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AUDIO - DUwHF #291 - Rebecca Siscel
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VIDEO - DUwHF #291 - Rebecca Siscel
Rebecca and Howard reminisce about their early days in dental school together at UMKC, why Rebecca left a successful private practice to teach dentistry, and a little bit of everything in this episode!
Howard: It is a huge honor today for me to be podcast interviewing my classmate from, we graduated 1987 University of Missouri-Kansas City Dental School. I tortured and abused her for four years. The reason I brought you in here today is because you, we went to dental school in Kansas City, and you were from St. Louis, and after an amazing 28 years of practicing real-world clinical dentistry in the St. Louis area, you decided to take up teaching.
I just thought, I've always believed that deep down inside, everybody who ever went to school, from first grade into high school, at least one day was looking at their teacher and thinking, "You know, some day, I'd like to be a teacher." I watched all four of my little kids come home on one day or another and tell me when they grew up they were going to be a teacher. I think a lot of dentists are wondering, tell us about that. Why did you do that? What's it like going from owning a dental office, and you were very successful, you used to buy and sell offices, your husband is a dental business broker. What made you decide to just say, "I want to teach"? You've been doing it two years, now, right?
Rebecca: I've been doing it two years, full time. I think I was just at the point that I felt like I was on this treadmill with my practice that I was just ready for a change, ready for something different. Love dentistry, still, but just ready to go out there and try something different. You've raised your kids, you've, just looking for the next challenge, I think, more than anything.
Howard: Now would you say, when you said you were on a treadmill, doing fillings and crowns was monotonous, would you say you were having burn out?
Rebecca: Maybe a little burn out. I just think, you know the business, there's never, if you're a solo private practitioner, you're never leaving. It's Saturdays, it's Sundays, you never get away from that practice, really. After 26 years of doing it, I think I was just ready for a change, just to see what else what out there, too.
Howard: Now what's, you're teaching now in Arizona, at Midwestern.
Rebecca: At Midwestern.
Howard: They have a dental school outside of Chicago, Missouri.
Rebecca: They've got one in Downers Grove, Illinois.
Howard: That's a suburb of Chicago.
Rebecca: A suburb of Chicago. Then they have the one in Glendale, Arizona.
Howard: Glendale, Arizona, which you're at. But don't they have another one in Missouri?
Howard: They just have two.
Rebecca: Just the two.
Howard: Or are they going to break ground on one?
Howard: I thought I ...
Rebecca: There is another dental school in Arizona that has opened up another location in Missouri.
Howard: Oh, A.T. Still.
Rebecca: A.T. Still, mm-hmm (affirmative).
Howard: Okay, well, they were originally from Missouri, aren't they?
Rebecca: They are in Kirksville, Missouri. They had a DO school, and then they've opened up a dental school in Kirksville, and then Kirksville is a smaller town, so they didn't have the population to make a dental clinic. St. Louis, who had lost Washington University back in the late eighties, had a need to be filled, so the students are going to St. Louis, then, for their last two years of dental school.
Howard: It's funny, you and I have been out of school 30 years, because when we got out of school, they were closing down dental schools, every, they closed down like six. They closed down Emory and George Washington, and Northwestern. They closed down six or seven and a lot of people were crying, "What's happened to dentistry? They're closing down the schools." Then the pendulum swings way too far one way, and now three decades later, it's swinging back and they're opening up schools. Now it's the exact opposite. When they've opened up six new schools, everybody is like, "Oh, too many dentists." When they were closing down the dental schools, everybody was like, "Hey, what's happening to our profession?"
Tell your viewers, tell the profession, what's it like to be a teacher?
Rebecca: The transition was, I think we all kind of imagined when we were in dental schools, it seemed like the instructors were holding up the walls a lot and chit-chatting, and didn't seem to be ...
Howard: When you were in school.
Rebecca: When we were in school, yeah. They didn't seem to be working as hard, I think, as we imagined. It's a lot different now. We're a lot more interactive. It was more of a transition than I think I anticipated. Because you think, okay, I know dentistry. To look at a preparation and know how you want it to look versus to explain it to somebody, go back and be explaining the cavosurface, gingival axial lining. You can look at it and see right there, I would change it, but to explain is a real process. It was a pretty big transition for me. I think it took about a year before I really felt comfortable.
Now I'm just embracing it, I'm really enjoying it. After being in a solo practitioner for 26 years, you know, to be kind of in your own little world, to be surrounded by a lot of colleagues that are coming from all over the country, very similar, we're all around the same age, to have that interaction with your colleagues. Then the students also, I'm really enjoying it.
Howard: Specifically what do you do, you teach clinic, or any didactic?
Rebecca: Yes. I'm on the clinic side, so that means I get the third and fourth year dental students. My specific school is set up where the third and the fourth year dental students are paired together in teams. They work together, they kind of mentor each other also. We are not really a department-based dental school, so we are on the floor, doing all varieties of dentistry on the floor, just like you would in private practice. Really try to model a private practice for the students.
Howard: You mean, when you don't have a department, you don't have on the specialty, you don't have endo, perio, pedo, prosth.
Rebecca: We do have, I mean we do, but most things are being done on the floor. I know when we went to school, we were teams, and we had a specialist for each team. Each team had an endodontist, a prosthodontist, what else we had? Ortho was a specialty then, I guess. We had a dentist that was your restorative dentist. If we were doing a filling, we went to that specific dentist to check that. In our case, we are general dentists that are overseeing and checking, one student may be doing endo on the floor, another one may be restoring implants, a variety, a little bit of everything through our day. It keeps you challenged, you got to be on your toes.
Howard: What's the health of the profession? What kind of kids are being attracted to dental school, and is the graduating classes make our profession proud? You having a generation gap issue?
Rebecca: No, I think that's one thing I was really wowed by. I think the caliber of students that we're getting, or individuals coming into dentistry are exceptional. [crosstalk 07:04] I was so impressed to just see them in the clinic, just how ready they were to start, to go from mannequins to working on human beings. They're just very nice, kind individuals. I think they kind of lift you up, too, in that they are appreciative and they're kind, so it makes it fun to come to work every day.
