The Money Issue - American Student Dental Association
Transcription
The Money Issue - American Student Dental Association
Views this powerful will inspire you to live and work where life is large and what you do with it matters. At the Indian Health Service (IHS), bonding takes on a whole new meaning. With friends, family and coworkers who share similar rock-solid values, you can live surrounded by natural beauty and build a mission-driven career as big as the horizon. You’ll be a vital member of the IHS Division of Oral Health team, serving American Indian and Alaska Native communities in 35 states across the US. Our mission: To prevent dental disease through community programs and limit existing disease through clinical programs. Our modern, well-equipped facilities — many with digital imaging — are located in some of the most spectacular areas of the country. And you’ll have time to enjoy life, with a 40-hour workweek, 10 paid federal holidays and weekends free. Join us. We’re looking for someone just like you. Get the big picture at www.dentist.ihs.gov. Careers with the IHS Division of Oral Health: Discover your Opportunity Begin your Adventure Find your Purpose The policy of the IHS is to provide absolute preference to qualified Indian applicants and employees who are suitable for federal employment in filling vacancies within the IHS. IHS is an equal opportunity employer. letter from the editor B ank accounts, and lack thereof, weigh heavily on the minds of dental students. In a 2012 membership survey conducted by ASDA this year, an overwhelming majority reported that student debt is the dominating issue of concern. We invest in our education physically, mentally and financially yet it is the monetary investment that many feel is simply overwhelming. The Budget Control Act of 2011 was enacted and my financial aid package will be distributed this August. “Attention Student” my message read. “As a result of the Budget Control Act of 2011, effective July 1, 2012, graduate/professional students are no longer eligible to receive subsidized loans.” What it failed to mention was the consequence. It means I will be paying about $8,000 more in interest payments alone. It has become essential to be a diligent financial manager more than ever. In an ADA News special report from September 2011, the ADA estimates the average cost of dental education rose 68 percent for private schools and 104 percent for public schools over the last decade, with no signs of slowing. That’s huge. It’s unnecessary. And it is students who absorb the increased fees. The firm GL Advisors estimates that the average dental student graduates with more than $200,000 in loan debt. Tuition is rising while resources to aid students are becoming scarce. New dentists are graduating with a record-breaking amount of debt. Will we see graduates driven to enter into a career solely based on financial constraints? Will high tuition adversely affect a predental’s decision to choose dental school? This is not an issue of greed, but of concern for the preservation of our profession. Our concerns are being heard. ASDA President Colleen Greene, Harvard ’13, is shining the light on student debt management. The ADA is investigating ways to reduce the cost of dental education. In a series of speeches to college students this spring, President Obama sympathized, stating that he has been in our shoes and would work with Congress to stop the doubling of interest rates on Subsidized Stafford loans. The legislation was approved by Congress on June 29 and caps the interest rates at 3.4 percent until June 30, 2013. So, how do we reduce costs, spend less and graduate with the least amount of debt? This issue of Mouth aims to help you navigate your own debt crisis and make smart financial decisions. Our authors worked to compile the best financial resources and education, paying attention to both breadth and depth. Do yourself the favor of reading GL Advisor’s article on the art of managing student loans. It offers expert advice and techniques for the modern dental student. What you learn today could save you thousands in the future. Megan Guthman and Kara Ward, Alabama ’14, wrote an article on the best ways to manage your money while still in school. They reminded me that every dollar counts and that smart spending will help relieve the financial burden upon graduation. Indeed, thrifty is the new black. As we work toward becoming clinicians and perfecting our dexterity, let us not forget that financial fitness is an important component. My philosophy is simple: action trumps acquiescence. Educate yourself on financial matters. Become diligent in your spending and borrowing. Plan for the future. Put your money where your mouth is. Eve Lofthus, Missouri '15 contributing editor D ue to the rising cost of higher education, student loan debt for dental school graduates has more than tripled in the last 17 years, with the national average surpassing $215,000 last year.* With debt levels of this size, all dental school students must understand their student loan repayment options and available strategies to minimize the cost of their debt. This article provides an overview of options that all upcoming and recent dental school graduates should consider when developing their debt repayment plan. Federal student debt relief programs are available to help recent graduates obtain payment relief and savings on their federal student debt. The nuances of these programs must be fully understood to ensure eligibility and maximization of potential benefits. Income-Based Repayment (IBR) may be a favorable option for those entering a practice following graduation. IBR limits monthly loan payments to 15 percent of a borrower’s discretionary income. For up to three years after repayment begins, the government will pay any interest on their subsidized loans not covered by the reduced monthly payment. Be sure to use the most accurate income documentation when applying for IBR to ensure the lowest possible monthly loan payment and the highest subsidy. Pay As You Earn has been renamed to ICR-A. ICR-A is a new repayment plan that will be available to help borrowers further reduce the cost of debt. ICR-A limits monthly loan payments to 10 percent of a borrower’s discretionary income and provides loan forgiveness after 20 years. These terms also reflect changes to IBR that will take effect for new borrowers on or after July 1, 2014. Qualification requirements are still being finalized but borrowers must have no outstanding federal loans disbursed prior to October 2007 and must have at least one loan disbursed after October 2011. Deferment options allow a borrower to temporarily suspend payments and receive full subsidies from the government. Deferment should be considered by recent graduates who are entering a residency program as part of an overall student loan repayment strategy. Understand that forbearance is different than deferment, in that forbearance does not provide subsidies. Public Service Loan Forgiveness (PSLF) provides tax-free loan forgiveness to federal loan borrowers who make 120 qualifying payments while working for an eligible public service entity. Therefore, PSLF is relevant only to a subset of dental school graduates, such as those considering working for a nonprofit group or in academia. Only direct loans are eligible for PSLF, so many borrowers interested in pursuing PSLF will need to transfer Federal Family Education Loan (FFEL) program loans to Direct Loans via the Federal Direct Loan Consolidation program. Federal Direct Loan Consolidation As referenced above, federal consolidation with the Direct Loan program may be necessary to position loans to benefit from PSLF. Other benefits include an option for eligible borrowers