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.

5-Stars for those two smiles!

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…

Student Loan Debt

Dentistry, Lifestyle

Just FYI, this will likely be a recurrent topic on my blog. In some form or another, I will write about matters of finance.

So, admittedly, I do not live a glamorous lifestyle. We certainly spend money on the essentials in life; we buy all the food and clothes we ‘need,’ we both have reliable transportation, and we isle shop at Costco and unwittingly rack up those $100-200 bills a couple times a month.

When I started dental school, in 2007, I sat through an insanely brief presentation on student loans, our tuition costs, and some repayment options we may have when we finished. Throughout my 7 years of dental training, I never gave that presentation or my debt burden a second thought. I obliviously signed the paperwork to qualify for loans, I ensured my tuition was being paid; but terms like ‘compounding interest’, ‘principal’ and ‘deferred payment plan’ did not really resonate with me at the time. I wish it had.

I accrued well over $200k in student loans over that time period. I remember in 2014, sitting in-front of my work computer during my lunch break just feeling so stressed out and overwhelmed. I had finally seen my overall tuition payback amount, compared it to my bi-weekly paychecks and just felt so helpless.

Two websites saved me.

The whitecoatinvestor.com. My brother, the physician, luckily turned me on to this website. It was JUST what I needed. I even received his book one year as a Secret Santa gift. Authored by an E.R. doctor that discussed personal finance issues: student loan debt and refinancing, saving for retirement, and investing, among other things. The site has become immensely popular, he’s grown from just blogs, to podcasts, offering online courses, and authored additional printed books. It certainly may not be for everyone, he found a niche and speaks to a specific audience of high-income earners; but the philosophy works across the board, and the premise of saving, investing, and quickly paying down debt should be universally followed.

Also mint.com. That overwhelming feeling I described earlier, came largely from being unorganized with my finances and not really having a short- and long-term plan. I will say, this website a) has a lot of advertising and b) invokes a lot of trust out of its users in that, a lot of highly sensitive account information could be potentially compromised. If you can bring yourself to trust their encryption algorithms, then this site offers fantastic budget tools, income vs. expense tracking, and even allows goals to be established.

I guess it is worth mentioning, I have no financial interest in either of the sites above. In fact, if anything, I would like to extend a thank you to Dr. Jim Dahle (founder of WCI) and Intuit (maker of Mint.com) for helping me get on a better financial path.

Once my wife and I put a plan in place; monitored spending, set goals, budgets, basically used many of the tools on Mint, we started chipping away pretty quickly at the debt. When my wife decided in 2013 to go back and earn her Pharm D degree – only to graduate 3 years later with yet another $200k debt to our household – we at least now had a better understanding of what it would take to manage that momentous amount.

In August 2017, we submitted our last payment to the lenders for our student loans.

A couple of things I attribute our quick payoff to:

  1. Re-financing our student loans. At the time, our interest rates on our federal student loans ran about 6.8% to as high as 7.4%. Thanks to the advice of WCI, I immediately found a company to re-finance with and cut those rates in half. Another approach I took was, in the process of re-financing my home loan to a better interest rate, I took equity out of the house and put that cash towards a significant portion of my student loan principal.
  2. High-income earning. I think it is mathematically infeasible to pay off $400k in 3 years any other way. Fortunately we pursued professions that pay relatively well; supplemented by a disciplined lifestyle and controlled spending habits, we were able to pull off the impossible. In case you are wondering, we have a joint account and unanimously put money towards any and all debt.

To this day, we live comparably to where we were in 2017. We still set goals and we still control spending. Now money that once was going towards student loan debt is much more appropriately being redirected to saving for retirement, a down-payment on a dream house, helping our kids with their own college tuition costs, charity, etc.

You know, I do remember one useful thing from that financial loan seminar at the beginning of dental school. He said,

“If you live like a dentist when you’re in dental school, you will live like a dental student when you’re a dentist.”
Christopher A. Kypuros

I am not yet where I want to be financially. I still have to work for a living. But I am blessed to not have a mountain of student loan debt weighing on me everyday. Student loan debt is out-of-control in this country. There was an actual game show about it for goodness sake (Paid Off with Michael Torpey)!

