tag:blogger.com,1999:blog-31917519568417412092024-02-07T18:53:36.934-06:00Air Force Dentistry from College to CaptainA complete account of what it's like to be an Air Force dentist through the eyes of an HPSP student - Matthew Lee, DDSUSAF DDShttp://www.blogger.com/profile/16462820168288467617noreply@blogger.comBlogger56125tag:blogger.com,1999:blog-3191751956841741209.post-56929719817813595212020-02-11T18:33:00.002-06:002020-02-11T18:33:27.267-06:00Farewell, a decade laterI started this blog 10 years ago, today.<br />
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My life has been surprisingly predictable if you were to look forward way back in 2010 and try to guess where I would be today.<br />
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Granted, the path was well-marked. I had just gotten accepted to dental school and received an HPSP scholarship, so things were pretty predictable from there. But the journey was anything but predictable. Multiple moves, all the people I met, the things I saw and learned. None of them were on my radar in February 2010.<br />
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I'm happy to announce that I'm grateful for the path I chose all those years ago and wouldn't change a thing about it. The destination was what I had hoped it would be, and what I had planned to do.<br />
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I am still happily married, have my first child on the way, own my own dental practice, and am genuinely grateful for all the people I met along the way in this last decade of my life.<br />
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As of know, I don't plan to monitor this blog any more or post any further updates. If something changes, then you'll know!<br />
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But for now, thank you. Thank you to all the hundreds of people that emailed me along the way and made me part of <b>your</b> own journey. I hope it's everything you dreamed it would be.<br />
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Thanks for reading for the last decade.<br />
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Here's to another wonderful 10 years, and many more!<br />
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Signing off,<br />
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Matthew Lee, DDSUSAF DDShttp://www.blogger.com/profile/16462820168288467617noreply@blogger.com0tag:blogger.com,1999:blog-3191751956841741209.post-91786044569618116482019-09-02T18:17:00.003-05:002019-09-02T18:28:48.016-05:0045 Days of Practice Ownership<div class="separator" style="clear: both; text-align: center;">
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I alluded to it in my last post, but I have officially purchased a dental practice in Greeley, CO.<br />
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The name is <b>NorthStar Dental</b>, and you can find me on the web in these locations:</div>
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Website: <a href="http://northstardentalgreeley.com/">NorthStarDentalGreeley.com</a></div>
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Twitter: <a href="https://twitter.com/nsdgreeley" target="_blank">@NSDGreeley</a></div>
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Instagram: <a href="https://www.instagram.com/nsdgreeley/" target="_blank">@NSDGreeley</a></div>
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Facebook: <a href="https://www.facebook.com/NorthStar-Dental-100869881283040/" target="_blank">Click here</a></div>
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I've learned a few things in my first 45 days, but I mainly want to discuss the differences between military dentistry and civilian dentistry here.</div>
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<b>1. Treatment planning</b></div>
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Military treatment planning is very conservative. This stems from the fact that we are often so booked out, that it's easier to push off that tooth with some visible fracture lines to next year, or do a big filling and hope it doesn't break in the meantime, rather than stuffing the schedule full of crowns.</div>
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In civilian practice, you can pitch the option of a crown as soon as you know a filling is a poor long term solution which means your crowns are going to be far more predictable and often not require a core buildup for the patient (which saves them $) if the existing filling is small.</div>
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<b>2. Problem solving</b></div>
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The military has a multitude of issues but most of them are small. However, this constant small background annoyance is akin to a constant static slowly invading your work life. There's a lot of problems that you can't fix at all, or that take so long to fix that you just start to ignore them.</div>
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In civilian practice, problems get solved very quickly. There's a host of helpful people waiting to service your practice via equipment purchases, financing, supplies, etc. </div>
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Example: It took 8 months to get new curing lights in the military. In my new practice? 4 days.</div>
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<b>3. Administrative tasks</b></div>
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One big benefit of the military is that you have a lot of enlisted personnel to help with admin duties. But wait a minute, you also have your own! Writing notes, running programs, the list goes on and on. None of them are that hard, but again, it's like the constant static in the background.</div>
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In civilian practice, you have far less that you are "required" to do yourself (treatment notes are an obvious example here). Not to mention you can run your "programs" (referrals, etc) however you want! My admin burden is probably 10% of what it was in the military. My staff is small and efficient and takes most of this load away. Now, I do have a host of new issues to deal with, but with the right leadership background, I have had no problems at all with these new items and I have <b>more</b> down time (yep) than I did in the military.</div>
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<b>My overall thoughts after 45 days:</b></div>
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I have been totally surprised at how easy the transition to civilian practice has been. The everyday joy of treating patients that actually chose to come see you cannot be understated. Having a very small team of highly motivated individuals makes you far more productive than having large military teams (ironically) bogged down with red tape and hours of extra non-dental work. The nearly total lack of administrative tasks in the civilian world is a dream. Solving problems instantly means that there's no buildup of stress "static". Being able to actually lead a clinic and have ultimate autonomy is wonderful.</div>
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I've loved it so far. If I had to put a number to it, I would say it's about 20% as stressful as I expected, and 2x as fun.</div>
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<b>My big caveat: </b><br />
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If you're thinking of getting out just to associate forever, think twice. The military has such a great end goal for those that can stay for 20 years, and many private offices hire associates too early which means you won't be busy enough. Working for a corporate office might work because they typically have a better pulse on their needs, but you may burn out quickly because you'll definitely be seeing more patients.</div>
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So let me encourage those that are considering getting out. Do it!</div>
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If... you want to own a practice :)</div>
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P.S. If you decide to get out, you *must* use an intraoral camera for *every* exam finding. Showing the patient what you are seeing is far and away the best tool for gaining trust and building rapport. </div>
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USAF DDShttp://www.blogger.com/profile/16462820168288467617noreply@blogger.com0tag:blogger.com,1999:blog-3191751956841741209.post-83947715700690261962019-06-24T19:30:00.001-05:002019-06-24T19:31:37.134-05:00The End of the Beginning -- And An Offer for ReadersI started this blog in February 2010 with the intention of chronicling my journey as an Air Force dentist and being a resource to help out people who had questions.<br />
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I was "scratching my own itch", if you will. I didn't see anything on the internet like what I wanted to read. So I made it myself.<br />
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500 emails, 250,000 page views, and a few phone calls later, I'd say it was quite a success.<br />
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After a long 10 years, I am finally in the process of leaving the military and acquiring a dental practice for myself. I can't say really anything more than that, but now you know. I've already learned a ton along the way, and I'm hoping to help military dentists get over the fear of transitioning into practice.<br />
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If you're a dentist (military or otherwise) considering transitioning to ownership, <b>please contact me (my email is on the right side of the page)</b>!<br />
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I would love to help you better understand if this is the right step for you and even do some help you look at different practice offers, associate contracts, or just brainstorm your next steps.<br />
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As for the future of this blog...<br />
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I've struggled recently trying to decide what direction to take it, if any, given the facts that:<br />
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1. I'm leaving the military (so the title doesn't work super well)<br />
2. It makes me no money (so I can't sell it)<br />
3. It's a very narrowly focused/designed blog (so there's not much else to explore)<br />
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However, I think it may be beneficial to continue my story in some way and I haven't quite decided if that will happen here at this domain or on some other blog that is tailored more towards my next phase in life. Stay tuned.<br />
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I've received literally hundreds of emails over the last decade and this blog has been a central location for those looking for information about military dentistry, the Air Force HPSP, dental school, and life in the military.<br />
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My email is still live, so keep the questions coming! Like I said at the top of the page, I'm welcoming any and all questions from those looking to transition to ownership.<br />
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It's been an honor and a pleasure, and I'm excited for the next step in my journey and helping you with yours.USAF DDShttp://www.blogger.com/profile/16462820168288467617noreply@blogger.com1tag:blogger.com,1999:blog-3191751956841741209.post-76506998570231560522019-01-23T19:45:00.000-06:002019-01-23T19:56:02.054-06:00Nuts and Bolts - Part 3/3 of Organizing a Military Dental Clinic<span style="font-size: large;"><b>Nuts and Bolts - Part 3/3 of Organizing a Military Dental Clinic</b></span><br />
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Practical tips for making your clinic more efficient. These are actual, real world things you can do to help improve different areas of your clinic.<br />
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<i>Post contents:</i><br />
-Supplies<br />
-Patient Records and Forms<br />
-Meetings<br />
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<u><span style="font-size: large;">Supplies:</span></u><br />
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<b>1. Everything has a home</b><br />
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Make sure every single supply has a "home". Some bases have storage areas that can accommodate everything, but some don't. That's ok! Everything should still belong somewhere. NEVER order a supply and deliver it straight to the treatment rooms only and don't just throw the box on a shelf somewhere. You MUST have an area that the rooms are restocked from that itself is a holding area for the clinic. <b>An assistant should never ever ever ever run out of an item and not know where to look for more. The process CANNOT be "tell me when you're low". The item must have a home!</b><br />
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With that being said, this "home" should have standardized labels! NEVER place a box on a shelf by itself unless it's a large box and <b>the shelf itself has a label</b> for that item. Always place the box, or the items in the box, into a standardized container with a label on the front that will allow ANYONE to find that item again later. See #2 for how to do this.<br />
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<b>2. How to label item containers in supply areas</b><br />
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Every item must be labeled on a standard container with at least the following information:<br />
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-Item Name<br />
-Manufacturer<br />
-Manufacturer Number<br />
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These 3 pieces of information are all you need to reorder the correct item. Do NOT just rely on the name alone. Too many products sound similar to trust the name alone! We moved to this system at my previous base and one had 1 item ordered incorrectly in 2 years. At my new base? We accidentally ordered an extremely similar, but extremely wrong, version of the "right" product last month that has wasted money and time, not to mention we have to start over and order the right thing (which we are now out of).<br />
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We are working on it :)<br />
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<b>3. Have a doctor supply huddle</b><br />
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Every time you get new doctors in the clinic, sit down and go over the supplies. There's no reason that the doctors in the clinic can't compromise on 1 or 2 types of bond. Every single doctor should not have a special bond for themselves. This is ludicrous and adds unnecessary work and strain on the supply chain. Bond is just one example, but it goes for everything.<br />
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<b>4. Develop a simple system for alerting the person who does the ordering</b><br />
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Here are some ideas that have worked well --<br />
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<li>Place a sticky note on the low supply container. The Logistics person sees the sticky note and orders more. When they order more, they write the date the item was ordered on the sticky note and the sticky note stays on the item until it comes in, at which point the sticky is removed and the item is restocked.</li>
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<li>Pros</li>
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<li>Eliminates verbal communication </li>
<li>Eliminates Logistics person being notified multiple times about the same item</li>
<li>Eliminates the assistants and doctors wondering when an item was ordered</li>
<li>Good for clinics with 1 supply area</li>
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<li>Cons</li>
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<li>Stickies sometimes fall off</li>
<li>Required Logistics person to visually scan supply area</li>
<li>Not ideal for clinics with multiple "main" supply area</li>
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<li>Create a re-order clipboard. The logistics person keeps this clipboard in their area and techs and docs come write down items they need.</li>
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<li>Pros</li>
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<li>Centralizes all ordering information</li>
<li>Good for clinics that hold supplies in multiple areas</li>
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<li>Cons</li>
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<li>Same item might get logged multiple times</li>
<li>Handwriting might be an issue</li>
<li>Often still required Logistics person to go look for the low item to decide how much to order</li>
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<li>Create order sheet binders or forms that can go in special areas. Many clinics have supplies that are exclusively held in an Endo cart or Surgery room. Hang a printed and laminated Excel sheet with the applicable information (name, manufacturer, manufacturer number) in the room or on the actual cart itself. </li>
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<li>Pros</li>
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<li>Makes reordering very simple, because the item is identified as being low and the reorder information is right there</li>
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<li>Cons</li>
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<li>Make sure the sheet stays updated with new items or item changes</li>
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<li>BONUS: Same as the "order sheet binder" idea, but just place the info in a relevantly placed Excel document on a shared computer drive. Post the location of the document in the relevant location. This is the same concept as the binder, but more accessible for the person who likes their information digitized. Plus, when you modify it, there's no need to print it off.</li>
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<b>5. Consider pre-sterilized burs</b></div>
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I love these so much. Individual burs, sterile from the factory, at practically the same cost as whatever burs you are currently using. </div>
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<li>Pros</li>
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<li>No more nasty looking bur blocks!</li>
<li>No more burs running through sterilizers 20 times (or more) before they get used</li>
<li>No more "is this rust or blood"?</li>
<li>Eliminates entire process for your sterilizer workers</li>
<li>Safer for everyone (assistant, doctor, sterilizer techs) due to fewer burs needing to be handled (ie: decreased needle sticks)</li>
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<li>Cons</li>
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<li>Takes up more physical space in the treatment room and in the supply area</li>
<li>Packages must be opened when needed, stalling your work slightly during the appointment vs having an open bur block with several types of burs</li>
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Brasseler and SS White make tons of these. There are other companies as well that should be easy to find with a Google search. Email me if you want some catalogs. I also recommend some magnetic bur holders from Dux Dental to act as temporary bur blocks.</div>
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<b>6. Standardized treatment rooms</b></div>
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This is easier if your clinic was built so that all the rooms are the same. This is far harder if you have various types of room layouts in your clinic. Consider at least making all the basics (barriers, suction, etc) standardized. At my previous assignment, we had literally every room standardized, with the exception of the 3rd drawer in a rolling cart, so the doctor could add special things they wanted into that specific drawer.<br />
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This made room checks unbelievably simple. Doctors could move to other rooms in a breeze. Assistants knew where everything was in every room. It's a dream come true.<br />
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My new clinic was built within the last couple of years, but was actually designed very poorly with little foresight. We have 3 different types of room configurations in the clinic among our 12 treatment rooms (in addition to a severely dwarfed main supply area). I'm still scratching my head trying to figure out how best to serve our patients with these bizarre construction limitations. If I had it my way, we would demo the place and start over! Whoever designed Buckley would have been wise to recall this famous quote: "Begin with the end in mind" -Steven R Covey.</div>
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I put this step last on purpose. You must have the previous 5 things accomplished or the standard room will be a nightmare to try to create and enforce.<br />
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<b>Note: In order to make this stick, you must have the room photographed so that binders with these photos can be made of what a "perfect" room looks like so the standard you create isn't lost! The binders are used by the techs to standardize the rooms, and used by the docs and NCOs to enforce the standard. </b></div>
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<u><span style="font-size: large;">Patient Records and Forms:</span></u></div>
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<b>1. Have a weekly record scan program</b><br />
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I wish I thought of this one, because it's so simple. Basically, you have someone in charge of reviewing a set of records weekly.<br />
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You have a form on the wall where that person can log the date, the record range they checked, and how many errors they fixed.<br />
