Friday, August 31, 2018

An inside look at working in public health dentistry

Think back to your personal statement for dental school. What did you say in it? My bet is that you mentioned something about your desire to help people. About how you knew a dentist somewhere who helped someone in a way that only a dentist could. About how that experience planted in you a desire to do the same thing. That one day, you hoped to be a dentist who not only did that for every one of your patients but also for the world!

OK, so maybe you said it with more tact or with less drama, but I have read enough prospective student personal statements to know that a good number of applicants include that to some extent. Now imagine if that dream came true. Imagine you didn’t have to worry about student debt. Or about running a business. Or do anything other than what you originally wanted to do: help people. To focus on dentistry and nothing else. Well, that’s what I do every day. And for some reason, it is one of paths least traveled.

Public health is the hidden gem of the dental profession. Not only can it give you freedom from student debt through loan repayment and scholarship programs, but it can also give you the freedom to practice without outside pressures attempting to influence your clinical decisions.

My own path to public health started with one of those scholarships. I was awarded a four-year scholarship from the National Health Service Corps. It allowed me to graduate from dental school with little to no loans, and it paid 100 percent of my tuition and fees, in addition to giving me a living stipend each month for other expenses. In turn, I gave a year-for-year public health service commitment.

Working in public health has its pros and cons, just like any other field. Most public health jobs come with decent pay and amazing benefits (health/life/malpractice insurance, retirement plan, etc.). Add in a set salary (aka a lifetime “minimum income guarantee” as they call it in private practice) and subtract pressure to produce and run a business (which most of us haven’t been trained for), and you have yourself a pretty fulfilling career. It is also clinically stimulating. Contrary to popular belief, it is not all extractions. In fact, I would say that my treatment plans are some of the most complex you’ll see

A typical day for me is filled with a well-rounded sample of procedures. My schedule reads like the chapter headings of a general dentistry textbook: examinations, restorations, extractions, endodontics, removable prosthetics, fixed prosthetics, etc. You would be hard-pressed to find a day where I was bored or wasn’t being challenged in one way or another. And the best part? I do the best dentistry I can for the patient, regardless of insurance, his or her ability to pay or anything else that might hinder me because of discount programs and government grants that allow me to do that. And that feels good. Think of it as not occasionally volunteering at your state’s Mission of Mercy but working there full-time.

Of course, there are cons, too. If you are business-minded or entrepreneurially inclined, the lack of control for certain things may frustrate you. Does my organization need better marketing and public relations? Absolutely. And I wish I could help with that, along with a number of other things, but the managerial and administrative issues are not my domain. But this also has an upside. Not being able to do something about those things also means that I don’t have to do something about other things. Angry patient? “Let me get the clinic manager for you.” Employee conflict? “How about we get HR on the phone?” Insurance issue? “Here is the number to our billing department.” And I can go home knowing that whatever the issue is, it will be taken care of.

In the time that I have been practicing at my clinic, I have already seen so many lives changed due to programs that we have as a community health clinic. These patients, who most likely couldn’t afford to receive care anywhere else, are not at all shy about expressing their gratitude, often with tear-filled eyes. This is where the real giving back happens, where I can do what I was trained to do and what I enjoy most. Where those who don’t have the privilege of private dental insurance can find hope and quality care at an affordable price. Thinking back to the reasons why I wanted to become a dentist, it is hard to imagine myself practicing anywhere else.

~Dr. Kyle Larsen, Colorado ’17, National Health Service Corps 

This blog post is the last in a series focused on career paths you can take after graduating dental school, as part of ASDA’s inaugural Career Week. Explore residency, specialties, associateships, buying a practice and non-traditional careers via webinars, blog posts and social media content all this week.

There is enough time in the day: Part 2 -- Clinical struggles

How often do you find yourself thinking that there aren't enough hours in the day? Practice management consultant Jen Butler has a way to fix that. In the second of a three-part series on how to create a productivity blueprint, she shares ways to overcome your clinical productivity backlogs.


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Thursday, August 30, 2018

Dental distributors move to settle 2016 antitrust litigation

Benco Dental has announced the settlement in principle of a 2016 antitrust lawsuit that alleged price-fixing. The other defendants in the lawsuit, Henry Schein and Patterson Companies, stated separately that they had set aside millions of dollars in anticipation of the case being settled.


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To build your dream or buy it?

