Listen on iTunes
Watch Video here
VIDEO - DUwHF #889 - Jeffrey Hoos
Stream Audio here
AUDIO - DUwHF #889 - Jeffrey Hoos
Dr Jeffrey Hoos, opened his private practice in 1979, with one dental chair and a baby that came one week later. Today 38 years later, the Brush & Floss Dental Center has 4 partners and a staff of 25. The office is open 6 days a week and 4 evenings a week. The mission statement of the office: Provide the highest quality care, for the greatest number of patients, and at the same time maintaining a balance between personal and professional lives.
Dr Jeffrey Hoos has an educational goal of: Provide dental education for professionals that will enhance their professional lives, provide information that will allow them to provide a higher quality care for their patients. Balancing: the Art, Science, & Business of Dentistry.
Howard: It is just a huge honor for me to be podcast interviewing Dr. Matthew Lee all the way from the North Pole. I kid you not. He is a practicing general dentist and Captain in the U.S. Air Force, currently stationed at Eielson Air Force Base in the heart of Alaska. He graduated in 2014 from the University of Oklahoma College of Dentistry and completed a one year AEGD at the U.S. Air Force Academy in Colorado Springs in the summer of 2015. He is one of four general dentists serving at Eielson Air Force Base and enjoys all aspects of dentistry and loves to learn more ways to make dentistry more efficient and enjoyable.
His family consists of an awesome wife and a great dog. When he's not doing dentistry he enjoys listening to podcasts, reading, working out and making life more fun. The reason I wanted to get you on the show is because they don't want to hear a bunch of grandpas everyday talking, they -- I am utterly amazed at how many of our viewers are still in dental school, even at D1. I keep asking people to shoot me an email: email@example.com, tell me your age, where you're at. I can't believe people in D1 are consuming podcasts fresh from dental school. And a lot of people complain about getting out of dental school with so much debt. But on your Air Force journey, how was your student loan indebtedness?
Matthew: So the way it worked for me was that I applied for a scholarship called the HPSP, it stands for Health Profession Scholarship Program. I applied for that before dental school even started. I was accepted, fortunately, to a four-year scholarship, which meant the Air Force was going to pay for all four years of dental school. So what happened was, during dental school when I got a bill, it went to the Air Force and the Air Force paid for it, so I didn't see any of them. The only costs I had were part of the cost for my scrubs and I think there was something else at some point, I don't remember. But I graduated dental school with zero debt. They actually pay you while you're in dental school, so they pay you a stipend. It's about twenty-five thousand a year right now, divided up into 12 months. So living in Oklahoma, the cost of living was dirt cheap and so I actually saved a decent chunk of that during dental school. So I actually came out of dental school with cash in my pocket and zero dental school debt and just owed the Air Force a few years of my time, which I'm paying back right now and it's a lot of fun. So it's worked out great. I'm super, super excited about it.
Howard: Did they buy your dog?
Matthew: They did not buy my dog because she was from a farm. But I had the money from my stipend to buy my dog, so it worked.
Howard: Now is this something you have to do before dental school starts? What if you were listening to this show right now and you're a freshman or sophomore, can you pick it up on the tail end?
Matthew: So there are two main ways this is done. So there are fewer four-year scholarships, and that would have to be before dental school. So, I always tell people, "When you're thinking about dental school, start thinking about this too." If you want all four years paid for. What's more common is that you get into your first year of dental school and the bills start coming and you go, "Man this sucks." And there are three year scholarships available. So there is an opportunity for those that are freshmen at dental school, especially right at the beginning, because you do have to kind of catch this pretty quick for those that might be in their first semester or whatever. To contact a recruiter and get a three-year scholarship, so they can get their last three years of dental school paid for. And the catch is that then you only have to serve for three years rather than four. So there are definitely some benefits even to doing that. Those are a little bit easier to get and there are more of those three years available versus the four years.
Howard: And so four years isn't that long. Most people work at a clinic or corporate dentistry as an associate for four years.
Matthew: Right. And I'm in an interesting situation because I never had the debt to be able to appreciate not having the debt now. But looking at people that are working corporate or working associates or whatever that have -- they've been working for seven or eight years and they're still working to pay off their loans. They're sort of balancing, "How much money do I spend on myself or my family versus how much do I pay off on this debt?" And for me it doesn't -- 100 percent of the debt is gone and so I can 100 percent focus on the dentistry at this point. And so yeah, four years it -- it seemed like a long time and now that I'm about halfway through it, it's like: I can't believe I'm halfway through it. And I'm already thinking about what am I going to do when my Air Force contract is up? Am I going to stay in the Air Force, am I going to get out? That kind of thing. So it goes by quick and it's nice to just not have that burden at all. It's really, really nice.
Howard: Millennials have a high corporate turnover. Business Insider just had an article the other day where even at these major companies like Facebook and Google and Amazon and eBay, their average millennial only stays two years, the turnover is very high. But the general dentists that we've studied, they actually can attract and retain their associates to stay longer. Usually it's because the associate feels they are learning more about dentistry, they're in maybe some implant program or some orthodontic Invisalign program. Do you feel like you're getting a lot of continuing education in the Air Force?
Matthew: The classic answer: yes and no. So coming right out of dental school, the Air Force in particular -- the other branches are a little bit different -- The Air Force in particular really pushes all of their graduates to do a one year AEGD. And most of them do. And they have tons of spots for them. You do have to apply to it just like any other program. But I did one and that's what most Air Force dentists will end up doing. That one year AEGD was -- to have that for free, and then you're getting paid as a captain during that time. So you're getting normal: "I'm a dentist/Air Force pay" during your AEGD and it's a really, really great education. You're with specialists all the time, you're learning all this stuff that -- in dental school you knew enough about to not hurt anybody, now you're learning it well enough to do a good job. I remember coming out of dental school I thought root canals were the craziest thing ever. And I was just not that interested in them. And then during my residency I had a really, really great endodontist. And now I can't believe I'm saying this: I enjoy doing root canals when there's one on my schedule. It's more fun than, "Oh no, that's terrifying.” Because you learn new techniques, you learn different approaches. You learn from an endodontist one on one, so the AEGD is great. As far as continuing education goes, beyond that unfortunately it's a little dictated by where you are geographically. It's tough up here in Alaska to find a ton of stuff close. And the Air Force doesn't always pay to send people places. But we just had a federal dental services meeting in Anchorage last month. And so it's only a six-hour drive. So we drove down to Anchorage and did that. So there are opportunities, definitely. But as far as the Air Force goes, they push the AEGD and then you’re kind of on your own for CE. But they do have online stuff you can take through the military and different little courses and things like that.
Howard: One time when I was in Anchorage -- I went out with my dad and my brother Paul and we flew into Anchorage -- we drove down to Kenai Peninsula and went salmon fishing for a couple days, then went down to Homer, went halibut fishing for days. But we decided we were going to go up to Fairbanks and see if we can get a glimpse of what is it, Mount -- what's the tallest mountain? Denali?
Matthew: Denali. Yeah, it's halfway between Anchorage and Fairbanks. If you're making that drive you'll see it if it's a clear day.
Howard: What did they used to call Denali?
Matthew: Mount McKinley. So the history behind it is that the state of Alaska has always called it Denali. And then, I want to say it was in the '50s or something, the federal government started calling it Mount McKinley because it was sort of this political thing about somebody that was running for an office at some point, and so somebody had kind of named this mountain Mount McKinley and it stuck on a federal level. And then Obama came, I think it was like two years ago or a year ago -- two years ago -- said, "Hey, on a federal level, we're going to start recognizing it as Denali again." And so it's really funny, around here we have things that are like Denali bank and then we have Mount McKinley bank and so all our maps are changed now and stuff, so --
Howard: But before we left, we still had three days to kill. So we did something that most Alaskans have never done. And that is, we drove the oil pipeline access road all the way to Prudhoe Bay.
Matthew: Did you really? That's insane
Howard: It was a private road. We were eating breakfast at a diner and we said, "Well we want to drive up and see the Arctic Ocean." They go, "You can't, because there's only one road and it's a private road and there's no trespassing." And I said, "So if we do, we'll get arrested? Or what would happen?" And he said, "Well I guarantee you won't get arrested, there's not one single sheriff or anything on that road." He goes, "Just make sure you got a lot of extra gas and tires." So we went to Wal-Mart and bought five gallon deals for extra gas and four tires. We got all the way down that alley and they were just laughing at us, they could not believe we were so stupid we did it. There's nothing up there. There's no hotels, fast food restaurants, it's an oil camp. And we said, "Damn what are we going to do?" And they took us in. We showered, shaved, we ate at the mess hall. It was a blast and the only thing we saw in the Arctic Ocean was this white sheet of ice. We didn't see water.
