Dentistry Uncensored with Howard Farran
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387 Military Dentistry with Anthony Carbonella : Dentistry Uncensored with Howard Farran

387 Military Dentistry with Anthony Carbonella : Dentistry Uncensored with Howard Farran

5/7/2016 12:31:46 PM   |   Comments: 0   |   Views: 467

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VIDEO - DUwHF #387 - Anthony Carbonella


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AUDIO - DUwHF #387 - Anthony Carbonella


Anthony became interested in dentistry when he was 9 years old and had his one and only filling done. His dentist was one of his mom’s best friends; so, he was always felt very welcome at the practice. Dr. Carbonella shadowed him in high school for 100 hrs and became completely hooked.  He went to UConn undergrad with every intention of getting accepted into UConn School of Dental Medicine. The summer before dental school started, he was offered a USAF scholarship for school. After graduating, Dr. Carbonella went onto active duty, did AEGD residency in California, got lots of good training in every specialty, then was assigned to McGuire Air Force base in New Jersey. He’s been at McGuire for the past 3.5 years and has been moonlighting for the past year for private practice experience and to save some extra cash. In the past has lectured to younger "airmen" on the benefits of retirement planning and being smart with money. It's a passion of his. Next spring he is leaving for San Antonio Texas where he will start the TORP (Tri Service Ortho Residency Program, Army, navy, and Air Force). Other than that, he is the oldest child of 4 boys, who all went to UConn. He is engaged to his lovely fiancé Angela who is a jersey girl through and through, Columbia University graduate, and a child psychologist. 

Books mentioned during the podcast:

-The Little Book of Common Sense Investing by John Bogle

-The Total Money Makeover by Dave Ramsey

-A Random Walk Down Wall Street by Button Malkiel

-Millionaire Teacher by Andrew Hallam

-The 7 Habits of Highly Effective People by Stephen covey

-How to Win Friends and Influence People by Dale Carnegie

-The Magic of Thinking Big by David Schwartz 

Email Dr. Carbonella at anthony.carbonella.2@us.af.mil to inquire about Military Dentistry.


Howard:

It is a huge honor for me today to be podcast interviewing Anthony Carbonella, who's an captain in the United States Air Force, and I'm so excited to have you on the show because you're a young dentist, you're 30 years old and you're in the military and the topic today was military dentistry. I'm so excited about this podcast. Your bio you got interested in dentistry when you were nine years old when you had your one and only filling done. Your dentist was one of your mom's best friends so you always felt welcome at the practice. You shadowed him in high school for 100 hours and then was completely hooked. You went to U Conn undergrad with every intention of getting accepted into U Conn School of Dental Medicine. Summer before dental school started you got offered a United States Air Force scholarship for dental school.

 

Anthony:

That's right.

 

Howard:

After graduating went on to active duty, did AEGD residency in California, got lots of good training in every specialty. Then got assigned to McGuire Air Force Base in New Jersey, been at McGuire for the past three and a half years, you've been moonlighting for the past year to get private practice experience and to save some extra cash. You've given a couple lectures to the younger airmen and listed guys and gals 18 to 21 years old on the benefits of retirement planning and being smart with money, it's a passion of yours. Next spring you're leaving for San Antonio, Texas where you start the TORP, Tri-Service Ortho Residency Program, Army, Navy and Air Force. Is that to become an orthodontist?

 

Anthony:

That's right.

 

Howard:

Right on, looking forward to that very much. Other than that you're the oldest child of four boys, I have four boys.

 

Anthony:

Yes, I've heard in the podcast.

 

Howard:

You would be my Eric, and you all went to U Conn. Two brothers are pre-med, engaged to a lovely fiance Angela who's a Jersey girl through and through, Columbia University grad, child psychologist. Thank you so much for doing this show for me.

 

Anthony:

Yes, thanks for the intro.

 

Howard:

Let's get right to the military. Where along in school can someone get a military scholarship? Is this something you got to get locked up before you walk into dental school or is this something you can do after freshman, sophomore, junior, or senior year?

 

Anthony:

It all depends, back in '07 when I was graduating from college the military was looking to grow a little bit, to take more people in, so these scholarships were easier to come by. They actually reached out to me to offer me the scholarship. Nowadays we're a little bit fatter and happier in terms of number of people that we have, so they're not actively reaching out to people to offer scholarships because it's kind of the other way around, you have to seek it out.

 

Howard:

It was expanding in 2007 and they were going out after you and now it's contracting and you have to go out after them.

 

Anthony:

Right, so it's not impossible to get them. For instance my brother is pre-med right now, he is actively applying to try and get a military scholarship to fund his medical school, whereas I had no intention of joining, not that I had anything against the military but it didn't cross my mind at the time. Once they contacted me I was like okay, that's interesting, let me look into this and it turned out to be a really great fit.

 

Howard:

What did they pay? Did they pick up tuition or room and board, what do you owe them?

 

Anthony:

Sure, so they will pay the tuition at any school that you get into whether it's a state school, private school, that's 100% covered. I let them off a little bit easy by going to a state school but still a considerable amount of money there. Then every two weeks you get a stipend for living expenses, they expect for you to pay for housing and food and they want you to be comfortable while you're in school, not have to worry about the finances of everything so you can focus on school. Then even better then that, every time I bought a book or something that was required for school I just had to submit the receipt and they would reimburse me on that as well. It really was basically 100% coverage of everything. I think the only thing I paid for when I was in dental school was the fees for my board certification but that was pretty much it.

 

Howard:

Did your dental school book stores, did they sell beer?