Howard: I always, whenever I'm in a dental school, at least twice I sit there and I look at the caliber of people there. Then I'm looking at the caliber of us five guys that lived in our bachelor pad five blocks from dental school. I just think, man, you're twice as honorable as me and my five roommates. I just think they're exceptional.
Rebecca: They really are.
Howard: They're so bright-eyed and bushy-tailed.
Rebecca: I think so much now, I mean, part of the admissions process, you know, so many of these students have done volunteer work. They've really researched the profession and know, have a good idea of what they're getting into.
Howard: You know, that's a secret. I don't know if a lot of dentists listening are aware of this, because they might not be working in a dental school or close to dental school, but one of the biggest secrets on getting accepted to dental school, if you have no voluntary work on your application or resume, you're dead on arrival. They want to see that I went and volunteered at the St. Vincent de Paul, or I went to Mexico, African mission, or went to Vietnam.
Rebecca: That's right.
Howard: If you have no charity, I know you're [inaudible 08:37].
Rebecca: Well, we say, everybody that's applying for dental school will say, "I'm passionate about dentistry," but how did you take those words into actions? What did you do? Did you just volunteer one thing, or did you go through many different aspects of dentistry to really volunteer and get an idea for what you, the profession is, what you're getting yourself into also?
Howard: Are you glad you became a dentist?
Rebecca: Absolutely, absolutely.
Howard: Let's go back, I've always wondered this about dentistry. I've always thought the curse of dentistry, the one bad thing about it is, let's say you have two kids. One, ever since they were a little kid, just starts drawing and painting, and everybody is like, oh, my god, you got talent. The other kid goes to eight years of college in Art School and gets a doctorate in art and drawing and painting, and then all the people are like, oh, my god, this little girl who never went to school, what a magnificent painter. This girl's got a doctorate in painting, and it's like, hey, you need to practice more.
Because dentistry, it's not like you're a math major or physics major, where it's all in your head. You got to translate your head, I mean, we work with our hands. When you're checking on students, I'm just curious, when you're checking on students, do you sit there and look at kids and say, that kid's really got a set of hands. Maybe an A, B, or C, D student. This kid is like, maybe an honor roll valedictorian, but those preps are just ... Do you see that? Or is dentistry technical enough where the painting art, like could you sketch me? Could you draw me right now, to where if I showed it to my four kids, they'd all say, that's my dad. I can't do that to you. I don't have that ability.
Rebecca: Right, I mean, have me sketch out a tooth, and it's not a very pretty tooth sometimes either, I think.
Howard: When you're checking students, do you see that variance or is that not really an issue?
Rebecca: Well, don't they say, I mean, I don't know if this is, I mean, I believe this to be true that most of us are average dentists technically. There's a few that are exceptional, skill-wise, and there's a few that are a little more subpar, but most of us are in that same range. I think I find that to be true. Then I think we bring so much else to the table, our personalities, how we relate to people, how we relate to our staff. I think that, you can have exceptional technical skills and not be a people person and be able to relate to people, or maybe not even be a compassionate person.
Howard: Those are the ones who fail miserably.
Rebecca: Yeah, oh, yeah.
Howard: If you get an A in people skills and you're the worst dentist in town, you'll be a millionaire.
Rebecca: Well, don't they say, they judge you whether you care or whether you hurt them when you were giving them a shot. I still think that probably holds true.
Howard: What are the seniors thinking about when they're graduating? Are they bright-eyed and bushy-tailed, are they afraid, are they nervous? What are their issues when you go back 30 years ago, into their heads right now?
Rebecca: I think they're probably very similar to the way we were. I think they do have an advantage now. I know when we graduated from school, I don't know how much you remember this.
Howard: Oh, she points to me. Like I don't remember. Did I kill that many brain cells in college?
Rebecca: Do you remember, we had graduation, I think it was on a Sunday night, and then we had boards the following Monday morning. Rather than enjoy graduation, our families are all there, we were losing our cookies because we knew the next morning we were going to be, or hoping our patient shows and our inlay cast the way it was supposed to.
Howard: Are they still doing boards now like that?
Rebecca: Well, their boards, they're doing, I mean, most of the students now are taking their boards in the spring, winter/spring so that they're ready when they graduate to really hit the ground running, that they've got that out of the way prior to graduation.
Howard: Are the boards on live patients or mannequins?
Rebecca: Live patients.
Howard: See, that, just by definition of any form of intelligence, you know it's not a standardized test and it can't be fair. I remember on my board patient, I had this guy who I was paying money to come in for a filling, and he no-showed. How was that my fault?
Howard: I mean, I still was able to scrounge up a, I went to the sterilization room, I was at Loma Linda, I went to the sterilization room, there's these five lovely ladies in sterilization. I just said, "I'll do anything for anyone with a cavity." Some sweet little, what religion is out there in Loma Linda, what city is that in? It's one of the nine cities in that blue zone book, where they have the, ten times as many people living to be ... Latter-day Saints, is it? Seventh-day Adventists.
Rebecca: Okay, okay.
Howard: That whole Loma Linda, Redlands, area is the oldest living group of people in all of North America. They have ten times as many people living to be a hundred, there's like ten cities [inaudible 13:33], you got to read the book The Blue Zone. Their religion is mostly vegan, and they're just sweet and adorable people. All five women in this [center of 13:43] sterilization are just working their tail off trying to find this little boy from Kansas ...
Rebecca: They felt sorry for you.
Howard: A person with a DO. I just thought to myself, a test should be standardized. The other thing I thought was crazy is, I just paid, I just graduated $350,000 in debt and I got to go take a test to prove to who? The state?
Rebecca: Well, we know, 30 years ago, everybody was saying, the system has to change, this is unfair. Here it is, 30 years later, nothing has changed. It's all pretty much the way it was then. It's very similar.
Howard: At least the pot is legal now. When we were in school, we had to hide it. You remember that?
Rebecca: No, I don't remember that.
