The Reimagining of a Dental Career -- I Thought I'd be Rich, But I Found Wealth in a Different Way

By Bill Jackson February 27, 2023 13 mins read 152 Views

By Dr. Tyler Scott, WCI Columnist

It is both incredibly surreal and profoundly humbling to be writing this article.

When I began reading The White Coat Investor almost 10 years ago, I never could have imagined the scope or magnitude of its impact in my world. An impact not only on my finances but on nearly every corner of my ever-changing life. My jobs, my careers, my wife’s career, where I live, and especially how I live have all been directly and positively influenced by the guidance I have found here. That influence has come from Dr. Jim Dahle and from all of you who comment, post, and contribute across the WCI network. You have collectively made my life better, and I am deeply thankful.

Today, I am grateful and honored to share with you the beginning of my constantly evolving professional and financial story. I don’t expect widespread acceptance of my choices or my perspectives, and I don’t intend to convince anyone of them. Rather, my hope with this post and all future posts is to make a contribution to the accumulated wisdom, levity, and collegiality of this community that has been so useful to me.

With that preamble in place, I now offer the meandering story of my dental career and a few possible lessons learned along the way.

Applying to Dental School Without a Worry About Student Loans

When I began seeking out a dental school spot in the summer of 2007, I was desperately hoping to get into any of the 13 schools where I applied—with the goal of returning to the suburbs of Salt Lake City in 2012 to buy a private practice as a newly minted general dentist.

I gave no thought to the cost of my education since every dentist I knew had given me the same advice regarding student loans: “Just worry about getting in, doing well, and the rest will take care of itself.” I naively and enthusiastically agreed. All that mattered was getting in and then, after four years of training, I would come home to take my rightful place in the pantheon of rich dentists on the east bench of the Salt Lake valley.

Fast forward two years to the end of my first year of dental school at Oregon Health & Science University. My elation and pride at becoming one of the few people in my extended family to graduate college—and the first to attend a post-baccalaureate program—had faded, and mild anxiety about my economic future had begun to build.

I had been in training for less than a year and had already taken out $55,000 in loans just to cover tuition. My wife had secured a good job that was paying our living expenses in Portland, but a change in tort law in Oregon had (allegedly) been the cause of significant increases in tuition. Tuition costs that had been projected to be $40,000 for my first year and $180,000 total when I chose OHSU had quickly become almost $60,000 for the first year and $280,000 for all four.

I knew I was going to be a rich dentist with a 4,800-square-foot house and a boat in no time but still . . . $280,000 felt like a lot.

I started asking the dentists back home how long it took them to pay off $280,000 of debt at 6.9% interest. The looks on their faces when I asked this question were as stupefying as their responses:

“Well . . . ummmmm . . . you see son, I graduated a few years back when things were a little different. My schooling cost about $60,000 total. My parents paid for a good chunk of that, and I borrowed the other $35,000 at 1%. I’m still paying it off; it’s just a couple hundred dollars a month.”

With a resource-scarce elementary school teacher for a mom and a Pakistani immigrant drywall hanger for a dad, I was rich in emotional support. Sadly, the Department of Education accepts neither multicultural parental pride nor unfettered borrower negligence as payment.

Temporarily panicked, I settled my nerves by turning my attention away from debt and toward income. I thought, “This is OK, no problem, if I’m going to owe this much, I just need to start doing the leg work to find a really good-paying job.” Prior to this moment, I had never thought to ask what it costs to buy a dental practice in the suburbs of Salt Lake. My temporary panic adopted some level of permeance when I met with a practice broker who showed me a listing of current practices for sale in my area that ranged from $700,000–$1.2 million.

Combine this with some casual home shopping my wife had done—a few favorites ranged from $400,000–$800,000 (a bargain by today’s comparison)—and suddenly the reality of my dreams came into acute clarity. With a projected first-year income of $150,000–$200,000 in the intensely oversaturated dental market of northern Utah and a looming combined debt of $1.4 million–$2.3 million, even my financially ignorant mind came to an inescapable conclusion.

This is not going to work.

More information here:

Freedom from Student Loan Debt: A Dentist’s Story

Maybe Joining the Military Is an Option (It Was Not)

With Plan 1.0 (move back to Salt Lake City and be joyfully rich) off the table, I shifted gears to Plan 2.0—temporarily move almost anywhere and be contentedly middle class. Step 1 of that plan was to buy myself an emotional support chalupa at Taco Bell and eat slowly while I figured out how to break this news: first to myself and then to my wife. Step 2 of that plan was to get someone else to pay for the rest of dental school.

One of my classmates was in the military. His school was paid for with the HPSP scholarship, and he also received a $20,000 signing bonus, a monthly stipend, and officer pay during school breaks. Perfect!

