Working on the road

I'm writing this from a drive-by Starbucks in Stockton.

For this week, I'll be doing some temp work for one of the corporate chains in California.

It's a pretty busy schedule with quasi-borderline treatment planning.
A lot of the work is subpar. A lot of it is rushed.
It'll be things like 4 quadrants of scaling and root planing and a crown in one hour.

In the mornings, there is a "huddle" that consists of assigning each dentist a production number.
We're expected to make that amount of money.

The assistants don't really know what's going on.
It's fun for them, because they do more than the usual suctioning.

However, for us dentists, it's pretty gruelling.
We're expected to do quadruple the usual private clinic production at HMO rates.
We're expected to do it to the minimum standard of care.

It's a numbers game. We are supposed to make at least 4 times what we cost to the company.
Otherwise, it's a loss.

I'm glad that I'm just a temp, an I intend to stay that way...
Because here, you get what you pay for.

Faking it

At the place where I'm renting space, I've been helping out with billing when I'm not seeing patients.

Its a test of patience. I've been learning that insurance seriously screws us over more than I thought. On the patient's side, there are always additional costs: increasing % responsible, increasing deductable limits, and the same coverage cap since the 1970's. On our end, we doctors get paid way less each year.

I'm not going to get myself in trouble by stating the actual amounts in question ("confidential" according to the insurance companies), but it's sometimes as stupid as 30% reimbursement or nothing.

Moreover, the music is driving me nuts!

I really, really can't stand the muzak that is playing down here. As a jazz, R and B, rock, indie, (anything but muzak), it's pure torture to listen to the Chipmunks Christmas carol play every five songs. It's pure smaltz with a double dose high fructose syrup.

While I can't do too much about the ripoff known as insurance, I will try to have music that doesn't suck.

Buying my first practice

For the past 18 months, I've been working as an associate under the pay as an "independent operator."

Essentially, this means that I'm working much harder for far less pay, relatively little control over quality control, and I'm taxed twice thanks to Obama. I've found many, many taxes that I have to pay on many levels that I never knew existed.

On the plus side, this has slowly taught me to think like a businessman. I've learned to think as not only a dentist, but also a receptionist, office manager, assistant, and accountant. I've learned about quality, profitability, and the concept of working capital, as I've scraped by from check to bill, to student loan.

It's about time for me to buy a practice and make it official.
I am a dentist. Hear me squeak.

Gypsy dentist

Thanksgiving is a nice little sanctuary from the happenings of everything. It's a nice time to enjoy family, friends, good food (hopefully), and reflect of things to be thankful about.

The day after Thanksgiving is another matter.

For me, it's not about black friday, shopping, or the like. Rather, it's a time for me to consider the state of life as a new dentist: bills, student loans, and the pressing need for more work.

I've come to realize that I'll be living like a gypsy for the next year.

Between looking for work, driving to work, and working in different cities each day of the week (if I find more work), I can feel more than a bit of a connection with the Tinkerers, the Romas of yesteryear.

In that spirit, I'm going to build myself a damn good guitar for the road.
I'll keep you posted as I build up my workshop and get the tools that I need.

Mise en Place

Today at church, I had the strange vision to develop a cooking class to equip fellow servants of the Lord.

As I mulled over the truly important things, it made me think of dentistry: particularly mise en place...or to have everything in the right place.

Like a chef, a dentist should have everything well organized, and in it's proper place.
The burs should be arrayed in a logical fashion. The handpeices should be polished and oiled.
The lab area should be clean. The chairs should be spotless.

Controlled messiness is fine. Disorder and slop is unacceptable.

Anyways, that's my take on things.

-Matt

Chocolate - is it wrong?

I've recently become very interested in the possibility of making my own chocolate truffles.

I'm not too satisfied with most of what I can afford, and the boutique chocolates available are too expensive for my paltry, student-loan riddled pocket book.

Anyways, I'm not sure if it'd be totally wrong...but I'm really tempted to give it a try.

Please let me know what you think!

My obsession with beauty

I wish I wasn't obsessed with beauty.

The thing with dentistry, is that I think it's really important to have a good idea of beauty.
With so much flim flam, I believe that understanding the basic tenets of beauty is very valuable for my patients.