 

Anthony:

I wish yes, no unfortunately not.

 

Howard:

What are your thoughts, there's Army, Navy, Air Force, Marines and actually Marines don't have dentists but the Navy dentists take care of the Marines because Marines isn't actually a separate division in the military, isn't it a subdivision of the Navy?

 

Anthony:

Correct, yes they're a subdivision of the navy, so it's pretty interesting. The base that I'm stationed at it's a true joint base. We're not just an Air Force Base, it's Army, Navy, Air Force, Marines and Coast Guard, so I get to treat patients from every single different branch of service. I don't have any personal experience going to clinics from other branches, but I will say that when some of the sister service people come to see me they do comment on how nice the Air Force clinic is and stuff like that. Besides my own personal bias the patients seem to think that the Air Force has got it pretty good.

 

Howard:

In the military there's what, three million people in the military? Isn't the Pentagon the largest employer in America?

 

Anthony:

Yes I believe so.

 

Howard:

You think of the troops as young kids, what is the average age, I mean is it 80% kids 18 to 21 or is it really just a full population?

 

Anthony:

It's a pretty full population, most people let's say they enlist at 18, they stay 20 years so they're retiring when they're getting up towards their 40s. Some people will stay all the way for 30 years so they'll be getting into their 50s but that's not as common. I would say the average patient coming in to see me is somewhere in their 20s.

 

Howard:

They average in their 20s and some of these places might be different. I remember I went into the dental clinic in San Diego, it was a 99 chair at the Marine Base and it seemed like everybody looked like a very young man.

 

Anthony:

Yes that's right, for instance where I'm going to be doing my residency in San Antonio, that's the base where every person who enlisted that's where they go through boot camp, basic training, so that will be a very young base, most of the people coming through there are fresh out of high school or just shortly after that so that will be a really young base.

 

Howard:

For that young base it's mostly going to be fillings and wisdom teeth?

 

Anthony:

Actually when they're at basic training they get a pretty cursory dental exam at first to make sure that there's no big emergencies that are going to arise when they're going through those 12 weeks of boot camp. They'll get a pano, they'll an exam, and if they need their wisdom teeth out on an emergency basis there is an oral surgeon present to do that, but typically they don't get their comprehensive treatment planning until they get to their next duty station. The emergencies are taken care of and then they'll show up at a base like the one that I'm at for their initial exam and we'll work up a full treatment plan and then take care of them at that point.

 

Howard:

How many dentists work for the United States Military? Do you know that number?

 

Anthony:

I know that in the Air Force there's about 1,200. I couldn't quote you on the sister services.

 

Howard:

The Air Force is much smaller than the Army isn't it?

 

Anthony:

It is, I think we're about 300,000 at this point [crosstalk 00:08:33].

 

Howard:

300,000 in the Army.

 

Anthony:

In the Air Force, I think the Army's probably close to double our size but again I don't have the exact figures on hand.

 

Howard:

Is it true that Army stands for Ain't Ready for Marines Yet?

 

Anthony:

I'm not going to get involved in their [inaudible 00:08:50] there.

 

Howard:

You're not going to address that issue?

 

Anthony:

No.

 

Howard:

The point is, but you said how many dentists work for the Air Force?

 

Anthony:

I think about 1,200.

 

Howard:

You think probably the Army has twice that many if they're twice as big?

 

Anthony:

I guess that could be a reasonable guess yes.

 

Howard:

Then you have the Navy and if the Air Force is 300 and the Army is 600, what would the Navy be?

 

Anthony:

I think they're somewhere in between I'd have to say.

 

Howard:

That could be 1,500.

 

Anthony:

Sure.

 

Howard:

You're looking at five, six, seven, eight, nine, 10, 11, you're looking at over 5,000 dentists.

 

Anthony:

Sure.

 

Howard:

They buy so much materials they have a dental research facility.

 

Anthony:

That's right.

 

Howard:

What's the name of that and where's it?

 

Anthony:

It's called DECS.

 

Howard:

DECS.org, desc or is it .gov?

 

Anthony:

Let me get the exact web address for you and I can email it to you.

 

Howard:

The point I was making is they just do some of the best dental research in the world but they only disseminate it to the 5,000 military dentists. Dental Evaluation and Consultation Service, they do so much amazing research. Private practicing dentist they think CRA or whatever, but my God this is some of the best research in the world. Are you a fan of their research?

 

Anthony:

Yes, in fact when we decide if we're going to buy a new product or something within our individual clinic that's the first place that we'll go to look to read the review and see what they thought about it. They are the Bible on which products are good and which ones to avoid. For instance we just bought a couple of Isolites and they gave it an excellent rating and we may not have bought it prior to reading their review.

 

Howard:

Do you know anybody there?

 

Anthony:

At one point I did, the people change over so quickly. I could reach out if you needed me to.

 

Howard:

Yes, I mean I wouldn't mind reprinting some of their summaries in Dental Town or putting a link to it on the website because so much about ... I hate to say this but so much of dentistry and research is commercialized. I'll just say this on pharmaceuticals and you can read in between the lines, but a pharmaceutical company have a new pill, so they'll have 20 different medical schools around the world do research and they all say about this but then one school for some reason they screwed it up it looks really bad, another school screwed up the study it looks really good and they bury all the other research and only push out the one that looks so good.

 

 

The thing about these military research people they're just no money incentive at all, it's just down and dirty research and you don't have to worry because when people say this research came from a dental school we'll go in those dental schools. A lot of those professors are taking grants from companies and doing research and if they're not getting good results they'll go find someone else or they'll do 20 dental schools and just publish the best. DECS.gov, that's a phenomenal.

