Should you specialise? – PDP006

Jaz’s Introduction: Should you specialize? Do you ever regret that perhaps reach your full potential as a dentist because you didn’t become a specialist. Or maybe you can’t stand being a GDP and you yearn to limit your practice to specialize in something. Or maybe you love the variety and you don’t think you could do the same kind of stuff day in day out. And the thought was puts you off. We interview today with Harjot Bansal, who’s doing his MClinDent in prosthodontics at the Eastman. And it’s great to have a perspective in terms of what it’s like in terms of commitment, time, money, intensity, and all those things that so if you’re thinking of specializing that, and that could be quite a helpful thing to consider. I’ve also got some gdps, and people with special interests, given their two pence about the subject, it is a bit like a debate, you know, I’m a little bit biased towards team GDP if you like, because you know, someone has to represent gdps, I will be sort of having a debate with Harjot and the guests to sort of gather different perspectives. The Protrusive Dental Pearl for this episode is to show your human side to your patients. Okay? So I sort of discovered this by accident where six months ago, I changed my surgeries, computer desktop background to a photo of me on my elective in Vietnam, it’s a lovely photo op, I’ll put it in my blog post. It’s me with these Vietnamese children in a rural village and everyone’s smiling, I think I’m handing out stickers or something, it was just a perfect shot captured. When new patients come in the addition of that photograph really creates a warming environment. If you can find a way to make an icebreaker with your patients, then that’s always a great thing to do. So that has worked really well for me, I think when patients sit down, and directly in front of them, we have this big TV screen, it’s got the photo of me as a desktop background. They really feel at ease, and I can see it in their body language since I put this photo up. So I mean, you could use in lots of ways if you’re a hardcore Westham fan, have somebody in your surgery that shows that. Or maybe if it’s a photo of your children or loved ones, a framed photograph, perhaps, or maybe a photo of your pets. I think all these have a really nice touch, really nice human touch. And if you try this, you’ll see that patients will notice and it really humanizes you and I think as dentists, we really need that. So the pearl for today is to humanize yourself. It’s really, really powerful with nervous patients. Okay, so this episode is a little bit different to my last ones, I’ll be hopping from guest to guest, and I’ll try and mix it up to vary a little bit.

Main Interview:

[Jaz]
Harjot Bansal, thank you so much for joining us on protrusive today, it’s been good to have you obviously, we’ve been friends for a while now. And I’m always liking your work on Instagram. And I know you keep us off, very busy, clinically, academically, all those things. So for those of you out there listening, you don’t know Harjot. Harjot, can you please tell us a bit about yourself?

[Harjot]
Jaz, thanks for having me on today. I am currently working in practice, and currently studying part time doing my prosthodontic training at the Eastman, which I started about six, seven months ago now. So I’m halfway through the first year,

[Jaz]
How many years this course?

[Harjot]
So it’s three years through the MClinDent. And then the final year is your MRD exams, specialist training exams, essentially. So for the part timers for myself, it’s three `days a week for three years. And if you’re a full time as you can do this full time, it’s full time five days a week, for two years.

[Jaz]
But that then you still even if you do a full time, you still need to do the MRD, right?

[Harjot]
Yeah. So there’ll be another it’ll be another year. Absolutely.

[Jaz]
Full time. Is that another year full time?

[Harjot]
Well, it’s not quite full time. I think you have a little bit less time where you actually go in but I end up seeing a lot of the full timers who are doing the MRD year in a lot. You know, they’ve got a lot of work to do. They’ve got patients to finish off the court, cases that we need to try and finish and lab work to do as well. So it’s pretty much yeah, it’s going to be either three years or four years.

[Jaz]
One thing I remember speaking to a lot of people in my journey from even as a dental student to where I am now as a young dentist is I’ve asked a lot of people about different postgraduate programs and one thing you constantly hear is that Eastman is just a different kettle of fish. Eastman is like, really hardcore, Like it’s, you know, the, for example, the cons conservative density, MSc was also known as the divorce course for example, you know, it’s really full on. Can you vouch for that? Is it really how did it, how it is?