Matthew: What time of year was it that you went, do you remember?
Howard: It was in June, in the king salmon run.
Matthew: Okay, yeah, I've heard -- I haven't looked into that much but I've heard basically if you want to go to Prudhoe Bay, you've got to fly. Like you've got to fly in. But it sounds like surely there is a way to get there on the ground.
Howard: There is a road right next to the pipeline, the access road. And it's a private road. What is it? British Petroleum? Is it BP?
Matthew: Great question. I don't know.
Howard: I think it was British Petroleum at the time or whatever. But man, it was the coolest thing I'd ever seen. Once we went over Brooks mountain range, it was the first time in my life I seriously felt like I was on a different planet.
Matthew: Yes. Oh, that's so funny. I always tell people when they ask what it's like in the winter here, I say, "It's like you're living on a different planet. You get three hours of sunlight and it's negative 30. And frost is covering everything and there's no wind. It's like you're living on a planet you've never been to before. It's the most bizarre place ever to live." And in the summer, it's completely opposite. The sun doesn't go down. It's beautiful. Everything starts growing and exploding again because there's sunlight everywhere. It's like living in two different places at once. It's crazy.
Howard: What is the mission of the Eielson Air Force Base?
Matthew: So first of all, I have to have a slight disclaimer when we traverse into Air Force territory that anything that I say is my opinion and not an official position strategy or endorsement of the U.S. government Department of Defense or the U.S. Air Force. So now that that's out of the way, this is all public information that I'll let you know, and anything that's more secretive I don't really know that much because I'm a dentist, but I'll let you know what I do know. So the mission of Eielson Air Force Base, currently it's actually a training base. And so our pilots -- it's called the Aggressor Squadron. And so the goal of Eielson Air Force Base is to bring other nations to our base and help them train against our pilots to fight our common enemies. So our pilots basically study tactics of China, Russia, those kinds of countries, and they are trying to mimic their tactics in order to help train our allies to fight them mutually. So our planes have these cool black and gray paint schemes and different things and you can go on the Eielson website and take a look at the different paint schemes that they have and stuff. It's really, really cool. It's a very interesting mission because we're like the fake bad guys up in Eielson. It's because we have a massive air space up here and so it's perfect for training. So any day of the week you can be driving home and F16s are taking off and then you'll see planes from Japan or whatever and they're flying around the sky, and you walk out to lunch and like five or six of them will take off in a row and stuff. So it's pretty neat. We do have a National Guard unit here that has some refueling planes and stuff. So you hear those take off every once in a while.
Howard: Then what is your patient base like? I assume it's mostly young guys? Mostly guys, young?
Matthew: Yeah that would be the summary of it. I mean, we do see females obviously, there's plenty of females in the Air Force now too.
Howard: What percent is it female?
Matthew: I would say probably 40 percent, maybe 60 percent male.
Howard: Wow. I had no idea it was up to 40.
Matthew: And that's just a rough estimate, me thinking off the top of my head. But I can think of -- when we do wisdom tooth extractions up here most of my patients are male but plenty of them are female. Yeah, because they've got females in all the different career fields and everything .
Howard: So what would standard deviation one be? Your 68.5%. Would it be humans between like what, 22 and 40? Or what would it be? I'm trying to get a feel for what kind of dental cases are you getting.
Matthew: So if I had to give you an average patient it would probably be a 22-year-old male. That's kind of what we see most of because we get those people that have been in a few years, kind of younger coming into the Air Force, because as people age they either get out or decide to do something else. So most of the people in the Air Force are kind of that younger, that 20 range. But we've got patients in their 40s and 50s. We still see the National Guard patients and they tend to be older. But typically we're seeing a lot of times like 17, 18 year olds right out of tech school. I've had to talk to patients before about, "Hey, let's talk about brushing your teeth." A lot of them come from families that just didn't emphasize this stuff. And so for a lot of these folks, the military was kind of like their way to go experience the world and go get out of their town or whatever. And they want to work hard and they want to do the right thing, and so it's talking to them about oral hygiene and different things like that.Some of them come in and are they're fairly intelligent and they've got it all together and that kind of thing, but we definitely see a good mix of patients. Most of our patients are healthy. That's a big thing because it is the Air Force so our medical histories are usually pretty short. Maybe one or two meds, but most patients probably aren't taking anything. And so that helps a lot because we do a lot of I.V. sedation. So very uncomplicated cases typically, as far as medical histories go.
Howard: I think the most profound thing about Singapore and Tokyo: Singapore's fluoridated water, Tokyo is not. And they've had the exact same decrease of disease, missing and filled teeth. And when I was lecturing in both of those cities and podcasting dentists there, they said it's home care. If you teach your children home care, the diseased, missing and filled teeth go down. And if you're drinking Mountain Dew and not brushing your teeth, it doesn't matter if there's fluoride in the water.
Matthew: Exactly. And that's a huge emphasis we have in the military, because these people are working weird shifts and difficult jobs and they're around people that are doing the same thing, and so energy drinks are massive. I mean, any time I see cavities, even just one on a guy I'm like, "So, what are you drinking.?" And it's always Red Bull or Mountain Dew or whatever. Something liquid with caffeine in it.
Howard: I've never tried a Red Bull because I read one time that something like 50 Americans die each year drinking those high-energy drinks and they're usually guys my age. I'm 55. How old are you, 29?
Matthew: I'm 29, yeah.
Howard: So your heart could probably take three red bulls but I'm not going to risk mine.
Matthew: Do you drink caffeine at all?
Howard: Yeah, I drink coffee in the morning.
Matthew: Okay yeah. Red Bull, Rockstar, that's the drink of choice in the Air Force right now.
Howard: And I notice all the UFC fights are promoted with Monster, that M green.
Matthew: Yeah that one too.
Howard: So I assume you're doing mostly wisdom tooth removal and cap fillings.
Matthew: Yeah that's a lot of what it is. We do get crowns as well from time to time. But a lot of it is simple, like class one class two, and then guys come in and they need their wisdom teeth taken out and they're 19 years old and they've got a couple impacted teeth here and there or whatever; they're having pain or they just need to come out for whatever reason.
So there's four of us at Eielson. One of them is the commander, so they don't see as many patients. But the other three of us, typically we do two wisdom teeth cases per week. Each of us do, so one guy's got Tuesday morning and he does two cases, I've got Wednesday morning and I do two cases. I.V. sedation.
Howard: What percent I.V. sedation?
Matthew: Of the wisdom teeth cases?
Matthew: 95 at least. I mean, it's pretty common. So in the one year residency the Air Force is huge on I.V. sedation. Basically everybody gets it because our patients are so healthy. And so it usually doesn't become that much of an issue, medical history wise, so we sedate just about anybody who wants it.
Howard: You know, that's a rock-solid point you talk about. There's only three publicly traded dental corporations on earth that I've been able to find and their lawyers won't let them do I.V. sedation on any humans under 13 or over 65 because that's pretty much all the trouble. And you just said it exactly, the Air Force is not afraid of this because you're working on males, sapiens, that are 22 years old with a short health history. But man, when you start getting -- it seems like every three months somebody is posting an article on Dental Town about some 2, 3-year-old kid that didn't survive sedation. And then I also read another report recently that if you're over 75 and you have sedation, that you will always have permanent neurological effects from the sedation.
Matthew: Is that based on the particular medications that they're giving, or what was that? Do you remember?
Howard: Basically it was just saying that when you have an old ape and when you turn the brain off a 75-year-old, it doesn't turn back on completely. And it was an interesting study. That is one of the things I've never done because I've always been scared of it. Seems like in Phoenix, out here it seems like every other year somebody is put down, doesn't come up, it's all over the newspaper. And then I've met dentists -- I've lectured a lot -- I've met dentists that lost a patient and ruined their whole psyche. They didn't smile about their career anymore, it's just such a -- So what's the protocol of the sedation you guys use?
Matthew: So we use Dexamethasone as our steroid. We use Fentanyl as well and then we use Versed. So we're inside of a medical clinic and we just put the prescriptions in like normal prescriptions and walk down the hallway and they hand us our vials. We draw them up and then that's how we do our sedations. Usually I'll give the Dexamethasone and the Fentanyl and then kind of get everything gowned up and then start giving them the Versed. The nice thing about I.V. sedation is -- I got a guy the other day, kind of a bigger dude and typically it takes a little more to knock them out. And I had given him three -- we've got ten in our vial to give -- so three milligrams, and he was like out already and I was like, "Okay I guess I'm done." And started the surgery. And then you get little females that you're like, "Oh, this will knock them straight out.” And you give them five and they're still talking to you. So you do have that ability to give more or less and titrate that effect, and then whatever is left over we just dump in the sink and then we both have to verify and sign that we wasted what we thought we wasted and that kind of thing. So it's pretty controlled and our patients are nice and healthy. So it's usually pretty easy.