With changes in the marketplace, building a dental practice from the ground up has sparked interest for many new doctors. Though risky, the personal and financial rewards can be plentiful and attainable.

While advisors have historically championed buying into practices to take advantage of cash flow and income to tackle student loan debt and begin accumulating wealth, what we’ve seen is that there are fewer practices on the market and more competition for the ones that do hit the market. We see baby boomers working and keeping their practices longer, leaving new dentists with a tighter market to begin practicing.

Additionally, graduating doctors are not the only buyers.  Now more than ever, new doctors are competing with the growing corporate entities and established doctors trying to increase their footprint.  As a result, advisors and consultants are reevaluating startup practices.

Each year, our firm surveys our orthodontic clients to gather comparative data. The latest edition of our Orthodontic Practice Comparison Report showed the average orthodontist surveyed produced $1,913,238 by the provider and had an overhead of 53.7 percent. This equates to approximately $885,800 of income before paying practice debt and perks. In contrast, an average associate works 16 days per month at $1,157 a day; he or she will make $222,144 for the year.

Looking at the opportunity costs and long-term benefits, we found that despite the challenges associated with startups, the payoff could be significant if important factors were in place.

Living your dream
I met the client, who we’ll call Dr. John Doe, and his wife when he was in his last year of orthodontic residency. Although concerned with the amount of dental school debt he carried, he came to me knowing he wanted to start his own orthodontic practice. After months of hard work, he opened his practice. In the beginning, it was tough. Here are a few financial challenges he had to watch for:

  • Cash flow: The way orthodontic contracts are structured creates a lag in collections. It takes about 12 months for collections to catch up and match the production from the prior period. As such, you should have another source of income in place. In this case, Dr. Doe’s wife was able to sustain them during the beginning of turbulence.
  • Staff: Staff costs are the largest single expense in an orthodontic practice. On average, the surveyed clients spend about 18 percent of collections on their staff. Dr. Doe started with an assistant and a front office staff to ensure patients were assisted. Since the beginning, he has only added staff when necessary.
  • Rent: The average surveyed client is typically more established and spends about 6 percent of collections on rent. Considering Dr. Doe was running a startup, he kept rent at approximately 10 percent of collections. It’s common to see new orthodontists overspend on rent with a large space they will “grow into.”

The payoff
At the end of his first year, Dr. Doe barely made enough to service his debt. But those days are long gone. His income has grown exponentially. Now, he exceeds $1 million in production. Dr. Doe is the first to tell you that starting your own orthodontic practice isn’t easy, but he would be one of many that will tell you it was worth it. Startup or buy-in, ownership can bring you the opportunity to control your own destiny.

~ Judson Crawford, CPA, Partner, Cain Watters and Associates

Income, home ownership linked to dental visits

Adults who own a home and make more than $2,900 per month are nearly twice as likely to visit the dentist as those who do not own a home and earn less overall. These findings come from a new study that sought to evaluate how wealth correlates with dental health in the U.S.


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Wednesday, August 29, 2018

4 keys to a successful associateship

I considered writing this post about obtaining the ideal associateship. I quickly realized, though, that “ideal” is misleading and different for everyone. Our goal should be a successful associateship — one that creates success for both the associate and the practice. This looks different across the board, but in my experience in several different environments, the following have been keys to success — or causes of failure.

Begin with the end in mind. For many, your first job will not be your last job. For others, you may find your forever practice immediately. Either way, your discussions when entering an associateship should involve the end of your associateship, whether that is a buy-in to the practice or your exit from the practice for another opportunity. You need to have a clear understanding of how an exit would look if it occurred. Inquire about previous associates and ask how and why they left. This is not a bad thing and shouldn’t necessarily reflect poorly on the practice. If this is something that is discussed and understood, and both parties agree, there is nothing wrong with an associateship being your stepping stone to future ownership somewhere else or on your own.

If there is an opportunity for buy-in or buy-out, that path and timeline should be established in writing in the associate contract. Things could change, but if you truly feel the practice is one you will want to purchase, I encourage you to have a contract that outlines how that will occur. Some associateships won’t be the right fit, and an associateship is as much your opportunity to evaluate a practice as it is the practice’s opportunity to evaluate you. Think of it more as a dating–engagement–marriage scenario!

