The butt of the joke

By | January 25, 2021

There is an old joke that goes:  “What do you call the person who graduates last in medical/dental school?”

Photo of Dr. Simpson

Dr. Simpson

Pause for effect.


Usually laughter ensues.

But it’s not nearly as funny for those of us who were actually in that bottom tier of the class. I had a couple family members who, while I was in dental school without knowing how well or poorly I was doing, told me that joke, almost as if they thought it was motivating.

Would being in the bottom tier forever relegate me to being a lower tier dentist?

While I have been practicing for several years now, have had many different career successes and received the ultimate patient compliment several times (“You’re the best dentist I’ve ever had!”), the joke still haunts me and remains in the back of my mind. Maybe I work so hard because there’s an insecure part of me that knows I was almost that person who graduated last, and I still have something to prove?

As I was discussing writing this with a dear friend from school, she told me about one of our professors in pre-clin who mockingly asked her if she was going to be a certain specialty because she couldn’t get a class III restoration done. My friend said she still hears that professor in her head when she’s having a hard time with a prep. She graduated in 2009.

Recently, I was talking to another dentist whose daughter is in dental school. She mentioned that on a recent phone conversation, her daughter lamented, “Mom I try and try so hard but I still just get Bs.”

That feeling of my best isn’t enough is demoralizing. The overarching feeling is I am doing everything I am capable of, I don’t know what else I can do, and I’m still just “this.”  I am average, or worse, the butt of a joke.

One of the things that I talk about with dental students who I have worked with and young people who I mentor is to not to let their confidence get wrapped up in their performance as a student. I can distinctly remember days when I wouldn’t get the grade I was expecting on a wax up, and I would go to my dorm room, turn out the lights, and lay on my bed and mope about how horrible I was. The students who did well were so confident. I remember being quietly jealous of them and wondering how they managed to do so well. What did they have that I didn’t have?

My wish is that we, as accomplished dentists, can talk to more pre-dental, dental students and new dentists about this. Tell them: Do not let your confidence get wrapped up in how you perform as a student, and let it spill over into how you see yourself as a practicing dentist.

Of course, being successful at anything can boost the self-esteem. That’s inevitable. Unfortunately, dental schools can — by its sheer nature of fostering competition —be breeding grounds for only gaining confidence based on performance.

Dental school is so all encompassing that there’s hardly time, nor do we have the mental energy, to do this kind of self-evaluation work, even though it’s so necessary.

However, now that we are practicing dentists and all adults with full lives, I encourage you to take the time do ask yourself, “Who am I without this profession?”

Because it takes more than top grades to become a good dentist: Character matters.

Are your confidence and self-worth tied to your performance at work?  Were you number one in your class but assistants don’t want to work with you? Do you fly across the country giving lectures but your associates are terrified of you? Are you a specialist who gets a lot of referrals because you do great work, but you find out that some of them think you’re a jerk?

One of my classmates committed fraud and had his license immediately suspended a few years ago. I am pretty sure he was in the top 5 in our class.

No matter if you were the end of the class that’s the butt of a joke end or you were at the top, your skills can be developed and perfected, but that character … I’m not so sure.

I put in so much work after graduation learning our chosen craft: sitting alongside mentor dentists, taking CEs online and in person, going to study clubs, getting involved in organized dentistry, reading articles and texts books. And this wasn’t out of insecurity, this was out of sheer desire to improve and move forward and to be able to offer quality work to my patients.

Unravel your confidence and performance from each other. Know who you are without this profession, and it makes the profession even better.

Dr. Elizabeth Simpson is a New Dentist Now guest blogger. She grew up in Indianapolis and graduated from Tufts University School of Dental Medicine in 2010. Liz is a general dentist working full time for two Federally Qualified Health Centers in Anderson and Elwood, Indiana. She is a member of the American Dental Association Institute for Diversity in Leadership program and has started a toothbrushing program at an elementary school in Indianapolis. When she’s not working she enjoys reading, going to the movies, traveling and spending time with her family and friends.

5 thoughts on “The butt of the joke

  1. Michael Davis DDS,

    Great perspectives. I’m proud you are my colleague.

    This is more correct than many realize- “One of my classmates committed fraud and had his license immediately suspended a few years ago. I am pretty sure he was in the top 5 in our class.”

    The top graduate one year at my old dental school (Ohio State) was doing actual dentistry at a clinic I formerly worked at in Albuquerque, NM, while an undergrad. Yes, I’m certain he learned a lot. However, it was FRAUD. The clinic had him working on days I wasn’t there, & billed out under my legitimate insurance credentialing. Once I learned, I immediately quit. (At that time, the dental board was fully corrupt. So, that was a worthless avenue. Today, he would have received a board discipline & maybe be bounced from dental school.)

    1. Sue Keller, DMD

      I am so sorry that happened to you and thank you for your courageous action in a toxic unethical environment.

  2. Casey Norlin

    Grades can be so artificial and do not show the true character of a doctor. I found my old dental school transcript and was talking with my sister who is stressed out because she didn’t do good on two exams during one of her classes last term when our family farm was almost lost in a wildfire in Oregon. I told her, guess what I have failed tests before, first term in Anatomy I remember getting 68% (welcome to dental school) and in the end of second year another professor telling me that even though I are passing all my clinical classes, I was getting low Bs on clinical work and that they had concerns for entering the clinic. Well almost 5 years out working for the government in public health with benefits and loan forgiveness I am better then owning my own business so class ranking has nothing on financial success, I have a wonderful fulfilling time being an army officer and working with the military leadership for the State of Oregon, they have never asked me to repeat the Kreps Cycle but they do place a lot of trust with me for various missions, and my clinical skills must be “somewhat ok” when I have been asked to help other doctors with their extractions. Like muscle Failure and life resistance can you stronger. Remember grades A,B,C,D was started in education to indoctrinate people for factory work so we could be graded on the items produced. For example that is why A1 steak sauce uses the name A1. Good article and I enjoyed reading it!

  3. Cathy Hung

    Great article Dr. Simpson. When I was in my third year there was a part-time perio faculty who checked my cleaning and she never gave me more than a B. She constantly told me “you are going to fail”. I was intimidated and felt less confident with my skills because of the constant comment. Then I overheard her discussing about preparing for perio board and that she was worried she wouldn’t pass. I realized that she was a young faculty who projected her fear onto me. I think that we as a community need to build more inclusive atmosphere and more supportive of the younger generations’ goals to help them succeed, not the other way around. We need to be more encouraging, rather than holding on to the older ways of having one climb up the ladder to prove him/herselves with negative reinforcement.


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