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

Uncategorized

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!