Howard: At least their weed is legal, they can buy it at a store now. They're coming out, so they're worried about the boards. You've been there two years. Let's just go back to last year's class.
Howard: You've been there, so you've already had a graduating class.
Rebecca: I've got two graduating classes.
Howard: Okay, so a year out of school, just off of the, what's your class size, about 140?
Rebecca: It was, now it's going to eventually be 140, but 110.
Howard: So 110, when a hundred people walk out of dental school, a year later, is it like what percent got a job, what percent open their own practice? I opened up my practice, my practice opened four months after graduation. I graduated May 11, and September 21, it opened, and it's still there to this day.
Rebecca: I think you were the exception. I think when we graduated, I mean, I went back to St. Louis, and there weren't a lot of jobs available. We had to pound the payment to find some. I know my first job, I know the hygienist made more than I did, and I was okay with that, because I knew I had to pay my dues. I think very few back then went into private practice, or a solo practice, started their own practice right off the bat.
Howard: That's true in hospitals. The residents don't make a fraction of what the nurses make, and then we're doing 24-hour shifts.
Rebecca: Yeah, but I think back then when we graduated, I went into an associateship, and back then, we used the term capitation dentistry. It was a clinic setting. I think there's a time and a place for everything that allowed me to get my speed up, get my confidence up, learn what I liked about a practice and what I didn't like about a practice. After a few years, I was ready to make that leap. I think most students are the same way now. I think most of them are going out and working for some, whether it's an individual or a corporation, and I think that's probably a good experience for them, in that they are, that they're not sitting, twiddling their thumbs waiting for a patient to show up.
I mean, I remember when we graduated, there were dentists that would say, "Oh, sure, I'll hire you. I don't have any patients for you, there's a chair here." That would not have done me any good. I don't think that probably serves the graduates well, either. I want them to get out, I want them to be busy, I want them to get their confidence, get more experiences, and learn what they like and don't like.
Howard: Do you know off the top of your head, their clinical requirements to graduate? What is it like, 75, I think we were 50 extractions, 75 fillings, 15 units of endo.
Rebecca: Twenty-five crowns was the only thing I do, for some reason, I remember crowns.
Howard: From us in school?
Rebecca: Yeah, it was 25 crowns.
Howard: So 25 crowns, I think it was 50 extractions, 75 fillings, 15 units of endo, 15 canals of endo, and 15 units of removable. That's how I remember it.
Rebecca: You remember better than I do. I only remember the crowns.
Howard: Do you know what the requirements are nowadays?
Rebecca: We are competency-based, we are not numbers-based.
Howard: Explain that.
Rebecca: I think, well, we talk about competency and we talk about proficiency. Competency means that you're able to sit down without a lot of instruction and know what you're doing and do a good job on whatever procedure that might be. Then you keep doing those procedures and you become more and more proficient. I think it works out, I think their numbers are significantly higher than what we were doing to be able to graduate, but they're not based on the numbers. I mean, I don't know about you, I think for most of us, when we got to our number, we quit, pretty much in school. Do you remember that?
Howard: You know what, yeah.
Rebecca: I mean, I remember, you got to 25 crowns, and then you started passing them on to the person, your friends who still needed some. In that case, we know what the average of our classmates are, and so the bar just keeps being raised. I think that's a good concept.
Howard: You know what I used to love the most in clinic for us? We had that program where, it was about 45 minutes away was Leavenworth penitentiary.
Rebecca: They didn't let the females go.
Howard: Really? Are you serious?
Rebecca: Yes, I remember, I was very angry about that. I wanted to go to prison, I wanted to check it out.
Howard: Just to see all your family members, and friends and cousins.
Rebecca: Pretty much, yeah. [crosstalk 18:36]
Howard: Hey, a family reunion. No, what I liked about it, he was so grateful to have someone helping, because he had a whole prison of deals, and they'd just leave you alone. Whereas in dental school, in the clinic, it could take three hours to do an MOD amalgam.
Rebecca: Oh, yeah.
Howard: In the prison, you just had them there, do whatever you want.
Rebecca: Well, we went to the VA, I remember we went to the VA, we did a rotation there. I remember I went, we had lots of opportunities when we were in school. I volunteered and went in the middle of Missouri to, it was almost like a Winnebago that had a couple of dental chairs in it. We'd go to areas with special needs patients. I volunteered for a week to work on special needs patients. They did give us lots of little opportunities, it seemed like, outside the school.
Howard: Yeah, I really enjoyed that, I really liked that. Hey, I want to switch subjects just a little bit. You used to buy and sell practices when you were practicing, and your husband is a lawyer, and he was helping you on the legal buying and selling transactions, and now he's doing that. Does he do that full-time in Scottsdale now?
Howard: This is a hobby thing he does on the side.
Rebecca: Yeah, just more like a side. I think it's more word of mouth, he doesn't advertise it, but I think just through the years of practice that when opportunities came available, that I would buy a practice. Sometimes almost flip a practice, take a practice that ...
Howard: Yeah, you have an amazing business mind. Walk through what, what were you doing? Why did you see a practice, why would you buy it, why would you flip it? How does that work?
Rebecca: Well, when it started, I had a full-time practice, and there was a practice in a community about 30 minutes outside of St. Louis where I'd gone to high school, and it was a dentist that had had a lot of health issues, could not sell the practice. I went and looked at it, and it was in pretty poor shape. Told the practice broker, nah, not really interested. He said, "Do me a favor, go back and look through the charts. I think there's more there than what you think." Went back and tried to finagle how I could have my full-time practice and then take on this satellite practice.
I cut back a day on my main practice and went to this satellite practice two days a week, and gradually just built it up, turned it around, I had it for seven years. Bought new equipment, ended up moving it to a nicer area, but the patient base was there, it just hadn't really been worked, I guess you would say. Once I got it so it was kind of busting at the seams, I found a dentist that was ready, had been an associate, ready to buy a practice. Sold the practice to him and then went back to my main practice. Picked up that day again.
