Friday, June 15, 2018

50 Days, and 3 Lessons Learned

*50*

That's (roughly) how many more days I will be here in Alaska.

It's been a wild journey. I still have, at minimum, just over a year left on my military commitment. If I choose to separate in 2019, my wife and I will likely settle somewhere in Colorado. Fortunately, my next base is also in Colorado, so that would be an excellent way to transition.

I also wanted to quickly touch on three things about the military to give prospective dentists a heads up about this world:

1. Flexibility vs stability

One of the tough things about military dentistry is that it doesn't afford you the flexibility that private practice can afford you. However, this is certainly a double edged sword. What it lacks in flexibility, it gives back in supreme stability. A steady and predictable paycheck, a pre-set number of days off per year, working 5 days per week with federal holidays off, 7-4 every day with a 1 hour lunch. You can pretty much plan out your whole life, but you can't magically have more time off or more money (and that's just fine for many). Many people see control of these two things, time and money, as the pinnacle of self-actualization, and you're just not going to have that in the military. Some people even enjoy the unpredictability of where they'll live next, something that is nearly impossible to emulate as a dentist in the private sector. Don't get me wrong, the time off is better than most jobs and the pay is certainly good, but it's an incremental and perpetual carrot at the end of a pre-cut stick. On the flip side, others are willing and able to forfeit the stability of the military for a chance at more flexibility and freedom with their time, life, and finances.

2. Inefficiency

The military is quite inefficient, and we don't do nearly as much dentistry as our civilian counterparts. I would argue that, by in large, it is of equal or greater quality, but there's virtually no incentive to learn new techniques and procedures or even do more dentistry per hour or per appointment. This can lull many people (in all military jobs) into a pattern of trying to work less and less for the same financial benefits. In the military, more productive work does not equal more freedom or more money; it's the dark side of having that job stability and it can be very demotivating to a person over a long period of time. There are other factors as well that make military dentistry inefficient: limited physical building space, limited support staff, lack of standardization, administrative burdens placed on the dentist rather than support staff, etc. I strive for efficiency, but that's under the pretense that I may not stay in the military long term and getting a higher volume of experiences is necessary, and fulfilling, for me. For those civilian dentists out there, it would floor you to see how little dentistry most actually accomplish with vast number of days we are in the clinic. It's not unusual for a young military dentist to "produce" about $200k/year on about 200 working days/year. That's the equivalent of 1 crown, or about 4 2-surface fillings per day. It's possible to push yourself to do much more than that, but be prepared to be met with resistance from those around you that don't see the value in the push to be faster, better, and more efficient.

3. Long term thinking

Ironically, there is very little long term thinking in the military, at least on a local level. While I would certainly argue that this is also a problem on the civilian side, it's surprising that a military force would lack this focus and direction. This one thing alone could help so much to alleviate the problems associated with point #2 above, since people tend to be more efficient and productive when presented with clear and meaningful goals. Because of this constant pull to see the military as a job, rather than a higher calling and working towards a tangible goal, people tend to get in a rut very easily and quickly and decide not to improve or change the systems that operate within the military. The other reason that people get into a rut is that individuals are constantly moving in and out of different places and it's hard to establish any long-term local goals. This means that people get burned out quickly if they try, since the team is always changing around them. So people usually move in and out of places with the idea they they will just do their job, collect their paycheck, and go home. People certainly do their jobs, but people rarely do more than that because there's 1. no long term goal/thinking and 2. no real incentive to step outside of their day-to-day tasks. This can be a drain on the team and its members. People promote to higher ranks in a relatively step-wise manner, so just being even slightly above average will set you on a nice career trajectory.

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These are not necessarily universal negative things, but three important things to think about and they all come with their counter-points. I think they are all natural outcomes of a "salary without bonus" payment structure and a "move every 3-4 year" system. Honestly, I don't have any good solutions for the downsides, so you'll have to decide for yourself if you want to live inside these structures for a long term career. There are certainly exceptions to the rule, but the fact that we can call people that deviate from point #2 and #3 above "exceptions" help prove that, by in large, the rules exist.

I hope these musing give you some insight into military dentistry and whether its right for you. I had a vague idea that these were tradeoffs of the military system, but I now believe they are so powerful that few can truly muster the strength to rise above them regularly without ultimately deciding their vision for the life is better articulated outside this structure. If you try to beat down the walls of these structures long enough you'll ultimately give up (and work your way up the ranks for your career) or get out. More power to those that can endure, or ignore, it for a whole career. And even more power to those that see this calling as the purpose for the life and truly do make a difference.