After all, I'm in the business of making people feel beautiful.

In my obsessive self-quest, I've met many pretty people and truly beautiful people as well.
I've seen countless masterpieces of art. I've handled and made a few myself.

Beauty is perfection.
Perfection is attained by perfect practice.
Perfect practice is by carefully measuring results, calibrating and removing sources of error.

If this sounds like drudgery, it sort of is.
However, I think that this is a worthy price for my patients.

-Matt

ps. Hopefully, I'll get a decent camera sometime in 2011 to show you what I mean.
I stopped taking photos, as they don't do justice to the subject.

Why I haven't been posting

Dear readers,

My apologies for not posting much the past several months.
I've been working on the job search, and recently been a bit unmotivated.

I've learned that DentiCal creates a certain mentality and a certain lack of gratitude.
Even with the 25% chance of reimbursement, even with the 20% reimbursement of fees, even with putting up with a higher chance of getting sued--I have to deal with patients that can't be bothered. It's been a bit upsetting, so I've been focusing my attention on other things like spending time with friends, and learning to be a normal 27 year old.

Nevertheless, I really love dentistry.

Even with everything that sucks about dentistry, I can't help but love it.
It's like the chef with scarred and pitted hands.
I know of no other profession where I can be constantly challenged with getting better, where I'm paid to make friends, and where I can be paid to treat people like family.

I was chatting with Dr. Li at the Berkeley Free Clinic.
We agreed that reimbursements are down. Overhead is up. Our staff drive better cars than we do. However, the trust that we receive from our patients is sacred and beautiful.

And I wouldn't trade it for all the money in the world.
But we wouldn't trade this

Why Obamacare scares me

After about eight months of paperwork, I'm finally a MediCal/DentiCal provider.

The thing is...MediCare has been largely cut since July 2009.
It only covers kids 6 months to 18 years.
It only covers a limited number of not-ideal procedures.

And get this...it pays ~$20 for an exam, $5 an Xray, etc.
I'd lose money after paying my staff.

If Obamacare touches dentistry, I'm genuinely scared.

The Dental Van

Last night, an interesting ad came up on Craigslist: an opening for the Oakland Dental Bus.

It's a nonprofit service created by a lawyer-turned-dentist in Arizona.
Originally, it was run out of his home.

Now, it's a national organization the provides dental care to needy kids in schools across America.

This is how it works:
The van goes to the school site.
Equipment, Xrays, chairs, portable ops are set up.
Patients are seen, treated, and (if needed) referred to get further care.

This sounds just like what I did in Cambodia, but in some ways better:
1. No airline ticket or antimalarials needed.
2. I can help the local community.
3. I get paid (not much) doing it.

It sounds like a lot of fun!

Visiting an orthodontist

I was tempted to do two posts, but I won't.

This is one of the times when I really wish that I had a better camera for dentistry.
At Dr. Vicki Wang's office, I was given a quick review on cases for interceptive dentistry.

Essentially, there are a cases that should be caught before they get really bad:
1. Open bites
2. Cross bites
3. Skeletal malocclusions

It's important, because the bone gets harder once a youth turns into an adult.
One that happens, it requires expensive, painful surgery to get it fixed.

Some bumps

Yesterday, I called Youth Uprising in a vain attempt to get plugged in.

I called in the morning and reached a live person.
When I mentioned that I was interested in volunteering, she immediately shunted me to an answering machine.

You may call me an elitist outsider, but I'm a bit miffed.

Regardless of race or profession, my policy is to try to treat everyone with equal respect.
I do this regardless of whether I'm speaking to world class researchers or janitors.
I'd expect the same thing from any group that I work with.

I may call these people again, but I'm hesitant to waste my time.
I really do feel like the youth of Oakland are not being provided resources that they need.
However, I'm a bit wary of what type of hoops I'll have to jump.

I'll be calling on Dr. Pamela Alston, community dentist and long-time philanthropist in Oakland.

Guidelines

I explored Stanford on Friday by Strida.

Most of the students (and staff) were out of school.
However, I still got some very good tips regarding helping out non-profits.

1. Securing partnerships with private industry.

From Leah at the School of Business I learned that one must "pitch" proposals to a company and outline:

1. Gain: What will the company gain from helping you?
   
2. Exposure: What publicity will they get? Are you touting their product/reputation, or adding it to a long list of "sponsors."
   