 

 

Now that you've been in there three and a half years is there really any difference worth talking about between Navy, Air Force, Army dentists? Who fixes up the Coast Guard, is that also Navy?

 

Anthony:

I guess it depends on who's closest to them, I don't think that they have too many of their own dentists, but the Coast Guard here in New Jersey they come to us. They're few and far between and you always know a Coast Guardman comes in because they carry their full medical record with them and it's always a Bible, that thick. I'll come into the treatment room and I'll be like oh someone from the Coast Guard's here when I see that Bible on the counter. We get the full range on base like I had said. In terms of difference between them, again I haven't been to any of the sister service clinics, but the patients will say I don't know if it's just me but they'll say that they're getting some pretty nice treatment at the Air Force facility.

 

Howard:

These dentists, how's the pay for military dentist?

 

Anthony:

I mean that's all published, I have no problem sharing that. I think to start out it was in the 80s, mid-80s probably. Now the nice thing is there's a portion of your pay that goes for housing and it goes up or down based on what your zip code is. When I was living in Northern California it was X amount and then when I moved here to New Jersey it went up considerably and that portion of your pay is tax free so that's really nice. When I go to Texas that portion of my pay will shrink a little bit because it correlates with the cost of living associated with the area.

 

 

At this point now that I'm almost five years in on active duty my pay is around $110,000 and-

 

Howard:

That's a nice steady climb, 80 to 110 in five years.

 

Anthony:

Within five years yes. It's been nice, it's been nice, I mean some of my friends working in private practice are making more, but the next thing out of their mouth is but my student loan payment is X and some of them it sounds pretty crippling. It's been a really great opportunity from a financial standpoint for sure, I have no complaints about I don't care that I'm not making 150 like they are, 160 like they are because I don't have the debt to worry about.

 

Howard:

That debt, I mean a lot of those guys are going to take 15 years to pay that off.

 

Anthony:

That's right, since I got into this whole finance thing I try and rub a little bit off on them but they're already swept up into the whirlwind of life, building houses, buying new cars and doing all of that crazy stuff and on some of them I'm kind of worried but that's that, it's their life and how they choose to live it.

 

Howard:

I met so many dentists, I mean I've had dentists in my house in my front room balling about their finances. I mean crying tears, going through bankruptcy, losing everything and sometimes they're sitting there and they have five cars and you're like dude, are you a rock star? Did I miss your latest album? How the hell do you become a dentist and think you're a rock star?

 

Anthony:

That's right, yes my friends aren't so much into the cars or anything and I would know about it, you could see on my wall that's my passion, my hobby, but I think it's the whole having to deal with the delayed gratification through college and dental school. Once people start getting a little bit of money to rub together they feel like they deserve to go out and spend it and reward themselves with a lot of nice things and I'm not saying that we don't deserve those things, but I think if just for a couple of years, two, three, four years out of dental school you consider to live a more simply life and really start to save, pay down your debt pretty aggressively and stuff. That might be the smarter way to go.

 

Howard:

What they don't understand is that a worst case scenario, a dollar and fool will soon be parted. If you have a dollar it will pay you a nickel a year for eternity. I mean Rockefeller's dead and that trust fund is still in bonds just kicking out a nickel for every dollar he put in that thing and then that car or that house just this infinite money pit and it seems like these dentists get out of school and most of them, they literally have to get into their 60s or retire and they're still paying interest, they're still paying a nickel on dollars they've already spent instead of earning a nickel on a dollar they saved. I mean they just never cross the chasm.

 

Anthony:

That's right, I actually just listened to that from your 30 day dental MBA, that exact podcast and I thought you did a good job at driving the point home on that how make your money work for you, and really the only way to do that is by saving and investing. Investing in appreciating assets not cars and stuff that are just going to keep going down.

 

Howard:

Did you listen to that on YouTube or iTunes?

 

Anthony:

iTunes yes, I got really into podcasts let's say about a year ago listening to them in the car. I have a longer commute so I wanted to try and be productive, maybe learn something during my commute so I've been listening to you, a little bit of Dave Ramsey, other financial stuff and it helped to pass the time.

 

Howard:

Who's Dave Ramsey? The dentist?

 

Anthony:

No Dave Ramsey, the big Total Money Makeover guy, baby steps and he's a very anti-debt type of guy.

 

Howard:

Tell him I want to interview him on my show.

 

Anthony:

Sure, yes that'd be incredible.

 

Howard:

Where's he out of?

 

Anthony:

He's in Tennessee I think.

 

Howard:

Tennessee, that's a pickup line when you go see your girlfriend Alicia tonight, you say hey Alicia are you from Tennessee because you're the only 10 I see. I did that 30 Day MBA, I think that was 1994.

 

Anthony:

Yes I think so.

 

Howard:

Now it's 2016, I had algebra so I should be able to figure out how long ago that was. Is that still relevant?

 

Anthony:

I mean I thought so.

 

Howard:

Was that 22 years ago, are you kidding me?

 

Anthony:

I believe so.

 

Howard:

That's a 22 year old information. Did you still gain from it or you listen to it thinking it's all outdated?

 

Anthony:

No totally, I mean I thought a lot of the info ... It was the essential parts of whatever you needed to know about that topic, pretty timeless information. The only way that I knew that it was dated was that you referred to each one of them as a tape, so I got a kick out of that. Other than that it was all pretty relevant.

 

Howard:

Did I say 8-track or VCR?

