Craving the Controller

Lifestyle, Uncategorized

Throughout my life I have witnessed the evolution of video game systems. In 1985, I was six when Nintendo released their very first game console (in the United States). My parents gifted it to us a couple years later, but once it arrived into our house, my brother and I were hooked. We would play Super Mario Brothers, Duck Hunt, Zelda, Contra, Tetris, etc. so much that the unit would overheat; and of course we would simply take the game cartridge out of the console, and with great fervor, would blow on it until we were blue in the face. Then we would immediately pop it back in to the console and hope that our near cyanotic episode was enough to buy us a couple more hours of play. We knew cheat codes (“up, up, down, down, left, right, left, right, B, A and Start”), glitches in certain games, hidden levels, you name it.

Over the years, we weren’t ‘lucky’ enough to own every platform that was introduced onto the market. In fact, we owned the original NES (Nintendo Entertainment System), the Super NES, and a first generation XBOX. That’s it. Never an Atari, never a Sega Genesis, nor any of the Sony PlayStation series. I know what you’re thinking – what a rough and deprived childhood I must have had, right? Tell me about it.

In elementary school, I can still recall sleep-overs at friends houses staying up all night rescuing the princess from Bowser in Super Mario Bros. or button-smashing away to defeat (Mike Tyson’s) Punch-Out(!!). I would invite junior-high friends over right after school to come play Street Fighter II or Teenage Mutant Ninja Turtles on the Super Ninetendo system. But I actually hit a peak of ‘addiction’ later in life, right before registering for dental school, when three friends and I would get together every week or so and play the game Halo. No joke, we would play basically from early evening until the sun started to crack through the shutters. Then I would somehow make it home, and dream about Valhalla (a map in Halo), and snipers (a weapon in Halo), and trying to annihilate my friends at the game. We loved the online multi-player option for Halo, but we’d still meet regularly for the camaraderie and joy of witnessing someone’s face when you just finish rocket launching them from behind.

Life ended up interfering with our Halo group. I eventually started dental school, one friend moved away to Phoenix, another left to serve in the military and it all just unfortunately fizzled out.

A few years ago, I got excited to gift my two boys a Nintendo Switch. My wife initially opposed the idea. She was nervous (and rightfully so) that our boys would become addicted to video games. According to this article, 6 to 15 percent of all gamers exhibit signs that might be characterized as addiction. Emotional signs such as a feeling of restlessness or irritability when unable to play, preoccupation with thoughts of previous online activity or anticipation of the next online session, lying to friends/family about the amount of time spent playing and also staying isolated from others in order to spend more time gaming. Some physical symptoms might present as fatigue, migraines from eye strain or intense concentration, Carpal tunnel syndrome, and exhibiting poor personal hygiene.

Video games today are undoubtedly better than the 8-bit, pixelated consoles I used to play on. The graphics are insanely good, the online multiplayer setup gives them a social setting to feel accepted in, and all-round the games are designed to be more addictive then ever before. What’s worse, many games now are streamed – requiring minimal computing power and little more than a solid internet connection. Gaming companies have also become increasingly cunning in that they offer games for free and instead, now charge for things within the game. If not offered free of charge, have moved towards a monthly subscription-based model versus when I was a kid and my parents would have a one-time charge to buy the cartridge. Also, games now-a-days rarely have “levels” to beat, and therefore allow for continuous play and generally have no ending.

After dental school/residency, I never resumed my love of video games. I have so many precious memories, but now – older, more educated, more enlightened, more self-aware – I can’t help but consider the opportunity costs on the countless hours I spent on video games. I should have participated in sports or clubs instead of rushing home to turn on the Nintendo. How much better could I have done with my education? How much earlier could I have entered my career?

“Changing our thoughts, actions, experiences- and in the process changing our brains- is what will help us finally feel satisfied and free from the desperation of not being able to get enough.”

– Omar Manejwala

We ultimately decided to purchase the Nintendo Switch; however, that ended up not being the source of their addiction. After all, there are computers, phones, tablets, Apple TV’s, and so many other means of accessing games if they so desire. Before it was Angry Birds and Candy Crush. This generation seems to be all about Minecraft, Roblox, Fortnite, and something new seems to come out every day.