to extend the repayment term or lock in a fixed rate on variable interest rate loans. Consolidation can take months to complete, so timing is important. Borrowers with loans at various rates must consider performing multiple consolidations grouped by interest rates to maintain flexibility to retire higher rate debt more quickly. Many student borrowers have a diverse loan portfolio with a variety of interest rates. It’s critical to set apart loans when implementing a repayment strategy. Federal repayment options such as deferment, forbearance, or extended repayment plans can help free up more funds to target the higher rate debt. Refinancing higher rate debt into lower interest rate loans may provide borrowers another opportunity to lower their student debt. The marketplace for refinancing loans has been very dynamic the money issue in recent years, so stay abreast of your options. assessment, ASDA members can retain GL Advisor's service at a discounted fee for their first 12 months of service. Student loans and related federal programs can be confusing. Taking full advantage of program benefits requires an in-depth understanding of each program’s details. To learn how you can benefit from federal programs and other repayment strategies, sign up to receive a free personalized student debt assessment from GL Advisor by visiting www.glAdvisor.com/ASDAMouth. You can also contact GL Advisor with questions at 877-552-9907. *ADEA Survey of Dental School Seniors 2011 Graduating Class and internal GL data. with nor endorsed by the Department of Education or any other government agency. Insurance services are provided by Graduate Leverage Insurance Services, LLC and investment services are provided by Graduate Leverage Investment Advisory Services, LLC. GL Advisor is a division of Graduate Leverage, LLC. GL Advisor does not offer all services to residents of North Dakota at this time. GL Advisor is not affiliated Our holistic approach to financial management focuses on supporting our dental professional clients with investments, insurance, tax planning and practice or home purchases. After receiving a free Get competitive dental malpractice insurance coverage with protection you can trust from “A” (Excellent) rated* Professional Solutions Insurance Company. To learn more, call 1-800-718-1007, ext. 9191, or visit www.profsolutions.com. PSIC Professional Solutions INSURANCE COMPANY * Malpractice insurance is underwritten by Professional Solutions Insurance Company, 14001 University Ave., Clive, IA 50325. Professional Solutions Insurance Company is rated ©2012 PSIC NFL 9191 ALL “A” (Excellent) by A.M. Best for financial strength and operating performance. A.M. Best ratings range from A++ to S. the money issue I never doubt that my dental education is a worthwhile investment. But as I spiral into debt, I am forced to navigate dental school on a budget. The key is to balance the essential with the frivolous. Look at your bank statements and categorize what you spend on most. Many bank websites have tools for this. If your bank doesn’t, Mint.com is a free resource with a mobile app to keep your budget in check. Once you’ve determined your spending priorities, set goals and stick to them. If you overspend in one area, take from another to avoid going over your limit. Remember, any purchases made with loan money will be repaid, plus interest, in the future. My budget is divided into three areas: living expenses, food and fun. Living expenses are generally fixed, but there are a few strategies to keep costs low. As a single woman, the easiest way to cut down on living expenses is to split rent and utilities with a roommate. Do you live in an apartment complex? Cut a deal with your neighbor and pay them for Internet access. If you’re not a TV fanatic, a Netflix subscription can suffice to keep you entertained. I have Whole Foods tastes with a Wal-Mart budget. I try to pack my lunch, cook my dinners as much as I can and eat meals out only twice a week. Take a look at your local grocery store’s weekly ad to stock up on things while they’re on sale. At the beginning of dental school, I struggled with guilt over spending money on myself. I learned that money invested in your quality of life and friendships during dental school is well spent. Save room in your budget to see your favorite band or a long weekend at the beach. Pay attention to local blogs and newspapers listing free events in your city. The summer is full of festivals and outdoor events to enjoy. Let this “fun” category roll over to the next month to save for a good splurge. You deserve it! the money issue M y husband and I married during my first semester of dental school. We were excited about combining lives. We quickly developed a budget but soon realized that keeping track of cash flow for two isn’t easy. Five dollars extra here, $10 there,and before we knew it, the month’s money was gone. Money became the source of our arguments and we realized that we needed to change our approach. After asking friends and family for advice, we reluctantly decided to use cash only for certain budget categories. Money for groceries, gas, eating out and personal pending is put into labeled envelopes at the start of each month. It’s taken some getting used to but it’s easier for us to avoid overspending and arguing when we can physically see how much money is left. Even if envelopes aren’t for you, it’s smart to know where your money goes. My favorite envelope is individual spending. Before we got married, a friend advised us to set aside personal money, even just $15-$20 a week. It’s money we don’t have to agree when, where or how to spend. For instance, David loves to stop for chicken biscuits on his way to work and I enjoy drinking over-priced coffee while studying. Try to find a way to incorporate some personal splurging into your budget. Maybe it’s treating yourself to a movie and popcorn or happy hour after school with classmates. Factoring rewards into your budget will strengthen your ability to stick to it. Each month brings hard-to-predict expenses. To account for this we set aside money each month in accounts for things like car repairs, gifts and emergency spending. We also save monthly for a vacation each year. We don’t need to use the money every month, but when we need it, it’s there. Automatic withdrawals are our secret to being disciplined. In our experience, unless you go out of your way to set money aside, it will get spent. Another secret to being smart with money is communication. We try to meet monthly to see how everything money-related is going. Even when money is tight, knowing you are on the same page with your spouse makes all the difference. 