Betsy Shapiro: Welcome to the American Dental Association's Practice Podcast, Beyond The Mouth, where we won't discuss clinical dentistry, but everything else is fair game. I'm Dr. Betsy Shapiro, a Director with the Practice Institute of the ADA. In this episode we're talking about federal dentistry, which is the broad term for dentists serving in some sort of governmental capacity, such as branch of the military, the Public Health Service, Veterans' Affairs or the like, and we're going to talk about what it's like changing between some sort of federal dentistry and going into private practice.
Joining me today is Dr. Julia Mikell. After graduating from the University of North Carolina, Chapel Hill, Julia accepted a commission in the United States Navy Dental Corps, next came a term as an associate dentist, followed by finding her current dental home in Columbia, South Carolina, when she purchased a practice from a retiring dentist and made it her own.
Julia, welcome to the show.
Julia Mikell: Thank you. It's nice to be here.
Betsy Shapiro: We are delighted to have you. You have kind of done it all, worked for the government, worked for someone else and now working for yourself, so I'm looking forward to a really interesting conversation, kind of about how that all went. I'd like to start with your time in dental school and ask you when and how you started thinking about going into the military?
Julia Mikell: Well, that probably started with how I ended up in dental school and that came from, I was the first person in my family to go into healthcare. My parents worked and helped me with college expenses, but when it came to coming to dental school, that was all something that I took care of. So I worked, I had a job, I had some grants, I had some loans, but when it came time to get out of dental school, I knew that I was going to have to be able to find something that was financially viable.
I didn't have a dentist at home that wanted to take me into the practice. I could have found something, but I didn't have a mentor, I didn't have someone that brought me along. A lot of my classmates had a dentist that over the four years that they were in dental school was sort of mentoring them and leading them towards an opportunity in a private practice. So when I looked at my options, I knew that there were quite a few faculty members at my school, and a few people who had graduated in the years ahead of me, who had all had very good things to say about the Navy Dentist Corps. So I looked into it and I decided that it really suited me. It solved my financial concerns, it was a very admirable job, I thought, and then it also solved my interest of wanting to be able to travel. It sort of looked like a right fit for me.
Betsy Shapiro: Did anyone try to talk you out of it?
Julia Mikell: would say no. I think that people that knew me felt that it was a good fit for me. Certainly the financial part was a big aspect of it. I was coming out of dental school with, at that time what was considered to be a lot of loan debt, and I needed a job and I needed a job that was going to have good benefits. This was a way to go into dentistry without taking out any more debt. But that was probably the biggest aspect of it from the people that I would have wanted to hear their opinion on.
Betsy Shapiro: Well, in full disclosure, my husband made the same choice except he went with the Air Force, I have to tell you that. Although he thought the Navy, what was his phrase? He thinks the Navy has the coolest uniforms.
Julia Mikell: But in my opinion they also have the best locations.
Betsy Shapiro: Well, there's a whole other story about his choice and wanting to see the world and then ending up in Southern Illinois for the entire term that he served, which is an unhappy tale on his part. But yeah, that's okay.
Julia Mikell: I can imagine.
Betsy Shapiro: Did you know that you wanted to do general practice dentistry at that point?
Julia Mikell: I think that at the time when I was in dental school, that again was a financially based decision, that when I was going into the Navy, I knew there would be opportunities to investigate, to specialize because they have excellent opportunities for that. But I was very happy with general dentistry, and I knew that I could strategically position myself in locations in the Navy that had large dental clinics, where I could get the opportunity to do little mini residencies in all the specialties, and then if one of these specialties kind of peaked my curiosity, I could investigate that. But coming out of dental school, I was content with a general practice.
Betsy Shapiro: I asked that because that's what Bob was thinking too, and in fact for him it worked out to then go on and enter an endodontic program through the military. I mean that was very helpful for him. He got a broad exposure to a lot of things in general dentistry, and then little mini residencies, just as you described it. I mean, not formal residencies, but he'd be taken under the wing of whoever was at the base and do a little more oral surgery, do a little more of this and that.
Julia Mikell: Right, in my large practices in the Navy Dental Corps, I was six months in oral surgery every day, six months in endodontics every day, six months in pediatrics every day. I did all the specialties that anybody could do in a regular advanced education general dentistry program. But it was not a graduate program, it was just my daily job.
Betsy Shapiro: Where all where you based through your time?
