Now or Never

First off, my sincerest apologies for neglecting to write frequently on this forum. Whether it was business or simply being uninspired, I am sorry for not having made any posts here in a while. As I am practically a week away from my 45th birthday, I felt an inclination to write a bit about updates in my life. Probably the most grandeur of which, is the news that – as of two weeks ago – I gave notice to my dental office that I am leaving. In September of this year (2024), it would have been 10 years working at this office. I have written before on this very blog about why I chose to be an associate versus an owner for so long; however, I have recently come to the realization that there really is a finite amount of time for me to create any kind of lasting legacy for myself. The two original owners of my group cashed out to a private equity (PE) company several years ago. Surprisingly, since then, things have been steady and, dare I say it, slightly improved from how the original owners would run things. The PE company introduced a 401k retirement plan and a generous continuing education allowance that I never really had offered to me before. They addressed some staffing issues, which ultimately made the office busier i.e. more productive. The PE even had the budget to address some of the cosmetic shortcomings within the office, and had a legal team that can handle disputes with the property manager and owner of the aged building we reside within. I know what you’re thinking….so why leave, right?

“There is no passion to be found playing small – in settling for a life that is less than the one you are capable of living.”
~ Nelson Mandela

Before I address that question, I should say that over the years I have been presented with and declined more than a hand-full of offers to join other groups or start my own venture. In every case, the build-out costs were too exorbitant, or the barrier of entry was too cumbersome for me to consider it viably. I would entertain (even be excited about) the idea of it for several weeks or months, and then ultimately talk myself out of it for being too risky of an endeavor. Each time regressing back to the comforts and stability of my existing associate position.

Perhaps the biggest reason my brain convinced me of is that, the associate position afforded me a comfortable living wage along with ample time with my family. I am blessed with how much time I have with my boys; to go watch them play tennis tournaments, to pick them up from school, to readily take vacations together. There are moments and memories that I am grateful we were able to create because of how cushy my work schedule is/was.

I do not think it would be wise for me to start from scratch. Maybe as a new or recent graduate, sure. I am literally 10 years out of residency training, and I absolutely do not think I have the time/energy/patience to start a new practice from scratch. Real estate costs have increased, supplies are more expensive, staffing have new hire minimum wages, and build-outs of dental offices have historically been ridiculous hard to afford.

So in February of this year, when I casually responded to an Indeed job post in search of a pediatric dentist in the Las Vegas area – I had no idea what would quickly transpire. I first spoke with a recruiter for the group, and informed him right off the top that I was not interested in making a lateral move in my career; that the only position I would entertain should have an equity component included into it. He asked for a little time to take my demands back to the owners of the office(s) and explore whether that was doable. Later that night, the owner texts me to arrange a dinner with his partner, himself, and an operations director within the company.

Come to find out, this group has 9 existing (general) dental offices, and think the future growth is in building up their orthodontic and pediatric components of the practices. The owners seem extremely affable and down-to-earth, and want someone that seems like they’ll work hard to increase the pediatric dentistry presence within the community. They’ve experimented with pediatric dentistry for about a year in one of their locations, but want a (eventual) partner that is a good fit for their team.

This opportunity checks a lot of boxes for me. They have already established themselves and clearly know how to grow a brand and create offices. After a six-month dating period, there is buy-in potential for me to be a partner and have some equity on the table. It has an unique opportunity for me to be a ‘pediatric director’ and eventually oversee the operations of offices versus simply being a workhorse and doing the dentistry one patient at a time (which, don’t get me wrong, I still very much love to do).

This happened so dizzyingly fast. I had a lawyer review the contract, and although quite expensive, offers some peace of mind that my interests are guarded against in the fine print of things. I gave my notice to the group, and plan to serve out a contractual 90 days while they find a new provider to replace me in the practice. Probably the last – and certainly the hardest – task left is breaking it to the staff I have worked with all these years. My existing office crew is filled with quirky, captivating, hard-working women that make going into the office every day so enjoyable for me. When it comes time to break the news, I am sure I will have to fight back tears because of how attached I feel to all of them.

In any case, thank you for taking the time to read this. I think, the older I get, I come to realize that I have lived so much of my life in a bubble of comfort and stability. And, although scary and at times asininely uncomfortable, I think leaving my comfort zone and taking on some (calculated) risks standing to give me some rewards and accomplishments in life that will leave a legacy for myself. Anyone else taken similar risks? I would love to hear about them! Thanks again!

Private Dental Practice vs. DSO Dominance

Dentistry, Lifestyle

Spoiler alert! This post is ALL about dental talk. You see, for the past several months – since I was notified that the company I work for (for the last seven years of my life mind you) was now under the ownership of a large dental support organization (DSO) – I have been deliberating whether it is time for me to pursue an ownership or partnership arrangement of my own. I have written about this very subject here; however, that was under the (much more ideal) circumstances of being employed by two pediatric dentists and not some massive private equity company that buys up dental offices for investment purposes. While the name of the new owners is irrelevant, their portfolio currently consists of over 250 dental offices across the country and they are continuously growing aggressively.

This business model is not new. In fact, I am sure you have seen many of your local, private-practice physicians selling to private equity companies. As a pediatric dentist that works closely with anesthesiology doctors, I witnessed first-hand when they started to be taken over. Once a large investment firm enters the picture, and really gets its claws into an asset class, you have to believe they are going to streamline the shit out of it in order to drain every last dime of profit out of a business they acquire. In the case of the anesthesiologists I work with; all of a sudden they were forced to work with an expanded lineup of surgeons, taking on more call schedules, learning new systems, performing post-op surveys, and more.