2012 ADPAC Video Contest Why ADPAC? What does ADPAC do for you? Prize Winning Team Receives $2000 Contest Begins: May 21, 2012 Submission Deadline: September 15, 2012 ASDA Members — Create a video that explains what ADPAC is, why joining ADPAC is important or help illustrate what ADPAC has done and will continue to do for your future profession. All submissions will be shown at the ADPAC Booth during the 2012 ADA Annual Session in San Francisco, CA. • Participation is limited to current ASDA members Videos are subject to disqualification if they contain: • Videos may be in the form of an original drama, comedy, documentary, interview, public service announcement, music video, or any combination • Copyrighted or trademarked material including material taken from TV, movies, DVDs, the internet, books, manuscripts, recordings, pictures, or soundtracks UNLESS appropriate documentation granting permission to use such material is included with the entry. See http://www.copyright.gov/ for U.S. copyright regulations • Videos should not be more than 3 minutes in length • Applicants must include two copies of the video. Each copy must be on a disc or flash drive and be formatted in standard AVI Format • Unlicensed software • Material or language that would be deemed inappropriate content for the general viewing public For entry form and complete contest rules contact: Natalie Halpern at halpernn@ada.org. the money issue FAQs F eel lost when it comes to financial decisions? Here are some frequently asked questions with answers to help you gain financial knowledge and make smart choices. Q: What is the average salary for dental school graduates? It depends on several factors including geography, specialty and practice opportunity. Typically the range is $80,000$120,000 for general dentists the first couple of years out of school, but you'll see exceptions to that on the high and low end. Source: Dr. Christopher Salierno, ADA New Dentist Committee Q: How much do you start to pay each month for loan repayments after graduation? According to the OUHSC financial services website, this depends on the amount you owe, your interest rate and if you choose standard, graduated or extended loan repayment. Standard payment plans feature a fixed dollar amount paid each month for the term of the loan, about $2,250 with a 10-year loan term. This standard option gives you the lowest total money paid throughout the duration of repayment. In a graduated plan, you start paying a smaller amount for a few years (like $1,100) and then have higher payments later. An extended plan allows you to pay that small amount each month for the duration of the loan, but typically over the course of 25 years. This plan will cost you the most in the long run. If you choose to pursue income-based loan repayment however, during your first few years out of school you may get away with paying very little each month, although you are still technically in repayment. Q: What is income-based loan repayment? Income-Based Repayment (IBR) caps your required monthly payment at a lower amount based on your current income and family size. This can be applied to Stafford, PLUS, Consolidated and even undergraduate student loans. With IBR, you are not required to pay your loan interest each month, so you can be paying near nothing and still be in repayment. For the first consecutive months in IBR, if your taxes are zero, the government picks up the interest balance on the subsidized loans. This is typically the best repayment option during residency years and often during your first few years out in practice. Just be sure to file those taxes while still in dental school so you can take advantage of this option! Q: If I have any “extra money” either now or once I start working, should I use it to pay off loans or invest it? It depends on how the rate of return on investments compares with the rate of interest on your loans. Perkins loans are fixed at 5 percent and Stafford loans at 6.8 percent. Grad PLUS loans are at 7.9 percent if through the government or 8.5 percent if through a lender. So, if you were able to miraculously find an investment that displayed a 7 percent rate of return, you should first pay off any Grad PLUS loans as they have interest rates greater than 7 percent. However, investing would be preferable to paying off Perkins or Stafford Loans as they have an interest rate below 7 percent. Q: What is the average cost of applying to dental residencies? Your costs will depend on how many programs you apply to and where you get invited to interview. Here is a sample of what you will be paying for: • MATCH: approx. $90 to register • PASS: approx. $100 per school. Application fees vary depending on the number of schools you apply to. The price per school decreases with more applications. The first school costs about $200 and drops from there. If you apply to 20 schools, the average cost per school is roughly $100. the money issue • NBDE score reports: $30 each • College transcripts: approx. $10 per copy • Airfare: up to $1,000 per interview. Costs depend on the distance to your interview and how far ahead of time you are given a date (often only 2-3 weeks notice). • Hotel: approx. $300 per interview. If you have friends or even acquaintances by the school where you are interviewing, ask if you can couch surf for a night to save some cash. If you need a hotel, keep it cheap but safe. • Office supplies: $50-$100. Don’t forget the manila envelopes you need to send to each school, nice paper for resumes, paying for postage, etc. burden of carrying both personal and office costs while disabled could be financially catastrophic. Business overhead expense insurance helps to cover office overhead expenses during a disability. A business overhead expense insurance plan can help you protect your future by helping to keep your office open. Anticipate a high cost associated with applying to dental residencies and budget wisely. Source: Dr. Brittany Sonnichsen, recent Connecticut dental school grad and incoming Ohio OMFS resident Business Owners Package: A BOP policy serves as your “homeowners” policy for the office. It provides protection against the physical loss of property (not malpractice) in your office due to a covered event (fire, flood, theft, etc.). Q: I heard that ASDA offers its members free insurance. What exactly is this? ASDA members have access to the same group insurance offered to ADA members. A student can establish a foundation of personal insurance protection before entering the business world as a dentist. The benefits include $50,000 of life insurance and $2,000 of monthly disability insurance – all free during dental school or residency. Students who sign up for the disability insurance also get up to $150,000 to repay student loans if they become disabled before graduation. Coverage is provided by the ADA Insurance Plans, underwritten by Great-West Life & Annuity Insurance Company. To enroll or learn more, go to www.InsuranceForDentalStudents.com. Malpractice Insurance: Take the time now to choose the strongest defense available to you. Make sure you have a contract that will give you the control of how claims are handled. Your career, reputation and assets are on the line. Q: What types of insurance will I need to open my own business? Disability Income Insurance: A serious disability due to either illness or accident might completely eliminate your ability to practice. Disability income insurance is essential and should be among your first priorities. A disability policy helps protect a portion of your income. Business Overhead Protection (BOE): Income ceases quickly upon experiencing a disability, but office expenses continue. The Business Reducing Term Disability: The burden of a loan repayment when you cannot work can cause a great deal of pressure on your business. A business reducing term plan will pay back any loans you took out to open your practice if you become totally disabled. Life Insurance: Many lenders require life insurance as collateral in case you pass away before you can repay the loan you took to open the practice. If you would like additional information, contact Treloar & Heisel, Inc. at 800-3456040 or visit www.th-online.net. Source: Treloar & Heisel, Inc. Q: What is the cost of malpractice insurance for new dentists? According to Mary Taylor at Medical Protective, the cost depends on a variety of factors: practice location, practice organization type, procedures performed, policy type and policy limits. Many companies will discount the premium for new dentists to help make the transition from school to practice easier. Medical Protective offers new graduates a 75 percent, 50 percent and 25 percent new-topractice discount during the first three years of practice. ASDA members also can receive another 25 percent discount on their first policy