The dark days of dentistry

You want to know a secret?

Sometimes I don’t want to go to work. . . Sometimes I don’t want to pull that tooth or make that denture or place that composite.

Dr. Vaughn

Dr. Vaughn

Sometimes . . . I don’t want to do dentistry at all.

But if you’re a practicing dentist reading this right now, you know full well that this is no secret. That this happens to everyone. And if it hasn’t happened, have no doubt that it will.

I’ve been out of school two years now. And while that’s not near long enough to develop a solid practice philosophy or to really figure out where my place is in the profession, it’s plenty long enough to have a few of those dark days.

What am I talking about?

I’m talking about backaches, headaches, handaches. I’m talking about patients that don’t like me. Patients that I don’t like back. Procedures that make me sweat that shouldn’t make me sweat.

Just yesterday, my arm spasmed and locked up during an extraction of a single rooted premolar. I couldn’t believe it. And what’s worse is that it happened minutes after so confidently telling the patient that “this will only take a minute.”

And then there’s the stories you hear from your colleagues. Oh those stories! Anything you can possibly imagine – the worst of the worst – and I bet it’s happening in a dental office somewhere in America right now: insurance fraud, verbal abuse of staff, overtreating patients, undertreating patients, and every sort of treating in between. Condemning our entire ethical handbook one code at a time.

Many of us have heard stories of associate dentists being taken advantage of. New dentists are particularly vulnerable here. I’ve heard of new dentists having all of their preps checked. Of being told they can only do hygiene. Of being hired on and then not even being paid because the practice was actually a sinking ship.

“Well why don’t they just look for a new job then?!”

Sounds easy doesn’t it? Just go get a new job.

Go ahead. Dive into that black sea of classified ads looking for an associate who “is willing to work nights and weekends” and “is proficient at molar endo and impacted third molars.” Ads that make magnificent claims about their 5-star practice that end up being worth no more than the paper the ad was printed on.

It’s tough out there. I’ve sat in interviews that have made my gut turn. I’ve been told that I’d “have to burn a few bridges to work here.” Or that “no vacation time is allowed your first two years.” And what’s worse is that most of these only want you two days a week. So if you want to pay the bills (and chip away at your half-million-dollars in debt), you accept the offer and then go right back to the job hunt to find a second mediocre job that hopefully won’t conflict with the first one.

You see. . .the fairy tales I heard growing up of how great of a profession dentistry was, have many times turned out to be just that. . . fairy tales.

But one thing I know for sure, is that fairy tales have silver linings and morals and lessons they aim to teach. And so do the dark days of dentistry.

What I’ve learned is that these days don’t last forever. The pain is only temporary. And if we’re able to stay motivated and get through them, the clouds will certainly pass.

I don’t talk about the dark days because I enjoy them. I talk about them because it’s an unfortunate but concrete reality. The stories above are all real and completely free of exaggeration. Those are our new dentist peers out there living these stories every day. And so to not talk about them and pretend they don’t happen is to create false security in who we are as professionals.

Dentistry is not exempt from the terrible, horrible, no good, very bad days.

There will be days where you want to give up. There will be days where the stresses seem to be too much. But don’t let them overcome you. Find an outlet. Vent your frustrations, and be free of them.

Because one day you will find that perfect job. You will pay off that monstrous debt. You will find your place in this profession that you’ve been working so hard for your whole life.

And when that does eventually happen. When you find your place. Don’t forget who you were and where you came from and all those struggles you faced in your early days. And when the tables turn and you are the owner dentist interviewing a bright-eyed, naive new dentist. . .

Remember that the dark days are real, and that this new dentist may very well be in the thick of them.

For information on staying well in the dental profession, visit ADA Center for Professional Success.

Dr. Joe Vaughn is a New Dentist Now guest blogger and a member of the American Dental Association. He grew up in Alabama and recently graduated from The University of Alabama at Birmingham School of Dentistry in 2015. He now lives in Seattle, Washington, and works at Neighborcare Health, a community health center in Seattle. Two cups of coffee, writing and indie music are everyday occurrences for Joe. Go Seahawks and Roll Tide!