For someone that is close to retiring, some of these DSO offers may not be so bad. I imagine they give a very hefty upfront payout, and after mandating the doctor(s) stay on for ‘x’ amount of years (to ensure minimal attrition occurs), I am sure there is a golden parachute that many people receive on the tail end of the acquisition as well. My bosses both have to stay on four more years, but after which, they can and likely will retire from dentistry forever. Me? on the other hand. As a mere employee, with absolutely no equity stake, I get squat from the buyout and have yet to see how they plan to ‘trim the fat’ (so to speak) within our company. They’re a big company that tries to entice you with a matching 401k plan you can enroll in, some solid health insurance plans you can participate in, and some perks that smaller run organizations may not be able to afford to provide their employees with – but, its the changes in the day to day operations that scare me.

For example, I heard the words ‘production goal’ uttered from my office managers mouth for the first time in seven years last week. She also asked my lead assistant ‘why we ordered so many nitrous oxide tanks’ for our office? Something that has neither changed/increased, nor been scrutinized or questioned, up until this point. The way I see it, they are still in a transitionary period where they do not want to rock the boat (i.e. don’t spook the staff, keep changes to a minimum, etc.) – but certainly, the tides are changing.

While I am grateful that the transition has at least kept me gainfully employed; in the last couple months I have updated my CV, set up a LinkedIn and Indeed profile, arranged lunches with some pediatric dentists around the valley, reached out to dental supply reps and expressed interest in any partnership/ownership opportunities they may be aware of. Out of the five dentists that I reached out to, two recently sold some or all of their practice to a DSO, one is content and is not interested in any arrangement, but two are willing to discuss my coming onboard with some equity stake on the table.

“Success comes from taking the Initiative and following up…Persisting…

What simple action could you take today to produce a new momentum toward Success in your life?
– Tony Robbins

For the last seven years, I have worked for someone else because it has afforded me a comfortable working environment, good pay, a flexible work schedule, and no interference in how I chose to practice clinically. And, I am not a risk-taker. Or, I have been too afraid of failure. Unfortunately, I have come to realize all the time I have worked, was to build up someone else’s brand and valuation.

One of the pediatric dentists I met with recommended a book called “The Millionaire Master Plan” by Roger James Hamilton. He spoke highly of the book, and claimed it would expand my way of thinking and put me quite a few years ahead in terms of wisdom and self-awareness. I am a few chapters in, and so far a good portion of it has been dedicated to helping someone recognize their ‘genius’, their strengths and weaknesses, and talks about expanding on those traits to build your wealth.

For the sake of completeness, I should say that I have also toured a couple of empty, grey-shell office spaces as well. The problem here is that, dental build-outs can be quite costly, plus you have no cash flow for the first several months/years, plus you’re competing against the deep-pocketed DSO’s with their endless marketing dollars and – it really steepens the curve when it comes to opening up a start-up. I also have investigative work to do (with the help of an attorney), to review my existing contract and gauge the enforceability of my non-compete and other restrictive covenant clauses.

My way of thinking is changing. I am now seeking opportunities I would normally be too nervous to pursue. I hope to write again soon to share the results of some of these meetings, and with any luck, announce that I may have new endeavors underway. Thank you for taking the time to read all of this, and sorry to limit it primarily to the dental folk out there. Enjoy your day!

Conquering Change

Dentistry, Lifestyle

Recently, I was made aware that the office I have gainfully been employed at for the past seven years was going to be sold to a larger, private-equity company. One of two owners called me to break the news about the transition, and nonchalantly tried to reassure me that not much should change about the terms of my employment other then who signs my paycheck.

I have never been one to embrace change well. I would almost go so far as to say I fear it.

I see day-to-day change take place in front of me constantly, and I struggle to accept even that. My kids getting older is a prime example. Google Photos reminds me of this day ‘7 years ago’ and I am an emotional wreck. Why do they have to grow up so freaking fast?

Listen, I know, it is a part of life and we cannot control it. Without a doubt, my best days are when I manage to block out the seemingly infinite “what if’s” scenarios that float around in my head. When I somehow silence all that noise that occupies my mental space, my days are much more peaceful and happier.

Years ago, I read a book called “Who Moved My Cheese” by (Patrick) Spencer Johnson. From what I remember, it was a quick enough read with a very simple message. Life moves on, and so should we. “The quicker you let go of old cheese, the sooner you find new cheese.” The author devotes the book to trying to embrace change in work and throughout our lives.

I have worked for enough large DSO’s (Dental Support Organization’s) to know they are not run the same as smaller, privately-owned offices. In an attempt to streamline operations and cut costs (and maximize profits), something’s gotta give – it may impact the quality of dental materials, the staff, the schedule – it could touch on every aspect of the practice.

As a mere associate, I am not privy to the terms of the sale and transition of ownership. Only time will tell what changes will come. The way I see it, at best, my office stays as-is and nothing changes. At worst – the autonomy I have enjoyed in picking out my own materials and setting my own schedule starts to disappear. What would be utterly devastating is if my beloved staff get spooked and decide to quit.