Howard: So what about on your -- let's switch over to operative, restorative dentistry. Are you guys doing amalgam or composite?
Matthew: I do 98 percent composite, actually. And that's one thing that -- there's a little bit of a misconception that in the military you're slinging amalgam all the time, and part of that is due to your leadership at your base or whatever, but with us being a pretty small clinic we all kind of get to do the dentistry we want to do, sort of. So we have a great composite that we use and I like it a lot. So that's what I use for a majority of my cases. We've got another guy who's probably 50/50 composite amalgam and then another guy that's like me who's probably 98 percent composite. But there are definitely indications for amalgam and we'll use it when we need to.
Howard: What is your composite protocol? What did you turn out liking?
Matthew: So we use Tetric EvoCeram Bulk Fill. It was actually introduced a couple of years ago by a guy who was at our clinic and he brought it in and really liked it. It's pretty translucent so we get a really good cure depth on it. It's got really good hardness and the shrinkage is very minimal. So it kind of met all the criteria of a good long term, bulk fill, stable composite. We've had a really, really good luck with it. It blends well with the surrounding tooth structure and stuff too. So we like it for posteriors and then we use Filtek Supreme for anterior stuff.
Howard: So you use 3M ESPE Filtek supreme on the anterior, then Ivoclar Tetric EvoCeram Bulk Fill on the posterior.
Matthew: That's it. Yep. And that's an Eielson thing. So I was surprised when I got into the air force that I thought I was going to show up and they were going to be like: every Air Force clinic uses this composite, here you go. And we use this, so here you go. But there are a lot more local decisions than I thought, as far as the clinic goes. Like saying, "Hey, can we try this product." Or, "I really like this wedge system," or whatever it is and based on the budget we can order that stuff for people and try different products and kind of tailor what we want to -- what the providers want and stuff like that. So it's interesting, there's a little more ability to be flexible on a local level than I expected when I got in. So that's kind of nice.
Howard: I've always thought one of the most interesting things about the Air Force is that you guys have probably one of the greatest dental research facilities that does research on all these materials. Are you familiar with that site?
Matthew: Yeah, I think it's called DECS. I think that might be what you're talking about?
Howard: It's called DECS?
Matthew: That's an acronym and I don't know what it stands for.
Howard: Dental evaluation and consulting service.
Matthew: There you go. And we have access to that on our military side and a lot of that stuff is public as well. They make product recommendations for us and they'll try to survey new products and come up with good information so we can make better decisions on a local level, as far as what we want to use and stuff like that. So we use that from time to time when we're looking at different products and stuff.
Howard: So have you ever met any of their evaluators or do you know anything about how they operate? Like how many people they have on their team?
Matthew: I don't. That's the short and the long answer.
Howard: How many dentists work for the Air Force?
Matthew: I believe at last count it was about a thousand and that also includes people that may not even be clinical anymore. Because once you kind of get higher rank, and maybe you're on an administrative route and you do more leadership type stuff and so maybe you're commanding a squadron and you don't really see patients that much. I believe it's about a thousand now across the world.
Howard: I'm on the website. There's like nine people on the team and everybody in dentistry, they talk about these little research things from universities that might have a very small clinical sample size, then here's nine people for the Air Force trying to make good information available to their 1000 dentists around the world. But typical military or government, they're after the hard-core research, not the marketing and advertising of their website. They're not into self-promoting themselves on Facebook and Twitter and all that. But man, if you could shoot them an e-mail -- and here, I'll shoot you the site. But yeah, they got so much amazing information. And one other thing I want to harp it on you, is they're still showing that amalgams last 38 years and composites last half that amount of time, so I assumed that maybe they're giving you the freedom, even though the research people are saying, "Dude the amalgam lasts longer than composite." But what is your thoughts on all that?
Matthew: Well I think a lot of it depends on the user, because the amalgams that I see fail are, at least in my limited Air Force practice, it seems to be two things. It's either the tooth was under-prepped or recurrent caries. I did a crown on a guy the other day who had an amalgam and the darn thing just broke. When you go to prep it out you realize that it was just very, very shallow in that one spot and then it kind of transitioned into that occlusal area and that's right where it cracked and then recurrent caries. That's where they're fracturing, is that transition on like an M.O. where it transitions from mesial to occlusal, where there may be caries on the mesial and the occlusal and that little transition didn't have any, so they prepped it shallow or whatever. Or doing slot preps with amalgams and they just don't hold because you're relying on mechanical retention, but you're also trying to preserve tooth structure at the same time and you can't really play both games with amalgam. But then I've seen amalgams on guys that are -- the whole tooth is amalgam and it's been there for, like you said, 20, 30 years. So when it's done right, it's great and in a way, it's less technique sensitive than composite as far as moisture control goes. But as far as your prep goes, it's not the same prep as composite. And I think it's easy to forget that as we do more composite and then we go back, when we need amalgam that couple of times to remember like, "Okay, I've got to have a certain thickness or this thing is going to break. I got to have mechanical retention because I'm not bonding it in." And that kind of thing. But we see really successful amalgams and we see amalgams that break after two years.
Howard: You know, the composite. When you mentioned your Tetric EvoCeram Bulk Fill, you said that the shrinkage was minimum. So that makes it good, whereas amalgam, it's corrosion, expansion, the seal is incredible. But I think most people on Dental Town forget when they're talking about how long this is going to last is: that tooth is attached to a human. And just like we said earlier about Singapore versus Tokyo, home care is everything.
Matthew: Yeah. Well that's one reason that the Air Force likes amalgam is because it is a little more conducive to maybe that less than adequate home care like we were talking about earlier, energy drinks. We actually have a program in place that if someone is in the high caries risk category, and we have our own Air Force way to screen that, it's advised that we don't do any fixed work on them until they have had all of their restorations completed and we know for sure the disease has been under control for at least three to six months, and then we can do a crown.
The treatment of choice if they need a cuspal coverage is a cuspal coverage amalgam, which if you did that on the civilian side it would kill your practice. You can't make any money doing giant amalgams. But in the Air Force we can because that's not the goal. The goal is to stabilize these teeth and make sure that we don't waste the taxpayer’s money. So you do a giant amalgam, you bring them back in six months and go, "Okay things look good, we can cut this out and do a crown." Or leave the amalgam until it fails or whatever it is. So it definitely has a place, especially in the Air Force when we are trying to be cognizant of not wasting the taxpayer’s money.
Howard: So it's four dentists, how many? Four dentists total at your air force base? What's the size of the patient population?
Matthew: I believe it's about two to three thousand patients, maybe slightly less than that. I believe it's around 2000, because one of our dentists doesn't practice full time. She's -- just because there's so many meetings and stuff that you've got to go to and she's kind of the administrative person, but she is a dentist and then the three of us, we practice pretty much full time.
Howard: So what about the work life balance? What is your schedule and emergencies or weekends? Or what's the work life balance for you, the wife and the dog?
Matthew: It's pretty good. So the on-call schedule works -- currently one of us is on call all the time. And so with four of us, basically one week a month, but we almost never get called. I haven't gotten called in a year. Just because our population is pretty tiny. And we do have an emergency room up the way at Fort Wainwright which is an Army base in Fairbanks. So if patients have a true emergency they can go there. Basically when the days done you can go home and it's kind of nice. Our hours right now are 7:30 to 4:30, Monday through Friday. Wednesdays, we do some training type stuff. But basically when it's over you go home and you're done. We get all the federal holidays. Usually we get an extra day tacked onto the federal holiday. So like today we got Labor Day coming up and I'm off today. So Labor Day is not till Monday but we have the day off today. And so we're going to go camping after this.
Howard: Where are you going to go camping?
Matthew: There's a little place south of Delta Junction.
Howard: And what are you going to do out there? Is it on a stream? Are you going to fish or hunt or what?
Matthew: We might fish a little bit, it's on a little river. We're going to get out and just hang out. Sometimes it's nice to just get away and just see the mountains and stuff like that. So we're just going to go out, hang out with the dog and stuff. But work life balance is great, it's pretty predictable.
Howard: Are you in a city where your wife has got a job? Is she able to get a job on the base or how does that work?
Matthew: Yes so she's a nurse. We live in North Pole, like we talked about at the beginning, which is in between Fairbanks and Eielson Air Force Base. So if you drive north --
Howard: How many people live in the North Pole?