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<i>Common errors to look for:</i><br />
Duplicate records<br />
Poor handwriting (rewrite the record)<br />
Misfiled records<br />
Records with missing or incorrect colored tags and papers<br />
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This would be in addition to the monthly records review, because that program doesn't hit every record. This does!<br />
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<b>2. Put all the forms in the same place on the network drive</b><br />
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Nothing drives me crazier than having a medical history in this folder, the initial charting in that folder, etc.<br />
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Put them all in one spot! Here's why:<br />
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Makes it simple to train new people (the forms are <b>here</b>)<br />
Makes it easier to update forms (this is the only version of the form, let's update it)<br />
Eliminates redundancies (no more having 3 versions of the same form floating around)<br />
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<b>3. Develop a naming system for the files so they are printed correctly</b><br />
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This is how we name our files:<br />
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"(BW, Yl, Double sided) Fly Cover Sheet, updated 31 Oct 18"<br />
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This naming scheme answers 5 questions:<br />
1. Black and white, or color?<br />
2. What color paper do I print it on? (In this example, Yl stands for "Yellow")<br />
3. Do I print double or single sided?<br />
4. What form is this?<br />
5. When was this form last updated?<br />
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No more misprinted forms! Yay!<br />
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<b>4. Put the date the form was updated on the form itself</b><br />
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In the example in #3, we would also have "updated 31 Oct 18" printed somewhere on the Fly Cover Sheet itself. This helps us know if a form we are holding in our hands is the most recent version or not.<br />
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<b>5. Put physical forms in as few locations as possible</b><br />
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No more forms in treatment rooms. Period. This is where forms go to die and get resurrected 2 years later in a chart out of nowhere.<br />
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Find a centralized location, or two, that all the forms can be stocked. This is much easier to replace forms and make sure everyone is using the same version now that they aren't scattered to the 4 corners of the Earth.<br />
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<b>6. If the form is part of a program, type the directions ON the form itself</b><br />
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Class 3 forms are standard in the Air Force, but we added a couple things to ours. We minimized some fonts to make room for these instructions:<br />
<br />
"Putting a patient in Class 3<br />
1. Have patient sign this form<br />
2. Write up treatment note<br />
3. Assemble completed chart and place chart in Class 3 box in records room<br />
4. Class 3 NCOIC will take chart and... etc...<br />
<br />
Taking a patient out of Class 3<br />
1. When treatment is completed, write treatment note<br />
2. Take the blue chart tag out of the chart<br />
3. Take this form out of the chart and place the form in the Class 3 box in records room<br />
etc..."<br />
<br />
Now, it's extremely obvious what to do with a Class 3 record! Again, this forces the doctor or tech to go through the proper steps, get the chart to the right person so that person can run their OWN checklist for the Class 3 program. This ensures that all Class 3 charts are handled identically, and HOW to handle them is clear and obvious.<br />
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How easy would it be to train a new person on what do to with Class 3 charts using the above instructions? If they can read, pretty darn easy.<br />
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<u><span style="font-size: large;">Meetings:</span></u><br />
<u><br /></u><b>1. The length of a meeting is a maximum time limit</b><br />
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Don't feel obligated to stretch the meeting to fill the time allotted. Consider that a "maximum time". If the goal of the meeting is accomplished sooner, leave!<br />
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<br />
<b>2. Have an agenda for every meeting</b><br />
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This is why people hate meetings. They turn into a circus of confusion and pointlessness. If the goal of the meeting is "let's brainstorm XYZ" then that's great! But set aside time for that type of work, don't make it the default. For everything else, plan it out in order and get to it. A powerpoint on the wall that helps guide the meeting is a great way to keep everyone on task.<br />
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<br />
<b>3. Don't hate the meeting, hate the chaos</b><br />
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This sort of goes back to #2, but don't hate the meeting itself. If you are prepared with an agenda for the meeting, then implement it use this time to work ON the business/clinic. This is the time to build a better machine! If absolutely no one wants to attend the meeting, you should think very hard about why it exists at all, or how you can make it more efficient (or how you can convince the team that the meeting will result in better outcomes). To gauge interest in the meeting, don't ask a large group. Ask individuals one-on-one.<br />
<br />
Don't eliminate the meeting just because you as the meeting leader don't see the purpose. There could be other people looking forward to that meeting for a variety of reasons and they deserve the chance to speak in that setting if they were expecting it.<br />
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Most meetings need to happen, but simply don't have an aim and end up running into chaos problems.<br />
<br />
<br />
<b>4. Be prepared and be decisive</b><br />
<br />
Meeting chaos stems from a variety of places I've already mentioned, but the big one is indecisiveness. Make the decision and move on. "Let's talk about this later" is still a decision. Don't let a group of people spin on a topic forever unless the purpose is to get everyone to brainstorm ideas.<br />
<br />
Actually, most decisions are made before the meeting beings (most meetings are a time to disseminate information), unless there is designated decision-making or brainstorming time. If you are prepared for the meeting, a lot of it should be delivering clear and concise decisions to the relevant group, or soliciting feedback from a group to finalize a decision. Once you get the feedback, finalize it. Start moving on it. You can adjust later.<br />
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Also, it shouldn't take an entire meeting to decide the theme for the summer picnic so don't let it. Most people won't care anyway, so have a separate conversation later with the group that cares... which brings me to point #5.<br />
<br />
<br />
<b>5. Don't waste everyone's time</b><br />
<br />
If the decisions in the meeting, or outcomes of the meeting, are only relevant to 1 or 2 people there, consider having a discussion with those people only. The entire clinic doesn't need to hear a discussion about which bonding agent 3 doctors like the best.USAF DDShttp://www.blogger.com/profile/16462820168288467617noreply@blogger.com0tag:blogger.com,1999:blog-3191751956841741209.post-33766191905701794952019-01-13T16:17:00.003-06:002019-01-13T16:17:56.147-06:00Principles for Thinking - Part 2/3 of Organizing a Military Dental Clinic<b><span style="font-size: large;">Principles for Thinking - Part 2/3 of Organizing a Military Dental Clinic</span></b><br />
<b><br /></b>Below is a list of concepts, ideas, thinking principles, thought experiments, mental models, or whatever else you want to call them. I do not claim to be the originator of any of these concepts, but all of the following are some synthesis of the many ideas I've gleaned from the books I've read and the experiences I've had.<br />
<br />
They are "how to think" about certain types of problems, without delving into any specific issues. Hopefully these can be useful ways for you to think about problems as you work to come up with solutions.<br />
<u><br /></u>
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<u><br /></u>
<u><br /></u>
<u><span style="font-size: large;">Would they choose to come here? (for military clinics)</span></u><br />
<u><br /></u>If your patients had a choice, would they choose your clinic? In the military, they don't have a choice! This question is the best way to think about the entire patient experience, and will ultimately lead to a more streamlined and efficient clinic all around.<br />
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<u><span style="font-size: large;">Build it for the new person</span></u><br />
<u><br /></u>You should do your best to *<b>never</b>* build a system just to accommodate a person. You build it to accommodate a position and fulfill the purpose of that role. Now, having said that, you may have to tweak it for a certain person but the resulting outcome should not change.<br />
<br />
Example: some people prefer digital lists of supplies while others prefer written lists. The resulting outcome should still be identical.<br />
<br />
When creating a system, imagine yourself as a new person walking into the clinic for the first time and as yourself the following question.<br />
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<b>How <u>quickly</u> could we train a <u>new person</u> to be proficient enough to run this system <u>alone</u>?</b><br />
<b><br /></b>This question is the measuring stick for every system you create. The quicker the training to sufficient proficiency such that you trust them by themselves, the better the system.<br />
<u><span style="font-size: large;"><br /></span></u>
<u><span style="font-size: large;">The poisoned river problem</span></u><br />
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Imagine a village living on the edge of a river. One day, the water in the river starts making people sick. What is the best way to solve this problem?<br />
<br />
1. Build a water filter<br />
2. Remove the contamination upstream<br />
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Most people will answer #2 but actually do #1 in their life, because #1 simpler. Don't give in. Solve the <b>real</b> problem! Stop building filters. Filters are for emergencies, they are not solutions.<br />
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<u><span style="font-size: large;">Ask "why?" several times</span></u><br />
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I can't remember specifically where I learned this, but "why" is the most powerful tool you have to get to the root of any problem. It should be asked several times before settling for the answer.<br />
<br />
This is a summary of a real conversation I had a few months ago.<br />
<br />
Me: "<u>Why</u> are we out of XYZ forms?"<br />
Person A: "Well, Person B isn't here"<br />
Me: "<u>Why</u> does B need to be here?"<br />
A: "She prints them" // *<b>(MOST PEOPLE STOP HERE!)*</b><br />
Me: "<u>Why</u> can't you print them?"<br />
A: "I don't have access to the forms"<br />
Me: "<u>Why</u> not?"<br />
A: "I don't know, they tried to give me access but it didn't work"<br />
Me: "<u>Why</u> didn't you follow up?"<br />
A: "Person C was working on it but I haven't heard anything"<br />
Me (talking to C): "<u>Why</u> doesn't A have access to the forms?"<br />
C: "Person D is in charge of that, and I tried for a while to get A access but they couldn't do it"<br />
Me: "What is D's email address?"<br />
...<br />
<br />
In 2 hours, person A had access to the forms via an email and phone call I had with person D. Most people would stop at the first question and just accept the problem. No more!<br />
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<u><span style="font-size: large;">Pay attention to your shoulders</span></u><br />
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Shrugging your shoulders is admitting defeat. I do this too, usually without thinking. But don't let the shrug be the final response. You know you're making things more efficient and simpler when the shoulders of people around you are being shrugged less and less.<br />
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A shoulder shrug says "I don't know, I don't want to put in the effort to find out, and I give up".<br />
<br />
It's ok to not know, but it's not ok to not know who DOES know or how to find out. A shrug is an indication that people are too far removed from the solution to take any action at all. A shoulder shrug is an indication to make things easier or more accessible!<br />
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When someone shrugs their shoulders, this is a silent request for a better system.<br />
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<u><span style="font-size: large;">Remove redundancies</span></u><br />
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If there's 3 versions of the same thing, but only 1 is the real version, hunt the other 2 down and get rid of them. Bonding agent, rubber dams, paper forms, whatever.<br />
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Having more than 1 version of something, especially if it's no longer used, adds confusion to the supply chain and your clinic at every level.<br />
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<u><span style="font-size: large;">Organize relentlessly</span></u><br />
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This sort of plays off the previous comment, but be relentless in your pursuit of organization. Do not accept clutter. A cluttered work space (unless a project is in progress, obviously) means the mind is cluttered. Our mind is a powerful tool, don't waste its energy on clutter.<br />
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<u><span style="font-size: large;">Don't let other people dictate your programs</span></u><br />
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Put your foot down, standardize the process, write down how to implement it, enforce the rules you set, and watch the chaos subside. This often takes lots of up front work (although sometimes it just takes making a decision to stop tolerating something), but the ultimate result is a better process for everyone, and a happier work-life for you.<br />
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<u><span style="font-size: large;">Don't ever rely on verbal transfer of information alone, except in emergency situations</span></u><br />
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Every important verbal exchange should be followed by an email or a note, and every interaction you have with those you work with that involve one-way exchange of information should involve as little verbal communication as possible because this is where things get either confused or forgotten. Exceptions are very routine items that require very short instructions, like "please check XYZ before you leave today". An email would defeat the purpose here.<br />
<br />
Sometimes conversations must be had in person, and they are more efficient that way, but summarize the conversation with a note or an email, especially if action will not be taken on that item immediately.<br />
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Example: If you're running logistics, don't let people come <u>tell</u> you an item is low. Have them mark the low item bin itself or write it down on an order form (more on that in part 3). Asking them to verbally tell you something is begging for trouble. Some day, you will forget or hear them wrong, or they will get used to telling you and filling up your brain instead of putting the information somewhere simple for you to access.<br />
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<u><span style="font-size: large;">Think into the future</span></u><br />
<u><br /></u>The clinic needs enough supplies to last through a shortage, and enough notice to get an item before it runs out. If you know that product X takes 30 days to come in from the day you order it, you better have some way to know when you are getting close to a 30 day supply. Stop waiting for the product to dwindle down and then panicking that it's low. This also touches on the previous point. If you run into this problem once, design a better way to communicate.<br />
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If the same problem happens again, that's on you. You're not thinking into the future. This is a key mistake I see people make very often.<br />
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<u><span style="font-size: large;">Have projects ready for down time</span></u><br />
<u><br /></u>Sometimes things break. Sometimes patients cancel. Have some projects ready that can be handed off and worked on during this down time. Stop just working "in" the clinic and start working "on" the clinic.<br />
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Everything can be simpler, better, or faster. Everything. Make it so.<br />
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<u><span style="font-size: large;">Your clinic is a machine. Build a better machine.</span></u><br />
<u><br /></u>Could you imagine the hilarity of watching a family push a Flintstones-style car down the highway? It would be absurd.<br />
<br />
But we do this ALL THE TIME! How often have you watched a coworker (you and I aren't exempt here) complain about a process but fail to actually do anything about it? They keep pushing their Flintstones car down the highway, complaining about how slow it is, and never really thinking it might be time for a new car.<br />
<br />
The car is a symbol of the system you've created. If you're not getting the result you want, build a better system!<br />
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<u><span style="font-size: large;">Put instructions at the point of contact</span></u><br />
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If you want someone to do something when they encounter an particular object, make it obvious.<br />
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Example: If you want people to know where they can print new forms, post an address to the computer drive on the wall above the paper forms! Tada!<br />
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<u><span style="font-size: large;">The good system you'll actually do is better than the perfect system you won't</span></u><br />
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I don't care how good a system is. If it's too complicated or burdensome to actually use, it's no good. Make something that's good enough but simple enough that people will actually follow it. Then you can gradually improve the system from there.<br />
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<u><span style="font-size: large;">Start now, but make things editable</span></u><br />
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There's two problems that occur when you make a system too hard to modify:<br />
<br />
1. You have your ego tied up into the time it took to make it perfect<br />
2. You're more reluctant to change it because it will take a lot of effort<br />
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Example: At my first base, I typed labels for all our supplies. It looked nice, but it took forever and was a pain to change. At my new base, I made blank cards that we can just handwrite. It doesn't look as nice, but it's been much easier to make changes and it works functionally just as well as the typed versions. Besides, once we are stable for a while, I can always go back and type the labels.<br />
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Get started, but be prepared to change course. It doesn't have to be perfect before you begin. In fact, it shouldn't be.<br />
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<u><span style="font-size: large;">Be thankful</span></u><br />
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Give people specific thanks and praise for what they do. Every. Single. Day.<br />
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People are far more motivated to continue doing good things than being constantly told to fix bad things.<br />
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<u><span style="font-size: large;">Write it down, and take a picture</span></u><br />
<u><br /></u>If you want something TO GET DONE a certain way, <b>write</b> it down. Checklists, how-to guides, easily accessible Powerpoint presentations... it doesn't matter. Don't rely on mouth-to-ear transfer of knowledge.<br />
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If you want something to LOOK a certain way (a standardized room, for example) then you MUST take <b>photographs</b> and make them easily accessible. Photos are the gold standard for standardizing anything visual.<br />
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Bonus: Add pictures or computer screenshots, where applicable, to whatever written process you want people to follow for added clarity.<br />
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<u><span style="font-size: large;">If you want it to <b>fail</b>, fix it and walk away</span></u><br />
<u><br /></u>This sort of piggybacks off of the previous point, but you must have a process for duplicating your solutions.<br />
<br />
Here's the progression, applied to treatment rooms:<br />
<br />
1. Create the standard (develop a standard treatment room) <b>*(MOST PEOPLE STOP HERE)*</b><br />
2. Make the standard reproducible (take photos of a perfect room setup)<br />
3. Give people time to hold the standard, and then enforce the standard (the photographs, not a person's opinion, is the ultimate authority, so use them to enforce the standard)<br />
