don’t mean to paint them with one brush.  But, around here, I continue to see the same thing.  So for me, if it quacks like a duck, smells like a duck, poops like a duck…it usually is a duck.

Here is the thing: I would go to the place where my insurance covered more, too. But I would expect the same care. I would expect the same ability from the dentist. But, in this case, it didn’t happen. 

They are all responsible for producing a product that is going to last—a product that is ethical, a product that is fair in cost. This is not happening.

To me, there is a lot of blame to go around. I blame the insurance, I blame the dentist, and I blame the corporations.

The corporations should be responsible for educating their young dentists. Insurance companies should monitor what is going on with their providers (heck, the insurance company is paying more out doing it this way). And dentists should want to stop overtreating for the sake of making more money.

I know, I know, I know... I am not suppose to bad mouth other dentists in front of the patient, but at this point it is getting REALLY hard not to. 

I tried to remain calm and stick with the facts. Let’s get some better X-rays and see what is going on now. Let’s forget about the past.

Here is one of the X-rays I took: 

Well, you have three spots of decay. They are large, but I think we could get away with doing big fillings. 

We won’t be doing any RCTs, we won’t be doing any crowns (which, of course, her corporate dentist told her she needed). The total cost of my treatment was about $1000.

So, we did it. Here is the X-ray:

Restorations came out great.  She had no pain. Her teeth looked awesome.  She was thrilled.

Oh, you see I went ahead and smoothed out the shrapnel on the mesial of #18, which I didn’t think was healthy. 

How is going to her insurance dentist saving her money? What am I suppose to do with this? 

What the laws here in Florida say is “sit down and shut up”: A dentist is not allowed to blow the whistle on another dentist. I think this is fair but again, what am I suppose to do with this?

Am I supposed to tell the patient to blow the whistle? The problem is that she really doesn’t have a case. This dentist could probably defend this treatment. Not being that great of a dentist is not a crime. 

And, I know, I don’t know all of the facts and I am not or was not in this dentist’s shoes when he/she was doing this.  But this is smelling so much like a duck to me. 

This is your profession that this dentist is pooping on. What do you think? Am I being too hard on this person? Does this make your blood boil, too?

John Gammichia, DMD, FAGD

How’s Your Paperwork Coming?

So for some unknown reason, I recently looked at my licensing certificates. I freaked when I noticed that my state license to prescribe controlled substances had expired. How could that happen? I quickly dug through all of the paperwork in my desk drawer (you know that drawer where you keep dosimeter records and radiology reports). I found equipment maintenance inspections mandated by the state but performed by private companies, along with the state inspections that repeat the same checks. In that way, the government can ensure that your office schedule is disrupted more than once. I understand the purpose—it’s a good thing that we’re required to have things monitored. I’d like to know if I’m being overly irradiated or spraying diseased water. But why twice in the same time period? (My state would actually allow the same inspection, by the two different entities, in the same week.)

After thumbing past those file folders in my “important paperwork drawer,” I found the one that actually licensed me to practice clinical dentistry in the state; thankfully, it was current. “At least I can still work on my patients,” I thought. A copy of that license was sandwiched between numerous CE certificates, study group flyers, and self-study booklets.

Of course, my numerous certificates are prominently displayed in frames on my office walls, just in case some curious patient might like to read one, or all of them—which I believe pretty much never happens. In light of the expired certificate, I wanted to double-check them all against my file copies, just in case. While handling them, I asked my assistant if she had some free time to polish the glass. When I saw the look on her face, I did it myself.

Then, toward the back of that all-important file drawer, I found a copy of last year’s application to the Federal Drug Enforcement Administration. It was current and so was my certificate. At least I wouldn’t get in trouble with the feds.

Then, in the very back of the drawer, I finally located what I was looking for: a copy of my January 2015 application to the Maryland Department of Health and Mental Hygiene (MDHMH), Division of Drug Control, on which I had recorded the check number for my payment to the State of Maryland. After carefully reviewing it, I remembered it being filled out a few months ago. Everything was in order. That was my signature. Nothing was missing or out of place. How could I not have my certificate to prove to inquiring, or skeptical, patients that I was not some schmuck prescribing drugs without a license?

I desperately wanted to find out why the state hadn’t received it. Were all my prescriptions from that date until now invalid? I hadn’t received any notice from the government, pharmacies, or anyone else that I was in arrears.

A simple phone call to the number listed on my copy of the MDHMH application was answered by a menu, which delivered no options germane to my current dilemma. So I listened again and hit #2, which brought up a second menu with more options that didn’t apply. I finally decided to let my office manager, who happens to be my wife, deal with it. She immediately punched in #0. After riding elevator music for 10 minutes, she got an actual person on the phone.

