The Money Issue - American Student Dental Association

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letter from the editor
B
ank accounts, and lack thereof, weigh heavily on the minds
of dental students. In a 2012 membership survey conducted
by ASDA this year, an overwhelming majority reported that
student debt is the dominating issue of concern. We invest in
our education physically, mentally and financially yet it is the
monetary investment that many feel is simply overwhelming.
The Budget Control Act of 2011 was enacted and my financial
aid package will be distributed this August. “Attention Student”
my message read. “As a result of the Budget Control Act of
2011, effective July 1, 2012, graduate/professional students are
no longer eligible to receive subsidized loans.” What it failed to
mention was the consequence. It means I will be paying about
$8,000 more in interest payments alone.
It has become essential to be a diligent financial manager more
than ever. In an ADA News special report from September
2011, the ADA estimates the average cost of dental education
rose 68 percent for private schools and 104 percent for
public schools over the last decade, with no signs of slowing.
That’s huge. It’s unnecessary. And it is students who absorb
the increased fees. The firm GL Advisors estimates that the
average dental student graduates with more than $200,000 in
loan debt.
Tuition is rising while resources to aid students are becoming
scarce. New dentists are graduating with a record-breaking
amount of debt. Will we see graduates driven to enter into
a career solely based on financial constraints? Will high
tuition adversely affect a predental’s decision to choose dental
school? This is not an issue of greed, but of concern for the
preservation of our profession.
Our concerns are being heard. ASDA President
Colleen Greene, Harvard ’13, is shining the light on student
debt management. The ADA is investigating ways to reduce
the cost of dental education. In a series of speeches to college
students this spring, President Obama sympathized, stating
that he has been in our shoes and would work with Congress
to stop the doubling of interest rates on Subsidized Stafford
loans. The legislation was approved by Congress on June 29
and caps the interest rates at 3.4 percent until June 30, 2013.
So, how do we reduce costs, spend less and graduate with
the least amount of debt? This issue of Mouth aims to help
you navigate your own debt crisis and make smart financial
decisions.
Our authors worked to compile the best financial resources
and education, paying attention to both breadth and depth.
Do yourself the favor of reading GL Advisor’s article on the
art of managing student loans. It offers expert advice and
techniques for the modern dental student. What you learn
today could save you thousands in the future.
Megan Guthman and Kara Ward, Alabama ’14, wrote an
article on the best ways to manage your money while still in
school. They reminded me that every dollar counts and that
smart spending will help relieve the financial burden upon
graduation. Indeed, thrifty is the new black.
As we work toward becoming clinicians and perfecting our
dexterity, let us not forget that financial fitness is an important
component. My philosophy is simple: action trumps
acquiescence. Educate yourself on financial matters. Become
diligent in your spending and borrowing. Plan for the future.
Put your money where your mouth is.
Eve Lofthus, Missouri '15
contributing editor
D
ue to the rising cost of higher
education, student loan debt for
dental school graduates has more than
tripled in the last 17 years, with the
national average surpassing $215,000
last year.* With debt levels of this size, all
dental school students must understand
their student loan repayment options
and available strategies to minimize the
cost of their debt. This article provides
an overview of options that all upcoming
and recent dental school graduates should
consider when developing their debt
repayment plan.
Federal student debt relief programs
are available to help recent graduates
obtain payment relief and savings on
their federal student debt. The nuances of
these programs must be fully understood
to ensure eligibility and maximization of
potential benefits.
Income-Based Repayment (IBR) may be
a favorable option for those entering a
practice following graduation. IBR limits
monthly loan payments to 15 percent of
a borrower’s discretionary income. For
up to three years after repayment begins,
the government will pay any interest on
their subsidized loans not covered by the
reduced monthly payment. Be sure to use
the most accurate income documentation
when applying for IBR to ensure the
lowest possible monthly loan payment
and the highest subsidy.
Pay As You Earn has been renamed to
ICR-A. ICR-A is a new repayment plan
that will be available to help borrowers
further reduce the cost of debt. ICR-A
limits monthly loan payments to 10
percent of a borrower’s discretionary
income and provides loan forgiveness
after 20 years. These terms also reflect
changes to IBR that will take effect for
new borrowers on or after July 1, 2014.
Qualification requirements are still being
finalized but borrowers must have no
outstanding federal loans disbursed prior
to October 2007 and must have at least
one loan disbursed after October 2011.
Deferment options allow a borrower
to temporarily suspend payments
and receive full subsidies from the
government. Deferment should be
considered by recent graduates who are
entering a residency program as part of an
overall student loan repayment strategy.
Understand that forbearance is different
than deferment, in that forbearance does
not provide subsidies.
Public Service Loan Forgiveness (PSLF)
provides tax-free loan forgiveness to
federal loan borrowers who make 120
qualifying payments while working for
an eligible public service entity. Therefore,
PSLF is relevant only to a subset of
dental school graduates, such as those
considering working for a nonprofit
group or in academia.
Only direct loans are eligible for PSLF,
so many borrowers interested in pursuing
PSLF will need to transfer Federal Family
Education Loan (FFEL) program loans
to Direct Loans via the Federal Direct
Loan Consolidation program.
Federal Direct Loan Consolidation
As referenced above, federal consolidation
with the Direct Loan program may be
necessary to position loans to benefit
from PSLF. Other benefits include an
option for eligible borrowers to extend the
repayment term or lock in a fixed rate on
variable interest rate loans. Consolidation
can take months to complete, so timing
is important. Borrowers with loans at
various rates must consider performing
multiple consolidations grouped by
interest rates to maintain flexibility to
retire higher rate debt more quickly.
Many student borrowers have a diverse
loan portfolio with a variety of interest
rates. It’s critical to set apart loans when
implementing a repayment strategy.
Federal repayment options such as
deferment, forbearance, or extended
repayment plans can help free up more
funds to target the higher rate debt.
