A Few Things I Wish I Knew When I Was a Young Doc


A Few Things I Wish I Knew When I Was a Young Doc


By Dr. Courtney Dunn

1. Practice where you are needed

I was in dental and orthodontic school at a time where students were mesmerized with tales of young dentists moving to wonderful places and making more money than we even thought was possible. We heard of successful young doctors paying off practice loans years ahead of schedule and orthodontists with months long waiting lists of new patients. The predominant message to us was all you have to do is practice where you want to live, treat people well and you will become a huge success. The docs telling us these stories were trying to give us good advice, and for a while, it was probably true. But, when the economy tanked, those of us who picked a location based on awesome weather, family proximity or general lifestyle experienced a jolt of reality. Those outliers who ignored conventional wisdom and found a location that actually needed an orthodontist had a much easier time.

I can’t imagine the message to current orthodontic residents is the same as it was when I was a student, but I still consistently run into people who are looking to practice in the most saturated areas in the country. I actually know orthodontists whose practices are growing at such a high rate that they desperately need associates, but can’t convince residents to come to their area. They complain about “wining and dining” future prospects and speak of new grads actually turning down very high salaries because of location. Why do people insist to work harder to make significantly less money? You will have a much easier time in business and life if you can find a place that needs you. And if you end up in a less than ideal location – travel often. You will have the money to go wherever you want – and probably in the first class cabin.

2. The real world is really, really different

As orthodontic residents, we live in the bubble of academia. Orthodontic residents are astute enough to realize that the real world is different, but they aren’t quite aware of how different. Residents feel that we get a glimpse of the world with the part time faculty sharing their experiences. This will vary greatly depending on who the part time faculty actually are. As I was educated in the Midwest and shadowed some part time faculty in their Midwestern practices, I had a feel for how I was going to run my practice. When I selected a large urban area in the Southwest to practice, I quickly realized those Midwestern rules didn’t apply and I needed to adapt to a different professional culture.

Secondly, in the real world patients have budgets – and many options for orthodontists. In residency, we have the luxury of offering TADS, orthognathic surgery and expensive appliances at significantly reduced or no cost to the patients. Because of this, we get to try a lot and it is awesome! We come out of school so eager to incorporate this new, exciting technology. Patients are sometimes much less enthusiastic. TADS are great, but often scare mothers. Surgery is expensive and often not covered by health insurance plans. People may not be that excited about having holes drilled into their children’s jaws to speed up treatment by a few months. And there is that 500-pound gorilla sitting in the room – overhead. You may want to use these great adjuncts and the patient may agree, but mom may be visiting 4-5 other offices and will ask you to match the cheapest price. Do you really need to use those expensive products?

3. Find a good attorney as soon as possible

Good representation is notoriously expensive. Because of this, many new graduates shy away from consulting an attorney when they should. Fresh out of school, I considered myself competent enough not to get sued. So, securing a relationship with a good attorney was very low on my priority list. What I didn’t know was that the need for an attorney has very little to do with malpractice. Your attorney is there to help you with a variety of business related items, and when you need them they are worth every dime. I never anticipated how many situations I needed to talk to or use an attorney. Never sign a lease agreement, employment contract or practice purchase agreement without someone representing your interests (ask me how I know).

4. You don’t know what you don’t know

Every day I learn something new. Every. Single. Day. I thought I knew it all when I graduated from residency, but there was so much I didn’t understand. There was also a great deal I was not ready to understand. This applies to all aspects of running a business and the clinical practice of orthodontics. Keep your ears open and learn as much as possible. You may think you know it all, but you don’t know what you don’t know.

5. The only thing that is constant is change, so embrace it

It is important to have a vision for what you want and to never compromise your personal ethics. But, it is also important to adjust that vision as you see newer and better ways to do things. Change may also be required out of necessity to keep your practice open and profitable. That large, one doctor practice you always wanted may require a partner to run it smoothly. You may need to add satellite locations. You may need to take additional PPO insurances or drop some plans where reimbursement is low. You may not be able to use those expensive brackets you fell in love with in residency. As we are graduating more and more orthodontists, staying on top of the changing market and adapting to said changes may be the differentiator between someone who makes it and someone who doesn’t.

6. Surround yourself with successful people that are better than you

It easy and comfortable to associate with people who are similar to yourself. But, limiting your circle to these people will only inhibit your personal and professional growth. Spending time with people who are significantly “better” or smarter than you will broaden your horizons in unimaginable ways. I was recently at a roundtable discussion with a group of high achieving orthodontists and was overwhelmed with the amount of information and inspiration I was experiencing after a few short hours. Your life will dramatically change when you can see things through a fresh perspective. Make sure to choose that perspective from someone who is wildly successful. I’ll paraphrase Dave Ramsey, “You can’t get rich doing what broke people do.” Spend time with people who are rich, and I’m not just talking about money. Find people who are rich with love, gratitude, intelligence, wisdom, generosity, creativity – everything you hope to achieve. Your life will be better because of it.