My husband has, just through my business transactions and just being around dentistry for a lot of years, and being an attorney, was very familiar with all the ins and outs of things, so when, the practice brokers were familiar with him, the accountants in St. Louis, so when dentists that were either buying or selling a practice didn't have an attorney, his name was mentioned, and he didn't have to learn the ins and outs of a dental contract or what to look for or what was good for a dentist or bad for a dentist, and was very fair. Through word of mouth, he does a lot of that, too.
Howard: You and I were talking before we started taping. It was interesting, during the 2008 financial meltdown, the last, the Great Recession, you were saying in St. Louis, nobody went bankrupt. Here in the Phoenix Valley, 88 went bankrupt and three blew their heads off. What do you think that was?
Rebecca: I don't, I mean, I just was surprised. Obviously, people would like to, the weather is, you don't have the winters in Arizona that we do in Missouri. In Missouri we have the severe summers and the severe winters. Obviously, I think more dentists probably want to come to Arizona as opposed to the midwest. I was surprised when I did come out here, when we talk about the Great Recession, in St. Louis, I didn't know of any dentists that went under. We would complain that we were slower or we had more holes in our schedules, but I was shocked by the severity when I came to Arizona of the numbers they talk about of dentists that actually went bankrupt and went under, and just how much more competitive it is.
When students are graduating and they want to stay in Arizona, sometimes I encourage them, you know, maybe look at the midwest, that there might be more opportunities there, too. I mean, I'm sure it's that way any area of the country that more people want to vacation and live too.
Howard: I mean, it was very personal for me. I had dentists and their wives bawling in my front room, and they're asking me, "Howard, what can I do? What can I do?" It's just not the time to sit there and say, well, how many bad decisions back do you want to start? You just hurt. I cried real tears. It hurts. The reason I'm saying is, what I'm curious, what percent of those hundred, you got 110 seniors right now, what percent of those 110 are going to sit there and say, "Hey, business is supply and demand, I know nobody needs me around a city that has two dental schools. I'm going to go hit small towns and rural, go back the midwest where it's needed."
Versus how many of them say, "God, Phoenix, you got the Cardinals, you got the Suns, you got the hockey, you got Scottsdale, you got a hundred amazing restaurants. I don't care about the money, I'm staying where I'm not needed." What's the breakdown in attitude?
Rebecca: I think you see it go both ways, I did see it go both, you know, where students would go into some little town in Oklahoma, knowing that that may not be where they always want to be, but they were going, had more opportunities there. Then there were some students that struggled a little bit more because they did want to stay in the Phoenix area. I think everybody eventually, you know, they did find something. When I say eventually, maybe it took them a month after graduation, but pretty quick, it seems like everybody is able to find jobs. It may not be their, I don't believe in a dream job. I think that's a pie in the sky. I think at least a starter job, to figure out what they want ultimately.
Howard: Who's the major employers? Is it mostly just small individual private dentists hiring these associates? Or is it more Army, Navy, Air Force, any public health service, corporate dentistry? Who's hiring the most of these people?
Rebecca: I don't think you're seeing as many, I think, as many solo practitioners as what we used to see that would pick up an associate. I think you're seeing more groups, you're seeing more corporate, you're seeing a lot of military. A little bit of everything, but I think definitely, students are getting out and are going into some type of group practice situation.
Howard: I remember, I remember when we were in school, you were a pioneer. I mean, you're the generation, we were freshman in '83.
Rebecca: We were freshmen in '83.
Howard: 1983, and now it's 2015. Can you believe that?
Rebecca: We had 120 in our class, we had 20 females.
Howard: And the senior class had one. That's how I remember it. It was funny, because back in the day, they were saying, "Oh, you girls are going to take up all these seats, and then three years after graduation, you're all going to get married and have a baby and we're wasting the University of Missouri's education department, edu-macating some woman who's just going to go home and make five babies." Every one of them girls is still working 28 years later. Would you say, first of all, was that what they were saying back in '87?
Rebecca: Yeah, and you felt somewhat defensive, because I know me and most of my female peers that we were all very driven women, pioneers in a sense because we were definitely the minority. Yeah, I didn't like hearing that, and what I have found to be true after, gosh, almost 30 years, as far as I know, almost all my female counterparts are all practicing full-time still. Most of them as owners of their own practices.
Howard: Of those 20, how many of them married a guy in the class? How many of them married a dentist from our class, or from the dental school?
Rebecca: I can only think of a couple.
Howard: There was that one blond girl who married a guy older, a year or two older, and they went to New Mexico.
Rebecca: Mm-hmm (affirmative). There was, I mean, there was a few. I mean, I would say, I don't know, a handful.
Howard: A handful, but there's only 20 to begin with, so a handful would be 5. It would be 25 percent.
Rebecca: That's right. I would definitely say the majority did not.
Howard: When you went to school, you were the first class where 20 percent of the class was women. What percent of the class, the hundred you're working on now, what percent of the junior/senior class?
Rebecca: I think we're, I mean, we're getting around 50/50.
Howard: What percent of those do you predict will be working 30 years? You think they're the same type of 20 girls like you were?
Rebecca: Absolutely, absolutely. I don't think, yeah, I don't think we're looking at it as a hobby at all. I think we're looking at it as a profession.
Howard: Let me ask you this. The Arizona Dental Association, the executive director Kevin Earle, who I love and adore, and Terry Xelowski, who my president, that's her, Dental Town, that's her husband. They had a conference last month, and it was just billed "Women's Issues in Dentistry." They had three or four women dentists, and all they talked about was women in dentistry. Now you couldn't have a conference, "Issues for Short Fat Bald Dentists."
Rebecca: You could, you could.
Howard: "Issues for Irish Dentist Alcoholics." If I said, there might be issues in women in dentistry, someone would just say, you're an idiot. But if the Arizona Dental Association has a conference just on women's issues in dentistry, I want to ask you, you've been a pioneering woman dentist, you've been a dentist for 30 years. Are there women's issues in dentistry?
Rebecca: I don't know that there are. I think ...
Howard: Has it changed from 30 years ago to today?
