What I learned in my general practice residency

Photo of Dr. Deshpande and professor

Blogger Sampada Deshpande, D.D.S., practices in Bay Area, California. Due to her specialized training, she is often approached for care by patients with special health care needs. Author of the book “Persevering,” Dr. Deshpande earned her dental degree from the University of Washington and completed a general practice residency at Alameda Health System. She is a recipient of an ADA 10 Under 10 Award, Academy of General Dentistry 10 to Watch honor and Denobi Award. She founded the educational nonprofit New Dentist Business Club in 2019 and is the product manager for SamsoSmile, an automated insurance verification service. You can reach her on her website, sampadadeshpandedds.com, for more information.

Going back to school for a general practice residency after four years in private practice was not what I imagined it to be. It was better. The only regret I have is not having done it right out of school, despite my mentor advising me to do so. Had I taken her advice, I would have been gifted with the perspective, mentorship and vision I have today, years earlier.

First, the elephant in the room. Why did I go back for a GPR?

Things changed by the end of year two of practice, when I began experiencing serious burnout and realized there are aspects of general dentistry that I don’t like. I also felt stuck in one insurance-driven practice after the other, where “what’s covered” is the question of the day.

Practice ownership seemed exciting; however, I felt disillusioned about starting a practice only to be doing exactly what I was doing as an unhappy associate. I believe this is a question many associates debate.

Year three was when I was able to connect the dots, thanks to the Leadership Education in Neurodevelopmental and Related Disabilities fellowship I completed at the University of Washington. The LEND fellowship reminded me of my passion to serve those with special health care needs. It taught me the gaps that exist in our current health care system. I was alarmed to understand the dismal rates at which adults with special health care needs receive dental care in the country. When I moved to California, it became obvious to me that I needed to go back for a GPR to gain the necessary skill set and training to serve this population.

4 things I learned in my GPR

1. Learning endodontics from an encouraging endodontist

We all have had the experience of learning endodontics from professionals who scare us into thinking general dentists can’t do root canal treatments well. We are made to believe we don’t have the knowledge or the experience. And that is absolutely true for most new graduates who do not have a robust endo experience in dental school.

However, while an endodontist may be able to do things more efficiently and should be referred to, when the times arise, there simply are not enough endodontists out there to do all the root canals that need to be done. Learning to do root canals in the right way has been one of the greatest benefits from this residency. Our superb teacher, Raymond Scott, D.D.S., was a gem of a person who made root canals fun and calming. I looked forward to the days he was attending because I knew I was going to have fun that day!

How many root canals were we completing on average in this residency? Between six to eight every week. Do the math. The endo experience I got out of residency at Highland Hospital was unbeatable.

2. Learning how to give a successful inferior alveolar block

There will always be a percentage of times that I miss an inferior alveolar block and need to give it again. However, prior to this residency, I am embarrassed to admit, I used to miss it probably half the time. In year three of practice, I had gotten so humiliated about missing it and disappointing patients that I would dread seeing a No. 19 or 30 crown prep on my schedule (the most common teeth that need crowns, fillings or root canal treatments). I don’t mind admitting to this now because I know I have finally conquered the beast! All credit goes to Akshay Govind, D.M.D., M.D., the head of oral and maxillofacial surgery at our residency.

3. Patients with special health care needs

Working with this patient population has probably been my most treasured experience this past year. I’ve found that many patients with special health care needs can be treated safely in a regular dental clinic setting and need not be fully sedated. They need more time, desensitization, patience from the team and additional supports, as necessary.

One thing that helps tremendously with this population is using teledentistry. We can get the full medical history prior, understand what specific wheelchair transfers they need, find out if they require transport before and after the appointment or an American Sign Language interpreter, etc. It makes the following appointment in the clinical setting very smooth.

Being on Epic and having access to a patient’s full medical history, including labs, and sometimes the ability to contact their primary care provider, is also a huge boost. I can’t imagine being able to treat patients with medical comorbidities and complex surgical and treatment histories without a system like Epic. I would often quiz patients on their medications, while simultaneously eyeing what was on their Epic, and sometimes, the differences were very big. Medical-dental integration should be the norm, not optional. We should demand more from our practice management software solutions.

Patients also have a habit of remembering only the more positive details of their lives — “selective memory.” I had a patient tell me very convincingly that his hemoglobin A1c was 6 this year when in fact it was 9 in the past month, per Epic. This made it unsuitable for us to extract his teeth that day. By not getting the complete medical history of a patient, we are opening ourselves up to liability. In the case of a poor outcome from a procedure, the first person to be critiqued would be the doctor because “you should’ve known better and done more research.” Our role as a health care provider should be taken seriously.

4. What is an emergency and what could wait until Monday

While there are many, many more things we learn in GPRs, I will end with this point. In private practice, I can remember several times patients and bosses talked me into performing certain procedures because they were “emergencies.” These procedures, such as addressing post-operative discomfort after an extraction or restoration, performing temporary crown re-cementation, etc., would be added on to an already full day. Team members would scramble to seat multiple patients and prep rooms at the same time. At the end of the day, everyone feels depleted and exhausted, only to repeat the same dance the next day.

Being through the GPR program and having seen a few true emergencies, you gain much-needed perspective. Personally, I have gained the confidence and wisdom to say the golden word: no. Being in control of your schedule and taking care of your assistant will serve you many times more favorably in the long term than you expect. Taking care of our mental health in this profession is very important, and the time to do it starts now.

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