Associateship Week 1

Are you curious about the transition from student/resident to associate? Reflecting on her first week in practice, I interviewed fellow dental blogger, Dr. Alenna Monet from The Dental Journey. She offers some great insight into her first week as an associate dentist, including her workload and when she finds time to squeeze in hygiene checks!

If you are unsure whether to pursue a residency or associateship immediately after graduation, be sure to check out this post. Prior to her associateship, Dr. Monet completed a one-year post-graduate residency. Dr. Monet is one of the most upbeat and outgoing dentists I know. Her new patients are incredibly lucky to have her as their provider!

What was the transition like? Did you receive an orientation?

I did not receive a formal orientation, but I did stop by the office on the Thursday before I started to get acclimated to everything, including where things were located and the computer system. I also looked around the operatories (although, my operatory changed until we found one that worked best for me because I am left-handed).

Do you have an assistant?

Yes, I have an assistant and there are floater assistants that can help grab things as needed. We have a couple assistants for the hygienists as well. We also have an in-house lab tech, which is amazing because she can mill out the cerac crowns.  

Has the staff been helpful?

The staff is awesome and extremely helpful. I can ask anyone anything and they find whatever I need. They also order materials that I prefer to work with that may not be in the office. For example, I asked them to order SDF and boom it was here by the next week! The front desk staff and office managers are also very helpful and make sure I understand how things work to run the office like a well-oiled machine. My assistant codes out all of my treatment when I finish procedures, which is helpful when I am running to another operatory or hygiene check. 

Did you do anything the weekend before you started work to get ready?

I did not do anything in particular to prepare. The only thing I did was visit the office for one day the prior week to get acclimated and to introduce myself to staff. I always write down what procedures I am doing a couple days ahead so I can mentally prepare myself for the day. So, that was something I did to prepare, but I do that daily. 

What types of appointments did you do? 

My first week was a little different than expected because a doctor in the office was injured the day before my start date, so I had to take over his schedule. As it turned out, this actually helped my schedule because typically when you start at a new location you mainly do comprehensive exams and hygiene checks (to increase your patient load). Instead, I did fillings, extractions, comprehensive exams and limited oral exams. Usually, you would not do extractions and restorations in your first week. This would only occur if there was a patient overload and the office had patients ready and waiting to be seen, and don’t mind seeing a new provider. 

How many patients did you see per day? Is there a standard for this?

I see anywhere from 6-10 of my own patients a day, depending on the length of each procedure. Additionally, I see a wide range of hygiene check appointments per day, ranging from 15-32 hygiene patients. There are a total of 4 doctors in my office, and usually 3 are present on any given day, so we split up the hygiene exams amongst each other. If one of us is busy with a procedure, the other doctors will do the hygiene exams. 

I also dictate how many “units” I want for each procedure, meaning how many minutes I want to complete a particular procedure. Since I am new, I give myself enough time to finish procedures because I don’t want to short-change myself on time or run over into future appointments. Generally, I give myself an hour for restorative (depending on how many teeth and what surfaces we are doing), two hours for endodontic procedures, and an hour for extractions. All of this is really case-by-case, depending on how difficult I think each procedure is going to be. 

I wouldn’t say there is a standard for the amount of patients or the workload; I think it just depends on how the office works. However, the general rule of thumb for a new dentist is to begin by completing hygiene exams and comprehensive exams to build a patient base. When you do hygiene exams and the patient takes new bitewings, you will check for caries, new crowns needed, or any other issues. Once you complete the exam, that patient will be placed on your schedule for future procedures.

What I have noticed in private practice- that is very different than residency or dental school- is that most patients don’t need extensive treatment plans and have pretty good oral hygiene (not all, of course, but most). I have had some more challenging cases that required me to take diagnostic casts and photographs. This allowed me to think about their case while the patient is not there. I usually inform the patient that their treatment plan may change after I give it some deep thought and they always understand. I have had very nice patients who appreciate their care. 