[Harjot]
See, I think you need to tie you up with your personality as well. The first three months of the MSc in conservative dentistry that you just mentioned at MClinDent in prosthodontics, which I’m doing, they run side by side, we learn all the same content. They don’t do the removal stuff we do removable prosthodontics as well. And the first three months is super intense. It’s really it’s the Phantom head course, which involves learning a lot of different kind of prep designs and understanding your material sciences as well, understanding the laboratory side of what you’re going to be implementing on your patients. And it is just a lot to get on board. And there’s no doubt that I was the 9 till 10,11 at night.

[Jaz]
Yeah, that’s I’ve heard that see late at night, early in the morning. It just takes over your life for a period of time.

[Harjot]
It does. But you know, at the end of the day, I think it doesn’t have to be that way. There are people on the course you’ve got, you know, families, they’ve got kids, they are just really, really good at getting things done. You know, they’ve condensing the workload and learning efficiently and working well that they just are able to get things done. So it’s up to you as a person. You don’t have to be there. But there’s a lot of work there’s no doubt.

[Jaz]
Course a man who knows he needs no introduction, Dhru Shah, periodontists giving his input on why he specialized in and why it might not be right for everyone. And it’s all follows on from the transition to private dentistry, I think it was episode three, which is definitely worth it as got lots of good, great feedback and probably my most listened to episodes if you haven’t heard Episode Three, do check that one out. It’s got it’s full of gems from Dhru Shah.

[Druh]
I think people end up specializing for the wrong reasons. Most of the time. A lot of people have found in spoken to say, I don’t like NHS dentistry. In practice, I’m going to go and specialize. I don’t mean to specialize for that reason. And, you know, it’s been alluded that dentistry is a long career. Now, I ended up specializing because of what I enjoyed, I enjoyed this edge class,

[Jaz]
How long did it take you to figure out that that’s what you enjoy?

[Druh]
5 years, 5 long years, I was doing very long hours. So you know, six days of practice, six days in hospitals, Sundays, I did extra days with the maxfacts surgeons, eventually, I realized that. So I’m the only specialist who says if you want to do good quality dentistry, you don’t need to specialize. Don’t specialize if you want to do that, you’re going to spend shedload of money, your fees aren’t cheap, you’re going to be working in a system that is an ideal, which carries a lot of stress with it. And this goes back to our podcast when we talked about pain and pleasure, do not do this to move away from pain, go towards pleasure. So my advice to young dentists is to say, look, take your time, do a multitude of roles, perhaps stay in a practice for, you know, quite a few years and see your work coming back, understand it and then think do you want to really enjoy just one part of dentistry? Or do you want to be a practitioner who enjoys doing many aspects of dentistry

[Jaz]
And you can still limit your practice to a lot of things that you may choose to I’ll do, I won’t do endos, but I’ll do everything else. I know some practice to do that. And they haven’t specialized in one thing, but they’ve limited their practice to their own niche that’s fine. And that’s what that means. And the other thing I’ve been reading or listening to audiobooks for is their personal finance, when you actually think about how much you invest in terms of loss of earnings and how much you’re spending the fees. Okay, that money put into a mutual fund in a tax protected account something and the interest accrued in the stock in stocks or shares over the years and, and then the fact that once you do become a this, you know, all singing all dancing specialists, it takes that one complaint to ruin your life. That’s a completely different spin on putting on it. It’s very volatile.

[Druh]
You’re right, that’s why I said sacrifice is big for specialisms. So unless you thoroughly focus and enjoy something, specializing is something that you have to be careful about, don’t do it to move away from or run away from something, if you’re going to really enjoy it. That’s why you’re doing it because

[Jaz]
then it’s very rewarding, you know, as for you in all sorts of ways, once you’ve done it for the right reasons.

[Druh]
I mean, let me be honest, it’s a monotonous job for me, you know, 90% of my work through planing, understanding chronic pain patients, okay, maybe now it’s 70% is I sort of diversify a little bit more. But this is what you get. Are you ready for that? And financially, you know,

[Jaz]
And most endodontists if they’re not doing, you know, I suppose MTA plugs all the time. fancy stuff that they’re doing in the primary root filling of a broken down belly, restorable lower molar with a patient who can’t open very wide that’s why they got referred to you. So this is the real world is not all, you know, it shouldn’t fantasize at once. I’m a specialist, I’ll get happiness, you have to actually think about it in a different mentality. And then it comes back to mindset once again.

