Since October 2016, I’ve gone through the process of applying for the Army Reserves and commissioning as a captain, O-3 to a unit based near me in Atlanta. A great benefit of this opportunity is loan repayment options, but I want to make it abundantly clear that you should not apply to the military for the sole reason of loan repayment. Not only is it a duty that should be carefully considered for personal reasons, but it is also an extremely arduous application process that may become aggravating if you are in it for the wrong reasons ie: money. In this post, I will go over the process I went through to get into the Army Reserves, then will summarize what I “get” in return.

I’ve always been interested in serving my country after dental school. I applied for the HPSP (Health Professions Scholarship Program) prior to school but was too late applying for consideration. Throughout dental school, at Boston University School of Dental Medicine, I would speak to military booths at ASDA conferences, continuing education events, and even went to recruiting offices in my junior year. In July 2016, after graduation, I started working with my Atlanta, Georgia recruiter for the Army, explaining to him that I had a dental associate job in the private sector but was interested in the Reserves.

The Application Process

The first step is to fill out a large packet of paperwork that needs to have the right signatures and initials all in the correct places and documents for just about everything. This part doesn’t take much brainpower but it takes a lot of time because you have to gather information about your family members, gain letters of recommendation, and document every address you’ve lived at for the past 10 years. It’s very time-consuming. Once I completed these documents, I was taken to a day-long physical at MEPS (Military Entrance Processing Station) to verify my document packet and make sure I was medically qualified. Your recruiter will submit your packet to aboard.

The board reviews your packet and either select you or not. Your recruiter can’t give you too much information on this because the board will be faced with the budget, the current slot availability, and other things that determine how many selects they can review. Do not be fooled into thinking there’s a guarantee that you get in. Also, don’t get discouraged if it takes a long time to hear back from the board. In November 2016, four months after my application process, I heard I had been selected.

I received a phone call in March 2017 that everything from the board had been signed by the Department of Defense and I was ready for commissioning. I had a nice ceremony at my house with my family where I signed a contract and swore an oath of office. It was a very exciting time and seemed like everything was done and in motion.

In April 2017, after being selected, I took a fitness test, the OPAT (Occupational Physical Assessment Test) to be assigned to my unit for final clearance. I was then cleared to go get my military ID and get my uniform. This was done with my recruiter to escort me around the base. I met my unit administrators, the full-time team that runs the show when the unit is not drilling on the weekend.

Finally, in May 2017, I was contacted by my unit administrator and was told I needed to start my online training. It wasn’t glamorous but taking webinars on phishing scams and web hacking was my first report to duty.

After almost a year from the application process, I’m officially on a normal schedule with my unit to report for drill weekends. If you’re interested in signing up, know that this process took almost a year of “hurry up and wait”. If you are interested in the military, look up medical recruiters not your local enlisted recruiter, which is the best way to get the most recent information, details, and timelines.

Expectations

Okay, so what is expected of me for my service? I can only speak to the Army Reserves as of my application from 2016-17 but here’s my personal highlighted list for both Giving and Getting from my newly acquired position in the military:

What I Give

• I owe at least 8 years of service, but not all have to be active. Staying in longer can lead to promotion and can lead to retirement after 20 years (can combine with any previous active duty time towards retirement, as well).

• I report for drills 1 weekend a month. This is usually 2 days, but it can be 3 days if need be.

• There is a month each year that has 2 weeks AT (annual training). This can be a wide range of things and I can’t speak on this too much yet.

• Basic Officer Leader Course (BOLC) is a 6-week mini-Bootcamp for officers. Dentists are known to be babied in the military, but this is an opportunity to learn the ins and outs of the Army while getting a light taste of boot camp in San Antonio: 3 weeks are classroom-based, which can be done online from home, and 3 weeks are field training onsite.

• I can be deployed at any moment the Army needs me. Deployment for Reserve dentists has to be conducive to maintaining a private practice, so the deployments are left at 90 days.

• Physical fitness is a given for the military. I’m not expected to be an Olympian, but I’m a fool to not keep in shape and watch what I eat a little more than if I didn’t have physical standards.

What I Get

• $40k a year in loan repayment or $25K cash bonus a year. The loan repayment caps out at $250k at 7 years. Um… sign me up.

• Position of Captain, O-3 (Army and Air Force, Navy is Lieutenant because Captain is O-6) upon commissioning. This is taking a major leap into the ranks, so this is quite an honor.

• Pay for each drill weekend and AT (and the one-time BOLC) based on Captain (or Navy Lieutenant) salary, including housing allowances for the AT if not on a base near you.

