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Dr. David Maconi on General Practice Residencies – Episode 23

The Dental Amigos host Dr. David Maconi, a practicing dentist who completed an AEGD residency at East Carolina University where he largely focused on developing skills in implant placement, surgical extractions, and cosmetic dentistry. Dave is currently working in a large DSO practice near Columbia, South Carolina and has recently begun his own charity-based podcast interviewing experts in their respective fields and making donations to charity for each interview.


Dr. David Maconi

In this episode, Paul, Rob and Dave chat about the difference between AEGD and GPR programs and the potential benefits that these programs may have for the dentists who complete them: the ability to expand their skills, learn advanced procedures, network with mentors and potential employers, and more. They discuss how these residencies can impact a dentist’s job search as well as the potential economic benefits of these programs for both the dentists who complete them and for their employers.

YDL: Maconi Transcript

Intro: Welcome to the dental Amigos podcast with Dr. Paul Goodman and attorney Rob Montgomery taking you behind the scenes of the dental business world. All the things you didn't learn in dental school, but wish you had. Rob is not a dentist and Paul is not a lawyer, but since rob is a lawyer, we need to tell you that this podcast is for informational purposes only and it shouldn't be considered legal advice. Listening to this podcast does not and will not create an attorney client relationship as is always the case. You should formally consult with legal counsel before proceeding with any legal matter. Learn more about the dental amigos at www.dotthedentalamigos.com and now without further ado, here are the dental amigos.

Rob: Hello everyone. I'm Rob Montgomery and welcome to another episode of the Dental Amigos where we're joined as always by the head Nacho himself. Dr. Paul Goodman. Great to be hereRob Paul. It's good to see you. It's going to be back after our little uh, holiday hiatus.

Paul : I know a break from some dentisting and the real world. It was nice.

Rob: Cool. And uh, so today we have a guest, which is great. Dr. David Maconi. Dr. David Maconi, graduated from the University of Maryland in 2017 he completed his AEGD residency at East Carolina University where he largely focused on developing skills and implant placement, surgical extractions and cosmetic dentistry. Dave is currently running a practice for a large DSO, a near Columbia, South Carolina and recently began his own charity based podcast where he interviews experts in their respective fields and does good things with that. And he makes donations to charities for each interview. So we're happy to have a Dave with us today. And without further ado, here's Dave Maconi. Welcome amigo thanks for being on the show.

Dave: Hey guys, happy to be here. Thanks for having me on.

Paul : Really Fun to talk to you, Dave, when we start with some hard hitting questions. Uh, so if we went to get Nachos in a South Carolina, uh, this weekend, where would we go? And, uh, what would our topping beer, what's your favorite topping?

Dave: For me, you know, I'm not too picky about, you know, what kind of meeting is on there, but I'm a huge cheese guy. A lot of my friends know me, has just been obsessed with cheese, so any type of meat is fine as long as there's loads of case of on there.

Paul : Yeah, you and my wife would along. Cheese is a one her favorite thing. It's a staple of the Nacho plates of sounds fun. I'd like to do that.

Rob Montgomery: Hey Dave. So, um, you know, tell us a little bit about your your podcast. As a fellow podcaster. It's always fun to have another podcaster with us, uh, what you do with that and, and uh, how you, uh, how you give back with that too.

Dave Maconi: Sure. So, yeah, so finished up the residency this past summer and now that I wasn't having to study and you know, being class and I just thought, what's a good way to use some of my time? And I've been into fitness since I was probably about 10 to 12 years old. So as you obviously know, podcasts have been really big lately and I watched a lot of like Joe Rogan and people like that. And so I just thought the idea was really cool, but I didn't want to do it - certainly I don't do it like for income or anything like that. So I thought like, what's a good way that I could make it? Yeah,

Rob: It's a hobby. It's a passion.

Speaker 4: Yeah. Right, right. And you know, so I figured if it doesn't go anywhere, what's the way that could be worth it? And I thought, I'll at least have it so I can donate to charity for every one. And so any guests I have on, I asked him what charity they stand behind and then I'll make a personal donation. And then hopefully, you know, the people who watch it, they will see it and they'll like the idea and they'll make a donation too, and you know, it's not like the, uh, the content really isn't about the charity. It's kind of like during the intro we've mention it and then we get on to things like fitness and health and, and you know, things that a lot of people are really interested in. But the charity aspect of kind of just a gentle reminder for people watching. Um, and that's called the Brains and Gains Podcast that's on youtube. I'm on Instagram as well, just under my name Dave Maconi.

Paul : No, you see, that's a great message. And uh, uh, if I'm on the charity, it will be the Paul Goodman Nacho Fund. Now, just joking.

Rob: So tell me, what kind of stuff do you talk about on the podcast though?

Dave: So right now it's been a lot of PhDs in the field. Um, some medical doctors as well. So like I said, it's actually a science has been a huge passion of mine. Um, some Dietitians as well and just really, you know, um, different aspects. So some powerlifters that some bodybuilders. I'm just talking about the ways to reach your goals, but you know, I, like I said, it was my interest being very buried for a while there. I bring on people from different areas, but mostly for fitness goals. And I think eventually I'll probably branch out to like life success as well. But for the most part now it's health and fitness related.