with Medical Protective. After the new to practice discounts have expired, most dentists can expect to pay between $1,500-$2,500 per year during their careers for malpractice insurance, although it can be more for more litigious areas like the New York City or South Florida. Q: Learning to run a business is very important for prospective dentists, but we get minimal coursework in this area. How else can we learn this information? ASDA recognized a need in this area and created a new conference open to all members. Co-chair of the planning committee, Dr. Ryan Dulde, explains, “the National Leadership Conference [will be held] in Chicago this November, allowing dental students to customize their own meeting from four different programming categories such as advocacy, career planning and business leadership, ASDA chapter management, and more.” Sessions include personal finance, specialties and career options, marketing tactics for your practice and how to ace any interview. Visit www.ASDAnet.org/NLC for details. The ADA also offers business resources to for dentists. Visit ada.org/adabusinessresources.aspx for more information. The New Dentist Conference also hosts some of the best practice management lectures and allows you to connect with other young dentists and share stories about successes and challenges. This meeting is held in June each year and welcomes student attendees. Q: What scholarships are available to dental students and where can I find them? Many schools have a scholarship information area that contains applications, guidebooks or other helpful resources. You can also approach your Student Service’s staff with questions or requests. Your local state dental association also may be an excellent source of potential funds, as they typically sponsor several scholarships for students. If there isn’t information readily available on their website, don’t be afraid to ask. continued on page 16 T HO UGHT S O N L I F E AS A NE W DE NT I S T Look Past the Paycheck. Find a position where you can be proud of your work. Erin Topley, DDS is a 2009 Graduate of the University at Buffalo School of Dental Medicine. Dr. Topley’s Tips for Graduating Dentists: Get a lot of experience. See as many patients as you can. I have worked at the VA, a children’s Medicaid clinic, and now in private practice. I’m learning as much as I can from two wonderful mentors to prepare for opening my own practice someday. Network in the community. After graduation I moved across the country and had difficulty finding a job. I sent out many resumes to no avail. Finally it was a recreational kickball teammate who knew someone who offered me an associateship. Live like a student financially for a few more years. You’ll save a lot of money in the long run if you start paying down student loans early. I also joined a state loan repayment program that’s been a great benefit. Don’t buy cheap liability insurance. When buying insurance, cheaper is not necessarily better. If I ever have malpractice issues, I want someone in my corner to protect me. Fortress insurance came very highly recommended to me by several established dentists in the community, so I feel confident that Fortress is the correct choice for my career. Dr. Topley is also a cartoonist! See her artwork at www.toothlesstoops.com. As a new dentist, you’ll need to protect your career and your reputation. Fortress Insurance Company is dedicated to the dental profession exclusively. We are owned and operated by dentists and only insure dentists and dental students for professional liability. Fortress provides aggressive claims defense, valuable risk management, and outstanding customer service. To apply for a Fortress insurance policy* from an independent agent in www.dds4dds.com Sign up for access to student resources your area, call our Policyholder Services Department at 800-522-6675, or visit dds4dds.com and click on the Agent Map. Board Exam Coverage and New to Practice Discounts Available *The language in contained in each policy of insurance establishes the specific terms and conditions of insurance and will supersede any statements contained herein. the money issue National ASDA offers the Ryan Turner Memorial Scholarship. The scholarship awards $1,000 to an individual who demonstrates passion for organized dentistry and service to the organization. The winner’s ASDA chapter also receives $500. Even the Internet can be a great way to search for funds. Several dental organizations like ADEA offer multiple awards to students for research or to help fund their dental educations. Scholarships are an excellent way to help finance your education and all too often are not sought out. Q: What are the advantages and benefits of getting your dental education sponsored by programs like the military or public health? Military branches such as the Air Force, Navy or Army offer loan repayment programs. You can receive a benefit package that includes salary, bonuses based on tenure and contract length, retirement plan options, and health care and life insurance. You also get a large number of paid vacation days and housing stipends. You also can also take advantage of their loan repayment programs. These programs recruit mostly general dentists, but have positions for other specialties as well. Check out their .gov websites for more information. You can also contact a recruiter in your area who can meet with you and discuss all the options available. Through working with Indian Health Services, you can receive $24,000 each year towards your loans (in addition to full salary) for a two-year commitment. Once 0RACTICE -ADE Perfect you are accepted into the loan repayment program, you can stay in the program until all loans are paid off. You can even pay back undergraduate loans if the money is going toward the cost of prerequisites for dental school. The IHS has numerous sites where you could practice, especially in Central and Western states, and takes your location preferences into account. Another way to repay loans in the IHS programs is to apply for National Health Service Core loan repayment. The NHSC funds, unlike with the IHS program, are non-taxable. You can apply to both repayment programs and fall back on IHS grants if declined by the NHSC. Source: Dr. Timothy Lozon with Indian Health Services and .gov websites continued on page 34 3- 4REMENDOUS%ARNING0OTENTIALs$ElNED#AREER0ATHTO/WNERSHIPs0ROVEN0RACTICE-ODEL #OMPREHENSIVE-ARKETING"USINESS3UPPORTs/NGOING0ROFESSIONAL$EVELOPMENT Dentist Opportunities available nationwide! At Aspen Dental we recognize that our success is a direct result of empowering and supporting ambitious dental professionals. We provide a professional, fast-paced, entrepreneurial work environment based on a mutual respect that keeps our interests aligned. Together, we build and develop successful, patient focused dental practices. Aspen Dental’s loan reimbursement program offers a benefit potential up to $150,000, no service obligation and a simple application process. AspenDentalJobs.com/284 We’ve got the perfect opportunity for you! Join Aspen Dental – the premier network of dental practices. 