4. Develop repercussions the failing the standard (what happens if the standard is not met?)<br />
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<br />
<u><span style="font-size: large;">A car uses more energy than a spaceship (how to create a system)</span></u><br />
<br />
Ok, sort of. A spaceship uses WAY more energy to get off the ground and into space. But once it's in space, it's aided around the Earth by the force of gravity and does very little work to propel itself in orbit. Eventually, it travels farther than a car could ever go.<br />
<br />
A car is under the same gravitational influences, but it must have constant energy input because it deals with FRICTION. It takes way less work to move a car on a road than a spaceship from a launchpad, but the car takes the same amount of work every single day, and ultimately, the car can't go that far.<br />
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Look for <b>friction</b> in your clinic. Where are people complaining? Where are people bumping up against the same problem over an over? Where are things harder than they need to be? Where are things taking 5 steps when they could take 3? Where are efforts being duplicated for no reason?<br />
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Can you be a spaceship and put in a lot of energy up front right now to make the friction go away forever?<br />
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This is how you create a good system.<br />
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(Amazon's "One-click ordering" is an example of reducing friction)<br />
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<u><span style="font-size: large;">A system is a 3-part answer to "how do we... ?"</span></u><br />
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The answer to this question must be:<br />
<br />
1. Obvious ("here's an <b>obvious location</b> to find clear, documented directions on how to handle certain patients")<br />
2. Clear ("here it is, documented in <b>easy-to-understand and follow</b> language")<br />
3. Documented ("here it is, documented completely, so that <b>you could do what I do if I'm not here</b>")<br />
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If you don't have these three components, you don't have a complete system. <b>People plug the holes of incomplete systems. </b>An incomplete system is going to collapse when the person (or people) that is running it eventually leaves.<br />
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If you have someone just manhandling the Class 3 program, answering all the questions, doing all the work, but none of what they do is obvious, clear, and documented for someone else, you are asking for problems.<br />
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Tip: ask people to document their own jobs! Most are happy to do so.<br />
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<u><span style="font-size: large;">Create decision ladders</span></u><br />
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For my Class 3 program, I have a file on the computer that is basically a "how-to" guide called "Class 3 Operations Manual".<br />
<br />
Open that document and you'll find only 3 main points. What do do daily, what to do weekly, and what to do monthly.<br />
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Each section has references to other places on the network drive where there are directions on how to create certain forms, how to log our patients, and where the log is located.<br />
<br />
In fact, once you navigate to the patient log, the log itself has instructions on how to use it!<br />
<br />
Do you see what I've done? I hand over the starting point (the "Class 3 Operations Manual") and it points the reader--<br />
<br />
Where go to<br />
When to go there<br />
What to do when they get there<br />
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Boom. All they have to do is open that first document and "climb the decision ladder" to each step. Every rung is built for them. There's only one way to do it.<br />
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Systems fail when there is a gap in the ladder so wide that the climber has to find another path to keep climbing. That's where mistakes are made.<br />
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<u><span style="font-size: large;">Don't let old problems disguise themselves as new problems</span></u><br />
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Sometimes we fix a process, but something that was created under the old process pops up and causes discouragement.<br />
<br />
If you created a new process on 1 October, 2018, then give it some time! If a problem pops up that was created before 1 October, 2018, no sweat. That problem says absolutely nothing about your new system!<br />
<br />
Now, if the problem popped up in November, then you may need to do some tweaking. But old problems will bubble up, just have your head wrapped around when the problem started and don't nuke your new system or add a bunch of new steps just because old problems are still out there.<br />
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The goal of the new system is to prevent new problems from arising.<br />
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<i>Side note: It might also be good, when creating a new process, to have a sister-process that can go try to hunt down old problems that might exist. The sister-process can be shut down when everything is corrected. (Example: you have a new chart color system, so new charts get the new colors as the patients come in for treatment, but for a while, someone needs to go through the old charts and proactively update their colors, too.)</i><br />
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<u><span style="font-size: large;">Don't enforce a standard that doesn't exist</span></u><br />
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"Have your rooms cleaned and looking nice by the end of the day" is 100% unfair.<br />
<br />
Your definition of that statement may be different than the person who has to clean the room.<br />
<br />
Who is right? You both are. And by default, neither of you are.<br />
<br />
Have a checklist or photographs of every standard you wish to enforce. If the standard is unclear, make it clear and then <b>update the checklist/photos</b>. You cannot rely on someone's opinion as a "standard". This allows the standard to change on the whim of the person enforcing it. Not good.<br />
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<u><span style="font-size: large;">Ask "what's the most annoying thing you deal with?" and fix it ASAP</span></u><br />
<u><br /></u>
<a href="https://en.wikipedia.org/wiki/Learned_helplessness" target="_blank">Learned helpless</a> will drag someone down slowly over time, to the point that they may fail to realize that their situation is solvable or avoidable.<br />
<br />
People typically either:<br />
<br />
1. Fail to see the "real" underlying problem as something small and easily solvable<br />
2. See the problem, but lack the experience or critical thinking skills to come up with a sustainable solution<br />
<br />
Solving someones most annoying problem will accomplish and demonstrate a few things:<br />
<br />
1. Helps them realize their problems are really not that big, usually just an accumulation of small issues<br />
2. You're on their side, you are a team, and you want them to win<br />
3. Being "busy" and "stressed out" does <b>not</b> have to be the default operating mode<br />
4. Paying attention to the little things and fixing those can lead to a spiral of success, instead of a spiral of destruction<br />
5. Most of the things they don't like about their job are the accumulation of small loses, not just a few big problems<br />
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<i><br /></i>
<i><br /></i><u><span style="font-size: large;">Automate your brain</span></u><br />
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With calendar alarms, reminders, and digital to-do lists, you should never ever forget a task or an event.<br />
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If you are, you're relying on your brain to be a calendar or a to-do list. This is secretary work for your brain, something it's notoriously bad at doing.<br />
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Write it down, make a calendar alert, whatever you have to do. There is no excuse for "forgetting" these things, because <b>they should never try to be "remembered" in the first place</b>.<br />
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<u><span style="font-size: large;">Big goals, little steps</span></u><br />
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You can't complete big audacious goals in 1 day. Many will take months or years to fully realize. This can be hard in the military, but you <b>can</b> do it if you focus on the smaller pieces!<br />
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Set an intention to accomplish big things, but break the individual steps into small and manageable pieces that you can accomplish.<br />
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I even like to have daily goals that are very small (example: research 1 new item each day).<br />
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Here's why:<br />
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On your "off" days, when you're just too busy to really get anything done, you can still find time to do your one small step.<br />
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On days when a patient cancels or you have a ton of unexpected free time or energy, you can slay a weeks worth of work!<br />
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<u><span style="font-size: large;">Double the time, halve the results</span></u><br />
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Anticipate that any change you want to make will take twice the time and be only half as effective as you hope it will be.<br />
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This isn't to discourage you from trying to make changes, but to keep in mind that difficulties are often impossible to see, especially when the perfect end result is to clear in our minds.<br />
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Be prepared to work hard, long hours to get things done. Keep moving forward, and you will accomplish them.<br />
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USAF DDShttp://www.blogger.com/profile/16462820168288467617noreply@blogger.com0tag:blogger.com,1999:blog-3191751956841741209.post-66869003966973967572018-12-29T11:51:00.000-06:002018-12-30T20:07:38.519-06:0010 Books that Have Helped - Part 1/3 of Organizing a Military Dental Clinic<b><span style="font-size: large;"><u>Organizing a Military Dental Clinic - 3 part series</u></span></b><br />
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This is part 1 of a 3 part blog series called "Organizing a Military Dental Clinic"<br />
<br />
I'm going to talk about what I've learned from running logistics at 2 bases over the last several years, and hopefully it will help some military (and even civilian) dental clinics! I was fortunate enough to be part of some awesome teams that have won MAJCOM and Air Force level awards, but those victories were a testament to the systems and habits we created, not the will of the people in the clinics. I don't claim to have all the answers, but I have tried a lot of different things and I'm a relentless experimenter so hopefully these posts can help spark some new ideas for you and your clinic.<br />
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<b>Ordinary people can do extraordinary things with the right habits and systems. </b><br />
<b><br /></b>
<b>You don't need "superstars"; leaning on them may work in the moment, but things will crash when they are gone.</b><br />
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Let me say that one more time: this is not about the PEOPLE, it's about the SYSTEMS and HABITS you <u>create</u> and <u>enforce</u> over time.<br />
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There is a basic level of competency required, obviously, but I'm betting that most of the things your clinic does could be simplified significantly, making everyones job and life much more enjoyable.<br />
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<div style="text-align: center;">
-------------</div>
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<b><span style="font-size: large;">10 Books that Have Helped- Part 1/3 of Organizing a Military Dental Clinic</span></b><br />
<br />
Books are the #1 way I've learned (with podcasts coming in at a close #2) what you're about to read in this 3 part blog series. Obviously, the knowledge must be applied, but I firmly believe that <b>you can only imagine combinations of that which is already in your mind, and the best way to add new things to your mind is to digest knowledge from the great thinkers</b> via books and podcasts.<br />
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Here's my list of 10 books, in no particular order, that can help you become a better thinker when it comes to organizing your clinic.<br />
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<b>1. The Power of Habit - Charles Duhigg</b><br />
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<i>A modern classic on "how" to think about what we do every day. We are our habits. Instead of trying to change people, change the structure and incentives to drive them to the result they want. We aren't trying to change people, we are changing their habits. This is not a "quick fix" book, but it can lead to permanently new habits, which is the ultimate goal.</i><br />
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2. Extreme Ownership - Jocko Willink</b><br />
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<i>Stop blaming other people for failings that happen on your watch. If you're in charge, own it. This extends to your personal life as well, but is relevant here for your work, too. Discipline = Freedom. </i><br />
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3. The Goal - Eliyahu Goldratt</b><br />
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<i><span style="font-family: inherit;">This is a business book disguised as a novel (or maybe the other way around). It's a fun read that makes you think about how you can pull what you're learning into some real life actions for your business or clinic. This book gave me an actual idea for our supply chain at my first base that we ended up implementing and utilizing. For that reason, it had to make the list.</span></i><br />
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4. The E-Myth Revisited - Michael Gerber</b><br />
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<i><span style="font-family: inherit;">I wish this was <b>mandatory reading</b> for all Air Force officers. This is the bible for how to think about any organization, even in a 1-person shop. The basic premise is to imagine your business/clinic as a prototype model for thousands more (even if you never plan to build a thousand more). The reason? This will force you to simplify things so aggressively that your business/clinic will start to run well almost regardless of who you plug into those spots. People will need less and less training and expertise to run your ever simpler clinic as you trim waste and make things better. This is a vital concept for military leaders when we don't know who will come and go. </span></i><br />
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5. Principles - Ray Dalio</b><br />
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<i>Another modern classic. This will be a book that will go down in history as one of the most dense and actionable books ever written. I can't say enough about it. It's a big book, but it gives so many unbelievable mental models to think about your life and business/clinic. I wanted to dip the whole thing in highlighter. My favorite concept? Imagine yourself as 2 people (because you ARE 2 people -- reptilian brain and neocortex). Most people run life on autopilot (reptilian brain) without stepping back and imagining themselves from the outside. </i><br />
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<i>If you've ever played a video game, this concept comes easily. You are the person playing the game </i><span style="font-style: italic;"><b>and</b></span><i> you are the character participating. Most don't realize this and just behave like the character, reacting to everything in life, without stepping back and making intentional choices. It's very akin to the concept of working "on" the business and not just "in" the business, as laid out in Michael Gerber's <u>The E-Myth Revisited</u>. </i><br />
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6. The Life Changing Magic of Tidying Up - Marie Kondo</b><br />
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<i>Nope, not a joke. This book was written to help people organize their homes, but I can tell you, it is <b>much</b> more than that. This book helps you re-think about how you see "stuff" in general. This is an essential read for those wanting to organize anything in their life, and I'm dead serious. This will change your relationship with "things" forever, and by extension, dental supplies. You'll be much more decisive at ridding waste from your life, leaving room for the things that really matter. What could be more critical when trying to organize a dental clinic? Trust me on this one.</i><br />
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7. The Checklist Manifesto - Atul Gawande</b><br />
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<i>Ugh, not another checklist. Ok, look. I hate being told what to do with those silly things, too. But dammit, they work. I love it when a patient can get a consistent experience and ultimately, checklists are the best way to focus new hires, establish consistent protocols, and enforce processes. Checklists save brain power, they put everyone on the same page, and they eliminate confusion. This book will make you smile every time you see a well designed checklist, and it will make you much better at making them yourself to systematize your clinic. I love sneaking checklists onto all sorts of things without people even realizing what it is. More on that in part 2/3.</i><br />
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8. Essentialism - Greg McKeown</b><br />
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<i>This book is all kinds of awesome from every angle. The big takeaway here is to help your mind focus on what's really important. Too many of us treat our entire to-do list as an emergency and we end up freezing or just getting the wrong stuff done. It will help you think more about first-order problems instead of fixing the surface-level issue (you know, like the problems you "solve", only to watch them pop up again in a month?).</i><br />
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9. Switch - Chip and Dan Health</b><br />
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<i>I love this book so much. It was one of the first books I read on the subject, and I've gone over it several times since then. It will help you think more deliberately about how changing the environment itself can help drive the behavior you want. It's not just about changing the people, which often doesn't work, but changing the way they work to eliminate ways they could get off course. This book has been pivotal in my work over the last few years. Another book I wish was a <b>mandatory read</b> for Air Force officers. Shape the path!</i><br />
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<b>10. Ego is the Enemy - Ryan Holiday</b><br />
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<i>You're not that special. Seriously. Once you can separate your ego from what you're trying to do or create, the sky is the limit. The harder you hold onto what people think of you, the lower opinion they will hold of you. Strip your ego away, be definitive, make the hard decisions, and own the results. Apologize when you screw up, be transparent, and don't skirt responsibility. Those with inflated egos are typically the kinds of people that don't build systems, because they don't trust other people to run them or they are too insecure about what other people will think if it fails. Get over yourself ;)</i><br />
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<b>Bonus! The Power of Consistency - Weldon Long</b><br />
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<i>This was the book that convinced me I had to read more books. It's the best. I'll leave it at that.</i><br />
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I have a lot more books, so if you want more recommendations, don't hesitate to email me (see the right side of my blog for my email address).USAF DDShttp://www.blogger.com/profile/16462820168288467617noreply@blogger.com0tag:blogger.com,1999:blog-3191751956841741209.post-38037647037312004122018-11-27T20:22:00.001-06:002018-12-05T10:36:44.711-06:008 Year Recap Post, FAQ, and My FutureThis is an ambitious post. My goal is to make this post a very concise summary of my experiences over the last 8 years and answer some of the most common questions I receive via email, as well as an update on my future plans.<br />
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<b>Before dental school</b><br />
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<i>Recruiters</i><br />
If you have even the slightest inclination that you might want to pursue the Air Force HPSP (Health Professions Scholarship Program) for dental school, contact a recruiter. There is a link on the right side of my blog, or you can find it <a href="https://www.airforce.com/find-a-recruiter" target="_blank">HERE</a> and select "Healthcare Student or Professional".<br />
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Unfortunately, the recruiting system gets a bad rap for being unresponsive and often unhelpful, so if you're having trouble getting in contact with a recruiter in your area, start looking outside your area and contact one of those instead. They can probably help you get in touch with your actual recruiter who isn't returning your calls and emails.<br />