Rob: That's really cool. So your audience, I assume just by virtue of the fact you're a dentist, you have some dentists to listen, but you go beyond the, uh, the dental world with, uh, with your show.

Dave: Right. Yeah. And I liked that. I have, you know, two different aspects because I know some people who love dentistry and it is their entire life and I obviously like it, but, um, I think if I was doing dentistry 24, seven and I didn't have another outlet, it would get to me. And at the same time, if I was just doing health and fitness stuff and I was a trainer 24, seven, it would get to me as well. So I liked that I can kind of have those two separate areas.

Rob: Yeah. That's cool. I mean, I always find too that I think it's important to kind of go outside of your, your usual realm and, and talk to some different people and kind of be involved in some different things. That brings, uh, a new perspective to a, to what you do. I mean, a lot of the people that we've had on the show, the most successful people, you know, the Mark Costes is of the world. Uh, and some of our other guests, you know, Gary Takacs they kind of came to where they are now through, uh, through a path. It wasn't served as falling in line and doing what everybody else does. And they kind of bring other life experiences and world experiences and business experiences to their, their dental world. And you know, there are the really the, the leaders and a lot of respects in the industry. And I think it's hard if you're not bringing in fresh ideas from other places it's hard to see how you kind of can kind of carve out a, a meaningful niche for yourself in the dental world too.

Speaker 3: Okay.

Dave: Oh sure. For sure. Yeah. It seems like some of the most successful people and they have other avenues that they're successful as well, not just necessarily one place.

Paul : I think it's, I totally agree. And also I've just mentioned this in one of the groups the other day that some of my most important coaches have been totally non dental or trainers in our office. And a lot of times, uh, I got those coaches or trainers by just good timing, which is another word for just being lucky. But I encourage young dentists, you know, when they are asking about, you know, who to get as a consultant, practice management, anything to, you know, seek outside of the dental world raw for different perspectives. Rob's helped me, uh, without a lot and listen to different podcasts like Tim Ferriss and things like that. So I think that's an important message for dentists. I think what you're doing is great.

Rob: Dave, I mean, I think also, you know, one of the things that I personally am working on for myself and in my office and something that we're, we're starting to get more involved and on this podcast it's just really the importance of taking care of yourself. You know, and we're all in, you know, stressful professions where it's really easy to kind of just forget about, you know, your health, your wellbeing from a mental health standpoint and from a physical health standpoint. And you know the profession of dentistry is very demanding from a stress standpoint and from a physical standpoint. So if you can maybe talk to our listeners a little bit about how you use this, the exercise component and how that, uh, how that ties into your practice of the profession.

Dave: Well, yeah, especially, you know, as you said, as dentists, we're constantly on Stober on it. It can be very stressful. We were going, we're getting off, sitting down, getting up, sitting down. And so, I mean, it's very clear from pretty much every study on the matter that exercise helps with joint pain. It helps with longevity, things like that. And consistently that people, you know, you have some people say, oh, you know, they have an issue with their knee, let's say, and they just rest. And a lot of times they'll find that the longer they rest, the worse it gets. And then the actual activity is what helps them because you're getting blood flow, things like that. And you know, that that applies obviously, not just with dentists, but any, uh, any stressful job you have. And so for people who, I find that people who end up being inactive, which is very common, you don't have to, you get of school and out of the sports people just kind of tend to get lazier. It just, it seems to like age and you know, I know people who are in their fifties who have been maybe either bodybuilding or maybe not taking it as seriously, but I've always been active and there's just a huge difference in not just how they look physically, but in their productivity in life and their mindset, you know, obviously I think it's, it's pretty well known now that exercise helps for depression. Um, so you know, a lot of times people get stuck in their office. They're there 50 plus hours a week. Exercise and being out in the sun are both very helpful for depression and a mindset in general. So I think just for overall health, you got to stay active in some way. It doesn't have to be in the gym. But you know, some way keeping yourself active.

Paul : I liked it. And there's a great, great, uh, it also rob. So we've stretched or stressful a PR. We have a stressful professions, but we also have stressful positions we put ourselves into, you know, being hunched over a patient. But additionally, what I found is being this medium mates practice owner, you know, I just flew to Portland for an asthma event, which was great, but you know, everyone knows the experience of sitting on a plane. So I just want to share with Rob so he can understand what being a dentist is like. It's like being in the middle seat on a plane and the person next to you is kind of mildly annoyed at you the whole time. And when they get up, someone sits down is also mildly annoyed. So the stressful position is not only just being hunched over, it's also just being in someone else's personal space for your profession all day long, who doesn't want to be there? And it's just a lot to deal with. I think exercise and being in shape just, just helps you deal with that.

Dave: Sure.

