Nuts and Bolts - Part 3/3 of Organizing a Military Dental Clinic

Nuts and Bolts - Part 3/3 of Organizing a Military Dental Clinic

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.

Post contents:
-Supplies
-Patient Records and Forms
-Meetings

Supplies:

1. Everything has a home

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. 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!

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 the shelf itself has a label 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.


2. How to label item containers in supply areas

Every item must be labeled on a standard container with at least the following information:

-Item Name
-Manufacturer
-Manufacturer Number

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).

We are working on it :)

3. Have a doctor supply huddle

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.


4. Develop a simple system for alerting the person who does the ordering

Here are some ideas that have worked well --

• 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.
• Pros
• Eliminates verbal communication 
• Eliminates Logistics person being notified multiple times about the same item
• Eliminates the assistants and doctors wondering when an item was ordered
• Good for clinics with 1 supply area
• Cons
• Stickies sometimes fall off
• Required Logistics person to visually scan supply area
• Not ideal for clinics with multiple "main" supply area

• Create a re-order clipboard. The logistics person keeps this clipboard in their area and techs and docs come write down items they need.
• Pros
• Centralizes all ordering information
• Good for clinics that hold supplies in multiple areas
• Cons
• Same item might get logged multiple times
• Handwriting might be an issue
• Often still required Logistics person to go look for the low item to decide how much to order

• 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. 
• Pros
• Makes reordering very simple, because the item is identified as being low and the reorder information is right there
• Cons
• Make sure the sheet stays updated with new items or item changes

• 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.

5. Consider pre-sterilized burs

I love these so much. Individual burs, sterile from the factory, at practically the same cost as whatever burs you are currently using. 

• Pros
• No more nasty looking bur blocks!
• No more burs running through sterilizers 20 times (or more) before they get used
• No more "is this rust or blood"?
• Eliminates entire process for your sterilizer workers
• Safer for everyone (assistant, doctor, sterilizer techs) due to fewer burs needing to be handled (ie: decreased needle sticks)
• Cons
• Takes up more physical space in the treatment room and in the supply area
• Packages must be opened when needed, stalling your work slightly during the appointment vs having an open bur block with several types of burs

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.

6. Standardized treatment rooms

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.

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.

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.

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.

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. 

Patient Records and Forms:

1. Have a weekly record scan program

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.

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.

Common errors to look for:
Duplicate records
Poor handwriting (rewrite the record)
Misfiled records
Records with missing or incorrect colored tags and papers

This would be in addition to the monthly records review, because that program doesn't hit every record. This does!


2. Put all the forms in the same place on the network drive

Nothing drives me crazier than having a medical history in this folder, the initial charting in that folder, etc.

Put them all in one spot! Here's why:

Makes it simple to train new people (the forms are here)
Makes it easier to update forms (this is the only version of the form, let's update it)
Eliminates redundancies (no more having 3 versions of the same form floating around)


3. Develop a naming system for the files so they are printed correctly

This is how we name our files:

"(BW, Yl, Double sided) Fly Cover Sheet, updated 31 Oct 18"

This naming scheme answers 5 questions:
1. Black and white, or color?
2. What color paper do I print it on? (In this example, Yl stands for "Yellow")
3. Do I print double or single sided?
4. What form is this?
5. When was this form last updated?

No more misprinted forms! Yay!


4. Put the date the form was updated on the form itself

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.


5. Put physical forms in as few locations as possible

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.

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.

6. If the form is part of a program, type the directions ON the form itself

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:

"Putting a patient in Class 3
1. Have patient sign this form
2. Write up treatment note
3. Assemble completed chart and place chart in Class 3 box in records room
4. Class 3 NCOIC will take chart and... etc...

Taking a patient out of Class 3
1. When treatment is completed, write treatment note
2. Take the blue chart tag out of the chart
3. Take this form out of the chart and place the form in the Class 3 box in records room
etc..."

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.

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.



Meetings:

1. The length of a meeting is a maximum time limit

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!


2. Have an agenda for every meeting

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.


3. Don't hate the meeting, hate the chaos

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.

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.

Most meetings need to happen, but simply don't have an aim and end up running into chaos problems.


4. Be prepared and be decisive

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.

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.

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.


5. Don't waste everyone's time

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.

10 Books that Have Helped - Part 1/3 of Organizing a Military Dental Clinic

Organizing a Military Dental Clinic - 3 part series

This is part 1 of a 3 part blog series called "Organizing a Military Dental Clinic"

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.

Ordinary people can do extraordinary things with the right habits and systems. 

You don't need "superstars"; leaning on them may work in the moment, but things will crash when they are gone.