This is the second office now that has been sold out from underneath me. Because I have been just an employee, as the practice changes hands – even though I worked hard to build it up, because I have no equity stake – I reap none of the benefits of its successes throughout this sale taking place. The two original owners (not much older then I am currently) have now paved a pathway for retirement for themselves; and I am but a commodity being sold along with the chairs and other equipment.

On the flip side, I have been compensated well over the years and had I invested more wisely (thanks a lot Celsius Network), I might also in my own right have been on a path towards financial independence. Plus, over the last seven years I have not been burdened by administrative hassles of running this practice – and when the A/C fails, addressing staffing issues, dealing with payroll matters – none of that has really weighed on my shoulders.

“Change happens when the pain of holding on becomes greater than the fear of letting go.”
― Spencer Johnson, Who Moved My Cheese?

How my staff will respond to the new owners, how my pay will be affected, how my patient schedule may change – all of these are unknowns that occupy my mental bandwidth these days. Mixed in with regrets about not building up equity all these years and reaping zero ownership benefits. And do not get me started on the massive financial setback I have incurred with the atrocious investing missteps on the Celsius ordeal.

Lately though, when I am not caught in a moment of self-doubt and insecurity, I am convinced that – however horrendous these last several months may have been – I am more open to taking on the challenges of practice ownership, I am a wiser/more cautious investor, and I am, for the most part, optimistic about what the future has in store for me. I am even finding ways to enjoy my kids getting older and the fun activities I can do with them now versus seven years ago.

Hope you handle change better than I do. Every day I feel I have to convince myself there is light at the end of the tunnel. Thank you for taking the time to read my post today! Please feel free to share with me your own stories of taking on change in your life!

Attending the AAPD 2022 Conference

Dentistry

Last week, I went down to San Diego, California to attend our American Academy of Pediatric Dentistry (AAPD) 2022 Annual Session. In order to be an actively practicing dentist in Nevada, I need at least 40 continuing education hours every 2 years; and these conferences usually knock a big chunk of those requirements out of the way. Not to mention, with the AAPD being a fairly large organization, the invited speakers and presented topics are high caliber.

In case you haven’t read some previous posts, I was president of our local chapter (the Nevada Academy of Pediatric Dentistry) for one year back in Jan 2020 to Jan 2021. In addition to informing our members of new COVID guidelines within their practices, dealing with state Medicaid cuts for dental reimbursement – I also worked with my executive committee to plan our annual business meeting and CE course. Mine was an extraordinary year; as an organization, we were implementing our very first online meeting. Finding sponsors proved to be difficult (many companies reported their own financial hardships), but our speakers were kind enough to donate their time to talk to our small group (plus we had no large venue to book) so fortunately we were not on the hook for the honorarium we have paid to our speakers in the past – so it was a bit of a wash for us in terms of our bank balance.

Anyways, the AAPD had also done virtual meetings for the past couple of years so certainly there was this universal consensus amongst attendees of how satisfying it was to be back to in-person meetings. You had not only pediatric dental professionals attending, but office staff members were invited, a bunch of children were present – I mean, it had the makings of a total super-spreader event. Let’s hope it wasn’t? I masked for all of 5 minutes. I got there and realized maybe about 1-2% of people were wearing one and I admit I got into a total ‘when in Rome’ kind of mindset.

If you don’t already know, I am an introvert and not particularly fond of crowds. When I arrived, and lots of people were standing together and socializing – and I didn’t see any familiar faces, I awkwardly stood alone at a table with continental breakfast wondering if I made the right choice to attend in the first place, and thought to myself anxiously whether the next four days would be like this very moment. I consider myself fairly affable, but I am not comfortable introducing myself or striking up conversations with strangers.

Fortunately, I eventually found my boss, some dental school friends, and even met some new people along the way. I spent time roaming the exhibit hall where many of the sponsors set up booths and promoted some of their products. I learned about dental procedures (e.g. tooth autotransplantation, molar substitution, etc.), attended some mini-clinic courses, and heard from M.D. physicians talking about mental health screenings on teenagers and adolescents.

Perhaps my favorite part of attending this year was listening to the keynote lecture by a guy named Ben Nemtin. He is an impressive young motivational speaker and is the author of a book titled “What Do You Want to Do Before You Die?”. His backstory discussed bouts of deep depression, but then went on to speak about how him and his friends started a journey to cross things off their bucket lists – resulting in more fulfilment in their lives by helping others, setting goals, and accomplishing their dreams.

Here are five things I took away from his speech:

Write your bucket list – make it a project.
Share your goals – make yourself accountable with others. “Fear is the taxes you pay to achieve your goal.”
Be unstoppable – be persistent. Take as many “no’s” to get the “yes”.
Moonshots – shoot for unrealistic goals.
Give – happiness is only real when it is shared.

“Today is the oldest you’ve ever been, and the youngest you’ll ever be again.”
Eleanor Roosevelt

In addition to the course, my family used this as an opportunity to turn our S.D. trip into a mini-vacation. We were able to hit up Legoland, had some fun at Belmont Park, went to the beach and saw Balboa park. All-in-all, I was very glad I attended this years annual conference!

Thank you so much for taking the time to visit this blog and read through this post!

Figuring out Fatherhood

Dentistry, Lifestyle, Uncategorized

Colleagues in the dental field, upon discovering I do pediatrics, always squeeze in the phrase “it takes a special kind of person” somewhere into the conversation. I have also heard the words “thank God for people like you” on more than one occasion. If you have read any of my previous posts, I almost never miss an opportunity to gloat about how lucky I am to do what I do. Sure, there are stressful moments mixed into each work day – the deafening loud screamers, the biters, the pukers, and my personal favorite, the parents that tell me how to do my job. However, I would not trade my profession for any other, ever, period.