“Err, uh, did you send in the form and include the payment?”

“Yes, I have a copy of the form, but the check is electronically processed. I can contact our bank and get a copy.”

“Then check out our website. Everything is there.”

Click.

There was nothing on the website confirming that we had applied or sent in a check. But there also was nothing that said my license was expired. In the meantime, we had contacted my bank for a copy of the cancelled check and, to our dismay, found out it had never been processed. To address any issues—and we had a big one—the site directed her to the same number she had just called. Now my wife is not one to put up with idiots, which seemed to be what she was up against. But what else to do?

She called again. This time she got someone who was very helpful who told her that the government office had recently moved and all the renewal applications for a three-month period—yes, three months—had been “misplaced.” Yes, all of them—not just mine. So the reason our check had never been cashed was because it, along with the form, had been lost.

The nice lady also informed my wife that they had extended all the expiration dates for everyone involved; it’s just that they never bothered to tell anyone. It would have been nice if the first phone call had revealed this. They must be constantly receiving calls about this. I can imagine another agency being developed, over several years’ time and at considerable expense, to deal with this problem.

They ended up faxing a form letter to us stating that all expirations dated Dec. 31, 2014; Jan. 31, 2015; and Feb. 28, 2015 (mine), had been automatically extended to 2016 and 2017 respectively. We managed to fold and stuff this letter of explanation in the same frame with that expired certificate of mine in case a patient ever noticed the date.

To date, no one has.

Question: Does anyone honestly believe that an out-of-control bureaucracy will get any more efficient? Or that an ever more glutinous government will somehow magically make our offices run more effectively?

Jim Rhea, DMD

Feeling Like You Matter

Growing up in Toronto, the seventh son and twelfth child of 13, in a liberal Jewish family, it was hard to get a word in edgewise in a family of strong, individual personalities. Adults may want kids to remain quiet and stay in the background, but kids don’t want to be that way. We wanted attention. We wanted to be heard. We wanted to matter—even though we did not understand the world around us.

When I turned 13, I led my congregation in Sabbath services with my bar mitzvah. I worked hard to prepare for that big day, and after chanting the weekly portion of the Torah, I had the opportunity to give a sermon in which I described in English what was just chanted in Hebrew and I offered my considerable (or so I thought) wisdom as to how those lessons may apply to our world today. Hundreds of people sat and listened to what I had to say and, for that morning, what I had to say mattered.

After that, it was back to being relegated to the status of people thinking and/or telling me that “I don’t understand and don’t know what I am talking about.” Later in my teen years, I started to visit my second oldest brother, Howard, in his home. (Howard is 17 years older than me, and his kids are closer in age to me than I am to him.) We would watch TV, and talk about science fiction and fantasy, the movies we saw, and the books we read. He listened and talked to me like my opinion mattered and he helped make me feel like I was important. In my formative years, that resonated with me, and as I look back, it still resonates well with me. I have never forgotten how that felt.

In my general practice, like most, I have lots of families and patients of all ages. But when a child, preteen, or teenager is in my chair, I talk to them as if they are older. I treat them like they matter and show them that their opinion counts. I engage them with questions, find what really gets them excited or happy, and chat about that. And when it comes time to talk dentistry, even though the parent is invariably in the operatory, too, I talk to the patient and let the parent listen, as opposed to talking to the parent and having the child listen. It’s a powerful, yet subtle difference for me.

Twelve-year-old Hayden came to me recently for a third opinion. His parents brought him, but when I greeted him, I said, “So I understand I am the third dentist you are seeing about some pain you are having. Tell me about what you are feeling.” Mom was standing right there, but I wanted Hayden to talk to me. He told me that his upper front teeth hurt, especially when he wakes up in the morning. He told me the other two dentists only talked to his mom and told her what was going on but he did not understand what they were saying, so he did not trust the solutions being presented. I thought that was a pretty reasonable thought process and I applauded mom for listening to her son. It was a friend of theirs, a local orthodontist, who recommended they come and see me.

I took a look at Hayden and did a visual examination. Then I took out my intraoral camera and I showed him his own mouth and described what I was seeing.

Hayden had a deeply 100 percent overclosed bite. He had a posterior open bite. He had anterior maxillary excess. He had narrow arches, and he admitted he snored and had trouble breathing through his nose.

I told him that he is growing, and that his lower jaw is trying to grow, but his front teeth are in the way. I showed him how narrow his upper jaw was and that he was pushing his lower jaw forward against his upper teeth as he was subconsciously fighting to open his airway. We also took some digital X-rays and showed him those as well.

