Management + Leadership

5 things I wish I had known before becoming a dentist

For fourth year dental students, graduation is just around the corner. In this post, the dentists who wrote “So You Want to be a Dentist?” offer some advice they wish they’d had before graduating dental school.

1. Debt is real

I’ll admit when I was in dental school and signing loan documents for $30,000 or more at a time, it didn’t quite seem real.  I never saw most of that money.  What I did see was just deposited in a bank account and used to live on.

I wish I had taken a little longer to think about that money.  It almost felt like a paycheck.  Just money I was getting paid and that was mine to spend on the things we all spend money on.

But those student loans were a loan.  That money had to be repaid–with interest–and so it wasn’t free.  That realization is critical as you decide to borrow for school, buying a practice, purchasing equipment or whatever it is.

Those loans will erode your ability to make and take home money.  As you start repaying those loans it will affect the choices you can make. Those loans will slow down how quickly you can enjoy financial freedom and really live your life. (Visit MO’s Money Monday series for more on managing debt and personal finances.)

2. Teeth are attached to people

Again, it’s kind of obvious right? Before dental school and for the first couple of years in dental school, drilling on teeth and fixing them seemed pretty straight forward.  It was kind of mechanical.

Just follow the steps. Cut here. Bond there. Pack this. Shape that. Boom! Done. But I started to realize the simple mechanical steps were one thing. The person you were doing these things to was another. That person has emotions. That person has fears. That person has expectations.

Those things and a host of others affect your ability to do the dentistry. The person’s demands and emotions can affect your ability to focus on the task at hand and doing it to the highest degree possible.

When a patient is flinching and squirming its easy for you to get a little nervous. When you are nervous, it’s normal to just want to get it done and get the patient out of the chair. When the patient tells you they hate the dentist, it’s natural to feel a little offended and not feel as compassionate. But these are part of the job and you need to overcome the challenges of working with real people.

3. New stuff does not = lots of patients

Dental suppliers and sales reps will eagerly tell you about the latest and greatest in dental equipment. The salesman at the interior design store will happily sell you beautiful carpets and furnishings. They’ll all insist that you need a beautiful well-appointed office with the latest technology and newest dental equipment.

It doesn’t always work out that way. For the majority of practices, you do need a nice facility with up-to-date technology and equipment. But it doesn’t have to be brand new or 5-star-hotel nice.

In the majority of towns, where the majority of dentists will practice, it’s smart to have an attractive facility that is up-to-date. But there is a strong argument to be made that going all out and having a boutique practice with everything brand new and high end will work against you.

For one, all that high end brand new stuff costs a lot of money (debt). For another, the majority of people want to know they are receiving care in a clean, comfortable office and that the equipment and materials are modern. They really don’t care if your carpets cost you a fortune and if the countertops are Italian marble.  In fact most patients will see those things and assume the price of your services are high–even when they aren’t.

Be aware of where you practice and the patient population you serve, then shop for new stuff.

4. Dental insurance limits your freedom

It’s unrealistic in today’s world to think that we can practice dentistry without accepting dental insurance as a form of payment. It has been around so long and so many people rely on it that you pretty much have to accept it.

But know that by signing up as a PPO dentist means the insurance company, not you, will have the bigger influence in a lot of areas.

The insurance company, not you, will determine what is a fair and reasonable price for your services. The insurance company, not you, will “determine” what treatment is best for your patient.

And like it or not, a lot of patients will listen to their dental insurance carrier when deciding what treatment to receive. Many patients look at dentistry as just another commodity or service that you should try and get at the best price.  And because their dental insurance “pays” for their dental care, they are likely to do what the dental insurance will pay for.

So signing up with dental insurance companies is likely necessary. But know that in so doing, you will likely limit your ability to practice dentistry on your terms and get paid what you legitimately deserve.

5. Your team can make or break you

People come to the dentist to have their teeth fixed. They want to come to a dentist who is great at what he does and is a nice person.  I don’t mean to burst your bubble, but, you probably aren’t the only reason or maybe even the biggest reason they come to your office.