Rob: Yeah. I think also it's nice to just have something else to just do in the course of your day. You know, like if, if all you do is, is do dentistry, think about dentistry manager practice and then you go home after, you know, doing 12 hours of that, you know, you're probably not that interesting of a person to be around, you need that little break where it's like, hey, you know what, today I, you know, you think about your day or what you're going to do or reflect on what you've done. And you know, I ran five miles, I swam 3000 meters. I lifted this. Like it just gives you something else to kind of focus on. And you know, I think it's, which is a healthy thing. I mean, if all you ever do is just obsess over the practice of your profession, you know, I think it's going to be hard to really sustain that over, over the long haul. You know? And I think a lot of people, if you look at, even just to put it from an economic or a monetary standpoint, if you're planning on being in the game for a long time, which is kind of what a lot of people want to do, if you're going to make money, you have to do it in a way that you can actually sustain. And beating your brain's against the, you know, in every day, uh, while it may have a, uh, uh, an a, an uptick in the short term, but you're, you're not gonna be around 15 years right now if you're still doing that.

Dave: Sure. And I just make one other point on that is I think most of the evidence shows that the most productive people, they, people who exercise regularly, and I know a lot of people said like, they don't have time, but when you exercise, it just seems to be that you find a way to get it in and you do become more productive. And I know throughout all four years of dental school, I was in the gym about four days a week and I was also sleeping about seven, eight hours a day too. So it wasn't, you know, like I had to be barely get any sleep or cut corners in order to go to the gym. I mean, if anything has seemed to allow me to be more productive at other times of the day.

Rob: Oh absolutely. And I think it's, it is counter intuitive and it's easy when you're, you know, you have a family and you have other obligations and business obligations to do that. But you know, my, my thinking with that is, you know, you just have to make time for yourself. It's important and you know, also to schedule it, you know, and if you, you know, it's like this is what I'm going to do and this is my time. I'm going to carve that out for an hour, whatever, four days a week and just make that sacred. Because again, it's important to the people around you to do that. And it is easy to say I'm too busy. But like you said, Dave, that's been my experience too, that no matter how busy you are, if you stopped doing that, you're just going to be less productive and then just not have as much time.

Paul : Sounds like you're getting too much sleep though, Dave. So I'm going to offer this to you free of charge. I'm going to send my a five month old down there for a week and you know, see if that disrupts your pattern and all.

Rob: We've got a four month puppy that way too. So I think I could work out more if she were sleeping, so that's cool. But yeah, thanks for sharing that. I'm actually really interested to check out the podcast and we'll talk about the end of the show. We'll be sure to put the link to that in our show notes. So, um, Dave is, you know, you are a, uh, an alum of a, an AEGD program. We definitely want to drill down on some of the benefits of that from an employee or associate standpoint and an employer standpoint. But before we roll with that, I, I actually am curious, and this is something that I'm not fully aware of. Like what is the difference between an AEGD and a GPR?

Speaker 4: Sure. I mean, at least in my experience, the AEGD is more university based and the GPR is generally more hospital based. So ECU actually had an AEGD and a GPR pretty much right next to each other. And you know, we, we talk with the other residents, so we've got a good feel of what they did. They definitely seem to get more surgical experience than us. Um, but for most other things, I would say we got more experience. And though it depends on what you want to do. I think if you're going to work in a hospital than a GPR makes sense. For me, and you know, the other, you know, the attendings who helped us in the Agd, some of them had done GPRs and they said the same thing that they had learned some cool things in the AOR. Um, they had learned a lot of medical management, but it didn't necessarily help them in private practice. And I'm sure, you know, Paul can talk about the GPR and I think they're both great. But for me I was always happy that I did the AEGD, um, just because it seemed a little bit more applicable to what I would be doing in practice. You know, we have, um, a prosthodontist with us too, was really good. Um, one guy who wasn't actually a prosthodontist, but he was, you know, he had done a ton of CE in that. Uh, he was really great with the cosmetic stuff. Um, so for me at least the AGD made a little bit more sense, but maybe Paul has a different opinion there.

Paul : I was just listening to a great podcast with Tim Ferriss with the founder of stripe and Tim was ask him how he made good decisions. People have told me I'm, you know, a good decision maker. They come to me for advice on decisions. And what he said really struck home with me is that both are good and you set yourself up to make a good decision whether you're doing a GPR or AEGD. So I'll describe that like Tacos or Nachos. We would both like those are good, both good choices, but then you pick one that fits your personality type. And also by doing some real, you know, old fashioned research, whether it's going there, seeing the residents. Uh, one thing I'd like to point out, and I am a huge proponent of GPRs and a AEGDs, but just they're just different cultures for each, each one, even amongst, you know, different AEGD. So I encourage people to really research, go to the programs. But what I wanted to ask you a day, because we, Facebook has allowed us to connect with so many dentists across the country, which is just great. But dentistry and dental schools have a lot of regional trends to them. Right? So I went to Penn, you went to Maryland. Uh, I see on the east coast, a lot of people do do GPR or AEGD is I go into the middle of the country. There are as many programs where, when did you make the decision to do an AEGD in your dental school process?

