Ask Dr. Christiansen

Gordon J. Christensen, DDS, MSD, PhD

For more on this topic, go to www.dentaleconomics.com and search using the following key words: dental assistants, in-service education, clinical time, Dr. Gordon Christensen.

Q: I was recently at one of your courses, and I heard you say that you have no plans to retire, in spite of being able to retire. Since retirement is a goal of many people, I would be interested in hearing why you are not planning to retire, and what suggestions you can share regarding what has kept you excited about dentistry.

A: Centuries ago, work was (in a religious sense) considered to be the curse of mankind for our sins, a sort of dreaded punishment. People worked only to make enough money for their existence. Many people feel that way today. Recently, I was standing in line in a grocery store waiting to pay. On finally getting to the salesclerk, I commented on how busy she was. She responded with a statement all of us have heard, “I like it to be busy because it makes the time go faster.” Since my feelings about my “work” are diametrically opposed to the feelings of that woman, I didn’t have a good response for her.

I’m often sorry I don’t have enough time for my profession to do the creative things I want to do. After many years of practice, research, and teaching, I consider myself to be in the best time of my life. I do what I want in the profession, when I want to do it, and for whom I please. Life is full of many joys — my wife, dentistry, my devoted and loyal professional staff, religion, grandchildren, hobbies, and thousands of friends around the world.

However, I often talk to dentists who have an attitude similar to the woman at the grocery store. They are not excited about their profession, and I have pondered why they do not enjoy a profession about which many nondentists are envious. All this relates to your question about retirement and why I do not long for that time in life.

I’m going to provide you with some of the reasons that I have not burned out on dentistry after several decades in the profession. These are not just my own ideas. These are related to the characteristics of the lives of many well-known people who have a love of their professions and have kept working well into their senior years.

Enjoying your work

It is mandatory for personal satisfaction that a person in any vocation enjoys his or her work. Unfortunately and often, that is not the case.

I have been a counselor for university students for many years, which has been necessitated by activities and responsibilities requested by my church. One group I supervised was comprised of young married couples and young children. The average age of the adults was about 25. Almost all of them were enrolled in university degree programs.

Many of these students, in spite of their initial commitment to one field of endeavor, would get involved with that specific vocational path and then change to another, after they learned more about the specific field. This indecision caused an unfortunate and significant waste of time on their part, while supporting a spouse and small children.

How does a person determine what brings enjoyment and satisfaction to their lives? How could these college students have avoided the loss of time that impeded their career development? They should have looked into the area of their initial choice in far more depth before starting an educational program in the area, and eventually wasting time and financial resources.

Let’s apply this same concept to dentists and their like or dislike of their involvement in dentistry. All practitioners have certain aspects of dentistry they enjoy and some that are objectionable to them. They are able to easily identify these areas, sometimes while they are still in dental school.

Fig. 1 — Some dentists do not like the surgical areas of dentistry. If this is not your preference, eliminate surgery from your practice.

I suggest that practitioners make an effort to determine which areas of dentistry are most enjoyable to them, and which areas they can accomplish best. Then they should emphasize and continue to develop those areas through active practice and continuing education. Soon, such directed effort toward those areas of the profession develops competency and expertise in those areas.

As examples, some dentists do not prefer to include the surgical aspects of dentistry in their practices. On the other hand, some do not like the mechanical aspects (Figs. 1 and 2). The following seven clinical specialties in dentistry allow you to include only the areas of dentistry in your practice in which you have a genuine and proven interest. Exclude any of these areas from your practice if you do not enjoy doing them — endodontics, orthodontics, pediatric dentistry, periodontics, prosthodontics, radiology, and oral surgery.

When you enjoy doing some aspect of dentistry, you become very good at it, your stress is reduced, your income is increased, and your day-to-day life is improved. Make a list of the areas you enjoy and do not enjoy, and make some changes.

Broadening and increasing your dental knowledge on a constant basis

This is the main factor that has kept me excited and eager about dentistry for my entire career. At the end of each year, I spend time determining what new concepts or techniques would excite me professionally.

We are told by psychologists that having 10% or 15% of our activity in a learning area keeps our vocation interesting, motivating, and makes one much more satisfied than limiting oneself to only familiar tasks.

I use the following method every year to determine those areas that are new and interesting to me, in which I am deficient, or that need updating:

Select an area that interests you in which you are not currently involved.
Find some continuing education courses on the topic of your interest.
Attend the courses that you deem necessary to obtain minimum competency.
Implement the new concepts into your practice. I suggest doing so at the end of several clinical days to reduce the stress related to the new procedure and to avoid disruption of your schedule.
After gaining initial competence in the new concept, move it into your normal practice schedule.

A few of the topics I have achieved competency by applying the previous procedure are: ceramic veneers, tooth-colored inlays, onlays and crowns, apicoectomy, third-molar extraction, implant prosthodontics, implant surgery, electrosurgery, use of a clinical camera, PowerPoint computer presentations, periodontal surgery and grafting, occlusal equilibration, minor tooth movement, and many others.