Continuing education is imperative. I learned more in my first four years of practice than I did in the entire four years of dental school, and my dental education was phenomenal. Dental school is not the end of your learning. Practice will teach you an immense amount, but you must continue your education. For me, this was a vital piece of an associateship. I wanted to not only be able to continue my education, but also be encouraged and supported to do so.

Continuing education can be costly, and you may have to take time out of the office to participate in a course. Weigh this into your compensation, and even negotiate a continuing education plan or stipend into your contract. Also, network, join study clubs, go to local meetings and get to know dentists outside of your office. This should be something your associateship encourages and supports.

Learn the business of dentistry. You will enter practice as a well-educated clinician. You will not enter practice with a true understanding of the business of dentistry. Finding an environment in which you can learn and understand the business of practice is imperative. Insurance claims, payroll, employee handbooks, scheduling for success, managing your search engine optimization and more — these are things that never entered my mind in dental school. Yet they’re all a part of my weekly routine in practice.

An environment that encouraged me to learn and take ownership in these items was vital for my growth. It is important that you know how an office operates and be given the opportunity to be involved in and learn the business to be truly successful. Not everyone wants to be part of the business of the practice, but how are you to know you are being compensated properly if you don’t even understand how money comes into and leaves the practice in which you are working? Explore these items early in your discussions.

Be flexible. To some, this may sound simple, but consider this: Your perfect associateship may not be just one. Most students look for a single, full-time opportunity when looking for an associate position, but think about stepping out of the box and exploring the idea that sometimes working two or even three places “part-time” may actually afford you more in all of the above facets and beyond. When you are in more than one environment regularly and you allow yourself to embrace that, you may actually learn more.

Dentists tend to live in their own bubbles in their offices, sometimes falling into the trap that their way is the best way to do something. This is human nature. But as a young dentist, I can honestly say that I have learned more by exposing myself to several different practice modalities (some simultaneously) and, more notably, I have been able to decipher what truly works for me in a practice.

~Dr. Becky Warnken, Marquette ’13

This blog post is the second in a series focused on career paths you can take after graduating dental school, as part of ASDA’s inaugural Career Week. Explore residency, specialties, associateships, buying a practice and non-traditional careers via webinars, blog posts and social media content all this week.

CDC study: U.S. HPV vaccine rate increasing 5% annually

The number of U.S. adolescents who have received the human papillomavirus (HPV) vaccine has increased five percentage points annually since 2013, according to a new report from the U.S. Centers for Disease Control and Prevention (CDC).


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New guidelines recommend optimal number of opioids

How many opioids should you prescribe following dental surgery? It depends on the procedure, according to a panel of dental experts from Johns Hopkins University. They recently published new prescribing guidelines for 14 types of dental procedures.


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Comments:
8/22/2018 10:59:10 PM
sedation doc
Just fx'd my wrist and had surgery. Been dealing with acute back issues for the last 3 months. I am getting annoyed being treated like an addict when I get my Rx's filled. I think the pendulum has swung to far in the opposite direction. hopefully we can get back to a happy medium.

Tuesday, August 28, 2018

What I wish I’d known in dental school

Going into dentistry was one of the greatest choices I’ve made, and I want every dental student to know they’ve chosen a rewarding profession in which they’re likely to succeed. For me, dentistry was the plan since childhood. Although I didn’t understand what being a dentist entailed back then, I remember thinking, “I could be a good dentist.”

Fast forward about 15 years, and I was in dental school — and it was harder than I expected.

Here are some things I wish I’d known while in school:

You will question whether or not you’re good enough.

There were so many assignments and so much reading that it often felt like I’d never be able to keep up. What made it even more difficult was the fact that some students seemed to be breezing through. It was hard to believe that the hard work was going to pay off (which, spoiler alert, it certainly did.)

Your classmates will quit — and you’ll wonder if you should, too.

I’ll never forget how the ones who quit seemed so relieved. It was tantalizing to think walking away could be so easy. Even though it was hard, I knew quitting was never an option. I put my head down and focused on the light at the end of the tunnel. You should also seek out support from students in the same boat as you.

Pay attention in every class, even if it doesn’t interest you.

It can be difficult to pay attention, but it’s important, even in the classes that don’t interest you. Learn as many different techniques and procedures as you can. The more you know, the better you’ll be at diagnosing and delivering care to your patients someday.

The real world is nothing like dental school.

When you’re in dental school, it almost seems like you’re practicing. The truth is, whether you find a job at a practice, start a residency program or take on your own business, the real world is nothing like dental school.