His teeth, individually, were fine. What he needed was to see the orthodontist and get his treatment started right away. And, because I talked directly to Hayden, with mom listening, he took ownership of his own body and his mouth and he was ready to move forward. Hayden was happy, and therefore, so were mom and I.

I have learned that everyone just wants to feel just a little bit important. They want to feel like they matter. And, to make them feel that way, sometimes we just need to stop and listen to what they have to say. It makes my day less of a grind.

Warm regards,

Larry Stanleigh, MSc, DDS, FADI, FICD, FACD

Survive and Advance

It’s widely known that the first Thursday and Friday of the NCAA Men’s Basketball Tournament, known as “March Madness” (err, March Sadness now that my team is already out of it), are two of the most unproductive days of the year for American businesses—especially now with the advent of live Internet streaming. Good luck getting that project done with a split computer screen playing four games at the same time! If you’re OK with that, it’s also one of the most fun times of the year.

Watching these games, I get the most joy not in seeing the superstar that puts up 30 shots to score his beloved 20 points a game, but the camaraderie, unselfishness, and teamwork that the elite teams have. Even for the mid-majors looking for that big program-defining upset, it’s the teams that pass, defend, talk, and move as one unit that advance to the further rounds.

The same can be said about our dental teams. That teamwork and togetherness is what gets us through the day without pulling our hair, our assistant’s hair, or our patients’ hair out. Without it, we’d be hard-pressed to get hygiene patients in and out on time, and have rooms cleared for our next restorative case—not to mention, be able to leave work on time and head home to our families. When your team has its system down, man, is it pretty to watch!

But it takes work—a lot of it. It takes communication—even more of it. And it takes a willingness to put the team ahead of the individual. As your team grows larger, so do the breakdowns in communication and effort, and, sometimes, this results in problems within the team, and visible, palpable issues that the patients notice. So let’s outline the starting lineup of the perfect dental team, one that could punch its ticket to the Final Four:

Starting at point guard, from a dental school near you, standing not-too-tall, but with loupes to see the minute details of that inlay prep—Dr. Dentist! He/she sets the pace of play, “dribbles the ball up the court,” controls the team, calls out plays. He/she is the leader, and if he/she doesn’t initiate the communication or teamwork, the team won’t win—it will be bounced from the tourney early.

At shooting guard, our “right-hand man” and partner in crime—the dental assistants! These high-scorers sit face-to-face with us all day, every day. Communication, teamwork, flow is paramount or the offense won’t work. They create their own offense sometimes, working on their own, keeping the team moving. Watching a seasoned dentist and assistant work is like seeing the best backcourt in the country pass and score with ease.

At forward, our teeth-cleaning, oral hygiene-instructing superstar—the dental hygienists! These players can score on their own, but it takes the entire team to keep the offense going. X-rays, medical histories, treatment planning, perio charting, and hygiene checks—it takes the shooting guards and point guard to open up the court and allow them to run their offense in the way only they can.

And, at center, the do-it-all with a smile on her face at all times—the patient care coordinators! These workhorses (that sounds bad, but it’s meant as a compliment) are the backbone of our team. You can have the most prolific guards and forwards known to mankind, but without a competent center, good luck. You won’t win a single game; geez, you may not even have jerseys to wear! They often have to make their own offensive or defensive play calls. They communicate with the rest of the team and really set the outline for how things flow.

If you don’t get all of my basketball jargon, the moral of my lesson is that it takes all parts—several different players—communicating, giving 110 percent effort, and working together as an efficient team to succeed on a daily and a long-term basis. We have to be positive and pick up teammates when they’re “not having a good game.” We can’t be a one-man team. These are all lessons that coaches are, without a doubt, telling their players before these big matchups, and they are ones we can also apply to our own dental teams.

Enjoy the madness everyone!

Donald Murray III, DMD

Finally—Spring Equinox!

For those of us who have survived the third coldest Michigan February in 135 years (according to the University of Michigan’s records), this day is a welcomed celebration of warmth. The average temperature last month was only14 degrees. The signs of spring—melting snow and chirping birds—remind me that there is a laundry list of things that I want to get accomplished. There is still time to dust off the to-do list and get to work. What is on your list? Perhaps taking the Fellowship exam?

I was at our Michigan AGD annual meeting last weekend having lunch and this very topic came up. I heard members say that they haven’t taken the exam because they feel “there isn’t enough time to prepare for the exam,”  “I don’t want to travel to take the exam,” or “I don’t have enough CE for Fellowship, so why take the exam?” I’d like to debunk some of the myths surrounding the AGD Fellowship Exam and let you in on how I prepared for it. I wrote about what Fellowship means to me, but I didn’t include insights on how to get there. First, let’s clear up some misunderstandings that may be holding you back.   