There have been studies that show an alarming correlation between video game addiction and depression, restlessness/sleeplessness, and even substance abuse. It can grow to be quite dangerous.

For a short while, I contemplated setting up parental controls, installing spy software, and cutting offer internet access to get them to stop playing so much. However, I genuinely do not believe that will inhibit addictive behavior. It is more reactive versus being proactive; and I feel like they will always find a way around the barriers I keep putting up. I would rather find solutions and methods that help decrease their cravings as well as distract them from thinking about gaming in the first place.

What I have found so far to be the most effective thing at helping overcome their dependency on video games and screen time as a whole is enrolling them in outside activities. Our kids take tennis classes, Kumon tutoring, and piano lessons. On weekends, we will try and do family board or card games, bake together, or go to the park. As dental school seemed to do for me, my hope is that – if we offer them better ways to occupy their time, and minimize exposure to the addictive substances – hopefully the brain rewires and overcomes dependency on things.

Everything in moderation, right? I think depriving them outright is not fair; they should be able to have some commonality and shared interests with other kids their age. But I want them to not be constantly thinking about them, or throwing tantrums when we tell them to turn it off. I want them to read books, spend time outdoors, interact with people, observe the world around them, become cultured. Recognizing and controlling obsessions and addictions is not easy for anyone; however, with some help and support from family and friends we hope to overcome these obstacles in life.

I love self-improvement, mental health and various psychology topics; I would be curious to know if anyone else has similar experiences and other good options to overcome addictive behaviors and tendencies. Please feel free to leave comments or contact me with your thoughts. Thanks for taking the time to read this post!

Hiding My Hair Loss

Lifestyle, Uncategorized

This next post has been a long time coming. On this site, I have written about my astounding student loan debt, my parenting faux pas, my time as president of an organization, and even a disconcerting medical condition that occurred to me fairly recently. Perhaps the reason I have been so reluctant to write this next post is because I have spent so much time, effort and money over the years trying to conceal this problem in the first place. Well, without further ado, here is a little tale about my struggles with hair loss.

In my early 20’s, I started noticing a few hairs on my head started to go scraggly. Even more distressing were the ones that would shed outright; usually discovered to my dismay while shampooing in the shower. Certain, close family members of mine (i.e. uncles) had an early history of hair loss; but my father retained a healthy mane well into fifties and sixties, and my mother (while thin) didn’t have any appreciable alopecic areas on her head. Please note, there can be genetic (e.g. family history, male sex hormones) and/or environmental (e.g. stress, nutritional deficiencies, thyroid conditions, etc.) causes to hair loss – I would strongly encourage everyone to seek the true etiology before starting on any particular treatments and therapies.

I just knew mine was not your normal ‘ordinary day’ hair loss. I started noticing discernable areas of my scalp in the mirror. By 23 years old, I took it upon myself to start visiting dermatologists and hair-transplant consultants to see what my options are. My form of hair loss, as best as I can tell, is the typical male pattern baldness known as androgenic alopecia. Back then (and perhaps even now?), the Norwood Scale was used to gauge the various patterns and stages of balding.

The Norwood Scale

Fortunately for much of my twenties and thirties, I fell under a Norwood stage I classification – where, especially when styled just right, there was not much noticeable change in the hairline or elsewhere. Now, in my forties, I have progressed to a stage III/IV where the hairs on my vertex/crown have more appreciably thinned and there is more generalized loss within my front and mid-scalp sections.

The dermatologist I saw in my twenties (and who has since retired) was a family friend of ours. With great reluctance, he prescribed me Propecia to help slow my hair loss. I say “reluctance” because, however rare, it may have sexual and other adverse side effects. He also made me promise that, when my wife and I decide to start a family, I stop taking the medication for several weeks (preferably months) prior to trying to conceive in case it may cause some unintended birth defects in our unborn child. Again, please consult a health care professional before starting any particular treatment; but personally I credit this medicine for retaining much of what I have left on my head today.