• Education opportunities too numerous to list with the Army. For example, I’m interested in Airborne School once I get settled in.

• Affordable life insurance. It’s never fun to plan for unforeseen tragedy, but this helps make it an affordable option.

• And, not to be cliché, but the opportunity to serve your country. If this isn’t the main appeal on this list, I would highly recommend reconsidering applying. There is a lot of work that goes into this commitment and it is an honorable position, so it may not be the simplest means to loan repayment (NOT discounting how much it helps!!).

Debt Management in The Military

I think I’ve talked enough about how debt management is not the primary reason to apply to the military. I can now briefly discuss how this new position in the Army Reserves is going to affect my student loans.

Upon graduation, most financial advisors suggested I sign up for the PAYE or REPAYE income repayment plans. I won’t go into the details of those in this post, but I was never going to pay off my loans on those plans. The plan was to have remaining balances forgiven at the end and pay tax on the forgiven amount. I’m going, to be honest; I hated the idea of this. It seemed like cheating and that it would only add burden to taxpayers because I was working a system. With the loan repayment help, I’m getting for my service, this is no longer the case. I WILL pay off my debt. I can’t tell you how long it will take me, but it’s a huge relief to know that the plan is not to pass my debt along to Uncle Sam/everyone else. There are several programs that have loan repayment, but the military is a forerunner in this arena and has some of the most enticing options.

If you DO sign up, the loan repayment will be very structured and I can’t tell you every detail until my taxes come around in 2018. The way it works is that you get your loan repayment in one lump sum at the end of the year of service. A year of service starts at commissioning and depends on getting enough credits going to drill, AT, BOLC, events, etc. to qualify. This IS taxable money! So it’s not $40k taken off your loans.

Also, your loans must be federal loans to qualify for repayment and it only repays principle (will not pay interest with repayment funds). That’s huge… make sure you don’t refinance any loan principal that you plan on getting help with via repayment funding. Financial planning is key to all of this. When we’re talking hundreds of thousands of dollars in income/debt/ repayment, do not feel bad to ask for help.

If you’re seriously considering signing up for Army Reserves, please feel free to reach out to me with any questions your recruiting office can’t answer. There’s a lot of information and one can only help if they have experienced the process themself. Luckily, I had a great and committed recruiter that had experience as well. I’d be happy to answer questions about Army life, applying, what to expect, or how it helps with loans.

 

David Lane, DMD

CPT, 63A

7236th MSU

daveslane@gmail.com

It’s always easy to write off people saying things like “you’ll learn more your first year out of dental school than the whole time during school”. I’m not going to try to prove that argument. but I will say I learned how to “do life” completely differently after graduating. It’s also a time where you’re thrown into a deep pool of things that aren’t skill-related.

To be honest. I usually disregarded people that said your first job won’t be your last. I disregarded the professors of the business courses when they emphasized the need for what seemed like an ideal contract. I ignored a balance between financial concerns with a Utopian view of “just find the perfect practice and the money will work itself out”.

Openness is the key to these things. It’s not that each of those concerns cant is worked out if they’re not ideal. but finding an ideal situation out of school may be a little tougher than expected.

My first job was in the works starting in my third year of dental school. Planning how I would fit into the practice way in advance. talking about partnership. discussing CE paths out of school. It seemed perfect and I took all the time to make sure it was a good fit. It’s very possible to find the perfect fit with all the right research. but I learned that it is not always the case. Disclaimer: that’s perfectly fine.

Problems for my first job arose quickly from a contract that was never completely agreed upon (I will be writing another post to follow this one about contract reviews). Once the business conflicts started coming to a head and finances became involved. The relationship with the practice owner started to sour. They did wonderful dentistry. they led me in wonderful directions for what to expect from myself. I was learning a lot and improving my skills. but the friction forming in the office led our conversation to find a new job far sooner than I’d expected.

Again. I learned that this was perfectly fine. I took what I learned from that office but I also learned what I needed to prioritize in my next job:

1. ) I needed to make sure I was going to be able to make loan payments. There is no compromise in this. as materialistic as it sounds. Do NOT take a job if you think it can put your financial stability in danger. Income-based payments help with the loan part of things. but the other expenses need to be considered as well and should all be fixed into a budget. Also. I wouldn’t talk about the future purchase of practices at this time. It can be disappointing when money doesn’t pop out of the ground as I sleep and practice buy-in becomes less realistic right out of the gate.

2. ) I would make sure there was nothing in the contract that was not legally enforceable in my state (why complicate a contract with clauses that cannot be upheld in law?).