45 comments

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  • Yes, there is always a silver lining : )
    Nice article, Joe.

  • DR ROBERT ALLEN

    MY FIRST PATIENT WAS SEEN IN THE CLINIC AT VCU IN 1953; MY LAST WAS SEEN A MONTH AGO. I COMPLETED SUCCESSFUL 60 YEARS OF ACTIVE GENERAL PRACTICE. THERE WILL BE A FEW BUMPS IN THE ROAD–THERE ARE WITH EVERYONE.

    I NEVER HAD THE FEELING I DID NOT WANT TO GO INTO WORK. AT AGE 83, I DECIDED IT WAS TIME FOR YOUR GENERATION. I AM STILL ACTIVE IN MY DENTAL SOCIETY ACTIVITIES ( THE ADA & VDA)

    I WISH YOU ALL THE PLEASURE AND SUCCESS THAT I ENJOYED FROM DENTISTRY.

    DR. BOB ALLEN, ADA LIFE MEMBER HAMPTON VA
    .

    • Melissa Rosson

      Dr. Allen, What a legacy! Congratulations!! I’ve been practicing 8 years- to imagine 60 years- what a blessing!

    • As a “green” dentist of 23 years, I am so happy to read your comments. I just recently completed a 400 hour mini residency in surgical implant dentistry and this is what I want to do till I retire 30 years from now.

      This is a wonderful profession. So many opportunities

  • Karen Littleton

    This is why I just bit the bullet and opened up my own practice right out of school. It has its own stresses, but overall not as stressful as what I’ve heard from other dentists. I was able to pay off my loans a lot faster too and that was a major load removed from the stress pile.

  • Stephanie Fransoso

    Wow great article Joe! Thanks for writing about what many people think about and are too afraid to discuss. This article is so relevant but refreshing! As with any job, there will be good days and bad days, trials and triumphs, but in the end, we all need to remember why we chose this fabulous career in the first place. I think its important for us young people to appreciate the distress in moving toward our “ideal job.” Ive been through rough patches as an associate already and Ive realized, not only did I learn so much but Ive grown tremendously. Thanks again for an honest read!
    -Stephanie Fransoso

  • Lew Mitchell,DMD

    Joe, as always, I enjoyed reading your article. Dentistry is hard work and physically demanding and yes there are tough days! But the good days definitely out number the difficult ones and there is immense joy when your services truly transform one’s oral health or transform a patient’s attitude and appreciation for regular preventive care. The personal relationships and friendships are life changing! Thank you, Joe, for sharing your thoughts. The ADA exists to serve its members- in fact the ADA’s mission statement is “Helping All Dentists Succeed”. Please let us know how the ADA can help you and your “New Dentist” colleagues. Take Good Care and Come Home whenever you can! Sincerely, Lew

  • Robert Imagawa

    Organized Dentistry has been asleep on the job. Perhaps, we should have unionized back in the early 70’s. Unquestionably, graduates in business have shifted corporate priorities to profits at the expense of quality products and management. Firstly, tuition and educational debt accumulation shouldered on future workers is an anomaly and insult to traditional social obligations of those who have to give to the have not. This “free marketizing” of tuition and fees was started as a form of social and political censorship born from the disastrous Vietnam War and social upheaval. It is wrong and unnecessary. Furthermore, bigger is not necessarily better. Corporate healthcare payers have dumped their clerical work onto the laps of the doctors. They, thrive on “back-room” diagnostics and patient management for the purpose of controlling costs. In other words, it’s management without the knowledge of what is being managed. The result is that only 40% of dental premiums goes toward patient care. Dentistry is falling by the wayside like yesterday’s pharmacists.
    Are we headed towards a practice in the back of Walmart or Walgreens?