Refinancing higher rate debt into
lower interest rate loans may provide
borrowers another opportunity to lower
their student debt. The marketplace for
refinancing loans has been very dynamic
the money issue
in recent years, so stay abreast of your
options.
assessment, ASDA members can retain
GL Advisor's service at a discounted fee for
their first 12 months of service.
Student loans and related federal programs
can be confusing. Taking full advantage
of program benefits requires an in-depth
understanding of each program’s details.
To learn how you can benefit from federal
programs and other repayment strategies,
sign up to receive a free personalized student
debt assessment from GL Advisor by visiting
www.glAdvisor.com/ASDAMouth.
You can also contact GL Advisor with
questions at 877-552-9907.
*ADEA Survey of Dental School Seniors 2011
Graduating Class and internal GL data.
with nor endorsed by the Department
of Education or any other government
agency. Insurance services are provided
by Graduate Leverage Insurance Services,
LLC and investment services are provided
by Graduate Leverage Investment
Advisory Services, LLC.
GL Advisor is a division of Graduate
Leverage, LLC. GL Advisor does not offer
all services to residents of North Dakota
at this time. GL Advisor is not affiliated
Our holistic approach to financial
management focuses on supporting our
dental professional clients with investments,
insurance, tax planning and practice or
home purchases. After receiving a free
Get competitive dental malpractice insurance coverage with protection you can
trust from “A” (Excellent) rated* Professional Solutions Insurance Company.
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the money issue
I
never doubt that my dental education is
a worthwhile investment. But as I spiral
into debt, I am forced to navigate dental
school on a budget. The key is to balance the
essential with the frivolous.
Look at your bank statements and categorize
what you spend on most. Many bank
websites have tools for this. If your bank
doesn’t, Mint.com is a free resource with a
mobile app to keep your budget in check.
Once you’ve determined your spending
priorities, set goals and stick to them. If you
overspend in one area, take from another to
avoid going over your limit. Remember, any
purchases made with loan money will be
repaid, plus interest, in the future.
My budget is divided into three areas: living
expenses, food and fun.
Living expenses are generally fixed, but
there are a few strategies to keep costs low.
As a single woman, the easiest way to cut
down on living expenses is to split rent
and utilities with a roommate. Do
you live in an apartment
complex? Cut a deal with
your neighbor and pay
them for Internet
access. If you’re not a
TV fanatic, a Netflix
subscription
can
suffice to keep you
entertained.
I have Whole Foods tastes with a Wal-Mart
budget. I try to pack my lunch, cook my
dinners as much as I can and eat meals out
only twice a week. Take a look at your local
grocery store’s weekly ad to stock up on
things while they’re on sale.
At the beginning of dental school, I struggled
with guilt over spending money on myself. I
learned that money invested in your quality
of life and friendships during dental school is
well spent. Save room in your budget to see
your favorite band or a long weekend at the
beach. Pay attention to local blogs and
newspapers listing free events in your city.
The summer is full of festivals and outdoor
events to enjoy. Let this “fun” category roll
over to the next month to save for a good
splurge. You deserve it!
the money issue
M
y husband and I married during
my first semester of dental school.
We were excited about combining lives.
We quickly developed a budget but soon
realized that keeping track of cash flow
for two isn’t easy. Five dollars extra here,
$10 there,and before we knew it, the
month’s money was gone.
Money became the source of our
arguments and we realized that we
needed to change our approach. After
asking friends and family for advice, we
reluctantly decided to use cash only for
certain budget categories. Money for
groceries, gas, eating out and personal
pending is put into labeled envelopes at
the start of each month. It’s taken some
getting used to but it’s easier for us to
avoid overspending and arguing when
we can physically see how much money
is left. Even if envelopes aren’t for you, it’s
smart to know where your money goes.
My favorite envelope is individual
spending. Before we got married, a friend
advised us to set aside personal money,
even just $15-$20 a week. It’s money we
don’t have to agree when, where or how
to spend. For instance, David loves to
stop for chicken biscuits on his way to
work and I enjoy drinking over-priced
coffee while studying. Try to find a way
to incorporate some personal splurging
into your budget. Maybe it’s treating
yourself to a movie and popcorn or
happy hour after school with classmates.
Factoring rewards into your budget will
strengthen your ability to stick to it.
Each month brings hard-to-predict
expenses. To account for this we set aside
money each month in accounts for things
like car repairs, gifts and emergency
spending. We also save monthly for a
vacation each year. We don’t need to use
the money every month, but when we
need it, it’s there. Automatic withdrawals
are our secret to being disciplined. In our
experience, unless you go out of your way
to set money aside, it will get spent.
Another secret to being smart with
money is communication. We try to
meet monthly to see how everything
money-related is going. Even when
money is tight, knowing you are on the
same page with your spouse makes all
the difference.
2012
ADPAC
Video Contest
Why ADPAC?
What does ADPAC do for you?
Prize Winning Team Receives $2000
Contest Begins: May 21, 2012 Submission Deadline: September 15, 2012
ASDA Members — Create a video that explains what ADPAC is, why joining ADPAC
is important or help illustrate what ADPAC has done and will continue to do for your
future profession.
All submissions will be shown at the ADPAC Booth during the 2012 ADA Annual Session
in San Francisco, CA.
• Participation is limited to current ASDA members
Videos are subject to disqualification if they contain:
• Videos may be in the form of an original drama, comedy,
documentary, interview, public service announcement,
music video, or any combination
• Copyrighted or trademarked material including material taken
from TV, movies, DVDs, the internet, books, manuscripts,
recordings, pictures, or soundtracks UNLESS appropriate
documentation granting permission to use such material is
included with the entry. See http://www.copyright.gov/
for U.S. copyright regulations
• Videos should not be more than 3 minutes in length
• Applicants must include two copies of the video. Each
copy must be on a disc or flash drive and be formatted
in standard AVI Format
• Unlicensed software
• Material or language that would be deemed inappropriate
content for the general viewing public
For entry form and complete contest rules
contact: Natalie Halpern at [email protected].
the money issue
FAQs
F
eel lost when it comes to financial
decisions? Here are some frequently
asked questions with answers to help you
gain financial knowledge and make smart
choices.