3. ) I bought a house. so I would make sure no restrictive covenant (which isn’t upheld in Georgia anyways) would not exclude me from work near my house.

4. ) I would need plenty of autonomy. This is personal. Coming out of school. I wanted help with certain things and only occasional input on others. Make sure you are in a mentorship-heavy office if you want extra supervision. but make sure there’s a structure for you to fill your own shoes if you need some space to work. I would always recommend having someone to learn from. but just know the amount of supervision can vary greatly.

Since taking my new job I’ve been able to learn a lot from a different perspective and have refined different skills while maintaining the ones I worked on at my first office. There’s more to learn out there than I could have imagined leaving dental school: different philosophies. new procedures. different practice models. All of these things will have value on their own accord. so I’ve learned to appreciate each experience for its own circumstance. It wasn’t the start I imagined having out of dental school. It’s even close to being the opposite of the plan I had set up for months leading into graduation.

Taking advantage of every situation has been the key to me learning new things and refining skills from dental school. I’m not trying to be the old guy that downplays what you learn in dental school. but I can speak from experience when I say the learning curve out of school is steep. but it’s a wonderful experience to get into the profession we’ve trained for.

Coming into the finish line for dental school can be daunting. And maybe it should be. There are a lot of life decisions to be made in a very short, very busy year. Am I going to specialize? Where should I move to? AEGD, GPR, or straight to practice? To make it even more complex, all of these questions have several subsequent decisions alongside them. Getting the ball rolling starts a lot earlier than the 4^th year though. I found it useful to reach a decision through a process, not an impulse.

Dental school is a great way to find out how to do things, but actually doing them autonomously is a completely different ball game. I realized a great and understanding mentor was my primary concern, and this became the focus of my post-graduation planning. Many school faculty and administration would suggest that a residency is the only real option to gain an extra year of mentorship. I will not deny that AEGD’s and GPR’s are uniquely capable vessels to continue education while getting more experience in current general dentistry skills. I’ve heard great experiences from many programs and the close supervision they offer is exactly what many of us need coming out of school to be comfortable in “the real world”. That being said, the most important part of my leap out of school was finding a great mentor and work environment, not just finding a great residency.

I was introduced to my boss through my hometown dentist, and I was instantly impressed at the importance she places on continuing education as well as the flow of her practice. She is busy, but she does not rush. She does not over-reach her abilities but takes courses to learn how to expand her skill set. She also told me she was ready for someone to come in and learn, not just to punch their time-card. A lot of employers will feign these opportunities, so asking for details about CE, scheduling procedures you’re not comfortable with yet with them (hands-on training), and 1-on-1 meetings to discuss the business aspects of the practice is important to make sure you will get tangible benefits from these offers.

Since I’ve started practicing, my boss has hopped into my op several times to bail me out of extractions that were over my head, tweak treatment planning for complex cases, and look at how to approach a patient completely differently than what school felt like. She checks preps and impressions until we’re both comfortable with lending more independence. She reviews materials, lab information, and most treatment planning with me.

She has also taught me skills that I did not get a chance to practice in school.

None of this is just saving me from struggling. It came with advice and ideas on how to improve the next time.

Again, this is not to say a residency isn’t the best option for any single person. It’s just important to realize what the benefits are for any given situation right out of school. Finding an understanding mentor, continuing your education, expanding your skillset, and not being thrown into an uncomfortable or dangerous environment are key features of successful ventures out of school. If you can find the perfect combination of these in a residency, you will be able to grow tremendously. But if you’re able to find a great opportunity in private practice, do not write off the potential of this position simply because it’s not a residency. The leap out of school is hectic, regardless of how you choose to leave. Make sure your leap is set up with a clear set of points that are focused on how to make you succeed. Ready, set, go!

It’s not surprising to hear that you have to take a news story with a grain of salt these days. Journalists only have a job if they’re able to get people to hear their stories. New York Times’ Catherine Saint Louis recently wrote a piece about flossing recently that I’m sure everyone has heard about. This article is far from the first of its kind and certainly not the last. But each day since the story has been published on August 2, I’ve had patients come in and make sure I’d heard about the “news” on how necessary flossing is. Whether the patient is joking or not, it’s discouraging to hear that the public is being told that part of their basic dental hygiene is not important (the title of the article is “Feeling Guilty About Flossing? Maybe There’s No Need” for crying out loud).