[Druh]
It goes back to mindset again, yes, but yeah, that’s my thing.

[Jaz]
What advice would you give someone when they are at that Crossroads where a lot of people think oh, I need to specialize to be good or that’s a pathway for me.

[Mahul]
I don’t think you need to specialize to be good per se.

[Jaz]
So that was Mahul Patel. Someone I really respect he’s in fantastic educator.

[Mahul]
We are in a long career. Right? We are on average in a 45 year career In my opinion, we start dentistry on average about the age of 23 or work towards, you know, our late 60s. 45 years of doing teeth is a very long time. My advice would be not to rush into anything too hastily. Because if we break down 45 years into thirds, the first third of your careers 15 years. The next third is another 15, which takes you up to 30 years. And then the last third is, you know, between 30 and 45 years. So I would say the early starts of one’s career, one should try and do as much as they can look at working in primary care, maybe look at working in secondary care to get different ranges of experience, like you have done, going out back into primary care, and then making more formalized decisions from there.

[Jaz]
And I really liked the way that he broke the long career down into little chunks, and how to think about each one. So that was a real nice way of doing it,

[Mahul]
The training pathways these days are a lot more clear cut, and they do allow entry at a much younger age. And that can be, you know, to an advantage of a younger dentist looking to go into specialist training because the pathway is there. So as long as they’ve carried out the right requirements, can tick all the boxes on their CV, go in at the interview, do well, they’ll get accepted, hopefully in their center of choice. But I think you don’t necessarily have to be a specialist to be good at anything. There are plenty of general dental practitioners who are excellent clinicians. And that’s one way to look at it as well.

[Jaz]
He works in referral practices in the West End and Walden some of his courses are just fantastic. Focusing around splint therapy, tooth surface loss, rehabilitation of the worn dentition Harjot man ,when you’ve made a conscious decision that you’re going to immerse yourself in a subject and you’re paying the fees, and you’re there. You know, I think a lot of personalities were like, right, I’m here. Now, let me just max it out, do the do the most I can. But obviously, for those who can’t, because they’ve got families and whatnot. And there’s so much you can do then I suppose they just do the most they can within reason. Without upsetting the balance.

[Harjot]
Yeah. Exactly. And the thing to remember is, you’re quite right, when you’re paying that kind of money, you want to really take everything away from me that you can and I’ve definitely been back in on the weekends and after work about to come in just to finish some things off. But I mean, it’s part and past, you know, what you’re getting yourself into, and it is really intense. And you just got to like you said, You’ve got to immerse yourself into, you’ve got to enjoy it as well at the same time, right? You wouldn’t be doing it if you hated it. And there are days where you just feel like oh my God, I’ve got so much to do. But actually what you find is, is that after the initial three months, then comes with the kind of reading that you need to do all the seminar work, which is really intense.

[Jaz]
If you don’t mind roughly, what kind of fees would you be looking at, if you’re thinking of specializing and to be honest with you, it’s not specific to Eastman, if you want to do the perio MClinDent, or no Queen Mary’s, you’re paying roughly similar sort of fees, is that correct?

[Harjot]
Anywhere between I’d say the 12 and kind of 15 to 18,000 pound mark is what you’d be paying for any of these kind of mono specialty, like you said, You’ve got to get the most out of it. It’s important to keep busy and to do as many cases as you can even if you feel like you’re overburdening yourself or you’re taking more time out to do it. You know, you’re there for a reason. You know why you’re there, you’re making loads of sacrifices, not just financial, time spent with family and doing other things, social things, just make the most of it and just immerse yourself in it, you know.