    • James G. Kouzoukian, DDS

      You mean like the profession of optometry? Do you think the DSO’s and corporate entities have this in store for us? Were similar corporate entities successful in relegating the optometrist to the dark dungeon of the back room BEHIND the storefront optician? You bet they were, way back in the 1970’s.

  • DR ROBERT ALLEN

    Very good discussion; too bad not all dentists take time to look around (on internet). Many of my friends practiced 40+ years and never even ever walked into another dentists office–never walked in anther’s shoes. With the internet we have opportunity to share without guilt what is truly going on in dentistry. Nice to be a part of this discussion.

  • William T Schlosser, DMD

    Truth! I also felt lied to in my early years about what dentistry and being a dentist would be like. Fortunately with Christ and a great spouse, we made it through the lean times. Stay involved in determining dentistry’s future. When I retire I want to be treated like I have treated. Cared for by the decision maker, not an employee at a big box store! I don’t know the answer for the next generation, but these thoughts are with me today: Be sure to live within your means, strive to be debt free, invest in you and your family, enjoy your coworkers or get new ones, help the profession stay independent, find a mentor, and persevere!

  • Dr. Vaughn,
    I understand you! I remember a day that I wanted to quit and I was helped by a seasoned dentist from Salt Lake City named Chuck Foster. He invited me to work with him and some others on the Utah Dental Association’s dental access committee. It is kind of couterintuitive that giving more will help save you attitude about our profession, but it is the answer. In my 26 years of practice I have worked in the US Army as a dentist, started a practice from scratch, as an associate, at an HMO, at a prison, at a developmental center, bought two practices, worked in a potential partnership, shared space with another dentist, and I am getting ready to build out a new space. I have seen good dentists, bad dentists, and just really ugly immoral cheeting dentists. Good dentist are a special and rare breed. Please consider looking around and getting to know great dentists in your area. I know one in your area that would most likely be happy to talk to her. Her name is Amy Norman. She belongs to a group that is meeting in Seattle today trough Sunday at the Hyatt in 8th and Olive in downtown Seattle. The name of the organization is the International College of Cranio and Mandbular Orthopedics or ICCMO. It was started here in Seattle. It is full of good( financially and ethically), caring dentists from all parts of the World. You may consider coming and dropping in. I would love to talk to you and any other dentist who reads this post.
    Your friend
    David

  • Dear Dr. Vaughn,
    After 43 years into dentistry (not counting dental school) I can relate to your comments and am glad to see
    that someone is talking about the occasional “dark days”. There have been more than a few for me.
    Bear in mind however that US News and World Report just listed Dentistry as the #1 health profession in
    2017 for a reason. As a mentor in the Temple University Kornberg School of Dentistry’s “Mentoring for Life”
    program, I think it is important for young dentists to stay connected to their colleagues both young and
    more experienced. Help is available!
    Best wishes,
    Larry Stone

  • Joe,

    Just wanted to say, nice article! The dark days are real. Even when you “think” you have found your place in world, they still exist. Sorry, but staff issues, health issues and insurance headaches will continue throughout your career, BUT the greatest thing you have done is acknowledge it. Both the mental and the physical stresses (your arm, my stroke) are real, and depression is a real danger, and not just in dentistry. You can see it for what it is, a problem but it can be overcome. It will take hard work but there is light at the end of the tunnel. Study clubs, organized dentistry, teaching and even volunteer dental opportunities (Union Gospel, Mission trips) can all help to support and show that you are not alone in the “dark days”, and actually you’ll get to meet alot of good solid dentist, trying to do their part and help out. Good luck Joe, and know you are not alone in this.

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  • Dr. Vaughn
    Yes, there will be many dark days ahead of you. I have been practicing for 25 years and there are times I do not want to go into work. And times I dread making another denture crossing my fingers I get a good suction. Or times I take a radiograph and pray the margins are closed on my crown. But I think you are ahead of the game by recognizing that this profession is not for the weak. We take a lot of crap from patient and insurance companies-and yes, it is stressful. But as time goes on you will see the positive outweighs the negative. As long as you put your head down on the pillow at night and know you did the best job you can do for today, that is all you can ask for. And believe me when I tell you, as your practice grows, the love you have for your patients will grow and the good will far outweigh the bad. Make sure you find an outlet that does not involve dentistry and make friends with people who aren’t dentists. You need to have a balance in this profession. I wish you all the best

  • To avoid this better to start own clinic and make practice. When we start a new clinic we should give attractive offers and best treatment to get good name in the market. Once we get the good name, then you no need to turn back.

