Noel Kavanagh and George Wright discuss some of the considerations for recent graduates starting out on their dental journey.
Qualifying from dental school is a significant milestone in any new graduate’s personal life. It’s the beginning of a professional career. You have reached the first of many destinations. You now switch platforms and a new journey beckons.
Once the dust has settled, and after the euphoria of getting through your final exams, there are some important questions to consider before you make any decisions about your future career.
Where to now? What is the route? What challenges lie ahead? If I change my mind in the middle of the journey, what happens?
In this article, we explore some of these and the potential risks that can derail our professional ambitions early on in our career. The psychological impact and loss of confidence can make the destination seem even further away and sometimes out of reach. To avoid this, we will also suggest some risk management strategies to help you overcome the obstacles. This will help to you to resume your journey.
Where to next?
One of the first decisions concerns your first ‘paid’ dental job. Would you like to join a general dental practice as a self-employed dentist? Given a choice, where and what type of practice? Or would you prefer a salaried position in the community services/HSE or within a dental hospital? Are you tempted to travel overseas and seek a job in another country?
These are just some of the questions to be answered. You will have to consider the pros and cons of each.
Deciding on a practice
There is no foundation training currently available in Ireland. Therefore, many new graduates start their professional careers working as an associate in a practice setting. This can seem quite daunting. The safety-net of support from undergraduate clinical tutors and peers is no longer available. You must ask yourself whether you feel you need it and how frequently are you likely to use it.
This will influence your decision with regards to what type of practice you join and what level of support is available from the practice team. For some, this will be as an associate working alongside their ‘principal’. Others may begin their professional journey in a practice owned and/or operated by a non-dentist.
Something to consider very carefully, before accepting any job offer, is the potential support structure that will be available to you.
A good starting place is to look at the range of skills of existing team members. In particular, explore whether established colleagues will support and coach you as you settle into the world of general practice.
There are differences between working in a small practice that offers general dentistry and working in a large practice with both generalists and specialists on-site. The multidisciplinary environment potentially offers a different experience. You will be able to peer into the specialist carriage on your journey.
Clinical decision-making and treatment planning without a tutor peering over your shoulder can feel quite liberating at first but it can also be daunting and lead to self-doubt. In a dental school environment, we are used to having treatment plans scrutinised and approved by clinical supervisors.
One day they are the train drivers and the next they have jumped off and you are now in charge of the patient journey. They are your passengers. You are charged with the responsibility of their safety and welfare. It can be a little nerve-wracking and it takes time before you feel confident and comfortable in the role.
It is at this point that the benefit of working alongside supportive colleagues can really come into its own. Having the ability to knock on the surgery next door and run a treatment plan or radiograph by a colleague can prove invaluable. Having senior colleagues available to assist you with a difficult extraction, or support you with a challenging patient, is a benefit not to be overlooked.
It is also prudent from the outset to clarify and understand the business expectations. The business of dentistry is inextricably linked with the clinical side. It is important to understand if the practice owner(s) have any financial expectations and to ensure that you are comfortable with them and that they do not pose a threat to ethical working practices.
Some new graduates may inadvertently find themselves in a situation where there is pressure to hit certain financial targets or other key performance indicators (KPIs). KPIs and other metrics are an integral part of practice management, but they should not become targets. If they do, then they will drive the wrong behaviours and herein lies the risk.
If combined with a low associate percentage or a sliding scale of remuneration, the consequence may be the temptation or pressure to carry out more ‘high value treatments’ such as implants, cosmetic dentistry or short-term orthodontics without the requisite training and experience.
The take-home message here is that not all jobs or practices are equal. Think carefully about taking your first job offer.
The early days
When you have found a position, it is important to orientate yourself with the practice policies and procedures ahead of your first day seeing patients.
Do you understand the practice procedure for dealing with a medical emergency? Where are the emergency drugs kept? What is the practice complaints procedure? What fee structure is applied to patient care? These are all questions that should form the basis of your induction, preparing you for when you greet your first patient.
It may be helpful to have a list of questions for your new colleagues to ensure you have all the information you need to start delivering safe care from the outset.
One of the biggest changes from dental school, or indeed moving practices, can be the changes to dental materials, instruments, laboratories, and local referral centres. It is quite possible that you will be using a new software package for your clinical records and/or radiographs and having the ability to orientate yourself to the new systems ahead of your first day can help ease the pressure, as you get to grips with your new surroundings.
Similarly, dental materials may differ and taking the time to understand the manufacturer instructions of use for common materials will save you time and stress when you first come to use a particular material.
Perhaps the biggest shift when starting out in a new practice is getting to know a new group of patients. Your patients may come with existing expectations based on previous interactions with colleagues at the practice. Taking time to get to know your patients is key to providing excellent care. Some say that a poor clinician who is a good communicator has fewer problems than a good clinician with poor communication skills.
At Dental Protection, we often see complaints that relate not to the specific treatment provided, but to failure in communication leading to a breakdown in the professional relationship between the dentist and the patient.
Concerns regarding a lack of informed consent may arise. That treatment charges were unclear or that the patient perceives their care was rushed or uncaring. Taking time from the outset to build a rapport with your new patient can pay dividends in the long run.
Dental Protection offers a range of communication skills training courses. This includes some on managing adverse outcomes, consent and the principles of shared decision making; these are available free of charge as a benefit of membership. You can access them via the website (dentalprotection.org).
Clinical confidence and competence
New graduates are sometimes asked to provide treatments outside their confidence or competence. Either, by patients or colleagues within the practice.
A central pillar in clinical risk management, is recognising and working within your clinical competence. This requires a certain level of personal insight and emotional intelligence.
The oft quoted Dunning-Kruger effect (DKE) is just one example of a number of cognitive biases that affect our perception of the world around us. The DKE is a bias that causes people to believe that they are more capable than they really are. They do not yet have the knowledge, experience and understanding to recognise their own incompetence.
There is no substitute for knowledge. It was Confucius who said that real knowledge is to know the extent of one’s ignorance. It is important to garner knowledge and it may be worth considering the benefits of further educational opportunities. Also, availing of high-quality accredited courses for the more complex treatments.
Take time to build up your skills over time; it is prudent to start out with the more ‘straightforward’ cases, while having the support of a clinical mentor.
It’s not unusual for new dental graduates to feel overwhelmed. Struggling with clinical time pressures and/or trying to keep up appearances of coping well. During the early days, it is important to maintain a healthy work-life balance. Having a support network around you will be key to helping you to decompress after a challenging day in the surgery.
Attendance at professional networking events such as the annual Dental Protection conference or Dental Protection Young Dentist Conference can provide an excellent opportunity to meet colleagues from across the profession. This can build your network in a relaxed and supportive environment.
Finally, have the courage to reach out for help if you are finding your journey stressful. Or, if you find yourself in need of someone to talk to. Dental Protection operates a dentolegal advice line that is available 24/7 for any emergencies. You may also wish to have a look at the range of wellbeing resources that are available on the website (www.dentalprotection.org).
Above all, remember that we are with you all the way on your journey; we want it to be an enjoyable and fulfilling experience because we know how important that is to you.
This article first appeared in Irish Dentistry magazine. You can read the latest issue here.