 

Anthony:

That's right, and whenever you would refer to one of your boys I mean you were quoting ages like this one is six or this one is seven, eight, so I knew that was outdated too, but all of the information was really good. I mean I listened to it all the way through, I wouldn't have done that and wasted 30 hours or so if I didn't think I was getting something out of it.

 

Howard:

Tell me the absolute truth and do not lie, you have to be honest. Did you get all the way to the end?

 

Anthony:

I did, yes I did.

 

Howard:

You're the first guy.

 

Anthony:

I did.

 

Howard:

Most people drove off the road, went off the bridge, went off the cliff somewhere in the 20s.

 

Anthony:

No I did, like I said it really helped me to pass the time and some of the topics I was more into than others. The personal finance one I really liked, the ortho one I really liked, pediatric dentistry, that kind of stuff. Some of the other things didn't interest me personally as much like a lot of the economics and stuff, but I know that some day when I get out into private practice that's going to be important for me so I still tried to take something out of those too.

 

Howard:

I always thought when I was making those that when you get those concepts in your head ... Like science and undergrad, you're sitting there thinking why do I need to learn geometry and trig and physics to do a root canal but you'd be surprised when you get older that the physics you are thinking about that when you're elevating and looking at endo files and all that.

 

Anthony:

All the time.

 

Howard:

Out of nine specialties, why did you pick to specialize in ortho?

 

Anthony:

When I was in dental school, I don't know about other dental schools, but I'd be willing to bet that there's not a ton of hands on ortho experience.

 

Howard:

There's none.

 

Anthony:

Exactly, so I never put a bracket on a tooth, I might have taken some elastics, some of the O-rings off and taken some photos maybe with a resident for a couple of days, but I didn't really have that much exposure to it so how am I supposed to know that I want to do it coming out of dental school other than well that seems like a nice life, they make a lot of money. Once I got to my residency they spent a ton of time with us doing every specialty including six ortho cases. I worked them up, I took the steps, I bonded the brackets, I did the Bolton analysis, I put the wires on, changed them, saw them once a month and I got six patients. Now they were limited cases, nothing wrong in the posterior, just crowding and spacing up front, but I was able to work six patients through in about a years time and at the end, looking back I was like you know what? I enjoyed that the most out of all the other specialties.

 

Howard:

Why do you think the 56 American dental schools they teach you endo, perio, pedo, they teach it. Why do you think it's just a no show from ortho? Do you think that's just a trade union, the orthodontist specialists just keeping the curriculum out of there, I mean are you cynical and just think it's that because I do know in the United States if you're an orthodontist and you start teaching ortho to general dentists you are blackballed. You might as well walk in there and tell them you're on drugs, they don't even make eye contact with you. I've heard this from so many orthodontists, they're afraid to teach general dentists.

 

Anthony:

I'm not sure, I mean I always thought that it was in dental school they're trying to teach you the bread and butter stuff that you're going to be doing everyday, fillings and crowns and stuff like that because we didn't do a lot of crown lengthening surgery in dental school either. When I got to residency we were doing all sorts of perio surgery, so I was like wow, why didn't they teach me this? I don't know if it's a time thing or what but the kids who come to dental school saying I know I want to be an orthodontist I just didn't quite understand how they knew that unless they did a bunch of shadowing at an ortho clinic. I really had no idea what it was like until I got to my residency.

 

Howard:

Back to the DESC, you guys are placing so many ... When you're treating a young population like let's say it's wisdom teeth and restorative, on molars that's the tooth most likely to be decayed, missing, filled, root canal, extracted, replaced with an implant, crown, whatever. Are you guys doing amalgam or composites?

 

Anthony:

It's really up to the providers discretion in that case. I tend to gauge what type of patient is this? Are they aesthetically minded, are they going to bug out if we go with an amalgam or am I going to be able to get good isolation on the tooth, is there no choice? If I'm not going to be able to get good isolation then we're going to go with an amalgam, and I do like having that as an option to go with. I couldn't quote any statistics but for some reason I find that in the high [inaudible 00:25:32] patients that I have the amalgams are just a little bit more resistant to secondary decay. I don't even know if that's true, that's just-

 

Howard:

How could it not be true, half of every ingredient in amalgam is used anti-bacterial. I mean half of it's mercury, the other half is silver, we have silver nitrate in dentistry. Tin, the hygienist use stannous fluoride tin, mercury, silver, zinc, copper, every one of them is an anti-bacterial and to of course they last longer and of course they're anti-bacterial. What I like about it, the thing that bothers me the most is I mean if you're supposed to be a doctor and you're treating a population of 2,000 and you just get rid of one tool, just say I'm metal free, I mean are all your patients the same?

 

 

To me I look at my population, I say that guy needs an amalgam, this guy wants a composite and I'm good with that. I don't like the extremism because when you're young it seems like everybody's black, white, yes, no, up, down, everybody's an extremist and all the great philosophers they just preach moderation, moderation. As you get older and older and older the piss and vinegar goes away and you start seeing everything is 50 shades of gray and you got to have that tool, I've got it in my office.

 

Anthony:

There's many times when I'll get done with a procedure and I'll be thinking to myself, wow I was really happy that we still have this stuff around. I don't know if a composite would have worked in that situation. I do do some resin modified glass ionomers for when let's say a class five lesion or something, but yes in some situations I just don't think composite's going to work out.