[Jaz]
So it’s a fees. That’s per year, obviously. If you listen to the USA episode that I had with Kristina, they’re paying, you know, far more than that in the US for speciality programs. So you got to take that into account. But also then on the flip side, there’s the three famous letters, LOE, loss of earnings, okay? So when you’re not there, doing teeth in a practice, and you’re doing it in a university setting or a hospital setting, then there’s a huge element of loss of earnings, and you need to be able to sit down and you know, speak with your accountant maybe? Is that a good idea to do to see if it’s possible to make a make a plan, financial plan?

[Harjot]
You know, I don’t think anyone would go into all Well, I hope no one would go into this kind of course, without having really thought about it very carefully. And I had to do loads of planning beforehand, I spent probably about 18 months planning finances and how am I going to pay for everything. And there were lots of things that I had to take into consideration, financially. Loss of earnings was one of the main things but I’m going to come on to loss of earnings in a second actually. But yeah, you know, the fee structure changes every year. There’s it always increases slightly every year. So you need to be able to set aside enough money to pay your tuition fees. In terms of loss of earnings, here’s the strange thing actually is although I’ve gone from being in practice full time to now, three days a week on in practice, let me see Mondays, Thursdays Saturdays. I’ll probably say even though I’ve cut out two week days, I don’t think I’ve ever seen the loss of earnings damage. And I’ll tell you why. It’s because you become more confident in what you’re doing. Your prescribing pattern also changes. So yes, there’s a loss of earnings, but I don’t think it’s as substantial. If you’re a full time student, then yes, that’s something you need to take into consideration. You could plan bit more carefully and put some money away. There are grants available

[Jaz]
Student loans, is that I mean, excuse my ignorance, but for postgraduate programs, speciality programs, is there a sort of student loan program?

[Harjot]
Take it up professional, they take out loans with the banks, they take out professional loans and then student loans. We’ve all been through the student loans company and some of us are still trying to pay that off.

[Jaz]
Yep. Guilty.

[Harjot]
Yeah, same here. They don’t give you any more money, unfortunately, for your post grad training,

[Jaz]
but it’s good to mention about you know, even though you cut down some days, your earnings doesn’t take as you know, as proportional overhead basically. And because you’re already reaping the rewards of increased knowledge and soil, working like a prosthodontist thinking like a prosthodontist.

[Jaz]
This is Catherine Tannahill, who told me one of her professional regrets, if you like is not specializing as an orthodontist. So for her to be pursuing a diploma in orthodontics is perhaps the next best thing

[Catherine]
I love learning is the first reason. And I’ve been doing gathered enough to orthodontic knowledge over the last few years, and more experience. And the more I know, the more I realize, I don’t know. And I want to be able to tackle more complex cases and refer less out to the practice

[Jaz]
Lourens is a successful private practice owner and he’s also doing the diploma with me. And he had this to say,

[Lourens]
Think from I don’t know, but you and me, Catherine, but I think we’re a little bit older. And so to go back to uni now, it would be hard to come and go reducing waste. I think. If I was born more your age. Yeah, I would consider it

[Jaz]
The main thing, but do you think you’d have to be a specialist to be successful to have fulfillment and Catherine talks about that or to do great work?

[Catherine]
No, definitely not. I think there’s such an orthodontic need out there. I think all people want at the moment, the current trend is straight white teeth, and people are asking for orthodontics more and more. So the demand is there. The need is there. I don’t think there are enough orthodontist,

[Lourens]
Especially with the NHS, considering orthodontics more of a cosmetic treatment now. That is definitely increasing the need and also with the kids not wearing their retainers. And then the majority of the desired treaters or relapse caps from NHS ortho.

[Jaz]
What’s the point? Why specialize? Why did you specialize?

[Harjot]
I never really thought about it. When I qualified I remember being a DF1. And the point at which I thought I need to not necessarily specialize but do something extra. And I remember it was quite vivid, really. I was sitting in the keynote lecture. At the BDA conference in Manchester, all the DF1s have to go on it. And Basil was wrong. He was talking. And I remember thinking to myself, right, how do I get to doing that kind of work? What kind of Route wanting to take and specializing and doing kind of structured learning and kind of formal pathway was something I didn’t even think about even at that time. It was only when I’ve been on a few courses, and I even did, Basil’s course, and I thought it was absolutely amazing. And I talked to a lot of people who had done similar courses, that I realized, actually, if I want to be doing a certain type of work and more dentistry that I like to do, where I could be a bit picky about the cases I wanted to do, then for me, I wanted to be able to do have enough depth of knowledge to be able to do that kind of work. There were some very influential people who really gave me a bit of impetus when I saw some of their work really, into thinking actually, specialist training is what I need to do, to do the kind of cases they were doing.