3. Liability: Where is the event held. How liable will they be if some freak accident occurs?
   
4. Goal: What is the goal of your project
   
5. Cost: How much will it cost the company to help you? How much time and expense will be incurred.

2. Grassroots involvement.

Amanda (at the Haas center for social reform) recommended that I seek out a local grassroots organization to get an understanding of the true needs of the community as they perceive.

Otherwise, one risks the appearance of being an "elitist outsider."
She pointed me to Youth Uprising.

A really crazy idea

Yesterday, I was walking the streets of Oakland.
I marveled at the wasted potential of the crazy energy coursing the streets.

Well, I'd like to do something about it.

My goal is to provide something for Oakland youths to aim for: higher education, a decent salary, and a higher calling. I'd like to find the best and brightest, and pair them with a life-changing internship in some cool/prestigious institution. Also, I'd like to present them with an ipod.

Here's my crazy idea:
Have a contest with three categories: Academics, Performing arts, Static Art.
Each winner will get a trophy in the form of a customized ipod.
Additionally, the winner will get a fastrack to a valuable internship (which will hopefully pave the way to a great education and the career of their dreams).

This is all fairycake right now.
Before I talk to the schools, I'd like to assess what partners are available.
I'd like to gauge the interest and available partners they are willing to spare.
If I have to, I plan to buy the ipods out of pocket.

Tomorrow, I'm driving down to Stanford and Apple to learn about what's available.
If God permits, I'd also like to drop by IDEO as well.

Can't hurt to try right?

Thoughts on Oscar Grant

On Tuesday, I went to work to be surprised by the sight of a cardboard sign in the front window.
It had "We want Jutice!" scrawled in crayons in upper case letters.

All across Oakland, these signs adorn businesses...along with hastily erected plywood barriers, metal grilles, and police cars. It's a charm against looting, and a hope that windows will not be broken.

At the corner of 15th and Broadway, young African American men pass out posters demanding justice for Oscar Grant. They're decked in hoodies and camo pants.


While my condolences are with the young man's family, I think this is a big mess.
The police officer will be indited for manslaughter, not murder (no premeditated intent).
As a result, people will probably take to the streets.

As for me...I'm still coming in to take care of my patients.

First presentation

As a health care provider, I think that it's important to educate.

As per mom's suggestion, I'll be giving a talk to the neighborhood associate next Friday.
I've tentatively called it, "How to keep your smile."

In actuality, it'll be about keeping one's teeth for a very, very long time.

I'm a bit nervous.
I'm supposed to speak for a full hour.
My audience is ~50-60 years old, and I'm probably younger than most of their kids.
Also, the talk will be translated (thanks to mom).

Anyways, I've been preparing for the past week.
I'll be using some material from Bill Strupp, as well as the ADA, and Rose & Mealey.
I'll also have to find some way to make it fun.

Wish me luck!

AGD blog

I'm 26.
I hate fads.
I don't tweet; I don't AIM; and I barely blog.

However, I do appreciate good writing.

I recently chanced upon the AGD blog.
It's pretty good. In many ways, it's what I'd like my blog to become.

AGD is the Academy of General Dentistry.
It focuses on function, and not flash.

I'll be looking into getting AGD and AACD certified in the next couple years.

Anyways, I'll update about my recent experience with Bill Strupp after I get more coffee.

Late night musings

I've been thinking about what it means to be a dentist.

It's almost been a year since I've graduated dental school.
I've gotten a lot faster. I've gotten better. I've gotten older.

In some ways, I've become disillusioned with dentistry.
Dentistry is a business, and I'm not a good businessman.
Between the profit and the patient, I'll choose the patient's welfare.

In other ways, I know that I have a long ways to go.
It's humbling to see an ideal molar root canal in thirty minutes, when it takes me five hours.
It's humbling to see preparations that look machined.
It's humbling to think of the stupid mistakes that I've made.

Likewise, it's frightening to think of all the really bad dentistry that I've seen this past year.
I've seen a lot of teeth butchered that were perfectly fine.
I've seen patients triple-booked because the head dentist doesn't expect his patients to come...all the time...every time a wait of forty-five minutes..