 

Howard:

I'm looking at you and you're a charming, handsome, young man, I still haven't seen one of your molars. I mean I'm just seeing your canine to canine, I'm only seeing upper front six, lower four, I have yet to see a bicuspid or a molar on you. What's so funny is at least three times when I tried to talk a woman, it was a second molar, have no clearance, she grinding on her tooth, there's nothing there and she's why, why and I'm just in there thinking I'm the only person that's ever going to see it. Three times in my life I've put a full gold crown on a second molar and still see her every six months she still has no idea. All of mine are gold, if no one's going to see it why wouldn't you want it to last the longest?

 

Anthony:

I do a lot of gold crowns and my patients are ... I'll explain to them these are the three choices. We could do the gold, we could do the all ceramic, we could do a mixture of metal and the ceramic but these are the pros and cons of all of them. If you were a family member of mine and for tooth number two here I would 100% be recommending the gold crown because it's going to wear so nicely. Out of all those three choices it's the least likely to chip off a little piece of it or something like that, so I tend to do a lot of gold and in the end all the patients seem to be happy. They forget that they've got a gold tooth up there.

 

Howard:

It's so funny because I just lectured in Johannesburg, South Africa and the more attractive, not at the dental convention but just when you're at the hotel going around to see. The more attracted the girl was the more likely one of her laterals, usually it was on the right, they just put a full gold crown on there. It's funny because in America girls will put gold in their ear, nose, rings, belly button, ankle. I noticed in Singapore, Malaysia, Indonesia a lot of girls just put a little gold dot, some of them put three and they were gold foils and it's just purely cosmetic, and then you come to America and you say well how about a gold on a second molar, no one will see it and they freak. Yet they've got six gold bars in their ear.

 

Anthony:

That's right.

 

Howard:

Back to ortho, so again why do you want to be an orthodontist and not an endodontist, periodontist, pedontist, oral surgeon?

 

Anthony:

Again back to residency, my cases were really interesting in that some of them, let's say the patient had an implant and they deployed for six months, they lost their retainer like many patients do and they come back and the molar behind it was mesially drifted and now the implant is non-restorable. I learned how to do simple molar uprighting and then I was able to restore the implant. I liked the collaboration, I liked the fact that the general dentist, the prostodonts, the periodontists sometimes has to turn to the orthodontist to get that little assist in making the case come out as best as it can.

 

 

Other than that I tended to like the problem solving side of things. To me ortho seems like it's going to be more of a mental game than a skills game, hand skills. It just seems to be a really good fit. I tend to be a little more laid back and easy going and the orthodontists that I worked with were always just smiling, walking around the clinic, always seemed to be in a good mood and I was like you know what, I kind of want to be like that.

 

Howard:

Orthodontics is a mental game, saying that ortho is just glue and rubber bands is like saying construction is just hammers and nails, it's a big thought game. That's cool, and my son Ryan who's my podcast guy, when he was an undergrad up in Flagstaff he got a part-time job at an orthodontist office and just loved it. What was his name? Michael McLaughlin, but I do know your name Carbonella and that's got to be either Italian, Italian or Italian, which one is it?

 

Anthony:

It's Italian.

 

Howard:

It's Italian, and you loved working there. He was a big mentor of yours and that was a great thing. You're lecturing to kids on the benefits of retirement planning and being smart with money, what are you telling them?

 

Anthony:

What I was finding was I would especially notice it during lunchtime, a lot of the assistants congregate in the break room and they're all going out to eat every day, bringing back whether it be McDonald's or pizza or something and this and that. I'm all for eating and going out every once in a while but every single day I was thinking in my mind wow, they're not making a ton of money and they're spending a ton of money on lunch and stuff like that. Have they ever had any financial seminars or anything like that?

 

 

When I would work with one assistant I'd be working, doing my thing and kind of start asking them questions about finance and what I found was none of them had. After talking to enough of them I was like would you guys want to do a basic finance, retirement planning 101 type of thing? It turned out that they did, so I put together a really quick PowerPoint presentation about it and we met during lunch one day and just went over the basics. Saving money, the power of compound interest, what a Roth IRA is and stuff like that, and a couple of them actually bought into it and I'll see them around the clinic and ask them how's your retirement fund going or which step are you at in terms of this or that?

 

 

I don't know, I got a lot of personal satisfaction out of it because no one ever reached out to me in that way when I was that age, and I really wish that they had because I was living like a dentist when I was in dental school, not like a student because I have this military paycheck coming in. I was going on vacations, buying nice cars, doing dumb stuff and had I been a little bit smarter with that money that was coming in I would have been a lot further into my retirement savings now. I figure if I could make at least one person not make the same mistake that I did then it would have been worth my time.

 

Howard:

Yes I didn't have a car all through undergrad and all through dental school, I didn't buy a car until senior year of dental school and I mean we would go to the government food bank. Any time we walked in there they'd give us a five pound brick of this and rice and this that, I'd go there. It was an eight block walk from my home and dental school in downtown Kansas City to my apartment where me and Rudy lived and the food bank is on the way there. I'd stop in and say I'm a dental student and blah, blah, blah, and I told my job and they go oh yes you qualify for all this stuff. What they don't realize that all those things they buy really increase their stress.

 

 

If you got that presentation you should make an online dental [inaudible 00:35:21] because they'd probably really respect someone their own age telling them to. When grandpa tells them that they're just like an old fart, whatever, but when a 30 year old tells them that I mean you would relate so much more with dental students and they're big fans of Dental Town and the show and everything, that would be an awesome program. How much can you put away in an IRA each year?

 

Anthony:

I think it's $5,500 this year.

 

Howard:

$5,500?

 

Anthony:

Yes.

 

Howard:

You can put into an IRA.

 

Anthony:

Into a Roth.

