Because my practice caters to patients who are concerned with the materials going into their mouths, I’ve been researching all the products we use in our office to get a better idea of the ingredients inside them. A great place to start is the Material Safety Data Sheet (MSDS). You’ll not only find what your material contains, but some MSDS sheets will even go so far to give you toxicological information about their own product. I like to think that we use one of the better composites on the market, one that is free from some pretty controversial compounds. However, after closer research, I found that even it had possible toxicological impacts. Taking a step further, I found multiple studies that looked closely at the ingredients of our composite and were able to make a better judgment of its safety for my patients.

A great tool for some of my most sensitive patients has been a material sensitivity test better known as a Clifford Material Reactivity Test. From a simple blood draw from your patient, serum antibodies can be detected for thousands of dental materials. From zirconia crowns to acid etch, a Clifford Test can tell a patient what materials are suitable and not suitable for them. From there you can avoid using products that can cause potential acute or chronic reactions.

Product representatives are also a great resource. And while they’ll always be biased towards their product, they should be able to provide you with very thorough information about their products. And if they can’t, they at least have access to the developers in their company who can answer more technical questions. I recently contacted one of my labs to get more information about the gold that was used in their gold crowns. What I soon found out is that they actually offered five different types of gold with different percentages of gold and other metals that could be used for restoration. Had I never asked, I would just ask for a “gold crown”? Now I have the luxury of choosing the gold I want.

At the end of the day, it is impossible to know the in’s and out’s of every material. But taking the time to familiarize yourself with some of the most common materials in your office will allow you to provide a more personalized approach of care for your patients.

For those of you who know me more on a personal level, then you are aware of my love for organized dentistry. Throughout dental school, I had the privilege of serving in numerous leadership roles from being the first delegate of ECU ASDA, ECU SoDM Trustee to North Carolina Dental Society, and the 2015-2016 National ASDA District 4 Trustee. Serving in those various roles, radically positively changed my life and had enhanced my love for dentistry.  Because I have served in so many different leadership capacities, over time, I became very consumed with my extracurricular activities, which ultimately caused me to have minimal free time for anything else. It was my #2 priority (school being #1, of course).

At one point I was traveling so much, members of the North Carolina Dental Society joked that I was a part-time dental student…LOL. I have to admit they were correct. Even though I was super busy, I loved every minute of it and thanked God that my school allowed me to be the leader I wanted to be all the way up to graduation.

Once I graduated, I was at a new pivotal point in my career. I have now entered the profession I have worked so hard to become apart of and began to ask myself “now what?” Between graduation and the start of my residency program, I sought out advice from my mentors, family, and friends. I was encouraged by others to devote all of my attention to my program. And I agreed! I knew completing a general practice residency would afford me the ability to adequately and comprehensively treat any patient that I may encounter and it required my undivided attention. I attempted to focus only on my residency for the first month and a half. Although I appreciated my love one’s recommendations, something in me didn’t fill fulfilled. Something was missing, and that something was service.

I have always been the type of person who was never okay with just being a student. I learned a long time ago (the hard way), to never sacrifice the things you love doing for either work or school. I found myself beginning to fall into that same cycle again which previously led to a stressed and depressed version of myself. I was not going to allow that to happen again.

From the moment I had that realization, my goal has been to determine ways that I can be both an excellent resident and still contribute to the profession. Shortly after I changed my mindset, I receive an invitation to speak at the Oklahoma ASDA’s Chapters Career Advancement and Leadership (CAL) Conference about “Organized Dentistry 101”! I was super excited and honored to be asked to share with the students about the in and outs about ASDA and the ADA. Being a leader in ASDA has afforded me the ability to connect with students through the art of public speaking. Over the years, I have been able to share my story with others about how I overcame challenges and used those dark seasons to propel me into the women I am today. Through sharing, I have been able to help others push through as well, in which I believe is my sole purpose in life.