Patients see you for maybe 10 minutes when they come to get their teeth cleaned.  Patients spend a little more time with you when you “fix” their teeth.  But, the majority of the time is spent with Judy at the front desk.  They spend a lot of time with Paul the hygienist.  Even when you’re fixing their teeth, for a lot of that appointment their mouth is occupied.  Jenny the assistant is the one socializing with them before you come in and after you’re done.

So it’s obvious that several other people spend a lot of time with your patients other than you, the doctor.  Therefore it is critical that these people with whom your patients are spending most of their time be great!  Not only great but great in the role they play in your practice.

If your patient walks in the front door and Judy at the front desk is too busy on the computer to greet them by name and offer a warm smile and a handshake, that patient isn’t going to have a great start to their visit.

If Paul the hygienist is rushed and just gets down to business, how will that patient feel?  Most patients want to be acknowledged.  They want to feel like they are the star of the show.  They want to know that Paul remembers them and is interested in what is going on in their life.

If a patient feels unappreciated and rushed in your office, it will be pretty easy for them to go somewhere else for the smallest of reasons.  So, having the right team members in the right positions can make or break you.

~Dr. Marcus Neff, author of “So You Want to be a Dentist?”

Drs. Troy Stevens and Ryder Waldron also contributed to this post

product_thumbnailFor more in depth information on these topics and others, click here to buy a copy of the book “So You Want to be a Dentist?

Dr. Marcus Neff

Dr. Marcus Neff is a general dentist in Idaho Falls, Idaho. He graduated from Marquette University School of Dentistry in 2003. He is also the author of "So You Want To Be A Dentist?"

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25 Comments

  1. This is a very helpful article. Thank you for sharing.
    Do you have a website? What is it? I’d like to know more about what you offer.

    1. Hi Brett-
      ASDA’s website is ASDAnet.org. Thanks for reading!

  2. Edward Starr says:

    Hi Brett-

    Thanks for the awesome advice. As an aspiring dentist and current dental assistant I can definitely see the value in having a cohesive team. Great point about each patient spending time with numerous employees. Making sure that all employees are trustworthy and can offer the patient a great experience surely adds to the overall experience at one specific practice. Great post, thanks for sharing!

    Edward Starr
    Tulane Student

  3. What a great article and really hit home my friend. Brought back a lot of memories from when I was in dental school. Thank you for sharing your story with us.

  4. This was helpful information and I think I wouldn’t mind buying your book.

  5. Holly says:

    As a practicing RDH for the last 35 years, this advice is priceless. Graduating from dental school today has incredible challenges and so many new dentists are struggling.

  6. Great advice about the staff. As a hygienist I have temped in other offices besides my regular position. It’s important that they reflect your views. If the hygienist recommends sealants for children & you don’t, that presents a problem. If you think implants are wonderful but you assistant explains how many she has seen fail, patients wonder about you. I know my boss’s philosophy on taking x-rays, SRP’s etc. but I asked HIM during the interview because I wanted to make sure I was working in a practice that shared my views. I feel that I am a hygienist, not a salesperson. I will recommend the treatment I would recommend for family members. I could never work in an office that was based on production rather than my performance. I once had a retired dentist tell me that if you treat every patient like your friend rather than a dollar sign, you will have a successful practice. : )

  7. I’ve worked in dental offices since 1998 with a Business Degree background and I couldn’t agree more. It’s a difficult profession for dentists, the good news is there are lots of people out there who can help recent grads out with this sort of thing. If anybody would like help with these issues reach out to someone, get a mentor and ask questions. I’m available by email: ericyourcoach@charter.net
    Once you have all the skills to work with people it’s not that hard. 🙂

  8. Very well written article, insightful and practical. Dental schools should seriously give their students real life practical advice. At the end of the day, the dentist and their staff are taking care of their patients and treating them right. Make the patient feel good, and everyone is happy.

  9. Sarah Cards says:

    Becoming a dentist was the worst decision I could have ever made. I stay depressed each and every day as people hate me, I can’t get paid by insurance companies while being blamed for doing an unnecessary procedure, I lost my husband, I had to file bankruptcy after practicing 20 years, and no one appreciates dentistry. My advice is to steer clear of going into dentistry as there are WAY too many dentists in the U.S.