I imagine that the “special kind of person” comment implies there is a certain degree of patience and compassion for these little patients that those individuals maybe do not have a want or willingness to exert. Mind you, I do not say that judgmentally. I recognize that everyone on Earth has different skills, talents, and abilities – and what suits me may not befit someone else. I already established in my last post that I certainly do not have what it takes to be a Chippendales dancer.

Nevertheless, this notion that I may somehow possess a special amount of patience is an interesting one. At work, I am proud to say, I always try and maintain the utmost professionalism. I treat children with low-functioning autism, with attention deficit hyperactivity disorder (ADHD), and with various other medical and behavioral conditions. The truth is, throughout most of my brief appointment – whenever I have an unruly child in the chair – I think to myself how demanding and taxing it must be for the parent to take this on day in and day out. Really, kudos to them.

At home however, unfortunately, my parenting style does not always feature that same calmness and composure.

When I was younger, well before my children were born, I was driving down the street, stopped at a traffic light, with my window rolled down. At the same street corner, waiting to cross, was a father and his young boy (probably no more than around 7 or 8 years old). I caught only a brief portion of their altercation before I had to resume driving, but the dad was berating his son about his bike, either ruining it…not riding it properly, something to that effect. I remember thinking to myself, how could any material object be worth laying into your kid like that?

Little did I know back then that I would have progeny of my own one day. As recently as yesterday, I chastised my younger son for 20 minutes about being too distracted/not concentrating and doing ‘poor quality work’ on his Kumon (a math and reading tutoring program) assignments. (Ironically, he’s eight.) It is a lecture I have given to him time and time again. A few months ago, at a park, he left his tennis racket unattended somewhere and it was stolen. The drive home was filled with my reprimanding him about being more responsible with his things. I guess, so much for my ‘material objects’ memory huh?

I wish every moment could be remembered like this one above.

For the record, I am not proud of these outbursts and punitive moments of mine. All too often, I ultimately regret the vehement way in which I handled the situation. My biggest fear is the emotional scar and substantiality of the memory it creates in their mind. Although for me, disciplinary moments like these seem infrequent and tend to occur far and few between; in the mind of a child, I imagine it carries immense weight and detracts from the many jocund times we share together. And that is sad to me; because I truly do make concerted efforts to play with them, talk with them, take them places, and provide them things that I was bereft of as a kid.

The reasons for (and root cause of) my overly aggressive outbursts are probably outside of the scope of this blog post. But like so many other things in my life, in an effort to right wrongs, I try and self-reflect on shortcomings and character flaws within myself. I need to work harder at managing my expectations for my kids. While (I think that) I am trying to instill a good work ethic in both of my boys; I feel I am also setting myself up for disappointment and frustration when they aren’t delivering on things I myself believe to be important. I have to learn to exercise more patience and tolerance to the simple fact that they are children; and mistakes, and messes, and imperfections in all forms will help them learn, cope, and even correct certain behavior in the future.

When I think about the miracle of childbirth; and how even from the point of conception, we need so so so many countless processes to go right before we’re given a beautiful, healthy baby – I almost feel ashamed of myself that I let petty things like messy handwriting or a stolen tennis racket ruin a moment and a memory in time I have with my two young boys. Don’t get me wrong, disciplining and punishments have their place. I am just going to make more of a conscious effort to handle their foibles and failures with a tad bit more of tranquility. Every child is a blessing; I have to work harder to appreciate that fact not only at work but within my own home.

Really, thanks for taking the time to visit this blog and read through some of these posts. I can always use help in the parenting space, so please feel free to send any comments and questions my way!

Enabling vs supporting

Dentistry, Lifestyle

Today, I attempted to do some fillings on a highly anxious nine-year-old girl. She was sobbing practically non-stop, grasped tightly to her stuffed animal, and basically blocked/ignored all of my various behavior management techniques. Mentally she did not succumb to the oral sedative, she could not care less for my tell-show-do spiel, and she could not bring herself to stop crying well enough to tell me what was frightening her. The mother denied any past emotionally-distressing dental visits and claimed she behaved perfectly fine with her other medical doctors. Needless to say, I accomplished nothing in the office and her parents were made aware she will likely need to go under general anesthesia to get her dental treatment done.

Very few of my appointments are completely aborted like this one was. In fact, the rarity of it is probably why I am so heavily bothered right now; and I only wish I could have more effectively understood this patient’s disposition. In a child with a learning disability or mental health issue, (at least to my aberrant mind) there is more of a justification to why that individual may not be able to tolerate such a procedure. However, a supposedly healthy, ‘normal’ nine-year-old (with a stuffed animal?) without any previously traumatic dental appointments acting with such resistance really makes me question her resilience and coping skills for other difficult situations in her life.