Q: What is the average salary for dental
school graduates?
It depends on several factors including
geography,
specialty
and
practice
opportunity. Typically the range is $80,000$120,000 for general dentists the first
couple of years out of school, but you'll see
exceptions to that on the high and low end.
Source: Dr. Christopher Salierno, ADA New
Dentist Committee
Q: How much do you start to pay
each month for loan repayments after
graduation?
According to the OUHSC financial services
website, this depends on the amount you
owe, your interest rate and if you choose
standard, graduated or extended loan
repayment. Standard payment plans feature
a fixed dollar amount paid each month for
the term of the loan, about $2,250 with a
10-year loan term. This standard option
gives you the lowest total money paid
throughout the duration of repayment.
In a graduated plan, you start paying a
smaller amount for a few years (like $1,100)
and then have higher payments later. An
extended plan allows you to pay that small
amount each month for the duration of
the loan, but typically over the course of
25 years. This plan will cost you the most
in the long run. If you choose to pursue
income-based loan repayment however,
during your first few years out of school you
may get away with paying very little each
month, although you are still technically in
repayment.
Q: What is income-based loan
repayment?
Income-Based Repayment (IBR) caps
your required monthly payment at a lower
amount based on your current income
and family size. This can be applied to
Stafford, PLUS, Consolidated and even
undergraduate student loans. With IBR,
you are not required to pay your loan
interest each month, so you can be paying
near nothing and still be in repayment. For
the first consecutive months in IBR, if your
taxes are zero, the government picks up the
interest balance on the subsidized loans. This
is typically the best repayment option during
residency years and often during your first
few years out in practice. Just be sure to file
those taxes while still in dental school so you
can take advantage of this option!
Q: If I have any “extra money” either now
or once I start working, should I use it to
pay off loans or invest it?
It depends on how the rate of return on
investments compares with the rate of
interest on your loans. Perkins loans are
fixed at 5 percent and Stafford loans at
6.8 percent. Grad PLUS loans are at 7.9
percent if through the government or 8.5
percent if through a lender. So, if you were
able to miraculously find an investment
that displayed a 7 percent rate of return,
you should first pay off any Grad PLUS
loans as they have interest rates greater than
7 percent. However, investing would be
preferable to paying off Perkins or Stafford
Loans as they have an interest rate below 7
percent.
Q: What is the average cost of applying
to dental residencies?
Your costs will depend on how many
programs you apply to and where you get
invited to interview. Here is a sample of
what you will be paying for:
• MATCH: approx. $90 to register
• PASS: approx. $100 per school.
Application fees vary depending on the
number of schools you apply to. The
price per school decreases with more
applications. The first school costs about
$200 and drops from there. If you apply
to 20 schools, the average cost per school
is roughly $100.
the money issue
• NBDE score reports: $30 each
• College transcripts: approx. $10 per copy
• Airfare: up to $1,000 per interview. Costs
depend on the distance to your interview
and how far ahead of time you are given a
date (often only 2-3 weeks notice).
• Hotel: approx. $300 per interview. If you
have friends or even acquaintances by the
school where you are interviewing, ask
if you can couch surf for a night to save
some cash. If you need a hotel, keep it
cheap but safe.
• Office supplies: $50-$100. Don’t forget
the manila envelopes you need to send
to each school, nice paper for resumes,
paying for postage, etc.
burden of carrying both personal and office
costs while disabled could be financially
catastrophic. Business overhead expense
insurance helps to cover office overhead
expenses during a disability. A business
overhead expense insurance plan can help
you protect your future by helping to keep
your office open.
Anticipate a high cost associated with
applying to dental residencies and budget
wisely.
Source: Dr. Brittany Sonnichsen, recent
Connecticut dental school grad and incoming
Ohio OMFS resident
Business Owners Package: A BOP policy
serves as your “homeowners” policy for the
office. It provides protection against the
physical loss of property (not malpractice)
in your office due to a covered event (fire,
flood, theft, etc.).
Q: I heard that ASDA offers its members
free insurance. What exactly is this?
ASDA members have access to the same
group insurance offered to ADA members.
A student can establish a foundation
of personal insurance protection before
entering the business world as a dentist. The
benefits include $50,000 of life insurance
and $2,000 of monthly disability insurance
– all free during dental school or residency.
Students who sign up for the disability
insurance also get up to $150,000 to repay
student loans if they become disabled
before graduation. Coverage is provided by
the ADA Insurance Plans, underwritten
by Great-West Life & Annuity Insurance
Company. To enroll or learn more, go to
www.InsuranceForDentalStudents.com.
Malpractice Insurance: Take the time now
to choose the strongest defense available to
you. Make sure you have a contract that
will give you the control of how claims are
handled. Your career, reputation and assets
are on the line.
Q: What types of insurance will I need to
open my own business?
Disability Income Insurance: A serious
disability due to either illness or accident
might completely eliminate your ability
to practice. Disability income insurance is
essential and should be among your first
priorities. A disability policy helps protect
a portion of your income.
Business Overhead Protection (BOE):
Income ceases quickly upon experiencing a
disability, but office expenses continue. The
Business Reducing Term Disability:
The burden of a loan repayment when
you cannot work can cause a great deal
of pressure on your business. A business
reducing term plan will pay back any loans
you took out to open your practice if you
become totally disabled.
Life Insurance: Many lenders require life
insurance as collateral in case you pass away
before you can repay the loan you took to
open the practice.
If you would like additional information,
contact Treloar & Heisel, Inc. at 800-3456040 or visit www.th-online.net.
Source: Treloar & Heisel, Inc.
Q: What is the cost of malpractice
insurance for new dentists?