Dave: Pretty much as soon as I found out about them to be honest, you know, because that was probably when I really started hearing about them. That was maybe my second or third year as far as looking into the details. And I just talking to some of the students above me, they were just telling me about the experience they got and it was fine. You know, you got the minimum requirements and maybe you got a little bit more than that. Um, but just talking with them and then talking to some people in private practice, it just seemed like most people recommended doing one. Um, you know, I think maybe if you have a parent who is in dentistry, it's not as essential. Um, but it just seemed consistently they were telling me that more and more people are doing it and I just wanted to, when I was applying for jobs, I wanted to have that advantage. You know, I didn't want to have to try to explain why didn't do one and and act like maybe I could make up for it here and there. I just want it to have that experience so that I was more confident going out into the real world with it.

Paul : As you had pointed it in, since I'm a Nacho ordinary person, I had a parent in dentistry and I did a multiyear GPR so, and my dad was the one who encouraged me to do that. And you know, I know we'll, we'll talk about different points here, but one of the ones I would just like to point out is that, you know, when you're in a GPR or AEGD and to keep with the theme of the gym, you really get to work out a dentistry in an environment where you can practice and get training on patients that are there for learning purposes. And you, you know, do good work on them, but private practice, as you could probably tell us now being in private practice the vibe is a lot different than a residency program, right, with the patients.

Dave: Yeah, hugely. And you know, I think we mentioned before, I'm the only dentist in this office right now, so there's just no way I could be doing that if I went straight out of school. And I think that probably applies to most people at a school, not everybody, you know, some people would be able to, but um, that residency just huge. They helped me to not only the competence but the speed. It's hard to say how many I specifically see myself, but on the schedule, it's just me and the hygienist we see probably post to 40 patients a day. And you know, when you're coming out of school and you're seeing maybe two to four patients and that's a jump to that, um, it's just not that feasible. So it is very different as you said. And also just your ability to do certain procedures. You have somebody in your corner, you know, if there was maybe a calcified tooth that I want to do endo on and I have a year of this experience and an endodontist at my side helping me out, well then when I see that in private practice or you know, any, you know, after residency you're just going to be more comfortable and sometimes you're still gonna have to refer. Um, but you know, you've done it before. Same thing with like impacted wisdom teeth. You know, I do that fairly often now and that's definitely not something I would've been able to do directly out of school.

Paul : Excellent plan, Rob. I'm uh, their favorite clients. They made me a tee shirt and everything here at the Montgomery law firm, but getting to know Rob coming. You know, we're doing the podcast from his office and I just, you know, for our listeners and for you, David and I had embraced this because I was a server for many years. So when you're a server, you're a dentist, you're just constantly on stage. There's no such thing as off stage with your clients. So you're working on them. So if things go off script, you know, instead of saying wrong, you really can't plan it out behind the scenes and then go back to the patient where in other professions, you know you have the opportunity to be away from your clients. So the more practice you can get on patients and in environment that I call, you know, supportive and uh, you can call someone over and say, Hey, could you look at this prep or implant impression or help me with this wisdom tooth extraction and that's the way it's supposed to be in AEGD or GPRs and I have three awesome young associates in my practice all uh, have done a GDS or gprs because I can't really do that in private practice the same way because the patient will want to be losing confidence in the younger dentist and I was that younger dentist at one point and it's just a difficult part of our profession.

Rob: Well not to mention too like where do you have time for that? I mean like you're running a business. One thing if you, if your, if your job or what your purpose, when did you go to to quote unquote work that day is to help young dentists in a residency program. But if you're trying to generate revenue in your practice and you spend your whole day mentoring young dentists, then while it's nice you're probably not going to be in business for real long

Paul : Dave, you're in a unique scenario where you're the only dentist there, uh, which comes with pros and cons. But I work in a group style practice and a lot of the people say, well, I want to have a mentor but the mentor doesn't have time for mentoring because they're too busy patienting. And you can mentor at the end of the day or you can, you can have a quick drive by. But when I worked with my dad for years, we would come into the office together and a lot of times not speak until the end of the day. And it's just because we're both working on our patients and you only really can go and get help if there's sort of a major problem going on. So that's why, you know, your point's a good one Rob, because it cuts into the menotrs' productivity if they have to mentor during a private practice day.

Rob: I think that if you think about it from an employer standpoint, uh, you know, the ability to, to hire someone who has had that training, so you don't have to be the mentor at that level. I mean, I love mentoring young lawyers for sure. But I, I prefer to do it at a higher level. There's a difference between mentoring and basic training. And I would think as an employer, the ability to essentially outsource the basic training part, the heavy lifting in the early days, just from an economic standpoint is worth so much. And probably he probably can't quantify it, but maybe you can. I mean if you have somebody that's fresh out of dental school and that means that that day you can do four less procedures because you're going to mentor them, I guess you probably can pull it out for sure. Number on that.

Paul : Uh, I would ask Dave, you know, tell us some of the procedures you do in a typical day, uh, at your running, your large DSO and how some of your AEGD training just comes into play on an hour by hour basis.