Like I've said before, I would absolutely do this again, but I'm leaning a little more toward the "flexibility" end of the spectrum now and starting to see the unbreakable ceiling above my head in terms of what I want my life to look like in the long run.

As always, email me with any questions you may have!

Friday, March 9, 2018

Books! (Thoughts and Opinions)

I love to read.

And by "love to read" I mean "I'm pretty introverted but mentally restless and books are kinda therapy, too." But it didn't start that way.

I was never an avid read growing up. I was like most kids: read the Cliff Notes before a test, ask a friend what a book was about, and occasionally read one or two during a school year.

In college, things changed (sort of). I read a LOT more, but by necessity. I rarely read a book I chose, but at least I was going to classes I chose, so I was sort of reading what I wanted to read by proxy.

In dental school... ugh. No way. Too much to do. I don't think I read a book that I chose for the first two years. Then, something changed.

I got into clinic more, and my schedule opened up. Then, I realized I was really bad at some stuff and decided (with little formal education left on the horizon) to start using books to fill the gap. Excellent! I started with recommendations from faculty and lecturers at my dental school and books I already owned.

It was mostly finance stuff. I began with some of the classics like "Total Money Makeover (Ramsey)" and "The Millionaire Next Door (Stanley)". Then I heard about "How to Win Friends and Influence People (Carnegie)".

Next, I picked up a book for myself, also by Carnegie, called "How to Influence People by Public Speaking". Why? Well, I was class president and I was going to have to give a speech at our graduation dinner in May 2014, so I started reading that book in August 2013 and prepared my speech for the next 8 months with that book as a guide. Really. And it helped; a lot. I was hooked.

So it started as a blanket recommendation from many people: 1) Books are important 2) Here are some to try

And it evolved into: 1) Wow, they were right and these books are helping 2) I should pick books to fill my weak spots

And a book worm was born.

I read about 10 books in 2013 and 10 more in 2014, then about 5 in 2015 (my AEGD year when I was super stressed), and 15 in 2016.

2017 was a big year for me: 40.

***Below is my personal philosophy on reading books***

General Principles:
-Pick books that fill your weak spots; duh :)
-Don't just pick books because you already agree with the author about other things (and don't discount authors you disagree with!)
-It's ok to disagree with some things in the book and find value in other things
-If a book is not interesting or helpful, it's ok to stop reading it
-It's ok to read multiple books at the same time (ie: don't feel like you have to finish one to start another one)

*Print Books:
-The best for non-fiction (can be easily referenced)

*Audiobooks:
-The best if you lack time to read (ie: your commute is crazy long) and books that don't require detailed notes or reference

*Combo Print/Audio:
-This is AMAZING and the recommended method (though I've just started trying it)
-The audio acts as a pacer for your reading and allows you to read slightly faster, while the print text is valuable as a way to highlight and have later as a reference
-Combining audio and print does two things: 1) decreases distractions 2) enhances what you actually remember
-Cons: You essentially have to buy the book twice. Boo.

*Digital Books:
-Meh, not for me, but some people love it... give it a shot and see if it works for you!

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///Book Reading Timeline///
-If you don't know what to read, here's my best suggestion of types of books to start with
-Basically, you are starting within, and moving outward starting with your brain and then with your "soul" (as I'll refer to it).
-No strictly religious or fiction books are included here but add them as you see fit :)
-I recommend reading at least 1 book in category 1-5, but then jump into any books that you absolutely need right away for your personal situation. If there aren't any, follow on with 6-10.


1) Books about the human brain and how we think
-Suggestions: Brain Rules
-Goal: Understand how your brain works

1) Books about how to think... about thinking
-Suggestions: Moonwalking with Einstein, The Wisest One in the Room
-Goal: Increase self-awareness

3) Books about interacting with other people
-Suggestions: Captivate, How to Win Friends and Influence People, The Charisma Myth
-Goal: Increase awareness of others and how to interact with them

4) Books about the individual "soul" and meaning (philosophy)
-Suggestions: You Can Be Happy No Matter What, Meditations, Ego is the Enemy
-Goal: Understand who you are and clarifying your values

5) Books about the collective "soul" of humanity
-Suggestions: 12 Rules for Life, Man's Search for Meaning, The Selfish Gene (controversial addition, but I think it's a very valuable read in this section)
-Goal: Understand your place in the fabric of humanity

6) Books about general achievement in society and leading people [most non-fiction "self-help" fall into this category and many from category 1-5 will cross over into this area]
-Suggestions: Extreme Ownership, It's Your Ship, Deep Work, Grit, 10X, The Power of Consistency, Essentialism
-Goal: Practical methods and mental models for increasing your efficiency and productivity in all areas of your life 

7) Books about personal finance
-Suggestions: Total Money Makeover, The Investment Answer
-Goal: We don't get this education in school, and we suck at it!