According to Mary Taylor at Medical
Protective, the cost depends on a variety
of factors: practice location, practice
organization type, procedures performed,
policy type and policy limits. Many
companies will discount the premium for
new dentists to help make the transition
from school to practice easier. Medical
Protective offers new graduates a 75
percent, 50 percent and 25 percent new-topractice discount during the first three
years of practice. ASDA members also can
receive another 25 percent discount on their
first policy with Medical Protective. After
the new to practice discounts have expired,
most dentists can expect to pay between
$1,500-$2,500 per year during their careers
for malpractice insurance, although it can
be more for more litigious areas like the
New York City or South Florida.
Q: Learning to run a business is very
important for prospective dentists, but
we get minimal coursework in this area.
How else can we learn this information?
ASDA recognized a need in this area
and created a new conference open to
all members. Co-chair of the planning
committee, Dr. Ryan Dulde, explains, “the
National Leadership Conference [will be
held] in Chicago this November, allowing
dental students to customize their own
meeting from four different programming
categories such as advocacy, career
planning and business leadership, ASDA
chapter management, and more.” Sessions
include personal finance, specialties and
career options, marketing tactics for your
practice and how to ace any interview. Visit
www.ASDAnet.org/NLC for details.
The ADA also offers business
resources to for dentists. Visit
ada.org/adabusinessresources.aspx
for
more information. The New Dentist
Conference also hosts some of the best
practice management lectures and allows
you to connect with other young dentists
and share stories about successes and
challenges. This meeting is held in June
each year and welcomes student attendees.
Q: What scholarships are available to
dental students and where can I find
them?
Many schools have a scholarship information
area that contains applications, guidebooks
or other helpful resources. You can also
approach your Student Service’s staff with
questions or requests. Your local state dental
association also may be an excellent source
of potential funds, as they typically sponsor
several scholarships for students. If there
isn’t information readily available on their
website, don’t be afraid to ask.
continued on page 16
T HO UGHT S O N L I F E AS A NE W DE NT I S T
Look Past
the Paycheck.
Find a position where you can
be proud of your work.
Erin Topley, DDS is a 2009 Graduate of the University at Buffalo School of Dental Medicine.
Dr. Topley’s Tips for Graduating Dentists:
Get a lot of experience. See as many patients as you can. I have worked at the VA, a
children’s Medicaid clinic, and now in private practice. I’m learning as much as I can from
two wonderful mentors to prepare for opening my own practice someday.
Network in the community. After graduation I moved across the country and had
difficulty finding a job. I sent out many resumes to no avail. Finally it was a recreational
kickball teammate who knew someone who offered me an associateship.
Live like a student financially for a few more years. You’ll save a lot of money in the
long run if you start paying down student loans early. I also joined a state loan repayment
program that’s been a great benefit.
Don’t buy cheap liability insurance. When buying insurance, cheaper is not necessarily
better. If I ever have malpractice issues, I want someone in my corner to protect me. Fortress insurance came very highly recommended to me by several established dentists in
the community, so I feel confident that Fortress is the correct choice for my career.
Dr. Topley is also a cartoonist! See her artwork at www.toothlesstoops.com.
As a new dentist, you’ll need to protect your career and your reputation. Fortress
Insurance Company is dedicated to the dental profession exclusively. We are owned and
operated by dentists and only insure dentists and dental students for professional liability.
Fortress provides aggressive claims defense, valuable risk management, and outstanding
customer service. To apply for a Fortress insurance policy* from an independent agent in
www.dds4dds.com
Sign up for access to
student resources
your area, call our Policyholder Services Department at 800-522-6675, or visit dds4dds.com
and click on the Agent Map.
Board Exam Coverage and New to Practice Discounts Available
*The language in contained in each policy of insurance establishes the specific terms and conditions of insurance and will supersede any statements contained herein.
the money issue
National ASDA offers the Ryan Turner
Memorial Scholarship. The scholarship
awards $1,000 to an individual who
demonstrates passion for organized
dentistry and service to the organization.
The winner’s ASDA chapter also receives
$500.
Even the Internet can be a great way
to search for funds. Several dental
organizations like ADEA offer multiple
awards to students for research or to help
fund their dental educations. Scholarships
are an excellent way to help finance your
education and all too often are not sought
out.
Q: What are the advantages and
benefits of getting your dental education
sponsored by programs like the military
or public health?
Military branches such as the Air Force,
Navy or Army offer loan repayment
programs. You can receive a benefit package
that includes salary, bonuses based on
tenure and contract length, retirement plan
options, and health care and life insurance.
You also get a large number of paid vacation
days and housing stipends. You also can
also take advantage of their loan repayment
programs.
These programs recruit mostly general
dentists, but have positions for other
specialties as well. Check out their .gov
websites for more information. You can
also contact a recruiter in your area who can
meet with you and discuss all the options
available.
Through working with Indian Health
Services, you can receive $24,000 each
year towards your loans (in addition to full
salary) for a two-year commitment. Once
0RACTICE
-ADE Perfect
you are accepted into the loan repayment
program, you can stay in the program until
all loans are paid off. You can even pay back
undergraduate loans if the money is going
toward the cost of prerequisites for dental
school. The IHS has numerous sites where
you could practice, especially in Central
and Western states, and takes your location
preferences into account.
Another way to repay loans in the IHS
programs is to apply for National Health
Service Core loan repayment. The NHSC
funds, unlike with the IHS program,
are non-taxable. You can apply to both
repayment programs and fall back on IHS
grants if declined by the NHSC.
Source: Dr. Timothy Lozon with Indian
Health Services and .gov websites
continued on page 34
3-
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[email protected]
www.medpro.com
800-4MEDPRO
©2011 The Medical Protective Company®.
Trust the dental malpractice experts.
the money issue
G
raduate students across the United
States may notice a change in their
financial aid award for the 2012-13
academic year. Subsidized federal loans
are being replaced by an increase of
unsubsidized Stafford Loans. Every
student is responsible for 100 percent
of the interest accrued by their federal
student loans while enrolled in a
graduate or professional program.
On Nov. 22, 2011, co-chairs Senator
Patty
Murray
(D-Wash.)
and
Representative Jeb Hensarling (R-TX)
announced that the committee could
not reach a bipartisan agreement
available to the public before the given
deadline. Sequestration was enacted
and the cuts began. The Congressional
Budget Office estimates that the cuts
will reduce nonexempt spending by 7.8
percent in 2013. The interest subsidy for
graduate students is nonexempt.