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<i>Application process</i><br />
Everything flows through the recruiter. You need to be in decent shape, have excellent grades and DAT, and nail your interview.<br />
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For the interview, focus on all the generic questions (strengths, weaknesses, etc), but be prepared for <b>additional questions</b> like: Why do you want to be in the Air Force? Why do you think you would make a good Air Force officer? What leadership experience do you have?<br />
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You're an officer candidate, not just a potential Air Force dentist.<br />
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<i>Choosing a school</i><br />
<b>Go to the school in the area with the cheapest cost of living! </b>Your stipend does not change based on where you live, and you'll devour the stipend if you're living in Los Angeles vs living in Oklahoma. I spoke about this on the <a href="https://www.choosefi.com/099r-market-fluctuations-stick-to-your-plan/" target="_blank">Choose FI podcast, episode 99R</a> at minute 57:40.<br />
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<b>During dental school</b><br />
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<i>Money!</i><br />
You get paid about $2,000/month during school, and the Air Force will pay all your other required bills directly. Some things (scrubs, loupes, books) will be on you to buy, and then you will submit some reimbursement paperwork to the Air Force. You should have some information of some contacts at AFIT that can help you out.<br />
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<i>Military obligations</i><br />
You don't have any! Yay!<br />
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<b>After dental school/AEGD-1</b><br />
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<i>COT</i><br />
The timing of COT depends on your school summer schedule and when you commission, but most dentists go after dental school. You may find the <a href="https://drive.google.com/file/d/0B0dpNC2PSScKRXVwamltZ3FwZUE/edit" target="_blank">COT Survival Guide</a> helpful, but keep in mind that it was written in 2014. Also, check out the newest <a href="https://www.afpc.af.mil/Portals/70/documents/Home/AF%20Fitness%20Program/FITNESS%20CHARTS.pdf" target="_blank">Air Force PT Test Score Charts</a> to get an idea of where you'll land and <b>start training for this test during dental school</b>! Here's a good <a href="https://www.youtube.com/watch?v=Cbeb2G0ZdbY" target="_blank">pushup</a> and <a href="https://www.youtube.com/watch?v=BgAiDS4fF_I" target="_blank">situp</a> video to help you out, but remember, the official Air Force guidance on fitness is found <a href="https://www.afpc.af.mil/Portals/70/documents/Home/AF%20Fitness%20Program/AFI%2036-2905_FITNESS%20PROGRAM.pdf" target="_blank">here</a> at A5.3 and A5.4.<br />
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<i>AEGD-1</i><br />
Unfortunately, my AEGD-1 experience was not all that great, but most students love their experience. Having said that, despite my misgivings about the training I received, the year itself was very formative for me personally and the experience was one that I count as one of the most pivotal in my life. <b>I certainly must recommend the AEGD-1</b> for the sheer fact that it's going to be difficult to operate as an Air Force dentist without this advanced training, since the Air Force has their own system to "allow" you to do certain procedures (called "credentialing"). Even if you did a procedure in dental school, a residency may be required to do it in the Air Force (restoring implants, for example).<br />
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You are required to apply for, and accept, an AEGD-1 now. Not everyone will be accepted by the Air Force, but there's enough spots for most applicants. Plan on going.<br />
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As far as what base you get, you'll fill out a preference sheet just before your 4th year of dental school, but they could send you to any of the 12 or so AEGD bases. I don't really have any insight as to why they send people where they do.<br />
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<i>Specializing</i><br />
I get asked this question a lot, and it's a bit of a moving target. Some specialties do allow you to apply right out of dental school, while others want you to have a few years of experience (or an AEGD-1) under your belt first. Your AFIT contacts should have this information.<br />
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<b>After residency/Being a dentist in the Air Force</b><br />
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<i>Where will they send me?</i><br />
Assuming you do an AEGD-1 like most Air Force dentists, you'll get a list of bases (in February-ish of your AEGD year) that need dentists and you'll get to rank them based on where you want to go. Unfortunately, while you do get a say, you're not guaranteed a top choice. I got my 16th choice, but it ended up being the best thing for me and my career.<br />
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I got to go to a small and remote base that was in dire need of organization and streamlining, as we were updating and planning for the arrival of a new F-35 squadron in the coming years. Previous officers hadn't <a href="https://medium.com/@jeffmarr/a-summary-of-the-e-myth-revisited-by-michael-e-gerber-5732d6529a5a" target="_blank">systematized the clinic functions</a>, but instead just relied on the people to run the place. When those people left, so did their ideas and processes, and the clinic was constantly starting over on processes when people would leave! I stepped into some roles that most young Captains don't get to experience, and got to hone my organizational and systematizing skills that would ultimately prove very valuable for my life and career.<br />
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<i>What's a normal day like?</i><br />
It depends on what base you go to, but a fresh Captain out of residency will usually be doing dentistry about 80% of the week. The rest of the time is set aside for training, PT time, or lunch. Expect to do a lot of restorative, with some single unit crowns sprinkled in as the mission permits and requires, and exams. If you did an AEGD and have the training, you'll probably be doing some IV sedation and restoring implants as well! Elective procedures (anterior crowns, veneers) will depend a lot on what the mission of your base is, and how well staffed the clinic is to suit your desires. I did almost no esthetic work at my first assignment, but a dentist at my new base is doing lots of anterior crowns and veneers because the mission is much less strenuous here.<br />
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<i>What's the best part about being an Air Force dentist?</i><br />
This depends on how you look at it. The normal answer is that you get to do dentistry without being pressured to produce a certain level of $, while having a nice slow pace to the day and getting lots of vacation time (as compared to a typical civilian corporate job). I think the "bad" things are actually good, and I detailed them a bit more in <a href="http://usafdds.blogspot.com/2017/09/3-benefits-of-being-military-dentist.html" target="_blank">this post</a>.<br />
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As far as vacation days go, you get 30 days per year that accumulate at a rate of 2.5 per month. It depends on the base's specific rules, but this 30 days <b>usually <u>does</u> count the weekend</b>.<br />
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If you leave on a Friday and come back Monday, that's 4 days you have to take off. Monday-Thursday would also be 4 days. Your "leave" days start and end in your local area. The definition of "local area" depends on your base's rules.<br />
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<i>What's the worst part about being an Air Force dentist?</i><br />
Again, this is going to be very personal, but I think the worst part is the slow pace and the lack of incentive to produce. However, there are lots of dentists that love this part of the job and would consider this a benefit, since they can take their time on their dental work and typically don't have to work any harder than they want to. You just need to know what Air Force dentistry is like and weigh your personality against it.<br />
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(If you didn't notice, I cheated here by using the same answer -- no pressure to produce -- for best and worst part, which leads me to...)<br />
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<i>How is Air Force dentistry difference than civilian/private practice?</i><br />
*These are my opinions from having worked in 2 civilian practices during my time as an Air Force dentist*<br />
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<i>-Quality of work</i> - I believe the Air Force tends to have higher work quality than most civilian providers. We don't have time pressures or too many cost pressures, so we typically get to spend as much time as we need to get things done the right way. Also, most of our dentists are a few years removed from a 1 year AEGD, which lends to even higher quality knowledge and care.<br />
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<i>-Patient experience</i> - I'll give the edge to private practice. I think most Air Force bases do not put enough emphasis on customer service, and our outdated charting system results in far too many records errors. However, there's a host of different ways this is managed on the civilian side, but at least on the civilian side, a dissatisfied patient can choose to take their business elsewhere. This is where the Air Force slips behind: our patients don't have options so we aren't incentivized to give them a good experience and we too frequently miss the mark.<br />
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<i>-Clinic organizational structure</i> - Unbelievably, I give the edge to private practice here, and it's not even close. One of the most surprising things to me about Air Force dentistry is how disorganized the organizational and accountability structure is at the clinic level. There's usually some holes in accountability and organization at some level that lets a litany of small problems leak through constantly. There's very little focus on creating good systems. Instead, most clinics rely on strong-willed individuals to run large portions of the clinic that end up suffering mightily when they depart for a new base. It seems there's no real training on "systems thinking" that would alleviate so much of the constant stress and little mistakes that occur daily in military dentistry. Everything I've learned about how to lead people, implement systems, and build/design a clinic has come almost exclusively from books I've chosen to read on my own. The military doesn't teach you this.<br />
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The biggest problem here is that, contrary to popular belief, there's just no incentive to be organized in the military because our patients are walking through the door and our appointment books are filled no matter what we do. Most are content to do "enough" and never really get to the point of optimizing and organizing things so they actually run as smoothly as possible. Things run satisfactorily, and that's all that matters to most.<br />
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For example, both bases I've been at didn't even have a consistent system to ensure the same items were reordered properly each time something ran out! There aren't even consistent locations for some items to be stored, so if they're out, it's impossible to know what was there without consulting someone who had the room memorized. (This is one area I've worked on at both of my bases to eliminate waste and confusion. It's usually just as simple as placing the order number and item name on standard containers and ensuring that 100% of items coming into the clinic have a permanent location, that everyone agrees on 1 method for altering the Logistics person that an item is low, and items don't just get tossed on a shelf or into a room.) If a certain person out for the week, good luck.<br />
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Often, an item would run out and there would be no accountability until the clinic was in an "emergency shortage" and had to rush order the item to the clinic. Fortunately, we have all the time in the world to do dentistry so typically these errors just result in rescheduling the patient or doing some less efficient procedure to get the job done. The minimal consequences of being disorganized tend to perpetuate the "good enough" mindset.<br />
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*Caveat: Most military clinics are far larger than civilian clinics, and the disorganization is far more obvious the bigger you get. Small civilian clinics can often survive (and typically do) just on the personality of the lead dentist, with little regard for attempting to imagine the business as a prototype model for a franchise (a la "The E-Myth"), but this fails in a military setting because there's always more than 1 dentist. Large civilian clinics that are poorly organized simply can't maintain their business structure and end up closing or restructuring. Large military clinics, on the other hand, stay open no matter what. In my experience, the larger the civilian clinic (if it's been open for a few years), the more organized it is vs a smaller 1-doctor civilian clinic.<br />
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<i>-Employees</i> - This is a touchy subject, so I'll tread lightly. I'm calling this one a tie. Here's why.<br />
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In the military, we sometimes get people that just flat out don't want to be in the dental field. Some have personalities and skillsets that are more well suited for some non-medical field. These kinds of people probably wouldn't last long in private dentistry (but to be fair, they would have never wanted to work there in the first place!). But, in the civilian world, you have an outrageous 60% (or more) of dentists that will be subject to embezzlement at some point in their career. That sucks! Civilian employees are no more saints than the military employees that don't care about their job but at least the military ones aren't stealing money from you.<br />
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Here's a huge positive with the military side: sometimes you get outstanding coworkers that have big dreams and aspirations and they understand that their performance in whatever job they have is an important stepping stone to the life they want. These are true gems and a total win for the military. Many civilians aren't thinking about the next thing, but in the military, some are constantly focused on learning and growing and getting to the next step, and it makes them valuable assets to your clinic.<br />
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In the end, people are people, including dentists. If you don't want to worry about hiring and firing, but also can't cultivate the team you want, the military is the way to go. If you're able to have those hard conversations, listen to your employees, facilitate their personal growth, and have studied and practice leadership and management, private practice is the way to go because you can create the office culture you want with the people you hire vs using the people you're given that may not want to be there. <b>It's up to YOU</b> as the dentist (and the officer) to create the culture you want and use the strong ones as your pillars while you build a new culture (military) or team (civilian).<br />
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<b>Are you going to stay in the military? Why/why not?</b><br />
<b><br /></b>
I'm not staying in. I have a lot of personal reasons for this, but here are the top 3:<br />
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1. <i>I believe that my experiences and skills can better serve humanity in a civilian setting</i><br />
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The Air Force is great, but it has its limitations. I can't run a clinic how I want to, I can't hire and fire, and I can't do the dentistry I want to do. Promotions happen in a stepwise manner, and your leadership skills don't really have any bearing on how quickly you can get into a command position. It has to do with your rank, which has to do with your time in service. I'm not a huge fan of the "wait and get promoted" style that the military uses to choose their leaders. Even if I could get into a command position, I don't get to choose who works at the clinic, and that can be a big hindrance to the development and progression of a clinical mission.<br />
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At the end of the day, I have a strong will and lots of leadership experience that is just going to take me far too long to manifest in the military setting. The limitations of the military also come with a lot of safety nets that suit many dentists very well, but not me. If they would make me commander of a clinic and double my pay, I'd think about it ;)<br />
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2. <i>More time freedom</i><br />
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Notice how I did not say "more money". That's not a typo. I don't necessarily want more money, but what I want is more choices.<br />
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One "benefit" of the military is getting 30 days paid vacation every year plus a lot of federal holidays. But you know what? I still have to come to work 5 days per week, do a lot of non-dental stuff, and generally spend a lot of time doing dental work at a slow pace that I could accomplish in half the time. Lots of dentists in the military do less dentistry than me (and many do more), but we all still have the same schedule.<br />
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I could walk out right now and work 3 days a week and easily make the same amount of money. Or, I could work 5 days/week and make 2x as much as I'm making now. So what's the big deal about all these "days off" in the military? It's a logical fallacy in my opinion. <br />
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Which one is better -- making more money or working less? It's personal. It's about having the options.<br />
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Right now, my plan is to leave, buy a practice, implement my vision and systems, maximize productivity and systematize an outstanding patient experience using new technology and beautiful office esthetics, serve my community well, and have the freedom to work far less than I do right now.<br />
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<b>Time is the currency of life</b>. Don't let someone in the military use the "days off" argument as a way to convince you that you have more time freedom as a military dentist, because it's not true. Your skills have an extremely high value in the civilian world that, <b>when leveraged properly</b>, is far more valuable than what the military can offer you.<br />
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It takes more work to be a leader in the civilian sector than the military sector, but it's worth it. Read some leadership books, work on your management and leadership skills, and build a practice that lets you build a life of your choosing and take off half the year if you want to. We can't get our time back.<br />
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3. <i>Self-actualization</i><br />
<i><br /></i>
I've read about 100 books in the last 2 years. I firmly believe that knowledge without action is worthless, so I've put a lot of action behind what I've learned. I've completely changed my diet, my workout routine, my morning routine, my habits, my beliefs about myself, and the way I handle stress (among many other things). I've also come to the realization that the life I envision for myself is not possible in the military.<br />
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Despite my emphatic shouts of "you must do the military for dental school", I firmly believe that a 3-4 year commitment, when utilized properly, is plenty of time to wrap your head around what it is you want for your life, your family, and your legacy on this planet.<br />
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This is getting a bit philosophical, but I mean it wholeheartedly. I have big plans and visions for my life, and I personally feel I would be doing a disservice to myself and those around me if I stayed in the military at this point. What I want for my life can't be accomplished in a military setting, and I feel it's time to break free and start to build that new life.<br />
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I must admit, when I graduated from my AEGD-1 residency, I was lost. I hadn't read more than a couple books that year, I was not confident in my dental or leadership skills, I had failed part of a PT test (and had it wiped from my record on a technicality), and I was generally confused about my future and what I had to offer.<br />
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But, over the course of the last 2-3 years, I started following and listening to leaders from all walks of life and came across a common theme: leaders are readers. So I started reading again.<br />
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It became an obsession that has continued to this day. I don't recognize the lost, confused, and complacent version of myself from 2014 and 2015. I'm a new person and I have books to thank for it. Those that know me from back then would be shocked at this statement, because I've always been driven, but I had lost my personal identity on what, exactly, I was driving towards.<br />
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I can't unread what I've read, or unthink the thoughts these authors have given me. I have a new confidence in my life and in my future, and I'm excited for the next step of my journey.<br />