There are some psychology concepts we briefly discuss in pediatrics such as (B.F. Skinner’s) operant conditioning, and positive/negative reinforcement and how each influences desired behavior. I also try to stay mindful of the developmental milestones children should be achieving, and try to raise awareness and arrange appropriate consultations when they are clearly not being met. The patient I had today clearly exhibited extremely fearful behavior (i.e. crying uncontrollably), still relied on comfort objects (i.e. stuffed animals), and willfully refused to be verbally interactive. Let’s assume she is not developmentally delayed; when someone exhibits such uncooperative misconduct, and realizes it provided her the outcome she desired (i.e. not getting dental work done) – my concern is, could that moment reaffirm in her mind that poor behavior rescues her from all circumstances she deems uncomfortable? What is the lesson she took away from today’s visit?

It begs the question though, where does parenting style play a part in all of this? In the few moments I was in the room with her, this parent met the criteria of a stereotypical “helicopter mom”; in that she hovered closely over the child the entire time (never once out of reach) and a bit overly involved in trying to pacify her daughter throughout the process.

Now, by no means do I profess to be the perfect parent. Far from it in fact. As you may know, I have two young boys. One has a borderline addiction to Minecraft and the other has a very unhealthy affinity for watching scary YouTube videos featuring Slender man. One tends to be clueless about his surroundings, messy and irresponsible with his belongings; while the other can have uncontrollable temper tantrums, often times is quite passive-aggressive, and (no joke) may one day turn out to be a kleptomaniac. At eleven and eight years of age – they already seem to know the full catalog of curse words, they consistently stay up past their bed time by at least an hour, and disobediently raid our pantry in search of sugary snacks.

In retrospect, I am starting to realize just how often I inadvertently enabled my children’s undesired behaviors over the years; all under the guise of trying to be ‘supportive’. Like when my son forgot to turn in multiple assignments throughout the school year, and my wife and I pleaded with their teachers to accept their work late. Even with minute challenges, like tying their shoe laces for them or cutting up their meals into bite-size pieces – these were obstacles they could have easily overcome and a great opportunity to build up their confidence.

It is perfectly natural to want to protect our children from difficult situations, or experiencing failure, or enduring pain, or undergoing embarrassment. Before we know it though, they’re older – and if we have shielded them from all of their struggles, I feel we may have deprived them of developing essential coping skills and the ability to build up resilience.

“We don’t grow when things are easy, we grow when we face challenges.” ─ Unknown Author

Within my own life, I know conflict has always helped me be more confident and grow as an individual. There is a sense of empowerment when we face fears and overcome obstacles. Lately, I not only ask my children to exercise perseverance and more independence through the problems they face within their own lives; but also, allow them to suffer more consequences and tackle some relatively uncomfortable situations without parental intervention.

I wish every child I treat in my clinic could have a pleasant and pain-free dental experience. Many kids unfortunately are overwhelmed with fear and anxiety before they even step foot into our office. “We are a sum total of all our experiences.” (BJ Neblett). I do not presume to be able to correct the behavior of every child within my one-hour appointment. Their past dental experiences, their environmental influences, their parent’s parenting style, and much more are all considerable factors. Fortunately we have various treatment modalities, and perhaps with time and enough positive experiences, even the nine-year-old with the stuffed animal can one day feel comfortable getting work done in the dental chair.

Thank you so much for taking the time to read this post. Please feel free to express your own thoughts and feelings on this matter, I love to hear various point’s of view.

Vacations vs burnout

Dentistry, Lifestyle

Contractually, I get ZERO paid vacation days a year. That is not to say I cannot take time off. In fact, my employer is quite accommodating of my vacation requests. However, when I am not in the office and not seeing patients, I am forfeiting any and all income for that period of time. Needless to say, that causes some internal conflict.

When I was younger, I remember someone telling me about the concept of ‘opportunity costs.’ They pointed out an example of how because Bill Gates’ net worth is worth so many several billions of dollars; that it literally would not be worth his time to pick up a $100 bill if he were to drop it on the ground. In fact, he called it a ‘poor investment’ of his time.

In the early part of my dental career, that same decision-making process always stirred in the back of my mind. Essentially, when I go on vacations, not only do I not bring in an income but I am also spending money on restaurants, hotels and flights. The other thing that weighs on me is that I work in pediatrics – so the times when it is usually most convenient to go on a trip (i.e. summer time, spring break, winter session) we are usually the busiest and therefore, the most productive. For these reasons, in my first few years of employment, I practically took no time off.

As time has progressed; I am settling into my career, my kids are getting older, and, more recently, with my health issues – I realize more and more how finite my life and time with my family really is.

I have said it before and I will say it again – I feel blessed to practice pediatric dentistry. Truly, I do not think any other profession could have brought me this level of satisfaction in my life. However, I work in a heavy Medicaid office where I am constantly surrounded by patients in pain from rampant decay, frequently get grief from parents about appointment wait times, and unfortunately, am often times immersed with a sense of hopelessness on whether we are even making an impact. Honestly, it can all start to wear on you a bit.

My family took a week long vacation last week to Yosemite National Park and a quick trip up to San Francisco. On our way back to Las Vegas, we drove along a small stretch of the Pacific Coast Highway. Lots of beautiful sites!

In the weeks leading up to the trip, I couldn’t help but feel a little more pep in my step. Just planning for it, packing for it, and the anticipation of it made me excited and really gave me something to look forward to. Since coming back (a week ago), I have put in a request for even more vacation days.

My goal from here on out is to find that right balance between work and play. Admittedly, going in to work every day feels quite repetitious and mundane. However, it is hard for me to say that I have truly felt burned out by it. I never dread going in. I look forward to conversing with the families and my co-workers. Conversely, I do want more time with my family, and want to get out and explore the world.