Rebecca: I don't think so. I looked at when we graduated, I came out and I know I had, when I came out of dental school, I looked at it that, I was an equal and I was treated equally. I didn't look that I was treated any different because I was a female. I was shocked to talk to female classmates of mine that came out with a different perception.
Howard: What were some of the other, you mean in our class?
Howard: What were some of the other perceptions?
Rebecca: Just that they were treated differently because they were a woman.
Howard: For better or worse?
Rebecca: That they thought, worse. Honestly, I think sometimes that's what you bring to the table. I came to school thinking I was an equal, and anything that did not go my way was not because I was a female. I just didn't bring that to the table. I think today, I think it's the same way. I think the male and female students, I look at them as individuals. I hope as a practicing dentist, a patient comes in and looks at all of us as an individual, not as a gender, necessarily.
Howard: I'm biased towards a gender, myself personally. All my doctors are women. They are. I mean, the men are, they're blah, blah, blah, you don't sense any empathy or sympathy, and my woman doctors, I don't know if it's because I was born and raised with five sisters and have fifty women working for me, but all my ...
Rebecca: Potentially, but there's still going to be women that are going to be hardcore and not very compassionate, and there's going to be men that are going to be extremely compassionate and giving and caring. So the stereotype ...
Howard: It comes down to how you make people feel, not where your genitalia is.
Rebecca: Right. Yeah, I mean, sometimes, if the patient came and said, "I want all my doctors to be women," sometimes, I almost felt like taking a step back, like, okay, what are your expectations?
Rebecca: Yeah, what are you looking for?
Howard: You know, I've been calling it since 1987 that if I was just going to set up a business model, like you're trying to set up a franchise, McDonald's or Marriott or Hertz Rent-a-Car, I'd have it all women dentists. I always thought they had the massive amount ... I mean, I had four babies, now a three-year-old granddaughter, I just would think Mary would be better for my four boys than Frank.
Rebecca: But don't you want them, okay, so you have four boys, but don't you want them to be looked at as individuals. You don't want anybody to have preconceived notions, or not want to see them if whatever they're doing in their profession, just because of their gender.
Howard: Let me ask you a completely sexist question.
Howard: Do you think the women in your dental school class are more likely to like pediatric dentistry than the boys?
Rebecca: That's interesting.
Howard: I mean, I'd rather jump off a three-story building than work on a three-year-old.
Rebecca: Maybe, I mean, I know ...
Howard: It's not overwhelmingly obvious, one way or the other.
Rebecca: Yeah, I mean, I know, I found seeing pediatrics in my private practice was a great practice builder. Would I rather work on an adult than a child? Probably, because most adults were a little bit more predictable, but I saw the children as a way to build the practice, because if mom and dad come to you for their child and they like you, then they may come also. I think it's a good practice builder. Yeah, I mean, maybe we being something a little different to the table.
Howard: Because there are some people saying that they would be leery of being a pediatric dentist right now, because the reason it was such a massively hot specialty is because it was a bunch of male, older, grouchy dentists like me who didn't want to work kids. I mean, we didn't even think about it, we just refer, refer, refer. Now that half of the class is women, there's going to be a lot less referrals to the specialty of pediatric dentistry, and that it might not be as lucrative.
Whenever you start making predictions, I mean, everybody has their own ... Do you think, based on, looking at that dental school class right now, of half women, and looking at when we graduated 30 years ago, do you think there will be less referrals to pediatric dentistry ten years from now?
Rebecca: Yes, but I think there will be less referrals, period. I think more dentists are trying to get trained to do more, because it is more competitive now. I think there will be less, I think because there is a need for pediatric dentists also that I don't think is being served necessarily, I think more general dentists period are going to be seeing more children.
Howard: Obamacare is getting, like the 20 countries with a national health insurance plan, dentistry is covered for 18 and under. Obamacare is now saying that when you sell a medical plan to a family, it has to include dental for the 18-and-under part. That's going to be massive economic upward pressures on pediatrics, so the supply of patients, or the demand of patients is going to really go up.
Rebecca: Right. Well, don't they talk about, I mean, there's not, there's more people that want to go into pediatric dentistry than there are programs. That right there, if you have an interest and you enjoy seeing children, and even if you wanted to specialize, there's not a program available, you can still see children as a general dentist also.
Howard: Well, you don't even have to go to endo school to be an endo. You know, some of the greatest endo, I don't know if they want, called out on this program, but it is Dentistry Uncensored. Who's the guy from Tulsa, Oklahoma, Ben? The guy who started Thermafill, that started it in Tulsa, Oklahoma, Ben Johnson. Back in those days, Ben Johnson is like, he just only wanted to do endo, so he just said practice limited to endo. Everybody to this day thinks he's an endodontist and went to endo school. There was another one, who was the most famous endodontist in Chattanooga, Tennessee, the big, John McSpadden.
I know dentists, I can point to you ten cities that are about maybe 10,000, eight to ten thousand people, where one of the dentists at the study club just said, "You know what? I love endo, and I've seen your root canals fail, and you're always bitching about endo, and we'll just, gentleman's honor, I'll be practice limited to endo, and I will never do a crown, I'm not going to steal your recall." They're endodontists. Some of these kids that can't get into an endo program, I'm like, well, go call every town that has six to eight dentists and find one where all six to eight dentists say, yeah, we all hate endo.
Same thing with pediatric dentistry. You can walk out of school and go into a town of eight where all eight men say, "Oh, my god, I mean, I would pay you." I remember when I opened up, there was a Denture World, and every time someone would do a denture, they'd bring in a coupon, they'd go, "Well, why should I pay $1,000 an arch, $2,000, here's a coupon Denture World, complete denture for $299." I'd say, anyone in this office, drive this grandma to Denture World. I'll call a cab and pay for it. I'll hire a limo to take you to Denture World, before I make you a denture for $299. There's just some things you don't want to do.
I tell kids, and they say, "Well, you should go to endo school to be an endodontist." Dude, everything you learn in endo school is probably going to be extinct in five years. I mean, I've been out 28 years. Are you doing anything that they taught you in dental school?