Let me say that one more time: this is not about the PEOPLE, it's about the SYSTEMS and HABITS you create and enforce over time.

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.

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10 Books that Have Helped- Part 1/3 of Organizing a Military Dental Clinic

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 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 via books and podcasts.

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.

1. The Power of Habit - Charles Duhigg

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.

2. Extreme Ownership - Jocko Willink

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. 

3. The Goal - Eliyahu Goldratt

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.

4. The E-Myth Revisited - Michael Gerber

I wish this was mandatory reading 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. 

5. Principles - Ray Dalio

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. 

If you've ever played a video game, this concept comes easily. You are the person playing the game and 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 The E-Myth Revisited. 

6. The Life Changing Magic of Tidying Up - Marie Kondo

Nope, not a joke. This book was written to help people organize their homes, but I can tell you, it is much 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.

7. The Checklist Manifesto - Atul Gawande

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.

8. Essentialism - Greg McKeown

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?).

9. Switch - Chip and Dan Health

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 mandatory read for Air Force officers. Shape the path!

10. Ego is the Enemy - Ryan Holiday

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 ;)


Bonus! The Power of Consistency - Weldon Long

This was the book that convinced me I had to read more books. It's the best. I'll leave it at that.

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).

8 Year Recap Post, FAQ, and My Future

This 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.

Before dental school

Recruiters
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 HERE and select "Healthcare Student or Professional".

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.

Application process
Everything flows through the recruiter. You need to be in decent shape, have excellent grades and DAT, and nail your interview.

For the interview, focus on all the generic questions (strengths, weaknesses, etc), but be prepared for additional questions 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?

You're an officer candidate, not just a potential Air Force dentist.

Choosing a school
Go to the school in the area with the cheapest cost of living! 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 Choose FI podcast, episode 99R at minute 57:40.

During dental school

Money!
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.

Military obligations
You don't have any! Yay!

After dental school/AEGD-1

COT
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 COT Survival Guide helpful, but keep in mind that it was written in 2014. Also, check out the newest Air Force PT Test Score Charts to get an idea of where you'll land and start training for this test during dental school! Here's a good pushup and situp video to help you out, but remember, the official Air Force guidance on fitness is found here at A5.3 and A5.4.

AEGD-1
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. I certainly must recommend the AEGD-1 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).

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.

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.

Specializing
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.

After residency/Being a dentist in the Air Force

Where will they send me?
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.

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 systematized the clinic functions, 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.

What's a normal day like?
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.

What's the best part about being an Air Force dentist?
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 this post.

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 usually does count the weekend.

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.

What's the worst part about being an Air Force dentist?
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.

(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...)

How is Air Force dentistry difference than civilian/private practice?
*These are my opinions from having worked in 2 civilian practices during my time as an Air Force dentist*

-Quality of work - 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.

-Patient experience - 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.

-Clinic organizational structure - 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.

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.

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.

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.

*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.

-Employees - This is a touchy subject, so I'll tread lightly. I'm calling this one a tie. Here's why.

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.

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.

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. It's up to YOU 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).


Are you going to stay in the military? Why/why not?

I'm not staying in. I have a lot of personal reasons for this, but here are the top 3:

1. I believe that my experiences and skills can better serve humanity in a civilian setting

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.

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 ;)

2. More time freedom

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.

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.

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.

Which one is better -- making more money or working less? It's personal. It's about having the options.

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.

Time is the currency of life. 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, when leveraged properly, is far more valuable than what the military can offer you.

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.

3. Self-actualization

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.

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.

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.

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.

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.

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.

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.

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.


--
As always, feel free to email me with any questions!

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

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

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

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

These three benefits of being a military dentist are:


1. Not Enough People

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

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

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


2. Not Enough Time

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

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

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

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


3. Not Enough Money

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

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

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

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

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

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

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

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

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

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

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

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



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

1 Year Later

I 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:

Easier than I expected:

--- 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!

--- 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.

--- 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.

--- 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.

--- Winter in Alaska - It's not even windy!  Come on!  Easy :)

Harder than I expected:

--- 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.


So that's an overview, and here's a glimpse into a very typical day in my actual-real-life-...life.

Monday, Tuesday, Thursday and Friday
-Get to work around 0700
-First patient at 0730
-Do some fillings, maybe endo or a crown prep
-1 hour for lunch!
-4 more hours of a seeing patients!
-1 hour of PT time on Monday
-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.