Dave: Sure. And real quick, I want to, I would want to caution people when they're applying for jobs or if they're thinking that they can get by without a residency. Um, because somebody that they're looking into with talking about mentorship, because everybody I talked to said that they were going to offer mentorship. And oftentimes those are from people who aren't even going to be in the practice. You know, somebody has a group practice, they say, hey, we want you to be at this one practice by herself, but you know, there's going to be great mentorship because we have a group chat or there's going to be great mentorship because x, y or z. And like you said, even when the person is there, it's often hard to get true mentorship. But especially if you're on your own. I mean, even for this Dso, um, you know, I, I've enjoyed my time here so far, but they even said, you know, there's, there's great mentorship, there's always people to talk to. The reality is 95 plus percent of the time I'm on my own. And whereas in a residency, they're there to help you, you know, that's why they're in the program. So, um, it's just a word of caution to people who think they might get just as much mentorship going into practice.

Rob: And then just, you know, from an employer standpoint, you know, again, they got free training. Somebody else trained here, it didn't cost them a dime, you know, and, and you're able to do all these things without them having to incur the costs. I mean, Paul, do you even hire associates?

Paul : What happens is I wouldn't for a few reasons and it, I, it's uh, I would actually clarify this way because I'm doing all the CE that I do, I meet awesome dentists who have not done residencies, but what did the, you know, I to steal rob where Dave and I just feel we're fortunate. You know, we had good awareness of GDS and gprs. So at Penn we did externships and you obviously were aware of one soon when he got into dental school. Right. You knew there was one that you could do.

Dave: Right, right.

Paul : There's many dentist, Rob and it's actually a little poignant to me that go to dental school for four years, pay to be there and they are just totally unaware that these programs exist. And many have said to me, I wish I knew you in dental school. I would have done this. But the, what do you think the issue is, Dave? It's really actually, even now, it's not easy to even find out where the programs are, what the programs are to kind of like old school information getting passed around. Why do you think that is?

Dave: Man, I couldn't tell you. I think dental schools in general are often a little behind in terms of how information is just given out. We were lucky enough we had a Facebook group and I think a lot of dentists was now most people or most classes, they have a Facebook group and somebody in my class, they just sent out a big pdf and they, uh, they just listed pretty much every AEGD and GPR that was out there. And then for me personally, I just looked at the states that I was willing to go to and I just kept narrowing it down.

Paul : It sounds like a Paul Goodman was in your class, but no, I'm just joking. But that was a good idea On Dental Nachos, there's group on the Facebook page, you can pin a post to the top and I don't know if you've noticed Dave, but you've contributed. The only one that I leave consistently at the top is which GPR or AEGD did you do and is it good, great or meh and I'd leave it there and I'm just so proud that people are contributing to it because it's just like a laundry list and you know, I don't know how this happens in the law profession Rob, but you know when people do internships, but it's, it's to me a little sad that there's dental students aren't getting more awareness so they could say yes or no to a GPR. I think a lot of times they say no by being totally unaware of their out there.

Rob: Well kind of like the classic academia, you know, you'll come to us, we don't have that, right? Yes. You know and mark it to you. But I'm curious guys, they, do you have a sense of what is the, is there enough supply for the demand? Like are these programs full or is this a situation where anybody that really wants to do it can, can find one.

Paul : How is it now? I know from when I was in school, but what would you say?

Dave: I mean there's definitely competition. I don't know personally anybody who wanted to do a residency, we didn't get in anywhere. Um, now obviously, you know, if you want, we can talk about the different quality of different residencies. You know, not every residency is the same and some going to be amazing and some are going to be probably not worth your time. But I can't think of any example that I know where somebody was trying to do a residency and they just couldn't do one, it seems like people could at least get somewhere.

Speaker 5: I would say it'd be in the Nacho guy and also for doing it. There's not close to enough spots for all the dentist, but the problem has been solved by sort of, not all the dentists want to do it. Right. So there's one of the things was crazy part about dentistry and I asked Rob, uh, uh, a lot of legal questions uh, along the way cause I had to learn about law cause I want to be Tom Cruise from a Few Good Men but that didn't pan out. But um, you know, certain states require it New York and Delaware two that come to mind immediately, right? So one of the reasons I tell dentists is that, you know, your life changes. So if you're on the east coast, you may want to work on one of those states. So you don't want to have to go back and do one five years out just to get a license there. But if every state did require it, there would not be enough spots. I actually think it would be a good move for residency programs to expand and get more spots. But there probably would be a period of time where there just wouldn't be enough for all the dental students that are graduating because there's 6,000 dental students graduating a year. Let's just say a thousand do specialty programs, or 1500. I don't think there are 4,500 spots a year for AEGDs and GPRs.

Dave: Sure, not to mention that, at least for me, one of the benefits of the residency was the personalized time we got. So if there were twice as many residents, you know, that's obviously going to have to get cut down.

Paul : Tell me a little bit about what procedures, like from your AEGD, you know, did you utilize this week or just even just share with our listeners? You know, one of the things I'm excited to have you on about is just sort of a day in the life of a brand new grad. Tell us some dentists and stuff that people like to hear.