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It is with no bitterness or resentment that I will wave goodbye to the Air Force, but instead, give it a warm farewell for a phase of life that broke me down, reshaped me, and sent me on my way with the confidence to design a life well lived.<br />
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--<br />
As always, feel free to email me with any questions!<br />
<br />USAF DDShttp://www.blogger.com/profile/16462820168288467617noreply@blogger.com3tag:blogger.com,1999:blog-3191751956841741209.post-11051079753099020262018-06-15T14:35:00.000-05:002018-07-21T14:48:43.780-05:0050 Days, and 3 Lessons Learned<b>*50*</b><br />
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That's (roughly) how many more days I will be here in Alaska.<br />
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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.<br />
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I also wanted to quickly touch on three things about the military to give prospective dentists a heads up about this world:<br />
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1. Flexibility vs stability<br />
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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. <b>What it lacks in flexibility, it gives back in supreme stability</b>. 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). <b>Many people see control of these two things, time and money, as the pinnacle of <a href="https://en.wikipedia.org/wiki/Self-actualization" target="_blank">self-actualization</a></b>, 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.<br />
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2. Inefficiency<br />
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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, <b>more productive work does not equal more freedom or more money</b>; 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 surprise you to see how little dentistry we actually accomplish with vast number of days we are in the clinic. It's not unusual for a young military dentist to "produce" 1/4-1/2 of what a civilian would on about 200 working days/year. It's possible to push yourself to do much more than that, but <b>be prepared to be met with resistance</b> from those around you that don't see the value in the push to be faster, better, and more efficient.<br />
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3. Long term thinking<br />
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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. <b>This one thing alone could help so much to alleviate the problems associated with point #2 above</b>, 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 and meaningful 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 even establish those 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 <b>there's 1. no long term goal/thinking and 2. no real incentive to step outside of their day-to-day tasks</b>. This can be a drain on the team and its members. People promote to higher ranks in a relatively step-wise manner, so staying the course will still set you on a nice career trajectory.<br />
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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 <b>decide for yourself if you want to live inside these structures for a long term career</b>. 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.<br />
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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. <b>More power to those that can endure, or ignore, it for a whole career. <u>And even more power to those that see this calling as the purpose for the life and truly do make a difference.</u></b><br />
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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.<br />
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As always, email me with any questions you may have!USAF DDShttp://www.blogger.com/profile/16462820168288467617noreply@blogger.com0tag:blogger.com,1999:blog-3191751956841741209.post-25996328149164750872018-03-09T22:45:00.000-06:002018-07-21T14:58:32.465-05:00Books! (Thoughts and Opinions)I love to read.<br />
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And by "love to read" I mean "I'm pretty introverted but mentally restless and books are kinda therapy, too." <b>But it didn't start that way.</b><br />
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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.<br />
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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>I was sort of reading what I wanted to read by proxy</i>.<br />
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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, <b>something changed</b>.<br />
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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 <b>using books to fill the gap</b>. Excellent! I started with recommendations from faculty and lecturers at my dental school and books I already owned.<br />
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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)".<br />
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Next, I picked up a book for myself, also by Carnegie, called "<b>How to Influence People by Public Speaking"</b>. 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.<br />
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So it started as a blanket recommendation from many people: 1) Books are important 2) Here are some to try<br />
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And it evolved into: 1) Wow, they were right and these books are helping 2) I should pick books to fill my weak spots<br />
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And a book worm was born.<br />
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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.<br />
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2017 was a big year for me: 40.<br />
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***Below is my personal philosophy on reading books***<br />
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General Principles:<br />
-Pick books that <b>fill your weak spots</b>; duh :)<br />
-<b>Don't</b> just pick books because <b>you already agree</b> with the author about other things (and don't discount authors you disagree with!)<br />
-It's <b>ok to disagree</b> with some things in the book and find value in other things<br />
-If a book is not interesting or helpful, it's <b>ok to stop</b> reading it<br />
-It's ok to read <b>multiple</b> <b>books at the same time</b> (ie: don't feel like you have to finish one to start another one)<br />
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*Print Books:<br />
-The best for non-fiction (can be easily referenced)<br />
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*Audiobooks:<br />
-The best if you lack time to read (ie: your commute is crazy long) and books that don't require detailed notes or reference<br />
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*Combo Print/Audio:<br />
-This is AMAZING and the recommended method (though I've just started trying it)<br />
-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<br />
-Combining audio and print does two things: 1) decreases distractions 2) enhances what you actually remember<br />
-Cons: You essentially have to buy the book twice. Boo.<br />
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*Digital Books:<br />
-Meh, not for me, but some people love it... give it a shot and see if it works for you!<br />
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///Book Reading Timeline///<br />
-If you don't know what to read, here's my best suggestion of <b><u>types</u></b> of books to start with<br />
-Basically, you are <b>starting within</b>, and <b>moving outward</b> starting with your brain and then with your "soul" (as I'll refer to it).<br />
-<i>No strictly religious or fiction books are included here but add them as you see fit </i>:)<br />
-I recommend reading <b>at least 1 book in category 1-5</b>, 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.<br />
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1) Books about the human brain and how we think<br />
-Suggestions: Brain Rules<br />
-<i>Goal: Understand how your brain works</i><br />
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1) Books about how to think... about thinking<br />
-Suggestions: Moonwalking with Einstein, The Wisest One in the Room<br />
-<i>Goal: Increase self-awareness</i><br />
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3) Books about interacting with other people<br />
-Suggestions: Captivate, How to Win Friends and Influence People, The Charisma Myth<br />
-<i>Goal: Increase awareness of others and how to interact with them</i><br />
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4) Books about the individual "soul" and meaning (philosophy)<br />
-Suggestions: You Can Be Happy No Matter What, Meditations, Ego is the Enemy<br />
-<i>Goal: Understand who you are and clarifying your values</i><br />
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5) Books about the collective "soul" of humanity<br />
-Suggestions: Man's Search for Meaning, The Selfish Gene (controversial addition, but I think it's a very valuable read in this section)<br />
-<i>Goal: Understand your place in the fabric of humanity</i><br />
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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]<br />
-Suggestions: Extreme Ownership, It's Your Ship, Deep Work, Grit, 10X, The Power of Consistency, Essentialism<br />
-<i>Goal: Practical methods and mental models for increasing your efficiency and productivity in all areas of your life </i><br />
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7) Books about personal finance<br />
-Suggestions: Total Money Makeover, The Investment Answer<br />
-<i>Goal: We don't get this education in school, and we suck at it!</i><br />
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8) Books about health and wellness<br />
-Suggestions: (Touchy subject, lots of misleading stuff out there) - Start with "Nutrition for Dummies" and go from there (seriously!)<br />
-<i>Goal: Again, we don't get this education in school, and we're fat </i>:)<br />
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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)<br />
-Suggestions (assuming "business"): E-myth, Good to Great, The Goal<br />
-<i>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</i><br />
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10) Books about the specific principles of your industry (dental practice management, for my example)<br />
-Suggestions: Uncomplicate Business (Farran), etc...<br />
-<i>Goal: Get better at your job/career</i><br />
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Bonus: Add any fiction books, books you think are interesting (history, cooking, whatever!), or books you <b>need</b> in your life after you've done 1 book in category 1-6<br />
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Final Thoughts:<br />
-The suggestions are just that, suggestions. There are infinitely more examples.<br />
-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.<br />
-After you pass a category, don't forget to keep reading about that category to strengthen your understanding!<br />
-Email me if you want more recommendations!<br />
<br />USAF DDShttp://www.blogger.com/profile/16462820168288467617noreply@blogger.com0tag:blogger.com,1999:blog-3191751956841741209.post-88495714467976957862017-09-03T17:44:00.001-05:002017-11-21T15:05:07.102-06:003 Benefits of Being a Military Dentist You've Never Heard Before (Companion Post to Dentistry Uncensored Interview)<i>[A couple of days ago, I was fortunate enough to record an episode of <a href="https://www.youtube.com/watch?v=Ox8QVUptA70" target="_blank">Dentistry Uncensored with Howard Farran</a> (#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!]</i><br />
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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 <a href="http://usafdds.blogspot.com/p/air-force-health-professions.html">HPSP</a> 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.<br />
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This post explores <u>three</u> themes from the book <a href="https://www.amazon.com/Uncomplicate-Business-Takes-People-Money/dp/0998971901/ref=tmm_hrd_swatch_0?_encoding=UTF8&qid=1504477498&sr=1-1">Uncomplicate Business</a>, by Howard Farran. He mentions <b>people</b>, <b>time</b>, and <b>money</b> as three pivotal factors in controlling your destiny as a dentist. <u>Don't miss how much you can learn about these 3 things while serving in the military</u>! They are often forgotten points of learning by new and seasoned Air Force dentists alike.<br />
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These three <u>benefits</u> of being a military dentist are:<br />
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1. Not Enough People<br />
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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! <br />
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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.<br />
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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.<br />
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2. Not Enough Time<br />
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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 <u>not</u> under your control.<br />
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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.<br />
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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.<br />
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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.<br />
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3. Not Enough Money<br />
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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?<br />
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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.<br />
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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. <br />
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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?<br />
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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!<br />
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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.<br />
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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.<br />
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Here are questions we have had to ask ourselves at Eielson when considering changes in supplies:<br />
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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?<br />
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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?<br />
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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?<br />
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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.<br />
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I hope this post was helpful. My goal here was to pick out 3 topics (<b>people</b>, <b>time</b>, and <b>money</b>) 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!<br />
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USAF DDShttp://www.blogger.com/profile/16462820168288467617noreply@blogger.com3tag:blogger.com,1999:blog-3191751956841741209.post-15017575728927980442017-07-10T20:14:00.002-05:002018-03-09T22:45:27.868-06:00Graduating Soon? How to Rank AEGD Bases.Sometimes in life, patterns pop up to give us hints. In this case, I've gotten almost the same email 3 times in the last 4 days! So... I think it might be time to visit this topic in its own post.<br />
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1. Location, location, location.<br />
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This is, in my opinion, the overwhelming and... essentially... only factor you should consider when ranking your AEGD bases. AEGD experiences vary significantly based on who the faculty is at your AEGD, and location has almost nothing at all to do with this. Pick a base that's located where you want to be and don't give it a second thought. If you just can't help yourself and want to give it a second thought, keep reading.<br />
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2. Faculty.<br />
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This is very hard to pin down. Faculty members are coming and going all the time, making it nearly impossible to make a judgement call on an AEGD base on this. However, if you must, you can consider emailing the residency directors at each base and requesting to get in contact with some of the current residents. You can pick their brain about who might be there and what experiences they have been offered as far as number of crowns, implant experience, etc.<br />
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3. Other stuff.<br />
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Travis AFB has an Oral Surgery program. Theoretically, this will limit the number of cases flowing to the AEGD program. However, it's well known that AEGD residents are expected to do wisdom teeth cases, so it's not as if you're going to run dry on them. I wouldn't put a ton of weight into this.<br />
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Your AEGD base of choice has virtually no bearing on what base you might get after your AEGD.<br />
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That's about it! In summary... location. Go where you want to go and don't worry about the other details. It's a lot to track down to rank bases that are really just telling the Air Force what you want and aren't a guarantee anyway.USAF DDShttp://www.blogger.com/profile/16462820168288467617noreply@blogger.com5tag:blogger.com,1999:blog-3191751956841741209.post-6156116190487582472017-02-04T14:36:00.001-06:002017-02-05T02:09:50.215-06:00Dental Tips from a Newbie I've been at this dentist thing for a few years now, but I'm constantly running across different tips and tricks that make my life easier as a dentist. I wanted to share them with you guys, because sometimes in the military, we have to be creative with the supplies we have at hand!<br />
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Hemorrhage control in restorative dentistry:<br />
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This is tough sometimes. You've got a patient that has less than ideal hygiene and when you drop the box for your prep below the gingival margin, inevitably you get some bleeding right into where you're working. Here are some tips to help you out.<br />
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1. Viscostat Clear on a cotton ball - Viscostat Clear is an excellent product that is comprised of 25% Aluminum Chloride to help control minor hemorrhage. Emphasis on "minor". It will not stop the gushers from gushing but it will keep minor hemorrhage at bay. However... if you saturate a small cotton ball with it and use pressure against the hemorrhaging area for about 3 minutes, you will be able to push the tissue back and control bleeding at the same time. Excellent for working that tissue distal to mandibular 2nd molars on crown preps or deep restorations. This saved my bacon on a CAD/CAM crown 2 days ago! You could use another hemostatic agent, but Viscostat Clear is what we use at Eielson.<br />
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2. Injecting surrounding gingiva with anesthetic - This was a trick I learned in my AEGD residency and it's saved me more than once. Here's how it works. Anesthetic has epinephrine in it to constrict the blood vessels so that the anesthesia stays in the areas we want it to stay. But this effect of epinephrine can also be utilized to control localized hemorrhaging. Let's say you are prepping a crown on #14 and the mesial marginal area is sub gingival and none of your hemorrhage control methods have worked. Take some anesthetic and insert the needle directly into the facial side of the papilla between #13 and #14 and inject 1/4 to 1/2 of the carpule with a fair amount of pressure. This forces epinephrine into the tissue and can keep hemorrhage at bay long enough for you to refine the prep and get a good impression. The best is to use a high concentration of epinephrine (1:50,000) but traditional anesthetic works well, too (1:100,000).<br />
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Note: Do NOT inject straight into the area that is hemorrhaging. The fact that you're stabbing pissed off gingival tissue will sometimes make it worse.<br />
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Prepping crowns:<br />
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This is a very stressful procedure for dental students and new dentists. You're taking away a lot of tooth in hopes that you can reduce a tooth enough for clearance of your material but not so much that compromise resistance and retention. Here are some tips to help you out!<br />
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1. Pick a more aggressive bur - If you pick a moderately coarse or medium grit bur, you're going to notice quickly that you sometimes want to push the bur faster than it will cut. I've found that using a very aggressive bur allows me to push at a constant rate and get into a "flow", if you will, of prepping instead of constantly feathering off the prep to let the bur speed up again. If you have an electric handpiece, you may notice that this isn't as relevant, as you can maintain pressure and not worry about stalling out the bur. However, I like to move quickly but smoothly. I never prep out of control.<br />