[Jaz]
Okay, can I just give you a counter argument? Are you ready for this? Yeah, I knew you’d mentioned Basil, was an absolute amazing clinician you know, his works, just Wow, you know. What about the Chris Orr’s? What about the [ ? ] ? They’re just BDS.

[Harjot]
Yeah, absolutely. And equally, I think that if you want to go down that route, that’s absolutely fine. But absolutely, there are loads of different ways to be able to get Your destination and achieve the goals that you want to do without having to do this kind of really expensive formal training, dedicate for three or four years. There are ways to do it. But I do feel that sometimes there are so many different courses out there. That said, there’s a reason why Well, for me anyway, there’s a reason why the formal courses that have gone through academic institutions have been there for you know, 40, 50 years is because they work. You know what I mean? And you always want to be, you want your learning to be deep learning, you also want it to have come from some kind of scientific grounding. And I think we’re all trying to implement kind of evidence based dentistry, but you really need to be able to scrutinize what you’re learning and where this evidence has come from. I think if you are part of an institution, you’re always going to be getting the latest knowledge.

[Jaz]
I agree or disagree. So I agree that I’m hoping that the institution’s we take teaching them the latest knowledge, but in your, tell me, in your clinics in Eastman are using and not in private practice in Eastman, are you using intraoral scanners, ie able to utilize the latest technology in that respect?

[Harjot]
This is the thing right? When we talk about things like intraoral scanners, and so we have got intraoral scanners at Eastman. We don’t use them in clinic, we have been trained to use them or use them in private practice, like you said, but we need to come away from our things, just gadgets, and we’re happy to play with really expensive gadgets, or are they really going to improve our clinical or clinical proficiency? Are we are we going to be doing better work? Are we actually doing better work? These are the things that we need to be able to scrutinize. We all like playing with, you know, new lasers and intraoral scanners and whatever the latest gadget is, but really to be able to say, is this really an important tool that I cannot live without? What does the evidence suggest?

[Jaz]
I think, you know, you need to learn it, you need to learn how to do you know, PVS full arch impressions in program you know, I think any dentist would need to learn that before they and then I think digital becomes a piece of cake. It’s more about the knowledge and implementation, occlusal design, lab technician communication. So yeah, I mean, I agree with you there. I mean, I think they although you might not have the most up to date cutting edge just because the scale of hospitals, but at least you’re learning, you know, timeless principles, which it would you say that’s alright?

[Harjot]
I think if you understand, if you have a really good solid foundation, then actually learning extra techniques on the side is going to be easier for you to do.

[Jaz]
And you can scrutinize them because you get knowledge, you get critical reasoning, evaluating everything, not just at face value, but actually, you know, the evidence behind stuff, which is a core component of obviously having a post

[Harjot]
Absolutely. And that’s what you want to do, right? Look we live in an age where social media is at the forefront of everyone’s lives almost. And every time you go on Instagram or Facebook, there’s always going to be someone posting something and you think to yourself, Well, actually, that looks really good. But actually, I wonder how that’s going to look in five years time, 10 years time. It’s easy to get carried away, but you really want to be able to scrutinize what they’re doing and say, Well, how good is that really, on a practical level? I wonder what it’s going to look like in the future?

[Jaz]
Well, the key word there is a predictability. Right? And with that, I was just, you know, thinking while you were, I was jotting things down as you we’re speaking about the specialist route versus being the best you can be with private courses and you know, being to level up, let’s say, to do [Manku and Crystal], which is you know, superhuman level if you like, but here’s my theory, okay? If you do it alone, and you do it via courses, okay, the chance of you becoming to the, you know, the level and knowledge and skill of these, you know, non specialist clinicians, maybe I don’t know, I’m gonna pluck a number one and 50. I don’t know, I just made it up. Okay. Whereas perhaps, through a specialist program, a top postgraduate clinical program, you know, it might be one in two, because I think we can both agree that not all specialists are born equal. And just because you become a prosthodontist, doesn’t mean you’re actually shit hot. I

[Harjot]
Absolutely. I completely agree with that. I think everyone is have different abilities, no doubt about it. Okay. And you can get better than that, you know, you can practice things, but there’s no doubt that even people with the same title, same degree, they’ve got to be of different abilities.

