Striving for Balance as a Resident, Associate or Partner
By Laura L. Milroy, D.D.S., M.S.
Residency is a time spent reviewing articles, completing research and managing clinical time. The workload required can be overwhelming. As chief resident, I warned our incoming residents that the amount of information you receive and are expected to retain can only be compared to attempting to drink from a fire hose.
I approached residency with an attitude of dedication – committing myself to learning as much as possible from the literature, my co-residents, mentors and clinical cases. I encourage all residents to take this approach as you will never have more time than you do in residency to learn the literature, document your cases and collaborate with peers. Having said that, it is also important to allocate time to other aspects of your life.
When I was a resident, I dedicated one day of the week to refrain from all schoolwork and spend time with family and friends. At first, this proved challenging as I felt my time would be better spent completing one of the many projects I had looming over my head. I found it hard to be present in the moment when my mind was occupied with my residency to-do list. I had to learn to temporarily ignore my residency obligations and live in the moment. I found that I was actually more productive during the week when I had taken time for myself. The primary key to balance in residency is organization. Organizing your time is imperative to fulfill your commitments and still find time for yourself.
After residency, I joined a large group private practice as an associate. I soon found that, although I was free of the incredible workload of residency, there were other stresses associated with being a member of a group practice, as well as being a new practitioner and associate. I had a lot of concerns regarding my transition from residency to private practice. I was confident in my clinical abilities, but was apprehensive about potential production, training new assistants, the expectations of private practice patients and referring doctors, and my student loan repayment. Like any new job, there was a period of growing pains, but, over time, my concerns were alleviated as I became more familiar with the practice, its staff and the local dental community. I learned to manage my student debt through budgeting and living within my means. Despite the demands on my time as an associate, I was able to achieve work-life balance. The key to attaining this was learning to leave work at the office and not take home the stresses of a grumpy patient or a dramatic staff member. This was an ideal time for me to focus on spending quality time with family and friends, enjoying my hobbies and resuming life after residency.
At the end of my year as an associate, I purchased a practice in partnership with another endodontist. Becoming the owner of a business and managing it with a partner came with its own set of challenges. The decision to purchase the practice and significantly add to my already hefty loan payment was difficult and stressful. Once the legalities of purchasing the practice were complete, I was faced with learning the general operations of the practice as well as the specific everyday ins and outs of the business. As a business owner and new dentist in the area, I had to concentrate more heavily on marketing and networking than I had previously as an associate. Being an owner is rewarding, but requires a great deal of time commitment early on to ensure the continued growth and success of the company. As I am in the early stage of my career as the owner of my own business, I am still learning how to achieve work-life balance. Thus far, I have found that the key is moderation in all things. I work hard to provide exceptional patient care, fulfill my practice obligations and ensure the future of the company, but balance this by spending quality time with family and friends as well as taking time for my personal hobbies.
As residents and new practitioners, we all have the common thread of endodontics in our lives but face different life circumstances and challenges. No matter what stage of life we are in, it is important for all of us to strive to find work-life balance. As we do this, we will find more enjoyment in both our personal and professional activities, and find more satisfaction and joy in our lives.
Practice Models: Dental Support Organization
In an attempt to give residents and graduating endodontists a flavor for the types of career paths available to them, the Resident and New Practitioner Committee is introducing a series of articles on different practice models. To kick off the series, the committee worked with Pacific Dental Services®, a Dental Support Organization, to provide the first overview of this practice model. PDS® is just an example of the many DSOs in the industry market.
As a new graduate from an endodontic residency, you will have a multitude of options to explore for your future career path. The Dental Support Organization model, a rapidly growing segment within the dental industry, is one option. Pacific Dental Services® is a DSO that provides business services to close to 400 doctor-owned practices across multiple states. The core concept of the DSO model is to provide business management services, which free the supported clinician to concentrate on patient care. Each DSO is different, so it is critical to take time to learn about the various companies the unique features when considering this career path option.
One component of the PDS® model is an infrastructure that supports specialty integration. This provides you, the specialist, with the potential to engage with one or multiple supported practices within a given geographic area. Most PDS-supported practices have a full range of specialists rotating or working full time in the office. The specialist has an Independent Contractor Agreement with the owner dentist and a highly collaborative relationship with both the owner dentist and associate dentists of the practice. The success of specialists is further supported by an environment that has a strong flow of continuing care patients, trained support staff, a specialty referral program and access to ample resources including CEREC® CAD/CAM technology.
Increasing levels of student debt and high practice start-up costs have led to the growing trend of DSO models in the dental industry. DSOs can provide knowledge and resources for practice administration and easier access to capital, and can capitalize on economies of scale to assist their supported offices in providing services at a reasonable cost to patients.
By David G. Meier, D.D.S.
A 73-year old Caucasian male presented to the endodontic clinic referred by oral surgery with a chief complaint of, “I need an evaluation to save my teeth.” The patient was diagnosed with multiple myeloma in 2011 and has received IV zoledronic acid (Zometa®) for over one year as part of the chemotherapy treatment. The patient reported a history of receiving sporadic dental care in the past, only on an emergency basis. A clinical exam revealed gross caries present throughout the mouth with all teeth present except #3, #12 and third molars.
Though full-mouth tooth extraction would be the treatment of choice in the absence of modifying factors, according an oral pathology faculty member, the risk of medication-related osteonecrosis of the jaw (MRONJ) would be as high as 10-15% in this case. It was determined that, with the exception of tooth #1, root canal treatment and decoronation of the remaining dentition would be the best option to prevent MRONJ. The oral pathology faculty member recommended extraction of tooth #1 due to the depth of caries as the risk of infection from leaving the tooth untreated was greater than the risk of MRONJ in an atraumatic extraction. The option of no treatment was also presented, and the patient consented to the proposed treatment. Although the patient did not have dental insurance, a medical necessity letter, written by the patient’s oncologist, was submitted to his medical insurance requesting coverage of the necessary treatment. The letter stated, “As part of J.C.’s medical therapy for multiple myeloma, I have recommended treatment with bisphosphonate therapy. Because of that, I have also recommended major dental work to allow the administration of medical therapy for his multiple myeloma. Such dental attention would increase the safety profile of bisphosphonate therapy.”
Over the course of 10 weeks and seven visits, RCT was completed on all of the remaining teeth under rubber dam isolation. Working lengths were determined using an electronic apex locator and verified with cone-fit radiographs. (These radiographs are not included due to the large number.) Immediately following obturation, teeth were decoronated at the level of the gingiva, and amalgam restorations were placed in the coronal three millimeters. At the last appointment, tooth #1 was extracted atraumatically and a seven-day course of amoxicillin and chlorhexidine was prescribed to reduce the risk of MRONJ in the area. The patient was scheduled for four-week and six-month endo recalls and for immediate fabrication of complete upper and lower dentures.
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