The end of June marks the end of most dental residency programs….or the beginning of a residency program for new residents. The incoming residents are all excited about their new phase of life ….while the graduating residents can’t wait to embark on their next journey. Today, I want to talk about what to consider when you want to specialize in prosthodontics. This is a biased view as it is really based on my own personal experience. But very often, I will be approached by dental students or dentists who are interested in prosthodontics. They are thinking of going back to school to pursue formal graduate training in prosthodontics. They come and ask me for advice because I have done it myself. Well first, there are usually two distinct groups of people requiring different sets of advice: the dental students/new dentists with minimal dental experience; or the dentists who have been practising for more than 10 years and have a very successful practice behind them. I asked myself what I really like to know if I were to decide to go back to school at these two stages of their life.
For background, I belonged to the first group. After completing dental school, I completed a one year general practice residency and then a three year prosthodontic residency before going into private practice. At the time, my reason for pursuing further education after dental school was because I didn’t feel comfortable to be practising. I felt I didn’t know enough. But I was always drawn to prosthodontics. In my view, prosthodontics is a very exciting specialty because you are able to improve the smile of your patients through many treatment solutions. In addition to that, I didn’t come from a family of dentists, so I have no awareness of what it is like to be practicing dentistry in a private setting nor do I understand the business behind running a private practice. In other words, I was a clean slate. I had no influence by anyone in dentistry other than my dental experience in dental school. I haven’t picked up any bad habits and have any perception of how dentistry should be done.
At the time, I was not married and have no kids. So I had lots of time on my side. The good side of pursuing prosthodontics at this stage of my life was that I could completely immerse myself into the program and got the most of it. Other than continuing to live like a college kid, I was a sponge and tried to absorb as much as possible. I was hungry for knowledge and tried to read as much as possible on many different topics in dentistry. I tried to expose myself to a variety of dental procedures by picking the brains of the instructors and faculty members by asking them to show me the tricks of their trade. I could take the time to try different procedures without having to worry about the overhead of running an office. I had an unbiased view of everything in dentistry. I could make my own judgement and my own conclusions after experiencing first hand a variety of procedures and discussing with different co-residents and teachers. I also had time to reflect at a different level in dentistry that I don’t think I would be able to do if I had a practice to run or a busy family to look after.
What I hated then was to continue to live like a student, not to have first class materials and equipment due to departmental policy or budget, and to constantly be a witness to institutional bureaucracy. When you have nothing to compare, you always think the grass is always greener on the other side. I always thought other programs will be better than my program. They have this…or they have that….The truth is the program is only as good as the residents. To succeed in any residency program is to realize that you own the program. There is always the good and the bad with every program. Having said that, if I were to evaluate any program now, some of the things I would want to know are the following:
1/How many residents do they accept? What is the dropout rate? Are the residents happy with the program in general? How do they view their program director(s) or other faculty members? Are there any collaborations between different residents from different departments?
2/How many people are on faculty teaching the residents? Are they all trained by the same institution? This gives me an idea how likely will I be exposed to only one school of thought?
3/What is the laboratory support for the residents? Is there an in house laboratory assisting residents. Do the residents do any laboratory work?
4/What type of procedures are commonly done in the program? How much time is spent on treating patients, on lectures/seminars or on research? What is their schedule like on a daily basis?
5/What type of support for the residents on trying out different procedures, materials and pursuing research projects?
As mentioned, no two programs are the same. Similarly, two different residents can come out of the same program with entirely two different experience. Every resident will have their own personal agendas and reasons for pursuing the program.
Fast forward to fifteen years later, after being in a private practice in both a general practice setting and a referral base setting, having taken some good quality continuing education programs, having a taste of running a business and now wearing the hats of a business owner, a prosthodontist, a wife and a mother, I ask myself if I were to go back to school now, what would I have liked and what I would not have liked.
One thing for sure is I would have been in a better position financially. However, my brain is a lot slower now. My attention span is not the same. But my skill of multi-tasking is at its finest trying to find balance with work, life and family. Back when I was in the residency program, I would spend my day time seeing patients or attending lectures in a classroom and spent the evening doing lab work or catching up on my reading. It was definitely not a 9 to 5 job for me. If I were to pursue the program now, I don’t think I would have the time to appreciate the lab work as much nor the time to read and learn from the literature during the last several decades that set the stage for dentistry and appreciate where dentistry was and how it evolved to the current state of thinking. If I have been in practice and used to taking good continuing education programs, I would be used to a good recipe cookbook to follow. However, in most formal graduate programs, there is often no structure. In other words, there is no spoon feeding. There is no go to list of steps when you want to consider tackling a full mouth reconstruction. No one will prepare a decision tree or algorithm for you to follow. You have to figure out everything on your own time. This lack of structure sometimes may be frustrating for some, especially those who have been in practice for many years, and have taken some good quality continuing educational programs that teach you how to do every step in detail. But it is this lack of structure that will force you to put all the pieces of puzzles together, to understand everything at a much higher level that I don’t think you will be able to otherwise.
At the end of the day, one may ask: what is a difference between a prosthodontist and a general dentist who performs many similar procedures. This is a question I had asked myself many times…Finally one day, as I was watching a reality show on some cooking shows, that I feel the light bulb went off. I can explain to a layman of what I do differently than a general dentist. You see, there are many excellent general dentists out there. Many who after taking on numerous continuing education programs, can probably deliver dentistry at a very high level. With good hands, hard work and perseverance, they can diagnose and treat many patients requiring advanced dentistry. The have a recipe that has worked really well. Similar to a home cook, who after trying out many different recipes, he/she will know what will produce the most delicious meal with proper flavour and textures. However, prosthodontists often don’t work with just one recipe. They have many. Like a professional chef on a reality show, he or she may be challenged to produce a typical dish using very limited ingredients. Prosthodontists, like a professional chef, understand the properties of key ingredients, the treatment is often customized based on many factors to deliver the most sensible treatment for the patient. Not every full mouth reconstruction starts with the central incisors. Not every case follow the same treatment steps. The question of whether to pursue a specialty program lies in whether you want to practice by following someone else’s cookbook recipes or by creating your own one.
Thank you for reading!
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