    I’m telling it like it is. Do something else because you will not enjoy dentistry.

    1. Pierre says:

      Sarah, do you have a plan to get out of dentistry ?

    2. John says:

      I appreciate you giving an honest answer that voices how horrible dentistry is as a profession. I agree with you, a student should run like heck away from going into dentistry as the number of dentists is WAY too high. I hate my job but have no way out of it.

    3. Sarah & John,
      That’s really too bad that you’ve had these experiences. Venting was not the intent of this article. In fact, ASDA helps students begin their career as dentists and encourages them to join the profession for all its rewarding aspects. I’m sorry it didn’t work out for the two of you but please try to stay positive here out of respect for our dental students.

    4. Tom says:

      …so you’re a dentist who hates her job. Just who the hell are you to dictate what someone should or shouldn’t do, just because YOU chose the wrong profession? Each of these complaints is your responsibility, and yours alone:

      -YOU stay depressed–don’t blame dentistry
      -people hate YOU–don’t blame dentistry
      -YOU can’t get paid by insurance companies–don’t blame dentistry
      -YOU lost your husband–don’t blame dentistry
      -YOU filed for bankruptcy–don’t blame dentistry
      -YOU are the unappreciated one–don’t blame dentistry

      You are a sum of the choices you make in this life. Some of these things were probably out of your hands, sure, but a good lot of them are dependent upon your attitude and approach toward overcoming obstacles. If you can’t surmount them one by one, that isn’t anyone else’s problem–and it sure to god isn’t dentistry’s problem.

  10. KC says:

    I feel compelled to comment. After working for a couple of years as I dentist for a few different offices, here are some things that I’ve learned:
    1) patient confidence is hard to earn but too easy to break. You can do great 8 procedures, but if the 9th one doesn’t go as planned, your risk of losing that patient is somewhat high. Even if the 9th procedure is well done in itself, but the patient experiences side effects/complications, this can also break their confidence.
    2) financially, the paycheck doesn’t always outweigh the risks you take on as a dentist. There is always a fear of treatment failures with threats of litigation, risks of blood born illness from needle sticks, the havoc that is caused by an unhappy patient, and the pressure to pay back loans. This is assuming that you are in network with insurance companies and abiding their fees. If you decided to branch out to do work fee for service, it’s not necessarily lucrative either unless you have been practicing for 10+ years and have established your reputation and saved up enough to start your practice with minimal debt.
    3) if you are working as an associate, you are very limited in terms of patient management and case management. Owner doc and his/her trustees will often try to dictate treatment plans and how the cases are handled.
    4)if you start your practice, be prepared to struggle financially for 5+ years, as practice loans are no joke. After paying off the practice loans and student loans, you will be lucky to take anything home for the first 5 years. In the beginning, you will need to be in network with insurance to help patient acceptance rate, see point #2.
    5) you can’t afford to get sick. A sick day for you means you have to cancel your patients, which patients don’t take too kindly to. It also means you lose the opportunity to make money that day, and your bills and loans are still due.
    6) dental work is costly and very few patients truly value their teeth over the purchase of a new car, purse, or vacations. Creating value for these patients is a difficult process and it’s even more difficult due to the rampant anxiety that plagues the population.

    1. Pierre says:

      so true KC !!! Can’t afford to get sick or take vacations and don’t ever divorce !

    2. Thank you for the advice, KC. We’re trying to keep things positive here on Mouthing Off since our readers are mostly dental students and predental students. I’m sure they’d also love to hear what you enjoy about your job.

    3. Christian says:

      Although Kim Kelly says all comments should be kept positive I think it’s good to see the negative side. People who are really into dentistry MIGHT find it discouraging to read this kind of comments but if they really want to be dentists they will find reasons to keep going. But for those of us who are not really sure and maybe not really passionate about dentistry, I think it’s good to know the downsides.