Howard: I mean, every time I turn around, in fact, I would say this. As I get older and older and older, I'm starting to refer more and more and more because some of those things like bone grafting. Some of that stuff just moves so fast. You can't be completely on top of ortho and implants and bone grafting and endo, I mean, you just, it's just too much information.
Rebecca: Right, but that's something wonderful about general dentistry is that we can pick and choose what we like, don't like. We can try to do lots of things, or we can start picking and choosing what we really enjoy, and that there are people out there that will, that we can refer to.
Howard: Okay, I want you to go, I want you to talk to this dentist out there. Most, all podcasters, they're multitasking, that's why they've exploded. Podcasts, when you watch a DVD or a RedBox movie, you got to sit at home on your couch. That's time intensive. These are all multitasking. Radio is getting crushed by podcasting, because people would just rather listen to their own programming than the local DJ.
There's someone out there, tell them, that's thinking, "I've always wanted to romantically go back to teaching, or I always wanted to try." What are the pitfalls, what's the dark side of leaving your practice and going to teaching? What are the great things?
Howard: Talk about them, because I'm sure you had things that you didn't expect, and things that turned out better than you thought, and things that you didn't see coming that were a pain in the butt.
Rebecca: Well, I said, being a solo practitioner, I'd been chief long enough. I was ready to be an Indian.
Howard: Chief what?
Rebecca: Chief. I'm ready to be an Indian, I don't have to be in charge anymore.
Howard: You were glad to relinquish.
Howard: You were tired of being chief.
Rebecca: Yeah, it's like, let somebody else make some of those decisions. I think because dentistry, everybody kind of had their own way they did everything in their practice, you do have to be able to say, if a school has a protocol, that you will agree to follow that protocol. You may have all these little shortcuts and things that you did in private practice and be able to, you have to have that personality to put that aside. I think students, you know, dentistry is very gray, but you have to teach black and white, because otherwise it's just too confusing for the students.
You have to kind of put your ego aside, and you have to sign onto the school's way of teaching and doing things too. That said, it's very, very enjoyable in that you get up every day and you, I feel like there's, pretty much everybody, the faculty that I work with, there's a spring in our step. We are energized. I think it just makes you realize how much you love dentistry.
I think you go back to school and you become more of a student again. You're trying to make sure you're sharp on all those things that you learned and all the new things coming up, because these schools now are teaching, our students at the end of the second year, when they're coming into the clinic, they're all certified in lasers. They're really on the ball, they're doing a lot of the digital, the CAD/CAM dentistry.
You become, you're challenging yourself, which is kind of energizing, too. You want to be the best that you can be for them. I have found that even now, not being the boss, that if you have a good receptive administration that there's a lot of feedback back and forth, that you really, you get where you want to work harder, not just for the students but also for the administration, too. I think you just have to bring the right mindset, the right personality into it. Rather than thinking when you get to a certain age about, well, when am I going to retire? When am I going to retire? I found that coming into this different environment, I may never retire. I love this, I feel energized.
Howard: I've always thought wanting to retire is a form of depression.
Rebecca: What would you do? And most of us in dentistry, especially we had our own practices, we're so driven. Are we just going to sit on our laurels? No, we're looking for something to challenge us.
Howard: I mean, Mother Theresa would never retire, the Queen of England won't retire. Everybody that has a vocation. I mean, can you imagine Mother Theresa just saying, "Next Tuesday at one o'clock I'm retiring. Screw the poor. I'm going to go drink some beer at the bar." I mean, it just couldn't happen. Is it a Monday through Friday, eight to five job?
Rebecca: It is, so going from my practice, I had my hours down to, Thursday at one o'clock I was done and had this very long weekend. I almost found I was getting bored, the kids are gone. What am I going to do in this long weekend? Now it's Monday through Friday, it's long days, you're on your feet a lot. I'm enjoying every bit of it.
Howard: That is so cool.
Rebecca: Yes, it is, it really is.
Howard: Sometimes you hear the dark side from dentists in all 56 dental schools that they want to go in there and teach, but one of the hard challenging things is politics. Whenever you have a big organization ... I mean, how many total students and bodies and humans.
Rebecca: Oh, my goodness. If we've got, the third-year class is 140 and the fourth-year class is 110, and then there's 30 faculty on the floor, not counting specialists, so there's a lot of bodies, and then that doesn't count assistants and receptionists. I think you just have, it's what you bring to table. I enjoy, especially after being in this little solo practice with my one receptionist and my one assistant and my one hygienist, it's kind of fun to be energized by all the different personalities and change.
I mean, one thing I'm enjoying about this school is that they're always looking, is there some way we can do this better, different? You have to embrace change. It may not work, it may not be the right way, but then you can accept that and change to something different.
Howard: I wanted to ask you this. In a dental office overhead, labor is the biggest cost. Then it's about eight to twelve percent lab, and five to six percent supplies. How does a dental school pick supplies, or labs? If I'm going to send this crown to the lab, do I have to use, do you have an in-house lab? Do I got to use commercial labs? What about supplies, what do you do ...
Rebecca: Don't they say, that's above my pay grade?
Howard: To answer that question?
Rebecca: Yeah. Well, no, I think you, it's basically a giant private practice, if you can look in those terms. Whoever is making those decisions, I'm sure are looking at ...
Howard: I mean, does the school just use one lab?
Rebecca: No, we have multiple, we have choices in labs to use.
Howard: Do you have your own in-house lab?
Rebecca: In-house lab ...
Howard: Not really.
Rebecca: We have a lab person that's more the coordinator between the students, the faculty and then the outside labs that we use.
Howard: So you have a short list of labs.
Rebecca: That we use.
Howard: Are most of them in the Phoenix Valley, or some mail-order ...
Rebecca: No, they're all local labs.
Howard: They're all local labs? Can I get that list?
Rebecca: That you want to use those labs?
