Decisions, decisions

How do I choose where/how I want to practice?

My practice management course has me thinking about all of the options that I have when I graduate from dental school. This is a very intimidating decision because if I don’t make the right one my family will have a very hard time financially due to my enormous student loan debt. I hate that part of this decision for me has to be financial because it goes against my beliefs as a doctor. I have to consider how much it would cost to purchase an existing practice, verses starting from scratch as well as the pros/cons of working for someone else. I also have to keep in mind that I will have close to $500,000 in student loan debt which equates to approx $5000 per month in student loan payments, in addition to being in the 35-40% tax bracket. (I cannot use my student loans as a tax deduction therefore I will have to pay taxes on my income before the reduction of about $60,000 in student loan payments which is so unfair as those payments go back to the fed govt since they are my loan source)The average dentist in AZ makes $120,000 per year, take out taxes and that leaves you with about 72,000, take out student loan payments and that leaves about $12,000 to live on. At least it will only take about 30 years to pay off my loans!

Option 1: Purchase an existing practice

A decent practice for a solo practitioner is between $500,000 and $700,000.

The new loan rules post 2008 is a 60/40 where I will have to put a 40% down payment on a purchase of existing practice. Wow, that is a lot of cheese!!

The benefits of purchasing an existing practice are:

Office has equipment and supplies

Staff who are familiar with patients

Patient base

Dr. will introduce and recommend you to patients

Negatives of purchasing a practice are:

No way to predict how many of the patients will actually stay with you

Equipment may be dated and require replacement

May not share same treatment philosophy as original doctor

May have to fire staff members that have been with the practice for a long time

Huge initial investment with really no guarantee that the patient base will remain with you, I have heard that you can expect 30-50% of the patients to go elsewhere.

Option 2: Opening a new practice

Get to choose location

Get to design office

Get to choose staff

Have to market and get patients, this may be difficult in this economy. A lot of established dentists are really struggling to make ends meet.

Purchase all new equipment

Would not earn a salary for perhaps the first year as I became established

I can decide how I want to practice; I get to set the tone of the practice

Can probably get everything I need for about $200,000, but then I need patients!

Option 3: Work for someone else

Choose between corporate offices and associateship in private office.

I would get a salary immediately, unlike if I started my own practice and would probably not draw a salary for a year.

Minimum production requirement (I will have a quota that I will have to meet)

No choice about the staff I will work with

My treatment plans can be changed by the office manager without my control, but it is my license on the line

Corporate business plan requires the dentist to see more than 30 patients in a day, often times with inferior work as the result.

Private office associateship is a huge variable because it really depends on the dentist who hires you but it is still production based and usually you will be given the cases that the other Dr. doesn’t want to deal with.

If money was not an object I would want to start my own practice because I know that I do not have the ability to ignore my morals just because my boss has told me to. I have worked in an office before with a less that ethical Dr. and I quit as soon as I knew what he was up to. I think that based on this I would have a very difficult time in a corporate dental practice as they are known for being focused on the production instead of what is in the patient’s best interest.  Building a practice from scratch is a scary thought for me though because I have such a financial burden from my student loans. I also need to be able to support my family so that my husband can come back home. We have been living apart for the past two years since the economy in Arizona has been hit so hard and he had to take a job out of state to support us. So I guess my big dilemma is……Do I take the soul crushing job that will pay the bills and get my husband home, or do I take the risk and open my own practice knowing that we will be eating a lot of ramen and my husband still wont be able to come home???

How did I get here?

I am a third year dental student with seven years of previous experience as a certified dental assistant. Due to my history and current circumstances I am often asked by people how I came to the decision to become a dentist and if I think that dental school is right for them. Let me start off by giving a bit of my back story.

I attended ASU directly following high school with the idea of majoring in elementary education. This early career decision was heavily influenced by my love of chalk. After a couple of semesters I realized that chalk was not enough of an incentive, but I had no idea what I wanted to do so I made the ill-advised choice to drop out. I worked for a while as a nanny and as a secretary.  I was bored working as a secretary and was searching for something more fulfilling but I couldn’t quite put my finger on it until a friend told me she was going to go to school to become a dental assistant. 

