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Rural versus metropolitan dental practice

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Rural versus metropolitan dental practice

This article critiques working in a regionally based versus a metropolitan practice in the early phase of your dental career, highlighting the adventures, advantages and pitfalls of each.

The Place - ‘we’re not in Kansas now Toto

It is perfectly understandable to want to stay near your friends and family. A good support network can be crucial when dealing with the unexpected highs and lows of practice. New places bring new challenges, and understanding the local demographic can be key in tailoring treatments for your new patients.. As a regional practitioner, the specialist clinical support can be lacking, with the nearest specialist several hours drive away. This can be pretty daunting when you’ve spent the last 20 minutes swinging off an impacted lower 8 that looked to be quite vertical on the OPG, but now the words of a lecturer about how 8’s are often more distally impacted than they appear radiographically are ringing in your ears or is that just the sound of the blood rushing to your head? Take a breath. You know what to do.
There are lessons in accurate treatment planning, consent and knowing your limits clinically in this scenario, but the reality is that we have all been there, swinging off that tooth, and it would happen regardless of where you choose to work. Nevertheless, metropolitan areas are densely populated with dentists and specialists making referral easy. However, when people choose to live in regional Australia, their expectations are already set that to see a specialist, they will need to travel great distances, and they are quite prepared to do that. Densely populated areas in Australia are often heavily over serviced, and this can impact on the ability of a new graduate to build their list. Also, the ethos of these patients can be one of shopping around, and some would argue that regional practices have a more family or community feel. In addition, more patients equals more treatments meaning that regionally based practitioners tend to have increased exposure to procedures and therefore gain experience more quickly.
So, if there isn’t a specialist oro-maxilliofacial surgeon working in the next room to refer to, who IS going to help with that 8?

The Person - ‘Show me the money!’

Your first principal is a bit like your first kiss, the memory lingers on long after it’s over. It’s very important that you remember, they are not just interviewing you for the position, you are interviewing them too! You will be much happier in practice if you are ethically aligned with the practice and if you have a principal, or an experienced fellow associate who is willing to mentor you, or at least look at a radiograph passed under their nose and give you an opinion. We are all learning, all of the time and no one should judge you for asking a question.
Returning back to the lower 8 – could you ask your principal to assist -perhaps something to think about after an interview, before you accept a job. Young dentists can and do flounder without postgraduate clinical support. Isolation in practice is not just caused by geography. It is possible to sit in your surgery, with practitioners situated either side and yet feel more alone than a regional dentist whose nearest colleague is 200kms up the road - I say this from person experience, of both sides of the coin.
Practice is not all about earning money (please say this sentence aloud). Choose a practice which is well equipped, with good materials and which offers services you are interested in and will enjoy. You will of course make money working, but gaining experience and providing good quality treatments is a better primary focus both for you and your principal than your hourly rate.

The Latte - ‘I’ll have a tall skinny latte, extra hot...’

Principals practise across both regional and metropolitan Australia. On what can we then base our final decision? Perhaps we need to step outside of the clinic and look at other aspects of life.
Cities have shops. Lots of shops, and cafes and restaurants and bars and theatres and shoes, lots of shoes. Regional areas can be lacking in all of these things. However, this is changing, rapidly, with increased access to all manner of goods being provided both on the ground and of course online! When evaluating an area you really need to consider access to goods and facilities that really, are your personal essentials. No barrier is insurmountable though – maybe moving 200km from your favourite chained coffee company is the excuse you’ve been looking for to buy that coffee machine!

The Lifestyle - ‘Show me a home where the buffalos roam’

It’s not all about the shoes though. Personally, I get great pleasure in walking to work every morning and not sitting in commuter traffic for 60 minutes each way. Other people need to be by the beach to recharge. There is no doubt that metropolitan areas offer a broader range of services and facilities, but often the most beautiful and tranquil parts of the cities are overpopulated or prohibitively expensive. Regional areas often offer a greater feel of community, and tranquillity. Sometimes it is nice when every one of your patient knows the name of your dog because they see the two of you walking before and after work. However, some people would hate that and opt for the anonymity of the urban jungle every time. When selecting the area you would like to practise, do be guided by the lifestyle, facilities and opportunities available to you, both inside the clinic and beyond, because at the end of that working day, you will walk away from your clinic and really, you need to be happy with your surroundings. Do consider support, professional and personal as isolation will not help you grow and develop as a practitioner – or as a person for that matter!

The Conclusion - ‘If you don’t have a dream, how you gonna have a dream come true?’

In summation, there is no easy answer, nor does the same practice environment suit every person. We are all individuals with needs and desires, ideas and emotions, and these factors should not be overlooked when making a decision. Of course, practice selection should be based on the clinic itself; facilities, staffing, materials, whether you are taking over a list or building your own and the principal or employer, but don’t shut the door on your feeling side to be solely driven by your thinking side.
I graduated from the UK and when I took my first job, I moved away from my university and my friends to be back by the sea in the regional part of the country. They all thought I was completely mad. To be totally honest, at times I did too, but I didn’t want to be a city girl any more, it just wasn’t me. We recently all met up at a wedding and each of us has followed a different path through dentistry and life and we were all happy with our choices. Many owned their own practices, some were lecturing, others were still studying to become orthodontists, there was even one girl who was studying a masters degree in law with a view to work for DPL. Your first practice is the first step on that path so choose well and for all the right reasons, and if your reason is that you simply can’t live without your extra tall skinny mocha decaf then you know where you need to be!

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