I did some research and found out that the Army is terrible with lots of open spots, the Air Force is awesome with zero open spots, and the Navy is tolerable with a few open spots. A bunch of paperwork, a trip to San Diego’s naval and Marine bases, a very weird day at something called MEPS (Military Entrance Processing Station), and several interviews later, I was told by my recruiter that I was approved for a three-year Navy scholarship. The Navy would pay for my last three years of school, and I would be a Navy dentist for three years after graduation.

Plan 2.0 was off to a great start.

Then, one day while I was in removable prosthodontics lab making dentures, the dean of admissions got me out of the lab, saying there were some “visitors from the Navy” that wanted to see me. Thinking I was getting some kind of welcome-to-the-club visit and leaving with a logo-emblazoned water bottle, I instead received an hour-long interrogation from the NCIS. Then, my scholarship was rescinded.

Apparently, I didn’t have satisfactory answers to why my dad lived in Abbottabad in northern Pakistan for so many years, who he lived with, who his associates were, and where those associates were now.

I was devastated.

It wasn’t until two years later when President Obama came on TV to tell the world that Osama bin Laden had been located and killed in Abbottabad that I understood why I had been catechized so intensely that day and why the US government didn’t want me on its battleships. In fact, when bin Laden’s compound was shown on the news, my dad called and said, “Hey, I know that place. I used to play cricket and chase goats over there.”

To be clear, my dad is not associated with Al-Qaeda. He’s mostly associated with gin martinis, vinyl records, and Monday Night Football, but alas, I was back to square one.

While confused and disappointed, I was undeterred in my pursuit of finding someone to pay for my exorbitant tuition. Instead of the military, I turned toward the National Health Service Corps (NHSC), a division of the federal government that offers a scholarship analogous to the one I had with the Navy. The NHSC would pay for my remaining training and provide a monthly stipend in exchange for a 1:1 service year payback. The catch is that the service payback had to be at a Federally Qualified Health Center (FQHC), which is almost always located in very rural areas or low-income urban areas. (You may recall that these were both very different than the Salt Lake suburb life I had imagined for myself.) This is because FQHCs are built and funded with the purpose of providing care to uninsured, undocumented, and/or working-poor patients who are unable to access care through the more traditional and familiar American healthcare system.

dental school student loan

This became plan 2.1: temporarily move almost anywhere and be contentedly middle class but on the NHSC scholarship plan.

I applied, and I was denied.

I found out later that the NHSC scholarship was incredibly competitive, and scholarships were preferentially awarded to applicants from minority or otherwise marginalized groups. While my dad is from Pakistan and I was raised in a highly-gentrified area of Salt Lake, my lived experience is one of a tall, white, straight, upper-to-middle class, Christian, privileged man, and hence I was not offered the scholarship (correctly so, in my opinion).

So, at this point, things weren’t exactly going according to plan. To be fair, I entered dental school without any plan, and I was getting exactly what I planned for . . . nothing. The old saying, “If you fail to plan, you plan to fail” was certainly proving true in my case.

The one glimmer of hope I had left was something I learned about in my NHSC application process. The NHSC offers a scholarship I couldn't get, but it also had a loan repayment program. At that time, if I worked for an FQHC with an HPSA (Health Professional Shortage Area) score of 18 or higher, I would receive $60,000 of tax-free student loan relief in exchange for a two-year commitment. If I stayed longer, I would receive $20,000 in both years 3 and 4 and then $10,000 per year for years 5 and beyond.

It wasn’t nearly as good of a deal as the scholarship, but it was something. This became Plan 2.2: temporarily move almost anywhere and be contentedly middle class on the NHSC loan repayment plan.

This plan worked out. Well, kind of.

More information here:

How I Went from a Negative Net Worth in My 30s to Early Retirement

Working with the Underserved and How That Made All the Difference

After graduation, we moved with our first child—a brand new daughter—to stunningly beautiful southern Oregon where we bought a four-bedroom house for $220,000 on a 2% mortgage (the monthly payment was $895). I accepted a job at a qualifying FQHC where I was paid $118,000 a year (a stark departure from the $250,000–$300,000 I had been led to believe I would make when I started taking pre-dental classes eight years earlier), great benefits, and a group of young idealistic dentists who were there partially for the loan relief but mostly for the cause of serving the underserved.

I was just there for the money.

In my mind, my wife had married me based on the understanding I would be a wealthy medical professional providing the life we had always seen the doctors in our neighborhood live (she and I met in high school). I could feel the heat of my mother-in-law’s proverbial stare searing a molten hole into my soul while I temporarily failed to bring her daughter back to the homeland. In other words, there was no world in which we were staying in this job for more than a few years.

Fast forward three years to 2015 and everything had changed. We fell deeply in love with southern Oregon, and I fell even deeper in love with public health dentistry.