Dave: Sure. So I would say for me, uh, the bulk of my current practice is restorative and surgery. So I'm doing a lot of full mouth extractions and dentures. That's a big base of what this practice is. Um, a lot of, we did actually have an associates under me for the first few months just temporarily. Once she left, I started doing a lot more fixed work as well. But I would say, you know, on a given day, maybe one to two full mouth extractions, a few crowns and endo here and there. Um, and I would say that that is actually the biggest thing I got from my residency. That helps because I think most people are probably fine with their restorative work outside of being on what they come out of dental school. But the endo and the surgery for me was huge and I, I literally could not be in the position that I'm in if it wasn't for that experience in residency. So just to give an example when I finished at University of Maryland and one of the things with University of Maryland that it's, it's a great school, but they have every specialty there. And so I think a lot of people know that when you have every specialty, things get referred all the time. So you really can't do third molar extractions as the dental there because they go to the oral surgery residency. Fnding endo was very hard. I think I did maybe two root canals my entire time in dental school because it just went to the residents. So when I my AEGD, I probably did about 30 to 40 a root canals and that was on the lower end. There was a guy who ended up loving endo once he got to the residency and he did probably closer to 60. So, you know, I'm not saying I'm amazing at endo, but I'm certainly much better. And so when I see a patient, I mean for the most part I'll do most of the endo that comes in the door. And then the extraction, the same thing. I had two really good oral surgeons and the residency, uh, that made me a lot more confident. And so on a given day, I mean, I could be extracting 50 teeth throughout the entire day. Um, and obviously now I'm much more confident with surgical or even anything but fully impacted. I'll probably still refer, fully impacted. Um, but partial bony, I'll do. Um, and yeah, pretty much almost everything that comes,

Paul : You said so many great things I like to share with Rob cause he helps a lot of people at startups and acquisitions. I do too. So a couple things is I get questions on Facebook behind the scenes. I say ask a dental, not just someone just asked me yesterday, do you know a good endo course I can take hands on in the real world? And I was like, I do not know one. An AEGD Is one where you're being paid to do CE. So Dave guys hands to 40 to 40 root canals under guidance in an AEGD where he's being paid to do it. Where this dentist is looking to pay to do this. And one of the things, we just had this this morning because one of my, someone posted, you know, I wish I did a GPR five years out. I said, can you post that? And a lot of dentists, Dave say, well you can just do CE, but it's rare to have it be done on patients. And if it is done in patients, just this one or two, like we teach an implant course, my first implant, I love doing it. Uh, but uh, what you said about the surgery was so important because surgery is the foundation of implants. And in a GPR we do full mouth extractions or AEGD these like, you know, rob, when you see clients I, you know, wanting to do a startup or acquisition, it would even be a good question to ask like, Hey, do you do these other procedures? Because those are the procedures they usually need to do. And the reason for this, Dave, and you would tell and rob and our listeners is when you need an extraction, you need it. We need a root canal, you need it. And you're willing to almost go to any provider who can do it. So old doc Smith or did your crown, you'll wait for that. So that's just an, you know, I just want to take a moment and talk about that.

Rob: Well, it's important. I mean we do, I mean, I don't necessarily drill down too deep with that, but I see it and you know, the, the people that do the startups and that do them well or the people that are able to keep more work in house. And so a lot of those people sort of the, the extreme juiced up people are, you know, the the military dentists, you know, those folks have the ability to do just about anything that, uh, that's going on in that office, which makes it a lot easier, especially from a startup standpoint. But also from an acquisition standpoint, if you have the capability to, to generate more revenue just based on what's happening in your office, that can only be a good thing. And a lot of times, Paul, I think people look at offices and say, you know, what kind of work are they doing here? What's being referred out? I know that I can actually add value to that because I do these other, these other procedures.

Paul : Totally. Dave, so I was just thinking of one of our Facebook friends from your clients in the Midwest. So what's interesting is Dave, you're living it, is dentists will say, I'm doing really well. I'm producing a lot of dentistry. And they say, what do you, what are you doing? And they say, surgery, uh, wisdom teeth, endo, let's just use that since I love it as the three point shots of dentistry and dental school teaches you the two handed set shot. And I've just seen the sixers recently Rob, but they're not too many 10 foot too. And it's set shots. So you know, that's, that's the new way to produce and dental school, like you, Dave said, it doesn't really address it, so you need to find an avenue to do that. So I appreciate your sharing that with [inaudible].

Dave: As far as the cost, I mean again, this is just my opinion, but I think people can be a little short side with that because yeah. You know, and actually I think Paul, somebody just posted in the Dental Nachos group like half an hour before we got started about wishing that they had done her residency and they're five years out now. Um, but you know, people look at the cost and he said, well, I might get 50,000 for residency, but I could make my day first year out, one 20 to one 50 and private practice. And that that's true. But you know, it just reminds me of when I was in I think my third or fourth year, and there was a guy who had gone through the military, so they paid for everything. And I was saying like, Oh man, like, you know, you're so lucky that they pay for all that. You're going to have so much less debt. And he said, yeah, you know, that is true. But if I'm in the military for four years, that's four years further away from owning than I would otherwise be. And you know, when you actually break down what a, you know, standard military dentist compared to an owner has the potential to make, then I would say it'd be actual net result isn't too different. And when you look at a residency, yeah you might lose $70,000 that one year, but how much more are you able to produce after that residency for the rest of your career and how much are you saving on CE? You know, I'll probably, I mean maybe I'll take some endo CE but I just don't need it nearly as much, you know, with anything with implants, I placed 15 implants during my residency. For me to play 15 implants in CE courses would cost, you know, thousands.