866-685-5818 Connect with us: Aspen Dental is an EOE. The easiest Dental Exam you’ll ever take DENTAL MALPRACTICE EXAM When selecting dental malpractice insurance, you should choose: The company with the strongest claims defense The most experienced company The dental malpractice company with the highest financial ratings Medical Protective is “All of the Above” Before you see your first patient, you’re going to have to choose dental malpractice insurance coverage. Some new dentists give it little thought and automatically settle for the first insurer they hear about or use their employer’s company. But it’s your career on the line, and there are significant differences in the quality and value of companies and coverage available. Choose the company that more dentists have trusted since 1899 to protect their reputations, practices and assets. Choose the strongest malpractice insurer — Medical Protective. Ask about our malpractice protection specifically designed for new graduates. dental@medpro.com www.medpro.com 800-4MEDPRO ©2011 The Medical Protective Company®. Trust the dental malpractice experts. the money issue G raduate students across the United States may notice a change in their financial aid award for the 2012-13 academic year. Subsidized federal loans are being replaced by an increase of unsubsidized Stafford Loans. Every student is responsible for 100 percent of the interest accrued by their federal student loans while enrolled in a graduate or professional program. On Nov. 22, 2011, co-chairs Senator Patty Murray (D-Wash.) and Representative Jeb Hensarling (R-TX) announced that the committee could not reach a bipartisan agreement available to the public before the given deadline. Sequestration was enacted and the cuts began. The Congressional Budget Office estimates that the cuts will reduce nonexempt spending by 7.8 percent in 2013. The interest subsidy for graduate students is nonexempt. According to the National Education Association, this equates to a loss of $3.54 billion in educational funds. Why is this happening now? After almost a decade of economic stimulus, corporate bailouts and defense expenses, the United States was set to default on its national debt on Aug. 3, 2011. On Aug. 2, President Obama signed into law the Budget Control Act of 2011. First, the nation’s credit limit was increased to raise the ceiling on the debt. This allowed the subsidizing of loans for the 2011-12 academic year. Second, the Congressional Deficit Reduction Committee was formed and charged with freeing up $1.2 trillion in budget savings by Nov. 23. Failure to do so would result in automatic spending cuts (called sequestration) across the board to government programs, including defense budgets and student aid funding. Most students have likely heard about the Budget Control Act but may not have the time to worry about it and some feel there is little they can do about it. As Jonathan Ruminson, a second-year student at Loma Linda, shared, "It is amazing how our government tries to motivate us to get an education, give back to society and pay more taxes, by taking away our incentives to accomplish those things." Can anything be done? According to the National Association of Student Financial Aid Administrators (NASFAA) website, the answer is no. They state that, “the failure of the deficit reduction committee to agree on a solution irreversibly set into motion spending cuts that guarantee the reduction of national debt.” Does this only affect federal loans? No. Most graduate students need PLUS loans to cover living expenses and part of tuition. NASFAA advises of two repayment incentives on these loans when they become due, granting a lower interest rate to those who pay through automatic debit withdrawls. If payments were made on time for the first 12 months, a rebate of 1.5 percent interest was given. The Budget Control Act will end these rebates. Only rate reductions for debit payment will remain in effect. The CBO projects that the end of rebates will yield a national savings of $3.6 billion from 2012-21. The added interest dental students will be responsible for makes the thought of working in the remote wilderness to qualify for loan repayment appealing. Perkins loans and Pell Grant funding are exempt from cuts. In fact, much of the money cut from federal loans will be funneled into the Pell program to ensure the maximum award is given for years to come. The amount of funding students qualify for will not change. By keeping current on these changes we can better prepare for repayment after graduation. Knowledge is power... for you and your patients Make sure your Crest Oral-B sales representative knows how to contact you at your new practice — go to crestoralbforgrads.com and follow the instructions on the page. Your representative will visit to share our latest news and materials, along with a “Welcome to Your New Practice” package for you and your new office!* Like facebook.com/professionalcrestoralb * While supplies last © 2012 P&G ORAL-12345 When you scan this bar code, the terms, conditions and privacy policy of the bar code reader that you select will apply. the money issue R ecently, I met with representatives from Patterson, Benco and Goetze dental distributors to get a crash course on investing in dental equipment and technology. “Do you sell electric typewriters?” This was a real question a Patterson representative got within the last five years. I laughed when he told me this, but realized that if I had gone to dental school in the 60's I would be asking the same question. I am the person who refuses to get the Facebook's Timeline, smart phones confuse me and self-checkout lines at the grocery store make me nervous. But as I learned, investing in your future office need not be a baffling process. Start by finding a company you can trust and build a relationship. When representatives know your office well, they can better meet your needs and give you better quotes on sales. First, certain pieces of equipment like operatory chairs and hand pieces are essential. You have no choice but to purchase them regardless of their profitability. Second, when investing in technology, a return on investment can be calculated for billable procedures. See figure on right. Adapting to new technology is described by a bell curve divided into the innovators, early adapters, early majority, late majority and laggers. The early innovators tend to waste money, since no new technology is perfect. Ideally, you want your office to fall in the early majority category. “The most important thing is to do your research on each and every product that you bring into your office,” explains Dr. Helen Lee, of Franconia Dental Care in northern Virginia. Although the technology can seem overwhelming at times, Dr. Maria Wong Kim in St. Louis advises to always consult with colleagues for advice. “I always speak to my fellow clinicians when considering a new piece of technology,” she says. “I feel more comfortable buying something they have had good experiences with.” Dentists rely heavily on peer feedback when buying new technology. Some consider product reviews by independent companies such as the Gordon J. Christensen Product Report or DentalTown Magazine. When consulting representatives and dentists, I found that opinions vary on whether the digital X-ray or intraoral camera has the fastest ROI. Technology that does not perform a billable service cannot show an ROI, but some increase treatment acceptance rate by patients. Dr. Lee says her intraoral camera was the best investment she made in her office. the money issue “The visual display of the patient’s oral health condition while I am explaining the proposed treatment plan has greatly increased acceptance of the proposed procedures,” she states. “It also makes it very easy for the patients to understand the diagnosis, which I think is very important.” CAM system would buy the digital impression and milling component. The milling component is the more profitable technology. If dentists choose not to invest in the milling component, they can choose from an array of digital impression systems available on the market. Two of the most expensive pieces of technologies are the CAD/CAM system and 3D imaging system. CAD/CAM stands for Computer Aided Design/ Computer Aided Manufacturing. A CAD/CAM system consists of two parts: digital impressions and milling. Digital impressions cut the need for impression materials, reduce chair time, and provide much more comfort for the patient. Chair-side milling creates partial and full-coverage restorations within minutes. The 3D imaging or 3D X-ray system creates a digital model of the patient. 