The Conference was fantastic and left my spirit feeling fulfilled. I was able to meet up and connect with a few of my old ASDA buddies as well. Huge shout to Oklahoma ASDA’s President, Lynna Van and the rest of the leadership team for the implementation of an incredible event. Sidenote: Check out my amazing gift they presented me with!! This event served as a reminder. Being a leader in organized dentistry comes with a tremendous responsibility to our profession that I had to learn to be more cognizant of. Due to the training and knowledge that I have received, it is important that I continue to share that with others to inspire future leaders. The most valuable lesson and reminder I have gained through this experience is to NEVER to stop staying committed to what’s important to you. We often make excuses for ourselves by telling ourselves that we don’t have time for certain things when we fail to make it a priority. Make your happiness a priority and watch how your life changes. Since the conference, I have made my public speaking a new priority and setting aside time further develop my gift. I look forward to sharing with everyone soon on what I am doing currently to assist my growth in that area in my life.

Until next time,

LaJoi E. Wiggins, DMD
@JoifulSmiles

“Do not follow where the path may lead. Go instead where there is no path and leave a trail.”

-Ralph Waldo Emerson

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

Your first year out you’ll probably be stumbling to figure out how to get through a workday and not being overwhelmed with the procedures on your schedule. The good news is, many of my new grad friends as well as myself have gotten past this hurdle and now we’re heading towards the next one. If you are being paid a percentage of collections or production, as most associates are, the next hurdle is to determine how your paycheck is calculated. And while it may seem pretty straight forward, it is more difficult than you think.

Whether you’re a salaried employee or working for some percentage of collections or production, it is important to be aware of what you produce for your office and how much of that you and your office actually collects. Unfortunately, this requires expanding your knowledge into the wonderful world of insurance. Sitting down with my office manager for just a few minutes to go over my gross receipts proves having staff that can understand the in’s and out’s of dental insurance is essential to a successful practice. I’m fairly convinced that dental insurance is more difficult to understand than actual dentistry.

Over the past year, I’ve been able to piece together all the insurance jargon, whether it’s “negotiated fee” or “predetermination”, or the one that always gets me “estimation of benefits”. Understanding these terms helps you better understand how you get paid. And if you’re like me, the new dentist salary requires strict budgeting and the ability to make projections for the future.

One important aspect of understanding how you’re paid is understanding how your practice runs its’ collection and production reports that are used to determine your payroll. Some practice management software makes this easy, while others may require a few tutorials from your office manager. One report that is great to use is your “day sheet”. Generally, this report will show what your daily production was, what cash payments were collected, and what insurance payments were sent out. For me at least, running various reports either daily, weekly, or monthly, help give me a sense of how I need to budget for that month.

If I haven’t convinced you yet how important it is to know where your paycheck comes from, let me make one last plea. In talking with various colleagues years ahead in their practice, I can safely say that we almost all agreed that at some point you will NOT be paid properly for your work. And even worse is that these errors in payroll will happen almost all, if not every pay period. The fact of the matter is that you have to be responsible for checking to make sure that your office manager hasn’t missed anything when doing payroll. Especially in a small private practice where one person is in charge of this huge task, double-checking their work will help to make sure you are getting what you deserve.

Hopefully, this acts as a good heads up for you new grads. And if you’re a new dentist like me that has any words of wisdom on this topic, please share below!

 

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.

April 18th was not just another tax Tuesday. It was the first tax day that I was not getting a tax refund. Instead, I had to pay taxes. It was a sobering day, to say the least, as I wrote my checks to the federal and state government. I kept combing through my tax documents certain that this couldn’t be correct, but as the saying goes, “only two things are guaranteed in life, death, and taxes.” Reflecting on this topic, I wondered what I could have done to not only reduce my tax burden but prepare myself better to be prepared to owe taxes in the future. And after talking with some of my colleagues, it seems like I’m not the only new dentist in this situation.

Let’s face it, this first year out has not been easy on my bank account. Whether it was licensure costs, student loan repayment kicking in, or trying to start saving and setting aside for retirement, at the end of the day the last thing on my mind was if I was paying enough into my taxes. Because I associate at different practices (three to be exact), I was paid differently at all three. And because the tax law’s in my state were vague, I ended up being employed as an “employee” at one of my offices, and an “independent contractor” at my other two offices. I had a fairly good idea of what these two designations meant when it came to paying taxes. I sat down early on with a close relative who is an accountant who gave me tips and spreadsheets on how to track everything that was coming in as well as all my business expenses. And while I was saving portions of my paychecks for what I knew I’d owe it taxes, I didn’t save enough.