Paul : That's, that's a $20,000 CE course right there. Just that is it at least a $20,000 CE course being conservative cause to place 15 implants under supervision and see what you do. I mean, just, that's why I, you know, I'm, I know I'm passionate about, but that's what I say they're actually paying you to do CE you'd like to do when you leave, you might as well do it before you go out and be able to use all these skills, just like you're saying,

Rob: but even beyond the seat, right? I mean, I think, you know, David, you're saying is true. I mean, I think looking at that and saying, well, I'm going to miss a couple of years, uh, of practice ownership because I'm in the military. First off, I think if you're in the military or in residency, you're going to be able to own a practice sooner, flat out. But very much whether you're looking at, uh, the economics here over the long haul have to have to be considered. And, and those are not as tangible. They're harder to kind of quantify. But most young associates are paid on a percentage of their collections or production, which means the more you're able to produce, the more money you're gonna make. That could be a very, very substantial difference. Uh, and if you're able to, to do four cases in a day versus 30, then guess what? You're going to make more money if you're able to do 30. But then even from an ownership standpoint, if you're thinking about doing a startup, as we just talked about a few minutes ago, it gives you a broader, a bigger net to, to throw out to be able to, uh, to, to keep your, get your revenue up. And then from an acquisition standpoint or an ownership standpoint, if you can do things that amount to several hundred thousand dollars a year more in revenue, then you know, and start looking at $200,000 or $300,000 now start multiplying that by 10, 20 years. Now you're talking about real numbers. So, and the fact that you're like, you know, just because you got out of the military where you got Alva residency doesn't mean you have to wait three or four years or five, whatever the number is to, to own a practice. You can do it when you're ready and it empowers you and allows you to do it sooner. So the initial ramp up might be a little slower, but the race over the long haul, I mean I to me, I don't see how the economics aren't much better.

Paul : And uh, Dave you shared so many good points. So when you do a residency, you get to deal with a lot of stuff you might not deal with again, whether it's people getting punched. We did, uh, people who, uh, I was at Einstein in Philadelphia. So during the night and punch, yeah, nice weather. People would fight outside there. So, so we would deal with them and they used them in, well they'd just be out there and they would be fighting and were, I was a hospital based one at GPR. But what's interesting, and you've seen even an AGD is, and this is what I really want to, if we have dental students listening or people thinking about it, it makes dentistry less of a big deal. Cause on my 27th birthday, the trainer from my high school called and said a girl was hit in the face with a field hockey stick. Can she come to my office? And he said it was pretty bad. And I just said without a hesitation, sure send her over and I stabilized was going on. She had an alveolar fracture. I refer her to an oral surgeon. But if I hadn't had experiences like that, it just would have been a huge deal. So for the dental students out there, Dave, would you say it's priceless to make things seem like less than a big deal? Or less of a deal when a crown doesn't fit, let's say, or you don't have a contact that's right when you've dealt with bigger procedures. So I just think, you know, that component of it is something that doesn't show up on the stat sheet, but you just makes you feel better or more confident about being a dentist.

Dave: Yup.

Rob: Before we wrap up and just kind of one other or line of questions I'm kind of curious about too. So you've mentioned a few times throughout the show here that different programs offer different things. You know, and I think you alluded to what you should be looking for or looking for those different, uh, aspects and the different residency or AEGD, you know, programs. If you could tell our listeners what types of things are you looking for, what are some of the differences and kind of what should they be doing from a due diligence standpoint, if somebody decides that they want to do one of these.

Dave: So, when you're looking at the residency is just what aspect they should be looking for?

Rob: Yeah, which ones are good, which ones are appropriate, which are more, uh, you know, tailored to what you think you want to do.

Speaker 4: Sure. Well, yeah, I mean for one, you know, if you have an idea of what you're interested in in dental school, look for something that focuses on that of course, but that might change. As I mentioned, there was that one guy in my residency who liked endo a lot, but he came in hating endo and he didn't want it to at all. And you know, just because of the faculty that we had, um, he loved it and actually he's only in private practice for one year now, but he's going to be going back to the specialized. Um, so, you know, keep an open mind. But for the most part I think we kind of get an idea of things we like. I would say for almost everybody try to find one that offers implants. Um, you know, I don't know the numbers in terms of how many currently offer implant training. But for me that was the biggest aspect of my program. You know, that, and then the endo and oral surgery. But if you can find one that covers implants, I mean, that's just such a huge advantage nowadays. Even in this entire area that I'm in, I'm one of the only people who I think is really trained aside from the oral surgeon who comes in the office as far as implants go. And if you get a chance to talk to the directors, like for our program is actually a little unique. Our director changed halfway through just because the previous one was retiring, but they have very different personalities and, and that can be a factor if you're going to be around that person, you know, every day you hopefully have somebody that you kind of jive with. So even as far as the personalities that are in the different programs can matter, although I think a lot of people you've only did not necessarily get to that point until they get the interviews. So I would say it's mostly focused on procedures and then the area you're going to be. And I don't think that's, that's one thing we've really talked about. But you know, a lot of times people go to a dental school where they can get in and that you might want to try a dental school in one state, but if you're going to live in another state doing a residency and I one year and then, you know, Paul, you're so big on making connections, which I totally agree with. Um, if you can do a residency in an area that you think you're going to live, that allows you a chance to make a whole year of connections and meet people in practices and find connections there where you might want to go afterwards.