  • Joe, I enjoyed reading your article. After practicing for over 30 years, the challenges that you endure each day are the ones we all still encounter. Of all the things I wished that schools would have prepared us better for, is the business of dentistry. I recall many courses in school that could have a had been eliminated and replaced with ways to start and run a small business.

    If I could offer any advice for young dentist, do your self a favor and purchase a good disability policy. The practice of dentistry is physically demanding and over time can lead to many musculoskeletal problems. Many dental professionals have these problems and had to be treated for them, work in pain everyday or leave practice entirely. Insuring your financial and personal future in the profession, is a wise investing decision.

    Dr. John M

  • Lawrence Leong, dds

    All things in life are subject to change, be mindful and strive on.

  • A dental clinic is a very demanding place. It is hard work. And work never finishes. this include all the staff in a dental clinic not just the dentist. The receptionist, the dental coordinator, assistants, steri nurses… all those infection control procedures, communications, changes in appointments, it is tough. On the other side we help people.
    They walk in with pain and walk out with no pain… it is a great job I think. it is not all dark guys…dentists help people get out of pain…we change people’s lives 🙂

  • A good blog always comes-up with new and exciting information and while reading I have feel that this blog is really have all those quality that qualify a blog to be a one.

    • DR ROBERT ALLEN

      Hello fellow dentists,

      I want to begin with an apology. Many dentists, young and old, have said some unpleasant things about the kind of practice you have joined.

      The fact is that the dental world is scared. It’s a difficult time to be in private practice. Offices that were once successful now have more open schedules. Dental insurance fees can’t keep pace with the rising cost of doing business. Dentists in the twilight of their careers aren’t retiring, dental schools are expanding their class size, and new dental schools seem to appear out of nowhere; all of which lead to fewer job opportunities. The opportunities that do exist aren’t always so attractive. There are offices that are on the slow side of the technology boom that have yet to adapt digital radiographs and other basic tech that patients have come to expect. Other practices fail to implement basic practice management software to allow us to keep up with the fast pace of business. And then there’s debt. More and more graduating student s discuss figures that are well above $200,000.

      So it’s not hard to imagine why a young dentist would find the large group practice attractive. Modern offices offering full schedules and financial reward? That sounds great! Those who worry that the quality of patient care might suffer would be given pause when they learn what the corporate structure can offer. Many of these offices employ multiple specialists to ensure that patients’ needs are met by those have received appropriate post-graduate training. The highest caliber of continuing education is often provided to employees at little or no cost.

      Another concern stems from the reports of employee dentists being pressured to perform unnecessary or aggressive treatment. However we can argue that kind of distasteful behavior can take place in any practice model. A solo practice owner can hire an associate and attempt to warp their judgement in exactly the same way. I’ve posted before about some of the horror stories associate dentists have experienced.

      And then there is the sweet promise that we won’t have to worry about the complex world of business. No after-hours paperwork and the stress of hiring and firing.

      Yup, the large group practice seems to alleviate many of the burdens of the young dentist. But it is that last point that I’d like to address here.

      All dentists, no matter what the practice model, should understand the basics of business. It may take a few years of study, but we must never lose the knowledge and control of our own practices. When we let someone else run all aspects of our business we lose our independence as health care providers. Look at our cousins in medicine. Both physicians and patients are unhappy with how the system has been changed.

      Sure, some dentists will prefer to remain employees and that’s fine. Ownership isn’t for everyone. But I would be concerned about a growing trend of young dentists who leave all business decisions to a third party. I would be concerned about the “franchise” approach to our profession for the sole reason that can remove our control of our own way of practice.