Myth: “There’s not enough time to prepare.”  

If you break it down into sections, it is doable. For a few months I gave up some ridiculous television program (that I am certain sucks knowledge from me) and used that time to study. 

Myth: “I don’t want to travel to take the exam.”   

Although the annual meeting undoubtedly is one of my favorite dental events each year, I understand that attending may not be possible for some members at different stages of life. The good news is you can take the exam at a local testing center! That’s right—you don’t have to take the exam at the annual meeting! I was surprised to learn that many people are unaware of the local options. The second benefit of taking the exam at a testing center—instant results (great for those of us who need instant gratification).

Myth: “I don’t have the required CE hours.”  

You don’t have to wait until you have all of the hours! TAKE THE EXAM NOW! Recent grads, take it! Your prep time will be minimal since little would have changed since you took your boards. The Fellowship exam is just one of the criteria needed in order to become a Fellow. The exam doesn’t expire; once it is completed, you are set! I believe the confusion arises in that, once you apply for Fellowship and you are approved, you have three annual meetings in order to participate in the Convocation Ceremony to receive your Fellowship.  

Now that we have that straight, the way I went about the exam was pretty simple. I downloaded the content outline into a blank document. I also purchased the most recent AGD study guide so I would have a good feel about how it was written. I took a practice run before I even began reviewing content and had a good idea where I needed to focus. That is where I started on building my study guide. This turned into a 62-page study guide that I built from old study exams that colleagues had previously purchased, as well as my own notes. I could see the breakdown of topics within a discipline and make sure every section had been covered. For me, the studying part really was the formation of the study guide. Once I had it complete, I reviewed it a few times and knew it inside and out—then I was ready (well, as ready as I thought I could be). 

I must point out, the Fellowship exam is not easy, but is absolutely feasible. I heard someone mention once, Fellowships are not given away, they are earned!

Stop making excuses for not taking the exam. You know you have ALWAYS wanted to do it, and now is the perfect time! I will even make it one step easier. Here is the link to the page on the AGD website that will provide you with the necessary forms in order to get registered!

Happy spring!

Colleen B. DeLacy, DDS, FAGD

Election Night

First and foremost, THANK YOU. Your response to my previous blog post, “I Tried to Hire an Associate Today,” was amazing. It was by far the post on which I have received the most comments ever. Apparently, I struck a nerve. I truly appreciated the time, thought, and candor that went into your comments. If you have not read them, do yourself a favor and read my previous post and especially the readers’ comments!

It was great to read the perspectives from fellow practice owners, as well as dentists working as associates. I think we all learned a little about each other’s perspective. The Daily Grind is a place for us to exchange ideas, thoughts, and concerns. It does not mean we always agree, but hopefully it means that we always learn.

It was interesting to see the numbers that our colleagues wrote about. As I mentioned, this is a difficult topic since numbers vary greatly by region. I came to the conclusion that whatever numbers work for you and your region are the right numbers. It’s kind of like buying a house. In some parts of the United States $1 million buys you a very nice place. In other places, you get a lot less. It’s the same with practices. In some areas, if you produce $1 million a year you are living like a rock star…in other regions, not so much.

So PLEASE, keep those comments coming for all of our blogs, because it’s nice to know someone is reading what we write. Again, thank you.

Now, on to a completely different subject...

I make it a rule not to place political posters of any kind anywhere in my office during elections—with one exception.

I do place placards/signs for my patients who run for office. They have supported my practice over the years, so I in turn support their efforts. It does not matter which party, if any, they belong to. They have my endorsement if they are my patient. I tell them that my endorsement, along with my influence in the community, should be able to deliver a voting block of about one vote.

 

On March 3, there was an election in our city. Two city council seats were available. One of my patients decided to run. We placed his signs in our office windows. He truly appreciated it, especially since, as I later learned, ours was the first business to ever display his sign. He was grateful for that. Every once in a while another patient would ask about the sign in our window. They were pleasantly surprised to learn of how we support our patients in their efforts. I assured them that if they ever ran for office I would do the same for them!

A cool benefit was that I was invited to the election night party with the candidate.  How many of those have you been invited to? They are pretty cool. Everyone is optimistic, and there is lots of food and drink for everyone. It is the candidate’s time to thank everyone who has supported his candidacy. The only bad thing is that these are usually on a Tuesday night. So it is a late night for the candidate and their families. However, a great time is to be had by all. Ultimately, my patient didn’t win the election but I was proud of him nonetheless.

So if anyone out there is thinking of running for president of the United States next year, you now know what it takes to get that all-important Dr. Alas endorsement. 