3D Not all distributors carry a CAD/ CAM system. The Cerec CAD/CAM system by Sirona is carried exclusively by Patterson. E4D by D4D Technologies is the CAD/CAM system through Henry Schein. Most dentists who buy a CAD/ imaging is as if you took a patient's head, dissected away all the tissue and worked with the skull. Software allows you to take cross sections, see thickness of bones, locate nerves, examine the TMJ, plan implants, and see incredible detail that traditional X-rays do not. Software for new technology improves quickly, so make sure your purchase can be updated. There is no formula for how to invest in an office. Work closely with your CPA and technology representative to come up with the best plan to upgrade your office. The right technology can make your office more efficient and allow you to provide better care for your patients. Try not to become the “typewriter” dentist! career transition W hat are you strengths? What are your weaknesses? Where do you see yourself in five years? Whew! Now that we’ve got that out of the way, it’s time to consider some interview questions that really get to the meat and potatoes of an associate/owner relationship. If you're considering an associate position, the interview is the time to determine if the hiring dentist is right for you, too. Unfortunately, standard questions don’t always get the job done, particularly if your goal is more entailed than “find a paying job.” If you’re on the lookout for an associateship with the potential for ownership, it’s critically important to ask questions that evaluate your compatibility with the hiring doctor. Here are four often-overlooked questions that can help you find a great fit. How do you handle conflict within the dental team? This will give you an indication of how much staff conflict regularly exists in the office and how a conflict between the two of you might play out in the future. You’ll also gain insight into the owner’s leadership style. Some dentists avoid conflict out of fear, allowing small problems to fester into big ordeals. Other dentists lacking patience, communication skills or humility may practice an authoritarian approach to management. As you can see, red flags exist on each end of the spectrum. When it comes to conflict, I look for three “C’s”: confidence, communication and consistency. Consistency is perhaps the most important of the three because leaders who fail to settle conflicts fairly and objectively (with each and every employee and incident) will lose credibility and respect in an instant. Occasional conflict will be inevitable, so look for a doctor who you believe has the skills to effectively navigate through the issue and return the focus to patient care. How important is mentoring in your relationship with an associate? There is a lot of learning that happens by virtue of showing up to work every day. However, if you’re looking for additional guidance and mentoring, you’ll need someone who’s willing (and excited) to teach. Many owners will appreciate your openness to learning and genuinely want to tutor you in their practice style. I personally believe that mentorship is crucial, but some associates and owners thrive in a more laissez-faire relationship that affords more independence. If your interviewer simply wants a warm body that increases production career transition and doesn’t ask questions, do yourself a favor and head for the hills. Tell me about your approach to patient care. Do you expect your associate to adopt your same clinical philosophy in full? For example, will the owner expect you to swap out every amalgam in a patient’s head for composite as standard protocol because she does? Will the owner expect you to take on every molar endo and surgical extraction because he does? Failure to discuss these questions can be a first-class ticket to a world of pain. We’re talking potential ethical dilemmas, litigation and early tarnish to your newly minted professional reputation. We will all have moments when our ethics are tested, but you might not expect the first test to come before you even land a job. Your patients trust that you’re giving sound advice and making wise decisions. What claims are you willing to make? To what level of risk are you willing to subject your patient? Take time now to consider where you stand so you are not caught off guard. As Will Rogers put it, “It takes a lifetime to build a good reputation, but you can lose it in a minute.” You can barter with benefits and negotiate wage…but there’s no such thing as “meeting halfway” on ethics. Will I be satisfied with what I have here and now? This last question is actually for you, the associate. My friend and mentor, Dr. Eric Peterson, gave me some great advice that I now share with you. When it comes time to make a decision, do not commit to a scenario in which your happiness will be contingent on future promises. Things don’t always go as planned and promises aren’t always kept. Ask yourself, “If things were to stay exactly how they are right now, would I be happy?” If you can whole-heartedly answer “yes,” then you can’t lose. “Perfect is the enemy of excellent’” is one of my favorite mantras, and it rings true for the art, science and business of dentistry. Don’t go looking for a perfect opportunity…because your job search might never end. Instead, look for an excellent opportunity that’s compatible with your ethics and goals, and feels good in your gut. Don’t hesitate to ask a ton of questions—it’s a simple way to get a happy and successful career started on the right foot. For “30 Interviewing Questions for Finding the Right Fit” and more tips for new dentists, visit Dr. Dulde’s blog at www.excursives.com. the money issue I f you asked graduating students what they hoped for their careers, owning their own practice would rank high on the list. However, very few seek this straight out of school. While it may be their dream, it’s a daunting task due to the amount of debt waiting for them after graduation. Like most fourth years, I am beginning to feel the burden of the debt I have accumulated. I now wonder if it is possible to take this path right out of school. from the magazine “Dental Economics.” Dr. Archibald admits he didn’t always spend his money wisely as a student. However, he was always aware where he was spending it and stayed within his means. Dr. Geoff Archibald, a 2007 graduate from the University of Minnesota, achieved this dream. He, along with a 2006 graduate, bought a practice in Minnesota. Dr. Archibald had no previous business experience and learned most of the basics credit cards. Second, everyone should have an emergency savings to cover two months of expenses. If a perfect job requires a move across the country, it is financially better to use savings rather than credit cards. Third, he suggests Dr. Archibald offered his approach to tackle debt. First, he suggests paying down any high interest debt, particularly anything more than 12 percent, such as investing in one’s retirement early. Maximizing retirement contributions at a young age provides greater time for the money to grow. While the market may seem unstable right now, many stock options are cheap and the market will likely turn around during your career. Fourth, if you don’t plan to buy a practice right out of school, start putting together a consistent savings plan for a future purchase. Even if it will be years away, money put aside for this will give you the chance to pounce on a practice