On this In-between-isode, Ryder talks about The Mandalorian, the live-action Star Wars series on Disney+. Star Wars is one of Ryder’s passions outside of dentistry and would love you to join him for this bite-sized episode of the Dental Realist Podcast.

Disclaimer: No Jawas were harmed in the recording of this podcast. 

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One of my favorite books is a book by Dale Carnegie called “How to Stop Worrying and Start Living”. In the very first chapter Mr. Carnegie introduces a simple but very powerful concept. He tells the story of Sir William Osler who was addressing the students at Yale University, and describing the secret to his success:

“What, then, was the secret of his success? He stated that it was owing to what he called living in “day-tight compartments.” What did he mean by that? A few months before he spoke at Yale, Sir William Osler had crossed the Atlantic on a great ocean liner where the captain, standing on the bridge, could press a button and—presto!—there was a clanging of machinery and various parts of the ship were immediately shut off from one another—shut off into watertight compartments.

“Now each one of you,” Dr. Osler said to those Yale students, “is a much more marvellous organization than the great liner, and bound on a longer voyage. What I urge is that you so learn to control the machinery as to live with ‘day-tight compartments’ as the most certain way to ensure safety on the voyage. Get on the bridge, and see that at least the great bulkheads are in working order. Touch a button and hear, at every level of your life, the iron doors shutting out the Past—the dead yesterdays. Touch another and shut off, with a metal curtain, the Future—the unborn tomorrows. Then you are safe—safe for today! … Shut off the past! Let the dead past bury its dead…. Shut out the yesterdays which have lighted fools the way to dusty death…. The load of tomorrow, added to that of yesterday, carried today, makes the strongest falter. Shut off the future as tightly as the past…. The future is today…. There is no tomorrow.

The day of man’s salvation is now. Waste of energy, mental distress, nervous worries dog the steps of a man who is anxious about the future…. Shut close, then, the great fore and aft bulkheads, and prepare to cultivate the habit of a life of ‘day-tight compartments.’ ”

Mr. Carnegie went on to say:

“Did Dr. Osler mean to say that we should not make any effort to prepare for tomorrow? No. Not at all. But he did go on in that address to say that the best possible way to prepare for tomorrow is to concentrate with all your intelligence, all your enthusiasm, on doing today’s work superbly today. That is the only possible way you can prepare for the future.” (Excerpt From: Dale Carnegie. “How to Stop Worrying and Start Living.” iBooks.) 

I have found that it is very challenging in dentistry to live in the present. We do so many challenging procedures every day and some times they don’t go perfectly. It’s hard to not think and worry about all the things we wish would have gone differently at the office. Likewise we have so much to do tomorrow. So many patients with treatment that will challenge our skills and abilities. It’s hard to not think about that upcoming case and not worry about all the steps that we have to get right and what if they go wrong.

I am finding more and more that as I really make the effort to let yesterday go–I can’t go back and change it in any way–and let the things of tomorrow take care of themselves, my stress level is a little less. I sleep just a little better. I can focus better on the task at hand and the quality of my care is a little higher.

Dentistry is a challenging and often stressful work. Master the concept of living in day tight compartments and you will enjoy a happier and more fulfilling career.

–Marcus Neff DDS

Dr’s. Neff, Stevens, and Waldron are co-authors of the book “So You Want to be a Dentist?: What you Must Know to Succeed in Dentistry”.  The book can be purchased at www.lulu.com, the iBookstore, Amazon.com, and many other digital retailers.

Debt is Real
This seems obvious, but debt is real money. We’ll admit when we were in dental school and signing loan documents for $30,000 or more at a time, it didn’t quite seem real. We never saw most of that money. What we did see was just deposited in a bank account and used to live on.

We wish We had taken a little longer to think about that money. It almost felt like a paycheck. Just money we were getting paid and that was ours to spend on the things everybody spends money on.

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

Those loans will erode your ability to make and take home money. As you start repaying those loans it will affect the choices you are able to make. Those loans will slow down how quickly you can enjoy financial freedom and really live your life.