Matthew: Oh I don't know. Great question, maybe 50. It's tiny. It's like a couple of Circle Loops and a couple of grocery stores and some fast food places. I've been told that if our Air Force base didn't exist, North Pole wouldn't exist, because it's a lot of just military people living there. But we live in North Pole, so it's between Eielson and Fairbanks. So my wife works at a clinic in Fairbanks and I work at Eielson and so we each have about a 20-minute drive to work. It works out pretty well. But it's interesting living in the North Pole because we have Christmas themed street lights --
Howard: Man, I bet. So you said something very profound at the beginning, that now you like endo. And so many of these kids walk out of school and they've already made up their mind they hate endo. And I just say, "Well if you do something and you’re losing at it and you're getting beat up by it, of course you're not going to like it. So if you're getting beat up you need to just keep taking courses until you can beat up that tooth, then that tooth's not beating up you."
What do you think was the turning point, the inflection point that made you feel like you went from hating endo to liking it and enjoying it?
Matthew: So I felt like, and I still feel this way, like our endo system was kind of confusing in dental school. It was sort of a mismatch of different systems that our endodontist really liked and kind of put together. So it was kind of confusing to go over these different files with these different tapers and different things and the way we prep the teeth and all the stuff. It was very confusing and hard to remember all at once. And I remember getting to residency and our endodontist was like -- so he made us start over basically. So he was like, "The first five cases you do, you're doing with hand files and then we're going to add rotaries." And it sort of built from a base level. It made sense why we were using the rotaries we were using once we got there. And so I wasn't like having to memorize numbers and rotary systems, I understood why we were using the rotaries that we were using and what I was trying to accomplish with them, rather than just like, "Go in this order and if this happens, start over and if this happens, start over." It was like, "Okay, I get to this problem, I know what I can do and I know I can troubleshoot it because I've done root canals with hand files before. So if I get in a bind I can use hand files, I can use rotaries, I understand that there's all of these different rotary systems, the risks and benefits of each one." We had to do lateral condensation, warm vertical condensation, so we just explored everything.
And in dental school it was more of like: this is the system that we like, this is what you're going to use, this is how you're going to do it. And even though that sounds easier, it didn't build a knowledge to work from. But at the same time, I could make the argument if I had the training I had in my AEGD and that was my first endo experience, I might have felt the same way. So it might have just been the virtue of doing endo enough that you finally get that.
But there are some really great systems out there now that kind of simplify endo for the GP. You got to know what your limits are. But like you said, it's just getting in there and doing it and getting beat up and knowing you're going to get beat up. And that's difficult to walk into a situation and be like, "Well this tooth is really going to suck and I might lose money on it because it's going to take me three hours." But you know that at least you got to explore that option to say, "Okay I really do suck at this and I hate it. Fine." But at least you figured it out. Or you do ten of them and you go, "You know what? I can do this, And I can at least do molars when I can see the canals and maybe I won't do retreats, but I feel comfortable with anteriors and premolar now, so I can serve my population better." But it's very difficult to tell your brain like, "I am going to intentionally walk into a situation that I know is going to be difficult so that the situation the next time will be that much easier."
So it's getting there and digging around and exploring. And I think a lot of the problem with that is we come out of dental school with so much debt, those that didn't do a scholarship or have parents pay for it or whatever, that you feel like, “All right, I've got to make money right away.” And you're like, “Well this root canal is not profitable and I don't really like it. Dentures. I don't really like it. Okay I'm going to do what I know how to do and that I know I can make money on, because the bank's knocking at my door, they want their money back.” And when you're in the Air Force, patients now, if I get a difficult root canal I can go, “Can I do this in an hour and a half? No, but thank goodness I'm in the Air Force and so I can just book it for two hours or two and a half hours.” And I can call an endodontist I know in the air force if I have trouble. I did that last week. I called a guy in the Army that I knew. I said, "Hey, I've got this weird case and this and this is happening. Do you have any advice for me?" And I just spent extra time on the tooth. And I would've lost money in private practice but now I've gained more, I've learned something different. And so one of the benefits in the Air Force is being able to book that extra time if you need it, just to explore stuff and just try stuff because it's hard to try stuff when you got student loan payments. So it can be scary.
Howard: You mentioned dentures. Have you ever made a denture in your very young population?
Matthew: Two, I think. One was a partial for a girl that had some trauma when she was younger and had some teeth knocked out and had gone through a couple of different removable dentures. And so we made one for her. Now she's going to get some implants I think. Another one was -- we do have an older National Guard population, also a trauma case. Believe it or not at a very long span bridge. One of the abutments was an implant and everything was failing: bone loss, periodontitis, that kind of thing. So had to section the bridge and make an immediate denture and things like that. Complete dentures, none. I did do some in my residency. But our Air Force population is pretty denture-less. It rarely pops up.
Howard: You said something extremely profound a little while ago. You know, when you were saying you were doing endo in school and they were mixing and matching all these systems. And one of the reasons these kids hate endo is like their paper points aren't made by the same company making their “got-to” purchase, so they don't have the same taper. And when you just get a complete system where some engineering mind was making it all go together -- but dentists do two things really bad. They mix and match company parts, especially in composites. They'll use this company's composite and another company's bonding agent and they don't have a Ph.D. in organic chemistry, they have a doctorate in dental surgery. And they don't understand. When I go to 3M SP in Minnesota, they have like 60 Ph.D. people in white coats that spent five years making this stuff. And it just makes them pull their hair out seeing how people are posting cases on Dental Town where they're mixing and matching bonding agents. Same thing when you go to Lichtenstein. Ivoclar has got another 60, 70 people in these white coats and it just really frustrates them. And then Michael Miller taught me something from reality. The most profound thing Michael Miller ever taught me when I was in Houston, he says, "Dentists don't even read the instructions. Like when it says, ‘mix for ten seconds’ they don't have a timer." And Michael Miller was showing me so many times, then Dan Fisher showed me again in alternate Utah. Where we were bonding on extracted teeth and it says 'scrub, apply for 10 seconds' and he'd say, "Well let's just do it for five seconds and then let's do it go for ten seconds, and then let's do it twice as long at twenty seconds to see how that even screws it up."
And you start realizing that when these PhDs in organic chemistry say, "scrub this onto the tooth surface for 10 seconds," they don’t pull it out of their butt. The tooth fairy didn't appear in the middle of their dreams and just say "ten seconds." There's a reason, and then you can play that with: what percent of dentists do not have a timer sitting next to them while they're using these things where the instructions tell them the time? And how many dentists never even read the instructions and then they say, "Well I'm out of the glue on this kit but I got glue in another kit.” God, just stick with one system that was designed from head to toe, from A to Z. Read the damn instructions. When they say ten seconds, either learn to count out loud with your assistant, have your assistant check you. Like when you count to ten, was that really ten seconds? Or when you count to ten does Matthew do it in eight seconds and Howie do it in 12 seconds?
Matthew: Yeah, I totally agree with you. It's funny when you see posts on Dental Town or other places where people say, “I'm really having trouble with this, that and the other." And like, "Really, the answer is like -- like, "Hey I'm having trouble, this isn't working." And the answer is really like, "What do the instructions say?" And it's so simple because I feel like a lot of times we can get out of dental school and be like, "Oh I have all this experience and all this knowledge and whatever else." And then you see a new product and you're like, "Oh this is a better bond." And you're like, "I'll just use it like I use my other bond." And you're using it the same way and it may not be used the same. Like you said, scrub for 10 seconds, maybe you should scrub for 20, or maybe you shouldn't air dry it. Or maybe you should air dry it for 10 seconds and not five or whatever it is. And so if you're having those failures, or anytime you get a new product: yeah, you're a dentist, but read the instructions! Because you're totally right, whoever designed it wants it to be used a certain way and the properties that it's supposed to have are contingent upon the fact that you're using it the way they want you to use it. So even though you're supposed to get twice the bonding strength, if you’re just scrubbing it for 10 seconds and it says 20, it might be worse than what you were using before. So yeah, I totally hear you on that
Howard: You're a blogger. If you go to USAF, or USA Air Force dds.blogspot.com, you've written some blogs. When did you start blogging? And tell us about your blogging journey.