opportunity. After the first four steps are achieved, dentists should consider making accelerated payments toward their school debt. A final piece of advice: being a successful dentist is not only about money. “Figure out what makes you happy,” he says. “Once you figure that out and know what you want, then you can make good decisions on how to get there.” PRACTICE PARTNERSHIP . . .WITH PATTERSON DENTAL THE RIGHT CONNECTIONS CAN TAKE YOUR CAREER TO EXCEPTIONAL HEIGHTS. N THAT YOU’VE KNOW L, O O H C S L TA ATION. N AND INNOV ST DAY OF DEN IO R T FI A R C U U O Y ED Y, M T FRO S FOR QUALI ENTAL STAND D N O S ER T T PA CLINICS OR DED SUPPLIES IN YOUR AN BR NSO ER TT PA AC TICE AFTER MAYBE YOU’VE USED ARING TO GO INTO PR EP PR ON S SE UR CO R NTAL, AT TENDED ONE OF OU LUE OF PATTERSON DE VA E TH T OU AB D NE R YOU LEAR GRADUATION. HOWEVE FOR THE LONG TERM. YOU IN YOUR CAREER G TIN OR PP SU TO D WE LOOK FORWAR PARTNER WITH PATTERSON DENTAL FOR THE PERSONALIZED CARE R. YOU NEED TO BUILD AND MAINTAIN A REWARDING DENTAL CAREE PRACTICE PARTNERSHIPSM WITH PATTERSON DENTAL. Call 800-873-7683 or visit www.pattersondental.com to start living your dental dreams. the issues I n the aftermath of the recent health care reform, dental coverage has become a hot topic. While assisting at a private practice, I saw that a large portion of the patient population was 65 years or older. Most lived on a limited income and had no dental insurance. Since the costs associated with dental treatment remains mainly a patient responsibility, it can be hard for these patients to pay for even preventative and routine care. Research shows that this issue is a nationwide epidemic. Since the first generation of baby boomers turned 65 in 2011, we can expect a steady increase in the number of people turning 65 for another two decades. These patients have Medicare, which covers hospitalization, outpatient physician visits, psychiatric visits, prescription drugs and even physiotherapy. However, the program has no funds for routine dental treatment. Organized health care has historically put dentistry on the back burner, which adversely impacts accessibility to dental care for people under Medicare. Of the $524 billion spent by the federal government on Medicare in 2010, none was spent on routine dental services. The recent economic recession has shrunk the savings and assets of many Americans who are either approaching retirement or already retired. Uninsured patients may become reluctant to schedule routine checkups, which could lead to the deterioration of preventive dental health care. Covering dental services under Medicare helps patients maintain dental health. Extensive and expensive future dental procedures can be prevented. A simple filling that could have cost about $150 might end up needing a root canal and crown, costing about $3,500 if left untreated. Lack of coverage will also impact dental practices, as dental insurance is responsible for roughly 45-50 percent of total income. Most dental practices would benefit if patients still have some form of dental insurance under Medicare. These patients would find it economically viable to keep going to their dentist for routine care. Even so, dentists are reluctant to accept patients covered under federal and state funded-programs because of the low reimbursement rates. Patients with Medicaid end up having dental treatment at either community health centers or schools, which are not always easily accessible. The dental community needs to negotiate for competitive reimbursement rates for services provided to encourage dentists to take part in programs like these. Covering routine dental care and preventive services under Medicare will help reduce the number of medical emergency visits related to dental problems. These medical emergencies are expensive compared to the cost of preventive dental care, and also ineffective with respect to long-term care. Emergency treatment is largely symptom-focused and fails to address the problem’s causes. Investing in preventive dental care through Medicare and other such programs is critical to avoiding costly procedures later on. Just as oral health is an integral portion of the overall health and wellbeing of the patient, oral therapeutics and maintenance care should also be considered an integral part of the health care system. the issues student perspective wo years ago, I crossed the Atlantic to study children’s book illustration at Cambridge School of Art. I lived on the fourth floor of a bed-and-breakfast on a rainy green island called the United Kingdom. I dried my laundry on radiators and consumed inordinate amounts of milky tea and biscuits. I grew accustomed to the cheerless dribbling rain, and I even learned to ride a bicycle in a dress on the left side of the road. My introduction to graduate level study was about to begin and it would be nothing like dental school. The key distinction between American dental training and an English art school is the philosophy of education. Cambridge School of Art uses the tutorial system. Students are placed under the supervision of one or several tutors. In my program I met Martin Salisbury, a world-renowned art critic and leader in his field of study, who met with students bi-weekly in one-on-one meetings and small groups. These tutorials were characterized by progress checks, support, formal and informal critique and dialectic discussion. It was challenging, inspiring and sometimes terrifying to study so closely with well-respected critics like Martin, but these tutorials were the most important part of my learning experience. In contrast, the first two years of my graduate dental studies have been characterized learning in a collective setting. Specialists and researchers impart their knowledge, expertise and skills in seminars covering a fascinating and diverse range of topics. Students follow a rigorous and unbending “eight to five” academic schedule. The highly organized and sophisticated schedule dental students follow serves as a scaffold for building confidence and competency. As a graduate-level art student in Cambridge, I was given an unstructured schedule. My tutorials were supplemented with only one seminar a week. The days of classroom-centered learning I had known as an undergraduate, and have returned to in dental school, were gone. Independent studies were expected to bear results that reflected my personal interests and research progress. As an American, it seemed like an inconceivable amount of free time. I found it daunting to develop my own academic goals and interests. student perspective But with the help of patient tutors, I developed independent learning skills that continue to serve me well. Another similarity between dental school and art school is the necessity to see your art as a trade and a set of skills, with a certain job in mind at the end of the program. In England, these skills were acquired organically with a mentor rather than in a large classroom setting. Similar to pre-clinical dental practicals, art students submit visual portfolios. Through this evaluation process we learn to receive criticism from instructors and develop a teachable attitude as students. Now I live in the Deep South where I sip sweet tea, drive on the right side of the road and enjoy the warm southern sun while studying dentistry. My experience with the tutorial system in England strengthened my desire to develop independent learning skills, and showed me the value of having a support system of mentors and peers beyond the classroom. My experiences as an art student and as a dental student are unique learning opportunities, and I am grateful to have each to draw from. Illustrations © Anna Lucy what are you reading? “T aking good care of their teeth Is something