From here on out is my real education.
I'll continue to seek out the best dentists in the SF Bay Area.
I'll try to apprentice under them.
I'll listen. I'll watch. I'll try to steal some portion of their mastery.

In this past year, much has changed.
However, my desire is still to be a dentist worthy of my patients.

Drill, fill, mill, and a shoe

The highlight of today was drawing a shoe.

Today, I did a working interview at a dental mill.
For professional reasons, I won't say where or who.
The staff was super nice, and the patients weren't too bad.

However, I wasn't too happy to see patients triple booked.

Don't get me wrong.
I love working fast.
I actually finished all the patients early, despite being triple booked.

However, I don't think that it's respectful to force your patients to wait so long.

I probably won't work at this place unless they offer me a really large amount of money.
I don't feel that this place allows me to be properly equipped to provide the quality of work my patients deserve.

Anyways, I'll post the shoe picture later.
I think that it turned out rather nice.

I need to go running, and get rid of all the bad karma now.

-Matt

ps. I think that I have the exact same vocal range as Alex Wong from the Paper Raincoats. His song "In the Creases" will be the very first song that I'll cover...ever.

pps. I think that I might get a Staufferesque guitar from the Viennese school as my main axe. I've recently become quite dissatisfied with the really great sounding instruments that I've made so far...

Drawing pastries

Friday, I enjoyed a rare moment of serendipity.

In my attempts to avoid thinking about dentistry, I went to the beach and tried reading "The Innovator's Dilemma." I had some good orange juice from Trader Joe's, really good Irish cheese, and a really stale bread roll.

I mention tried because the wind had other ideas.
The sun was nice, the wind whipped the sand through my pages.
Kids were playing volleyball on the side.
Kites were in the horizon, pulling surfers over kind waves.

It was too damned beautiful.
And I said, "Dear God, I really am blessed. Thank you."
And started drawing.



Sunday, today, I had another moment of serendipity.

For some reason, I bought a Milk French from Anderson Bakery.
As I contemplated eating it, I found myself fascinated with the subtle grooves and beauty in it.
I started drawing...and got a bit carried away.


After eating it and reverse engineering the recipe, I headed back for a binge of pastry.

The staff had a rather bemused look.
I think that they rather liked it, because they let me continue drawing.
As thanks, I gave Amy (a lass with a nice smile) a drawing of their saffron swirl danish.

After the asiatic sea salt sourdough, I decided to stop...

Yes, I'm a total dork...

-Matt

Maybe I should do something different

Last Sunday,
I went to Yoshi's with a dear friend who'll be going to New York.
We had the pleasure of watching Vienna Teng and Alex Wong.

I knew that it was nice, but I never thought that it'd make me rethink my life.
I'm still focused on dentistry, and getting better, but I'm glad to know that I'm not stuck being some William Hung.

My off hours have been spent way too much on the Internet looking at 19th century infill planes.
Or looking at manga. Or looking at building really great guitars. Or looking at old surgical instruments, hand tools, and ergonomic design...and just tinkering away.


Lately, I've been trying anything I can to not think about dentistry.

I think that songwriting fits the bill well.
-Matt

Craftsmanship

Dentists seem to fall into two categories: craftsmen and non craftsman.

I hope to fall in the former.

As a craftsman, I believe that it is vitally important to keep inspired.
People are never static objects, and each patient has different needs, demands, and an outlook on life.

Anyways, all this may be my way of rationalizing my impractical hobby/obsession with crafting fine things. I'm a tinkerer, a self-taught luthier, and a former martial artist...and now, I'm thinking of reproducing some of the fine old tools from the past.

Hell...I might buy a new camera to take some better pictures of stuff.

Here's a link to a guitar builder who has always inspired me.

Sorry I haven't been posting much...

I've been building a guitar.

I've been rethinking this blog, and what it is.
Originally, I was going to create a separate persona to educate patients and make dentistry less scary. However, there's a lot more to life than just pure dentistry.

Anyways, don't be surprised if my posts become very, very different.

Dental la-la-land

A couple hours ago, I realized that I'm probably too far into dental-la-la-land.