As dental professionals, we need to be able to recognize what our patients are reading and have an honest response to it. In short, Louis writes that “brushing with fluoride does prevent dental decay. That flossing has the same benefit is a hunch that has never been proved” in response to UCLA’s Dr. Hewlett explaining the benefits brushing and flossing by disturbing the bacteria that build up in our mouths over time.

For dentists, hygienists, and students, quitting flossing because there aren’t overwhelming amounts of clinical control trials may seem like a shortsighted idea. But that is where we must think from our training to connect with stories like this one. Not many patients research biofilms, periodontology, and cariology on their own or with credible sources. That’s what we’re trained to do. Explaining to patients how bacteria acidify oral microenvironments that lead to demineralization can help explain that without accessing the interproximal spaces, there is a very real opportunity for bacteria and caries to take hold. Biofilms left undisturbed are able to increase gum inflammation as well as allow bacteria to continue producing an acidic environment that will weaken tooth mineralization.

Is flossing guaranteed to solve all of life’s problems? No. Does it decrease the risk of dental concerns? Even Louis admits a study by Dr. Phillipe Hujoel at the University of Washington showing a 40% decrease in dental caries over 2 years when school children had their teeth flossed daily. Periodontal benefits can be seen every time we do a prophy or SRP.

The importance of this conversation with our patients is to say that there is no single expectation for all patients. Some people can never floss and never have any problems, but other patients get interproximal caries on every posterior tooth or have major subgingival calculus deposits that lead to mobility and bone loss. Though our intent should never be to scare patients into better habits, it is our job to make sure that misleading information is explained from both sides of the coin while recognizing the basis of such stories.

The American Academy of Periodontology has recognized that there are not many extensive long term studies specifically on how flossing is related to caries and periodontitis. However, an August 2 press release from the AAP explains that the long-term progression of periodontal disease and the number of factors that influence the speed of its onset require studies to be much more in-depth with data collection and be followed over a longer period of time. Because no research has yet presented to suggest that these factors do not influence the progression of periodontal disease, AAP recommends flossing daily until other information can prove otherwise.

In AAP’s August 9^th follow up press release, AAP president Dr. Aldredge explains their position on daily flossing:

”Gum disease is typically caused when prolonged exposure to bacteria in dental plaque causes an inflammatory reaction. Flossing is an effective and useful way to remove the plaque, especially in between the teeth or under the gum line- places where a toothbrush cannot reach;.”

We need to be thankful that our patients are willing to read about oral health as it presents in the news, but we also need to be aware of what they’re reading so that we can be prepared to have a conversation about it. Articles like this may go against our common sense, but it is logic that is explained in textbooks and lectures that our patients may not have access to. Having a great periodontist on your dental team is important, but let’s do our best to make sure the New York Times isn’t responsible for their next wave of referrals.

Sources:

Catherine Saint Louis. “Feeling Guilty About Not Flossing? Maybe There’s No Need”. New York Times. August 2, 2016. http://www.nytimes.com/2016/08/03/health/flossing-teeth-cavities.html?_r=0

“AAP recommends flossing”. American Academy of Periodontology. August 29, 2018. https://www.perio.org/press-release/new-study-suggests-the-ideal-sequence-for-removing-plaque/#:~:text=The%20AAP%20recommends%20flossing%20regularly,timely%20care%20from%20a%20periodontist.

Licensure Without Borders

Getting a license to practice dentistry is an exciting point in our lives, but it is also tainted by a process that many students have already heard about: live patient examinations. In addition to the ethical implications of using live patients in a single-treatment case, licensing exams are notorious for failing students based on factors out of the students’ control such as patients showing up late, having a lesion that is “too big”, not having enough subgingival calculus, and the list goes on and on. But another drawback to the current method of licensure that is often overshadowed by these conversations is the lack of a universally accepted exam.

The “portability” of these exams is an interesting issue. Each exam has many parallels to the others, yet completing the exact same procedures for the Massachusetts exam will not be accepted to confirm an individual’s competence in Georgia. Having just completed the Central Regional Dental Testing Services (CRDTS) exam to practice in Georgia after graduation, my eyes have been opened to the concerns associated with the lack of a universally accepted exam. Bear with me as I run through the sequence of events that illuminated this “other” concern with dental licensing exams.

The first hurdle I faced was a relatively small one: establishing contacts with the exam agency since it is not offered through (or even remotely close to) my school. With so much money and time being spent on this step of my career, I knew simply signing up was not going to cut it. Friends at schools that offered CRDTS were my first contacts, followed by asking lots of logistical questions to the agency staff itself. This was all prior to signing up to make sure things wouldn’t have to be shuffled too much.