  11. And also, most dental schools require a 3.5 GPA or better in the basic sciences and overall to gain admission. I

  12. tony says:

    I love how this conversation inevitably turned into a discussion on the hard reality of dentistry. The truth is that there is no terrific profession out there. If the job is easy to do, you’re easily replaced.

    But work hard, keep your focus, and save your money. You never know when you’ll decide this is your last year and that’s it

  13. Kelly M says:

    This is hilarious. The negatives are sadly true and when focused on, one will be tempted to have daily depression sessions. However; there is a however! Some patients really do appreciate you. Those few that write nice comments about you on your office website or send you thank you letters after completion of a difficult treatment that went well…it is important to give yourself credit when something good happens or you won’t get past the daily stresses. The business and financial parts of dentistry make up 80% of what makes it difficult. You’ll have to suck it up as an associate, if only to help you realize just how important a good financial manager and insurance coordinator are to the practice. The sense of being a “Team” is also quintessential. An owner has to deal with all the emotions and personal issues of her/his office personnel which, believe me, isn’t pretty. Beyond the negatives, why don’t I close with the one positive I cling to daily: there is no greater sense of accomplishment than when you start a difficult procedure and can admire you near-perfect result in the same sitting. Lucky for me, this happens multiple times daily. Take 5 extra minutes to do work you can be proud of…therein lies the secret to happier dentistry. Good luck to all.

    1. Steve S says:

      Thanks for the positive comments. As dentist we sometimes focus on the negatives, but you are correct…we sometimes forget those patients that do appreciate our time and efforts. I struggle daily with being a dentist, and if I’m being honest…get very depressed on almost a daily basis. I try to focus on the positive aspects of the job…hours, being my own boss, income, but sometimes I want to just walk away from it all and do something else. Personally I wouldn’t want my kids to be dentists unless they have an absolute love and passion for the profession. Life is too short to do something you don’t enjoy.

  14. Patrick says:

    As a dentist with 37 years behind me I will tell you that dentistry
    was a lot more enjoyable when I first started. Now insurance companies
    run the game. PPO’s are killing you ability to control you fees. Insurance
    companies PPO’s do not keep pace with inflation or your rising cost.
    And almost every insurance is now a PPO. If you signed up with a
    PPO 9 years ago and your contracted fee for a PFM was $800
    you can be still be looking at that $900 fee. Most dentist have to take
    insurance and most insurance is PPO. So you have lost total control
    of you income. Complain about the PPO compensation to the insurance
    company and they don’t care because your patients will just go elsewhere
    if you quit. So unless you can develop a high end, total fee for service
    practice you are going to work harder for less. And most young dentist
    will have a hard time putting together a total, insurance free, practice.
    All my comments also apply to the medical profession. Insurance
    companies are killing these honorable and must needed profession.
    I recently needed a new water heater in my office. It took one plumber
    two hours to replace the heater. The cost $1400 and the water heater
    at Home Depot was $450. So the plumber made almost $500 per hour.
    He has no staff, no OSHA, no insurance companies.

  15. Jim Park says:

    Only go to dental school if

    1. You can graduate without debt. If you’re leaving dental school with 475,000 in debt, in this current job market, you will never be able to pay that back.

    2. You have a job lined up with you Dad or Mom who are established dentists with great offices with lots of patients.

    3. You have volunteered at your local dental office for one month, shadowing the dentist and seeing what he/she has to go through on a daily basis.

    4. You have to have a tough skin and an absolute burning desire to work on crying kids. Your bosses will only be interested in upselling for more money. If you are an honest associate, you will have a hard time keeping a job.

    Please understand that dentistry is back breaking work. Try a pulpotomy on a screaming kid. Try doing a root canal on #15 on a patient who is scared and can barely open his mouth.

    Insurances are paying less and less and patients are complaining about 5 dollar copays. Everything about the job will continue to get more difficult.

    There you go.

    I just saved everyone $475,000 and 4 years of undergrad and 4 years of grad school.

  16. Thank you for all the comments and opinions! Dentistry is a dynamic profession and can surely be stressful at times. I hope that all this input can help future dentists navigate their paths within this profession. To prevent too much negativity, we will close the comments. Thanks for reading!

Comments are closed.