Julia Mikell: Well, I went into the Navy hoping that I could take advantage of a lot of things, so I did. I first started out in Charleston, South Carolina. That was for a year, and then they ask you to take what they call an operational billet, which means they want you to either go overseas or on a ship. At the time that I was doing this, ship options for a female dentist were a little limited.
So I went to Japan, and I was in Japan for a little over two years in a little town South of Tokyo. Then from there I came back to South Carolina and went to Buford, where the Marine Corps Recruit Depot at Paris Island is located, and served there in the interesting environment of a recruiting station, where you're seeing mostly these young 18 and 19 year old people that are coming into the military for the first time. Then towards the end of that tour and towards the end of my time in the military, I was on a ship for four months in the Mediterranean. So I kind of did a little bit of everything.
Betsy Shapiro: I'm just guessing from the tone of your voice, but did you enjoy that aspect of traveling around a little bit and seeing the different areas, and what the practice was like in those different locations?
Julia Mikell: I loved it. I think that was definitely one of the high points of being a military dentist was, for me, I took the advantage of the opportunities when they were offered. I ended up on the ship because they put out a request for a volunteer who wanted to do four months on the ship at the drop of a hat, and I raised my hand and went for it.
I thought the working with Marines was a new experience, very interesting. They have a slightly different way of doing things than the rest of the Navy. Then of course working overseas, and I traveled all over Asia while I was there. Because of course when you're in the military there's a pretty generous amount of personal leave time that you can take, and if you work that out with your Dental Department, then you have lots of time to travel.
Betsy Shapiro: My husband is going to be so jealous. I can't wait for him to listen to this. You obviously got some great clinical experiences and some good travel experiences and just exposure to different styles of practice. I mean, you probably did a whole bunch of wisdom teeth when you were working at the recruiting base and all kinds of other things elsewhere. Was there anything else that you can think of that came out of the military experience that you really enjoyed?
Julia Mikell: Well, the facilities were excellent. The equipment, the materials were excellent. The mentoring opportunities, all of the senior officers in the dental clinics are interested in helping the new dentist. So when you come into a new dental practice and you're one of the new kids on the block, you have all these other dentists that have been through that and want to mentor you, and help you learn the ropes, and help you have a positive experience.
The Navy Dental Corps emphasized continuing education. They brought speakers in, but they also sent you to excellent continuing education, at least for a week once a year. There were just so many things about it. The comradery. I mean right now I'm in a private practice. I'm the only dentist in my office and when I was in the dental clinic, and granted you can set yourself up in a Navy dental clinic that's a two dentist clinic, but I set myself up in clinics that had 10, 12, 20 dentists in it, and I really enjoyed that.
Betsy Shapiro: A built-in study club, right over the lunch table.
Julia Mikell: Exactly.
Betsy Shapiro: So what impacted your decision to get out of the military, when you finally decided to leave the military?
Julia Mikell: That was probably more a personal choice of wanting to be able to be with the man who is now my husband, and we met while we were in the Navy in Japan. I was very happy in the Navy, I felt like I was doing well and getting good feedback, but I realized that I did want to settle down, have a family, and be in one place, and not be uprooting and moving every two to three years when the Navy needed me to.
Betsy Shapiro: I would tell you that the same thing happened with my husband and I. I met him when he was studying in the endo program and he made the decision to leave that so that we would end up being married and being together, but it's a love conquers all.
Julia Mikell: Absolutely.
Betsy Shapiro: Beautiful part about dentistry is you can accommodate those choices and still make a living and make an impact and be helping people, which is what it's all about for me.
Julia Mikell: That's right.
Betsy Shapiro: I like that. So you've made this decision you're leaving, and you went into an associateship. How did you find the associateship and was it a challenge?
Julia Mikell: Well, I was living a few hours away from where my destination was going to be when I got out of the Navy, because we had decided we would live in Columbia, South Carolina. So I contacted the major dental supplier for that city and asked them if they had any way to help me find a associateship.
Betsy Shapiro: Brilliant.
Julia Mikell: They said, "Absolutely." So I made an appointment with one of their representatives and he took me around. He made some phone calls with some dentists who were looking for someone to come in, and he took me around and I interviewed with those, and then I got to pick who I wanted to go back and talk to. That worked out to be a nice associateship to start out my first year of private practice.
Betsy Shapiro: I'm telling you, those sales reps know everything. They know...
Julia Mikell: They know everything.
Betsy Shapiro: They do. They are the best pipeline for who's ordering fewer supplies and maybe getting ready to slow down, and who's ramping up and ordering more and looking for another person. It's a really good resource that goes undervalued, I think sometimes, by our newer members.