 

Howard:

Into a Roth IRA.

 

Anthony:

Right.

 

Howard:

What's the other IRA called, just an IRA?

 

Anthony:

A traditional IRA.

 

Howard:

What's the difference between a traditional IRA and a Roth IRA?

 

Anthony:

With a Roth you're paying the taxes now and then it's allowed to grow tax free.

 

Howard:

It's after tax money for a Roth.

 

Anthony:

Right.

 

Howard:

Roth is after tax money.

 

Anthony:

The only problem with a Roth is once you hit a certain income you no longer qualify to contribute. You could do something called a backdoor Roth where you contribute to the traditional and then at some point you switch it into a Roth. Luckily I haven't hit that income yet, so I think-

 

Howard:

What's the income for that?

 

Anthony:

I was surprised, I think it's under $200,000. I think it's under $180,000 that you no longer are able to directly do it that way.

 

Howard:

Then what's a traditional IRA? That's pre-tax money?

 

Anthony:

Yes exactly.

 

Howard:

But then you're taxed on it when you take it out.

 

Anthony:

Right.

 

Howard:

Is a Roth, when you take it out is it tax free?

 

Anthony:

Yes, there's no taxes owed once you reach retirement on the Roth because you've already paid them upfront, which is nice because later on in life you may be in a higher tax bracket and you were contributing back in your 20s when you were at a low tax bracket.

 

Howard:

What you said earlier about they're going to lunch everyday, or they're going to Starbucks on the way to work and getting a $5, $6 coffee and it's only $2.50 a day for every $1,000. I mean there's 365 days in a year so it's only $2.50 a day, so if you just save $2.50 a day. If you're buying a Starbucks everyday there's $5, so that's $2,000. If you're doing a Starbucks for $5 and then a $5 Subway for lunch now you're at $4.000.

 

Anthony:

That's right and what I did in one of my, I think it might have been an email out to them, I think I titled it you're eating your retirement for lunch and what I did was I calculated if you're spending $5 a day on lunch, instead if you were to invest that and get ... I know back in the day people used to quote 10%, 12% interest on your returns, I did 7% just to be conservative. If you do $5 a day, five days a week for this many years at 7% you ate this much of your retirement, a couple hundred thousand or if you're doing $7 a day. Some of them spend $12 or $13 a day on lunch so I thought that that was a pretty in your face numbers.

 

Howard:

The other thing I don't understand these dentists, they'll go get a house on a 30 year mortgage, 13 payments a year on a 12 month, 30 year payment you'll cut it off in 15 years. They want to learn something and they want to buy a shiny toy, they're flying across the country to see a course and they can't even do a 15 year mortgage on their house which is just one extra payment a year, 13 payments a year on a 12 month year takes a 30 year loan to 12 and just because they just don't understand money. What's so sad about the 30 year loan which I don't even think should be legal, I really think it's a crime. The SBA loan was made much years later and they put that thing at 24, I think the 30 year loan should be abandoned because the first six years are interest only yet look at the research, the average American moves every six years.

 

Anthony:

That's right yes.

 

Howard:

The only person making money on housing is Wall Street, the bankers, the financiers and these people who just don't understand money, they work their whole life so that a bunch of people can make millions a year on interest.

 

Anthony:

Off of them. Like I was talking about Dave Ramsey before, he's jamming in that down people's throats, 15 year fixed, 15 year fixed, that's what he's always saying. I haven't been able to settle down for long enough to buy a house yet but that's what I plan on doing.

 

Howard:

Dude you're single, the trick is you just don't marry a woman unless she already has a house. That's the trick on a house.

 

Anthony:

[crosstalk 00:40:34].

 

Howard:

It's easier to find a friend that has a boat than to buy a boat. Why do you buy a cabin? You telling me you don't have a friend that has a cabin? You don't need to buy any of that stuff. What's the difference between military and civilian? You're doing some private practice, making some extra cash, what's the bottom line difference between? Kristy writes business boutique is in Phoenix May 13th, that's interesting, so what's the difference between civilian and military dentistry from your private practice experience?

 

Anthony:

I've got to be honest I've really enjoyed both of them. On the civilian side the interaction with the patients is a little bit different. I'm not a big salesman on treatment plans and stuff, I really want the patient to have a desire, I want to give them the options and I want them to want it, I don't want to have to really sell it to them. In the military I can come up with whatever treatment plan that I want basically and execute it and the patient's typically okay with it because they're getting implants, they're getting crowns and stuff like that and they don't have to pay a dime. On the civilian side I would say that's probably the biggest difference is having to take finances into consideration and something that I look forward to getting a little bit more practice with.

 

Howard:

What else, what's next? I've got you 45 minutes long, I got 15 minutes left, what else do you want to share with these viewers?

 

Anthony:

Just more back about smart spending and stuff like that. Like I was saying, when I was in dental school I got a new car, well not a new car but lightly used car every two years. I couldn't spend the money fast enough, I was going out to eat with my friends all the time. I had a great time, developed some really great friendships and stuff, but I hit a moment probably a year after I got out of my residency I was like all right, let's sit down and make an Excel spreadsheet. I'm going to put my assets in this column, my liabilities in that column and at the end I'll get my net worth. It was not what I was expecting it to be and I was kind of angry with myself, how could I have gone through all of this, a year of residency and then a year of working as a dentist, making X amount and have a net worth close to zero?