Paul : I mean, there's such great value, a couple of things is (A) everyone feels bad for students and residents because you know, we think you have a lot of debt and you know, we don't have any money. So, uh, attendings like myself are always willing to figure out a way to get you to CE for no cost or low cost. Right? And at these events you can meet people in the area. So that's just a, a magical part of it. And as, as we move towards the end. But I did want to ask you, Dave, tell us a little bit, cause it fits in now with the job finding process and how either your AEGD helped you with that, with knowing how to talk to other dentist or just what you were asked during the interviews and more just about, you know, the kind of the current climate of finding a job after dental school or after an AEGD.

Dave: sure. Um, I was very fortunate in my residency to have, I'll give them a shout out, Dr Ben Dire. Um, he was, you know, one of the people who really helped out in the program and he had a lot of experience in private practice before he was in Pittsburgh for a while and then he was in Charlotte. And I don't know if everybody's in this, they're going to have access to somebody who was in private practice before, but he really helped break down, you know, what to look for when you're going into different jobs. He would help people look over contracts. Um, Paul, luckily I had, you know, kind of running to you.

Paul : But during your interview process was the extra procedures you could do, do people bring that up, you know, as, as a selling point for you or happy that you could offer that in their practices?

Dave: When I was looking at different places, they, everyone asks me what procedures I was comfortable with. Um, and you know, really coming out of dental school I probably would have just said, you know, restorative. Um, and most of it, uh, but now I pretty much said almost everything. I mean there aren't too many procedures. I mean obviously like there are some very advanced procedures that I won't do, but I think everywhere I interviewed they asked me, you know, what procedures are you most comfortable with? What do you like doing? And they all look favorably on me doing a residency. I think that's pretty universal at this point that they, you know, of course personality, things like that matter. Um, you know, I actually don't think your grades matter as much. Almost nobody asks me about what was your GPA or anything like that. Um, but you know, they look at how you can talk to people and what procedures you're going to be able to bring to the table if they hire you.

Paul : Awesome.

Rob: Cool. Well, you know, David's been chatting with you. If, uh, if our, um, uh, listeners once again touch with you, what's, what's the best way, uh, that they can contact you?

Dave: Sure. So, yeah, I mean, I'm in the dental Nachos group, so if somebody just wants to message me through Facebook, I've totally fine. Um, and then I have a, the podcast thing on Instagram. It's this Dave Maconi. Um, and if somebody wanted to get my email, if you want me to put that in the show notes as well, that's fine.

Rob: Awesome. Thanks. Anything you want to talk about or promote while, uh, while you're here?

Speaker 4: Um, I would just say close before, I mean, yeah, if anybody wants to check out that podcast, like I said, that's it. That's brains and games and you know, it's awesome when people make charity donations. And also a lot of times people will just send me, won't say that they made one, which is it always appreciated. Um, and I would just say what the residency, one of the things I guess we didn't touch on, and I actually don't know if you guys will agree with this point or not. Um, but for me it actually also helps me not only be more competent afterwards after the residency, um, but during school it allowed me to stress out a little bit less. And unfortunately I think most people are just kind of like rushing through their four years of dental school. Um, there was a guy who had like a, a countdown, like watching the second until graduation. And you know, it's like, to me it's like, man, you would hate dental school that much. It's just, I just think of the unfortunate way to spend four years and you know, like I said, I was able to work out. I was social, I had a part time job and dental school. Um, I actually enjoyed it and I think part of that was because I knew like, yes, I'm going to try and dental school, but I also have this extra year to kind of hone my skills when I'm getting out. So it just, it really just kind of took a lot of stress off, I would say.

Paul : Yeah. Well that's a great point, Dave. Thanks for sharing all this with us and cut, you know, next time I said give me a prescription for this dad bod. I used to look more like you but you know, this is what happened. So I even re motivating me, get back to the back to the gym. I'll just bring my five months old, the gym. I think that's allowed and uh, uh, thanks for sharing with our listeners and hope it gets a chance to see in person sometime soon.

Dave: Yeah, happy to talk again some. Thanks for having me on guys.

Rob: Great. Thanks for taking the time Dave and to our listeners, thanks again for listening and if anybody liked the show, we encourage you to go and put a review up on iTunes or Google or however you listen to us.

Outro: Don't forget to tune in next time to have the dental business demystified. If you're looking for more information about today's podcast, you can find it on thedentalamigos.com.

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