QUICK BITES Interested in exploring less-traditional practice opportunities, WSDA News interviewed members and others to highlight locum tenens and other part-time opportunities for dentists. From Latin for “to hold in place, “locum” or “locum tenens” refers to a person who temporarily fulfills the duties of another — especially a physician. Locum tenens dentists provide relief in a variety of situations and circumstances, ranging from illness, vacancies, maternity/paternity leave, vacations, and death. Other part-time opportunities, like clinical instruction or working simultaneously in multiple practices, provide additional pathways in dentistry.

Dr. Brittany Dean may not have the shortest commute to work these days, but it may be one of the most scenic. And fulfilling. 

For the past year, Dean has served as an intermittent provider — a locum tenens — to the Southeast Alaska Regional Health Consortium or SEARHC. Her commute involves a commercial flight from Seattle to Juneau, and then a trip on a much smaller commuter plane (along with supplies and other cargo) into local villages and towns like Sitka and Kake. 

She first heard about the opportunity in 2019, when a dental school colleague encouraged her to participate in a trip. Her plans to start a practice hadn’t gelled yet. Then, her father passed away suddenly. 

The timing left her in search of something professionally and personally rewarding, but without the full-time commitment of a traditional dental practice. Locum tenens dentists provide relief in a variety of situations and circumstances, ranging from illness, vacancies, maternity/paternity leave, vacations, and death.

“The change of scenery is a big thing, especially with everything else,” she said. “It’s great to go somewhere I feel needed and am benefitting the community. And learning more about these communities and their cultures has been very interesting, too.” 

^{Dr. Brittany Dean in front of SEARHC Hoonah medical and dental clinic.}

The model of serving as a visiting dentist is becoming increasingly popular, particularly as new dentists explore what it means to practice in today’s sophisticated — and financially challenging — environment. 

Currently, Dean spends one week a month in a handful of Alaska communities providing her expertise as a pediatric dentist. Although her travels were suspended for about three months due to the pandemic, she’s back in the communities helping with dental needs and with vaccination efforts.

“Sometimes, it’s exciting or interesting to contribute to the world in ways outside of clinical dentistry. For instance, I’ve been able to volunteer and give COVID vaccines at clinics here in Washington. That fits very much with me — one of the reasons I chose dentistry was to be able to improve the lives of people around me. I find that exciting,” she said. “Had I been working five days a week, I would not have been able to do that. I tried to use this time where I am not fully committed to a work schedule to do some things that are fulfilling and helpful.” 

A DIFFERENT TAKE ON RETIREMENT

Yakima dentist Dr. Tomas Holbrook’s career has taken a similar path. For the past three years, Holbrook — currently approaching retirement — has also served as a locum tenens one week out of the month in Kodiak, Alaska. Like Dean, he also enjoys providing service in an underserved area and mentoring dentists and hygienists in smaller communities. It is also a marvelous adventure and cultural experience.

^{Dr. Holbrook with Roberta DeTorres, an Alaska Native from the village of Ouzinkie whom he mentors. DeTorres, a former dental assistant, is now focused on her goal of becoming a dentist.}

“You can be a lot more selective about where you go and what you do [as a locum],” said Holbrook. “But on the other side of the coin, practices are doing things differently than what you are used to, so you may need to adjust,” he said. 

^{Dr. Tomas Holbrook lands a white king in Trinity Bay near Old Harbor. Fishing is one of the perks he enjoys while working in Alaska.}

Over on the Olympic Peninsula, Dr. David Chuljian is another semi-retired locum tenens dentist. After owning his own practice for 35 years, Chuljian decided he wanted to do other things, but still do some work as a dentist. Selling his practice and serving as a locum allows him to do just that — he’s even worked as a locum in his former practice. 

But now, he can do it without the additional responsibilities that come with private practice ownership.  

“For starters, I don’t have to hire staff or need to worry about making payroll,” he said. “I used to do my own accounting and payroll — not my own taxes but all the stuff leading up to taxes. Maintaining equipment. And in the pandemic, I didn’t own my practice when this broke out — but I can imagine just making the rent was interesting. In the pandemic, I might have just said, ‘I am done.’”

The idea of stepping into another person’s practice might be off putting for some. But for Chuljian, it was liberating in some ways. 

“I wasn’t running the practice — I was just taking over or managing during a vacation,” he said. “There are probably situations when you do that. But I wasn’t going to hire anyone new or fire anybody. I just had to keep things going and maintain the status quo.” 

Chuljian said that for where he is in his life, locum tenens is a good fit, particularly given the reduced responsibility. 

“Work is spotty sometimes. But there are jobs if you are willing to drive around,” he said. 

One of those drives he makes is to scenic Neah Bay, where he also provides dental care to the Makah Tribe. 

“It’s a great place to work. Where else can you go stand-up paddle boarding after work, and see whales, sea otters, and pelicans?” he said. 

“The scope of practice is everything from extractions to bridgework, and the people you’re working with are great,” he added. “Both the staff and the patients are super appreciative — that’s what’s kept me going back since 2017.” 

TEACHING OPPORTUNITIES

Locum tenens positions aren’t always focused on temporarily filling vacancies in traditional practice settings. For Connie Berrysmith, program director for the dental assistant program at Renton Technical College, experienced dentists are needed to supervise and collaborate with students. The school’s clinic operates two days a week and provides low-cost dental services to uninsured patients who often present with compromised health issues.  