Matthew: So this is the best. I mean, this is so funny. Because when I was applying for this Air Force scholarship -- I have no family members in medical, so no dentists in my family and very, very few members of my family with any military experience. Both my grandpas were in for a couple of years. And so I basically was going into this blind. I had talked to some dentists who had done military stuff before and some who hadn't ,who said, "Yeah, you should really look into this." And so I start looking online and I can't find anything. I'm like, "Who are these dentist that are doing this Air Force scholarship and what do they have to say about it?" And there's a little bit on student doctor network and a little bit here and they are on Dental Town and that kind of thing. But I was like, “I want to talk to somebody who has done this before.” And I basically had to trust my recruiter and I was really fortunate, I had a really great recruiter. That is not always the case, because these recruiters are health professions recruiters and so they're recruiting nurses, physicians, optometrists, dentists. So they don't always have the answers that you want as a dentist. Like, how is this going to impact my career?
So when I got this scholarship, I think it was back in 2009, right after I got the scholarship I found out in February 2009 or February 2010, I can't remember. Yeah it was February 2010, right before I started dental school. I was like, "Well shoot, I'm going to be that person and we'll see where this goes." And I couldn't believe -- I have gotten hundreds of e-mails from -- and I know so many Air Force dentists now, because they emailed me four years ago and now they're an Air Force dentist and they said, "Hey, I have questions about this or that. How does this work?"
So especially when I got common questions, I'd make a blog post to talk about it: How much am I going to get paid? How much influence do I have on where I go? Is this really worth it? Do they really cover everything? How easy is it?
I've had people email me and say, "My wife is really concerned about this and that, can she talk to your wife?" My wife has talked to three or four different wives in the last couple of years. I ended up going to dental school with somebody that I had talked to on my blog like six years ago and he ended up applying to OU and now he's in the Air Force. I don't know what else is out there, but I would imagine that I have probably spoken with more upcoming Air Force dentists than anybody in the dental field. I can't imagine who else would have. Obviously, recruiters talk to these people, that's the doorway. But until they're in the Air Force, the Air Force dental corps really has nothing to do with them, it's all about the recruiters getting them in.
And there's just a lot of bad information and a lot of missing information, and people are scared because it's the military and they see what's going on overseas and they say, "How is this going to impact me? Are they going to ship me to Iraq and hand me a pistol?" What's going on here? How's the Air Force different than the Navy, than the Army and that kind of thing. And so being able to be that person that's done this and doing it is super important.
I started this blog before I got into dental school and I just started -- every few months I just kind of talked about what was going on. I didn't always have all the answers and now I have a lot more because I'm actually a dentist in the Air Force. But when I started this, it was just right before my first year and I was like, okay, here it goes. And, okay, I got my first semester paid for. And then they paid for my scrubs. Here's how you submit this and that and the other. Second year rolls around: this is what dental school is like, by the way the Air Force thing is still going good. I get out of dental school: okay, time for officer training. This is what officer training is like. I do my one year AEGD: hey, I did my one year AEGD, this is what the AEGD is like. So the questions people asked me have evolved over time because I've answered the basic questions so much they're on the blog now. And now I'm getting more of like. So tell me what it's like day to day. So tell me what this residency is like, and that kind of thing and so it's cool to be -- I don't know if you've ever heard of Tim Ferris before, he's got a podcast as well. He always talks about scratching your own itch. When there's something out there that's missing that you want, be that something. And so that was kind of my motivation to do this, was like: I'm going to be the person that I wish I had when I was like, “I don't know anything about the military, I'm trusting my recruiter, I know a couple of dentists that are saying, “Do it, do it,” but I don't really know. I wish I could talk to a dentist.”
So now I'm that dentist for so many people and it's super cool. I've had like 200,000 hits on the blog in the last eight years for being such a little niche blog: dentistry, Air Force. It's a very small population but I've gotten hundreds of e-mails from people, I get e-mails every month: people wondering about it, concerned about it. "Hey, I'm a first year in dental school.” I've gotten e-mails from people saying, "Hey I'm in dental school and I've got the scholarship. But there are still questions I never got answered. What's it like?"
Howard: So how do you market your blog?
Matthew: I don't market it all that much. I don't put ads on it or make money off of it or anything like that. I kind of just put it out there. Sometimes I'll post them on my Facebook page just because I know that I'm friends with other dentists who might be interested in that kind of thing. But it has sort of promoted itself, because if you go search for like Air Force dentist on Google or ‘HPSP’, which is the name of the scholarship: like Air Force dentist, HPSP or HPSP dental or whatever, it pops up, it's one of the top results. So people are finding it because it started hitting that traffic when people were looking for: I'm interested in this scholarship, I'm interested in being a dentist in the Air Force. I heard that I can get my school paid for. And eventually the hits just kept coming and now tens of thousands of people are reading this thing because at least they're curious about it. They got questions about it. And so I feel like it's just kind of crept up the Google searches and I'm getting more and more hits every month because people are -- I'm the only one out there doing this stuff.
Howard: And another thing you could do for SEO is on Dental Town we got a blog section. So if you've already written your blog, you can repost it under the Dental Town blog deal, because where that can go viral is we added that share technique, so if you read a blog and you like it, they can hit share and it'll go to their Facebook, Twitter, LinkedIn, Pinterest, whatever and that would have a link to your site.
Matthew: Yeah that would be awesome.
Howard: There's two blogs that really hit home to me and why I wanted you on the show. Talk about the AEGD residency. You said the Air Force made you take an AEGD. Looking back, are you glad they made you? Would you recommend it? What should someone be thinking if they're in school and they're thinking about an AEGD -- a one year residency?
Matthew: So it's evolved slightly since I did it. As far as the Air Force goes, when I did it everybody had to apply. It was a requirement of the scholarship. But if you got accepted you could say, "No thank you, I don't want to go.” Now it's such that you are required to apply and if you are accepted you are required to go as a part of your Air Force scholarship.
As far as AEGDs in general, I think it's a really, really great way to start putting everything together from dental school. Because once you get out it can kind of feel fragmented. Like you learned all this science your first year, you got into clinic third year, fourth year was crazy because you were taking boards and just trying to do actual physical procedures on people. An AEGD is a really great way to talk with specialists, have a little more one on one time and start putting these pieces together. How does my biological science relate to my endo in ways that I hadn't remembered or thought of before, because I was so focused on doing the endo my fourth year or doing the prosth? And kind of revisiting some of those basic principles about prosth that you might have forgotten when you were in a rush to graduate.
As far as the Air Force goes, they're super, super high quality programs. There's a specialist at every AEGD base, there's only maybe 11 bases. I don't know, it fluctuates slightly from year to year but they're all the bigger bases and so you get a good, wide patient population. What you're able to do is a little bit dependent on the faculty that's there and what they're comfortable cutting you lose on. We didn't do a ton of crowns initially, just because our prosthodontist really focused on making sure we were making good impressions. She was all about the basics: make good impressions, take good intra-oral photos, do awesome diagnostic treatment planning type stuff. And so once we got into treatment it was a little bit later in the year.
Other residencies, they started cranking out crowns immediately and they wanted to get their residents in doing crowns, and so it kind of depends on the faculty you get. One of the big questions I get a lot on my e-mail is, "I'm going to graduate soon. How do I decide how to rank which AEGD base I want to go to?" I tell people just pick where you want to live, because in the Air Force people are moving every two to three years. For me to be like, “Oh yeah, Travis Air Force Base would be great because five years ago” -- it doesn't matter. They're all gone. All those people are gone. So for me to make a call on what a base was like -- even when I went through the U.S. Air Force Academy -- there might be one faculty that's still there and I'm pretty sure he's not. And so it's all different too. So for me to say, “Oh yeah, The Air Force Academy is a great residency or a not so great residency,” I can't make a call on that. People are moving all the time and so it's a very fluid situation .
Howard: Why do they move everyone around? They always tease that IBM stands for ‘I've been moved.’ Why do you think company, Fortune 500s, militaries, big corps move everybody around so much? What's that all about?
Matthew: I think it prevents stagnation and it prevents people from getting entrenched. We have all these different guidelines in the Air Force and some are very strong suggestions and some are rules and there are different ways to interpret them. And if you've got a commander that's like "I don't really know about this rule," and maybe they're interpreting it a certain way, that may be okay temporarily. And people have learned to work around that. But if they're the same person for 10 or 15 years, that boat, theoretically, can kind of start to drift away over time. By circulating people through you get fresh ideas, you get people that have done things at different bases, different ways. We've had a couple of people recently from different bases that have come in and said, "Hey, I noticed you guys are doing it this way. Have you thought about doing it this way? This is how we did it at our last base." We go, “Oh man, that's a great idea.” So it kind of helps renew those ideas. Kind of like fertilizer for ideas. We can keep rejuvenating those new people that have done different things and keep it fresh. And then it helps us refocus on the mission. Like okay our commander just left. What are we really here to do? You know. what's the mission and Eielson, blah blah blah. And it can be easy when you've got the same people, you just get locked into your day to day work and then it just becomes your day to day work and you lose the focus of the bigger picture a little bit.