After registering for my exam, it was time to use past networking to get help finding patients for the exam. I would be taking the exam in Birmingham, Alabama while I was originally from an Atlanta, Georgia suburb but attending school in Boston, Massachusetts. This meant very little overlap of patient possibilities with the exam site. The problem quickly became finding patients within range of my exam at that specific time.

As I practiced in my school’s clinic and simulation lab during the weeks leading up to my exam, a dentist from my hometown found a prospective patient that was highly motivated and agreed to go to the exam. This patient would cover my restorative requirements for the exams and took a lot of stress out of the picture. At just two weeks out from the exam, however, I could not reach the patient, and panic set in. I rescheduled any school patients I had the following week and flew down to Georgia to screen patients. Finding patients with the exact requirements of the exam that would be able to travel hours away for an all-day dental procedure seemed like a shot in the dark, but I was destined for failure if I didn’t try.

This was a point where I consider myself lucky amidst overwhelming stress. I have an extremely kind network of dentists near my hometown that all stepped up and opened their doors for me to bring family, friends, friends of friends, and even strangers in for screening. I could not imagine how tough it would be trying to move to a state where I didn’t already have a strong network of colleagues! Thanks to this network, I found three patients to cover all the requirements of the exam (one patient was confirmed two hours before my first day of examination!).

Georgia, like several states, only accepts a single exam. Since CRDTS is not accepted very broadly, there are large regions in the United States that do not offer this exam. Because of this, showing up to the exam revealed that I was not the only hopeful Georgian dentist there to take the exam from far away. Dentists practicing in New York were there with patients they had flown in from their practice. Dental students from the Northeast had hired “patient finding services” from California that added extreme prices to an already costly package of travel and exam expenses. The crowd was swimming with dozens of stressful horror stories, including some patients that did not show up as the exam day went on.

The exam itself was not anything different than what it was known to be (for better or for worse), but our profession is doing a tremendous disservice to incoming dentists by having borders to licensure drawn throughout the country. More importantly, I abhor the idea that I screened a patient for a single visit in a state that I cannot provide follow-up care for myself until my license processes in mid to late July. Because of state membership in different exam agencies, my exam required establishing incomplete, exclusive care. During my time at Boston University, complete, holistic and comprehensive care is something stressed before we even set foot into the clinic. Does our process to qualify individuals for dentistry contradict the very education we received to enter this professional field?

Despite conflicting views on the live patient examinations, dentistry as a whole needs to find common ground in licensure reform that puts our patients first. This exam is a critical moment in a developing dentist’s career, so making it accurate should only be as important as making it ethical. The borders of licensure are not jurisdictions. They’re barriers. With dozens (if not hundreds) of candidates being subjected to long-distance patient exams, these barriers are affecting a large group of future dentists and patients. It’s time we recognize that reciprocity of examination agencies deserves to be in the licensure reform conversation to eliminate moral divergences with patients and to make licensure for out-of-state students a more viable option.

After-note: For anyone trying to take an exam in another location I have a quick organizational suggestion to ensure a successful exam day:

• Read exact requirements for the exam so you know what to look for!
• Reach out to people taking the exam at their school or that have taken it recently.
• Reach out to the exam agency and apply for a date once you’re ready.
• Network with dentists near the exam location. A future/potential employer is a great place to start. If they offer to screen for you, great. If not, ask if you can use a space for screening yourself (checking laws in each state for what you’re allowed to do yourself and possibly paying a bay “rental” fee if the office has never met you). Now network possible patients for the dates of the screening. Coming from experience, I do not recommend screening right before the exam. It is unnecessary stress.
• Document everything! Print copies of anything digital, keep insurance policies with your confirmation letter, and organize these documents to have them all easily accessible for the exam. I even saw one student with brief summaries of each procedure, including examiner checkpoints to help review for test day!
• Get paperwork completed by your patients before the exam weekend if possible. Have x-rays stored with these consents/health history forms. Make sure x-rays have dates and patient name on the image. It can’t be a random picture!
• Set up accommodations for you AND your patient. Do not trust a patient to show up on a weekend at 7:30AM if they’re driving any measurable distance. Get them a hotel right next door so they’ve got no excuse. Get yourself a nice place to unwind as well. A friend’s couch can cut costs, but only if you don’t have to pay a retake fee because you didn’t sleep well.
• Set up an agenda and budget for the weekend. Both should be tentative and adaptable, but it prevents surprises out of left field.
• Roll with the punches! “Go with the flow” is too relaxed of a saying for the weekend, but just know that you have to get through a little over 48hrs of critique and then will be free once it’s all said and done!