dentist, tools, mouth, teeth

“Lean back and open your mouth”

This is my story about how a root canal has turned me into a critic of the American medical education model.  

First off, I am a layman. I am not a doctor; I am not a nurse, an EMT, a researcher, a pharmacist, or a scientist. I am not a medical student. If you are reading this and your profession excludes the aforementioned, I am just like you and you are just like me. What we know of medicine is maybe through books or television or movies, perhaps incidental experiences of being ill or that of a close relative or friend – we are in the same boat.

Secondly, this is not a short read. That’s not because it exceeds the depth or ability of us laymen, but because it matters and things that matter, most often, cannot be reduced to “tl;dr” – read from top to bottom, struggle with it if you must because I struggled to write it.

Third, and perhaps most importantly, it starts with a true story.

A root canal
A few years ago, I took a job which in retrospect, had caused me a great deal of stress. I became a “clencher”. At night, while I would sleep, I would clench so tightly that my jaw was sore. At work, when irritated, I would clench. While driving home in traffic, I would clench.

Eventually, I cracked the inside surface of my tooth. This took about a year and in the leadup to that, I’d had all sorts of pains that came with having a fracture in your tooth which exposes the nerve. It took six months for me to tell my dentist and for him to be unable to find it (resurfacing my teeth and trying everything out to fix it) and then six months for it to crack… And then another six months after he repaired the crack for us to figure out something wasn’t working.

Enter the Endodontist, aka the root canal specialist. My dentist sent me to a colleague of his and our appointment went thusly:

  1. Enter the office, go through the insurance process
  2. Sit in his chair, get prepped for an exam
  3. He does 1 of 3 tests to confirm that I need a root canal
  4. He then calls my dentist and has a 30 second conversation, tops
  5. He says to me: “Lean back and open your mouth”
  6. He inserts a syringe into my gum full of anesthesia and so begins step 1 of 4 of my root canal procedure

Let’s stop at Step #6. You may not be able to gleam this from the short statements I put above, but I didn’t know he was going to do that procedure at the time. I had no warning. It was literally “lean back and open your mouth” and boom I was having a root canal. When I relate this story, at times, someone is always outraged on my behalf about my endodontist’s lack of “bedside manner” and there is often frothing at the mouth, commentary on the personage of my endodontist, etc. etc.

And you know what? I don’t care and let me explain why.

My endodontist is not my regular dentist. I know his name but for the life of me, I couldn’t identify him walking down the street. He was, and is, an expert technician – this is not in any way an aspersion on his skill and number of years at this specialty – but he is a technician. He is not my ‘primary care’ dentist. He didn’t need my story to sort through how long it took for me to get from stressful job to sitting in his chair. He needed to confirm the problem and fix it, which is exactly what he did.

After Step #6, my 5 seconds of mental surprise/irritation disappeared. He and his team was fast, professional, and clean. I was out of the office in less than an hour, back in a few weeks later for step 2 of 4 of my root canal procedure, an appointment that was equally as swift and well-executed as before, and then onto steps 3 and 4 with my regular doctor.

My overall experience? Well, let’s just say, if in the future I need another root canal, there is only one place I’m going.

Tinker, tailor, doctor, dentist
On average, how long does it take to become a doctor or dentist in these here United States?


Medical Education Table (US)

Wow, that’s a lot isn’t it? If you pass through all the hoops “on time”, which would mean undergraduate 18-22, directly into medical or dental school thereafter, and not a trip or hesitation in the road, the earliest you’re fully licensed and on your own two feet with your own two hands, off the leash is 26. Anything even slightly fancier and say hello to your 30s and bite the bullet as long as you must.

Now, on its face, someone could look at this and say, yes, this makes perfect sense. In fact, many people do. The existing hierarchy of medicine had to do it and while I’m sure there are both some rebels and geniuses in the temple, the majority probably sits right in the middle of that average. That’s how traditions start – that’s how traditions are upheld! – but, let me tell you, in my area of work I had well before 26 to be on my two feet, and based on current events, the impact of my work isn’t necessary tiny.