I wish I was rich enough to leave $100 bill on the ground. Heck, I would pick it up even at the risk of my back giving out. Seriously though, I feel fortunate that I am now stable enough financially, settled enough professionally, and (thankfully) healthy enough physically to take some time off of work and enjoy life a little more with the ones I love.

I am always interested in what others experiences are, please feel free to agree/disagree and give me your take on things! Thanks for taking the time to read this post.

Annual Meetings

Dentistry, Lifestyle

There is a certain sense of euphoria and absolution I am feeling right now. It is the complete anthesis to the doubt and trepidation I was suffering from this morning; especially just minutes before our virtual meeting went live.

By the way, I have officially relinquished my duties as the President of the Nevada Academy of Pediatric Dentistry (NVAPD). My one year term ended earlier this month.

I have written about taking on that position in a previous post. COVID-19 created challenges this year no other president in our organization has ever had to face. I say that not to gloat; but the truth is the advocacy efforts increased tremendously, communication became far more critical, and good leadership in general becomes exponentially more difficult in times of crisis.

NVAPD annual meetings historically take place within the first few weeks of January. If you are lucky, planning that event could potentially be the ONLY responsibility the presidency title may call for. My year though, fugetaboutit. State budget cuts, PPE (personal protective equipment) shortages, disastrous legislative policies, dental office closures, the list goes on. This past year, MY year, was ridden with issues that needed to be addressed.

I do not want to insinuate that I handled these matters on my own. I had an incredibly helpful executive committee, I coalitioned (if that’s even a word) with other local dental societies, and I basically did my best to raise awareness and garner support from our members against policies that could have devastated (I mean devastated) dental coverage for underprivileged children in Nevada. That effort took a plethora of emails, some conference calls, drafting letters, making public commentaries, and conducting surveys.

So luckily for me, around October 2020, my advocacy efforts started to stabilize. Dental practices had pretty much found their footing and figured out how to stay safe opening up their office for patient care. It afforded me a chance to begin planning that upcoming NVAPD Annual Meeting I was still responsible for.

Historically, our meeting is a two-day event. Day one is generally a Basic Life Support (BLS) /Pediatric Advanced Life Support (PALS) course in the morning, and an Infection Control class in the afternoon. Day two is typically a one-hour business meeting in the morning, followed by a full day lecture by a keynote speaker.

My to-do list was as follows: 1) find a venue 2) find speakers for each event 3) find sponsors 4) promote the event to our members and 5) host the event.

Finding “a venue” was probably the easiest item on my agenda. In the past, we have rented a small classroom at our UNLV Dental School campus for day 1’s events, and a grand ballroom at a local casino for day 2. Each year there are generally about 50-60 attendees. We normally cater breakfast and lunch both days, with snacks kind of strewn in there somewhere. In this age of social-distancing, I had but to find a virtual platform to utilize and that was it. This past year, Zoom (no financial disclosure to declare) became a household name. Although I have been an occasional attendee, I had never actually ‘hosted’ a Zoom meeting – let alone held a conference on their platform. After some perusing, researching, reading tutorials and watching demos – I signed up for their Zoom Video Webinar package, allowing up to 100 attendees. It was a little confusing at first learning the lingo (co-hosts, panelists, etc.); but once you play around with it enough, it is remarkably simple yet powerful! The invitation and registration process, branding and marketing…there really was an impressive array of features available. Other state dental societies had made their CE free this year for their members as kind of a good faith gesture; I wanted for us to be able to do the same. Fortunately, purchasing this package for a month (or two) was reasonably priced ($55/month at the time of this post) and was a cost our organization could afford to absorb (especially considering casino ballrooms can set you back upwards of 10 grand).

Finding a speaker was a little more of a challenge. For most of the courses (BLS/PALS and Infection Control), I recruited the speakers from last year and fortunately they were available to help us again this year. However, I could not just as easily reuse the keynote speaker and topic. But perhaps I put too much pressure on myself about for finding one. We are relatively limited in pediatric dentistry for the subjects we discuss (behavior management, sedation, pulp therapy, etc.). Initially I was bent on finding someone that had some notoriety in the industry and maybe even a big social media presence. The harder I looked, the more discouraged I became – especially to find many of the topics and/or speakers had already presented recently (or were about to be presenting) at other state’s conferences. To make matters worse, I spoke to two individuals prior to the end of October that ultimately ended up declining my invitation to headline our conference. My confidence shattered, I was contemplating canceling that component of our meeting. Lucky for me, in early November, a pediatric dentist in our community just happened to check in on me, and ultimately put me in touch with a friend of his from Texas that does a lot of orthodontics in his practice. Perfect!

The year 2020 surely must have been a brutal financial year for many companies. In the past, companies welcomed a chance to set up their booth in the back of our conference hall and promote their products to everyone. But we were going virtual this year. I had to get creative. I took some initiative, wrote a carefully worded letter, and created a tier for our potential sponsors; in exchange for their financial support, I tried enticing them with their company logo on our website and on our advertising emails, and even a short video of theirs played during our virtual meeting. I reached out to many of the organizations that have supported us in the past – only a small fraction of those even bothered to respond to my email, and all that did informed me they were suspending such activity this year. So, that was a fruitless effort. I did manage to secure one dental anesthesiologist that recently moved back to Nevada and wanted to introduce herself to the community. Yay!