One day, you’ll have employees coming to you with every question and complaint, in addition to being a dentist. It’s up to you to put out the fires, and it can be overwhelming until you get your bearings. This is when having those well-established connections can help out.

In a way, dental school lasts forever.

Even though you’ve graduated from dental school, you should never stop learning. I believe continuing education is the best thing you can do for yourself and for your patients. It makes your own life easier because you’re able to learn more effective techniques, and it improves your patients’ lives because they’re getting better treatment when they’re in your chair.

~Neil J. Gajjar, BSc, DDS, MAGD, FADI, FPFA, FICD, FACD, Cert. IV Sedation

Neil J. Gajjar, DDS, MAGD, runs an eight-doctor practice in Mississauga, Ontario, and is the Academy of General Dentistry’s President-Elect. He’s devoted to his family and giving back to the industry as a clinical instructor and lecturer on managing medical emergencies in the dental office and oral pathology.

This content is sponsored and does not necessarily reflect the views of ASDA.

2018 Dental Excellence Awards nominating period begins

Nominations for the 2018 DrBicuspid Dental Excellence Awards are now being accepted, giving you the chance to tell us what products should be nominated in 11 different categories for dentistry's most prestigious awards.


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Dentures vs. implants: Study weighs cost, quality of life

When it comes to replacing missing teeth, dental implants improve quality of life, but fixed partial dentures may prove more cost-effective over time. These findings come from a new study evaluating the cost-effectiveness of different treatments to replace missing lower molars.


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Monday, August 27, 2018

A ‘match’ made in heaven: Selecting the right residency

You think you are finished. After surviving your classes and practicals and passing boards, you prepare for graduation and then you realize you have yet to figure out what exactly you’re supposed to do next. That was me in summer 2016. I had been so consumed with my school work and extracurricular activities that I neglected the reason why I came to school — to get a job.

I had an idea of what I wanted to do but didn’t know the route to get there. I loved pediatric dentistry, but I also had a special spot in my heart for special needs patients. I decided to complete a one-year GPR and gain more experience working with children. I figured if I felt the same when I was finished, then I would apply for a pediatric dentistry residency. I know what you’re thinking — why would I go through the application cycle twice? But when approaching this process, you must begin with the end in mind, and my goal was to become a pediatric dentist.

Applying for residencies is a major (and expensive) investment, so you want to make sure that you know the type of program to which you want to apply. Here are a few keys to making the decision-making process a lot smoother.

Decide what you like to do.

In preclinical simulation lab and clinic, pay attention to the type of procedures and patients that bring you the most joy. Maybe you like a particular specialty more, maybe you prefer to practice a little bit of everything. Use this insight to help pinpoint what you are passionate about. Once you figured out your passion, request additional educational and volunteer opportunities in that particular department.

Decide where you want to go.

This is comprised of three criteria:

  • Program details: Thoroughly research each potential program. Determine if you prefer an academic or hospital-based program. Review their website and jot down information about what each one does and doesn’t provide. Start contacting the ones that interest you and request an externship, which is where you learn the most about programs and can make an excellent impression. Depending on where you go visit, this process can be costly. Make sure the programs are tied to what you’d like to do in the future. If you are unable to afford the travel expense, tap into your ASDA network. Contact your colleagues who are currently at or recently completed the program and ask how they enjoy being in the program.
  • Location: While focusing on what a residency program has to offer is crucial, I believe you have to physically be in a place where you can thrive. Pick a residency in a location where you can be happy and has things in that area that interest you. I learned that for me to thrive in a learning environment, I have to be in a social setting where my personal life can flourish as well. For example: If you hate cold weather, a Northeastern program shouldn’t be your first choice because you may dislike living there, which could affect your overall outlook of the program. Residency is not just about growing as a clinician; you want to develop into a better person in the process, and to do that, you need to have a personal life.
  • Compensation: Find out what and how you will be paid or if you have to pay. There are positions that are salaried, tuition-based or offer a stipend.

Determine the right timing.

Everyone thinks that you have to go straight into residency immediately after graduation, and that’s not true. You can always apply at a later time. It is entirely OK to practice for a while and then apply later. You can even decide to complete an AEGD or GPR, then apply to a specialty program. There is no “right” path, only your own path.