      So whatever practice model employs you, please continue to ask questions, learn, and assert your opinions on how the office does business. I think there is a place for the corporate model, but we need to maintain our entrepreneurial spirit if we choose to work at that kind of practice. No one is better suited to regulate dentistry than dentists.

      All the best,

      Chris Salierno DDS “THE CURIOUS DENTIST”

  • The dark days are real not only for dentists, but engineers too.

  • Read your Disability Policy carefully– chronic conditions like Musculo-skeletal and ergonomic related problems are often not covered. Be prepared . Keep all your documents and consider hiring an attorney to help you file your claim should health problems develop.

  • I really appreciate your honesty Dr. Vaughn. It happens to anyone, some bad days happens. Every patients hates you, that’s the reality not because you are bad person but the procedure itself. Dentist plays a big rule specially for children to encourage them to visit the Dentist at least twice a year.

    From: southlake dentist

  • Yea, and feeling much the same. Half a mill of debt, a good portion of my free time dedicated to pain management like yoga or massage. My closest classmates who are now spread in different cities all say the same. Admittedly, I barely make ends meet by the end of the month with my loan debt, rent, and other debts like insurances and what not; I’m driving a 10 year old car because the thought of adding more debt is daunting right now. I’m glad I did a residency because I learned a lot but it was nerve wracking watching my interest accrue on my loans because residency barely paid enough for rent. I don’t even know how California graduates do it—they have to take personal loans during dental school for living expenses…I can’t even.

    Meanwhile, before my current job, I worked across different settings and was disillusioned at my older colleague. This is just a snapshot of what I witnessed across the various settings during my first year out:
    a.) dentist doing shitty work for corporation in order to produce to the standard of their corporation—a company sent me for a day to shadow their top producer so I can observe how he produces and welp, I saw them deliver bridges with giant marginal deficiencies and caries excavate leading to nerve exposures with no mention to the such to the patient just went ahead and filled it sans pulp cap…another practitioner for the same company was so overwhelmed and overworked that they literally collapsed of exhaustion in the middle of a work day.

    b.) Owner of practice doing shotty work, scams insurance at the benefit of working less—I caught multiple cases where he billed class IIs for class Is and left interprox caries because who has time to place a matrix band? same person did a bad root canal which 3 weeks later when the patient returned in pain, they extracted the tooth, cut off the apex, and retreated the rest of the root out of the mouth, then reimplanted it because it was better than refunding her money that she paid for rct + crown, and deducted from the advance payment she made on the crown towards the extraction of tooth (which was still in her mouth); did not return the rest of the money for the crown she never got; instead told her it would remain on the account for when they do the crown (patient was elderly and paying cash)—3 weeks later patient continued to seek pain relief, got Cdiff from being on so many antibiotics from him and her physician. I saw her once, 4 days after that ridiculous procedure had been done; she had a swelling on the gingiva and I offered her two options: 1.) I would remove the tooth and make her a temp partial (it was #9) 2.) have her f/u with him in a week as planned—she chose #2 because she honestly trusted him; I quit within a few days. I left disappointed that a seemingly successful practice was based on shady practices.

    3.) I’ve also worked in public health where some think the patients they serve don’t deserve cell phones so why provide standard-of-care dentistry (Tell me if you’ve ever heard this one: “they have a nicer phone than me!”). One clinic does comprehensive exams but then only offers extractions and refers to private practice for routine fillings—why even do a comp exam? Also, some of these places think that someone receiving cheap treatment should expect to wait 3-hours, so their patient check-in process takes 30-45 minutes and the dentist don’t have any control over it.

    I hope I can find a way to serve patients ethically and maintain science base practices while still having the time to take care of myself and pay off my loans before I’m 60. At this time that means being patient with the 45-minute check-in process and being ok with patients being upset because the wait is so long. As much as I want to have my own practice, the thought of adding more debt is daunting. It’s too bad that few opportunistic bad seeds have created bad practices and the culture has spread. I was once told that the dentist owner of well-known corporation said early in his career that his goal is to do “with dentistry what McDonald’s did for the food industry.”

