You Just Graduated Dental School. Now What?

Instead of a third-tier celebrity or a well-groomed politician spouting aphorisms you’ll forget by brunch, we want to give you graduates something substantive this year. Yes, this is a milestone. You have devoted four years to an advanced level of study to help others.

There’s much to learn, as these folks behind me can attest. Allow me to introduce:

-- Mike Bruno, D.D.S. general practice resident in dentistry at North Shore LIJ.

-- Susie Ko, D.D.S., general practice resident in dentistry at North Shore LIJ.

--Ronald Perry, D.M.D., director of the international student program, department of comprehensive care, at Tufts University School of Dental Medicine.

-- David Rice, D.D.S. founder of igniteDDS, a free continuing education community for dental students and young dental professionals.

-- Jack Saxonhouse, D.M.D., practice transition consultant for Doctor’s Choice.

-- Jordan Telin, soon to graduate the SUNY Buffalo school of dental medicine.

Who wants to start?

Bruno

The field is changing so fast, and there are so many new innovations and new things available, that if you’re going from what you learned through your education, you’re almost immediately not up-to-date. And a lot of that is on you. I don’t think it’s particularly stressed well that if you want to be good, if you want to be one of the preferred dentists in the area, you do have to do a lot on your own.

Ko

You learn more in residency on how to compromise. There are certain things we have to fix. But if your biting is off, but you only want to fix one small aspect of your smile, then fine we can figure it out. You also have to explain that if, down the road, you want to change something about your smile we might have to redo the work, because it’s not going to be right for you anymore.

Bruno

There are a lot of roadblocks that come along. It’s not you and the patient anymore. You have to play the game of keeping within the realm of insurance for people who can’t afford outside of insurance, because it’s a very large population and it’s an understandable concern. For the last couple of decades, the maximum coverage (for dental) has stayed very similar among companies. A patient may get a root canal, there’s no money left in their insurance reserves at that point, and you have to wait for the year to end for them to move forward with treatment. That’s not really what you want, because you want them to get to the most stable point as soon as possible so you can have a better outcome long term. You don’t realize those things in dental school. You get taught the ideal and you just try do the best toward that ideal, but in real life most things aren’t ideal.

Ko

You have to think out of the box a lot of the time. Keep up with your education: the articles, the different methods to do things. Then if you need to make it your own — change some stuff — make it your own.

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Perry

The biggest thing in your minds is, “I’ve got to get my requirements done. I’ve got to pass the CDCA exam or the WREB exam or the credits exam so I can practice and I’ve got to get a job. I’ve got to get a job!”

But you’re not asking the right questions.

Where do you want to get a job? Not only where do you want to get a job, where does your significant other want to get a job? Where do you want to settle? What kind of practice do you want to be in? Do you want to be in a family-oriented practice? Or do you want to be kind of like a meat-market? What’s the contract?

If you’re going to get a job, what does this mean? Does that mean I just give all the little fillings or do I have an opportunity to give crowns? Do I have to do all the exams? Do I get paid on exams? Do they pay for my liability insurance? Do they pay for CEs? Do they pay for uniforms? Do they pay part of my cellphone (bill)?

You’re not asking the questions to know whether this is a good opportunity or a bad opportunity.

Saxonhouse:

A lot go into situations with a handshake. If you’re going into an associateship, you want to know that there’s a future for you. And we recommend you get a signed contract.

Rice

One of your greatest pain points is debt load. That is a universal truism. The average number that’s reported lands around $275,000 in debt. I would argue that is a gross underestimate. I hear $300-$350 (thousand) every single week of the year. With that, there’s pressure. And with that pressure oftentimes, the tendency is to choose a job that’s going to pay well.

Ko

Your focus is to be the best dentist you can be and to be the best dentist to your patient that you can be. But you have to learn the other parts in order to alleviate your debt. How does billing work? Do I need to do certain procedures faster? Learning to manage your time better, learning how much your time is worth: I think that’s how you figure out paying back either your debt or making money for your practice.

Rice

Mentorship is the No. 1 thing. Your first three to five years out of dental school are your most critical years, so build a team of mentors. Have folks who are excellent clinical dentists. Get with the right financial advisers. You need a great accountant. You need a great attorney. Pretend you’re the CEO of your own personal company — build your board of directors with these mentors.

Ko

People who go straight to work, you don’t have that as much unless you’re working for someone who’s really good about being a mentor and open to teaching you. I don’t think that’s something that everyone gets, unfortunately.

Rice

It’s a tribe of sorts. I think most good people in all walks of life want to help, but because you really go through the trenches with all these people, you see yourself in every young student and dentist who is up and coming up. You want to give back.

The whole organized dental (tier) is a great place. As a student, ASDA. As a new dentist, the ADA. They’re tremendous networks, and a lot of it is because they have this national component that breaks down to a state component that breaks down to a local component, so you can really get into a good groove in your own hometown. Going to the dental trade shows — also huge. It’s a major trend that young dentists are not going, but those are huge opportunities for networking. All the right people not only go there, they designate time.

I’ve always been a subscriber of attitude before aptitude, so when I find people who are passionate — they’re hungry, they want to learn, they want to better themselves — I’ll answer that email or text or phone call every single time. When I feel like someone is going through the motions, when I get the impression that I’m just doing this because I know I’m supposed to do it, I’d rather invest my time in people who I know are very passionate and committed.

When it’s a mass email: “Dear Doctor” or “To Whom It May Concern” then I know I am part of a giant group of people you’re reaching out to. Life is about relationships. And if you emailed or texted or called and said, “Hey, David Rice, my name is so-and-so and I’m from such-and-such, can you help me?” Absolutely. But if you lump me in with 500 people, I’m not interested.

Does anyone have advice for current students?

Telin

It was the end of my first year, beginning of my second year, when I reached out to the current fourth-year dental students and said, “Hey, the workload seems to be getting heavier and I’m looking for a good way to manage it.” They were very willing to sit down with me and tell me what their plan was to get a grip on things. It was incredibly helpful. The first year there’s definitely a huge learning curve to understanding this setting and I think it would have been helpful to reach out to one of the senior year dental students a little bit sooner.

Ko

The good thing about dentistry — you make a decision that doesn’t mean it’s the end-all, be-all. If you decide during your residency and general practice that you want to specialize, you still have that opportunity. It’s not gone forever. There’s no “that’s it” with dentistry. Some people decide they don’t want to do dentistry anymore, so they end up working for a consulting company or a law firm or teaching. There are so many different options out there, so don’t despair.

Bruno

Most of the time you’re used to being at the top (in school), and you have that feeling when you’re done — I’m guilty of this — that you know so much and you’re ready to go. Each day has been such a learning experience and each year I’ve been in clinical practice is just an exponential growth — you learn so much more. It’s been months and you’ve seen how much you’ve done and how naïve you were. It was just that much to learn. It’s something that continues throughout the entirety of your career. We call it “practicing” for a reason.