Andy Alas, DDS

Attitude

It seems that I recently have had more than a few incidents that have negatively affected my work attitude. I’m sure most dentists who have been in practice for some time have experienced similar challenges, hence the existence of so many practice management companies. Most of these are beneficial in providing us with the managerial, leadership, and motivational training that we don’t get in dental school. I have used a few of these companies over the years and had recently convinced myself that perhaps I needed to hire another. But, before signing on to another $40,000 to $50,000 commitment, I decided to look back on the lessons I have learned, but inadequately implemented, in the past.

Many years ago, I attended a few sessions of Walter Haley’s Dental Boot Camp in Hunt, Texas. Walter and the boot camp are gone now, but I still remember some of his philosophy. Walter would have been the last to take credit for what he taught, because I remember him telling us that none of what he told us was new. He said most of his tenets came from the Bible, while the rest came from great teachers before him who had positive influences on his success. So, I do not credit Walter and his group as the originators, but merely the source, of these ideas. By the way, Walter was not a dentist. However, he did know how to motivate and transfer life lessons better than anyone I ever met.

Dental boot camp was emphatic about setting daily and long-term goals, writing them down, and reviewing them daily. Being a self-proclaimed procrastinator, I have not been good about this practice. I am pledging to myself to do as he said and, “Do what you gotta do, when you gotta do it—no debate.”

Another practice I will expand on is what Walter termed “getting the monkey off your back.” In our roles as practice manager, CEO, CFO, and doctor, it is easy to become overwhelmed with minutia that can easily be handled by our staffs. How many times have staff members come to you to seek a solution to a problem that you know they could have handled by themselves? We (I) need to give our staff permission and responsibility to handle not only clinical, but expanded management duties. One of the ways Walter said he handled this was by telling his employees that he had every confidence in them to solve the problem. One of his rules was that staff members could not come to him with a problem if they had not already considered at least three solutions—one of which should cost no money.

My favorite “Haleyism” was to “make up a list of things of which I will not put off.” Many of these should be included in an employee manual, regarding policies for expected performance, time off, etc. Others should be included in your patient management and treatment protocols. My most recent addition to his list concerns patients coming to me for a second opinion. I now insist on having all X-rays upon which the treatment recommendations were made BEFORE the patient arrives for the appointment with us.

So, if you need a management coach to help set up systems in your office, hone your leadership skills, or help motivate you and your staff, by all means, hire one. If you have invested in one or more management companies in the past and are still not where you want to be, try these things:

1. Make a list of daily and long-term goals and review it daily.
2. Make up a list of things of which you will not put off.
3. Give your staff permission to “make decisions,” not just perform duties.
4. Lastly, “do what you gotta do, when you gotta do it.”

 As Walter liked to say, what you seek is seeking you.

 Terry G. Box, DDS, MAGD

Talking About My Generation

I have seen several articles in dental journals and heard various podcasts comparing the Millennial generation to previous generations, and it is almost always in the context of lambasting Millennials as a lazy group who is difficult to deal with. Howard Farran, DDS, MBA, of the Howard Speaks Podcast on Dentaltown.com, called people born between 1980 and 2000 the most entitled generation to ever grace the planet. He particularly doesn’t like the fact that dental students and new graduates complain about their student debt.   

As a Millennial, I wanted to put in my two cents in defense of an entire generation and put things in context. According to the archives at the University of Pennsylvania, dental school cost $10,320 per year in 1980 (not counting additional living loans). Tuition at the University of Pennsylvania for 2014 was $68,278, with additional fees (still not counting living costs) adding up to more than $90,000 per year. These are not optional fees; these are books and supplies, instrument management fees, and clinic and technology fees. I put $10,000 into an inflation calculator and in today’s money $10,000 is equal to $28,362. 

So, I ask the old guard to consider this: If their tuition was three times greater than what they paid, how would that have affected their lives as they started their careers? I completely understand that my income potential long term is still much better than it would have been if I never went to dental school. I actually don’t even mind (that much) paying off my student loans, but I do dream of being able to refinance at a more reasonable rate, say 5 to 6 percent, as 6.8 to 8.2 percent on several hundred thousand dollars is hard to get on top of. 

Other things Millennials are repeatedly accused of include being lazy and self entitled. I am sure every group of several hundred people has a few bad apples; however, I don’t personally know any lazy recent graduates. Most of us work full time at several jobs; we work the late hours and we work Saturdays. I did not buy a new car or house my first several years. My husband and I rented, and when my car could no longer be driven, I purchased a basic model Subaru—not a luxury vehicle, although the Subaru felt luxurious to me. 