8) Books about health and wellness
-Suggestions: (Touchy subject, lots of misleading stuff out there) - Start with "Nutrition for Dummies" and go from there (seriously!)
-Goal: Again, we don't get this education in school, and we're fat :)

9) Books about the general principles of what you are trying to master (for many, this will be "business" type books regardless of your job)
-Suggestions (assuming "business"): E-myth, Good to Great, The Goal
-Goal: Precursor to step 10, because you need to get the big principles of how the pieces fit together and how to properly run a business (even if you're an employee) before looking at the pieces

10) Books about the specific principles of your industry (dental practice management, for my example)
-Suggestions: Uncomplicate Business (Farran), etc...
-Goal: Get better at your job/career

Bonus: Add any fiction books, books you think are interesting (history, cooking, whatever!), or books you need in your life after you've done 1 book in category 1-6

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Final Thoughts:
-The suggestions are just that, suggestions. There are infinitely more examples.
-This order tries to build you from the inside out, starting with the fundamental piece of human learning (your brain), then moving to other people's brain, then working on the fabric of who you are, and then who "we" are as humanity. Then, we look at specific principles for building the life you want, 2 categories chronically lacking in society that will greatly improve your life (finance and nutrition), and then we look at how we can learn about the skills required for our careers in a general sense, and then build off of those to specifics about our career.
-After you pass a category, don't forget to keep reading about that category to strengthen your understanding!
-Email me if you want more recommendations!

Sunday, September 3, 2017

3 Benefits of Being a Military Dentist You've Never Heard Before (Companion Post to Dentistry Uncensored Interview)

[A couple of days ago, I was fortunate enough to record an episode of Dentistry Uncensored with Howard Farran (#888), a popular podcast where Howard interviews all sorts of interesting people from the wide world of dentistry (and beyond!). My interview should be up in about two months. Be sure to check it out!]

Coming into my decision to pursue dentistry with the Air Force, I had heard all the typical lines about why I should (or shouldn't) do the HPSP to pay for dental school.  I made the decision to join the Air Force prior to even starting dental school, so basically I had to hope that the benefits outweighed the risks like I imagined.

This post explores three themes from the book Uncomplicate Business, by Howard Farran. He mentions peopletime, and money as three pivotal factors in controlling your destiny as a dentist.  Don't miss how much you can learn about these 3 things while serving in the military! They are often forgotten points of learning by new and seasoned Air Force dentists alike.


These three benefits of being a military dentist are:


1. Not Enough People

If you have any desire to leave the Air Force after your commitment is over, this one point is huge.  I've heard Air Force dentists complain extensively about the difficulty in managing and dealing with co-workers, many of whom either did not want to be in dentistry at all or did not want to be stationed where they are stationed.  They blow this off as one of the downsides of being in the military.  WRONG!  This is, in my mind, one of the overwhelming benefits!

When in your career would you be able to work to motivate and collaborate with a group of people from all areas of life, from all over the country, who may or may not even want to be doing what they're doing?  Working through this problem, rather than blowing it off, allows you to hone your leadership and people management skills in ways that your civilian dentist counterparts will likely never experience.

The other factor is that you cannot simply re-hire to fill vacancies. Staffing decisions are made at a higher level than your local clinic level, so clinics are frequently understaffed for all the needed positions.  The biggest area I see this is in how many dental assistants there are.  In a typical private practice, you usually have more dental assistants than dentists.  In the Air Force, it's typically a 1 to 1 ratio, meaning there are several 10-15 min breaks during the day where the assistant is breaking down a room or setting up a room and you're in your office working on notes or other things.  Realizing you have the capacity to work 2 or 3 times as much as you are can be discouraging, but just use that opportunity to get treatment done quickly so you can have free time to do other things.


2. Not Enough Time

I ended the previous section talking about how much free time you have in a given day, so you're right to be skeptical for a moment.  The problem (or as I'll argue, the benefit) is that on a larger scale, your time is not under your control.

