Tuesday, February 21, 2017

Dental Specialties: How Do I Decide?!

There are currently 9 recognized dental specialties (and contrary to popular belief, "esthetic dentistry" is not one of them):
Dental public health, endodontics, oral pathology, oral radiology, oral and maxillofacial surgery, orthodontics, periodontics, pediatric dentistry, and prosthodontics. 

And as a dental student, you will likely ask yourself this question.

"Should I specialize?"

There are so many components to this question, that it's difficult to hit all of them, but we'll try.
Here are the factors I think you should take into consideration before deciding to make the leap. 

1. Which dental school do you go to?

Each school has a very different track record as far as how many students it sends to specialty programs. There are some that churn out specialists left and right, and I would say that schools like UCLA, UCSF, UPenn, Columbia, Harvard, and Michigan all belong under that umbrella. There are others that really prepare their students to be excellent general dentists - a jack of all trades, if you will. For example, UoP and USC offer a very well-rounded clinical experience. Some schools, like Western Dental, even prepare their students with courses in Invisalign, and have an abundant, diverse patient population, and do not send more difficult student cases to graduate clinics.

I think your school experience is one of the major determinants for students choosing to specialize. In my experience, UCLA is not overflowing with patients and opportunities to learn a lot of dentistry, and I think it was one of the main reasons so many of us chose to specialize. 

2. What post-graduate opportunities do you have? 

Do you have any family that you hope to practice with in the future, someone who will help you get your bearings as a new grad? Do you have any family friends who are waiting for you to get out so you can finally take over their practice? As a current fourth year dental student, I don't know what it feels like to make real money, and after talking to many new grads who are practicing, money can fuel those life dreams - marriage, kids, a house, a private practice, etc. So if the opportunity is there for the taking, do you want to get started on real adulthood ASAP? Or would you rather spend time in residency to learn more?

3. What do you want?

After you've asked yourself these questions, it's time to do some honest soul searching. Some questions I asked myself, are: do you really, truly, want to be in academics? Are you okay with making the sacrifice in terms of salary? Do you want to be in private practice? Do you dream of having your own office, where you make all the rules? Are you better in group settings? Are you more of a lone wolf? Are you business-minded, and if not, do you want to be? Do you want to spend more of your early adult life in school or residency?

4. Identify core faculty, residents, etc. at your school who can help you make some decisions.

I'll start by saying that no one wants to admit that they made a bad life decision. So likely, every person you talk to will tell you that their specialty is the best choice. And to be honest, it probably is - for them. So figure out all those reasons that they were drawn to their particular specialty, find out what a typical work day looks like for them. Ask what traits are necessary in someone who will be successful in that field, and see if these things align with you.

5. Shadow.

Just like those pre-dent years, shadowing is crucial to understanding what you are getting yourself into. And if you are currently a dental student, you may very well know that shadowing was not at ALL indicative of what dental school, and being the actual dental provider, was like. Some specialties provide opportunities to do an externship. An externship is when students basically do rotations at other schools to see what a day in the life of their residents looks like. They are usually 1-2 weeks, and you are typically allowed to start going on them as a 3rd year dental student. 

6. If you anticipate specializing but you don't know what exactly, be prepared, but make your decision by about third year of dental school. (This is what I did)

Keep your grades up. Some specialties are extremely competitive which is why I mentioned #1 on this list, which asked "What dental school do you go to?" If you go to a pass/fail institution like UCLA or UCSF, specializing becomes kind of a free-for-all. Since we don't have ranks, none of us are really "barred" from pursuing any specialties. At other schools with actual grades and ranks, programs will only look at applicants who are in the top 15% of their class, etc, and I will honestly say that this route becomes much more difficult. 

Participate in academic work like research. Being involved in research helps you see how the rest of the professional world makes decisions on how healthcare is delivered. It is important to understand how to read papers and derive concepts from them. Generally, I think that any specialty you apply to will look at research experience favorably - with ortho, perio, and endo all having a particular emphasis on research. 

Be present in your third year clinical rotations. This is when many people finalize their decisions to pursue certain specialties. At most dental schools, the first two years are entirely "pre-clinical", which means that you don't participate in patient care, and are primarily focused on lab work and academics. Neither of these give a good indication of what each specialty looks like, but in your third year, you get to spend days to weeks in a particular specialty, and this may be when you figure it all out. That's what happened to me!

7. Find out if there are any programs at your school to help familiarize you with certain specialties. 

My school has an ortho track, oral surgery track, academic/teaching track, several pediatric and craniofacial selectives, a special endodontic selective, and weekly conferences/rounds where different specialties present cases. These are good opportunities to scope out the field at your school.

In conclusion..

If you're already in dental school, worrying about specializing likely qualifies as a first world problem. Dentistry is overflowing with new things to learn - new clinical techniques, new gadgets, new leadership strategies, etc. If you ask any of our clinical faculty, I think everyone will tell you that dentistry is truly a lifelong practice - one that never gets boring. You've already made the hard decision of deciding which area of the body you want to focus on for the rest of your life by not going to medical school. Good luck!