I do it my way?

Each year US dental schools graduate many thousands of freshly minted dentists and a good number of them are choosing to seek employment in "corporate dental practices" that promise them a high starting salary and the promise of helping them hone their developing dental skills. While making a high salary their first year out is enticing, recent graduates should remember that their primary mission should be to improve their skills and truly help the patients they are caring for. 

Many of these graduates may be either involved with treatment planning for patients or  treating patients whose treatment plans are developed by other dentists working in their facility. Unfortunately, financial pressures on clinics may encourage "over treatment planning" since this will boost the offices production numbers. Without naming names, I and some of my colleagues have noticed that patients coming for second opinions after visiting "corporate practices", have been treatment planned for fillings, extractions, crowns or implants that in our opinion are not needed. This is concerning and it is my hope that recent graduates will not feel pressured to go along with overly aggressive treatment plans that are not in the best interest of their patients.  

While engaging in these unethical behaviors maybe initially rewarding, it can't be good for a dentist's own self respect and  there is even a risk of being caught up in an investigation by a state board of dentistry. Most people enter the profession with the idea of helping others through mastery of dental skills and engaging in unethical behaviors is not only illegal, it is bad for their mental health.  Ultimately it will diminish a practitioner's love for their profession and the sense of accomplishment that it can provide. 

I've been a practicing dentist since 1980 and with the exception of my first three years in dental practice, I have worked in my own dental practice. Even when working for other dentists, I always maintained an independence. In my mind, my primary mission was to perform the best dentistry that I was capable of and maximizing my income was a secondary concern. 

Early in my career I worked in a number of "lower fee" dental settings and I enjoyed working in these practices because they allowed me the opportunity to perform all sorts of procedures ( Crown and bridge, endodontics, periodontics,  dentures and fillings).  Since few dentists graduate dental school being truly masters of all dental procedures, we have a need to perform many procedures before feeling truly confident in our ability to predictably practice excellent dentistry.

Most seasoned dentists, when  asked  would agree that  it takes five to ten years to feel truly proficient in most of the procedures they perform. It takes many attempts at performing any type of procedure for dentists to become fully aware of all the nuances involved in their dentistry and sometimes more is learned from less than optimal results than when everything goes as planned. 

Now after over 40 years in clinical practice, although I am confident in my abilities, I still am incorporating new techniques and my dentistry is still  evolving. Now many of my patients crowns are fabricated with the aid of digital dentistry. While I still fabricate many gold and porcelain fused to metal crowns, an ever higher percentage of the crowns I am treatment planning, are either zirconium or lithium disilicate ( all ceramic and metal free). Many of these are fabricated by my dental labs using digital scanning and milled restorations. 

While I still make posts for some endodontically treated teeth using cast gold and prefabricated metal posts, I also often use bonded graphite posts in teeth since this material may be "kinder" to the fragile remaining tooth structure for some fragile teeth. 

I teach every week at NYU College of Dentistry and participate in 4 dental study clubs. All in the time I spend on continuing education is easily 3-4 times the amount required by the NY State licensing requirements. Sometimes it seems like a lot of work, but I love dentistry and I still feel its important for me to provide my patients with state of the art dentistry.

Making money from our profession is nice but a greater satisfaction is provided by observing the restorations I have made stand the test of time, and knowing that my efforts have resulted in my patients maintaining their teeth. Over the long haul  this knowledge and my patients continued trust in our practice, is the greater reward.