The good news is, I paid my taxes in full and I’m still able to put a decent meal on the table. But going forward, I am now making a few resolutions so I don’t find myself in the same situation next April.

1) Finding an accountant who works with dentists: This was difficult to do last year. I didn’t have a lot of money to spend on hiring an accountant, so I turned to a relative. And while he did do his best to save me as much on my taxes as possible, there were a few things related to the dental profession that he was unsure of. I have learned that having sound advice from an expert is worth the money. And considering that my taxes will likely become even more convoluted as I move towards buying a practice, finding a good accountant is critical.

2) Better budgeting and saving: If you haven’t come in contact with some sort of financial advisor or planner since starting to practice, then you must be really good at avoiding them. They’re everywhere and they definitely want your business. And that’s not a bad thing. Finding a good financial advisor can help you navigate your personal budgeting as well as budgeting money for retirement, buying a practice, or in this case setting aside money for your taxes.

3) Reducing my tax burden: This will mostly come through the advice of my CPA, but simply talking to my employers could bring about some big changes. At one of my offices, I simply just asked the owner to make me an “employ” instead of an “independent contractor”. This not only resulted in savings for me, but the owner of my practice also had tax benefits from making me an employee.

I believe the key to surviving your first year out of school is to be organized and prepared for the many unknowns.

We have 363 days until the next tax day, so don’t end up like me.

Budgeting wisely and talking to the professionals can pay off.  Literally and tax-ally (I made that word up ).

Dental insurance always seems to be a hot topic in the profession. Lately, though, it has been a hot button issue in Massachusetts. Over the past few months, I have witnessed the influence and power of dental insurance companies. The impact these companies have on dentists vary from whether you’re a practice owner or a new dentist like me. Regardless of your position, dental insurance doesn’t seem to be going anyway any time soon. The question for me is, do you choose to follow the pack or jump ship and try to survive without them?

Over the past few months, a war has been waging against Massachusetts dentists and one of the largest dental insurers in the state. Essentially the insurance company is planning to cut reimbursement rates by as much 20% with no added benefit to the provider other than maybe an increase in newly insured patients. But let’s be honest, 20% is a big decrease and last time I checked reimbursements, like wages, should increase as the cost of living expenses increase, right? Well regardless of what I thought, I really had no say on the situation as an associate. My practice decided for me that I was going to continue to take the insurance.

My exposure to dental insurance has been minimal since starting to practice. In dental school, insurance was one of the last things I ever thought of, and most of the time my school worked out any financial issues that held the patient back from treatment. But now in private practice, where such resources are not available, dental insurance is always in the back of my mind when treatment planning. And I’m not just talking about those full-mouth restoration treatment plans. I’m even talking about the upcharge some insurances still have for composite fillings!

So why do I have to take these dental insurances? Why should patients even have dental insurance? Are they really benefitting? Am I really benefitting?

As a new dentist, I will say that accepting several different dental insurances has given me a steady flow of patients. And in many cases, patients with dental insurance have been more likely to accept larger treatment plans. Still, there is a vast majority who have turned down treatment together because their insurance provides no coverage, or I’m having to provide alternative-alternative-alternative treatment plans that maximize the use of a patients’ insurance while somewhat addressing their dental needs. I don’t know a single dentist that wants their treatment to be dictated by someone else, but alas here we are.

Whether it’s medical insurance or dental insurance, radical reform is needed. If we ever expect to get to a place where we can make patients healthy and afford to keep our office doors open, the middle man has got to go. Will it happen in my lifetime? I actually think we might get pretty close. And there are some very powerful people in our profession who actually agree! Until then, I’m staying focused on building my practice and improving my skills. If I can provide exceptional care with insurance standing in my way, imagine what I can do with it out of my way.

Share your dental insurance experiences in the comments below. Feel free to call out my jaded optimism or to offer up your own solutions to the problem!