Howard: Yeah, because I got a dental office now. I'd be very interested in what, because I'm picking my labs with three of us, it's the best decision ... No, it won't be public, I won't put it on [inaudible 45:07]. For a couple of labs to make a whole dental school happy, that's probably some major scrutiny.
Rebecca: Well, I think there's like maybe four labs that we use, and I think two are larger labs, two are a little bit smaller labs, too. Then we do have a lab tech that can do repairs, if we need.
Howard: What if, how does a dentist, what do you say to a dentist if this guy wants to use 3M and this one wants Ivoclar and this one wants [inaudible 45:29].
Rebecca: No, because again, you're, when you're hired, you are signing on to that I'm going to, there is, there's committees, if there's products that we really liked in private practice, or something new that we can present to a materials committee, who makes that decision, it's not an individual necessarily. You do kind of sign onto that it's different than private practice, that you're not making those decisions, they're, they do ...
Howard: It's not like, you were good with it. You were tired of making all the decisions. Your time just to relax a little.
Rebecca: I feel like I have a voice. I feel like I have a voice, yeah.
Howard: Don't you think when people sit there and say, you know, I couldn't stand the politics in this school? It's probably more them than the school. Because that's just life in general.
Rebecca: It's life in general. I kind of enjoy it. It's like, oh, this is, it's not boring, it's fun.
Howard: I only remember you four years at dental school just being sweet and adorable and nice and pleasant. I don't ever remember you grouchy or moody or mad.
Rebecca: Okay, well, that's good.
Howard: I don't. I don't have one single memory of you ...
Rebecca: I don't remember you grouchy.
Howard: Well, I was stoned.
Rebecca: You were stoned all the time.
Howard: I'm just kidding, I'm just kidding. Actually, we weren't stoned because back then no one had the money for that stuff. It was so damn expensive. You know what I mean?
Rebecca: I mean, we were scrappy, we were poor dental students definitely. We were very poor.
Howard: We were all poor, in fact, we only drank, we didn't even drink Budweiser. We drank Wiedemann's. That was the local, remember that little Wiedemann beer?
Rebecca: Was it Red Birds? Red Birds we would all go to, which I think now is some little Mexican restaurant. It was this dive bar and grill.
Howard: We were so poor, we only drank this local brewery would make these beers, and oh, my god, yeah. I used to love dental school. I just can't believe, I'm walking in dental school, I thought, oh, my god, four years seems so long. Now it was 30 years ago.
Rebecca: I know.
Howard: When people are telling me, they're walking in freshmen, I just can't believe it's going to be four years, I'm like, well, don't look at it as four years. It's four years, you're going to be having fun and meeting people and doing fun things and making friends.
Rebecca: Oh, yeah.
Howard: Don't look at it as like a four year block. I don't want to come back to the woman issue, because I think that's unfair, that since you're a woman, it's a woman issue.
Rebecca: That's okay.
Howard: I get this e-mail a lot, and I've probably answered it too many times on my podcast, but I don't get a ... One of my biggest complaints on the podcast is that, Howard, when you interview a man, it's always a dentist. When you interview a woman, it's always a consultant or a hygienist. I've had that complaint so many times, so I'm very, very sensitive to having, you know, I tell my editorial team, we can't have ten articles in Dental Town, they're all written by males. You just can't do that. If the planet is half blue and half red, you got to mix up.
Rebecca: Do you find that women dentists are not contributing enough to that?
Howard: Well, it's, yeah, it's a numbers game. I mean, if you go back, if you're 50 to 70, that's only maybe eight, nine, ten percent women, so 90 percent of the people saying, "I want to be interviewed," 90 percent are going to be men. Right now, though, waiting list for a man to be interviewed on my podcast is three months, but a woman, just tell me when.
Rebecca: I'm here, I'm available.
Howard: Here's a question I always get, and I'm sorry if I repeat myself to my listeners on the podcast, but I get this question all the time, and it's not just me. Linda Miles says she gets the same question, Sally McKenzie, Sandy Pardue, all the dental consultants get this question. Young girl goes in, she's 25 years old, she goes and gets an associate job for a doctor, old, fat, bald guy. He just says to the woman, go do this, go do that, go do that. They all jump. He's affable male. She buys the practice from him for $400,000, and as soon as he walks out the door, she says the same damn thing, and they all look at her like, "Are you kidding me?"
They say that when men say, do this, do that, they just do it, but when the woman comes in and says that, it doesn't happen that way. I can't [perceive 49:40] it, because number one, I've always believed this. I've always believed when you're in an organization, the people that are the nicest to you, and always get up and be real friendly, you got to leery about the most, because maybe they're being really nice to you because when you leave, you're Attila the Hun. You know what I mean? I don't know what it'd be like [inaudible 49:57].
Rebecca: I just, I guess I'd never found that to be a problem. I think it's kind of what you bring to the table. If it was all at once, I'm the boss, and I'm going to start ordering, well, of course everybody is going to take a step back. I think you have to prove yourself. I always found with my staff that I wanted to lead by example, so there was not a task or a job, we were one team, we were all working towards that same end. If they saw that I didn't mind cleaning a room, then they're going to do that much. I think I made it so that they wanted to work for me also.
Howard: I want to ask you this question. Some men theorize that there was easy lines of distinction between the man and his staff, because being a man, you're not going to go to Happy Hour with an individual, you're not going to go to lunch with an individual, you're not, because of other social pressures, you're not going to get too close to them. That maybe what the problem is with some woman dentists is that they're going to Happy Hour with them, they're going to bowling, they're going to concert, they're getting too close.
Rebecca: I agree with you, because I always, when I sold my practice, I told them I could be their friend then. I had staff that were with me 25 years, I didn't have a lot of turnover, but I did have to draw that line in that I didn't get into personal conversations, I didn't want to know all the troubles that were going on at home, they weren't my ... I had to be the employer. I did not go to Happy Hours, I did not, I had, the natural tendency when you get a group of women together is for everybody to be best friends, but I had to consciously draw that line and not cross it. Maybe that's why I didn't have the problems, you know.