    • I’m so disappointed in our profession that practice well below the standards of care. I can assure you that will catch up to them. Im glad to hear that you removed yourself and able to practice with ethics. Continue on and you will be successful.

  • Dear Winn,

    As an old geezer dentist, all I can do is validate your experiences. If anything, you’ve understated the problems.

    Other than the North Carolina dental board, tell me one state board, which has truly stood up to corporate dentistry abuses. (Loooooong pause) Okay, tell me what happens when dental school faculty tell the truth to students about corporate dentistry. (Remember the legal action for bogus defamation against 4 U/CO dental school professors?)

    Was your school flooded w/ DSO recruiters, on senior recruitment day? Ever wonder why w/ the current glut of dentists on the employment market, why many DSOs are forced to attract lesser skilled (& lesser legal & business acumen) recent grads? (Oh, you learned that hard lesson first-hand.)

    Do you wonder why organized dentistry maintains a “neutral” position w/ corporate dentistry, & enjoys their revenues from doctor employment ads? If you attend a professional meeting held by organized dentistry, are you curious about the degree of meeting sponsorship by corporate dentistry?

    Yes, in the dental profession, we’ve elected to eat our young. We graduate far too many doctors, w/ WAY too much debt, & place them in horrific employment situations. It’s a modern version of indenture servitude.

    In fact, certain persons in leadership w/in organized dentistry have down upon me for exposing the corruption w/in the DSO industry & at numbers of FQHCs. Why? They contend exposing the fraud & abuses hurts employment options for junior colleagues. We’ve forced young colleagues into being complicit in criminal & civil fraud, & it’s ME that needs to shut up. LOL! (Yeah, that’s their twisted logic.)

    Winn, you & your generation of doctors has been sold out at the highest levels of the dental profession. That included organized dentistry, state regulators, and academia. It sickens me. I truly wish I could do more. My heart is w/ you.

    Michael W Davis, DDS
    Santa Fe, NM

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  • Wow, extraordinary article. A debt of gratitude is in order for expounding on what numerous individuals think about and are excessively anxious, making it impossible to examine. This article is so applicable yet invigorating! Similarly, as with any activity, there will be great days and terrible days, preliminaries and triumphs, however, at last, we as a whole need to recollect why we picked this breathtaking vocation in any case.

  • Dr. Joe Vaughn thanks for the tips

  • You stated truths that many will not admit to. I thought once I graduated from dental school and completing a residency finding a job would be easy. Nope! It’s not easy. Dentists may have to try multiple work environments & clinics before figuring out what suits them. . I enjoyed this article and I am glad you acknowledged issues many dentists face but few speak on.

  • Is it legal for a dentist to work on a patient without a dental assistant present?

    • Christine Zwiebel

      Of course it is.

      • Unlikely but I suppose it depends on the state laws. Dental schools don’t have assistants for every dental student and residents so they’re usually are doing work on their own. It’s a liability for the dentist since then there are no witnesses in case the patient later claims something occurred; when it comes to treatment, it’s usually safer to have an assistant but I have never seen a state where it is required by law.

  • I am not a dentist. I do find it interesting that what dentist say about their trade is almost exactly what could be said about most trades other than the debt reward ratios. It seems the capitalist have not left one stone unturned and contiune to make sure they squezze every penney out of every transaction and deposit it in the 1 percent pocket. As long as we think we are one better than the next guy we will continue to serve the 1 percent thinking we serve ourselfs.

  • Dental school itself is miserable in so many ways while students are coming out less experienced due to increasing class sizes and international students graduating in half the time it takes.

  • Excellent article, I’m gathering information for the dental clinics guide Dental Office, I hope to see you there soon

  • Hi everyone
    I am 18 years of age and I am planning on going to a university to study dentistry. I would really like some tips and advise from you guys, thank you in advance 🙂

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