As a dentist, I know that dentists can easily get caught up in the new toy of the week: dental lasers, CERAC, underarmor sport guards, and stick on veneers. While these technologies offer very real benefits, I'm pretty sure that most people don't really care about it.

At the end of the day, most patients care about their smile.

At the end of June, I'll be going to a very well-regarded CE course on smile restoration by William Strupp. It'll be in Clearwater, CA. It's expensive. It's also supposed to be the best of it's type.

However, when I think about my patients...it'll be worth it.

-Matt, Dr. Goodtooth

Two weeks later

Two weeks after coming back, I've started to process my experiences in Cambodia.
However, I don't really know how to use the picture function on blogger yet.

I'll probably be posting up some memories (without pictures) the next couple weeks, and adding pictures as I figure out how.

-Matt

"I'm not going to rob you"

On the way to work today, I walked past a young black man with a 1990's era Marin Mt Tamelpias...a nice, underappreciated hardtail from an underrated company.

In my head I was thinking, "Nice bike."

The bicycle was on the ground. The gears looked intact, but I wasn't sure if there was a slipped chain. Overall, the cabling looked nice with minimal stress points.

As he lifted it and rode past, I respectfully made way for him.
And he said "I'm not going to rob you."


Wow.

There's something to be said for a society that creates such a terrible misunderstanding.
It feels like those shouting about equality and tolerance, are causing more problems than helping.

If you have any suggestions on how I can help, please leave a comment.

Back from Cambodia

I'm back from Cambodia.

It was an amazing, very blessed time.
There were amazing dental needs, and very amazing people.
Honestly, I learned a lot more from these people than they from me.

However, I've got to recover from jetlag before I can post more about it.

-Matthew

Durable goods

Sunday, I went to the "Man up" event hosted by the Durable Goods movement.

It got me thinking about the state of dentistry, and about value to the consumer.
In particular, I thought about the value of my service.

Many dentists follow established guidelines by insurance companies regarding how often they need to replace restorations or crowns. For instance, a crown can be replaced as often as every 5 years, and a filling every couple of years .

However, these insurance companies aren't dentists, and these standards are the minimum accepted. Additionally, one should look into the modes of failure:

1. Recurrent decay (most common):
If you don't brush and floss, all bets are off. Recurrent decay will set in, and undermine the area holding your restoration in place. Most failure is due to recurrent decay from bacteria that feed from stuff between your teeth. If you keep it clean, you should be good.

2. Crown Fracture (common for porcelain, amalgams)
If there was not enough material, or too much stress, or some sudden trauma, porcelain will fracture. Porcelain crowns look nice, and have a higher hardness than enamel or gold. However, porcelain fails by fracturing. Gold will deform into place.

3. Tooth Fracture ( Amalgams)
Amalgams are retained by mechanical retention. This means that they wedge against the teeth to stay in place. Amalgams tend to have a different thermal expansion than enamel, so will constantly wedge against the sides of teeth. That being said, they have self-sealing margins and can 10+ years if taken care of.

4. Shoddy work
I hate to admit this, but I've seen shoddy work. These include crowns with open margins, bad contours, and grossly plus or sub margins. Largely, this is from some non-American accredited provider. Often these are from patients that ask for a workup, go to China, Mexico or XYZ, and get cheap dentistry.
Frankly, I don't touch these unless a.) it's fixable and b.) my patient allows me to redo them.
I believe that you get what you pay for. Although, in my case you probably get more than you paid for. If I believe my work is sub-par...I'll make it right. Period.

That's my policy, and I'm sticking to it.
-Dr. Goodtooth

Something came up

I won't be posting too much because I'll be heading out to rural Cambodia.

It's not a vacation in the usual sense, but it is an amazing opportunity for me to get in touch with a corner of the world where the dental needs are very real.

On 2/17, I'll be flying extra budget class to Phnom Penh via EVA air.
After a day of acclimating, out team will be going into the countryside to the villages to do missionary dentistry using portable operatories, headlamps, and a kerosene generator.
We'll be done on 2/28, but I'll probably have to wait around Pnom Penh until 3/4 due to the Chinese New Year rush of flights.

I'll keep you updated sporadically.

-Matt aka Dr. Goodtooth

A touch of lube

A touch of lube.

It sound somewhat wrong...
but there's something nice about a dab of Petrol Jelly on the lips.

