Each year in general dentistry has taught me something about myself and this profession. As I prepare to go into a yearlong special-care residency program in June, I am looking back on everything I have learned in the last four years as a general dentist.
The first year of dentistry taught me about treatment planning…that I could no longer treatment plan patients in practice the way I did in school. We learn how to manage patients’ conditions on a comprehensive level in school, moving them systematically from the hygiene department to the restorative department and eventually to the pros department.
I found that many patients in private practice are not looking for that kind of care, some are only looking for immediate pain relief. I still remember an elderly patient who came to see me to replace a broken #8. The tooth was broken to the gum-line and the quick fix would have been an extraction and a bridge #7-9. She could have walked away in two hours with a temporary bridge and come back in two weeks for a permanent. However, that was just a month into my first associateship. On seeing the rest of her mouth, I saw a complete state of neglect. I saw the need for gross debridement and scaling/root planing. I saw several other broken-down teeth. I put on my dental student hat and treatment planned comprehensively. I decided to educate my patient and her daughter, who was accompanying the patient to the appointment. I sent them home with a treatment plan with a cost in the high five figure numbers.
I met with my owner doctor in a few days and realized my mistake. In my excitement and innocence, I had failed to see my patients’ fixed income per month and her limited ability to pay for the procedures I was describing. I never saw that patient again, because, in my owner doctor’s words, “She likely walked across the street and found another dentist to work on her immediate need.”
I want to stress here that the way I treatment planned for her was not wrong. Me focusing on the exact phasing of it was. We could have fixed her front tooth first and then educated her on the importance of hygiene. She could have used a payment plan or utilized care credit to pay for its upkeep and maintenance. She would have had the remaining root stumps removed when she was mentally and financially ready.
My second year in general dentistry taught me about speed. I was in a large practice where all employees seemed pitted against each other on production. We would get a daily ranking on who was the highest. It sounds like the Hunger Games and in some ways it was. I realized in this associateship that the more patients I see, the more I would make, but also the more I would be burnt out and be disillusioned with my work. I should also mention here that this associateship had me coming home upset most days. It was the cause for a lot of fights between my husband and I. He was so happy when I finally decided to leave that job!
I lasted in that associateship for exactly a year. I gave my notice on March 1, 2020, not knowing that I would receive two months of unemployment because of the pandemic. I used those two months to relax, unwind and find another associateship that was on the opposite spectrum of a production-heavy atmosphere. I recognized that I didn’t have to see 30 patients a day to take home a decent income. I could be working at a practice that was fee-for-service or that took fewer insurance plans, so that I could see fewer patients and not be as tired or burned out.
My third year in dentistry taught me my clinical limits. I saw an implant fail, a file break while doing a root canal and my team members, many of them in dentistry for longer than I was alive, lose trust in me because of those clinical failures. Due to this, I began to lose confidence in my own abilities.
I started to compare myself to more experienced dentists and wonder if I would ever be like them, and why I wasn’t as good as them. Luckily, I had an owner doctor who believed in me, more than I did in myself. She took out time to teach me good anesthesia technique, that I continue to use to this day. She allowed me to come to work on my days off and practice root canals on extracted teeth. She taught me how to fabricate implant crowns using CEREC. Most importantly, she told me, ‘You are exactly like me when I was fresh out of school. Don’t give up, keep practicing, you will be a great dentist.” With some encouragement, I began writing more and sharing my experiences with my friends and colleagues. That helped me feel less lonely in this profession.
This past year in dentistry has been my favorite yet. It has taught me my emotional limits. I have learned to not let what happens in the office stick in my head. This important rule occurred when I had a particularly challenging experience with a patient who was very anxious about treatment. I let her anxiety get into my own head and mess with my confidence. The experience almost took me away from dentistry and I began to ask myself why I should even be clinical anymore. Could I not own a practice and hire an associate to do clinical dentistry instead? Fortunately, mentors from my mastermind, the Creative Collective, came to my rescue.
The Creative Collective is a group of female practitioners, that includes dentists, chiropractors, physicians and others, that gathers monthly to share struggles and wins, and provides opportunities to lean on each other for support. It is a diverse community consisting of professionals interested in furthering their leadership and career growth. After sharing my experience with colleagues, senior dentists chimed in and shared strategies on how to protect your inner peace and mental health in this profession.
One of my role models, Dr. Laura Mach, described how to create an imaginary bubble around your own energy in your mind and harness the universe’s energy to help a person who is suffering in front of you. ‘It’s about protecting our own energy, enabling us to take good care of the person in front of us’, says Laura, who learned this from her aunt, a Reiki practitioner. I have since started to implement this and it has been a game changer.
I hope this post helps whoever is going through their first years of associateship and coming across what I know now are, “newbie pains” or experiencing the “dark days of dentistry” as a good friend, Dr. Joe Vaughn had quoted in a previous, very popular post on this forum. What makes dentistry unique is that no one day is the same and every experience teaches you humility.
If you are interested in learning more about the Creative Collective, please contact Dr. Shivani Kamodia Barto at firstname.lastname@example.org, who is its organizer and facilitator.
Dr. Sampada Deshpande, author of Persevering- A Complete Guide to Applications, Schools and Work Opportunities for Foreign-Trained Dentists in the United States, is based in San Francisco. A foreign trained dentist from Dubai, Sampada earned a DDS in 2018 from the University of Washington, where she also completed a LEND fellowship in 2021. She is a recipient of the ADA 10 under 10 Award, AGD 10 to Watch honor and Howard Memorial Award. Outside of clinical dentistry, she enjoys hosting the New Dentist Business Club, biking the city’s rolling hills, and advocating for innovation in technology via her work at Samsotech. You can reach her for speaking opportunities by visiting her website www.sampadadeshpandedds.com.