So I think it kind of helps cycle new ideas and keep that bigger picture in focus of why we're doing what we do every day. It's like, "Yeah I went to school debt free. That's awesome. But at the end of the day my job is to fix teeth so people can go drop bombs on people.”
I'll never forget when I went to my residency -- he was not kidding around -- our residency director, one of the first days we got there, and this was in the Air Force, he sits us down and we watch a YouTube video of some airstrikes on ISIS. And he just makes us watch it for like five minutes and he turns it off, and he was like, “Make no mistake, we are here to teach you guys dentistry. But at the end of the day we are here to protect this country and this is what we do. We protect the people that do this. And so don't ever forget that.” And it was impactful, I haven't forgot it. And those days when things get rough, especially in the Air Force, you can fall back on the fact that the crown didn't go great: it's not about the crown, it's about the human being that that crowns going to be attached to. And you got to do your best, because as cheesy as it sounds you're doing it for your country, you know? And so you've got to do the crown right because this guy has got to go fly a plane tomorrow or he's got to go maintain a plane, and if he's got a toothache or whatever ,you could cost X amount of dollars in the mission.
We've had stories before about patients that had pain in their wisdom teeth and we let them deploy. Not us personally at Eielson, but they've gone to a deployed zone and had an issue with their wisdom tooth and they've had to get evacuated out and then they hit a roadside bomb on the way back and it kills three people and that sort of hits home. Like, it really matters that we get these people stabilized, and dental is part of that. As cheesy as it sounds, “Oh yeah, we're just the little dentists.” And we never really deploy either. We're not the ones on the front lines dropping the bombs but we're making sure that the people that are dropping bombs don't have toothaches. I think there's a lot to be said for that in private practice too, because I think that even when you're in private practice you've got to have that bigger mission. Is our goal to improve the oral health of the Phoenix area or is it to educate patients? Or if you're in pediatric dentistry, is it to decrease the carries rate of children in your area? When it hits the fan and you wake up in the morning and you don't want to go to work, why do you still go to work? Yeah, it's to pay the bills, but what else? What's the bigger mission and what can everybody focus on when things don't go well? And it's easy in the Air Force, because we're protecting the country kind of thing. I don't remember what the original question was, but that’s your answer.
Howard: I just pushed your blog out on all my Facebook, Twitter, LinkedIn.
Matthew: Awesome, thanks.
Howard: And I wish you'd post them on the Dental Town blogs section, because you've written some amazing stuff and it'll still be promoting your site. But your dental tips from a newbie, that's an amazing blog that everyone should read.
Matthew: Yeah that was fun. That came from three months of very weird things happening in clinic and me going, -- chair side just kind of experimenting -- going, “This stuff kind of works. I should maybe post some more dental stuff.” So it's been a fun journey.
Howard: You want to go over -- you have that blog in front of you if you want to go over any of those highlights?
Matthew: I can pop it up really quick.
Howard: Pop it up really quick. That's just bread and butter down to --
Matthew: Yes, I remember one of them was -- we had a guy who had some trauma, working on an airplane or something hit him in the face and he came in and we tried to stabilize the tooth. A couple of days later he comes back and was like, "it's really hurting and I can't wait to get back home to get this thing pulled." So we're trying to do -- I'm trying to take out number seven and the thing is just -- every time I put an elevator on, the thing is just chipping and breaking and it's just a complete mess. So I've got this little tiny root down there and I was like, “I have heard that you can stick an endo file in those things and pull them out.” And I was like, “I'll probably get more leverage and it'll probably be way safer if I tie some floss to this thing.” So I tie a big, long piece of floss to this endo file and I crank in a 70 file and it fits really snug. And I twist it in there and I just grab it with my fist and just kind of turn. And I hold it for about 10 minutes and all of a sudden “bloop.” The thing flies out. Because I don't want to mess up the buckle plate, and he's had trauma so I don't want to induce anymore trauma if I don't have to. So that's always a fun technique.
Another one is when you've got a lot of tissue, especially behind some of those mandibular second molars, where you've got that tissue that's just hanging out there, you soak in a cotton ball and ViscoStat and you just push it in there for like 10 minutes. Dentists are very impatient. I know that because I am one.
Howard: ViscoStat is Ultradent, out of South Jordan, Utah?
Matthew: That's right. We use ViscoStat clear, I think they have another version too. But it's easy to get impatient and just like, whatever you put on there like, “Oh this should work immediately.” Like sticking a cotton ball on there, ViscoStat, I just hold it back and then all of a sudden you have this chasm behind the tooth and all the bleeding has stopped and you're like, “Okay, that looks great.”
Howard: The first time I ever saw that demoed was in 1987 at a local study club that Dan Fisher was speaking at. And he actually cut his own forearm and then started bleeding and then stopped it with ViscoStat.
Matthew: That's awesome.
Howard: Everybody in the room was like, “Wow, that dude's intense.”
Matthew: That's how you do it. Another thing that the Air Force is huge on is infection control. And so we've actually moved to -- all of our burs at Eielson are single use. We buy pre-sterilized Diamond Burs from Brasseler and SS White. So it's really predictable when you're doing crown preps. And that's another -- I don't know if I spoke about this tip exactly, but I like using those because I can just prep it and then when we're done we throw the bur away. That way the next time we're doing a crown, I don't end up with a bur that I'm like, “Oh man the grid's not that great on it.” So you're burning through time, wasting time prepping the two. So I really like those: they're peel packs, they're really easy. They're a lot easier for the assistants. When we got people moving all the time, we kind of have to -- I call it human proofing -- so we have to human proof our clinic as much as we can, because your assistant may be gone in six months so you can't rely on your assistant knowing what you like. You've got to set up the room the right way. We've gone to great lengths to standardize all of our rooms in the clinic and we make binders with pictures in them so that all the techs and all the docs have the exact same room. We do have some empty spaces so the docs can get what they want, but just making that consistency, so that if we got a chair down I can hop to the next room with a random assistant and we're not going to slow down at all. Having those single use burs helps a lot. One thing I learned that was really helpful in my prosth residency was just prep a little thicker than you think you're supposed to. We get so hung up about prepping these little shoulder margins and she was like, “Just prep a wider margin, it's going to be easier for the lab to see, you're going to get a better impression, it's going to be easier to prep that way.” And we got we got an Omni cam at Eielson, so we do Omni cam, which is super great for military stuff because we can get people crowns immediately, in a single day. So you got to prep wide margins for that anyway. So prep it a little wider margin, get in a little more aggressive bur, getting used to going fast kind of a thing. So all of that stuff is super good.
As far as oral surgery goes, I learned this the hard way, you're either going to have a smaller tooth or a bigger hole or the tooth's not coming out, especially with wisdom teeth. And I think dentists, coming right out of dental school it can be scary to take away bone. We didn't do any surgical oral surgery in dental school. It was all in my residency, and I feel totally comfortable taking out teeth now. Coming out of dental school I wouldn't have. So another tip now on that blog that you're referencing is just: don't be afraid to remove more bone if you need to get the tooth out, or section the tooth. You know, you got carries, the crown's broken, it's number 19. Just section it right now. Now you got two small teeth, it'll pop right out. Don't get a cow horn and get pissed when it keeps breaking 50 times. If it doesn't work in 10 seconds, go to the next thing. That's something I like to do is just roll with the next thing. Take more bone away, cut the tooth in half. If it doesn't work, do something different. You know, if it doesn't come out it's going to come out.
Howard: Well, back to choosing an AEGD. It's also true on choosing a dental school. I'm convinced -- would you choose a dental school, and they have a postgraduate oral surgery or endodontic training, all those good patients get shuffled over to oral surgery and endo and you don't get any. Same thing with AEGD. I mean some of these residencies the general dentists are going to do all the work. But if some of these AEGDs are also conjoined with a specialty training program, like to become an endodontist. And then a lot of those residencies the kids didn't get to do much molar endo. Do you agree with that or do you disagree?
Matthew: I do agree with that. I think we had an oral surgery residency at the University of Oklahoma and so that might have dictated our lesser oral surgery experience. We didn't have an endo residency so we did get to see our own endo stuff. But yeah, the AEGDs for the Air Force, some of them aren't specialty schools and so sometimes they'll get a little less oral surgery if they've got an oral surgeon.
I think a big thing on dental school, and I'm sure you agree with this, is to go to the school you can afford. That's relative, because if you're taking out loans, then by nature you can't afford any of them because you got to take out loans. But one thing that people ask me a lot on my blog, as far as choosing the right dental school is, “I've got dental school A, which is my hometown school. It's in my state.” Let's take Oklahoma for example, that's where I went. That was my cheapest option.