Julia Mikell: They also know the personality of the dentist as well. He asked personal questions, tried to get to know me a little bit, and I think he took me to offices where he felt like it would be a good personal fit.
Betsy Shapiro: Yep. Well, and it's to his benefit, you're going to be a good customer for him if he can help you make this transition, right?
Julia Mikell: Right.
Betsy Shapiro: Do you recall anything about what was the hardest part about your first steps, your starting out year in private practice?
Julia Mikell: It's a very exciting time and there's a lot of changes that are going on. If you enjoyed the military aspect of lifestyle, you miss a little bit of that order and discipline and structure, but you like a little bit of the freedom. I would say the biggest difference for me was the fact that I now had to take into consideration how much the dental procedures cost, and could my patients afford them. So treatment planning and communication with the patient about insurance and what their out-of-pocket expense would be, all of a sudden became really important in order for me to be able to do dentistry.
Betsy Shapiro: Was that a skill that came innately to you, kind of doing the checks and balances on financials, what your office overhead was versus what your patients could afford?
Julia Mikell: Luckily that was one of the things that my boss and my associateship was really interested in trying to help his associates learn. For instance, overhead, that never occurred to me when I was associate, that was not my concern, that wasn't until I got my own practice. I had a couple years before I had to worry about that, but the dentist who owned the practice that I was in, he helped me learn how to treatment plan, how to put the options together and how to present it to the patient so that they could make a good decision and be a partner in the process. But that was a lot to learn. That was probably the hardest part for me.
Betsy Shapiro: I know my husband has often said that one of the things he loved about the military, that helped him when he went into practice was process. We grouse a lot, as human beings, about process in governmental regulations, but he felt like he learned processes and structure in the military that really helped him in private practice. Now for you, you were going into someone else's practice who already had their processes in place. Were there frictions there or were you able to slowly introduced some new things, or how did that go?
Julia Mikell: I definitely agree with everything you said. I think that the Navy dentistry gave me the opportunity to understand that systems in a dental office are very important. When I went into the associateship, I was fine with accepting that person's systems just like I had accepted the Navy's systems. Then when it came time to have my own private practice, I knew it was time for me to organize the systems that suited the way I like to do things.
Some of those I adopted from the Navy, some of those I adopted from the dentist that I worked for, and then some of them I created myself. I think any dentist would agree that you have to have systems in place, or processes in place in order for everything to work, because there's so many different aspects to dentistry in private practice besides just doing the clinical work.
Betsy Shapiro: Absolutely. So how long were you in the associateship before you then went out on your own?
Julia Mikell: I ended up being in two associateships. My first one, I was in for a little over a year, and then a colleague of mine who I went to school with at Chapel Hill, she was also living in Columbia and her husband became terminally ill and she asked me to come and help her out for a little while. The first dentist was kind enough to let me out of that contract and I went and worked for her for about a year and a half, and then went into my own private practice.
Betsy Shapiro: I think that's a great example of the comradery, and we focus a lot sometimes on the competitiveness in the profession, but stories like that really bring it home that we do help each other out.
Julia Mikell: Absolutely. I think if you're honest and fair, I remember going to that boss for my first associateship, a little nervous about the conversation. But he knew the dentist that I was going to try to help and he'd gotten to know me and he wasn't threatened by that. He knew I was being honest about the situation and so was that other dentist, and it all worked out and we're all still friends now, 20 years later. We're in the same study club in fact.
Betsy Shapiro: Perfect. So, starting your own practice, you bought an existing practice, I believe, from someone who was retiring. Did they stay for a little while or did you just jump right in as they exited?
Julia Mikell: Yeah, this is a little bit different than most situations because this dentist was retiring for health reasons, had a brain tumor. He wasn't that old, he was only 54, was going to be able to live but wouldn't be able to practice dentistry. So he had to give up his practice and he had given it up nine months before he decided to sell it, so he never did practice with me. We did get to have a party together, he and his wife and me and my husband had a party to welcome the patients and let him introduce them to me. That was nice to have that turnover, but he never did get to practice with me.
Betsy Shapiro: That's an interesting situation though, an unfortunate one of course, but an interesting one because the practice has been inactive for about nine months and then you're coming in, how did it go?
Well, I accepted the fact that the practice had dwindled, because over those nine months he had asked other friends in town to help him with his patients. A number of the patients who were active with him had already developed a relationship with the new dentist. So the practice that I took over, he had a small practice to start with, but the practice that I took over really only brought on about 200 or 300 patients. It was a pretty small, it was a mostly building opportunity, let's put it that way.
