Should You Become a Dentist?
I am asked this question often. There are several factors to consider when choosing a profession and two of them are the return on investment you expect to receive from obtaining the education and the suspected level of personal satisfaction or job fulfillment you would expect to achieve while working. The latter is much more difficult to quantify as one can find satisfaction from multiple career choices.
As applicants to dental school know, dental school is expensive – both in opportunity costs and tuition. Such a significant investment of time and money should not be taken lightly. Unfortunately, dentistry cannot be practiced prior to committing oneself to the profession. In fact, there are some students who discover that they do not enjoy practicing dentistry during their third year of dental school. And there are even more young dentists who realize that dentistry was a poor choice for them after they graduate and begin practicing full-time. For these individuals, the task of practicing dentistry is not enjoyable and they often wish they had selected another profession, but feel stuck practicing clinical dentistry until their debts are paid off. This latter scenario can feel like a life-sentence for these young professionals due to the cost to enter the profession. This post is intended to help those considering the profession gain insights into what it’s like to practice dentistry in 2021. To be very clear, this post is not intended to persuade a student to pursue or avoid the profession. Since this is a blog post, it has its limitations and longer forms of media (like a book) may be a better solution. Regardless, this post is my attempt to share what I have learned after graduating from dental school more than six years ago and I hope it helps those considering a similar career path.
Would I choose dentistry again?
The short answer is “maybe”. It is difficult for me to decide if this career choice is really worth the cost in 2021. I spent about $400,000 to become a dentist and that level of debt can have a significant influence over one’s life. I have tried to make decisions that are most appropriate for myself and my family, but the amount of money I borrowed to become a dentist weighs heavily on me, and I don’t even have it that bad in comparison to more recent graduates.
I have the luxury of being well connected within the profession and know I am not alone when It comes to the costs. Before 2005, maybe even 2010, there were very few people talking about the absurd costs of dental education. Now, there are many of us talking about it online – you can read more about my thoughts regarding the cost of education here: https://oneloosetooth.com/dental-school-worth-400000/
After you get over the cost to become a dentist, here is what you should know.
Thick Skin is Required
The first quality you must embrace when deciding you want to be a dentist is that you must have thick skin. If you find criticism troubling or upsetting, I can say with confidence that you are not well suited for this profession. The process of becoming a general dentist in the United States involves organized hazing. The schools are not as bad as they were two or three decades ago, but you should be prepared to be told how terrible your work is over four years. If you are unable to cope with the sometimes undeserved criticism, dental school will be a challenging environment to navigate.
After you graduate, you will need to develop even thicker skin. You must be able to handle criticism from your colleagues, your employers, and your patients. Dentists are notorious for treating each other poorly. It is hard for me to explain how poorly we treat each other to those who are not practicing, but suffice it to say that dentistry is more art than science and since so many of our decisions have multiple answers, it’s rare for dentists to agree.
Patient Based Requirements
Navigating dental school is very challenging because of administrative politics and the fact that dental students have patient-based requirements. Patient-based requires (while necessary) often put the student in a challenging position where they are trying to find patients who need and can afford the treatment the student needs to complete to graduate.
Patient based requirements continue through licensure. The pandemic that began in 2020 may bring patient-based examinations to an end, but prior to 2020, licensing bodies required applicants to successfully complete a patient-based board examination. These examinations require students and faculty to identify patients who need treatment and then encourage the patient to delay the treatment they need until exam day (which may be several months away). As of late, these examinations have been called into question as the profession contemplates the moral hazard of patient identification and delayed treatment.
Lastly, because dental schools rely on patient based learning, the experiences among their graduates varies widely. While some students have exceptionally strong clinical experiences during there academic career, many find it challenging to obtain enough patients to build a portfolio of experiences that would make them a well-rounded dentist upon graduation.
Practicing Dentistry is Challenging
Most applicants to dental school underestimate how difficult it is to practice competent dentistry. Patients also underestimate the importance of choosing a talented dentist – most likely because it takes several years to develop symptoms associated with poor dentistry (assuming the patient develops symptoms at all). This is too difficult to explain to those who are not yet practicing dentistry, but believe me, the average dentistry struggles with practicing perfectly every day and you should be prepared to do the same upon graduation.
Insurance has Hindered Our Profession
Most people do not realize that dental benefits are often labeled as “insurance” when, in fact, these plans are not insurance at all. When we think about dental insurance, we typically think about health insurance where the participant has an annual deductible. Once the insured patient reaches their annual deductible, the health plan pays 100% of the remaining costs associated with healthcare expenditures for the year. PPO dental insurance never covers a limitless amount of benefits and the majority of plans have an annual maximum benefit of $1,500-2,500 dollars per calendar year. This means that once the plan has paid the maximum benefit, the patient is responsible for all additional costs associated with their care until the policy year resets.