According to the National Education
Association, this equates to a loss of
$3.54 billion in educational funds.
Why is this happening now? After
almost a decade of economic stimulus,
corporate
bailouts
and
defense
expenses, the United States was set to
default on its national debt on Aug.
3, 2011. On Aug. 2, President Obama
signed into law the Budget Control Act
of 2011. First, the nation’s credit limit
was increased to raise the ceiling on
the debt. This allowed the subsidizing
of loans for the 2011-12 academic
year. Second, the Congressional Deficit
Reduction Committee was formed and
charged with freeing up $1.2 trillion in
budget savings by Nov. 23. Failure to do
so would result in automatic spending
cuts (called sequestration) across
the board to government programs,
including defense budgets and student
aid funding.
Most students have likely heard about
the Budget Control Act but may not
have the time to worry about it and some
feel there is little they can do about it.
As Jonathan Ruminson, a second-year
student at Loma Linda, shared, "It is
amazing how our government tries
to motivate us to get an education,
give back to society and pay more
taxes, by taking away our incentives to
accomplish those things."
Can anything be done? According
to the National Association of
Student Financial Aid Administrators
(NASFAA) website, the answer is
no. They state that, “the failure of the
deficit reduction committee to agree on
a solution irreversibly set into motion
spending cuts that guarantee the
reduction of national debt.”
Does this only affect federal loans?
No. Most graduate students need
PLUS loans to cover living expenses
and part of tuition. NASFAA advises
of two repayment incentives on these
loans when they become due, granting
a lower interest rate to those who pay
through automatic debit withdrawls. If
payments were made on time for the
first 12 months, a rebate of 1.5 percent
interest was given. The Budget Control
Act will end these rebates. Only rate
reductions for debit payment will
remain in effect. The CBO projects that
the end of rebates will yield a national
savings of $3.6 billion from 2012-21.
The added interest dental students will
be responsible for makes the thought of
working in the remote wilderness to
qualify for loan repayment appealing.
Perkins loans and Pell Grant funding
are exempt from cuts. In fact, much of
the money cut from federal loans will
be funneled into the Pell program to
ensure the maximum award is given for
years to come. The amount of funding
students qualify for will not change. By
keeping current on these changes we
can better prepare for repayment after
graduation.
Knowledge is power...
for you and your patients
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contact you at your new practice — go to crestoralbforgrads.com
and follow the instructions on the page. Your representative will
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to Your New Practice” package for you and your new office!*
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the money issue
R
ecently, I met with representatives
from Patterson, Benco and Goetze
dental distributors to get a crash course
on investing in dental equipment and
technology.
“Do you sell electric typewriters?”
This was a real question a Patterson
representative got within the last five
years. I laughed when he told me this,
but realized that if I had gone to dental
school in the 60's I would be asking
the same question. I am the person
who refuses to get the Facebook's
Timeline, smart phones confuse me
and self-checkout lines at the grocery
store make me nervous. But as I learned,
investing in your future office need not
be a baffling process.
Start by finding a company you can
trust and build a relationship. When
representatives know your office well,
they can better meet your needs and give
you better quotes on sales.
First, certain pieces of equipment
like operatory chairs and hand pieces
are essential. You have no choice but
to purchase them regardless of their
profitability. Second, when investing in
technology, a return on investment can
be calculated for billable procedures. See
figure on right.
Adapting to new technology is described
by a bell curve divided into the
innovators, early adapters, early majority,
late majority and laggers. The early
innovators tend to waste money, since
no new technology is perfect. Ideally,
you want your office to fall in the early
majority category.
“The most important thing is to do your
research on each and every product that
you bring into your office,” explains
Dr. Helen Lee, of Franconia Dental
Care in northern Virginia. Although
the technology can seem overwhelming
at times, Dr. Maria Wong Kim in
St. Louis advises to always consult with
colleagues for advice.
“I always speak to my fellow clinicians
when considering a new piece of
technology,” she says. “I feel more
comfortable buying something they have
had good experiences with.”
Dentists rely heavily on peer feedback
when
buying
new
technology.
Some consider product reviews by
independent companies such as the
Gordon J. Christensen Product Report
or DentalTown Magazine.
When consulting representatives and
dentists, I found that opinions vary on
whether the digital X-ray or intraoral
camera has the fastest ROI. Technology
that does not perform a billable service
cannot show an ROI, but some increase
treatment acceptance rate by patients.
Dr. Lee says her intraoral camera was the
best investment she made in her office.
the money issue
“The visual display of the patient’s oral
health condition while I am explaining
the proposed treatment plan has greatly
increased acceptance of the proposed
procedures,” she states. “It also makes it
very easy for the patients to understand
the diagnosis, which I think is very
important.”
CAM system would buy the digital
impression and milling component.
The milling component is the more
profitable technology. If dentists choose
not to invest in the milling component,
they can choose from an array of digital
impression systems available on the
market.
Two of the most expensive pieces of
technologies are the CAD/CAM system
and 3D imaging system. CAD/CAM
stands for Computer Aided Design/
Computer Aided Manufacturing. A
CAD/CAM system consists of two
parts: digital impressions and milling.
Digital impressions cut the need for
impression materials, reduce chair time,
and provide much more comfort for
the patient. Chair-side milling creates
partial and full-coverage restorations
within minutes.
The 3D imaging or 3D X-ray system
creates a digital model of the patient. 3D
Not all distributors carry a CAD/
CAM system. The Cerec CAD/CAM
system by Sirona is carried exclusively by
Patterson. E4D by D4D Technologies is
the CAD/CAM system through Henry
Schein. Most dentists who buy a CAD/
imaging is as if you took a patient's head,
dissected away all the tissue and worked
with the skull. Software allows you to
take cross sections, see thickness of
bones, locate nerves, examine the TMJ,
plan implants, and see incredible detail
that traditional X-rays do not. Software
for new technology improves quickly, so
make sure your purchase can be updated.