Wednesday
-Get to work around 0700
-Do a 3rd molar sedation/surgery case at 0730
-See a couple more patients
-1 hour for lunch!
-Training day in the afternoon or catch up on things (usually no patients)
-1 hour of PT time

Here's how I would breakdown how I spend my time when I'm actually seeing patients:

Operative (fillings): 55%
Endo: 5%
Pros: 10%
Evals/Exams/etc: 20%
Surgery: 5%
Other admin stuff: 5%

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).

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).

Hope this was helpful!  A little "day in the life" for you guys.

HPSP Laptop Rental

My 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.

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?

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.

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 Laptops for Military Docs 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.

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.

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 Laptops for Military Docs is there to make it easy.

I'd love for some of you all to give this service a try and let me know how the process was for you!

Overseas

We got Alaska.

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).

First off, I'll talk about the AEGD now that I have some perspective.

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!

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.

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.


Second, Alaska!

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.

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.



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!

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!

When 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.

Stress

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.

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.

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.

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.

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...

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.

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.


Dental

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.

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.

How do deployments work?
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.

Where can I be stationed?
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.

Now for the AEGD.  Here's my halfway-point summary.

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.

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.

I think the biggest benefit and 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.

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.

I hope this was an informative post and I wish you all a wonderful 2015!

Steel on Target and Chemical Warfare

These 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.

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. 

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.

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.  

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.

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!

If you're about to head to COT, check out the COT guide on the Additional Resources page!

[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)]

And Now Everything is Different

In 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:

May:
Graduated dental school
Set up my move to Colorado Springs

June:
Wife quit her job in Oklahoma City
Actually moved to Colorado Springs
I left for COT (at the tail end of June)

July:
Wife got a new job in Colorado Springs
I did the COT thing in Alabama for 5 weeks

August:
Flew home from COT
Wife actually started her new job
I started my new life as a resident at the AF Academy


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.

Reason 1: It would be a novel
Reason 2: I started a new tab called "Additional Resources"

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.

Here are just a few thoughts I have about the last few months.

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.

With that said, let me talk briefly about a few things that I'll dip into more detail on later:

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.

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.

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!

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!

"I'm a Dentist, Don't Get Too Excited"

"... and if someone has a heart attack you should still call 911."

For the movie people out there you'll recognize this line from The Hangover.  It's a scene where Stu mentions something about being a doctor and his friend calls him out saying "he's a dentist, don't get too excited."

So here I am, finally done with school, and a dentist.  But don't get too excited because for me this is really just the beginning.  I've dreamed of this for a long time but really this is just my permission to being my career in a field that I find really fun and allows me to directly serve others.  Toss in the Air Force gig and you've got the whole package.  It really is a dream come true, I'm finally Dr. Matthew Lee!

But let's not get ahead of ourselves.  I haven't blogged in a solid 2 months and more happened in those 2 months than I can even wrap my head around right now.  So let's rewind the tape:

1) WREB - Western Regional Examining Board
This was the regional exam I elected to take because I planned to get a license in Oklahoma and it was available at my school.  Pretty easy decision.  For the Air Force I can get a license anywhere but my home state is as easy as any.  Details aside, I had to organize the back-up patient pool (since I was class president) and I'm glad I did because it really bailed a few people out.  One of my patients was my brother and the other patient was not related to me but due to HIPAA, that's all I can really tell you.  But he/she was wonderful.  My endo section went very smoothly and I passed everything!

Here were my scores:

Not too bad!  Things went well and that was definitely the most stressful test of my life since the DAT.

2) Graduation requirements

This fell into place very nicely for me and I was fortunate that it did.  I borrowed a crown prep from another student in case the 2 I had left fell through and I'm glad I did.  I had just enough points to graduate and, in fact, both of the crowns in my patient family ended up falling through.  Imagine that!  Endo was a minor nightmare for many folks and I scrapped by with exactly how many I needed to graduate.  It's a shame too because I actually found endodontics to be very fun and I'm really excited to learn some new methods to perform root canals in the future (Wave One?).

3) Speech! Speech! Speech!

So one of the cooler things I got to do as president was give a speech at our Senior Dinner.  This is a few days before graduation and it's where our class along with their close family and our faculty get together and eat expensive food together and dress really nice.  It's a blast (I had to help last year so I had been once before) and once of the best memories I'll have of dental school. 

Back to the speech part.  I had to give a speech (aka "reflection statements") and I found that very exciting.  I'm usually quite introverted and typically don't assert myself unless it's requested of me.  When it is requested of me, I go all out and try to do my best.  I got a lot of compliments after the speech which was very nice to hear and a comment I heard a lot was "I had no idea you were so funny"!  Well if you were class president for 3 years and constantly stressing out about not only yourself but everyone else, you'd be a pretty serious person, too.  That was over and I could be myself and my true colors came out I suppose. 