Fig. 2 — Some dentists do not prefer the restorative and laboratory areas of dentistry. They should eliminate these from their practices.

Reducing, changing your clinical time involvement and schedule

You may wish to consider changing your clinical schedule to one of the following different schedules, every one of which I have used at some time. Be sure to see if such schedules are acceptable to your staff and are legal in your area:

7 a.m. to 2 p.m. alternating every other day to 11 a.m. to 6 p.m. with breaks as needed for food during the seven-hour periods. The flexibility of this schedule allows for other life activities in addition to dentistry. The staff members usually prefer this schedule to the normal nine-hour schedule with a one-hour lunch break, and the revenue produced has been shown to be higher in one seven-hour session than with the conventional nine-hour session. This is one of my favorite schedules.
Evenings or early mornings on some days. You would be amazed at how many patients prefer to come in for dentistry in the evening or early morning. Of course, the length of practice time on the respective days must be altered appropriately to avoid too much clinical time.
Occasional Saturdays, thereby freeing weekdays for other tasks.
Long clinical days, but just three days per week. Many dentists prefer to practice three 10-hour shifts per week, with brief lunch periods. This schedule leaves four days of the week for other activities.
A combination of the previous schedules.

You may be surprised at how your enthusiasm for dentistry increases when there is time for other activities.

Creating variety in your life

What are your interests outside of dentistry? Do you have time to spend on those areas? I have many interests outside of dentistry. After a day of practice, I look forward to being involved in something completely different. I have always said that every day should have some activity in it that is enjoyable, relaxing, and fun. Only you know the nature of those activities.

Delegating clinical responsibilities to qualified, educated staff

One major area that has made dentistry far more enjoyable for me is delegating nearly half of the typical clinical tasks in my prosthodontic practice. Of course, this concept requires your approval of the delegation concept, determining which tasks are legal in your geographic area, training/education of staff, and staff competency in the delegated tasks.

I can testify from research and experience that many of the typical clinical tasks can be done by staff as well as or better than by me. What does this do for you personally? You have the same or more income with reduced expense.

You have more time to do other things. Your staff is motivated and happier, and you will probably be able to maintain your fees at a moderate level. The end of this column describes some PCC videos that will support this concept.

Other areas in which to use your clinical background

Some practitioners do not enjoy the clinical aspects of dentistry. What can they do to reduce this challenge and still use their dental background and education?

There are numerous areas for dentists who would prefer less clinical activity and interaction with patients, some of which may require obtaining an additional degree. These areas include:

Dental education is woefully in need of part-time and full-time teachers. If this activity is attractive to you, I suggest looking into teaching in dental schools near you.
Dental manufacturers hire dentists part-time and full-time. These dentists serve as resources for product development, interaction with practitioners, teaching other dentists, sales, and other roles.
Public health officials. Every state has some dental public health officials who guide the state government on matters related to oral health and its relationship to overall health, as well as assist in organizing and setting up oral health projects for the state residents.
Research. Research is ongoing in dental schools and with many manufacturers. Researchers are needed in both areas.

Have I discussed any areas of interest to you? You will find that a change of direction in your career that is still related to dentistry may provide the enjoyment and satisfaction you are seeking.

Is working longer than normal retirement age good or bad?

A recent editorial by geriatrician Katherine Schlaerth in the Los Angeles Times contained some interesting information on this subject that I will quote. “As a geriatrician, I’ve come to believe that working longer is generally a good thing. Most people just plain do better, both intellectually and physically, when they continue to work. Whether they have been laid off or retired voluntarily – they are likely to gain weight, become hypertensive, and develop depression. Increasingly, it has become obvious that the old dictum ‘use it or lose it’ definitely applies where humans are concerned.”

My personal “bottom line” statement about this subject is — if you enjoy your work — dentistry — and you are physically and mentally fit, why quit at some predetermined age? After years of practice, most of us finally know what we’re doing, what fails, and what works. Stay active!

My solution

I have not burned out in dentistry because I have found the areas that provide the most enjoyment for me. I am constantly learning new concepts and techniques in the profession. I have peculiar practice schedules that satisfy my need for free time for other things, as well as facilitate patient needs. I have significant variety in my life activities. I have extremely devoted and loyal staff, most of who have been with me for many years. And I have always been involved with education and research.

Practical Clinical Courses has many videos that will make your practice more efficient and help to develop some of the positive changes I describe in this column. Among the most popular and important ones are: Essentials of Effective Dental Assisting (2nd Edition) V4748, Dental Assisting for Posterior Restorations V4745, and Effective Use of Four-Handed and Six-Handed Dentistry V4714. All practices can benefit from these DVDs!

Dr. Christensen is a practicing prosthodontist in Provo, Utah. He is the founder and director of Practical Clinical Courses, an international continuing-education organization initiated in 1981 for dental professionals. Dr. Christensen is a cofounder (with his wife, Rella) and senior consultant of CLINICIANS REPORT (formerly Clinical Research Associates), which since 1976 has conducted research in all areas of dentistry.