[Jaz]
Do you do or what do you think of that theory that, you know, maybe by going it alone, you might not make it to where you want to be. Whereas when you get mentored in a postgraduate program, it might be more predictable in terms of you being able to do the kind of work you want to be able to do?

[Harjot]
But there’s almost going to be an endless amount of courses that you can keep going on, right? I think for me, as a young clinician, I really wanted to be able to have constant exposure for a good couple of years where I could really see my skills improving, getting better. And I think formal training and something very structured was just completely the correct decision for myself. And like you said, why there are so many different courses out there that you can achieve a goal that you want you can be these, you can be really amazing at the end of it, but you’re gonna have to go on quite a lot of them, there’s not gonna be one course that gives you that. But then you can do what you’ve done as well, because I’ve seen you know, you pick good courses to go on, you go to Dubai, you’ve been abroad, you do them here in the UK as well. And you’re picking really good people to go and learn from that’s also really important. Like, we’ve gotten to the stage now where it seems like everyone is opening up and everyone’s doing a course. But be really, really careful in learning from because you want to surround yourself with the right people, a lot of these people are really good as well don’t get me wrong, but you’ve we’ve got courses and everything these days that actually, the key thing is, is to be flexible, and not be dogmatic in your approach. But the only way to be able to do that is to have relevant knowledge, but also have relevant experience. And I felt like having some hospital experience and actually treating complex cases in a hospital setting, whilst learning on the side was

[Jaz]
gives you protected time. Yeah, it gives you a really, really protected environment, where every step, just like dental school, I suppose gets checked over. So you know, that’s a real bonus of epi. Now, one thing I like about being a GDP, if that a funny patient comes along, and you know, you just you’re not gonna, you know, some patients, their values and your values are so different. Or you find that it’s a particularly tricky root canal, I really don’t want to be a loss of earnings, right attempting this one, or I might mess it up that but also, you know, I can cherry pick my cases, like you know what, there’s a great specialist down the road, he’s in charge of vancil, he’ll treat you even though your mouth opening is 25 millimeters only, he’ll do your full mouth rehab. So there’s always that great thing about anyone listening here, you know, who’s thinking that gdps can’t do great work, it definitely can. And if a mentored, a postgraduate program for you is for you, then hydroids got some, you know, great points there for you to consider. But GDP is always have cherry picking ability that they can always say, you know what, I’m going to send you off to the specialist.

[Harjot]
I think a lot of what I’m learning now is and by I’m nowhere near the kind of finished article, but I do find that I seem to be getting some cases, especially internal referrals now. And it’s usually a lot of the times it’s not just tricky cases, tricky people as well.

[Jaz]
Yes. Because I almost didn’t want to ask you this, but like, do you find people fobbed off people to the specialist or the the hospital environment? Because that’s an easy thing to do, maybe?

[Harjot]
So you know what, I think it’s becoming a lot more. I think it’s becoming more difficult to do that, especially in hospital. Because at the end of the day, if it’s a difficult person? Well, look, we have difficult people in practice anyway. Okay. And sometimes, especially if you’re in the NHS, you have to treat them, that’s just the way it goes. Right? In the hospital setting, they have a really strict criteria, you know, and if it’s a difficult case, find a difficult case, if it’s a difficult person, we can’t even think about that, you know, they sometimes they have to be seen wherever it is whether it’s in primary care, secondary care, we do get I do find that sometimes you end up getting some people who’ve just because people don’t want to treat them. But I mean, that comes with you got to understand why is that person being difficult? Is it as a person, it sure wasn’t because they actually have some real problems. And you’re going to be that person that’s going to some form of