Once you’ve narrowed that down, when the time comes, be ready to apply early. Beat the crowd. Request your recommendations early, and be aware of AADSAS deadlines. At this point, you should already be aware of individual programs you want to apply to, their requirements and deadlines. Not paying attention to the subtle details could prevent you from getting an interview.

And always remember to be positive during this process. The decision-making and application process can be stressful, but keeping a positive mindset can make it progress more smoothly.

~LaJoi Wiggins, DMD, East Carolina ’17, Virginia Commonwealth University Pediatric Dental Resident


This blog post is the first in a series focused on career paths you can take after graduating dental school, as part of ASDA’s inaugural Career Week. Explore residency, specialties, associateships, buying a practice and non-traditional careers via webinars, blog posts and social media content all this week.

New caries assessment method encompasses primary, permanent teeth

Existing caries assessment methods typically don't account for decay in both primary and permanent teeth. Enter the Total Observed Caries Experience (TOCE) measure, which its creator says offers distinct benefits compared with other methods.


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Do's and don'ts for problem-solving: Be a problem-solver

A busy dental office will always experience its share of challenges and problems, but a positive attitude is often the first step to overcoming adversity. Think of a problem as an opportunity to improve performance, advises Dr. Roger P. Levin in his latest Practice Success tip.


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Friday, August 24, 2018

There is enough time in the day: Part 1 -- Personal productivity

How often do you find yourself thinking that there aren't enough hours in the day? Practice management consultant Jen Butler has a way to fix that. In the first of a three-part series on how to create a productivity blueprint, she offers an introduction to increasing personal productivity and how to take the first steps.


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Implant access remains low, uneven despite growth in use

Dental implant use has grown substantially since 1999, and the prevalence among those missing at least one tooth could reach as high as 23% in 2026 in the U.S., according to a new study. At the same time, access is still low and remains greater among certain groups, the authors noted.


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Thursday, August 23, 2018

Want to open a dental practice? Start with a vision

When I present at conferences or industry meetings, new dentists often approach me, eager to know whether there are any opportunities in private practice ownership these days. “Can anyone do a startup?” they ask with some trepidation. After all, the word on the street is that it’s not easy.

And the answer, quite simply, is yes. Anybody can open a startup dental practice. But that’s not the best question to ask. While just about anyone can open a dental office, the real question is this: “How do I open a successful dental practice?” The goal isn’t to open the doors of a dental practice, to have four walls, a roof and some equipment in place. The goal is to launch a successful and viable business. In fact, the goal is often much bigger than that. To all of these eager students of dentistry (and business) I say to start with a vision.

What does that mean, though? It means you will have to do some deep thinking. At a basic level —  business basics, that is — you may want to define what success means to you. Can you be profitable? What does it mean to “make a good living?” What kind of lifestyle do you want to support?

The next tier of your vision development will go beyond finances. Your vision needs to encompass what it means for you to feel fulfilled. Beyond being financially successful, does your practice provide you with pride and joy? How are you recognized in your community? How are you impacting the people you touch, whether they are patients or employees?

Leasing some space and putting in a few chairs will get you an office. What is the path to fulfillment? It requires knowing deep down what you want out of life. The first piece of advice I can offer you if you’re still trying to figure this out is to go and work for someone while you’re still in school or if you’re about to graduate. Try things out. See whom you like to work with. Not all patients are alike. Not all practices are alike. The more you live life and figure out what environments, experiences and interactions make you happy, the closer you will get to defining your vision.

In the results-oriented society we live in today, it’s easy to fall prey to the need for immediate gratification. “How do I get to the end result as fast as possible?” I hear over and over.  Again, that may not be the question that serves you best. While the end result is important, it will be that much more powerful (and attainable) if you put proper processes in place to build your business step by step. Whether your goal is to make a six-figure salary a year, or if you wish to own a multi-million dollar practice, you’ll need to map out exactly how you will get there.

Remember, the journey is often just as enriching as reaching the destination.

~Stephen Trutter


Stephen Trutter is the director of consulting and partner at Ideal Practices, national startup dental consulting firm focused on guiding dentists safely with a proven step-by-step process to achieve their goals of private practice ownership.

Insurance products offered separately through Treloar & Heisel and Treloar & Heisel Risk Management, which are divisions of Treloar & Heisel, Inc.
Treloar & Heisel, Inc. does not offer business consulting, tax, or legal advice.

This content is sponsored and does not necessarily reflect the views of ASDA.