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

Just follow the steps. Cut here. Bond there. Pack this. Shape that. Boom! Done.

But once you start doing them, you start to realize the simple mechanical steps of restoring a tooth are one thing. The person you are doing those things to is another.

That person has emotions. That person has fears. That person has expectations.

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

When a patient is flinching and squirming its easy for you to get a little nervous. When you are nervous, it’s normal to just want to get it done and get the patient out of the chair. When the patient tells you they hate the dentist, it’s natural to feel a little offended and not feel as compassionate.

New Stuff Does Not = Lots of Patients
Dental suppliers and sales reps will eagerly tell you about the latest and greatest in dental equipment. The lady at the interior design store will happily sell you beautiful carpets and furnishings. All of these salespeople will insist that you need a beautiful well appointed office with the latest technology and newest dental equipment.

It doesn’t always work out that way. For the majority of practices, you will need a nice facility with up to date technology and equipment. But it almost never has to be brand new, 5 star hotel, nice.

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

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

Be aware of where you practice and the patient population you serve.

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

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

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

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

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

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

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

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

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

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

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

Marcus Neff DDS, Troy Stevens DDS, Ryder Waldron DDS

Dr’s. Neff, Stevens, and Waldron are co-authors of the book “So You Want to be a Dentist?: What you Must Know to Succeed in Dentistry”.  The book can be purchased at www.lulu.com, the iBookstore, Amazon.com, and many other digital retailers.

The Dental Likability Factor

Many have heard the term “likeability factor” before.  Actually Tim Sanders wrote a book on it in 2006.  I would like to put a little twist on that phrase and call it the “The Dental Likability Factor!”

Dentistry is a very personal profession.  It feels like you need a PhD in interpersonal relations sometimes.  Every patient is a different personality and has different likes/dislikes and needs.  You will find that some patients are very easy to read.  They will communicate their likes/dislikes and needs to you with very little prompting.  On the other hand, you will encounter patients that you cannot pry anything out of them.  They are mysterious and wish to remain that way.  They are a closed book that cannot be opened.

A big reason that patients will come to you to seek care is because you are likable!  If a patient likes you they are more likely to take your treatment recommendations seriously and will pursue treatment that you prescribe.  If you don’t have the dental likeability factor you will not enjoy the same response.

There is a large amount of distrust in the general population right now.  Not only in dentistry, but in everything.  People are very skeptical about dentists and some think that we are out to get them.  They feel that the reason we prescribe treatment is based on the need for us to purchase a new Mercedes and not on the premise that we wa  nt them to be healthy.  Trust is fading and if you can connect with the patient and build rapport so that they like you, then they will trust you.

Dentists come in all shapes and sizes.  Some dentists love to chit chat with their patients and others want to just get em’ in and get em’ out.  I have found that both systems work.  It totally depends on the patient.  You will find that patients will gravitate to the dentist that is the way they “like.”  The patients will come back to you and refer to you if they like you.  I have found that through the years I have morphed into a type of actor.  Certain patients you have to be stern with, others very caring and sensitive to.  If you get good at switching between those different modes you can connect with a lot more people.

When I first graduated from dental school I loved to see patients coming back every 6 months to see me.  I enjoyed talking to them and getting to know them on a more personal level.  They would bring in their kids and refer people and such.  This was great.  This allowed me to get to know them and for them to get to know me.  I noticed that the patients that liked me stayed in the practice.  Others that didn’t, moved on.  This is ok!

You really must have tough skin in this profession.  Realize that you cannot please everyone all of the time. However, the more people like you, the more people that will be staying in your practice!

Dr. Troy Stevens DDS

Dr. Stevens is a co-author of the book “So You Want to be a Dentist?: What you Must Know to Succeed in Dentistry”.  The book can be purchased at www.lulu.com, the iBookstore, Amazon.com, and many other digital retailers.

It Can Take Years to Get Ahead in Dentistry

One of the misconceptions that I had when I first started dental school, or even before I started school, was that I would immediately be well off after I started practicing. I thought that as soon as I started drilling the cash would start flowing.  I mean really why had I put myself through the previous 8 years of education?  I wanted to make a good living.  What I found was not quite what I expected.  My expectations were way too high!