 

 

I just started to see everything a little bit differently. My car wasn't as exciting to walk out to the next day. My apartment that I lived in in Princeton, New Jersey for $1,800 a month for a one bedroom wasn't as nice as I used to think that it was. I just dove into learning more about it. The Dental Town magazine that comes I read Doug Carlson's articles and from there he recommended a bunch of books and websites and podcasts, so I got into ... I actually have them right here because I thought you might ask. John Bogel, Little Book of Common Sense Investing, that's where I learned about index funds which is one of the ways I invest now. Random Walk Down Wall Street, kind of explained how the whole stock market works. I didn't even know the difference between a stock or a bond, I'm not afraid to admit that.

 

 

I've got another one, The Only Winning Investment Strategy You'll Ever Need, Larry Swedroe, more Bogel stuff, so I just really dove in and started reading and opened my eyes about what it's going to take to have the life I'm going to want to have. I've been trying to keep it going ever since.

 

Howard:

Can you email me the name of those books and the authors so I can put that in the notes for these kids because they're driving their car, so that's a lot for them to remember.

 

Anthony:

Yes totally, and then also on the other side of things, finances is one thing but I found that when I wanted to improve my finances I was like okay, well money is one thing but what am I doing this for? I realized that I just wanted to improve my whole life overall, be a better friend, be a better now fiance, future husband and stuff like that. I started reading other books that were also recommended in articles I read. The Magic of Thinking Big, How to Win Friends and Influence People, I think I've heard you mention that one in one of your podcasts. Seven Habits of Highly Effective People, and it's really empowering stuff. If you open up your mind and become receptive to what it's saying and pick up the pieces that you can apply to your life it's been a fun journey so far and I'm just getting started with it, but looking forward to continuing for sure.

 

Howard:

The Seven Habits of Highly Effective People, Stephen Covey, he passed away this last year.

 

Anthony:

Oh I didn't even know that.

 

Howard:

Yes he fell off his mountain bike, bumped his head, that's tough. How to Win Friends, those are all great books. You epitomize it, all readers are leaders and another thing you talk about they're spending too much money, they might also be spending too much time on Netflix and TV and all these talk shows when the guys like you are reading. I mean I could pan over to my library but I mean I've read a book a week since I was a kid and all leaders are readers and here you show up to a podcast with seven books and you're just the bomb.

 

Anthony:

Well I appreciate it, I mean I'm not going to lie, I try and live a balanced life. My fiance and I we do follow a couple Netflix shows but there have been times we've gone on a binge and watched three or four episodes in a row and at the end I'm like man, I probably could have done something a little more productive today but I'm trying to make it a goal to do at least an hour of reading, self-improvement, that type of thing every day and a lot of these books talk about that.

 

Howard:

When my four boys were little, you got to be a leader, I would just walk in their room and say okay it's DEAR, it's DEAR, drop everything and read. I'd turn off their video game, TV, whatever and they used to love it, they'd run for their book, they'd run for the couch. I'd usually have to read with the youngest one that couldn't read or sometimes there was two of them and it's just a daily thing, it's just cool.

 

Anthony:

I can remember we used to have a summer reading list every summer that we had to pick four or five books and I remember as a kid my mom asking did you do your reading yet today and I'm like it's summertime like no, I don't want to read. I never understood why she was always pestering us about it but-

 

Howard:

Now you're a dentist, two of your brothers are in pre-med, what's the third one doing?

 

Anthony:

He went to U Conn as well to business school for accounting, decided that it wasn't a good fit for him so he's in a transition phase right now but I don't think I'm going to be able to sway him towards dentistry. I tried on the two pre-med guys but they're sold on it.

 

Howard:

What kind of med do they want to do and what do they think about the difference in finance one working for basically Medicaid, for my internationalists there's 17% of this show is international but the United States doesn't have a national health insurance like Canada and Australia and all that, they have a Medicare from the feds for the 65 and older, then each of the 50 states has a Medicaid for the poor, but Obamacare's kind of merging them, we'll eventually go single payer and the reason I know that's a fact is because the other 20 countries did it, I mean that's a huge sample size. They're all humans too, they all look at the same issues, problems and it seems like but the reason we don't have a single payer system is when people point to single payer system they always point to really small sample size like five million people in Denmark or Norway or Sweden or this and that.

 

 

America is a monster country and you have to compare the healthcare system of a country with a third of a billion people with India with a 1.2 billion, or China with a 1.3 billion, or Indonesia with 280 million, or Pakistan, or Bangladesh. For a country this enormous I think we're doing a very good job and I don't think you can implement a system say well this worked in Denmark. I mean Denmark has less people than Arizona.

 

Anthony:

That's right, I mean our grandfather was a pediatrician for 40 years, my mom's dad, my mom's a nurse, my oldest cousin is a pediatrician, I have another cousin who's a nurse, so medicine was always a huge part of my family. I was the first one to kind of break away and go the dental route and at one point I thought I had one of my brothers convinced to follow me down that path, I even said hey we can open up a practice, you can come join my practice someday or something. I think part of it is following in grandfathers footsteps, he's the patriarch of our family and just a huge influence in our lives. They seem pretty sold on the idea, the only problem is it's gotten so damn hard to get into school that the one who's been applying he had to take the MCADs again and finally he did get accepted, I'm so happy for him. The youngest he's a senior at U Conn now so we're still waiting to see if he's going to get accepted.

 

 

I wasn't able to sway them. I presented some of the financial aspects to them and just based on what people had been saying medicine versus dentistry it didn't seem to change their mind too much.

 

Howard:

Do you remember off the top of your head average dentist makes $175 a year, do you know what the average MD was making when you're presenting?