all bears do. That’s why Sis and Brother brush And go to the dentist, too.” -“The Berenstain Bears Visit the Dentist” I can’t remember my first dental appointment, but I still remember Sister Bear’s first trip in “The Berenstain Bears Visit the Dentist,” by Stan and Jan Berenstain. After my first pediatric patient was assigned, I went to my local bookstore for children’s stories that might ease her into the experience. In addition to the Berenstain Bears story, I recommend two newer books for pediatric patients: “Show Me Your Smile! A Visit to the Dentist,” by Christine Ricci, part of the "Dora the Explorer" series, and “My Dentist, My Friend,” by P.K. Hallinan. Each book tackles slightly different topics. “The Berenstain Bears Visit the Dentist” has the widest scope of themes, exploring everything from Sister Bear’s losing a tooth to what “scary” instruments might look like. It illustrates her fear of extractions in a sensitive and helpful way. The authors validated Sister’s fears, allowing her to be scared, but in the end her extraction was nothing to worry about. While the book is longer than most parents enjoy reading before bedtime (I recall my own mom complaining about this), it does a great job preparing pediatric patients for most procedures they will face in your chair. The second book, “Show Me Your Smile! A Visit to the Dentist,” focuses on the progression of the dental appointment. It follows patients though the waiting room before the appointment, taking radiographs, receiving oral hygiene instructions, receiving what are you reading? restorations, and earning stickers before going home. The book is targeted at 3- to 4-year-olds and is available in multiple languages. It received rave reviews from parents online and will probably be useful for a large number of patients, especially Spanish-speakers. “My Dentist, My Friend” is an adorable rhyming introduction to the dental appointment. The book discusses the role of the dental assistants “with welcoming looks,” the oral hygienist “showing kindness and care,” and the eventual gentle touch of “my dentist, my friend.” The story prepares patients for all the people who file in and out of the room. This would be particularly helpful in a dental school setting. I believe preparing a child for the dentist means preparing the entire family. This is simply one way to approach pediatric oral health literacy. Even though parents can read a dental-themed book to their children, they might not understand what it means. In a study published by Richman et al. in the September/October 2011 Journal of Pediatric Dentistry, parents who recognized dental terminology did not necessarily have a high level of pediatric oral health literacy. These books could serve as a starting point for conversation between the provider, parents and patients. Next time your patient’s parents call with concerns about the appointment, consider suggesting they read one of these books before they come in. Even if they don’t ease all of their worries, at least they had a great bedtime story. predental corner W hen you think about paying for a dental education, the first thing that comes to mind is usually the high cost of tuition. But the application process often is quite pricey as well. Between the AADSAS application fee, supplemental fees, buying an interview suit, transportation, lodging and deposits, it is almost guaranteed that you will spend $5,000 or more. From my interviews, I learned that the average dental applicant applies to 10 to 15 schools. According to 2010 ADEA statistics, about 41 percent of applicants graduate into dental school. It’s critical to cover your bases and apply to safety, target and reach schools. The interview process is unpredictable: some schools may grant you an interview even though $1,360, though this amount varies based on the number of schools to which you apply. However, most schools also require supplemental fees. My supplemental fees ranged from $45 are accepted. Most who are accepted between Dec. 1 and Jan. 1 get 30 days to put down a deposit. The time period for a deposit decreases the later you hear in the admissions cycle. These deposits to $100 per application, which totaled nearly $1,000. can range from a refundable few hundred dollars to a non-refundable few thousand. One of my friends was accepted to Pittsburgh on Dec. 1 and paid a $750 deposit. Then she was accepted to Maryland shortly after and paid a $750 initial deposit and the $1,000 second deposit. Weeks later she was accepted to Stony Brook, where she will be attending at the deposit price of $2,500 solely because of timing. Two other future dental students each put down $1,500 deposits to NYU, which went to waste once they were accepted into their dream school, UPenn, at a later date. your credentials are below average; others may deny you an interview even though your credentials are above average. Interviews greatly add to the expenses. First, you need to buy an interview suit if you don't already own one. Then there’s the cost of transportation and lodging. Transportation costs range from gas and tolls to flights to schools that are farther away. Some schools don’t let you choose your interview date, causing you to pay more for last-minute flights. For example, one school that I applied to assigned me an interview date and would not guarantee me another if I missed the first date. I had to purchase a more expensive flight because I could not book it further in advance. While some hotels offer group discounted rates for students interviewing at dental schools, staying at a hotel still costs about $100 or more each night. I stayed with friends at a few schools, but had to stay at a hotel for most of my interviews. I applied to 16 schools. My base application fee for AADSAS was Each school requires a deposit within a certain time, depending on when you The process of applying to dental school is daunting. I was accepted my first time applying, but some students take two or three cycles to gain acceptance, which amounts to double or triple the cost. Appications are an expensive, yet worthwhile investment. Optimize your chances of getting in by applying to a wide array of schools. just for laughs by John Syrbu, Iowa '13 the money issue Q: Should I buy or rent during dental school? Suzie Orman points to The New York Time’s online buy-rent calculator to see if buying your home will pay off based on home price and years you will be living there. For example, owning a $160,000 home is better if you stay there for five years or more and about breaks even with renting at four years. For dental students in a four-year program, renting is often just as good as buying. If you plan to continue with a residency, are in a DMD or Ph.D. program, or are looking to practice in the area of your dental school after graduation, buying might be the right choice. Q: What can I do with my money right now to make things easier in the future? Budget. Learning how to be responsible with limited funds will make managing your money later a less daunting. Build your credit (or at least don’t get any black marks). If you have a credit card, always pay your balance on time and don’t open multiple cards. Just opening up credit accounts can automatically lower your ratings. If you have undergraduate loans, always pay on time. Just one late payment can lower your credit score 100 points! Educate yourself. Attend any meetings or talks your school offers on managing finances or student loan debt. This same information may cost a pretty penny later on, so take advantage of the free advice while still in school. Launched Fall 2011 THE NEXT DDS provides you the support you need where you need it. www.THENEXTDDS.com Enroll for FREE today! BECOME A FAN ON | FOLLOW US ON MOBILE