Dentistry is not a get rich quick scheme!  Dentistry is a work for many, many years and manage your debt in hopes that some day you will be well off scheme.  This is one of the many things that I really wish I would have thought more about before I graduated.  Many dental students are under the false premise that the day they get out of dental school all will be well.

From my experience, and from talking to dozens of dentists, this misconception is not unique to me.  The reality of it is this.  We go to school for so many years.  We live like peasants for so long that we are simply about burst upon graduation.  We want some reward for our efforts.  We have been living by welfare standards trying to keep our student loans to a minimum and  by the time we graduate we are ready to live life, finally!  Well not so fast.  Let me explain what really happens.

Upon graduation you have hopefully already decided what direction you are going to take in your dental practice.  Associateships are not uncommon for recent graduates.  This allows you to get your feet wet before making the large jump into ownership.  If you associate, as I did, and many of my friends did you will soon get very antsy to buy your own practice so you can do things the way you want and not the way the owner wants.  Well this is all fine and dandy but let me say that this all takes money!

I will not go into all the pros and cons of practice ownership vs. associateships here, but our book “So You Want To Be a Dentist?” talks about the practice options available to you.  Let me just say this.  Generally speaking, at some point, you are going to want to buy a dental practice.  It’s a natural process of most people that go into dentistry.  It’s just the way we are.  We want ownership.  I thought for sure that was the way to get well off quicker than associating.

Well that’s not exactly true.  Did I make more money?  Yes!  Did it all go to debt service? Yes!  Did my headaches increase? Yes!

Along with practice ownership comes large loans.  Loans on top of all of your current loans.  Then comes the house payment, the car payment the student loan payment the payment for the practice and the list goes on and on.  We also can’t forget insurance payments.  Medical, disability, malpractice, and life insurance, etc.  Oh and now we have staff to pay, bills associated with the practice to pay, etc.  And who can forget the wonderful taxes!  There are many things as a business owner that you have to deal with that an associate does not.

What you find when you are out of dental school is that the amount of debt you have is directly proportional to the speed at which you become well off.  With all the other debt that you incur after school, on top of your student loans, it makes it very difficult to come out and live the lifestyle that you may think you are going to be able to, right off the bat.

Do not expect to come out and start living the high life immediately.  Most business loans are 7-10 year amortization s.  This is something that you need to consider when thinking of the direction you want to go.  Pile on your business loans, student loans and all other living expenses and it doesn’t take much to evaporate a $10,000/mo income in nothing but debt service.  Until you get your debt under control you will still be living under what you may have your expectations set at.  I know I never thought that after being out of school AND in practice ownership for 10 years I would still have debt that is large enough to keep my attention and prevent me from doing some things that I would like to do.

Will the time come that I will be able to do those things?  Sure.  But remember it is a slow process and can take many years to get there.  The quicker you pay off the debt, the better off you are.

Dr. Troy Stevens DDS

Dr. Stevens is a co-author of the book “So You Want to be a Dentist?: What you Must Know to Succeed in Dentistry”.  The book can be purchased at www.lulu.com, the iBookstore, Amazon.com, and many other digital retailers.

How Does Obamacare Affect Dentistry?

I have been asked this question over and over by patients.  Until recently I have mentioned that it really did not affect us in dentistry at this point.  However, today I had a rude awakening by my good friend and colleague, Marcus.  He brought to light something I had not considered before and caused me to rethink my answer to my patients.

Obamacare may actually affect dentistry more than I initially thought!  Insurance has been a difficult problem to deal with in dentistry and even more difficult is the PPO insurance plans.  These plans are taking the autonomy out of dentistry and pushing dentistry into the realms of the current medical model.

Insurance is now indirectly dictating treatment.  I can’t number the patients that will only do what their insurance dictates.  They want nothing to do with anything other than what their insurance will cover.  This is difficult for me, as a provider, to see because clearly the insurance company does NOT have the patients best interests in mind.  The insurance company is a business motivated by collecting premiums and paying out as little as possible.