 

Anthony:

I have an article here from the AGD, let's see, a while back, July 2013. They're saying that the average med student had total educational debt of $161,000 whereas the dentist had $203. Then the average doctor gets out and makes $177, well not right away but I guess average of all doctors, but then the dentist average was $194, so it looks like a little more debt but with a higher salary.

 

Howard:

Well the problem with the salary is that 2005 the average dentist was making $225 and 10 years later $175, so dentist's income has slid $45,000 in 10 years. It's consistently sliding $4,000 to $5,000 a year, just keeps going down. Humans, one of the thinker errors, linear thinking, that doesn't mean obviously it's not going to go to zero, but it has been going down every year for 10 years in a row.

 

Anthony:

What's the reason for that?

 

Howard:

Your increase in the supply of dentists, the class size have bunched up huge. On Lehman day September 15, 2008 was a monster crush to dentistry and we have not recovered to pre-Lehman days, either have lawyers and either have lattes. When you're talking about don't get a Starbucks on the way to work, yes Starbucks, lattes have not recovered since Lehman days and either has dentistry and either has lawyers. America has one million lawyers and people are starting to go online and getting generic forms, they're not always thinking well I'm going to ask my lawyer, it's amazing.

 

 

Well hey dude, thank you so much, it's so fun to have ... If I get 100 females on this show ... By the way you ever want to email me it's howard@dentaltown.com. It's always the same story, I'm junior, senior in dental school and I'm thinking about that or I'm a couple years out I'm thinking about that, but every once in a while, probably every once in a while somebody will say hey I just want to tell you old farts listen to your show too, I'm 56 or whatever. I had one guy the other day said he was a big fan of the show, he said he listened to every one, he was 72, I thought that was pretty cool.

 

 

It's fun to get someone their own age and like I said I think you can talk stronger to them than I can because they're just going to see me as grandpa and they're going to see you as come on this guy's my age and he's wise beyond his years and I need to read more, I need to get more financially literate, I need to lower my spending, quit living like I'm Rod Stewart or the Bee Gees or the Rolling Stones. I think all that stuff is stressful. I mean I don't want to manage some cabin. Some people ask me do you have a cabin? Why the hell would I want to manage a cabin, I'd rather go rent a cabin. Same thing with a boat, I mean I just go to the lake and they walk you to the dock and there's your boat. I don't want to take care of that crap and it saves you so much money.

 

Anthony:

I agree, hey how do I get you the PowerPoint? Right now it's kind of geared towards the military but I can make it a little more universal.

 

Howard:

Looking for an online CE?

 

Anthony:

Yes.

 

Howard:

I'm howard@dentaltown, but we have another that's in charge of CE, Howard Goldstein so his email is hogo, hogo@dentaltown.com. He's in Bethlehem, Pennsylvania and he's built all of our online CE courses and it's so cool that your friends are going to like this because they can watch that on their iPhone, they have their iPad, their Samsung Droid whatever and that would be a hell of a presentation. What would you call it?

 

Anthony:

I don't know, that's a good question. I think I called it Finance 101 when I gave it at work.

 

Howard:

I like that one time you said don't eat your retirement.

 

Anthony:

Yes okay.

 

Howard:

I thought that was catchy because the bottom line is if you want to change something in your life really big you just have to change something very small every day the rest of your life. You're not just going to walk up to a mountain and move it, but if you just shove it a little every day for a long time. The biggest changes in your life are when you change something little every single day and with finances it's the same thing and just going to a 15 year loan instead of a 30 year loan. Deciding I'm going to take my lunch and buy an IRA.

 

 

The other thing is when you look at divorces, divorces are over money, sex and substance abuse and substance abuse is obvious, but money it's because they're not sitting down together transparently with a plan and a budget and then they see this spending and they don't say anything and it builds up. Then when they're short they erupt and say well why do you do all that and why do you do that? Then it's not pretty and in fact what I'm reading is it's the number one cause of divorce is money. Not only eating your retirement, you might be eating your marriage.

 

Anthony:

I like that, no that's definitely true, I've heard that a lot.

 

Howard:

Maybe we should just call it why you should not eat your spouse. It's murder and you'll go bankrupt. Don't eat your retirement and don't eat your spouse. What I like about it the most is it's just minimalistic living is low stress.

 

Anthony:

I totally agree.

 

Howard:

Like out here on the desert, you have all this desert so there's no mowing, no landscaping, no nothing. What's their first great idea, I'm going to pay $10,000 and roll in a law and palm trees. Really, really, so you just want to spend all that time and money because you want to ... Why don't you go walk across the street and look at a palm tree? Anthony, thank you so much for your time and last question, how long you going to stay? You going to stay in there 20 years when you become an orthodontist? You going to leave, what's your plan?

 

Anthony:

They've been so good to me so far, it's hard to tell what the future will hold. Me personally I wouldn't mind, I like it, I like moving every couple years, I like seeing different places, the opportunity to maybe live overseas in Europe some day. Now that I'm getting married I got another person's feelings and wishes that I have to take into account, so after my residency we'll see where my next assignment is and how we enjoy that and we'll kind of play as we go.

 

Howard:

Well if you're listening to this on iTunes you've got to switch over and look at this on YouTube because he's in the Air Force and he completely looks like Tom Cruise. Down to the hair, good looks, you're a handsome devil. Thank you so much for spending an hour with me today.

 

Anthony:

Thanks so much Howard, I appreciate the opportunity and we'll hopefully stay in touch.

 

Howard:

Email your other podcast guy or anybody that you're listening to that you think would be great talking to your dental homies that I've love to interview.

 

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