Did you encounter any surprises/ things you weren’t prepared for in week one? How did you manage? 

So, my first week I was thrown right in, due to the other doctor getting injured, which was not our initial plan for my first week. My owner doc and office managers wanted to start me off slower and ease me into working at this office, but honestly I am glad I hit the ground running! Coming from a pretty fast-paced residency, I didn’t feel overwhelmed with the patient load during my first week. Even if I did feel overwhelmed for a millisecond, I got over it and got the work done. 

I managed by quickly figuring out the best time to do a hygiene check, in-between my own appointments. There is a huge learning curve with the timing of hygiene checks, but after a while you get the hang of when you should leave your current patient to complete checks. For example, after you anesthetize your patient, you can check the hygiene patients, then proceed with your appointment. You can also check hygiene after you have prepped and before you restore, and finally right before finishing and polishing, if you absolutely have to. And of course, you can make a round of checks after you have dismissed your current patient. We have 5-7 hygienists on any given day. They really appreciate when you make your rounds, so they can move on with further appointments. Time management is key!

I always keep track of my time while working so that I don’t run over my appointment. It is helpful to have a clock that is visible or close on the computer so you can keep yourself on pace, or you can ask your assistant to keep you on track as well. 

What are the challenges and adjustments that COVID has brought about as a resident/associate over the past few months? 

At the beginning of COVID, I was a resident in a hospital so it was quite frightening in the beginning because we didn’t know what was going on and information was constantly changing. We were also working in people’s mouths so it was pretty scary, to be honest. Once we started wearing N-95s and another surgical mask over that, it felt a bit more safe. From March until early June, we strictly saw emergency patients only. Then, we began to see more patients, but still kept the elective aerosolizing procedures to a minimum. Mostly, we saw patients needing extractions or with abscesses from infection. We also completed procedures that did not produce many aerosols like denture deliveries, unless the patients were in pain and needed a restoration. 

I started my associateship in July, when COVID protocols were in place, so I see 6-10 patients a day. We wear a ton of PPE and have a lab coat on and another gown over that. We change our scrubs at the end of the day and they are washed in the office. We leave our shoes at the office as well. Each room is fogged after each patient leaves the room. The patients must wear a mask when walking to and from the operatories, and their temps are checked when they come into the waiting room. There is a high vacuum suction shield in all of the hygiene rooms. So, the office is heavily equipped with protective features, which makes everyone feel safe to work. 

What tips do you have for rising seniors as they prepare to enter the field at this rapidly changing time? 

If you are going straight to work: 

  • It is somewhat difficult to find a good associateship position right now because offices are slowly opening back up, or simply don’t have enough money to pay an associate doctor. Just keep looking to find one that is right for you. However, you may have to look outside the area that you wanted to work in. 
  • Try to time yourself to see how long it actually takes you to complete procedures not including prep-check times. 
  • Really vet potential offices to see what they can offer you, as far as paying for CE courses, and mentorship from the owner doctors. Also, make sure you understand how your compensation will work (i.e., whether you will receive a base pay or if you are working on commission only). Also clarify if you are paid by production or collection (FYI, production is better).
  • Make sure your office has N-95s for you to use so that you feel safe. 
  • Call the specialists’ offices that your office usually refers to and introduce yourself. They may want to meet and take you out to get to know you. You can also ask them questions about dentistry, or just shoot the breeze!

If you are going to residency: 

  • Learn as much as you can!!!
  • Try everything because this will probably be the last time you will be overseen by more experienced docs.
  • Even if you don’t want to do something, just do it!!!! Seriously! Whether that be molar endo, or super hard extractions, just go for it. This is the time to try it all and see what you do and do not like. 
  • If there are specialists that come to your residency for lectures, pick their brains and ask questions because you will not get that opportunity once you leave residency. 

Dental students, what are you most excited about as a future associate? Dentists, what do you remember about your first week as an associate?


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