One of the coolest parts about the speech was when I promoted the hashtag #oucod2014 at the beginning.  To do that I busted out my iPhone and took a panoramic x-ray picture of the audience and tweeted it to @oucod2014, our official class Twitter account.  I encouraged people throughout the weekend to use #oucod2014 on Instagram, Facebook and Twitter so we could go back and search "#oucod2014" and pull up a bunch of posts and pictures from that night and the next few days, including graduation.  We actually had pretty good participation and it was a lot of fun.  Here's the pano I took on stage as well as a picture of me taking it:

It was more awkward for them than me, watching me slowly take a picture of everyone

Photo by Shak Feroz 

Photo by Shak Feroz

4) Email this paper and now you're a Captain

I have had tons of forms to fill out for the Air Force which I will definitely not go into (at least not here).  One of them was my new Oath of Office.  It doesn't actually have to be signed by someone in the military, just a Notary Public.  I went that route since he had someone in that capacity at our school.  I got the form from her in a PDF and sent it off to the proper Air Force authority.  A couples hours later I got a replying saying I was "good to go" so I'm pretty sure that means I'm a captain now.

Cool!

We're moving to Colorado Springs at the end of June, I'm flying out to COT on June 30, back to Colorado Springs on Aug 1, and my AEGD starts on Aug 5.  Whew!

That's all for now, sorry I've been such a bum about posting lately.  I hope to ramp this up more soon and flesh out some of the static pages on this site as well to have more information available.  I want to comb back through all the hundreds (seriously) of emails I've gotten from you guys and make sure all the relevant questions are addressed on the "Got a Question?" page.

Until I post again, email me if you have questions!  And in the meantime, check out my official website at MatthewLeeDDS.com!

I Can Almost Taste It

I'm officially in that weird stretch of school where things are almost done, and I feel a true sense of them being done, yet I still have a lingering stress of making sure everything actually does get done (follow that?).

I also feel like things really are starting to end as I bid farewell to some patients for the last time and reflect on all of the struggles my class in particular has had over the last 4 years with all the changes here at Oklahoma.

And finally, I'm starting to feel like this Air Force thing is real.  That's where this post begins.

Just after my last post in October, I found out officially that I will be heading to the US Air Force Academy in Colorado Springs, CO for my 1-year AEGD.  It is scheduled to begin August 5th and presumably will end around that same time next year.  Before that, however, I am slated to attend COT in the July class (June 30-Aug 1).  Right now my wife and I are trying to decide if we should move to CO just before COT or try to squeeze it in right after.  It's a tough decision and I'd rather move before, but it's probably going to come down to how comfortable we are financially.

Just before Christmas my wife and I actually went up to CO Springs to look around and we found two great apartment complexes just E of the Academy.  My housing stipend will be about $1600/month so we are shooting for something in the $1000-1200 range to maximize how much we can save while still enjoying our time there.  We plan to call the 2 complexes back in a month or so and whichever can offer us the better deal we will probably take.  We like one of them a little more than the other but we'll see how it all shakes out.

I haven't received my official orders yet but they should be coming soon.  That will allow me to schedule the AF to move my stuff and get that all sorted out.   My wife is a NICU nurse and she'll be applying for a Colorado license soon so she can start looking for jobs out there.  It's probably going to be a bit difficult considering she'll only be there for 1 year but I'm confident she'll find something, even if it's part time.  

In terms of dental school, things are coming together nicely.  I won't get into the details, but my class has taken the brunt of the changes here at Oklahoma the last few years and we are chronically behind in clinic compared to the classes before us and the upcoming classes behind us when we were them.  Fortunately the faculty seem like they're going to be flexible with us because we are simply running out of time to get everything done.  I think I'll actually be able to meet all of the requirements so I'm still working hard assuming that our requirements won't change (which they likely will).

So things are finally coming together and starting to seem real, but I'm still in the fog of school and working hard to finish up on time.  As soon as I do, I'll have about a month and a half off (May 10 - June 30) to just hangout, which will be very nice.  I'm such a high-gear person though that I think it's going to be kind of hard for me to have so much time off and I'm already trying to make arrangements to work part time or something for that short period that I'm waiting.  We'll see! 

Other than filling out tons of very similar forms for the Air Force that are emailed to me weekly (name, SSN, address... etc.), not much else has happened besides finding my AEGD spot and looking for a place to live.  Things will heat up even more soon once I get my orders and buy my uniform (soon!) so stay tuned for more frequent postings as school comes to an end and my Air Force journey begins.

As always, email me if you have any questions!