For the advertising portion, I was able to return to my graphic design roots for this meeting. I Google searched attractive event fliers, found one that I thought was visually pleasing, and fired up Photoshop to design a similar one for our event.

From October 2020 until basically the date of the event, I was sending out email reminders to our members about registering. Around December 2020, I started to feel my blood pressure rise in anticipation of this upcoming meeting. I learned to operate Zoom fairly proficiently; held several practice sessions with my executive committee and guest speakers. We wanted to make sure polls, Q&A, chat, etc. were all being displayed properly, as well as any PowerPoint presentations and videos we needed to broadcast.

After tuning into another state’s annual meeting, I decided to contact the president that orchestrated it and asked how I could mimic it. She was incredibly kind, probably spent a couple hours on the phone with me answering my questions, and ultimately I was able to assemble it. The best part of pre-recording the video (which, mind you, took long hours and several weekends to construct) was that I was able to time it perfectly to the hour I had available.

I initially purchased and downloaded Animotica from the Microsoft Store for my movie editing, but that had very basic/limited features and I found it difficult to use. After a little more investigating, I wandered upon HitFilm Express (no financial disclosures to declare). Let me tell you, AMAZING piece of FREE software! It had tons of transitions, some built-in text effects, sound-editing features, you name it. Highly recommend it!

So, there you have it. I apologize for disappearing for so long from this blog. I got tunnel vision on this project for the past several months, and any and all free time I had was devoted to this. Honestly, the past year was filled with a constant stress of tending to something or another NVAPD related. But overall, I would say the event went well, as did my year as president. I am however, looking forward to a little time off to just read, learn Spanish, play tennis with the kids, and try and clear my plate of responsibilities for a minute.

If you need any help planning a similar event, or have your own experiences you wish to share, I’m all ears! Thanks for taking the time to read this post!

On-line Reviews

Dentistry, Lifestyle

I work as a pediatric dentist in a heavy (and I mean heavy) Medicaid office. Generally speaking, these types of offices have high cancellation rates, low fee reimbursements, and occasionally long wait times. One facet is not independent from all of the others. When the office receives such low reimbursement and has a high no-show rate, we are forced to double book patients in anticipation some patient, and occasionally entire families, may not keep their appointment(s). It is a necessary evil. Thankfully, I have the help of a well-trained staff, and together we have learned to tough through those overwhelming moments when everybody decides to show up. We understand everyone’s time is valuable and we try and respect it by staying on schedule whenever possible.

Usually, if our office receives a negative review, it almost always is not directed directly at me. Someone will leave disgruntled remarks about an insurance issue they faced or, like the other day, voice their frustration about our office policy on needing to perform a ‘consultation’ before we are able to schedule a new patient for any dental treatment. The irony is that the lady had enough time to leave a lengthy 1-star review for an office she had never visited yet claimed we tried to “waist” her time and gas by making her drive to our office so we could properly evaluate her child’s behavior and treatment needs.

I do not know if it is because I take pride in my chair-side manner, and the fact that I thoroughly try to explain my thought process in developing my diagnoses and treatment plans to each and every parent; but when I received a negative Yelp review the other day, I couldn’t help but take it hard. We had an anxious 6-year-old girl come in last week, brand new to a dental setting, who had multiple decayed teeth, an abscess and has been in pain for the last month. The mom, who was in the room initially, was very pleasant and seemed to understand the options I had presented. I recommended we try and save some baby teeth with cavities, while the abscessed one was better off being extracted. I also informed her that because the patient is new to a dentist, perhaps giving an oral sedative to relax her a bit may offer her a better experience. She completely agreed and went up front to schedule. Just moments after they left for the waiting room, the grandmother of the child comes in and adamantly proclaims she wants all the infected teeth extracted, stating they are “just baby teeth” and that she knows what [baby] “root canals” are like and she does not want her [grand-daughter] going through that. Oh, yeah, and she wanted it done right away versus scheduling for a conscious sedation like I had recommended.

A quick side-note if I may: Baby teeth are IMPORTANT! They save space for the adult teeth to erupt into, they keep bone in the jaw stimulated and strong, and they can potentially spread their infection along to the adult teeth.

I am used to parents minimizing and misunderstanding how important baby teeth are. Heck, I did before I specialized. Now it is my job to educate them on not only how best to keep them clean and healthy; but also explain the duration of time we naturally need to have them around for in our mouths. Most are receptive and appreciative to get that information – and start to see some value in the baby dentition. This grandparent, however, had already made up her mind that those teeth should be pulled. After I started to get the sense that she could care less about my recommendations; I basically told her I do not feel that [extractions] is in the best interest of the child, I cannot allow her (who, mind you, was not even the legal guardian) to dictate the treatment that I provide, and I encouraged her to seek care elsewhere. Keep in mind, at no point did I change my tone or demeanor, I simply said something she did not like hearing. Sure enough, shortly after this encounter, a Yelp review appears saying how “rude” I was for stating she was trying to dictate my treatment and how she did not understand how I deal with kids all day.

I am pleased to report MOST on-line reviews about our practice are positive. In spite of our mildly lengthy wait times, people usually find the service we provide efficient yet thorough. In fact, that is the most common source of new patients coming into our office – beating out word-of-mouth, pediatrician and general dentist referrals. Luckily this ladies complaint will fade into the abyss of compliments and praise we receive from most people that visit us. And as I have said before, I try to be empathetic, the sweet girl has been having pain and that is never easy for a loved one to witness. Nonetheless, the sheer audacity of coming into a dentist’s office and telling them how to do their job is a bit overly brazen if you ask me.