You should always be striving to do more, and time is our most valuable currency.  In the military, or any government job, the concept of working overtime isn't really feasible from a dentist's perspective.  Being in a non-commander role, it's not really up to me to rally the herd and stay open an extra hour each week, or shut down on a Friday and fly everyone to Anchorage for a teamwork seminar.

Time is always against you, but in the military, this is especially pronounced.  Like I said in the previous paragraph, your time flexibility on a scale from 0 to 10 is somewhere closer to that 0.  Having to squeeze 10 unexpected patients into an afternoon that was set aside for military training so that the base can send those people to Guam by next week, are the kinds of time constraint issues you run into.  You exist to keep the Air Force running smoothly.  Your time is the military's time.  And if you can figure out ways to creatively control your schedule to continue improving your skills in this environment, you'll see huge benefits when you step out and finally get to control your own time.

Fortunately on a day to day basis, you do have control over the lengths of procedures, just not on the actual work week or overall schedule itself.


3. Not Enough Money

Imagine you're out and about on a Saturday when suddenly the craving for hamburger hits.  You and your spouse drive to a nice place to have lunch and then come home.  Does this seem like a money-intensive process?  Probably not.  Why not?  It costs money to put fuel in your car, it costs money for the wear and tear on the car, you need to have purchased car insurance and have a license to drive the car, not to mention the cost of the meal when you arrive. Did you consider all that?

Ok, now imagine you're 16 years old again and you want to have lunch with some friends.  You don't own a car and you don't have gas money because you rely on your parents for an allowance and you spent it all on a video game last week.  So your friend (who is 17 and has a job) decides to help you out.  They come pick you up and buy your meal for you.  It's a little annoying but they don't mind.

Being in the military is like being 16 years old again.  You have almost no control over the amount of your "allowance" that comes in each month and you foot the bill for your own dental license and often for your own CE courses.  You hope the "allowance" comes into the clinic on time so you can buy what you need and if it doesn't, you're going to have to choose between gas and food.

This sounds a little extreme, but it does happen.  The government has situations where they can't promise money to a medical clinic or dental clinic, and so your clinic may be forced to operate on a drastically reduced budget.  So what's the benefit in that?

Learning how to operate a clinic for 5 months on a budget roughly 35% of its normal size when you're in charge of ordering supplies for the clinic, forces you into all kinds of new and uncharted territories.  Finding out which items are crucial to not only keep the clinic open, but to maximize the potential to meet the specific mission of your base, is no easy task.  Saying "no" when people ask if you can buy this or that, or completely reorganizing every treatment room to streamline your supplies so that absolutely nothing goes to waste, are two delicate but vital strategies.  Some day you'll leave the Air Force and be a grown up dentist, not reliant on the Air Force's "allowance" anymore.  But those important financial pivot points will already be part of your natural decision making process.  Lucky you!

Not having money obviously means not having what you want.  But often times the standardization of the clinic will trump your preferences.  The benefit here is flexibility.  You'll need to learn to work with other doctors (and even your assistants) to come up with supplies you can all agree on.  It may not be your favorite bonding agent, for example, but it's cheaper and more efficient and the expiration dates are 2 years out, so it fits well within your clinic's goals.

These are the type of weird supply decisions that have to be made when there are people moving in and out of your clinic every few months.  We are fortunate enough to have such a tight-nit group of doctors at Eielson that agreeing on standardized supplies is rarely a problem.  Again, knowing the clinic's main mission helps clarify and point us in the right direction.

Here are questions we have had to ask ourselves at Eielson when considering changes in supplies:

Should we focus on getting every doctor exactly what they want, or take into consideration that assistants will get confused if every treatment room is set up differently?

Do we buy burs for $0.98/each and put the sterilization burden on someone to package all of these burs for us, or do we order burs that come sterilized from the factory for $1.01/each?

If diamond burs are not consistently cleaned properly, or sometimes get dull without the next doctor knowing, is it worth it to re-process these or should we move to single-use diamonds?

The list goes on and on.  The supply game is a hard one to play, especially in light of the money game!  But learning how to make compromises and think of the clinic mission every time you make a supply decision will lead to huge benefits in how you eventually think about your own practice some day.



I hope this post was helpful.  My goal here was to pick out 3 topics (people, time, and money) that are most often cited as downsides to military dentistry and show you how, when looked at from a different angle, are actually 3 of the biggest benefits. As always, email me (see right side of blog) if you ever have any questions!