The problem with stereotyping is always that when someone proves the stereotype to be true it is easy to forget the other 10 people they met who didn’t fit. We can all benefit from mutual respect and learn from each other. While we newer grads need to learn about practice and staff management, maybe we can help a more experienced dentist navigate the new digital software and show them how to set up a Facebook page. 

“I see no hope for the future of our people if they are dependent on the frivolous youth of today…When I was a boy, we were taught to be discrete and respectful of elders, but the present youth are exceedingly wise and impatient of restraint.” That quote seems like it could have come from a recent podcast, but many actually link it to the Greek poet Hesiod and suggest it was written 3,000 years ago.

Sarah Meyer, DDS

Dental Travels

Since graduating from dental school almost five years ago, I would like to think that I have been quite aggressive in the amount of continuing education (CE) I have taken. After graduation, I had some free time and I was motivated to learn all of the things that dental school did not teach me. I also enjoyed the socializing aspect of traveling to conferences and meeting like-minded dentists, as well as reconnecting with old friends. My boss generously offered to pay for my courses, so there was no stopping me.

I took a major break from traveling in 2014 when I had my son. I always try to attend the AGD and AACD annual meetings, two organizations that I enjoy being a part of. Since I missed them last year, I am planning on attending both this year, and I am finding it difficult to commit to so much time away from home. I appreciate that the AGD schedules its meeting so it falls over the course of the weekend but, no matter what, one dental meeting is essentially equivalent to being away for four to five days, particularly when traveling to the opposite coast. Sure those meetings can be designated times that I will make a priority, but then there are more intense CE courses at Spear and Kois that always fall on the back burner because there just is not enough time to attend them all (will there ever be?).

My son is almost a year old, but since he was born, I probably have been away from him for a total of six days. I try to be home to put him to sleep every night. Even though I still feel like a new mom, I know those days are going to be behind me soon, so I am trying to hold on to them for as long as I can. Many of you reading this may be thinking, why not just take the kids with you and turn the week into a tax-deductible family vacation? It’s not that simple. I know spouses and kids are more likely to come along when the dentist is male, but are there any female dentists out there who bring their husbands and kids to their meetings? In my case, I think it would be a huge distraction. I like to make the most of my time; I try to attend courses during the day and social events at night, and by the end of the week I am so exhausted. I am all about multitasking, but combining family time with professional learning and networking just does not seem realistic. I could see it being more of a possibility when the kids are older, but have you ever been on a long plane ride with a mobile baby/toddler? These are just situations I would like to avoid, if possible.

So what does everyone with kids do? Do you combine dental travels with family trips? Do you not travel for CE at all? If you keep them separate, then you end up taking so many trips—not to mention time away from the kids. What if you just want to take a trip somewhere with your spouse? Perhaps I am being unrealistic in expecting things to remain the same after becoming a parent. Let me know if there is hope.

Have a great week!

Lilya Horowitz, DDS

Loosening up the Purse Strings

I am obsessed with money. And I know, as a Christian, money is not supposed to be my god, but I have to admit, it is sometimes.

I think that kind of comes from being the breadwinner in the house. I think it comes from me listening to Dave Ramsey on the radio every day on my way home. (I don’t totally agree with everything he says.) I also think it comes from having to pay the bills every week, and sometimes feel like I am playing Russian roulette.

I add up the bills and click on the website that has my office checking account balance to see how much I am in the red this week. This is so stressful. Every week we have to go through the same torture. Each day we come to work and see what is on the schedule. We are jumping for joy when we see crowns listed, and we walk around like our dogs just died if all we see scheduled are sealants. Or how about the day you come to work and all your patients are sick… oh except for the all the redos—they always show up.

How can you not be obsessed about money? How can you not worry about it? How can you not get upset when there is nothing on the schedule? I mean we all know Friday is coming, payroll is due, and maybe it’s the same week the lab bill is due. I am starting to sweat just writing this.

In my first year out of dental school I read the book “The Millionaire Next Door.” This was a life changer for me. Look if you have not read this book, I think it was the MOST influential book I have ever read. You have to read it. (I have felt like I have done about half of what it says and I am about half successful at money.) But one thing I remember is the book says, if you do it right, then you are going to be cash poor.

What does that mean? Well, if you have $100. First you pay yourself; this is fancy way of saying put money away for the future. Now depending on whom you listen to, this should be more than 10 percent and up to 15 percent. Then, for my family, we tithe 10 percent (on the gross). Then you have to pay taxes. Let’s say that is 28 percent. Wow, the first three things are over 50 percent.