As I’m sure we all do in times of weakness and vulnerability, I turned to the Internet for answers. Forums like Hairlosstalk.com became my obsession, and I was constantly seeking other cocktails, potions, elixirs, “cures”, what have you to supplement and help stop (or better yet, reverse) my hair loss. Let me assure you, men’s hair loss is a multi-billion dollar (and growing) industry and there is no shortage of ‘strand-restoring’ products out there. Perhaps it was the recommendation of strangers online, or simply succumbing to the brilliant advertising and the promises of “stimulating regrowth” and “reactivating hair follicles” on the Rogaine packaging; but soon after starting Propecia – I found myself also applying 5% Minoxidil topically 2x a day.

Propecia and Minoxidil was my hair loss treatment regimen for over a decade, with relatively decent results. The scraggly hairs were no longer an issue, and hairs would still fall out in the shower, but in what seemed like more stable, ordinary amounts. I purchased expensive shampoo’s (e.g. Revita Hair Growth Stimulating Shampoo), tried vitamins (e.g. Viviscal Pro), used a micro-needling roller a few times a week, and even bought a laser helmet (e.g. Theradome EVO Laser Hair Growth Device) – but nothing really helped to any significantly appreciable degree.

About a year or so ago, I started noticing my hair receding in more substantive amounts again. I don’t know if there was elevated stress from the whole Covid-19 time period, I don’t know if maybe the tolerance or the efficacy for the medications I have been taking has started to reach its limit, it’s impossible to say. Nonetheless, it has concerned me enough that I have again started up consultations with dermatologists and hair-transplant specialists.

So far, the consensus among the three or four doctors (some dermatologists, some surgeons) I have met with (in-person or virtually) is that I am still not an ideal candidate for a hair-transplant (either FUT or FUE) procedure. While, in some strange way, that feels reassuring to hear – I am constantly paranoid about this problem progressing. My most recent research into hair loss remedies has introduced me to PRP (Platlet-Rich Plasma) Injections – which seems to be gaining popularity for this and other health conditions. Pricing and the recommendation on frequency seems to vary among providers, but I am resolved that this will be the next logical therapy in my desperate attempt to slow/stop my hair from falling out.

I would be remiss if I did not mention the psychological ramifications in all of this. While I recognize (and appreciate) that I am a lot better off than some male men in their forties, I can’t help but feel down, depressed, and distraught about my decrepit appearance. I already know my facial type is not fortunate enough to look good with a bald head, like the Bruce Willis or Dwayne Johnson’s of the world. I hate being so vain, and already struggle emphatically with aging and my fleeting youth. I spend SO much time trying to hide and disguise the problem; time I could spend with my kids, reading, exercising, just all-around bettering myself. So much expended energy worrying about how many strands I have waiting on the shower floor or in my comb. While I didn’t experience any erectile disfunction (thankfully), it is hard to pinpoint the hormonal changes that happen when you’re on medications (especially, electively) and the negative effects it may have on testosterone production and energy levels. I wish I could come to terms with it, accept and embrace it, age gracefully and focus on what really matters in life. For me (and many others suffering a similar fate), having hair is very much integrated into our identity, our self-esteem and our self-confidence; it a symbol of our youth, virility and feeling of attractiveness – and not so easy to let go of.

So, on that propounder-ing note, I thank you for reading this latest post. As with so many other topics, I wish I had better photographic documentation to incorporate in this post. Please feel free to contact me or leave any comments to discuss your own personal story and struggles.

Investing and Gambling(?)

Lifestyle, Uncategorized

Being born and raised in Las Vegas, growing up around slot machines and poker/blackjack tables, perhaps helped desensitize me a bit to the appeal of gambling. In my early twenties, I worked as a web developer and programmer for a local gaming company and it helped solidify in my head the notion that ‘the house always wins.’ As much as I love the idea of getting rich quickly, I knew that – at least in casinos, the cards were stacked against me.

After we paid off our student loans, I started to take some of that monthly income and began investing. Fortunately, I had already been reading content from The White Coat Investor for years; and his philosophy on refinancing, saving, investing – it was ingrained deeply within me. Now, there is A LOT to investing – certainly too much to cover for a mere post where the author tends to write extemporaneously i.e. here. There are countless books, websites, blogs, podcasts and forums in which to educate yourself and start the journey.