I was shocked to discover how rewarding it was for me to treat patients who lived on the margins of our society, who had been dealt an impossibly difficult hand in life, and who had lived with the pain and the shame of untreated oral disease for so long. I found such joy in going into our local schools to provide screenings; sealants; fluoride; and, most importantly, oral health education to disadvantaged students. I relished the unpredictability and challenge of taking a modified RV-turned-mobile-dental-clinic into the local pear orchards and providing emergent care to migrant farm workers from all over Latin America. I found so much satisfaction in navigating the myriad social and mental health challenges of removing all the infected teeth of chronically homeless patients and making them a pair of dentures they could be proud to show off with their first toothy smile in years.

Photo via Tyler Scott

I loved working with a team of dentists who were diverse, driven, and immensely talented. My dental skillset grew exponentially being around providers who had such a range of training and experience. To have 5-10 peers to review a treatment plan, look at a radiograph, support me through a new procedure, and just vent to was invaluable.

Stack that alongside Oregon’s expansion of the Affordable Care Act to include dental care which brought along with it the expansion of our clinic, pay raises, increasing wonderful benefits, and the ability to hire more providers, and I had accidentally found my dream dental career.

After five years, I had increased my pay to over $200,000; I had an administrative role at the clinic that was interesting, rewarding, and a welcome break from patient care; and I had received $110,000 of tax-free student loan forgiveness.

During this time, I overheard a conversation between two other dentists about some niche blog that supposedly could help medical folks make better financial decisions. In an attempt to find that blog, I stumbled upon Mr. Money Mustache, and I was immediately absorbed into the FIRE movement.

Not long after, I found the obscure blog my coworkers were talking about, and under the tutelage of Dr. Dahle and MMM, I continued to live on our same budget from dental school; I also eradicated the rest of my $280,000 debt within those same five years.

I ended up staying at this job for nearly 10 years. In hindsight, combining the NHSC loan forgiveness with Public Service Loan Forgiveness (PSLF)—especially with two-plus years of $0 COVID payments—would have been the more optimal strategy. But I didn’t know then what I know now, and I never once regretted being free from the immense burden of those student loans.

Plan 2.2: temporarily move almost anywhere and be contentedly middle class on the NHSC loan repayment plan had morphed into:

Plan 3.0: bask in the supernal satisfaction of public health and joyfully thrive in the majesty of southern Oregon.

More information here:

Paying Off Spouse’s Student Loans Together

Some Takeaways from My Journey

To recap the evolution of my professional career plans:

Plan 1.0: Move back home and be joyfully rich.
Plan 2.0: Temporarily move almost anywhere and be contentedly middle class—the Navy plan.
Plan 2.1: Temporarily move almost anywhere and be contentedly middle class—the NHSC scholarship plan.
Plan 2.2: Temporarily move almost anywhere and be contentedly middle class—the NHSC loan repayment plan.
Plan 3.0: Live and love my public health career in southern Oregon forever.
Plan 4.0: Move back to Utah and make a career change to finance . . . but that’s a story for another day. (Literally for another day. I plan to tell the story of my relocation to Salt Lake and my complete career transition in a future column.)

That is a path I didn’t see coming and one I never could have predicted. It is a path that has brought me tremendous happiness, incredible growth, and profound learning, for all of which I will forever be grateful.

Some possible big-picture takeaways from this meandering journey of mine may include:

See the end from the beginning. Know what your training will cost, know what getting into your chosen field after training will cost, and know if your desired field and desired place to live can support these costs.
Have a plan for how you will mitigate and then repay these articulated costs.
Don’t fret when your plan gets derailed. It’s impossible to know how the twists and turns of life may lead you to a better place than your plan ever could have.
Consider public health as a viable, long-term career option and not just a way to pay off your loans. It surprised me, and it might surprise you, too.

Some possible small-picture takeaways may include:

Don’t take peer-to-peer student loan advice from someone that’s been out of training for more than 10 years and/or who holds a Pollyanna view about your future.
Make plans to visit southern Oregon.
Don’t play cricket next to terrorist cells.

My journey from aspiring practice owner to wannabe military officer to public health provider revealed what I didn’t know I always wanted from healthcare—peer-to-peer friendships, diversification within my work, and a heart-centered mission that was about something bigger than my long-planned house and boat.

It’s a journey I wasn’t planning on, one I wouldn’t necessarily repeat, and one I will never regret.

Can you relate to this path that was filled with twists and turns? Have you ever thought about working with an underserved population? Have you found wealth that didn't include a high salary because of the work you do? Comment below!

The post A Dental Career Reimagined — I Thought I’d Be Rich But I Found Wealth in Another Way appeared first on The White Coat Investor - Investing & Personal Finance for Doctors.

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By: Josh Katzowitz
Title: A Dental Career Reimagined — I Thought I’d Be Rich But I Found Wealth in Another Way
Sourced From: www.whitecoatinvestor.com/a-dental-career-reimagined/
Published Date: Mon, 27 Feb 2023 07:30:09 +0000