Dave Ramsey had a bell he would invite guests that recently paid off their debt to come and ring. I have always wanted to ring that bell. However, just the sheer feeling of living stress-free from student loan debt is in and of itself an amazing, cathartic reward.

I would love to hear your achievement in paying off debt. And I would be happy to answer any questions you have about my own story. Thanks so much for taking the time to visit and read this post!

Programmer to Pediatric Dentist

Dentistry, Lifestyle

One evening my father came home from a dinner party and told me that he had an interesting conversation with a gentleman he met there that said computers were going to be the future. This was in 1997. That, sadly, is how I resolved to be a computer science major in college. Which was okay by me since I was addicted to AOL chat rooms anyhow. I had no idea what computer science entailed, no clue about programming languages, no concept of coding at all. But a degree that lets me sit at the computer all day and allows me to talk to random strangers in chat rooms? Sign. Me. Up!

To this day, I have no idea how that random stranger at the party knew the world would be dominated by Microsoft, Amazon, Netflix, Google and AOL. Okay, maybe not so much AOL. But oh how I miss that thrilling static sound of the modem connecting, and the euphoric notification that I have mail once it finally logged in. But I digress.

Come to find out, the field of computers and information technology certainly did not need another Indian person. I did not know it until I began taking classes, and quickly came to realize the fact that everyone in the department looked like me.

It’s hard for me to say if I ever really became passionate about programming. I would guess not. I learned several languages relatively well (e.g. C++, Java, Assembly, Visual Basic, etc.). I liked very much the critical thinking component of it, and thoroughly enjoyed the challenge of troubleshooting and debugging code. For four years, I went through the motions and became technically just adequate. However, that intrinsic passion hackers have? It wasn’t in me.

I could not have picked a worse time to graduate. The year 2001, the dot-com era was crashing, programmers were getting laid off everywhere you looked, and tech companies were over-working the few people they did retain. I was fortunate enough to land a job shortly after graduating for a local company that invented and promoted casino games. It was not so much hardcore programming as it was web-design and some Flash scripting; but beggars can’t be choosers. The pay was embarrassingly low, but the owner of the company owned several properties around the world he would allow employees to vacation at, plus I had an office with an amazing view overlooking the world-famous Las Vegas Strip; perks like that mixed with a low-stress work environment prompted me to stay for several years. I had designed some logos, some websites, some online Flash games; all-in-all, it was a chill and semi-creative (but not professionally challenging) position.

A couple years into that job, a college friend reached out and let me know of an opening for a programming instructor at a trade school he was working at. I had a fear of public speaking at the time, and I immediately applied for that job for no other reason but to set myself on a path to conquer that fear.

When you are afraid, do the thing you are afraid of and soon you will lose your fear of it.
-Norman Vincent Peale

Let me tell you, it was stressful. Class typically ran about 5 hours between the lecture and the hands-on component, and averaged about 20 to 30 students. Coming up with a weekly curriculum that keeps peoples attention for such a long period of time was not easy. And I was teaching to people from all walks of life; different personalities, different motivations and pursuing different types of degrees. I would have multimedia majors, engineering, and of course programming students. It also took a minute for me to accept the fact that I was now the one delivering the PowerPoints, administering the tests and grading the assignments.

Throughout the week I would teach some evening classes from 6-11 pm as well as some Saturday morning or afternoon classes. I was lucky my 8-5 gaming job offered me a little flexibility to bow out early so I could drive across town to get to job #2 on time. Looking back, I am still not sure how I managed to balance both jobs successfully. In fact, years went by complacently, but then slowly I started to feel the tides changing.

My gaming job hired a new manager, who introduced stricter (and often times unrealistic) project deadlines. Within months of his arrival, that same manager brought on the bookkeeper’s husband to be an additional I.T. ‘support’ guy; which had an unsettling “I’m training my replacement” kind-of feel to it. I put in my two-week resignation soon after. Even the teaching job had some dark truths slowly come to light; their aggressive recruiting and marketing practices brought in just any warm body willing to pay their steep tuition costs, and ultimately lead to their closure by the Department of Education in 2016. Luckily I saw the writing on the wall well before that, and realized it was time for a life change.

