Would you go back to school now?

Nov 28, 2010

If you had the opportunity today, would you return to residency training after being in general practice?

I was in private practice for 18 months before I decided to go back to school. When I start my residency in 2011, I will have been out of school for more than two years.

What prompted this career change? I've known for some time that I enjoyed endodontics and the special joys of helping patients in pain or special needs patients, performing challenging and medically necessary procedures, and being part of an interdisciplinary team. Peripheral influences were a mixture of academic ambition, intellectual boredom, and a stagnant economy.

With a decision like this, "analysis paralysis" is your enemy. This was how I started my residency application journey -- overresearching and overthinking. So many sources of information are available, and so many opinions you can seek. I felt like I had read or heard it all -- every online forum, every statistic published on income and job satisfaction, and every speculative comment on the future of our profession.

Finally, after much logical, left-brained contemplation, I realized: "Just do it."

First steps back

Dental school is a stressful environment. The pressures of balancing assignments, tests, patients, licensing boards, and clinical requirements, all while trying to have a life, can cause many tears and some nervous breakdowns. The upside of asking for letters of recommendation after being out of school for a while is that people tend to remember the good and forget the bad. The downside is that not much may be remembered at all, and you could get stuck with a hastily filled out sample recommendation letter template chosen by the Google gods.

Luckily, I had kept in touch with my mentors from school, and they remembered me as a likeable fellow. Still, getting a busy dean to put pen to paper for you is a formidable task. The critical people here are the gatekeepers -- the program secretaries or the personal assistants. Be nice but persistent, and start months in advance of the deadlines.

The application process is an avalanche of paperwork. But applicants want a centralized, standard application process, while program directors want the data presented to them just how they like it. Therein lies the crux of the problem. The centralized applications at the American Dental Education Association are excellent services, but their value is diluted when most programs require a secondary application anyway. Still, everyone does their best to make the information freely available and easy to understand.

The interview marathon

Interviewing around the U.S. was the most fun -- and the most challenging -- part of the process. You get to meet some brilliant people and visit some great new places. I joined a frequent flyer program and racked up airline miles. I enjoyed the cities I visited, and took some time to look around each area.

Taking time off can be challenging, especially if you have a family and a practice. In school, it's seen as an excused absence, but at work it can cost you a job or significant practice revenues. My wife took it well, but I could see the emotional and financial strain.

Also, be prepared to answer some uncomfortable questions. Different programs look differently at the experience on your resume. To some, my commitment to specialize was indicative of a love of learning, while others were skeptical of my ability to get back into education mode again. Not every program values real-world experience and the knowledge or biases that come along with it.

Numbers matter. Program directors need some objective criteria to make decisions, and high numbers are currently the best way to make this happen in your favor. I may have been a naïve dental student years ago, but thankfully I was blessed with good test-taking skills. Needing to retake a basic science test many years after you studied biochemistry or physiology can be tough, but if you do it successfully, it will pay rich dividends.

Also, do not limit your options. Cast your net wide enough and apply to a large number of programs. I applied to 23, and I met people who applied to every single one in the U.S.

Waiting to exhale

Remember your high school prom? I felt like I had asked 23 girls out on a first date. Six agreed to go, and I asked each at the end of the evening if she would go to the prom with me. They all said they would get back to me within a week.

Many specialties navigate this minefield through the ADEA Match process. Simply put, the Match is a contract to let a computer pick your date for prom night. The girls and guys rank each other based on the first date, and the computer pairs everyone up for the big prom night.

Unfortunately, the endodontic program directors do not believe in the Match. Endodontics is more like real life: A girl you dated could call and say, "Yes, I'll go to the prom" -- but what if you're waiting to hear from that hottie in chemistry lab? Hell hath no fury like a woman scorned, and I heard many stories of past applicants who got themselves in a pickle.

If you must withdraw after accepting an offer, be sure to do it nicely and respectfully. It's a small world and you never know who could be your examiner for board certification.

As for me, I am excited about landing a spot with my top choice!

Prashant Verma, DDS, is a general dentist practicing in San Francisco and a clinical instructor at the University of the Pacific School of Dentistry. In the fall of 2011, he will be attending the endodontics residency program at the University of Maryland's Baltimore College of Dental Surgery.