As always, I am happy to share with you the little information I have gleaned over the years. For starters, I subscribe to a FIRE (financial independence, retire early) movement; in which adopting a certain disciplined lifestyle and setting financial goals helps someone achieve freedom from the workforce. Of course raising your annual income, lowering your expenses, increase your saving/investing rate, maximize retirement accounts, reducing your tax liabilities, living below your means, etc. – it all feeds into successfully reaching this goal. Also, familiarize yourself with the 4% rule. In order to sustain a 30-year time horizon in retirement (adjusted for inflation), your nest egg should have about 25x what you expect to spend annually stored away.

Which brings me to my next point – calculate your savings rate and track your monthly/annual expenses. In addition to using our Mint account to budget and track expenditures, I also use an Excel spreadsheet to simply monitor our overall finances (monthly income, account balances, investment gains/losses, etc.). Consciously (and maybe, subconsciously?) seeing these numbers regularly not only keeps us organized and informed, but (for me at least) motivates me to improve/correct some spending habits. Generally my family stays within a 30-50% savings rate every month. Depends how early you start, but I have read a 20-25% rate (at least) is typically what you want to shoot for.

In order to start investing, I created an account (brokerage and retirement) with Vanguard. I love the story of Jack Bogle, the founder of The Vanguard Group – which was really my only deciding factor to open my accounts with them. I imagine Fidelity, TD Ameritrade, Charles Schwab, etc. have just as good (if not better) platforms set up as well. All my ‘long-term’ investing is done in Vanguard. There is some ‘uncompensated risk’ that goes along with investing in individual stocks and specific companies. Theoretically, a company can go bankrupt and you stand to lose everything. My distribution or asset allocation in my Vanguard account looks something like this: 1/3 Vanguard Total Stock Market Fund, 1/3 Vanguard Total International Stock Market Fund and 1/3 Vanguard Total Bond Market Fund. Every month, whatever I can contribute, gets split evenly amongst these three. The growth has been steady enough over the years, and there is a certain serenity in knowing my risk is drastically minimized because index funds are highly diversified. Another reason I have come to love Vanguard is because their fees and expenses to purchase and own these funds are so low compared to some other companies.

About a couple of years ago, I opened up a Robinhood account as well. All my ‘short-term’, active trading takes place there. Every month, a very small percentage of the money I set aside for investing purposes gets deposited here. Honestly, I consider this ‘play’ money – it affords me an opportunity to invest in companies I like (i.e. Apple [ticker: AAPL], Tesla [TSLA], Costco [COST], Netflix [NFLX], Berkshire Hathaway [BRK.A – which I can’t afford, and BRK.B]), and dabble in speculative stocks like GameStop (GME) if I so desire.

It has been interesting to see how my Vanguard (i.e. long-term, passive trading) compares against my Robinhood (i.e. short-term, more actively traded) account performs. The Robinhood app makes it super easy to execute trades; and within that simplicity, I think a lot of people succumb to their emotions and either 1) sell in a panic when the market or stock price is down or 2) buy in big on hyped-up meme stocks that are supposedly ‘going to the moon.’ Investing 101 teaches you either of these can be dangerous and really cut into your long-term gains. Timing the market is impossible. In my own experience, giving myself a fixed allowance every month to ‘dabble’ with has worked well; it allows me to keep myself in check and not get too carried away. If I happen to randomly pick some winners, great! However, in my mind, every single dollar I have placed into that Robinhood account is mentally money I have come to terms with completely losing. And just FYI, my Vanguard account is currently well out-performing my Robinhood gains.

The same appeal, and that ‘rush’ people get in casinos by putting it all on red (a reference to the game roulette in case it was missed) – that is a similar adrenaline high I get when putting a purchase order in on the Robinhood app. It can certainly be addictive, and really get you into some trouble. Which is partially the reason that I have not ventured into cryptocurrency trading, I do not feel I understand that investment vehicle well enough yet.

Arguably one of the most famous investors of all time, Warren Buffett, said quite a few things pertinent to my topic today. He said:

On Earning: “Never depend on single income. Make investment to create a second source.”

On Spending: “If you buy things you do not need, soon you will have to sell things you need.”

On Savings: “Do not save what is left after spending, but spend what is left after saving.”

On Taking Risk: “Never test the depth of river with both the feet.”