[Jaz]
I think you could be a real you can give them hope, obviously. But I remember when I was a DCT at guys hospital, the manner I’ve been working on consultant clinics, the amount of specialist referrals we’d get for really basic stuff, but there was other issues, let’s call it in the patient, and they were just being I thought they’re being fobbed off

[Harjot]
There was some specialties that are really good. And for just getting on referrals, endodontics, perio, for example, right? You’re always going to have a referral base, people are going to keep referring to you prosthodontics is a lot more difficult to achieve referrals for because most gdps do that and prosthodontic work, right, everyone does their own crowns, bridges, implants, whatever it is. So really, like I said, it’s not just about wanting to become a specialist, it’s just wanting to have a better understanding. So you can do the kind of work that you want to do the level of work that you want to do. And a key thing that I really like is I remember Basil once said in one of his courses when I first went on it was you want to try and do more dentistry on less people some more comprehensive cases, rather than new bits of dentistry. And if that’s the philosophy that works for you, then find that will work for everyone. But this is not a, it’s not a recipe right? Not everyone has to do this. And you’re quite right. You can be an amazing GDP just by going on courses alone. And actually, some of the people I really look up to, they haven’t gone through any kind of formal specialist training and they are incredible clinicians.

[Jaz]
Absolutely. Well, why don’t we say a few words about if you’re a young dentist and or a student or you’re a seasoned practitioner and you Considering specializing How’d you find which speciality is right for you and I’ll share with you what piece of advice actually you know Reena Wadia? Periodontist Okay? We did this like a talk, it was me telling Reena we was giving a lecture at King’s dental society when the lectures and evening and she said something really great that really resonated with me. Okay. And the question the audience was, how do I know what do I specialize in or you know, which was that along the lines, which is a common thing, you know, people not sure I wish I do endodontics a bit maybe they decided in a practice or one specialized but I’m not sure what in and Reena said something along the lines of and she said it more gracefully of something along the lines of you will gravitate towards it, you will open up these magazines, and journals, and you’ll find that you’re tending towards a particular thing over time, and you just, you know, naturally gravitate towards it. But for me, it was, you know, occlusion, splints, bigger cases over time, moving away from single tooth dentistry. And you know, more and more, I’m picking those up and reading more about that how to do this, how to use a in a few years goes about leaf gauges, how to use a leaf gauge, how to manipulate patient in centric relation, you sort of you find your way, in terms of your interests sort of lead you there. What do you think about that?

[Harjot]
Agreed. I completely agree, I also think this will happen according to what your experiences are, right? If you have found it difficult to take teeth out, you’re not going to really like all surgery, and you’re probably going to rule it out from day one. If you’ve had a hard time doing molar endodontics, I don’t think endo is going to really be the one for you. But sometimes it can be the flip sometimes by not being so good at something and then saying, Well, actually, I need to go on a short CBD course for this. And then doing some short endo course, for example, you might be like, I actually, I really enjoy this, I want to take this further, I was never really good at this. Now I really enjoy it because I understand it a lot better. And I’m going to try and pursue this a bit more.

[Jaz]
I’ve definitely seen that I’ve got some people in the back of my mind right now who went through that exact pathway, actually, they they weren’t doing much of anything or referring it out. And then they started to dabble in it. And they thought, you know what, that’s pretty cool. I’ve enjoyed my journey, and learning. And then they’ve gone the full whack and they’re doing specialist programs now

[Harjot]
The thing, the way to do it, though, is always to do a short course first. And I was really glad that I did Basil’s course, I now just finished VT and I’ve just done it, because it opened my eyes up as to where I was, and where I kind of wanted to be at some point in the future. And you don’t like I said, it was only through taking recommendations from people as to how they got there, which was specializing in formal training. And that was just something that worked for me. But I think do short course first do taster sessions a lot of these big institutions, Kings and the Eastman they do one day courses, ewisdom that was a good stuff on

[Jaz]
The thing I like Harjot is shadowing people and you know, yeah, you can shadow specialist, but you know, I’ve shadowed some brilliant gdps. And that sort of cemented my current standing that you know, I really enjoy general practice. But it was you know, being in that environment, watching their daily practice, and then able to inspire me. So definitely go out there. And if you’re thinking about prosthodontics, see if you can arrange a shadowing session in the West End, for example, with a prosthodontist and see their workflow.