Then you have to live. Then you have to eat. Then you have to have insurance: medical, disability, general liability, car, house, an umbrella policy, life, etc. Then you have to educate you kids. Then you have to drive. Then you have to get entertained. Then your team makes it to the Final Four and you HAVE to go. Then you have to have clothes. Then you have to get a stupid dog. Then you have to buy anniversary gifts (I love you honey!). Then you have to go on vacation. Then you have to get an iPhone. Sorry, but I don’t know why I am so obsessed with money.

But anyway, this is not what the blog is suppose to be about.

I have been doing this for about 20 years. And I know all the sayings, “How do you get rich? Slowly” or “steady plodding brings prosperity.” But, when will it end? When will I ever feel secure?

I bought my practice from my dad about five years ago, but I didn’t really starting making money until he left about two years ago. That is not what I meant. I have always made good money, but I felt like I had a little more room to breathe after he left.

I have an office savings account for the first time ever. It has been so nice buying large pieces equipment with cash instead of credit. The office is very healthy. But again, personally, I am living week to week. I am able to do all the things the book says, but I am cash poor.

Now I read this blog called The White Coat Investor. It is a financial blog written by a physician for guys/gals like us. High earners (theoretically) with high IQ’s (theoretically). He is a big Dave Ramsey guy too, and he is really smart about investing and living below your means.

He recently posted a blog called “Loosening the Purse Strings.” He talked about how he looks at his portfolio and see that it is pretty healthy so he is going to start spending money. He is about my age and he says if he lives modestly he can retire in about five years. He wants to finish paying off the house and he thinks he will be set.

So he started “loosening up the purse strings.”

He saved up and bought himself a $4,000 bike. Him and his wife saved up and went on a vacation to Belgium (or something like that). Then he saved up and took his family of four on a no-holds-barred vacation to Hawaii. Then they improved their house. Then he talked about buying a boat...

I was having a grand mal seizure every time he spent more money. I am not a miser, but I am not a spendthrift either. You see, I have been in this mode of week to week for so long that I don’t ever see me coming out of it. I don’t know my number (I actually do, but it is too high to reach). I don’t know what the number is going to be for me to breathe. What is that number going to be for me not to sweat the compressor breaking? For me not to sweat my car making weird noises?

I don’t know, but I do know that I am getting healthier. My number in my 401(k) keeps going up. I know that I have been funding some backdoor IRAs (read that blog). I know that I have been able to pay for my kids to go to this swanky private school (barely).

But I don’t see it getting any easier, because I see buying my son a car soon, then two kids in that swanky private school, then college, then two colleges and one more in that swanky private school. Oh, did I tell you I have forth kid who is five years old? (What can I say, my wife couldn’t keep her hands off me!)

So, I see me doing all the right things. I see me financially healthier. But it ain’t easy because I am still living week to week. I still sweat my schedule. I still sweat the big bills. I certainly don’t see it getting any easier any time soon. And for sure I don’t see myself loosing up the purse strings, much less buying myself $4,000 bike!

Where are you at? Are you healthy enough to loosen the purse strings? Tell me, is it nice?

Have a great weekend!
John Gammichia DMD, FAGD

Associates

I hired an associate once. Actually, twice. Well…I guess it was three times. One was OK. One was a disaster. The third was a nonentity and totally unprofitable. The other two were also unprofitable. Well…one probably set me back a little.

So why? Why keep beating my head against the wall? Early in my career, I did it to pay the bills: school loans, rent, etc.

I’ve found that many, if not most dentists are individualists. I don’t want to say we’re loners; it’s hard to be a loner in the midst of staff and myriad patient interactions every day. The movie “Ghost Town” centers on a dentist who hates people in general. One scene shows an overly chatty patient, and the dentist could care less about what she is saying so he quiets her by taking an unnecessary alginate impression. “That’s better,” he mumbles. I think that stereotype has changed for the better over the years. Most dentists I know enjoy what they do and truly like their patients.

Reading the various blogs that come through this site helps me realize how far we’ve come as dentists, not just clinically, but personally as well. Today, large clinical settings are becoming the norm. There are always pluses and minuses with any change, but on the whole, I believe the larger settings have been an improvement. Our cases are not always cut and dry; having a colleague at hand for a second opinion can improve the quality of our treatment. Some larger offices have in-house specialists available at least once a week so patients don’t have to go somewhere else when referred for endo, perio, ortho, etc. People like a familiar setting where they know the receptionist even if they don’t actually know the doctor they are seeing.

So, back to the associate-for-profit thing. As a solo practitioner, I never had an associate who was bottom-line profitable. I wanted them to be. At one point, I specifically wanted someone to share the overhead on my main office while I established a satellite practice in a small bedroom community near Washington, D.C. The game plan: keep production going to pay the high rent and overhead of the suburbs, while I worked the embryonic satellite practice. If things went well, I might even turn a profit. I didn’t. Unforeseen complications arose.