On Investing: “In the business world, the rearview mirror is always clearer than the windshield.”

Of course we all want to maximize our returns while minimizing our risks. However, there will be investment fees and expenses, market corrections/depressions, and asset classes that underperform just to name a few. Most investments just need TIME. The concept of compounding interest works; and for those individuals passionate enough to educate yourself, responsible enough to control your lifestyle, relentless and patient enough to withstand (and minimize) the failures along the way – I think they will earn the right to FIRE.

Thanks for taking the time to read this post! As a full disclaimer, I do not possess a business degree, have no formal financial training, do not stand to benefit any monetary gain from the companies mentioned above, and – for some – would recommend you seek assistance from a financial consultant or trained professional before beginning this endeavor. As always, feel free to ask any questions or leave any comments for me!

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!

My Exercise Expedition (Part I)

Lifestyle, Uncategorized

I suppose before I get into this next post, I should probably apologize in advance to all the parents and/or patients that I provide dental care for; this post will likely feature way more about your dentist than you ever wanted to know or see. Now that the disclaimer is out of the way…I wanted to dedicate this post to one of my (few) hobbies and pastimes, physical fitness.

I started working out probably in my late teens, early twenties. In fact, in my early twenties – a time when my body actually knew how to properly metabolize food – I remember getting a free body fat percentage check and it was pretty much in the range of where male athletes typically fall (i.e. 6-13%). Of course, I had youth on my side, no family at the time (i.e. less responsibilities, arguably less stress), a strict vegetarian diet, and I recall going at least three to four times a week (immediately after work) to the gym. I looked and felt great.

Unfortunately, you will have to take my word for it. You see, back then, smart phones had not yet been invented and I am pretty sure the term ‘selfie’ wasn’t even coined yet. Even if it was, it would have been such a pain to take regular 35mm film photos of my shirtless self, hope to God they weren’t blurry, drop them off to be processed, pick up the prints in the typical 7 to 10 day window, put them into my super slow flatbed color scanner, and all that – for what? To place them onto social media websites and dating apps that hadn’t even been invented yet? No thanks.

We obviously live in an age of information overload. We have so many fitness diets and workout programs, P90X’s and Pelotons, and a slew of Youtube training videos all guaranteeing 10-minute abs. CrossFit is all the craze, tons of Zumba zealots, and people are quite passionate for Pilates and of course Yoga routines. I wish I could tell you that I have tried a number of these programs; and offer you a list of the ones that have been most effective for me. The truth is, my family and work schedule are not conducive to my attending many of these classes, and frankly I am too cheap to subscribe to anything I cannot fully commit to.

In that same vein, let me take a moment to caution my readers that I am by no means a fitness expert. I have never recruited the help of a personal trainer, have no professional education in physical fitness, have never met or spoken with a nutritionist and/or dietitian, and essentially possess a basic understanding of the anatomy and physiology of our body.

2018 – Not a Chippendales dancer

Temporarily ignoring the messy counter-top, the filthy residue on the bathroom mirror, and the stack of laundry on the tub behind me…that was my body in late 2018. Back then, of course, there was no such thing as COVID-19 and therefore, I was not hyper-paranoid about avoiding the gym. Honestly, I never controlled my diet; but I exercised routinely, drank WHEY protein shakes on occasion, and would try my hardest to power through a good workout session.

2021 – Still not a Chippendales dancer

Fast-forward to 2021. Interestingly enough, three years later, and the nasty mirror residue and messy counter tops are still there! The big difference being, I am now quite noticeably way more gray up top. Anyways, since COVID is still very much a threat, I have invested in a small home weight rack (from Costco), and I work out to Youtubers like Heather Robertson and Midas. Also, lately, I have been making a conscious effort to cut back on processed foods and minimize my sugar intake. Finally, I try to be careful to drink plenty of water and get solid sleep every night.

My workout goals right now are to get more definition in my core region, rid myself of that stubborn belly fat (i.e. lose the love handles), and build muscle (without bulking up too much).

I am only a few weeks into a regular workout regimen. Three or four times a week, I wake up early and try and work either back/biceps, chest/triceps, shoulders, legs, and/or core and abdominal muscles. Already though I feel a boost in my self-confidence and mood, I feel more energetic throughout my day, and I feel overall just healthier. Ugh, I love that rush of endorphins at the end of a good workout!