This idea really peaked my interest. The pay was good and it was a chance to work with my hands.  We attended the orientation together and both decided that this was a good decision.  We attended the classes and studied diligently and both did very well.  When we completed the course I went on to take my radiology certification exam and got my first job as a dental assistant.  I was so very excited!  Having no actual experience I took the first job that I was offered which was M, T, & TH 7am to 5:30pm with a ten minute lunch break. Did I mention that it was also a 1.5 hour drive from my house? I didn’t care, I had a career!  My enthusiasm began to wane a few weeks into my dream job when I realized that my boss was not the poster boy for professional ethics.  I fully realize that I am not a perfect person, I have many flaws, but I have absolutely zero tolerance for abuse of power.  In medicine/dentistry knowledge is power.  It is the power we hold over our patients.  The moment that I realized that the dentist I was working for was taking advantage of his patients I quit.  Well actually, I duplicated the patient’s x-rays, gave them to her in an envelope and told her she was being mislead.  I grabbed my purse and announced to my boss that I would be leaving. He reminded me that I only had a 10 minute lunch so I better not go far, to which I replied that I was not leaving for lunch, I was leaving for good. I explained to my exasperated boss that I could not be associated with him any longer now that I was aware of how he conducted himself. He laughed at me, he told me that with my lack of experience I was in no position to judge his professional opinions and that I was lucky that he had even given me a job in the first place.  I left in tears.

 My husband was a full time student, he worked as much as he could but without my income we absolutely had no hope of making ends meet.  I called him from my car.  I was beside myself, I thought he was going to be furious.  Once he got a word in edgewise he informed me that he had gotten a phone call earlier from my family dentist’s office asking if I was available to work for them.  Dr. M had been my dentist since I was in the third grade and his assistant of 17 years was moving.  I called Dr. M immediately and said I would take the job, I started the next day.  This was my true dream job. The office had a wonderful atmosphere.  It was the perfect combination of lighthearted fun and camaraderie amongst the staff with compassion and passion for treating the patients.  I was in heaven.  Dr. M taught me the beautiful side of dentistry, where the patient’s best interest is the only interest that exists.  I learned so much from him, and I loved working with the patients.  My personal life was wonderful also. Since starting my dental assisting career, my husband had graduated from college and we had purchased a house.  (Which meant that we got to move out of my in-law’s house.)  After a few years of wedded bliss living on our own we decided it was time to start our family.  We were blessed with our first daughter in 2003 and after a few months off I returned to work for two days a week.  In 2004 I became aware of a dental school opening in Arizona.  I thought about going all of the time, but I didn’t quite mention that when I stopped attending ASU way back when, that I kind of just stopped going in the middle of the semester and didn’t even take my final exams.  Since I didn’t bother to withdraw officially, I failed all five of my courses.  With that awful track record I realized that I could not possibly get into dental school.  I wasn’t even sure if I was smart enough.  I had heard horror stories of organic chemistry.  I looked at the A.T. Still University website constantly, the prerequisite courses and bachelors degree mocking me.  I had mentioned in passing to my husband a few times that I was perhaps interested.  Just dipping the very tip of my toe, testing the water.  I never fully expressed how badly I wanted to go.  I was afraid of failure.  I was afraid I would be too old when I graduated.  I was afraid of how much it would cost for me to go back to school.  I was afraid of what my friends and family would say.  I did not have the best track record for following thru on things.  I was also afraid that I couldn’t even get back into ASU after leaving the way that I did. 

Fear is a powerful motivator.  I made a deal with myself years ago to not be ruled by fear and so I contacted ASU to see what I would have to do to enroll in courses.  After jumping through several hoops they accepted me, on academic probation under the premise that I could only take a maximum of 4 credit hours my first semester.  Well, I am the world’s most impatient human being and I did the math on that and realized it would take me forever to finish at that rate so I drove to ASU west and met with an advisor in the Life Sciences department.  After thirty minutes of appealing to her humanity, her independent womanness, her brunettness and any other commonality that I could appeal to she agreed to allow me to take a full load of courses with the new restriction that I could not withdraw or earn lower than a B in any course or I would be dismissed from the university.  I had done it, I had just jumped over one of the many hurdles that would fling themselves in front of me on my path towards my DMD.

At this point I had one wonderful daughter, my husband and I began discussing the possibility for more children.  Should we have another before I started back to school, should I wait until I was done with my undergrad and have another before I applied to dental school, should I wait until I was done with dental school?  Was one enough?  We went back and forth and back and forth and as the pendulum swang back towards one child being enough, I went back on the pill and finalized my enrollment at ASU.  True to form my second daughter had other plans (she had already been conceived when we decided that we were done).  I realized that I was pregnant three weeks before my first day of school.  This started my list of fears all over again.  The deal that I had struck with my advisor required me to complete what I had started or I was done.  I hoped that I would deliver during winter break, but of course #2 always has her way and she came two weeks into my second semester.