Begrudged and disillusioned, I started brainstorming alternative career paths. By now I was in my mid 20’s, never worked in a real software-development setting, and was resolved to pursue a profession where I could be my own boss. I knew something in the medical field should meet that criteria, I just didn’t immediately know what to do. My younger brother was already on his path to becoming a physician and advised me that it may be too long of a road to medicine for me to start over with. My girlfriend (now wife) was a pharmacy-tech (now pharmacist) and cautioned me that there were constant patient complaints and insurance issues that comprised her day, and she would not recommend that pharmacy life for me. Thus the decision to pursue the field of dentistry was born. I could put in 4 years of professional school, graduate and jump right into private practice.

I began by just enrolling in a couple of pre-requisite classes that pretty much all health professionals would need to take. Basic biology, chemistry, organic chemistry, and biochemistry. Fortunately some pre-req’s overlapped my Computer Science bachelors degree and I did not need to put in any more time towards retaking them. Unfortunately, some recommended classes, like immunology, histology, anatomy and physiology, I had no time to squeeze in before the next application cycle for dental school. Something about returning to school, more focused and driven, gave me the determination and perseverance to excel and perform better the second time around. I got high mark’s in my classes, scored within the 90th percentile for my Dental Admissions Test (DAT), and was accepted into the UNLV School of Dental Medicine Class of 2011.

Unlike my computer science classes, I was the only Indian person in my dental school class. Not that it really mattered any, but I also felt like I did not have the same strong science foundation that most of my classmates learned while acquiring their undergraduate degrees. I quickly regretted not taking those recommended courses I mentioned earlier, and struggled with the plethora of didactic material my first couple of years. I also had a tough time early on with waxing teeth, and even had to remediate a bit over my first summer session.

Around third year, I started to find my element. Operative dentistry was going well, fabricating dentures was fun, and I had some successfully completed root canals. My confidence was building. However, in my fourth year – as graduation neared – a bit of reluctance started to kick in as I realized how slow a dental student’s schedule was compared to that of the real world, and how I had only barely skimmed the surface of the advanced procedures in dentistry like doing implants, veneers, and molar root canals.

Some soul searching, some profound apologizing to my wife that I needed an extra year to get comfortable, and a willingness to endure yet another stressful round of applications – but after jumping through those hoops, I got accepted into a year long post-graduate General Practice Residency (GPR). Meanwhile, as an attempt to get some real-world experience, I also chose to moonlight at a dental clinic on Saturdays. The office they assigned me to, interestingly enough, mostly saw children on weekends.

The more I worked around children, the more I loved it. I dreaded my week in the residency doing general dentistry, and absolutely adored my weekends with pediatrics. To the point that, I just knew, deep down, I wanted it to be a full-time gig. If asking my wife for a year long extension to my dental school training was difficult, imagine the sheer agony of having to tell her I wanted to return yet again for an additional two years of training. My brother’s advice about the medical route being too long was a moot point now, because I will have essentially dedicated seven years of my life to becoming a dentist.

I LOVE being a pediatric dentist. My personality type does well with monotony. I do a handful of procedures very well; as opposed to a general dentist needing to be competent at a large range of things. I don’t have to sell anything; I diagnose disease and present a plan to treat it. And best of all, I get to work with children; every one of them are so unique and it keeps the day exciting and entertaining.

“Find a job you enjoy doing, and you will never have to work a day in your life.”
― Mark Twain

I still do not own my own practice. I am still an employee, which, goes against one of my original goals for wanting to become a dentist. But I graduated with well over $200,000 in student loans; and opening up a dental office is pricey. My practice owners allow me a generous amount of autonomy, I am incredibly grateful to be able to work (in a lot of ways) by my own terms. Plus, my own kids are young; and instead of having the headaches of practice ownership, lease negotiations, staffing, billing, payroll, etc. – once I physically leave the office for the day and I also get to mentally check out and go spend time with my family.