Betsy Shapiro: Well you get to build it the way you want it then, right?
Julia Mikell: Well and the people that came, a lot of them are still patients of mine and they're just the salt of the earth, most wonderful people, and they make me enjoy my practice every day. It was a gift.
Betsy Shapiro: Was building the practice the most challenging part, or what else were stumbling blocks or a little bit frustrating for you?
Julia Mikell: I'd say, one of the things I like about dentistry other than the actual clinical doing the dental part, is my patient interaction. Usually, for most people, and it is true for me, the things you like are the easy things. So meeting people, getting to know them, developing relationships, establishing a trust, those are all things that I enjoy and I'm good at and so that's not hard. To me, the hard part is managing the office, managing the personnel, getting them all on board with a common way of thinking about things, all of them buying into a team concept and a purpose. That's the challenging part for me.
Betsy Shapiro: You had some good background in systems and procedures and you'd been in a couple of private practices at that point. Did you rely mostly on the lessons you'd learned there, or did you have other resources that you tapped into as you were growing and developing your own practice?
Julia Mikell: I definitely have tapped into different things. I've hired a couple consultants over the last couple years, gone to some classes, taken the dental team to some motivational practice management speakers. I don't really feel like my experience in the Navy really is anything I can draw on for that. Maybe for team morale, but not for the day to day management of work and responsibility and accountability and things like that.
Betsy Shapiro: If you look back over your career to date, would you have changed anything about the path you went through?
Julia Mikell: I wouldn't have changed anything about dental school or the Navy. I would have taken more business classes in undergraduate, or I would wish that they would give more business classes in dental school.
Betsy Shapiro: Amen, yeah.
Julia Mikell: For the most part I would say I wouldn't change pretty much anything. I'm very happy with how things have gone. I have no regrets about the fact that I've raised a family while I was trying to run a small business. I have two children, the younger one went to college this week. So that part of my life, running my small dental practice and raising a family, and so there are certain challenges that you face when you try to do that. That have made it where my practice wasn't maybe my sole focus, like it might've been if I wasn't trying to tackle both of those important things at the same time.
Betsy Shapiro: Well, it's all about balance, for everyone I think, regardless of if it's children they're raising or elderly parents they're trying to take care of or nurturing other relationships and other roles in life, but dentistry has flexibility, which I love.
Julia, we want to thank you so much for joining us today. This has just been an excellent conversation. I think your perspective is really helpful to a lot of our dentists, especially newer ones who are sort of looking at the broad field ahead of them and trying to figure out where they want to land. And seeing how one aspect, going into federal dental services, can be useful at one point in time, and how transitioning out can be done and can be successful as well. Is there anything else you'd like to close with Julia?
Julia Mikell: I just think, if you're willing to consider the military for your dental career, go ahead and give it a try, take a look at it. It has so many different things to offer beyond what you see on the surface. So I think even though it's been a long time since I was a Navy dentist, from what I hear, it's still a great opportunity.
Betsy Shapiro: Thank you very much, Julia.
Julia Mikell: You're welcome. Thank you.
Betsy Shapiro: Now we're at the part of the show where we answer a question we've received from a member. In the practice Institute here at the ADA we answer member questions every day and wanted to share one we've received with our listeners. To help us out we have Katie Call with us. Katie is an integral part of the Center for Professional Success and is often the first point of contact for our members when answering calls or emails.
Here's the question: When I leave the military, how do I transfer or change my membership to the state in which I'm going to be practicing?
Katie Call: There are really two ways that you can do this. First and easiest would be to call the American Dental Association and speak with our Member Service Center. The staff there can help with all the steps and make sure that you don't skip a beat in your membership during the transfer. The number to call is, 1 800 621 8099.
Secondly, also effective, if you know where you're going to be practicing, you can call that State's Dental Society and they'll also be able to help you.
Betsy Shapiro: If you want more information on federal dentistry, you can visit the ADA at ada.org, and type in federal dentist in the search box to find all the resources available. If you're transitioning out and going into private practice, be sure to visit the Center for Professional Success website for all types of useful materials on going into an associateship, being an employee, starting a practice, and then the other practice management issues that come with those choices.
Find all of this at success.ada.org or contact us at our email address, firstname.lastname@example.org that's all one word, email@example.com.
We want to thank our sponsor, ADA Member Advantage, for their support and to Sandburg Media for producing this podcast. And thank you for listening to Beyond The Mouth.