Many people did not understand why I enrolled for that second semester.  I was told repeatedly to take time off.  ASU West is a small campus with a limited selection of courses offered.  My degree program was somewhat lock step because of the small campus there were specific courses offered in the fall or spring only, not both. If I took off that spring I would be taking off a year which would be a violation of the agreement that I had signed to re-enroll.  I was stuck.  I gave birth to #2 on a Thursday and was back in class Monday because I had a professor that told me if I missed any classes I may as well drop the class because I would fail.  I could not risk either of those options and so I did not miss any classes.  I did very well in my undergrad.  Despite having my second daughter that second semester of my first year I managed to complete my bachelors in just three years and submitted my application to dental school just in time to be accepted into the inaugural class at Midwestern University College of Dental Medicine.

The first year of dental school is really something that everyone should have to endure. It could be a reality show. It is more brutal than Survivor and has more drama than Jersey Shore. The curriculum, I believe is designed to either kill you or make you insane. I remember thinking that there was no possible way that I would make it thru. Dental school is not like your undergrad where you have a few classes sprinkled throughout your day and you can maybe even fit a nap in here and there. No, you are in class 8-5 five days a week and every Monday morning you have to arrive at 7am for a weekly exam which determines your entire grade in your class which covers more material than you saw in a year during your undergrad. I stayed after school every night and studied in the library. I was hardly ever home before 9pm. I was not sure how much longer I could continue doing this and then my husband had to make the very difficult decision to take a job out of the state. As I pondered that reality, I was even less sure that I could make it. With him home to help with the girls I was getting A’s but hardly any sleep and I think I lived on peanut butter M&M’s for an entire week once. I couldn’t even imagine how I could possibly do it without him. He left two weeks before finals my first quarter of school. I nearly died from the depression of having him gone and the stress of having to be Mom, Dad and dental student. I think I aged five years in that first month of him being gone.

I don’t quite know how I did it, I really don’t. I think my saving grace is that I am as stubborn as a mule, and I certainly was not going to let this stop me from becoming a dentist. I had spent way too much of my life on the sidelines already. Before I knew it the first year was over and I was studying for the first round of national boards. That is quite a daunting task but we had the whole summer to study and take it when we felt ready. I passed and had really never been so proud of myself. I was ready to start my second year. Second year of dental school is wonderful, the academic part is scaled back a bit because the hands on part has to be increased. I loved every moment that I spent in the simulation clinic. Second year was a bit easier for my family as well, I was able to be home more, but the best part was that my husband’s hours changed so he was able to come home a couple of weekends a month instead of once every couple of months like before. Before I knew it second year turned into third. We did not get the summer off so it was like becoming a D3 over night. We were in clinic. We were going to be working on actual patients. Wow, is that a strange feeling the first few days. It was really difficult for me to switch mindsets from the assistant that I had been for so many years to thinking like the doctor.

The New Frontier

I have decided to start a blog to chronicle my journey as a dental student. I am in my third year, so better late than never I guess! Attending dental school is a privilege that very few are fortunate enough to participate in. If you asked me ten years ago if I ever thought that I would be here today, I would have laughed and said no way! I realize now that I have become a very powerful role model for my daughters. Almost by accident they are being raised to believe that they can accomplish anything because they watch me overcome tremendous obstacles everyday. I wanted to begin this blog to give them a way to look back on this time from my perspective, and if I can entertain/help anyone else along the way...well that is just gravy.

I am not sure how often I will blog or what direction this may take, but I am always open to your comments/questions!

Starting a new blog is intimidating. Choosing the name is a daunting task that took quite a while. I thought I would share my brainstorming list...

Just a girl and a drill

A molar walks into a bar

Is that your gingiva or are you just happy to see me?

Show me your teeth

Dental girl

Chairside in a skirt

Lipstick and spit

With all that latex, you would think it would be more fun

A mom, a drill and a dream

Drilling my life away

Dental assistant turned dentist

32 teeth in one head? Who can live at that speed?

This is the story of a girl

Oh, you meant dental implants

Four crowns and a root canal

The insanity of dental school

Really? I am allowed to do that?

Open wide

Wide open

Listerine…my new perfume

The tooth, the whole tooth and nothing but the tooth.

Living the dream, one millimeter at a time