Well, that was the journey. I worry about the long-term physical demands of dentistry. And just like everyone else, I get burnt out and drained from time to time. But I feel truly blessed to do what I do. I hope you are all able to find a job you can find some joy in.

Thanks for taking the time to read this lengthy post. Please, contact me with your own journey or with any questions about my own! Take care!

Leadership

Dentistry, Lifestyle

A few years ago, I received a call one evening while getting ready for dinner. Apparently someone had nominated me for president of our local professional chapter, the Nevada Academy of Pediatric Dentistry. Should I choose to accept, I would join the committee and spend a year as president-elect, and then assume the role of president for a year thereafter.

If you read my first post, about being introverted, you would have some inkling that I spent a good portion of my life avoiding being the focus of attention. Yes, I joined several clubs in high-school… mostly to have something to pad my college application with. Not once did I ever consider/desire/strive to be in a position of power or take on a leadership position. I have never liked the limelight.

When I was a kid, I saw my father do it once, as he became president of our local Friends of India (FOILV) association. That baffled me. He had a similarly shy and reserved demeanor about him; and yet here he was taking on a role that required quite a bit of socializing, event planning, and worst of all, public speaking. To this day, I am proud of him still, but now I certainly feel like I have a new appreciation for his selflessness and his social consciousness towards helping our community be better.

The president position of our NVAPD, traditionally, was not really a very time-consuming role. Some years were better than others. We always have to organize and host an annual meeting; invite speaker(s), book a venue, find sponsors, arrange meals, provide continuing education credits, etc. Sometimes, Medicaid and political issues arise throughout the year, and so then there are other matters that the president typically has to tend to as well.

My president-elect year was quiet and uneventful. Granted, the president that year likely did an excellent job at blinding us to the many tasks she was likely under-taking. Frankly, I was hoping mine would be a similarly easy year.

My term started January 2020, and (for the first couple of weeks) was off to a good start – made a name change on our business bank account, deposited some checks that slowly rolled in, no sweat.

Then COVID-19 hit.

Don’t get me wrong, I love being a dentist; but its a bit scary when your profession calls for you to be mere inches away from someones mouth and open airway while a novel, aerosol-transmitted infectious pandemic plagues the world. In the uncertainty and chaos, we followed local and national guidelines from the CDC (Centers for Disease Control), ADA (American Dental Association), AAPD (American Academy of Pediatric Dentistry), and our state dental board.

For a short while, it felt like the blind leading the blind. Every organization was just as clueless as the next, and fortunately, dental offices in town shut down for a bit while things were being figured out. In dentistry, we take personal protective equipment and infection control very seriously and keep those high standards for every patient we see. However, temperature checks, social distancing restrictions, questionnaires, all of those measures and precautions are new to our standards of care and slowly started to emerge with time.

I appreciated the offices closing because 1) it afforded me time with my kids I normally would not take and 2) I started to devote more time to my duties as NVAPD president. I started drafting regular email correspondence to our members to update them about new state and national guidelines and restrictions; I worked with other local dental associations to try and acquire PPE for our members; as COVID-19 related state budget cuts started to emerge, I tried to unite our members and organize efforts to protest the politicians and legislators that were proposing a bill that could have severely threatened dental benefits for our most vulnerable patients.

At the end of the day, that was the main reason I took the president position. Certainly not for the fame, notoriety, prestige, what have you. I genuinely love my job and the patients I serve; and I want to do my part in protecting their access to dental care. If that means swallowing the uncomfortableness of being an introvert for a year – so be it.

In all fairness, I could have made this year as easy or hard on myself as I wanted it to be. One thing you will come to learn about me, is I tend to over-analyze, over-prepare, over-worry about almost everything. Very much Type-A, obsessive-compulsive characteristic traits. And although, internally, a position like this is very stressful; I am happy I accepted the offer and am glad I decided to step up to the challenge.

I am currently attempting to figure out how to host our very first VIRTUAL Annual NVAPD Meeting! I will keep you posted on how that goes! Wish me luck. Thank you so much for reading, I’ll be writing again soon!