“It really is a great opportunity to work with students and show them what good dentistry looks like,” said Berrysmith. “We want to give our students the chance to work alongside experienced dentists, and to maximize their time in the clinic. The dentists who work with us spend a lot of time working collaboratively with patients, students and faculty developing detailed treatment plans,” she said.  

Because of the health complexity in the patients they serve, Berrysmith said it’s helpful to have dentists who can bring more experience to develop comprehensive treatment plans, make recommendations and perform quality dentistry.  

“The dentists who have worked here have done so for many, many years, sometimes in addition to their own work in private practice,” she added. “Our dentists are deeply invested in the students and the teaching process. It’s a fun experience for those who enjoy being in a teaching role and sharing their experience with the students.” 

For Dr. Holbrook — who in addition to his locum tenens work in Alaska serves as clinical instructor for the Yakima Valley College Hygiene School — one issue weighing on his mind is filling vacancies at home. With three of the clinic’s doctors approaching retirement (himself included), trying to find replacement dentists to work part-time at the school has been challenging.

Then COVID happened. 

“COVID made it so private practice people in town are so busy trying to catch up, they don’t have time to go and volunteer,” he said. “The whole COVID thing made it really difficult at the hygiene school to find dentists to come in and work. A lot of the guys my age and older — they don’t want to go through all the COVID learning. I’m 67, one of the guys that retired is 73. Another had health issues and didn’t want to be exposed.” 

The school continues to search for volunteer dentists, drawing professionals from Ellensburg to Prosser. Holbrook says he plans to stay on until his niece — a second-year hygiene student at the school — graduates.

FINDING A BALANCE

For other dentists, like Dr. Daniel Tremblay, working part-time in multiple offices can provide more time for family commitments, and less worry about the financial demands of owning and operating a dental practice. 

After graduating from dental school, Tremblay completed his advanced education in general dentistry with the Yakima Valley Farm Workers Clinic in Yakima and was contemplating entering a practice with his mentor. When the timing on that fell through, he found work as an associate at a couple of different dental practices, first in Marysville, then Kingston, South Lake Union and now in Federal Way. 

“I don’t think I realized all the things that go into practicing as a dentist. Lots of factors put stress on choices for jobs. For friends who bought practices — they’re already clearing off debt from school and then the debt for the practice, supporting a family, continuing education costs, disability insurance. A lot of us had a rude awakening as to how much that can entail, especially as a new graduate,” he said.

“It takes a huge investment to go into dentistry,” said Tremblay. “And the business of dentistry has changed. In most professional positions you get an annual raise and are paid on a salary. In dentistry, insurance has impacted the business of dentistry by reducing their fees or not increasing them with the cost of inflation,” he said. 

“I think there are a lot more places looking for associates and not necessarily partnerships when they truly have an equity stake in a practice, given that their dentistry, name, etc. is their brand and connection to patients that come to a practice.”

As a mentor to about 8-10 dental students at the University of Washington School of Dentistry, Tremblay makes a concerted effort to coach his mentees about the practical and financial aspects of dentistry. Students don’t get a lot of training or counsel on what it means to run a practice, Tremblay said, which is why he advises all of his mentees to get involved with a financial adviser before they graduate. 

Unlike some of his dental school peers, Tremblay did not have undergraduate student loans, but he still finished dental school with $275,000 in debt.  

“It should really be a part [of dental school] — the economics of it, understanding debt load and how to manage it not once you get out of school but while you’re in school,” he said. There were programs about the business of dentistry, Tremblay added, but they were offered by private groups or companies outside of dental school and were not required courses. 

And there’s nothing like a pandemic to add stress to an already stressful situation. 

“For myself, I am content with what I am doing — I don’t have stresses of an employee leaving or what happens when something like COVID hits — you can focus on dentistry, take good care of people and be able to go home and enjoy time with your family,” he said. “I’m thankful to not have to worry about the headaches — I still treat the practice as my own, but at the end of the day, I don’t have the financial stake at risk,” he added. 

“You can be successful in dentistry, but it takes time and there’s quite a bit of monetary lead up to be successful.” 

Dean noted that, even within her own professional circle, there are more dentists who are pursuing locum tenens or part-time positions for personal or professional reasons.   

“I think a lot of times, what I hear is that newer dental school grads have trouble finding an option of working 4-5 days per week in same clinic, so they’re often putting two to three clinics together to make it work,” she added.  

For now, Dean and Holbrook will each continue their work as a locum in Alaska, soaking up the beautiful views, slipping out for some epic fishing, and enjoying time engaging with patients in rural villages who have limited access to care.

“At this point I don’t see any reason to stop. Things might change some time in the future, but I enjoy it and it pays well. Seems like a win-win right now,” said Dean. 

“I can’t believe people are paying me to do this!”

Interested in dental locuming or other part-time opportunities? Browse opportunities or place an opportunity wanted classified in the WSDA Classifieds. Wondering how you can plan for unexpected temporary coverage in your own office? Setting up a Mutual Aid Agreement can give you peace of mind. Learn more with the ADA's General Guidelines for Mutual Aid Agreements. To learn more about opportunities at the Yakima Valley Dental Hygiene Program, contact Director of Dental Hygiene Cheri Podruzny at (509) 574-4921 or cpodruzny@yvcc.edu.

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This article was originally published in the Spring 2021 Issue of WSDA News.