Back to Obamacare.

We are going to see a few things happen in dentistry:

• Increased numbers of children on Medicaid (Obamacare increases funding and access for children’s dental Medicaid).
• Decreased amount of companies providing dental coverage because it isn’t mandated like healthcare.
• Decreased adults wanting to pay for dental coverage because it’s not mandated and their premiums for health insurance are going up.

Let me explain:

– As all dental providers know, Medicaid currently is not great to put it lightly.  In some states it actually is not profitable to accept Medicaid.  With the amount of overhead that my office has, (which is not that high) we cannot afford to see Medicaid patients.  We simply either do it for no charge on a case-by-case basis or refer them to our annual Give Kids A Smile Day.  With many more children being on Medicaid this leaves an even larger access to care issue than we currently have!

– With the increasing costs of medical coverage I foresee that companies will begin to drop dental coverage as a means to buffer some costs.  Granted, in comparison to the cost of medical coverage, dental coverage is not that expensive.  However, with increased costs, companies always look for ways to offset those costs.  If this indeed happens, which I hope it does not, we will be seeing a lot of people stop doing preventative recall dentistry and move to being the “emergency” type of patient.

– Children are a great motivator for parents to do just about anything.  I mean why do you think McDonald’s started putting play lands in their restaurants and toys in Happy Meals?  When parents suddenly see that their children have dental coverage under Medicaid they may choose to drop dental coverage for themselves as a way to cut some personal budget costs.  Again, this will lead to many adults going into the “emergency” patient category and drop them out of the preventative recall system altogether.

So with these factors out there, I am much more worried about the effects of Obamacare on dentistry than I was initially.  There are some serious implications here that could have a negative impact on dentistry as a business!

There may be other things that I have not covered here.  Please comment below!

-Dr. Troy Stevens DDS

Dr. Stevens is a co-author of the book “So You Want to be a Dentist?: What you Must Know to Succeed in Dentistry”.  The book can be purchased at www.lulu.com, the iBookstore, Amazon.com, and many other digital retailers.

Debt

I think when I went to dental school I had this expectation that it didn’t really matter how much debt I was taking on.  I was soon to be a rich dentist! Now, I knew that debt had to be repaid, and that with debt, you end up paying back more than you borrowed, but I’ll admit that I kind of wasn’t all that worried about it.

So I was going to have $250,000 in student loan debt (today a dental student could easily have $300,000 or more in student loan debt) when it was all said and done.  This was “good debt” right?  It came with a long 30 year payback and a low government interest rate so I could afford the paymentsRight?

Well, yes and no.  That payment on the $250,000 is a chunk of change!  Add to that a mortgage, a car payment, and a lifestyle and it starts piling up pretty quick.  That says nothing of the practice debts that come if you buy or start up a practice.  Those debts can be very large and the terms of repayment on those are more steep.

When I left dental school and did a start up practice, I quickly found myself, between business and personal debt, near $1,000,000 in debt from dentistry.  The payments on that debt were very quickly swallowing up the meager profits from my dental practice.  This pressure absolutely affected how I was feeling about this dentistry stuff and put a strain on me mentally and emotionally.

Aside from producing more and more in my practice to be able to pay down debts, I decided I wanted to do something about eliminating my student loans.  I looked into the military and found that with the Army Reserve, I could make a six year commitment–one weekend a month, two weeks a year–and get $250,000 in student loan repayment.  I did it and I don’t regret it.  Serve my country AND get my student loans paid off–win win!

My advice would be, be as cautious and judicious with debt as you can.  It is going to have to be paid back.  The debt will influence how you feel, other choices you can make, and what you can do with your life.  You may look into military service.  You should proactively look at ways to avoid, eliminate, or at least minimize debt.

Dr. Marcus Neff, DDS

Dr. Neff is a co-author of the book “So You Want to be a Dentist?: What you Must Know to Succeed in Dentistry”.  The book can be purchased at www.lulu.com, the iBookstore, Amazon.com, and many other digital retailers.