[Harjot]
And you’re right. And it’s when you when you shadow people, and they’re giving you little these kind of golden nuggets of information that seem so valuable. You always remember them. And then you always wonder, where did you learn that from? And it’s usually because someone else has told them that when they shadowed them, you know, and I think you’re quite right. Finding the right people to shadow is important. It’s not an easy thing to do. And sometimes you do have to pester people, do what I did, I unlike what you did, as well, you know, going in on the weekends and assisting for free and taking photographs and just helping them out in whichever way you can. But you’ve got to do the legwork, right, you’ve got to put the hours in and you’ve got to be prepared to go in after work and maybe on the weekends to just kind of hang around and find how these people crystallize the treatment planning and how they got their thought process. So clear and concise.

[Jaz]
Absolutely. When you see all these photos on social media of these cases, or if you go on, let’s say right, that’s a restorative employment practice excellence group on Facebook. When you go on there, and you see the photos, what you’re seeing is an event like what you’re seeing is

[Harjot]
Yeah, absolutely.

[Jaz]
You don’t see the process that led to the event, you don’t see the blood, sweat and tears of hundreds of hours, the courses, the planning,I feel, yes, you do sometimes see the failures on this group, which is why I love these groups who show their full protocols. But you don’t see the 10 other cases beforehand where the dentist was not quite 100% happy with eternally every element of it and only when they got a case, which had a few more acceptable compromises where they’re happy to share it on social media, so You know, you don’t see the the hard work and the process that goes into it, you just see the event. So it’s always important to remember, there’s always going to be hard work, blood, sweat, and tears involved, no matter which path you’re going to go down, if you want to be at that caliber of clinician,

[Harjot]
Often the most important thing, or the thing that’s most valuable from looking at, like you said, photographs, or a treatment that someone’s done. And all you have is information, visual information, or maybe a caption, I found the most important thing is that should be able to talk some of these people really, really pick their brains as to what made you want to do it this way, and not that way. Because sometimes they don’t give you the alternative treatment options and why they specifically chose this, you know. So I’ve always found that really, really, really quite helpful, really being able to talk these people directly and say, Why have you done this? And also reflecting back on yourself and saying, Well, why haven’t I thought of that? Is it because I just don’t have the knowledge about it. I haven’t been locally relevant experience. And being able to learn from it really, you know,

[Jaz]
Now we can listen to some of my colleagues who are doing a diploma in orthodontics. This is Kiran Juj.

[Kiran]
The thought of having to go back to hospital and doing an act a job where I’m literally doing it to jump through a hoop. And I’m not really finding that I’m gaining any experience in the future I want to do and something I’m doing some I don’t really enjoy does put me off.

[Jaz]
Let’s hear Sunny Luthra’s input.

[Sunny]
If you want to just do regular routine, general dentist, that’s fine. There’s no issue with that. But I don’t think you necessarily have to be on the specialist list or be a specialist to do good quality dentistry really, good practice makes permanent. No one knows that actually mean. You could be doing it wrong and still be really good at doing it. You don’t want to be doing that, because you need to know how to do it properly. Now, there are many ways to do that. That’s for the individual to find out. But what I am saying is once you learn how to do it properly, get in there and do it properly. Don’t cut corners just because you’re getting a low fee on the NHS or you’re not getting any money or your principal or whoever saying referred about, No. Get in there and learn how to do things the right way.

Jaz’s Outro: So hope I managed to get into the nitty gritty of it all in terms of the true cost of specializing taking into account the loss of earnings, but also putting out there that some of the best clinicians I know are not specialists. However, as you heard from Harjot and his passion that you know, sometimes specialists really, really, really can make a massive difference in terms of how rewarding that can be when you limit your practice to something. So you know there’s no right or wrong answer. You got to live the career that you want to do it. You got to make it where you want to be and specializing is just one way of doing. So. catch you in the next one. Thanks for listening.