There is no formula for how to invest in
an office. Work closely with your CPA
and technology representative to come
up with the best plan to upgrade your
office. The right technology can make
your office more efficient and allow you
to provide better care for your patients.
Try not to become the “typewriter”
dentist!
career transition
W
hat are you strengths? What are
your weaknesses? Where do you see
yourself in five years?
Whew! Now that we’ve got that out of the
way, it’s time to consider some interview
questions that really get to the meat and
potatoes of an associate/owner relationship.
If you're considering an associate position,
the interview is the time to determine
if the hiring dentist is right for you, too.
Unfortunately, standard questions don’t
always get the job done, particularly if your
goal is more entailed than “find a paying job.”
If you’re on the lookout for an associateship
with the potential for ownership, it’s critically
important to ask questions that evaluate your
compatibility with the hiring doctor.
Here are four often-overlooked questions
that can help you find a great fit.
How do you handle conflict
within the dental team?
This will give you an indication of
how much staff conflict regularly
exists in the office and how a
conflict between the two of you might
play out in the future. You’ll also gain
insight into the owner’s leadership style.
Some dentists avoid conflict out of fear,
allowing small problems to fester into
big ordeals. Other dentists lacking
patience, communication skills or
humility may practice an authoritarian
approach to management. As you can
see, red flags exist on each end of the
spectrum.
When it comes to conflict, I look for
three “C’s”: confidence, communication
and consistency. Consistency is perhaps
the most important of the three because
leaders who fail to settle conflicts fairly and
objectively (with each and every employee
and incident) will lose credibility and
respect in an instant. Occasional conflict
will be inevitable, so look for a doctor who
you believe has the skills to effectively
navigate through the issue and return the
focus to patient care.
How important is
mentoring in your
relationship with an
associate?
There is a lot of learning that happens by
virtue of showing up to work every day.
However, if you’re looking for additional
guidance and mentoring, you’ll need
someone who’s willing (and excited) to
teach. Many owners will appreciate your
openness to learning and genuinely want to
tutor you in their practice style. I personally
believe that mentorship is crucial, but some
associates and owners thrive in a more
laissez-faire relationship that affords more
independence. If your interviewer simply
wants a warm body that increases production
career transition
and doesn’t ask questions, do yourself a favor
and head for the hills.
Tell me about your
approach to patient
care. Do you expect
your associate to adopt
your same clinical
philosophy in full?
For example, will the owner expect you
to swap out every amalgam in a patient’s
head for composite as standard protocol
because she does? Will the owner expect
you to take on every molar endo and
surgical extraction because he does?
Failure to discuss these questions can
be a first-class ticket to a world of pain.
We’re talking potential ethical dilemmas,
litigation and early tarnish to your newly
minted professional reputation. We will
all have moments when our ethics are
tested, but you might not expect the first
test to come before you even land a job.
Your patients trust that you’re giving
sound advice and making wise decisions.
What claims are you willing to make?
To what level of risk are you willing to
subject your patient? Take time now
to consider where you stand so you are
not caught off guard. As Will Rogers
put it, “It takes a lifetime to build a
good reputation, but you can lose it in
a minute.” You can barter with benefits
and negotiate wage…but there’s no such
thing as “meeting halfway” on ethics.
Will I be satisfied
with what I have here
and now?
This last question is actually
for you, the associate. My
friend and mentor, Dr. Eric Peterson,
gave me some great advice that I now
share with you. When it comes time
to make a decision, do not commit to a
scenario in which your happiness will be
contingent on future promises. Things
don’t always go as planned and promises
aren’t always kept. Ask yourself, “If
things were to stay exactly how they are
right now, would I be happy?” If you can
whole-heartedly answer “yes,” then you
can’t lose.
“Perfect is the enemy of excellent’” is
one of my favorite mantras, and it rings
true for the art, science and business of
dentistry. Don’t go looking for a perfect
opportunity…because your job search
might never end. Instead, look for an
excellent opportunity that’s compatible
with your ethics and goals, and feels
good in your gut. Don’t hesitate to ask a
ton of questions—it’s a simple way to
get a happy and successful career started
on the right foot.
For “30 Interviewing Questions for
Finding the Right Fit” and more tips for
new dentists, visit Dr. Dulde’s blog at
www.excursives.com.
the money issue
I
f you asked graduating students what
they hoped for their careers, owning
their own practice would rank high on the
list. However, very few seek this straight
out of school. While it may be their dream,
it’s a daunting task due to the amount of
debt waiting for them after graduation.
Like most fourth years, I am beginning
to feel the burden of the debt I have
accumulated. I now wonder if it is possible
to take this path right out of school.
from the magazine “Dental Economics.”
Dr. Archibald admits he didn’t always
spend his money wisely as a student.
However, he was always aware where he
was spending it and stayed within his
means.
Dr. Geoff Archibald, a 2007 graduate from
the University of Minnesota, achieved
this dream. He, along with a 2006
graduate, bought a practice in Minnesota.
Dr. Archibald had no previous business
experience and learned most of the basics
credit cards. Second, everyone should
have an emergency savings to cover two
months of expenses. If a perfect job
requires a move across the country, it is
financially better to use savings rather
than credit cards. Third, he suggests
Dr. Archibald offered his approach to
tackle debt. First, he suggests paying
down any high interest debt, particularly
anything more than 12 percent, such as
investing in one’s retirement early.
Maximizing retirement contributions
at a young age provides greater time for
the money to grow. While the market
may seem unstable right now, many stock
options are cheap and the market will
likely turn around during your career.
Fourth, if you don’t plan to buy a
practice right out of school, start putting
together a consistent savings plan for a
future purchase. Even if it will be years
away, money put aside for this will give
you the chance to pounce on a practice
opportunity. After the first four steps
are achieved, dentists should consider
making accelerated payments toward
their school debt. A final piece of advice:
being a successful dentist is not only
about money.