It’s human nature that when you rent, you don’t take care of things as well as you would your own stuff. Ever pick up a rental car at the airport, the one with coffee stains on the seat and numerous scratches that the attendant says, “don’t worry about those”? I know every scratch on my own car and they bother me. Well, not the ones on the truck, but that doesn’t count. It looks nice and rustic—well-used for the purpose—with all its dings and dents.

While working in my satellite office, I once got this call from my part-time associate. “The unit in the middle room has sprung a leak.” I told him to turn off the main switch and I would deal with it when I could. I arrived the next day to a minor flood. After fixing the unit and replacing the carpet, I was in the red. Sometime later, when I had almost broken even on the deal, he called to say he’d found a job that “paid better.”

Having an associate to help pay the bills never worked out for me. My office wasn’t large enough to accommodate two dentists at the same time—so we could never work together. It would’ve been nice to have someone to consult with on certain cases. That would be one main reason to get an associate, but only if he or she were in-office at the same time you are. Another reason could be as a transition. If you’re thinking about selling your practice, grooming a prospective buyer by introducing him to your patients will increase its value.

But if you’re a solo practitioner, don’t expect a windfall that will pay for that estate in the country.

Jim Rhea, DMD

Of Dog Shows and Whiplash

It’s the second longest continuously held sporting even in the U.S., behind only the Kentucky Derby. It predates the invention of the light bulb, the automobile, basketball, the World Series, and it has seen the passage of 25 presidents. It was formed by a group of gentlemen in 1877 and named after their favourite bar in their favourite hotel to show off the abilities and accomplishments of their dogs. The Westminster Kennel Club’s annual dog show in New York is dedicated to the sport of purebred dogs.

It is a remarkable group of people who participate in these dog shows. Things have evolved so that there are a variety of special jobs within dog shows around which people have created entire careers. There are the owners who pay top dollar for their purebred bundles of joy, and there are the trainers who bring the discipline to these dogs that enable them to “show” well and behave in these events before thousands of spectators and hundreds of other dogs. And finally, there are the handlers who do the work of “showing” the dogs at these events.

Brian (not his real name) is one such handler. He specialized in the large dog breeds and loved the work he did. He was so good and regularly had the dogs that would win these competitions all over North America. It was not a particularly lucrative job, but he loved the work he did.

About two years ago, Brian was driving on a road that was under construction when another vehicle failed to yield to the traffic in the construction zone and hit Brian’s vehicle from the rear. Although restrained by a seat and shoulder belt, his head and neck moved well beyond their normal physiologic range and he suffered a terrible whiplash injury. Additionally, his mandible travelled down and forward, and then snapped back and upward so quickly that he suffered a crush injury of the articular disc in his TM joint.

He had headaches, ear pain, dizziness, tinnitus, neck pain and immobility, shoulder pain, and more. It hurt to bring his back teeth together; chewing gum, steak, or raw vegetables brought about spasms of pain. He was disabled and could not pick up a medium-sized dog, let alone the big ones he loved so much.

Physiotherapy was helpful, but he was not recovering. His personal injury lawyer knew about the work I was doing with these kinds of injuries (based on studies with world-renowned physiotherapist Dr. Mariano Rocabado, who recognized what he calls the 50:50 rule, in which the mandible and neck interact so intimately that each must receive equal treatment if a person is to recover from physical trauma to this region), and he referred Brian to me for evaluation and treatment.

Personally, I prefer non-invasive reversible therapies as a first course of treatment. After a thorough examination, which included a detailed history, current complaints, objective observations, and other appropriate diagnostic tests, we embarked on a team-based, multi-disciplinary treatment regimen, working with a chiropractor, physical therapist, massage therapist, physician, and me (via an intraoral orthotic). In a reasonable period of time, we managed to return him to a normal, pain-free range of motion.

It was a great commitment to meet and be treated by so many people, but Brian believed that he was seeing the right team of people to help him, so he took the attitude of not being the victim but rather the instrument of his healing. He took charge of his health and took this experience as his opportunity to make real changes in his life.

Brian underwent an amazing transformation. He changed his diet, began working out, and he not only recovered, but also went on to lose 100 pounds and looks amazing! He is once again a handler for the big breeds and back into the competitions, wherever they may be held. I have found this change to be inspiring.

It is incredible that we get opportunities every day to make a difference in someone’s life. And, on a regular basis, I find that some of our patients are so inspiring that they change our lives, too.

And that makes it not so much of a grind now, doesn’t it?

Warm regards,

Larry Stanleigh, MSc, DDS, FADI, FICD, FACD