Howard: I believe Abraham Maslow, one of the greatest anthropologists of all time, sociologist, who wrote the pinnacle needs, the basic needs, food, shelter, and then self-esteem and self-actualization and all that. He said that you can't be friends with your employees, because you can fire these people, you can turn their life upside-down. If you get close enough to someone where they think, well, you're not my coach, you can't fire me. Imagine, you got fifty football players out there and he says, "Okay, everybody run bleachers," and a player is like, "You know my wife is pregnant, you know I've been up all night for three nights, you know I'm tired."
Go into more detail, because a lot of the young women, I want you to go into more detail about how you can respect, R-E-S-P-E-C-T, Aretha Franklin, but you cannot get too close and be their friend because once they realize you're their friend and you might not fire their butt when you told them, you'll be here on time. So go into more detail about that.
Rebecca: Well, I just think you have to consciously always be somewhat on guard, in that, you know, to step away if a conversation gets a little too personal about things that are going on, that you always have to remind yourself that you are the employer.
Howard: You don't want to hear about problems with their husband or babies.
Rebecca: No, no. I always ...
Howard: I think some young kids, some young managers under 30 might think, well, then I'm not showing empathy or compassion or care. How do you frame that in your mind?
Rebecca: I think you can mix that, because I think I always tried to be understanding but also kind of just kind of in a sense cut it off, in a sense that let the office be a way to get away from it, and try to forget about it for a few hours.
Howard: Yeah, a regular vacation.
Rebecca: I didn't want my office staff to have any drama in that when they left the office that they could leave the office, and then they could go back and only think about home, that there was just a line both ways with it, too.
Howard: Then the uncomfortable question that you probably don't want to hear, money. Were you making more in private practice, more in education? If someone is listening to you, it's like, how big of a pay cut do I, how big of pay cut do I take to go back to becoming a teacher? Are you almost like a volunteer charity?
Rebecca: I hate to be ...
Howard: Because sometimes you hear teachers complain, if I'd had my own practice, I could have just done one crown today and came out ahead.
Rebecca: I think I was fortunate enough to be successful enough in private practice that it allowed me to have these options available.
Howard: That means you got a pay cut.
Rebecca: That means I got a pay cut, yeah.
Howard: That was the politically correct ...
Rebecca: But I think it's nice not to have the burden of, okay, I could retire if I wanted to, but I don't want to. I'm not making the decision to teach or to have a career change because of the financial aspect. Was that politically correct?
Howard: You're basically Monday through Friday, eight to five. What's the school year? High school, you got three months' vacation. Is it a trimester program? Or a semester?
Rebecca: Well, it's, I mean, we have quarters, four quarters, but we are full-time faculty, so we, when the students, like right now, the students are on break, which is why I was able to come and talk to you. We have vacation days, they're very generous with us as far as continuing education. It's nice not to have the burden, that when you're there, whether it's a nine to five job or whatever, but when you leave, you've left it. I remember just every time my phone would ring that I didn't recognize the number, it'd be like, oh, it's a patient, it's a patient calling.
We do, we rotate having on-call, but when you have on-call for the school, you have your week, and then the rest of the time, you don't have to worry about that, that you can really leave it and really forget about it, which is nice after all those years of potentially having the temporary off or the toothache or whatever, too.
Howard: I think what I'm sensing in you is that you're happy, you're, I can just read the happiness and karma, you're just having fun, purpose, passion [crosstalk 56:48].
Rebecca: Yeah, and I would encourage other dentists, if they're of our age, seasoned, seasoned dentists, it's a good career choice later on, just to consider it, too.
Howard: Yeah. Well, and remember that challenge, what was that challenge, the ice bucket challenge?
Howard: What were they raising money for, I forgot why I [crosstalk 57:08].
Rebecca: That was M.S., wasn't it?
Howard: Was it M.S.? God, I had to do it like five times. Who's, the ice bucket challenge, I want to do some more of the women in our class. Who should I do next?
Rebecca: All right, who should we challenge?
Howard: Yeah, who should we challenge?
Rebecca: Let's challenge [Deedee Barons 57:26], Kansas City, Kansas.
Howard: Really? Right on.
Rebecca: Let's challenge Lori Englemann, Leawood, Kansas.
Howard: I love Lori so much, because she was a classy woman, she also married a short, fat, bald guy.
Rebecca: We all like our bald guys.
Howard: We all like our bald guys. So Deedee Barons and Lori Englemann.
Rebecca: Let's challenge them.
Howard: All right. Deedee, Lori, and I want to, you know who I want to podcast someday is Stephanie Carmana.
Rebecca: And Stephanie, okay.
Howard: Or is it Stephanie Van Dyne? What was her married name, maiden name? Van Dyne or Carmana?
Rebecca: She's Van Dyne.
Howard: She's Van Dyne?
Rebecca: She's Van Dyne.
Howard: That woman turned out to be the implant surgeon guru, I mean, she's amazing. She really ...
Rebecca: She's outside of Kansas City, also.
Howard: She just dove, man, she dove into implants. Well, hey, I really, really appreciate you coming down here.
Rebecca: It's been fun.
Howard: I love that school. You guys brought me in there a while back to lecture, I think it was after school, it was like an evening deal.
Rebecca: Yeah, it was in the evening, it was a student [crosstalk 58:28]. I tell all my students, you will forever have a bond with your classmates, that you went through this program in the same time and the same place, and you'll forever have the bond and be friends. I think that's really neat, too. I still have my yearbooks, I still have my yearbooks.
Howard: Yeah, I mean, every one of them, I feel like, is a brother or a sibling.
Rebecca: Yeah, it is.
Howard: Over the years, they just drop by your house. They'll call you up and say, "Oh, I'm going to be in town, can I stay at your place?" It's like, Dude, you don't have to call me. If I'm out of town, I'll leave you a key. Thanks for all you do, it was amazing going through school with you for four years.
Rebecca: Thank you.
Howard: Congratulations on your amazing career. If you ever need anything at Midwestern or whatever, just let me know.
Rebecca: Okay, great.
Howard: All right, thank you very much.
Rebecca: Thank you, thank you.