“Figure out what makes you happy,” he
says. “Once you figure that out and know
what you want, then you can make good
decisions on how to get there.”
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the issues
I
n the aftermath of the recent health
care reform, dental coverage has
become a hot topic. While assisting at a
private practice, I saw that a large portion
of the patient population was 65 years or
older. Most lived on a limited income and
had no dental insurance. Since the costs
associated with dental treatment remains
mainly a patient responsibility, it can be
hard for these patients to pay for even
preventative and routine care. Research
shows that this issue is a nationwide
epidemic. Since the first generation of
baby boomers turned 65 in 2011, we can
expect a steady increase in the number
of people turning 65 for another two
decades.
These patients have Medicare, which covers
hospitalization, outpatient physician visits,
psychiatric visits, prescription drugs and
even physiotherapy. However, the program
has no funds for routine dental treatment.
Organized health care has historically put
dentistry on the back burner, which adversely
impacts accessibility to dental care for people
under Medicare.
Of the $524 billion spent by the federal
government on Medicare in 2010, none
was spent on routine dental services. The
recent economic recession has shrunk the
savings and assets of many Americans
who are either approaching retirement
or already retired. Uninsured patients
may become reluctant to schedule
routine checkups, which could lead to the
deterioration of preventive dental health
care. Covering dental services under
Medicare helps patients maintain dental
health. Extensive and expensive future
dental procedures can be prevented. A
simple filling that could have cost about
$150 might end up needing a root canal
and crown, costing about $3,500 if left
untreated.
Lack of coverage will also impact dental
practices, as dental insurance is responsible
for roughly 45-50 percent of total income.
Most dental practices would benefit if
patients still have some form of dental
insurance under Medicare. These patients
would find it economically viable to keep
going to their dentist for routine care.
Even so, dentists are reluctant to accept
patients covered under federal and state
funded-programs because of the low
reimbursement rates. Patients with
Medicaid end up having dental treatment
at either community health centers or
schools, which are not always easily
accessible. The dental community needs to
negotiate for competitive reimbursement
rates for services provided to encourage
dentists to take part in programs like
these.
Covering routine dental care and
preventive services under Medicare
will help reduce the number of medical
emergency visits related to dental
problems. These medical emergencies
are expensive compared to the cost
of preventive dental care, and also
ineffective with respect to long-term
care. Emergency treatment is largely
symptom-focused and fails to address the
problem’s causes.
Investing in preventive dental care
through Medicare and other such
programs is critical to avoiding costly
procedures later on. Just as oral health is
an integral portion of the overall health
and wellbeing of the patient, oral
therapeutics and maintenance care should
also be considered an integral part of the
health care system.
the issues
student perspective
wo
years
ago,
I
crossed the Atlantic
to
study
children’s
book illustration at
Cambridge School of
Art. I lived on the fourth floor of a
bed-and-breakfast on a rainy green
island called the United Kingdom. I
dried my laundry on radiators and
consumed inordinate amounts
of milky tea and biscuits. I grew
accustomed to the cheerless
dribbling rain, and I even learned
to ride a bicycle in a dress on
the left side of the road. My
introduction to graduate level
study was about to begin and
it would be nothing like dental
school.
The key distinction between
American dental training and
an English art school is the
philosophy of education. Cambridge
School of Art uses the tutorial
system. Students are placed under the
supervision of one or several tutors. In
my program I met Martin Salisbury, a
world-renowned art critic and leader
in his field of study, who met with
students bi-weekly in one-on-one
meetings and small groups. These
tutorials were characterized by progress
checks, support, formal and informal
critique and dialectic discussion. It was
challenging, inspiring and sometimes
terrifying to study so closely with
well-respected critics like Martin, but
these tutorials were the most important
part of my learning experience.
In contrast, the first two years of my
graduate dental studies have been
characterized learning in a collective
setting. Specialists and researchers
impart their knowledge, expertise and
skills in seminars covering a fascinating
and diverse range of topics. Students
follow a rigorous and unbending “eight
to five” academic schedule.
The highly organized and
sophisticated schedule dental
students follow serves as a scaffold
for building confidence and
competency. As a graduate-level
art student in Cambridge, I was
given an unstructured schedule.
My tutorials were supplemented
with only one seminar a week.
The days of classroom-centered
learning I had known as an
undergraduate, and have returned
to in dental school, were gone.
Independent
studies
were
expected to bear results that reflected
my personal interests and research
progress. As an American, it seemed
like an inconceivable amount of free
time. I found it daunting to develop
my own academic goals and interests.
student perspective
But with the help of patient tutors, I
developed independent learning skills
that continue to serve me well.
Another similarity between dental
school and art school is the necessity to
see your art as a trade and a set of skills,
with a certain job in mind at the end
of the program. In England, these skills
were acquired organically with a mentor
rather than in a large classroom setting.
Similar to pre-clinical dental practicals,
art students submit visual portfolios.
Through this evaluation process we learn
to receive criticism from instructors and
develop a teachable attitude as students.
Now I live in the Deep South where I
sip sweet tea, drive on the right side of
the road and enjoy the warm southern
sun while studying dentistry. My
experience with the tutorial system in
England strengthened my desire to
develop independent learning skills,
and showed me the value of having a
support system of mentors and peers
beyond the classroom. My experiences
as an art student and as a dental
student
are
unique
learning
opportunities, and I am grateful to
have each to draw from.
Illustrations © Anna Lucy
what are you reading?
“T
aking good care of their teeth
Is something all bears do.
That’s why Sis and Brother brush And go to the dentist, too.”
-“The Berenstain Bears Visit the Dentist”
I can’t remember my first dental appointment, but I
still remember Sister Bear’s first trip in “The Berenstain
Bears Visit the Dentist,” by Stan and Jan Berenstain.
After my first pediatric patient was assigned, I went to
my local bookstore for children’s stories that might ease
her into the experience.
In addition to the Berenstain Bears story, I recommend
two newer books for pediatric patients: “Show Me Your
Smile! A Visit to the Dentist,” by Christine Ricci, part
of the "Dora the Explorer" series, and “My Dentist, My
Friend,” by P.K. Hallinan.