The pain you feel today is the strength you feel tomorrow.

– Unknown

For anyone starting to exercise and get fit (again, I am no expert); I would encourage you to set achievable goals for yourself, simultaneously control your diet and calorie intake, and be sure to watch your form so you avoid injuries. For me personally, the hardest part is just starting a routine after a long hiatus of not exercising; overcoming that initial laziness, doubt, and mental fatigue. It definitely requires self-determination, hard work, discipline and sacrifice.

Thank you for taking the time to read this post. I am not afraid to admit there is still so much I need to learn, and welcome any advice you are willing to share. If you have any specific questions about my own routine, I am always happy to share. I will continue to keep you all posted about my progress on this journey, and hopefully I will get around to cleaning that bathroom counter and mirror!

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…

Associateship vs. Ownership

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Yesterday, an owner of my office informed me they would be letting one of my assistants go – effective immediately. It is perhaps worth noting, this decision was not made on my recommendation. Nor was it based on any ineptitude the assistant had exhibited while on the job. In fact, the assistant had wonderful chair-side manner, patients adored them, they were always punctual and reliable, and got along extremely well with others in the office. I cannot dispute that there was certainly a valid reason for deciding to lay the assistant off; but it was not a clinical one and the loss of this employee is devastating to our entire office.

This is not the first time staff has come and gone without my having a say in the matter. My bosses are very considerate of my input and often times ask me about the goings-on of our location. They have given me ample leeway to practice dentistry the way I want. But moments like this make me realize I am not in the drivers seat for many aspects of how this office operates.

I graduated in 2014 from my pediatric dental residency. By now, I am confident enough in my clinical skills to be an owner of my own office. A couple of things weighed in on my decision to remain an associate.

First and foremost, outside of the patient exams and treatments and the corresponding clinical notes, I leave work and I go home to my family relatively carefree. My two kids are still young, and I enjoy being able to spend some time with them without the distractions and worries of running an office.

Second, I have it on good authority from several friends that own offices already, that staffing by far is the biggest headache. Employees call-out, quit, embezzle, and constantly demand raises; all of that minutiae I currently have the luxury of being oblivious to. Of course, it impacts me and I have to be at least a little concerned. If claims are not being collected adequately, it could likely impact my pay. Likewise, if we fall short too many assistants, some patients may need to be rescheduled on account of the insufficient staff and our production numbers are not the best.

Third, I have considered and investigated turn-key dental offices and new build-outs; and no matter what option I go with, the debt burden is ridiculously high to buy an existing or to start-up a new dental office. Pediatric dental offices especially do not come on the market very often, but the couple that I have seen would have set me back $500k-$1M easily. The wound from my student loan debt is still too fresh, and I did not feel ready to take on yet another ginormous loan.

Last, I have yet to learn the human resources and front-office side of the practice; all the billing and coding, the hiring and firing, the employee benefits packages, etc. Not that I couldn’t pick it up quickly, or even out-source a lot of it, I just have not taken the time to learn it. That is not as much of a deterrent for me as some of the other issues I mentioned above.

While I absolutely love my life as an associate, I would be remiss if I did not mention that there are two recurring fears I live with every day. The first is that I am not in control of my own fate. They could suddenly decide to close the office down one day, or I could be replaced with a new graduate willing to take lesser pay. Fortunately, I have a severance clause in my contract that helps protect me (in part) from the latter. As for the former, my family and I live a lifestyle so below our means that I could literally be out of work for years without feeling the pinch of unemployment.

The second, and probably most unbearable part of being an associate is honestly, incidents like the one that happened yesterday. We lost a phenomenal member of our team, and I had zero say in it. That really sucks. I guess there are going to be pro’s and con’s to everything in life.

And this probably goes without saying, but I thought it might be worth mentioning – your earning potential as an associate is of course always going to be less than if you were the owner of the practice. For me, that difference in income is worth it because I do not have to worry about the staffing, payroll, office supplies, leasing, you name it.

I would be interested to hear other people’s thought processes and internal reasoning on their own professional decisions with staying an associate vs. opting for ownership. Thank you so much for reading this post!