Complicating insurance even more is the McCarran-Ferguson Act (McCarran–Ferguson Act – Wikipedia) which exempts the insurance industry from most federal regulations regarding anti-competitive behavior. The McCarran-Ferguson Act was actually repealed in January 2021, so we hope that positive change is on its way – although, it will likely take several years (maybe a decade) for professionals and consumers to see any benefit.
Reviews are Brutal
The popularity of online reviews via Yelp and Google can crush the most well-intentioned practitioner. There is a strong argument that patients should not be able to review medical professionals online as they do not have the knowledge required to fully understand their condition and unique circumstances, but that ship seems to have sailed.
When we receive negative reviews about our practices, it is difficult to not take them all personally. It is also difficult to practice in a vacuum where one ignores the potential for negative reviews and how that may or may not affect one’s practice. Unfortunately, practicing defensively because one is afraid of a negative review can be to the patient’s detriment, but many dentist in competitive markets are forced to do just that.
Dentists do well. There, I finally said it. It should not be surprising to learn that dentists earn more than $150,000 per year because they are highly educated and skilled surgeons. However, what may be surprising is that after debt service (both student loans and practice loans), many dentists are not doing that well in comparison to their peers in other medical fields. So, if you want to be a dentist only for the money, look somewhere else.
You can still have a three or four day workweek as a dentist. While this used to be a major selling point for the profession, many career paths are offering comparable lifestyles in 2021 with the ability to work from home. So if your only reason for pursuing dentistry is for an alternative workweek, you have other options available.
Something to Note About the Workweek
Many dentists say they work three days a week, but neglect to say that they work three ten or twelve hour days and also do paperwork two or three days a week that they don’t count as “work” because it’s so much easier than clinical practice. Most practice owners I know work five or six days a week and some even work seven as the build their office. Dentists just don’t seem to count all the time they spending “working” if they’re not actually practicing dentistry which is a strange phenomenon.
In order to be a successful dentist, you must be able to handle stress well. We are under constant stress to perform nearly perfect treatment in a confined workspace. Most of us gravitated towards dentistry because we had a desire to create or build things and we wanted to combine our artistic side with our passion for the biological sciences. Unfortunately, the space in which we work (the mouth) is unforgiving and the difficulty of our workspace is grossly under appreciated. On the bright side, the soft tissues within the oral cavity heal remarkably well.
Working in the mouth is stressful (you’re using a drill next to someone’s tongue while they are awake and able to move) so you must be able to cope well under constant pressure. I had hoped that the stress associated with practicing would decrease with time, and while you do gain confidence and learn to manage stress as you work, the anxiety we feel while we try to safely perform treatment never seems to go away completely.
Side note: if you’re a dentist reading this and can relate, I found that the use of a rubber dam helps reduce the stress of accidental injury while working.
Dental Associateships Suck
This topic may deserve a post of its own. The job market for dentists is terrible. There are not enough good jobs available for the number of dentists seeking employment at any given time.
There are multiple reasons for this void in the profession, and it is very difficult to explain to applicants, current students, and soon-to-be graduates. You really just need to experience the job market for yourself to understand.
The lack of quality jobs in our profession has lead me to believe that if you do not want to own your own small business, dentistry is probably not a good fit for you unless you have plans to make a career out of practicing in the military.
There are obviously exceptions here, but most dentists would agree that this profession almost requires one to buy a practice to find stability and professional working conditions.
You Must Be Good With Your Hands
To enjoy the job, you must be able to work well with your hands and enjoy paying attention to the smallest of details. You do not necessarily need to be the greatest clinician for be successful, but it makes your life so much easier if your hands are capable of manipulating instruments with accuracy. While you can improve upon your skills, some people are just not capable of mastering the fine motor skills necessary to perform great dentistry. To test yourself, try drawing, sculpting, carving, assembling small parts or pieces, or painting. If you are skilled at any of the above, you will probably do well as a clinical general dentist.
During dental school, you may find that your fine motor skills are poor. If this happens, it’s okay. If you find yourself really hopeless with your hands, there are specialties that do not require much use of hand instrumentation. If you find yourself stuck as a general dentist with poor hand skills, don’t give up because you will find ways to adapt your practice to your strengths over time by incorporating more procedures that do not require as much dexterity as restorative dentistry.
You Must Have a Desire to Learn
Lastly, if you are the type of person who never wants to study again after you get a degree or certificate, dentistry is not a good career choice. State licensing bodies require a minimum number of hours of continuing education that we must complete each year to retain our licenses and we have a duty to our patients to stay up-to-date with current techniques and best practices. So, if you have a deep desire to be done with education at some point in your life, you won’t enjoy this profession.