The Courage to Care

It is a personal pleasure to welcome Steven Gold as associate editor of the Journal of the California Dental Association and to introduce him to the readership this month through his editorial comment.

Steve has been recognized for the excellence of his editorials and his publication, WestViews of the Western Los Angeles Dental Society, for which he served as editor for the past four years.

In his initial comment on these pages, Steve discusses courage. I believe he understands the importance of courage in engaging in the business of dentistry better than most of his peers. Not only did he initiate his own general practice of dentistry in fewer years than the average these days, but he also assumed a role of considerable service responsibility to his profession when he became editor of his component society a mere three years after graduation from dental school. For most new dentists, the factors and challenges described by Steve keep them focused on addressing their debt and starting up and building their own practices for a good number of years before they believe they have time to devote to their profession.

Steve’s courage in rapidly learning to make the important practice-related business decisions of contemporary dental practice and his interest in dental journalism have prepared him to contribute to his profession at an early time in his career. I believe that can be invaluable to his colleagues, be they new or long-time practitioners.

-- Jack F. Conley, Editor

I have been asked to contribute to the Journal of the California Dental Association in part because I fall into the category of "new dentist," meaning one who has been practicing 10 or fewer years. I applaud CDA for its efforts to reach out to new dentists and embrace diversity on all fronts. I thank our association for giving me the opportunity to contribute to our profession as CDA’s new associate editor. Representing the views of all new dentists is a daunting task and as such, I will not even attempt to do it. Rather, I will draw upon my own experiences, including my conversations with other new-dentist colleagues, to give some insight into what new dentists are facing today as they enter the profession.

So what are the challenges facing new dentists? I have identified three, which are of such importance that they deserve the attention and efforts of the entire dental profession. The first is debt. Today’s dental school graduates are the most indebted in history with some facing more than $200,000 in student loan debt. Compounding this is the fact that, while dental school tuition continues to increase by as much as 10 percent a year, starting salaries for young dentists in associateship positions have not increased appreciably in the past 20 years. This, naturally, leaves many recent graduates feeling the effects of high levels of financial stress. Well-meaning colleagues, friends, and family usually offer words of encouragement such as, "Don’t worry about the debt. Just work hard, and it will eventually get paid off." The comfort in these words soon fades when reality hits, typically in the form of the first mailing of student loan coupon books.

The second challenge facing new dentists is a rapidly changing health care marketplace. Managed care and third-party payment plans have frustrated even the most seasoned dentists. The confusion and frustration is magnified for new dentists who do not have experience in dealing with these issues. Many new graduates were warned in dental school not to get involved in managed care because quality dentistry cannot be practiced when fees are overly discounted. But avoiding managed care is simply not that easy. Many of the dental offices offering associate positions are already involved in managed care. Dentists attempting to start their own practice face the dilemma of keeping their schedules full, and managed care plans may appear to be an attractive option for them. Their rationale? I want to practice quality dentistry, but if I don’t keep my schedule full and find a way to pay the bills, I won’t be able to practice any dentistry.

Finally, new dentists face the challenge of acquiring the skills to run and manage a practice. A criticism the dental profession has faced is that dentists receive inadequate business training and, as a result, are poor business managers. In spite of this widely held opinion, many dentists have been able to build successful dental practices and are delivering quality care and enjoying a comfortable lifestyle. Today, however, competition and personal indebtedness leave little room for error in managing the business of a dental practice. Practice management courses in dental schools do an admirable job of providing an overview of the business of dentistry in the limited time allotted in busy dental school curricula. However, they fall short of providing the real-world, hands-on experience beginning practitioners need. Private consultants and firms can help, but consulting fees are high for new dentists and results are certainly not guaranteed.

Having painted such a grim picture, I can now tell you that, with very few exceptions, new dentists I speak with are excited and optimistic about the profession of dentistry and look forward to the joy their careers will bring. They see a future that will allow them to provide life-improving services to patients, gain personal pride and satisfaction from their careers, and enjoy comfortable lifestyles.

For this picture to continue to be a reality and for the profession to maintain its respected status in society, all dentists young and old must work together to overcome these challenges. Some may argue that doing so requires a multitude of complex solutions, however I feel it takes only one: courage. Older, more-experienced dentists must have the courage to give of themselves to the newer generations of dentists, to become mentors and be willing to pay new dentists the salaries they need to live on. In doing so they will, by nature, be the lights young dentists can follow. New dentists must have courage as well. In the face of financial adversity, they must maintain the high ethical standards the profession demands and continually seek to better themselves and the quality of their services through lifelong learning. Finally, organized dentistry must have the courage to explore creative and innovative ways of serving its members and of maintaining a profession that will always have a bright future for those who enter it. Courage of this nature is not difficult to find. It is within all of us who love dentistry and who truly care about the future of the profession.