Howard: Is that where you were born and raised?
Matthew: I was, yeah. I was born in Oklahoma City and raised there and I went OU in Norman and everything. But I interviewed at USC as well. And that was like a four to five hundred-thousand-dollar school. And Oklahoma was maybe two hundred thousand. And I'm sitting here going, “Well I've got an Air Force scholarship, should I just go to the more expensive school to get my money's worth.” But I would really caution people against that. I would go to whatever school is going to provide you with the lowest costs of living. Because the school is free regardless, and when you're in the military during school you get a stipend but it doesn't change based on where you live. You get twenty-five thousand dollars if you live in Oklahoma City or Los Angeles. And so if you're living in Los Angeles, it's all gone. You got a lot of rent and stuff. My rent was like 400 bucks a month in Oklahoma. I pocketed half my stipend during dental school and my dental school was still free. If I would have gone to USC, okay, my dental school was still free, but the cost of living is outrageous. I'm going to lose all that stipend. So I would tell people: think about the cost of living where you're going to school because that's going to play a big part in it and don't be afraid to just go to the cheapest dental school. You don't have to go to the nicest one and you may have a good reason to, but I wouldn't get too hung up on it.
Howard: Matty, you just reminded me of a nightmare memory I had. It was in NYU. Four kids were chipping in on a $2000 a month apartment. When I went there it looked like a small dining room. I mean, it was like a toilet. It didn't even have a bathroom wall around it, it had one of those partition things around it and the mattresses were on the floor. And I'm like, “First of all, who would pay two thousand for this room. And second of all, why are four dental students living in it?” And I just thought it looked like a refugee camp. So you're right, getting that same stipend and going to Kansas or Nebraska as opposed to Manhattan or San Francisco really changes your cost of living.
Matthew: Yeah. Right. I mean, you can get hung up on saying the Air Force is going to pay for the school so my scholarship was worth more if I go to expensive school. Yeah but it's still zero. Forget it, it doesn't matter. If you can pretend it's worth more, but the bill is zero regardless. Okay, so what else comes into play? Well, your stipend. Okay. Go somewhere cheap, that the cost of living is cheap.
Howard: But man, I'm sure the young kids in dental school get tired of listening to a grandpa talking on the podcast every day. I'm sure that it was very refreshing to hear someone come in that was a little closer to their age at age 29. So when were you born, are you technically a millennial then or?
Matthew: Yeah I was born in ‘87 so --
Howard: Oh my god, that's when I graduated from dental school. You just made me feel extra, extra old that I was a dentist when you were born. But Matt, loved your blog. I called you, you didn't call me. Love your stuff. Thanks so much for coming on and explaining another option in dentistry of going into the Air Force. I think you're an amazing man. Your patients are lucky and I hope to meet you and your dog and your wife someday.
Matthew: Thank you. Can I say one more thing really quickly? Just to kind of wrap it up. So the blog is usafdds.blogspot.com I know you said it earlier. My e-mail is on there. I have an email address that I use just so people can email me. And it's just firstname.lastname@example.org. I'm not a recruiter, but I can definitely help people get hooked up. I've helped people that had trouble contacting the recruiter, because I've got contacts a little higher up. Go to the website, my email is right there. You can email me, it's super easy. I am super happy to answer questions. I usually get back to them pretty quick. I just want to scratch my own itch and help people.
I think just knowing what your options are is super important. Don't feel like you've got to have a bunch of debt to go to dental school. There are other options out there, like we were saying earlier. Don't be afraid to try stuff when you know it's going to fail, because doing it enough will eventually lead to it not failing. That's how we got to dental school in the first place, was taking tests and doing bad on a test and learning from it. And it can be intimidating when there's a person on the other end of those decisions and when there's a big bill on the other end of those decisions. And the Air Force really helps drop the bill part of it and you can feel more relaxed to go try new things. And with me and endo, and me and doing wisdom teeth and I.V. sedation -- would've never dreamed of it out of dental school and now it's a pretty routine for me. So you've got to step in, you've got to do things that are scary. You got to do things that are hard because that's the only way you're going to get better.
So I got the blog. People need to just email me if they have questions. I'm happy to answer, I'm happy to help them out and get them in contact if they have issues. But if anybody is interested in it, the first step is to contact an Air Force recruiter. If you go to my blog on the right side it does have a link and you can contact one in your area. And that's the first step. But I'm always happy to answer questions and I think this is -- I tell my wife every day that I am more and more happy with the decision I made as everyday goes by and I see the debt at zero and my skill going up and it's been a fun journey. So I would encourage it for anybody. There's two other branches as well. So there are plenty options out there for people.
Howard: Now is the army -- which stands for ‘ain't ready for marine yet,’ right? I think that's undergraduate for the Marine Corps. Well, you know, another thing I wish you'd tell the army recruiters. One of the most often looked aspects of Dental Town is it has free classified ads. On any given day there's like six thousand free classified ads for looking for an associate, selling your practice, selling equipment. It's on the app too. We just added that to the app last month. It's on the Dental Town app. So those army recruiters, if they're looking for dentists, they should place ads on there. I'll tell you who is really taking advantage is the corporate dental chains. I mean, there's some chains, their employees just assigned to the Dental Town classified ads. Because a lot of those recruiters that find a dentist for a location they might be charged like 5000. So if they can find a dentist on a free classified ad on Dental Town it's huge. Also, a lot of people -- you won't believe how many people bought a really expensive piece of equipment and now it's just a furniture hanger. And so they put an ad on Dental Town and sell it. It's really an amazing service.
So I want to put on my last question. You're the same age as my oldest son, my dad hat: what if I was your recruiter? And you've been in two years or four years. What would make you stay? If I wanted to say, "Man you're all that and a bag of chips, how can I keep you?" How long do you have to be in there to retire? Is it 20 years.
Matthew: I won't get into too much. Currently it's 20 years. That is changing next year. The retirement system is getting a little bit of an overhaul where the government is going to start matching TSP, which is the government equivalent of a 401k. They're going to start matching TSP contributions and you'll be able to keep that when you retire. But to get the “guaranteed money” you still will have to stay in 20 years. But there is a new component to that where they're going to match some investment stuff which is kind of neat.
Howard: So what's going through -- when you and your wife are talking and the dog is listening in, what are your pros and cons about whether or not you'll stay 20 years?
Matthew: The pros: it's a very low stress, it's very flexible, it's a lot of fun. You get to work with other dentists. You get to travel places you would have never imagined. I would have never imagined I would be in the middle of freakin Alaska, negative 50 driving to work, going to do a root canals in the middle of the Arctic tundra. It's just really, really cool. You have options to live all over the world. The cons are the moving again. So it's a pro and a con. If you don't like moving, you're not going to like it. My wife is a nurse, she would rather be in a little bigger city to be at a different type of hospital. So for us, the family aspect is playing a lot into it as far as my wife kind of wanting to pursue her career. You can make a little more money when you're out of the Air Force. I make great money. All things considered I think that's one thing people don't realize. Air Force dentists make pretty good money considering the stress that they have. The stress is very, very low. The income is lower than private practice but you have no debt. And I think it's more than enough for what we're asked to do. But the sky's the limit financially if you get out and then you can live where you want, you have a little more control over your life. But when you're in, you get free medical care, free dental care. There are a lot of military discounts you can take advantage of when you’re active duty. You get to see the world. There is great specialty training if you want to be an endodontist, periodontist, oral surgeon. The Air Force has their own programs. It's easier to specialize in the military and the programs are world class, they're incredible.
So if you're thinking about specializing, you don't want to spend money on it, you like to see the world and you want a low stress job. I can't think of a better one. If you want to have your own practice and decide who you hire and fire; if you want to live where you want to live, if your wife doesn't like it, it's probably not the thing for you. So those are definitely the things to balance. It works for a lot of people. It doesn't work for a lot of people. And so there are some unique things to consider that are inherent to military life.
Howard: Have you heard of that company Insight?
Matthew: It doesn't sound familiar, what do they do?