Look, I get that everyone is entitled to their own opinion. I strongly believe that. God knows I have left my share of positive and negative reviews. For the few negative ones that I have been inclined to leave, I always appreciate when a business owner responds and goes out of their way to contact me to make things right. But this is not a ‘Taco Bell screwed up my order so let’s give them a 1-star review,’ kind-of scenario. In other industries too, but especially in health-care, you should put the majority of trust and treatment decisions on the person that went to school for it.

I will admit, I love getting positive reviews. I check at least a couple times a day to see if we have any new postings. I think it is human nature to feel that sense of accolade and approval from the people you work hard to serve. And while I have little concern that the recent negative review will damage my clinics overall stellar reputation in any significant way; I cannot help but feel a little outraged at the temerity some people have. I am used to the occasional snipe about our wait-times, and understand our office policies may piss some people off; but I draw the line when people can come into their friendly neighborhood pediatric dental office and treat it as if it is their local fast food joint – order whatever they want and have it done immediately at their beck and call.

This post feels like a bad review about bad reviews. Thanks for letting me have this rant and get this off my chest. I do not think anything changes for me, I still plan to leave both good and bad reviews for other businesses; overall I still find them useful and effective. Personally, before I post the bad ones, I think maybe sleeping on it and letting emotions settle down first is always a good idea. Maybe the less bridges we burn, the better sometimes. Anyways, as always, let me know your thoughts! Thanks for visiting!

Empathy and Ethics

Dentistry, Uncategorized

Not to come off as conceited, but I am pretty good at what I do. I practice evidence-based dentistry. I follow guidelines set by the American Academy of Pediatric Dentistry. And probably the most important thing is that I try and approach every child’s case with empathy.

When I was in dental school, I came across a video of a young physician giving a lecture to a class of dental students who, not long before his speech, had been diagnosed with Stage IV terminal lung cancer. He had been given something like a 6 month life expectancy. This doctor spoke about the ascent in his medical career, how his professional choices were always guided by his pursuit of wealth and acquiring materialistic things. He ultimately achieved what he thought was the pinnacle of ‘success’. He shared photos of his mansion, his multiple fancy cars, him posing with A-list celebrities, you name it. A luxurious lifestyle indeed.

And then, tragedy struck. After exercising one day, he felt a pain in his back. A physician friend evaluated him, and the grim diagnosis was made. In this lecture, he talks a great deal about regrets. Regrets in valuing the wrong things in his life. How, when he would view his patient’s charts – that is all they were to him, charts; not patients, not people with stories to tell and families at home that cared for them. The irony being, that he was now a chart on someone else’s stack.

I keep that doctor’s lecture in the back of my mind with every exam that I do. I tell the parents I talk to, that the recommendations I make are the same for their child as they would be for my own. I try and enter every exam and every treatment procedure with a mindfulness of ‘how would I want myself and/or my loved ones to be treated?’ As a health care provider, I feel like that principle and way of thinking has been a guiding light for me.

I had a residency instructor tell me once “you will not be able to satisfy everyone.” I am glad to have gotten that advice early into my career. I spend a good amount of time explaining to parents my visual and x-ray findings. I try to present in detail my treatment recommendations for their child. And I thoroughly try and answer any questions they might have. If they continue to have any disputes or doubts, I will attempt to resolve those concerns but, beyond that, I am a big believer in families getting second opinions as other dentists may be able to be more accommodating to their desires and expectations.

I have had parents wanting to extract cavitated but still very much savable teeth because they “were just baby teeth.” I have had parents decline any form of sedative being given to their child despite the kid being extremely uncooperative for their exam and needing lots of dental work done. I will try, to some extent, to hear the parents out, understand their point-of-view, present my own side of the story, offer my experience and insight; and hopefully we all can find some common ground to accomplish what needs to be done. However, never do let parents flat out dictate my course of care; and if I get the sense that they are dismissive of or lack trust in my training and experience, then I often times feel it is best for all parties involved to go their separate ways.

Probably one of the most hurtful and offensive things I have heard is when a parent believes my treatment recommendations are financially motivated. Coming up through professional school, we all take the Hippocratic oath to practice in the best interest of our patients. And, while that hopefully sets the high standards of care by which most (if not all) medical and dental professionals care for people; it is undoubtedly idealistic. Honestly, I cannot blame people for having that perception and that kind of cynicism that their doctors might be driven by greed.

When I draft a treatment plan for a patient, I take into consideration their age, their health history, their behavior and temperament, their nutritional habits, their home oral hygiene routine (or lack there of), all to try and gauge their cavity risk. I can proudly say I have never made a clinical decision where I put my own self-interests above what I think is best for my patient. But I do have a genuine concern for the direction I think the business of medicine and dentistry seem to be going. With the rapidly rising costs of tuition for these professional schools (nearly an average of $300k for dental school according to Student Loan Hero), with constantly decreasing reimbursements from insurance companies, and with dental schools graduating and saturating the job market – I hate to say it, but I think it may be a legitimate thing to wonder if all that debt burden starts to affect the way we practice in some way.

On that somber note, I want to thank you for reading this post. Hopefully there are some interesting points for discussion somewhere in all of this. As always, I welcome any thoughts and input. Until next time…