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2. Prep a wider margin - Another tip from my AEGD. I don't think I've ever had a case that I said "crap, my margin is about 0.2mm too wide on this one". A wider margin helps you out in several ways: 1) Easier for you to tell that you actually have adequate margin everywhere 2) easier for lab to discern between gingiva and margin and give you a good product 3) a wider margin gives you some "play" room in case the impression is less than perfect or there's some sort of issue in building the crown all the way out to the margin. If for some reason you'd need to enameloplasty the margin back after crown cementation, a wide margin gives you room to do this. Crowns don't fail from having adequate axial thickness. :)<br />
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3. Reduce occlusion a little more - In my opinion, you're better off reducing that extra 0.3mm than fighting for the wall height if you can avoid it. Not to mention, the area we tend to under-reduce is right in the middle of the prep which has no bearing on how tall the surrounding axial walls are. Get a #330 bur and carve depth grooves into the occlusal table and go down to them. Then smooth everything up! Now, this is not a blanket statement condoning negligent over-reduction, but if you're on the fence and are unsure, reduce a little more. This is especially true when prepping for CAD/CAM crowns that will be bonded into place.<br />
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4. Change burs only three times/don't prep the same area twice - This is how I prep, and it results in very fast and efficient crown preps without me having to waste my bur trimming tooth structure from two angles. Here's what I mean.<br />
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If you do your occlusal reduction first, you are inevitably reducing the occlusion on areas that will eventually be prepped away when you go to do your axial reduction (example: you reduce the entire occlusion and then end up prepping off the circumferential areas for the axial prep that you just reduced the occlusion on!). Don't do that! The axial reduction is virtually independent of occlusal clearance so do your axial reduction first. I always start "in the open", as I like to call it, on a nice wide area of the tooth that's easy to see. I prep the margin down to the most acceptably apical position depending on the material I'm using.<br />
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Let's take a #19 e.max for example (assuming it's ready to prep and doesn't need a core, etc.). I would start with my aggressive flat ended tapered bur mid-facial ("in the open"... a nice wide area of the tooth) and work my way towards the mesial until I broke through all the way to the ML line angle, keeping the bur as deep into the tooth as necessary to make a complete axial reduction with 1 pass. Notice how I never switched burs to pass through the inter proximal area? This touches on two principals: 1) I'm going to prep the interproximal area away anyway so I don't step up with skinny burs, I just push through it with my regular bur 2) prep a wider margin. So, I work through to the ML angle and then I come back to my starting point mid-facial. Then I work the same pattern, this time towards the distal until I break through and get to the DL line angle. Then I connect the DL and ML line angles across the lingual. Margin and axial reduction are done.<br />
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Occlusal reduction is next. Switch burs (first change) to the #330, or a bur of your choice with reference points, and cut the depth groves I mentioned in tip #3. Now switch back to the first bur again (second change) and level it all out to the depth of the grooves. Now switch to a fine version of your first bur (third change) and smooth everything. Done!<br />
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The problem with doing the occlusal reduction first is this: You are using false reference points on the outer edges of the occlusal table. If you reduce the occlusion, you don't yet know exactly which areas you're going to end up prepping off when you do your axial reduction. So do your axial reduction first so you have your smaller "true" occlusal table, and then reduce it.<br />
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<br />
Oral surgery:<br />
<br />
Caveat: I am not an oral surgeon but I do routinely perform IV sedations and extract impacted wisdom teeth. I don't do the crazy ones, but I've seen enough to help me become more proficient at taking out all kinds of teeth.<br />
<br />
1. Remove more bone - Don't be scared to take some bone away! Now, this is not a general rule, but it's true most of the time. On anterior cases, patience is going to serve the patient better than reflecting a flap and buzzing away 4 mm of bone to get that root tip out. But... for posterior teeth, you should recognize that if the tooth isn't moving now, it's not going to be moving much later. Do yourself and the patient a favor and remove some more bone on the facial aspect of the tooth and try again.<br />
<br />
2. Section the tooth - This can seem scary for a new doc, but sometimes it's what we have to do. I was recently extracting a severely carious #30 and the tooth kept breaking into pieces while I was trying to get leverage from the mesial. I had great visualization, so I took the handpiece and sectioned the tooth from F to L across the furcation, broke the tooth in half, and plucked both roots out in less than 20 seconds.<br />
<br />
3. Use an endo file - Huh? Ok, so I've seen this trick before and finally had a chance to try it a few months ago. A patient had facial trauma and had fractured #7. The problem is that there was a horizontal root fracture so the root tip was lying a good 3mm apical to the crestal bone. I got a set of endo files and took the largest file that would engage the root tip at least 1 full clockwise rotation. I wrapped floss around the handle of the endo file and twisted the file to engage the canal of the root tip. I pulled gently on the floss until, about 3 minutes later, the root tip popped right out. (Notice the clean and unused blade?)<br />
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<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi-mCl-7Bmx0Nftg2LLY0dFTsG3R-aDajFp3yCW9nHZ5PhxwKRPIpZzLT9Fdny8C_8YKwO-ofVvIoNqBrv-BjTps71Ut6ma5Wd-JSWFayWKzQNSYD41xTKXN2CxywIA2yBy7HgMjiF-QhMk/s1600/2016-07-26+at+12.11.24+2.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi-mCl-7Bmx0Nftg2LLY0dFTsG3R-aDajFp3yCW9nHZ5PhxwKRPIpZzLT9Fdny8C_8YKwO-ofVvIoNqBrv-BjTps71Ut6ma5Wd-JSWFayWKzQNSYD41xTKXN2CxywIA2yBy7HgMjiF-QhMk/s320/2016-07-26+at+12.11.24+2.jpg" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Extracting #7 with an endo file</td></tr>
</tbody></table>
<br />
<br />
So that's it for today. I'll try to catalog some more tips and do some more of these posts from time to time. Are there any other topics you guys would like my to discuss or give input on? Just another dentist trying to learn! USAF DDShttp://www.blogger.com/profile/16462820168288467617noreply@blogger.com7tag:blogger.com,1999:blog-3191751956841741209.post-25961979079586512032017-01-19T00:30:00.005-06:002017-01-19T00:30:59.818-06:00So, What's it Like in Alaska?This is a non-dental, non-military post. Having said that, I live in one of the most unique places in the United States and many people are curious about what life is like up here!<br />
<br />
My wife posted an excellent summary of our experiences so far, so I'll redirect you all to her blog (we're a blog family I guess) so you can read all about it.<br />
<br />
<b>So how cold does it *really* get up here? </b><br />
<b>Do we have normal stores? </b><br />
<b>Is it dark/light all the time?</b><br />
<br />
Check out her post right <a href="https://sugarandgoldblog.com/2017/01/18/life-in-alaska/">HERE</a> for answers to all your Alaska questions!<br />
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<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjx3g55XVCeIXF39BvaRpUqjKW3uybkW59_FjxmIhKSNC1ACxk31cqKcxnkj6KV0eo24TPuVl-c1NMc3acobMwMJ-QMvea1P6sYD0_sxl0kl_ActtnOkg8OY_V4DfkJFSFd9Uh74qCWT5RR/s1600/unspecified.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img alt="" border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjx3g55XVCeIXF39BvaRpUqjKW3uybkW59_FjxmIhKSNC1ACxk31cqKcxnkj6KV0eo24TPuVl-c1NMc3acobMwMJ-QMvea1P6sYD0_sxl0kl_ActtnOkg8OY_V4DfkJFSFd9Uh74qCWT5RR/s320/unspecified.jpg" title="Sugar and Gold Blog" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">A photo of my wife from Sugar and Gold Blog</td></tr>
</tbody></table>
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<br />USAF DDShttp://www.blogger.com/profile/16462820168288467617noreply@blogger.com1tag:blogger.com,1999:blog-3191751956841741209.post-45061164948746238492016-10-05T22:21:00.001-05:002016-10-05T22:21:51.960-05:001 Year LaterI saw my first patient out of my AEGD on September 21, 2015. So now that we are in October 2016, I've been an official "non-resident" dentist for a whole year. Here are my thoughts so far:<br />
<br />
Easier than I expected:<br />
<br />
--- Getting faster - I expected to slowly get faster but my speed was much better very soon. Having a good assistant goes a long way, and not having someone check every little thing really speeds things up!<br />
<br />
--- Additional duties - In the Air Force, you have "additional duties" which are programs or tasks assigned to you to take care of. I got assigned a few but since our base is small, they are easy to manage. Our AEGD faculty kind of scared everyone into thinking that small bases were a big extra workload but I haven't found that to be true.<br />
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--- Work - This is broad, but I do like my job a lot. I don't love it every day, but I'm learning and I do really enjoy doing what I do. It's fun! Finally! Isn't dentistry supposed to be fun? You get to manage your schedule without the stress of producing so it allows you to book harder cases out a little if you need to.<br />
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--- Working with co-workers - At my last base, we had a ton of staff because there were so many dentists. Here there is really just a small group of people doing everything. But everyone pulls their weight and we have a lot of fun together. <br />
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--- Winter in Alaska - It's not even windy! Come on! Easy :)<br />
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Harder than I expected:<br />
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--- Not much else - So... most things really are easier, smoother, and more fun than I anticipated. There are hiccups now and then and I don't mean to sound like things are easy... but most things are not as hard as some of the people at my AEGD made it sound. I guess it depends a lot on your expectations.<br />
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<br />
So that's an overview, and here's a glimpse into a very typical day in my actual-real-life-...life.<br />
<br />
Monday, Tuesday, Thursday and Friday<br />
-Get to work around 0700<br />
-First patient at 0730<br />
-Do some fillings, maybe endo or a crown prep<br />
-1 hour for lunch!<br />
-4 more hours of a seeing patients!<br />
-1 hour of PT time on Monday<br />
-Some days we have a doctor assigned to ONLY do exams, recently we have been just squeezing them into the schedule when we can because of staffing issues.<br />
<br />
Wednesday<br />
-Get to work around 0700<br />
-Do a 3rd molar sedation/surgery case at 0730<br />
-See a couple more patients<br />
-1 hour for lunch!<br />
-Training day in the afternoon or catch up on things (usually no patients)<br />
-1 hour of PT time<br />
<br />
Here's how I would breakdown how I spend my time when I'm actually seeing patients:<br />
<br />
Operative (fillings): 55%<br />
Endo: 5%<br />
Pros: 10%<br />
Evals/Exams/etc: 20%<br />
Surgery: 5%<br />
Other admin stuff: 5%<br />
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You get to work your own schedule a bit and put things were you like them. I prefer to do "big" cases right after lunch or leading into the end of the day (endo and pros).<br />
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Each base is different, and if you're at a large base you may not do any endo or oral surgery and very little pros. Depends on the specialists and the need at your base (AND your desire to do whatever it is).<br />
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Hope this was helpful! A little "day in the life" for you guys.<br />
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<br />USAF DDShttp://www.blogger.com/profile/16462820168288467617noreply@blogger.com4tag:blogger.com,1999:blog-3191751956841741209.post-53003650160936839742016-08-15T23:43:00.002-05:002016-08-15T23:53:51.582-05:00Educating Patients 2Another awesome infographic from our friends at Southcommon Dental. One of the most concise pieces of information for patients that I've ever seen. Thanks guys!<br /><br />
--- Everyone wants a healthy and beautiful smile that will last a lifetime. The dentists at Southcommon Dental in <a href="http://www.southcommondental.com/contact/" target="_blank">Mississauga</a> have designed an infographic showing how brushing, flossing, avoiding certain substances and visiting the dentist regularly will lead to a lifetime of good oral hygiene and a beautiful set of teeth.<br />
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<span style="font-family: "helvetica"; font-size: 12px;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjfsRmNYD7lcPc7jPHAa1gQYaymcxbvMxYkeaesJBaPFQwC27ocxrbGrNEieuvr8CURAxmlLhgVx-g-5-rRbks70pvuNWFKS639P1-j4cMrHaQkkHKJ0HbY0uku4uGOaG8GuA0fR0E96SG7/s1600/The+Complete+Guide+to+Good+Oral+Hygiene.jpg" imageanchor="1"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjfsRmNYD7lcPc7jPHAa1gQYaymcxbvMxYkeaesJBaPFQwC27ocxrbGrNEieuvr8CURAxmlLhgVx-g-5-rRbks70pvuNWFKS639P1-j4cMrHaQkkHKJ0HbY0uku4uGOaG8GuA0fR0E96SG7/s1600/The+Complete+Guide+to+Good+Oral+Hygiene.jpg" /></a></span>USAF DDShttp://www.blogger.com/profile/16462820168288467617noreply@blogger.com1tag:blogger.com,1999:blog-3191751956841741209.post-65338222355817809112016-07-02T00:55:00.002-05:002016-07-02T00:55:53.166-05:00A New VoiceMy whole life so far has been a push to get to the next thing. To achieve the next goal. I've been pushing and working to be right where I am (maybe not Alaska specifically, but you get the idea) since I decided to become a dentist back in 2007. But that was during college, a place I wouldn't have been without good grades and the solid work ethic I developed in High School. Which was obviously a carryover from that high-energy Middle School kid I was before that. Don't forget the little me who was always fascinated by science and helping others!<br />
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Ok, so I guess... theoretically... I've reached the place I've been pushing for my whole life. But what does that mean? <br />
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To me, it means this. It's time to decide what's next. I have thoughts and ideas about what I want to do, who I want to be, etc., but there's no carrot sitting out there for me to chase anymore. Not an obvious one, anyway. In some ways I feel like I'm "done" with what I wanted to accomplish. And in a purely goal-oriented sense, I guess I am. I didn't plan any further than this. I wanted to be a dentist. Poof. Done.<br />
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Now What?<br />
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I thrive on structure and planning. It's in my blood (all my blood cells are in perfect lines and neatly flow through their respective vessels). Until now, most of that structure has been structured for me. And you'd think that in the Air Force it would still be there. It is to an extent, but I'm undecided on if the Air Force is going to be my long term plan so even that structure may not apply to me. <br />
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From birth to the end of my AEGD residency, there were goals to hit and tasks to hit them. Now the goal is... whatever I want it to be! It's freeing and a little scary at the same time. My life has always revolved around some sort of curriculum or syllabus and has been divided into 9-week and 2-semester intervals. No more! It's summer time and for the first time ever, I don't really have a "summer break". I worked a lot when I was younger during high school and college (even dental school) and I'm so thankful I did. It showed me life outside of the academic bubble, and I'm fully immersed in that now.<br />
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The last few months in Alaska has sort of been me kicking up my feet and not feeling the pressure of performance from outside sources for the first time in my life. But as those voices from the outside fall away into the past, a new voice has emerged to push me.<br />
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Mine.<br />
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Ok, weird dude. What's that about? So without professors and instructors and mentors saying "don't do that" or "let me show you"... even "nice job!" and "good work!", I have to be that for myself now. It's made me thankful for the training I've received because I have an internal compass of what I want to do and what I want to be. I have to look at a filling and say "wow that's great!" or look at an impression and say "I really need to take this again", no one is doing that for me.<br />
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And it's slowly coalescing into a new vision for my life, one that's still pretty blurry (but getting clearer) right now. As a believer in Christ, I am constantly pulled towards things and ideas that allow me to give to others more than I take.<br />
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Just an introspective post for you guys. Remember that all the training you're going through is helping you develop your voice. <br />
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Specific questions can be sent to my email. Comments are moderated so they take a couple weeks sometimes for me to check up on. Have a great summer!<br />
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<br />USAF DDShttp://www.blogger.com/profile/16462820168288467617noreply@blogger.com4tag:blogger.com,1999:blog-3191751956841741209.post-49620564248142840682016-03-05T11:24:00.002-06:002016-03-05T11:27:19.817-06:00Educating PatientsHere's the thing. We go to school and learn to become dentists. How does this work? Well, we sit in classrooms for hundreds of hours, then we practice on some fake teeth, then we start doing the real thing.<br />
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So what happens when it comes to treating patients? Well, we think back on our education and we make decisions for treatment based on what we know. However, I truly believe that it's easy to put blinders on and forget to educate the patient on one basic question:<br />
<br />
What can I do to prevent all this?<br />
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A strange question to think about because for the dentist, we essentially rely on the work of bacteria in the oral cavity to keep us working! But our ultimate goal is to put the patient's oral cavity in such a position, and to educate the patient properly, that they can go home and maintain their oral health optimally for... ever! We are humans so this often doesn't happen, but I want to emphasize patient education today.<br />
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I spend a lot of time on patient education. I tell them how carcinogens in cigarette smoke can alter a cell's ability to properly duplicate itself; I tell them how small areas of demineralization on their tooth are in a fragile balance between repair and destruction; I tell them that calculus is a structure that a village of bacteria built as a way to protect itself so that it can go out and invade our mouths. <br />
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It's always exciting when new and highly applicable patient education materials arrive and I had the privilege of finding out about one just a week ago. It really is a wonderful balance of talking on a level the patient understands without using fluffy words and bogus language that doesn't hit on the severity of the issue. <br />
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Here's a little word from Southcommon Dental on the sweet infographic they've created that you're free to use with your patients!<br />
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---Most people know that if you don't take care of your teeth, you will eventually get cavities and have to pay an extra visit or two to the dentist. But what is actually going on in your mouth? Why do cavities form when you stop taking care of your teeth? Southcommon Dental has put together a <a href="http://www.southcommondental.com/" target="_blank">dental infographic</a> that delve into this topic and teaches you why not brushing and flossing ultimately leads to this problem. Check it out!<br />
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USAF DDShttp://www.blogger.com/profile/16462820168288467617noreply@blogger.com10tag:blogger.com,1999:blog-3191751956841741209.post-20982739883948937412015-12-30T12:54:00.002-06:002015-12-30T13:30:50.870-06:00HPSP Laptop RentalMy blog tends to be about me. Stories about what I'm doing or what I'm going through. I tie that in together with details about the Air Force (as much as I am allowed to divulge) and particularly the HPSP scholarship.<br />
<br />
However, as a "regular" practicing Air Force dentist now, I don't have much more to say along the way other than updates about how things are going in clinic and information that can help you along your HPSP path, whether that means talking you into or out of the scholarship (which I've done many times both directions!) or giving you tips along the way. My 5 year track record of being one of the only active HPSP student bloggers online and the many hundreds of emails I've received since this all began, gives me some unique insight into what HPSP students are doing and thinking about. So what's my point?<br />