Each book tackles slightly different topics. “The
Berenstain Bears Visit the Dentist” has the widest
scope of themes, exploring everything from Sister Bear’s
losing a tooth to what “scary” instruments might look
like. It illustrates her fear of extractions in a sensitive
and helpful way. The authors validated Sister’s fears,
allowing her to be scared, but in the end her extraction
was nothing to worry about. While the book is longer
than most parents enjoy reading before bedtime (I recall
my own mom complaining about this), it does a great
job preparing pediatric patients for most procedures
they will face in your chair.
The second book, “Show Me Your Smile! A Visit to
the Dentist,” focuses on the progression of the dental
appointment. It follows patients though the waiting
room before the appointment, taking radiographs,
receiving oral hygiene instructions, receiving
what are you reading?
restorations, and earning stickers before
going home. The book is targeted at 3- to
4-year-olds and is available in multiple
languages. It received rave reviews from
parents online and will probably be useful
for a large number of patients, especially
Spanish-speakers.
“My Dentist, My Friend” is an adorable
rhyming introduction to the dental
appointment. The book discusses the role
of the dental assistants “with welcoming
looks,” the oral hygienist “showing
kindness and care,” and the eventual
gentle touch of “my dentist, my friend.”
The story prepares patients for all the
people who file in and out of the room.
This would be particularly helpful in a
dental school setting.
I believe preparing a child for the dentist
means preparing the entire family. This
is simply one way to approach pediatric
oral health literacy. Even though parents
can read a dental-themed book to their
children, they might not understand what
it means. In a study published by Richman
et al. in the September/October 2011
Journal of Pediatric Dentistry, parents
who recognized dental terminology
did not necessarily have a high level
of pediatric oral health literacy. These
books could serve as a starting point
for conversation between the provider,
parents and patients.
Next time your patient’s parents call with
concerns about the appointment, consider
suggesting they read one of these books
before they come in. Even if they don’t
ease all of their worries, at least they had a
great bedtime story.
predental corner
W
hen you think about paying for a
dental education, the first thing
that comes to mind is usually the high
cost of tuition. But the application
process often is quite pricey as well.
Between the AADSAS application fee,
supplemental fees, buying an interview
suit, transportation, lodging and
deposits, it is almost guaranteed that
you will spend $5,000 or more.
From my interviews, I learned that the
average dental applicant applies to 10 to
15 schools. According to 2010 ADEA
statistics, about 41 percent of applicants
graduate into dental school. It’s critical
to cover your bases and apply to safety,
target and reach schools. The interview
process is unpredictable: some schools
may grant you an interview even though
$1,360, though this amount varies
based on the number of schools to
which you apply. However, most
schools also require supplemental fees.
My supplemental fees ranged from $45
are accepted. Most who are accepted
between Dec. 1 and Jan. 1 get 30 days to
put down a deposit. The time period for
a deposit decreases the later you hear
in the admissions cycle. These deposits
to $100 per application, which totaled
nearly $1,000.
can range from a refundable few
hundred dollars to a non-refundable
few thousand. One of my friends was
accepted to Pittsburgh on Dec. 1 and
paid a $750 deposit. Then she was
accepted to Maryland shortly after
and paid a $750 initial deposit and the
$1,000 second deposit. Weeks later she
was accepted to Stony Brook, where she
will be attending at the deposit price of
$2,500 solely because of timing. Two
other future dental students each put
down $1,500 deposits to NYU, which
went to waste once they were accepted
into their dream school, UPenn, at a
later date.
your credentials are below average;
others may deny you an interview
even though your credentials are above
average.
Interviews greatly add to the expenses.
First, you need to buy an interview suit if
you don't already own one. Then there’s
the cost of transportation and lodging.
Transportation costs range from gas
and tolls to flights to schools that are
farther away. Some schools don’t let
you choose your interview date, causing
you to pay more for last-minute flights.
For example, one school that I applied
to assigned me an interview date and
would not guarantee me another if I
missed the first date. I had to purchase
a more expensive flight because I could
not book it further in advance. While
some hotels offer group discounted
rates for students interviewing at dental
schools, staying at a hotel still costs
about $100 or more each night. I stayed
with friends at a few schools, but had to
stay at a hotel for most of my interviews.
I applied to 16 schools. My base
application fee for AADSAS was
Each school requires a deposit within
a certain time, depending on when you
The process of applying to dental school
is daunting. I was accepted my first time
applying, but some students take two or
three cycles to gain acceptance, which
amounts to double or triple the cost.
Appications are an expensive, yet
worthwhile investment. Optimize your
chances of getting in by applying to a
wide array of schools.
just for laughs
by John Syrbu, Iowa '13
the money issue
Q: Should I buy or rent during dental
school?
Suzie Orman points to The New York
Time’s online buy-rent calculator to see
if buying your home will pay off based on
home price and years you will be living
there. For example, owning a $160,000
home is better if you stay there for five
years or more and about breaks even with
renting at four years. For dental students in
a four-year program, renting is often just
as good as buying. If you plan to continue
with a residency, are in a DMD or Ph.D.
program, or are looking to practice in the
area of your dental school after graduation,
buying might be the right choice.
Q: What can I do with my money right
now to make things easier in the future?
Budget. Learning how to be responsible
with limited funds will make managing
your money later a less daunting.
Build your credit (or at least don’t get any
black marks). If you have a credit card,
always pay your balance on time and don’t
open multiple cards. Just opening up credit
accounts can automatically lower your
ratings. If you have undergraduate loans,
always pay on time. Just one late payment
can lower your credit score 100 points!
Educate yourself. Attend any meetings or
talks your school offers on managing
finances or student loan debt. This same
information may cost a pretty penny later
on, so take advantage of the free advice
while still in school.
Launched Fall 2011
THE NEXT DDS provides you the support you need
where you need it.
www.THENEXTDDS.com
Enroll for FREE today!
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