Howard: It's a computer software company I think. I think it's the second largest seller of Microsoft software behind Intel. It's just a huge company, they got thousand employees. I was having lunch one day with the two brothers that were the founders of that stuff and I said -- this is way back before the silicon, when the boom started hitting it was about '94 to 2000. You were born ‘87, so you don't remember that, but it was just an amazing -- the Internet was coming online, Intel was out, Microsoft, Oracle. It was the largest economic explosion I've ever witnessed in my life. It was from '94 to 2000. It was six years where if a monkey bought a stock it would go up. You didn't even have to do stock research. nothing could go wrong. And there were a couple of years in a row where I couldn't believe I'd made more money in stocks than being a dentist. And those were back when I was working seven to seven, Monday through Saturday. It was just crazy times. And I was sitting there having lunch with the two founders, and they live right around the corner from me, and I said, "Why you two? How did you get this going? How did your brain get this? You’re two boys from Iowa." And he goes, “No no no no no. We were born in Iowa but we are Army brats and we moved around every three years.” And he said, “Me and my brother,” this Eric and Timmy said, “We'd be laying in our bed and thinking: well, how come the last country we were in was so rich and why is this one so poor? And the next one?’” And after they had been moving around every three years, they finally lived through macroeconomics at a Ph.D. level so they could see the world from 30,000 feet up in the air, where everybody down on the ground is just born in their own tribe drinking their own Kool-Aid. They think everything's whatever their mom and grandma told them. And they lived through --
So one of the things I'm most proud of is I've been dragging my boys with me on lectures for literally their whole life, and it's kind of sad because Zach's the baby so he doesn’t remember some of these countries.
I mean in the last year, three out of four, except for the married one, to many countries and my god you just -- moving around. I can't think of anything that pries your book, pries your brain open. I mean, second to a book.
If you don't read, you only live one life. If you've read a thousand autobiographies you lived a thousand lives. So reading -- “all leaders are readers” Warren Buffett said the other day and his partner Charles Munger he said -- and Bill Gates said the same thing -- that all three of those read one book a week and they've never met anyone who is the smartest man in the room who didn't read a book a week and I'd say that is so true.
But traveling and moving around is just mind blowing. Just little things. Like I remember one time I took Zach to a country, he goes, "Dad, what is that smell?" And I said, "Well, this is what happens when you save money and combine the sewage with the water docks. In America it's separate, but here the rainwater going off the street is going in the same pipes as the sewage and you're smelling the sewage.” But it's just really traveling around the world. Like you say, you're born in Oklahoma but you've lived in Colorado Springs, now you're living at the North Pole. And you stay in there 20 years and live in five more different places, you'll never be the same.
Matthew: I totally agree. Yeah. Just to reiterate what you said, I think traveling -- apart from tourism, which I would consider is something different -- I think traveling and living different places and really experiencing different places is one of the most enriching things you can do with your entire life. It just totally rips open your perspective. Just the way people live up here, the way they communicate, the way things are traded. How expensive things are, how isolated it is, what people love to do. Totally different than Colorado. Totally different than Oklahoma. Just the people are different. And just understanding that whatever you thought about whatever it was when you grew up in Oklahoma, surrounded by the people you were always surrounded with: they may have been right, but there are other ways to think about this stuff. And I'm speaking very vaguely but I mean it very vaguely. There's a million different ways to look at the same thing out there.
You joke about showing a hundred dentists the same case and they'll come up with a hundred different treatment plans. It's like, man, I met so many interesting people up here in Alaska. The way we get our water, it's pumped from an electric well. We got to go do our filter. We have a heating oil tank on the side of our house. It's like, the way people live up here is just bizarre. And so it's really cool to see that and be able to appreciate fast Wi-Fi and central heating and just different stuff that, like you, it was a second thought growing up.
Reading is another big thing. I listen to books constantly. I listened to your ‘Uncomplicated Business’ book, I listened a couple of months ago and loved it. ‘Good to Great,’ ‘E-myth.’ There's another book out there called ‘Simplify’ that I listened to recently that I love. Memoirs -- Phil Knight's memoir ‘Shoe Dog.’ Just interesting things about interesting people and just learning all the time.
Because the old adage that you're the same person you were a year ago except for the books you read and the people you meet. And I told my wife -- you know, I had a year in my life where I only read a couple of books and I remember that time in my life and it's very blurry and it's very fuzzy and it seems like that whole year was the same. And I feel like every time I read a book I learn something new and I become a different person. And that's a very easy way to always get better.
Howard: But you listen to these books audio, right?
Matthew: Mostly, yeah. I read probably one to two books a month. But I listen to probably three or four books a month. Because I got a 30-minute commute every day. And I can listen to it on one and a half or double speed. And I'll listen to them again, because I like paper. I like physical books, you get to make notes and stuff. Sometimes it's good to hear a book and be like, “Do I want to buy the paper copy?” And I have done that before too.
Howard: Yeah, I think audio books is bringing books back to life. Because a wild animal sapien doesn't want to sit in a chair for five hours and read a book when you can be listening to the book while he's mowing the yard, cleaning the house, running errands. Look at movies, they were just visual with no sound and then phonographs over here. What was the name of that company? The talking machine phonograph company? And they both existed individually for 40 years till they combined them then it took off. And then the monkey could see, could hear, and then they added food and popcorn so you could eat too.
And I think these audio books -- I had mine hardcopy only and everybody kept asking me for audio and I added the audio. I sat down like this for five and a half hours and read that book and the sales exploded. I think little kids sitting in school, they don't want to read a book, they want to watch a video on YouTube. Education is just so much more richer when it involves more senses and you can be walking around doing things.
Howard: Matt, I hope you have a fun camping trip. I hope you don't get eaten by a grizzly bear. Are you going to take your dog to scare off the bears?
Matthew: That's right. We have bear spray. We have two cans of bear spray. It's actually very effective. I've never had to use it but --
Howard: I bet they were designed by the bears.
Matthew: Maybe. That's the trick.
Howard: Does the instructions say, ‘lay down on the top of the picnic table and spray this on yourself?’
Matthew: No it's the opposite. Fortunately, you aim it at the bear. But there are very specific directions that I don't know that I would be able to follow exactly if a bear was charging me.
Howard: That's serious stuff up there. I remember when we got to Prudhoe Bay we asked these guys, "So what's the worst part about living up here?" No one blinked, they said, “Polar bears.” And they said, "If we shoot a polar bear it will be on TV and we'll be ran out of town and they own this place and we can't do anything. They're not even going to trap them. They just let them rule." And those guys told me a story one time where this -- they called them lower 48ers .
Matthew: Yeah, I can't believe I use that term now but I do.
Howard: Basically it’s translation for complete dumb ass that doesn't know Alaska. And they said there was a polar bear and they were in their car taking pictures of it and the polar bear just jumped through the window.
Matthew: Yeah, they're dangerous.
Howard: That window, to the polar bear, was like me jumping through a garden hose. I mean, it was just nothing. And he said when you see a polar bear you just turn your car around and get the hell out of dodge. But I think I'd be more afraid of a polar bear than a grizzly bear. Which one would frighten you more?
Matthew: Yeah probably a polar bear. We don't get them where I am. You have to go further north like you said, to Prudhoe Bay. But bears in general, it's like when you see it, you turn around and go away. The minute you spot it, assume it's spotted you and get the hell out of there.
Howard: And they're so adorable. Somebody posted a case on Dental Town the other day of a grizzly bear getting a root canal and he was laying face down, his head turned to the side, and his feet, I mean, it looked like your grandpa’s feet. God that thing is so human like.
Matthew: Yeah. We went to a cabin a few months ago and it had been raining and so it was kind of muddy and we were hiking around and we saw big bear prints and we were like, "Okay we're turning around." And we had bear spray and everything but it was raining so you couldn't hear very well. And one of the ways to distract bears is you have some noise on your pack, because they don't want to be around you either. With the rain muffling it all, and we saw a bear prints and we were like, "We don't know if this is a week old or not," but we were like, “Turn around.” We see moose in our yard all the time and those are a little less threatening but they are -- that's a really cool aspect of living up here is you see moose. We see bald eagles. It's insane
Howard: You see a deer and you think that's all cool. But then when you see your first elk it's like: that is a whole other deal. But a moose is a whole other level up from an elk.
Matthew: They're massive. They're huge, and you'll just see this figure in the woods. We live at the end of our street and we're just surrounded by woods and you will see a moose just walk across the yard and we're like, "Okay, bring the dog in so the dog doesn't bark at the moose." And you just let the moose walk -- they just walked through our fence once, they just trampled it. We're like, “Okay, I'm going to go out and fix it.” But they're massive. It's a fun place to live. The wildlife up here is pretty crazy.
Howard: I think it was the best vacation I ever did with my dad and my brother, that was so cool. But I hope you have a rocking hot Labor Day weekend. Thank you so much for coming on the show. Thank you so much for your blogs and sharing so much information. This has been an amazing hour.
Matthew: All right. Thank you, Howard, I appreciate it. Have a good one.
Howard: All right, you too buddy.