However, I would never argue that it is equivalent to the care and protection of human life, not at all. Regardless, somehow, in some form, I think we can find a faster and better way to educate and train our medical professionals.

Still, let’s keep going – there’s more to this.

Let’s talk numbers
It is not cheap to make a dentist or a doctor. And more often than not, these things are paid with loans and we all know that education loans now stick to you as much as death and taxes. I will not reinvent the wheel here, so visit this excellent deep analysis done by Dr. Benjamin Brown done in 2010. (I’d like to point out we’re in 2014, and those numbers can now be considered discounted). At the time, almost $300,000 spent on education alone for a general physician.

If you were $300,000 deep, what would you choose to specialize in? You’re already more than a quarter of a million in the hole, potentially, what’s another $100-200,000 if it means on the flip side of that as a specialist you’re making tons more?

And that brings us to other numbers – the impending shortage of doctors in the US. 2013, the President and CEO of the AAMC, Dr. Darrell Kirch: “By 2020, we will need 91,500 new doctors.” Alarmist? Perhaps, the next number, in 2025 was 130,600 new doctors. Or maybe spot on because we do have an aging population that is living longer. And the practicing doctors are aging with them, so that means a good number are retiring with them, too!

What this means for today’s path
11 years whether or not you become a specialist. 11 years, whether or not you will spend your life making slices and doing sutures, or with your eye pointed into the lens of a microscope, or in an office seeing a new patient every 15 minutes for a cough and an ache, for blood work and a fever.

11 years just to get out the gate and I’m sorry, when you consider the facts, 11 years is simply too long.

You know why?

Because there are laymen, people like you and me, who would consider medicine, nay, would want to do medicine instead of:

  • Writing lines and lines of software code
  • Reviewing plans and formulas for buildings and bridges and treatment plants
  • Toggling and tweaking telcom lines and network servers
  • Jumping out of ambulances to administer CPR and using a defibrillator to save lives
  • Lecturing about dead authors and the lost histories
  • Building models and writing algorithms for the buying and selling of securities instruments

There are people, laymen, who if you put 11 years – or in many cases, potentially 2 to finish all the science and then another 7, so even 9 years to go from doing what they do to helping fill the shortage – and at least $200,000 of debt with it – they have to say no.

But, if you found another way, if there was another way, then I think you would hear more than just a handful say “yes.”

Getting to yes
Here’s where I acknowledge that my analysis may fall down or my solution may be lacking. So instead of pretending that this is all fully fleshed out, I’m inviting you into my thought process. Here are the things I’ve scrawled down on sticky notes and on my whiteboard, on the edges of my notebooks and tapped out on my iPhone while stuck on a subway train on my way to work:

  1. There is a limit to how much knowledge one can obtain and is usable – why do we assume our surgeons must be researchers and vice versa?
  2. There are different paths! We see it in so many careers. Why can’t we bifurcate them earlier?
  3. Remember the technician? Remember the barber-surgeon? He had the tools and knowledge of anatomy (not perfect, it was the Middle Ages, of course!) – how do we rebuild the paths to trades similar to how we managed them before?
  4. This will change the economic equation of medicine, vastly

Is this naiveté in its finest?
Perhaps. Maybe it is. Maybe, as a laymen, I lack the visibility and understanding to properly appreciate why we must start at 11 years and go up from there. Perhaps I have framed this too simply, from expert technician equivalent to surgeon, that there is an ability to bifurcate foundational knowledge from execution.

Give me the cons. Someone, anyone come with the rebuttal, come with many! The best way to make an idea stick, to see if it has real legs, is to try to chop off as many legs as you can and see if stays standing.

I think this has some merit. Prove me right or prove me wrong, but let’s start a conversation — the future of our healthcare system depends on it.

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