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One unknown aspect about the HPSP scholarship is this weird option in there to rent a laptop and have the military totally cover the rental. These days, people aren't usually thinking about renting a laptop (vs buying) and the logistics of renting electronics is less and less appealing. On the other hand, it would be nice to take advantage of this free offer from the military and be able to rent a high quality laptop for the few years you're in school. This would prevent wear and tear on your own machine and your dollar would go further to buy your own laptop for yourself once school is over.<br />
<br />
I think I've only heard of a few people actually utilizing the laptop rental reimbursement but that may change very soon. A company called <a href="http://laptopsformilitarydocs.com/" target="_blank">Laptops for Military Docs</a> is getting straight to the point. This company will give you step by step instructions on how to rent a high quality laptop from them hastle-fee.<br />
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Now I must admit, this company is very new and I have no personal or financial stake in this whatsoever. Obviously with them being so new, I did not personally rent a laptop through them (or anyone, actually). But every once in a while something comes along that I feel compelled to let my readers know about. This is one of those times! This company is clearly set up for specifically this reason and I have to believe that by focusing solely on HPSP students, they will be able to help you, too.<br />
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Technology is changing rapidly so consider a rental reimbursement during dental school to save yourself some money! It's an option that's free to you as long as you're willing to do the legwork and <a href="http://laptopsformilitarydocs.com/" target="_blank">Laptops for Military Docs</a> is there to make it easy.<br />
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I'd love for some of you all to give this service a try and let me know how the process was for you! <br />
<br />USAF DDShttp://www.blogger.com/profile/16462820168288467617noreply@blogger.com4tag:blogger.com,1999:blog-3191751956841741209.post-28973043197091516662015-10-18T21:48:00.000-05:002015-12-15T00:08:28.185-06:00OverseasWe got Alaska.<br />
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So it's been a while since my last post and I wanted to let the dust settle, per se, before I posted again. My residency is over and we have been at Eielson AFB for almost 2 months now. I started seeing patients a few weeks ago. Eielson is considered overseas for somethings and not others, so it's a weird mix of both! My assignment is only 3 years like an OCONUS assignment, not 4, but I'm not actually overseas in a foreign country (for example).<br />
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First off, I'll talk about the AEGD now that I have some perspective. <br />
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Not a lot more I have to say that I haven't already, to be honest. I will say that the personnel at your location can make or break the experience in a given specialty and you really have no way to know what each base is going to offer. People are moving all the time! Having said that, I don't see how you could survive as a brand new Air Force dentist without doing a residency. There so much "Air Force" stuff to learn that it would be really hard to learn on the job if you came straight out of dental school. With that being said, if you absolutely do not want to do a residency then think twice about the HPSP at all! You are now required to not only apply for, but also accept, a spot in an AEGD residency. That's right, no longer optional!<br />
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My AEGD was good, and the location was incredible. The Academy was a beautiful place to be! However, there were aspects of the residency that were less than ideal while other aspects were very well executed. It certainly wasn't a traditional educational environment like dental school but more of a "learn by doing" situation but the faculty all see their own patients most of the time. It had a tendency to feel somewhat disorganized at times with lectures being fit in where they could be and not a real over arching theme or long terms goals, except when outlined by each specialist as they saw fit. Syllabuses for different specialties either didn't exist or were usually incomplete, and there was a tendency for contradiction in lectures or between faculty that made things frustrating at times as someone trying to learn. It's something you have to embrace as part of the unavoidable nature of the constant movement of parts and pieces in a very large Air Force system. As someone who really likes to make their own way and be as proactive as possible, I encountered a surprising amount of opposition to that style and found it more beneficial to "go with the flow" most of the time.<br />
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On a positive note, I got to do quite a few IV sedations and 3rd molar surgeries as well as perio surgeries. I got to do far more root canals than I did in dental school, and I got fairly proficient in whats known as a "cuspal coverage amalgam", something you have to see to believe! I felt like I was adequately exposed to all the specialties enough to help me decide if they were something worth exploring further as a specialty. The general feel of the residency all seemed geared towards serving the Air Force population, and many of the skills I learned will serve me very well at my new base, even though I won't use many of them if I choose to leave the Air Force some day.<br />
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Second, Alaska!<br />
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Being on my own is really nice. It was weird at first, and still very much is, but you'll be amazed how much faster you can work when you're doing 1 or 2 fillings and there's an hour set aside to do it without faculty looking over your shoulder. You just sit down and crank it out. For me, it hasn't been all that difficult of a transition for me. I've always worked pretty fast so this doesn't seem that bad! I do feel a little rushed sometimes but considering this is my first experience out of an educational setting, I'm really pleased with it so far. This is a small clinic and was designed for a couple more dentists, so we have a lot of room. Having an office is nice too! I'm not sure what to put in it quite yet other than trail mix and extra paper. Very official.<br />
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Eielson AFB is not a very desirable location but to be honest, I really like it here so far. The people are very nice and for being a smaller city, they have a lot! Amazon still delivers here so I think we'll survive after all. We had to get our cars "winterized" but so far, we've only had 2 snow storms! It was actually quite nice out today and my wife and I went on a walk with our dog.<br />
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That's all for now! I'd love for some comments or emails with some ideas about what I should start posting about now! This is kind of the end of the road in terms of my journey from the end of dental school when I started this blog. I'm here, I'm done with dental school, done with my residency, and now a full blown real life Air Force dentist!<br />
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So let me know what YOU want to hear about and I will gladly, within the limitations of what I'm allowed to talk about, let you know!<br />
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<br />USAF DDShttp://www.blogger.com/profile/16462820168288467617noreply@blogger.com11tag:blogger.com,1999:blog-3191751956841741209.post-86402857982078826712015-05-23T10:00:00.000-05:002015-05-23T10:00:31.168-05:00Off We GoThe first 3 words of the Air Force song pretty much sum up the last 5 months of my life. I've severely neglected to post as frequently as I intended but that was partly due to the lack of particularly interesting things to talk about since January.<br />
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Not anymore.<br />
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The residency is coming to an end in a couple short months and the last 5 months have gone by about as fast as 1 month seemed to go back in the fall. Finally getting in the flow of clinic, understanding expectations a little better, having more freedom in clinic, a new oral surgery rotation schedule, Spring Break, some federal holidays, better weather, and some fun courses have all contributed to the increase in moral and the perceived increase in speed of the residency.<br />
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My wife and I were able to hit the ski slopes for the first time in March (I seemed to be on-call for most of the prime opportunities in the fall) and we took a road trip through a good majority of the state of Colorado for our 5 day spring break. It was the trip of a lifetime and I highly recommend it to anyone! Email me if you want information on where we went; it was incredible.<br />
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If you follow my on twitter, or read the tweets off to the side on my blog, you'll know that we got our base list not long after my previous post with all the bases that had openings. We had lots of great options but we were disappointed to find many of the bases we wanted were not available. However, we were still able to put bases on our "dream sheet" that were not on "the list" just in case an opening popped up. Surprisingly, it seems that many AEGD residents from around the country put bases high on their list that were not available (apparently) but ended up going there. To be honest, I have no clue what the list we got was all about because it seems like people went to lots of bases that weren't on "the list". So who knows! Maybe they just make their best guess at which bases will be open, I have no idea. <br />
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We got our #15 choice and I'll reveal what base that is once we get there. There's been a pretty heavy crackdown on information and things lately in the military as a whole so I'm going to try to walk the line of being transparent and safe with this information. For comparison, 2 of my classmates volunteered for their assignments, another got their #1 and another their #9 (I think). So overall, very good!<br />
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A month or so ago we had a meet up with all the AEGD residents across the country at Lackland AFB in San Antonio. It's something they want to try to do every year and it was a really fun experience to meet everyone and talk about some Air Force stuff. Every base was off the entire week (except us) so most of you doing an AEGD will get to be out of clinic for a week and hang out in San Antonio with all the other residents. We did go out a couple nights and it was a pretty fun time.<br />
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One thing that going to San Antonio helped me realize were the stark differences in each AEGD program. Some bases are set up poorly for certain things while others are set up well. I think my base is set up well for oral surgery because we have so many young cadets, but this very thing also puts us at a disadvantage for prosthodontics. I also assumed each resident would get similar levels of training but it seems that a lot of that depends on the faculty that are at the different locations as to how much freedom the residents will have to do certain things. Some seemed more intent on taking it slowly getting into clinic while others emphasize clinical experience as the main mode of education. If you're interested or concerned about these things, I would try to figure out a way to contact a resident at each of the bases. It sounds like a lot of work but it might help you figure out which program fits your personality better.<br />
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Two words of advice for everyone that does an AEGD. First, try to understand very clearly the expectations. I've run into trouble lately with not understanding expectations from faculty both academically and clinically for various reasons. Sometimes it's getting vague information or mixed information from different faculty members on the exact same topic. So get clarification when you need it and never assume a low level of effort will be enough. The Air Force is a little different than a normal AEGD program because people are coming and going all the time. So often the faculty aren't on the same page about what a resident should know or do in a particular situation so don't be afraid to ask.<br />
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Second, don't be shy to let your directors know that you want to do more of a certain procedure, or that you would prefer NOT to do a certain procedure when you leave. If you're performing well in all areas, but don't particularly like some of it, you could get stuck going to a base that needs the skills you do well, but don't like. So help the Air Force help you and be clear about what you hope to do when you leave the residency.<br />
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I hope to summarize my feelings about doing an AEGD once my AEGD is over and perhaps after I've been at my new base a few months and can truly appreciate what I've learned.<br />
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***FYI; I've heard from applicants and current HPSP students that the AEGD will be mandatory if you are accepted. I can confirm that I've heard this from higher ups as well. You are no longer permitted to apply and decline an AEGD in the Air Force.USAF DDShttp://www.blogger.com/profile/16462820168288467617noreply@blogger.com9tag:blogger.com,1999:blog-3191751956841741209.post-5614858432490725422015-01-03T11:16:00.000-06:002015-01-03T11:16:30.894-06:00When Stress is Stressful (aka: The Longest Post Ever)I'll get to the dental stuff in a second but first I want to talk about stress. This is not a scientific or philosophical discussion but simply some thoughts from my own brain about stress as it relates to where I currently am in my life.<br />
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Stress<br />
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I moved away from home ("home" here means anything within a 50 mile radius of where I was born) for the first time this summer and at first it wasn't too bad. Then for some reason around November things got difficult. The sun started going down sooner (sunlight always makes me happier!), the holidays were around the corner, and I started to get homesick. It's a funny thing when you miss people because typically nothing has changed really but you can no longer just go see them whenever you want. Even knowing that your family is suddenly 600 miles away just feels weird.<br />
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Then, of course, there's the residency. To be quite honest, the first couple months of the residency weren't half as stressful as the worst times in dental school. Dental school was a real drag a lot of the time and there was a ton of stress associated with graduating on time and actually making it out. With a residency, the worst that can happen (seriously) is that they kick you out. Really, that's it. You're still a dentist and though your pride might be shot, your life would not be severely altered in any measurable way unless the residency was an integral part of your future plans.<br />
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For whatever reason, I started letting things get to me. In a recent book I read, the author commented on a concept of "thought attacks" where you let one tiny thing get under your skin and suddenly your mind just creates this totally fabricated scenario in which things go terribly wrong or you are far too upset about something you shouldn't be and it makes the whole situation seem powerful and urgent and it consumes you in a flash. These started for me once the little criticisms began in residency. I'd make one little mistake and beat myself up for it, or answer one question wrong and extrapolate the consequences in my head to a place they never would actually go. Even having more "things" to do just seemed stressful even if I had plenty of time to do them. In essence, I was letting tiny things get to me in a way that I hadn't in the first couple months of the residency.<br />
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Combine these three things, and the last two months have been the worst in the residency for me personally. We are still new but we are treated and expected to act like full blown Air Force dentists for the most part. For a couple weeks I knew this but couldn't figure out why this was so stressful. It's because I had never done that before! Many of my classmates are on their own, but I'm not. I'm still in an educational environment so I often expect someone to tell me how or what to do. It wasn't until just recently that I realized a lot of my stress was coming from this circle I was trapped in. It goes something like this. <br />
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I have a procedure to do, I get to clinic, I'm not 100% prepared, I'm stressed out because the faculty want me to be more prepared, they help me through the procedure, I finish the procedure and everything is fine, I'm stressed because I didn't know what to do, because I'm stressed, I worry about the next procedure with that doctor, the next procedure comes, I get to clinic, I'm not 100% prepared... etc...<br />
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Ok so I think get it now. This is my education, this is my miniature dental practice inside of the Air Force. If I was in private practice I was going to have to learn all of this on my own anyway. I was trying to walk the line between being an autonomous dentist and a student. In reality, I need to have the mindset of an autonomous dentist who happens to be surrounded by experts willing and ready to help should the need arise. I'm not 100% student or 100% autonomous dentist yet and so I assumed I should act a little like both. I've started to realize that I need to fully own this, as if no one is going to help me, and allow the education to flow naturally from the areas I'm weak in rather than the areas I'm not prepared.<br />
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So my stress was coming from unpreparedness. Also, stress in and of itself is just a response our body has to a certain situation. Whenever we are stressed, everything seems urgent and it's hard to do things well. November and December were hard months in the residency for me but they also went by quickly. I've seen my family twice now (Thanksgiving and Christmas) and I realize that the AEGD is under my control. I'm feeling refreshed and the residency itself is nearly halfway over. <br />
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Dental<br />
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Now on to the dental things. I've gotten lots of emails lately and December was the biggest month for my blog since I started it way back in 2010. I'm going to address 2 of the more general questions now and then go into more detail on the residency.<br />
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Understand as I answer these questions that they are from the perspective of an Air Force dental resident who has been doing dentistry in the Air Force for all of 4-5 months.<br />
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How do deployments work?<br />
As far as I understand, deployments are quite rare. Not 0% rare, but usually they are filled by volunteers. This is also answered in the comment section of the "Got a Question?" page at the top.<br />
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Where can I be stationed?<br />
The possibilities are far and wide! For the AEGD, there are only about 10-12 bases with the program. As far as being stationed after the AEGD (or right away if you pass on the AEGD), there are about 50 US bases and around 15 or so overseas bases. I hesitate to post a map for security reasons and I'm just not 100% sure that would be ok. You can find this information by searching for bases and then seeing if the have a dental clinic. Not every base will be an option, they need to have a vacancy for someone to go there. Your recruiter should have maps of the US and overseas bases. <br />
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Now for the AEGD. Here's my halfway-point summary.<br />
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You work in a block clinic (Monday morning is Endo, Friday morning is Operative, etc.) so it can be hard to schedule sometimes. Your patient's appointments will often be a month apart because there might be other activities or holidays that lock out certain days that you would normally have clinic.<br />
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The clinical experience depends on the faculty preferences at your location. I've spoken to other AEGD residents who had done as many as 10 single unit crowns by Thanksgiving. I think only 1 resident at my location had done 1 single unit by that time. As of now, I believe a total of 2-3 single units have been delivered (I've done 0). This is simply the preference of the specialist at that base in terms of how they want to deliver cases and the style and method of teaching the different aspects of their specialty. My guess is that those other bases probably had single units ready to go when the residents arrived where as we typically work the patient from start to finish so a lot of cases I'm doing now will be ready to deliver in a couple months.<br />
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I think the biggest benefit <i>and</i> downside to the residency is the variety of procedures. I don't really feel like I'm getting far better at my core skills (fillings, crown, etc.) but I'm learning new things I never expected to do or enjoy (perio surgeries, sedations, different endo obturation methods). On the one hand that's great if you want to broaden your skills but not ideal if you wanted to do a high volume of more of the core skills.<br />