When I'm in the dental chair, my lips get dry.
I feel each tug on the lips more acutely.
And it gets more annoying with each minute.

A touch of lube says I love you in a nonsexual, nonthreatening way.

If you're ever in my chair and I forget the lube,
please let me know.

-Sincerely, Dr. Goodtooth

ps. Dr. Goodtooth receives no endorsement or support from different lube companies. Dr. Goodtooth also does not express any opinion regarding the use of lube, KY jelly, or Vasalene for any other purpose than moisturizing a patient's oral mucosa in the dental chair. Dr. Goodtooth does not endorse misuse or deviant abuse of lube (as it may result in bodily injury and/or discomfort). Please use lube in a responsible manner.

Christmas, and a note about Emergencies

The good thing about having a close relationship with your dentist, is that extraordinary services are sometimes received.

The bad thing, as a dentist, is rendering extraordinary services at inopportune times:

This past Christmas, I received a knock on my door at half past midnight.
It wasn't Santa Claus. It was mom.

She had lost her temporary crown, and was rather agitated. Nevermind that I'd warned her about it for the past three weeks straight. Nevermind that she'd held off making an appointment for six months.

It was mom, and she was in my room.

Later on in the morning, I stumbled into the office under the heavy influence of caffeine. I setup my operatory. I brought my special toys: suction mirrors, surgical light, and a plan B, plan C and plan D. For good measure, I had an E in my little bag of tricks.

The permanent crown went in with no problem, save for mom's tendency to do sit ups at inopportune moments. She'd also lecture me about patient comfort during crown delivery, when I was placing the throat pack.

It wasn't too much of a problem, just a bit annoying. It's mom.
I'd do it for any one of my patients.

Unfortunately, she spent the rest of Christmas bragging about it to relatives.

Note to self: don't take any more relatives as patients.

-Dr. Goodtooth

Note: While mom has occasional bouts of craziness (not limited to chopping down a tree, writing a book, killing crabs, and starting various one-woman crusade for various causes), Dr. Goodtooth and Mom maintain friendly relations and a fair trade collaboration agreement.

New Years at the Race tracks

New Years night was a blast: watching fireworks on the Embarcadero with friends and a hidden beer, weaving through cars and inebriated pedestrians by bike, and finishing the night with champagne and whipped cream.

However New Years day was more special, since I got a chance to meet up with Dr. Alton Lacy.

Dr. Lacy is a friend, horse racing aficionado, and possibly one of the world's best restorative dentist. It was $1 day at Golden Gate Fields, and a chance to see something that he loves. Amidst the cheap beer, cheaper hotdogs, occasional bouts of frenzied screaming in Cantonese, Vietnamese, Spanish and occasionally English, I learned something profound.

I learned that a dentist has a very definite shelf-life.

Towards the end, a dentist loses the facility to do dentistry. They lose the passion to perform, the physical ability, or both.

Often, a dentist will have a period where they enthusiastically throw themselves at work. Life is exciting, despite teh best attempts of Insurance companies to otherwise. Journals and study clubs are consumed with delight. Patients and staff are treated well, business picks up.

However, there's a point that ends it.

The trigger may be the wife, the kids, or simply the feeling of ennui. It may be that the dentist feels like they've mastered everything regarding dentistry. It may be that the dentist is saddled with an overabundance of loans and a paucity of sound investments. Or it may be that the dentist doesn't care.

Dr. Lacy isn't there yet, despite being well past retirement.

While we were eating, his tooth fell out.
He wiped it off, dunked in beer, and stuck it back it place.
Later in the night, he will make a custom composite post for himself.
Later still, he'll cast a custom buildup in gold, and cement it.

Dr. Lacy doesn't really accept new patients anymore.
He's too busy taking care of the ones he has.
However if you're ever interested in contacting him, give a call to Dr. Don Curtis in Berkeley, where he moonlights on some Tuesdays.

-Dr. Goodtooth

Resolutions for the 2010

2010 is here, and still fresh smelling.

This year, I've decided to make some fairly easy to keep resolutions:

• Sleep more
• Get off my butt and make something
  
• Have fun with friends

Hopefully, I'll be able to keep these resolutions this year.

-Dr. Goodtooth