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Is the residency worth it? I would say yes, but with a caveat. Yes because in order to do certain procedures in the Air Force you have to be "credentialed" by staff to do them. Simply doing them in dental school isn't usually enough but this partly depends on the base you go and what the leadership allow you to do out of the gate. If your goal is to broaden your experience and learn to have a better eye in all aspects of dentistry then the AEGD is worth the extra year. If your goal is to get your school loans paid and get out of the Air Force, and you have no interest in learning more about other specialities, then the AEGD might not be for you. <br />
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I hope this was an informative post and I wish you all a wonderful 2015!<br />
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<br />USAF DDShttp://www.blogger.com/profile/16462820168288467617noreply@blogger.com9tag:blogger.com,1999:blog-3191751956841741209.post-7182886956011887442014-10-26T17:39:00.001-05:002014-10-26T17:39:39.386-05:00When Learning Isn't FunI've got to say, one of the hardest things about being in school since I was 5 years old is getting up every morning and knowing only one thing for certain: that today I will learn something new. Unfortunately in the high-pressure environment of a dental residency, it's easy to forget that we (the other 4 residents and I) are learning and often we feel like punching bags where the fists are different tasks and questions that we aren't equipped to do or answer.<br />
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It's easy for you, the reader, to tell from that statement that an AEGD, or any residency for that matter, can feel like a beat-down at times. As I sit here and write this, I know for a fact that I'm going to feel very dumb and silly multiple times this week for either not knowing or forgetting something that someone expects me to know. However, once you come to this realization and strip away the stress that comes with chronic unpreparedness, you can start learning.<br />
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I had to figure this all out again in the last few months and coming to terms with this has been refreshing. I must do the best I can each day without sacrificing my personal health and wellbeing to perform at a high level. It's not just for me but for the future of the Air Force and I owe it to each of my faculty members and patients to constantly give my best effort. I will often fall short and I will often fail, but once you can realize that that is part of the way we must learn, it isn't so bad.<br />
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I know this is a little different than my other posts but I write it to point something out. When things seem hard, take a step back and try to understand why they seem hard. Often it's just that, they seem hard but really aren't. Perhaps it's our perspective that makes them hard. If I know ahead of time that the way they are teaching me is by asking me questions I may not know and having me do difficult procedures, then I can be totally 100% comfortable with not knowing things and failing! Because if I believe that the intentions of the residency are pure, to make me a better dentist, then I have to believe the methods are pure as well and that's ok.<br />
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It's been a hard month as we've transitioned into more clinic but I'm starting to get the hang of it. I can see improvements already and I know what the different faculty members expect. Best of all, I'm learning why they expect what they do. It isn't for their own self-pleasure or to make sure we all have a crappy time, but to improve our thinking skills and our hand skills to perform at a level that will allow us to exit in August 2015 and be able to handle far more cases with great confidence that we have never possessed before.<br />
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Because I trust the end is well intentioned, I can trust the process is well intentioned, too. And that in and of itself is why this next month will be better than the last. <br />
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USAF DDShttp://www.blogger.com/profile/16462820168288467617noreply@blogger.com11tag:blogger.com,1999:blog-3191751956841741209.post-13397480355116478902014-09-21T16:44:00.002-05:002014-09-21T21:39:16.405-05:00Steel on Target and Chemical WarfareThese last few weeks have absolutely flown by. I finally finished the COT guide and am seeing patients in my AEGD. Here are some thoughts so far about the experience.<br />
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If you don't want to be in the military, the HPSP is not for you. The "military" things die down a little after you finish in-processing to your base but you have to wear the uniform every day and operate in the understanding that you're doing dental work on members of the military to further the mission. </div>
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Air Force dentistry is awesome and frustrating at the same time. Having specialists and people who genuinely care deeply about the work they do is awesome. The paperwork can be confusing and redundant and sometimes you'll wish you could "experiment" a little more. By experiment I mean try some more cutting edge things. My base does have a CEREC machine but you won't see us throwing CAD-CAM crowns on any tooth we feel like. Everything the Air Force does is backed heavily with research because they have to do what is going to be the absolute best for airmen and soldiers in deployed situations. A posterior composite may work for a patient on a yearly recall, but amalgam has the better long term track record so you'll see much more of that on posterior teeth, for example.</div>
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The military community is special. People understand each other and get that the mission is crucial. There's an overarching feeling of teamwork that is really cool to feel every day. Some things about the Air Force are frustrating when it comes to dentistry but it's hard to ignore how important the dental work is. </div>
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Financially the Air Force isn't as lucrative as private practice but as a new clinician, I'm happy to be where I am to further my skills and training for free (and getting paid!). The compensation is more than enough without having student loans and you should be able to live comfortably if you are budgeting and planning correctly.</div>
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All in all, I'm really happy with my decision. I've had a few late nights but the weekends are always a welcome time to relax. I try to get absolutely everything done during the week so I don't have to come up and work on weekends. So far it's working out!</div>
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If you're about to head to COT, check out the COT guide on the Additional Resources page!<br />
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[The title of the post is somewhat of an inside joke but just know that they're very corny jokes about using burs to cut teeth (steel on target) and fluoride (chemical warfare)]</div>
USAF DDShttp://www.blogger.com/profile/16462820168288467617noreply@blogger.com6tag:blogger.com,1999:blog-3191751956841741209.post-77204101904239809892014-08-24T18:32:00.000-05:002014-08-24T18:33:08.461-05:00And Now Everything is DifferentIn a few short months, seemingly everything in my life is different than it was. Here's a quick rundown of everything that's changed in the last few months:<br />
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May:<br />
Graduated dental school<br />
Set up my move to Colorado Springs<br />
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June:<br />
Wife quit her job in Oklahoma City<br />
Actually moved to Colorado Springs<br />
I left for COT (at the tail end of June)<br />
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July:<br />
Wife got a new job in Colorado Springs<br />
I did the COT thing in Alabama for 5 weeks<br />
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August:<br />
Flew home from COT<br />
Wife actually started her new job<br />
I started my new life as a resident at the AF Academy<br />
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Dang. That's a lot. It was a lot, still is a lot, and definitely feels like a lot. I'm not going to get super deep into any of these things in this post for a couple of reasons.<br />
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Reason 1: It would be a novel<br />
Reason 2: I started a new tab called "Additional Resources"<br />
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In the "Additional Resources" tab, I'll be posting full documents of various experiences I've had. When I started this blog in 2010, I was chronicling my dental school and Air Force journey. As I've gotten older and time has moved along, some of these things have actually ended. That's awesome because that part of my life is now in the past and nothing about it can change again. This means I can post full documents detailing every little thing I want to talk about in a place that you can access and refer to without having to jump on my blog to read! For example, I'm almost done with my full writeup about COT which is a very common topic I receive questions about. I'm also planning to do one about dental school in general as well as one about what it's like to be a student on the HPSP scholarship. I'm technically active duty now so my HPSP days are over. I've also done a full move with the military so I can definitely give you some start to finish information on that as well.<br />
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Here are just a few thoughts I have about the last few months.<br />
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When change happens in life, embrace it. Understand that it is temporary but very necessary for us to move forward. Think of it like a rocket on the launchpad. It will never fly without a fast and abrupt change. The fuel must be ignited and that can be very scary. Eventually the rocket reaches outer space, does what it needs to do, and now a whole new thing has started because of that. Just like our life, we can't sit on the launchpad forever. Talking about doing something and doing it are very different actions and if you want something new, something has to change. <br />
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With that said, let me talk briefly about a few things that I'll dip into more detail on later:<br />
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Moving: This is really nice because the military will move all your stuff for you for free. You can move part of your things and that's totally fine. I would definitely take valuables with you in your own car (if you are driving). They are efficient up until you want them to deliver it. Expect delays of up to several weeks in the summer. Call the moving company and keep tabs on the progress of your move.<br />
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COT: This is not an easy month but it was worth it. You will learn fast and you don't have a choice. It's a 5 week flood of information and you'll feel like you're in some weird Air Force blender for 5 weeks while you sweat and march all over Maxwell Air Force Base. Be prepared to be sleepy on a daily basis but keep a good attitude. When you're being yelled at, ignore the volume and listen to the words. Keep a good perspective and it will go by quickly.<br />
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The Air Force: In-processing involves getting an ID card, making sure your pay is correct, doing computer training, etc. It's a long process but embrace it. The military is a massive system and it's a wonder they keep things as straight as they do. Respect those ranked above you and enjoy the process. If your mindset going in is "I can't wait to do my time and be out" you're going to hate it. Even if you are planning on getting out, you can't for a few years so make the best of it!<br />
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Time to run but hoping to keep the blog a little more consistent this year! Starting to see patients in a couple weeks at my AEGD so that should be a blast. Be sure to check out the "Additional Resources" tab in the coming weeks for a whole new set of awesome information!<br />
<br />USAF DDShttp://www.blogger.com/profile/16462820168288467617noreply@blogger.com10tag:blogger.com,1999:blog-3191751956841741209.post-2788702241655899842014-06-09T14:11:00.000-05:002014-06-09T15:08:35.725-05:00Cookies, Willpower and Life Systems (How to Do More and Not Hate It)As some of my frequent readers will know, I was the president of my dental school class for 3 years before we recently graduated. One of the ongoing jokes among my classmates was that I had more hours in the day than anyone else. I was often the first one in, the last one out, and the guy working on stuff while everyone else was relaxing. (Note: This did not give me the best GPA or make me the best student in my class, but I had a reputation for being highly productive. Do not get those confused!)<br />
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Now don't misunderstand this as me bragging about myself or trying to put others down in any way, because it's not. I view leadership as a service to others that I take very seriously, not as a hierarchy of importance, just a hierarchy of service. But that's a topic for another day.<br />
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How is it that I had the ability to work so hard and long while seemingly getting things done that others hadn't yet started or make study guides (with the help of many wonderful classmates) and flashcards for test after test after test?<br />
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Let me preface this by saying that some people are simply high energy while others are not. I consider myself a high energy person but I think that comes from playing to my strengths and who doesn't like doing something they're good at? I'm not, however, an extrovert that always has to be the center of attention and accomplish things to boost my ego, quite the opposite.<br />
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This post is about something else, something we commonly call "willpower".<br />
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Willpower is the ability to muster up the energy to do something that we otherwise might be inclined to put off until later, put off forever, or substitute something simple and more fun in its place. It takes great willpower to workout every day. It takes willpower to eat healthy. It takes willpower to save money. Why? Because there are a thousand other simpler and more intriguing options at our disposal.<br />
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<i>Instead of working out we could:</i><br />
Sleep in<br />
Get to work a little early<br />
Not go out in the dark cold morning<br />
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<i>Instead of eating healthy we could:</i><br />
Have some more chocolate (yum)<br />
Eat the rest of the steak right now even though we're full<br />
Go out to eat with our friends<br />
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<i>Instead of saving money we could:</i><br />
Get that new MacBook Air<br />
Buy the TV that's just a little bigger than the one we wanted<br />
Take a vacation now<br />
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What if you could hijack your own willpower and change your patterns? What if you could say "no" to good now so you could say "yes" to great later?<br />
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The following is a synopsis of a study I've read about countless times that changed my life. It taught me one of the most valuable lessons in my life: <b>willpower is like a battery, it can and will eventually run out and must be recharged! (Read: Ego depletion). </b>We can circumvent this by setting up systems in our life that don't force us to use willpower (or use far less than normal) so that we still have willpower for later. Here's the study, in summary:<br />
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2 groups of students are taken to a lab and seated at different desks in the same room. 1 group is given a bowl of cookies while the other a bowl of radishes. After each group is allowed to eat from their bowl, both groups are given a puzzle to complete. The group that ate the cookies worked on the puzzle for an average of 20 minutes longer than the students over at the table with the radishes! (Side now: the puzzle had no solution).<br />
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What does this mean? Essentially, it takes almost no willpower to resist cookies so these students had plenty of willpower saved up to work on the puzzle. Eating a radish is no fun and takes much more willpower and thus these students gave up easily on the puzzle since they had used all their willpower to eat the radish (and resist the cookies).<br />
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Link to full study description: https://www.apa.org/monitor/2012/01/self-control.aspx<br />
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There are some more details to the study that you can research yourself but I won't get into those today. Hopefully you get the take away and that is that willpower is a limited resource!<br />
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So what can you do about this?<br />
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In my life I've set up systems around me that allow me to use as little willpower as possible on the daily mundane tasks so that I have more willpower for later. Here are some things I do that help me waste less willpower:<br />
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-Leave my keys, phone, and wallet in the same spot every day (no willpower spent thinking and searching)<br />
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-Set out my workout clothes each day (when I wake up I just have to walk in, put on my clothes, and leave)<br />
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-Do a budget at the beginning of every month (I don't make daily decisions about finances)<br />
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-I keep my computer very well organized (no willpower wasted searching for lost items)<br />
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-I have a separate to-do list of things that need to be done later, that I cannot do today, in a separate list with an alarm set for the date and time I can actually do that thing (no willpower thinking about things I can't do anything about) [example: I have a form I've completed that I can't submit until July 1. So set an alarm for July 1 and forget about it and don't put it on your normal to-do list!]<br />
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-I cook chicken once a week and put it in a container so I never have to settle for junk food when chicken is ready-to-eat in my refrigerator<br />
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-Sunday is a pretty relaxed day, so this is when I plan ahead on my week and double check that my calendar is right and that I have all the food I need for the week (during the week, no willpower wasted thinking about all the stuff I have coming up or if I'm going to run out of something mid-week)<br />
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This kind of thinking, what I like to call the "Life Systems" approach, allows your free time to be much more productive than ever before. You haven't wasted your willpower looking for keys, stressing about how much is in your checking account, forcing yourself to dig out your workout clothes from 3 different drawers, so you have plenty of willpower left to tackle all sorts of other things in your day that do demand your attention. These tiny tasks that drain us little by little can be the difference between getting something done at the end of the day. I enjoy coming up with ways to automate those things in my life that are necessary but not that fun to do so that I don't waste my willpower (and time) on them.<br />
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I hope this post has helped you get an insight into my productivity and allows you to search your own life for ways you are accidentally sucking away all your willpower and wondering how hyper-productive people are able to get so much stuff done. If you'd like to read more about this idea, and other concepts that have helped me be more productive, here are some books I highly recommend:<br />
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<i>How to Fail at Almost Anything and Still Win Big</i> - Scott Adams<br />
<i>The Power of Habit </i>- Charles Duhigg<br />
<i>An Astronaut's Guide to Life on Earth</i> - Chris Hadfield<br />
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<i>Another secret to willpower is that we will always tend to default to things we know we can do! It's easier to get things done when we know what we're doing and adding skills to your life opens up new doors. Setting up systems gives you time to focus your willpower to learn and grow to become better at whatever you desire. <a href="http://www.webucator.com/">Webucator</a>, an online eduction company that recently reached out to me as a part of their "Most Marketable Skills" project in the Webucator Asks Project, offers many self-paced courses online including <a href="http://www.webucator.com/microsoft/index.cfm">Microsoft training courses</a> (Word 2013 course is FREE for a limited time!), as well as many others, to help you expand your knowledge and succeed in today's world.</i><br />
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Hope this was informative and as always, feel free to email me with any questions you might have!<br />
<br />USAF DDShttp://www.blogger.com/profile/16462820168288467617noreply@blogger.com2