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The Tostado Take: Lessons Learned Since Graduating by Dr. Julia Tostado

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The Tostado Take: Lessons Learned Since Graduating 

Balancing confidence, learning curves, and work-life transitions

by Dr. Julia Tostado

Graduation from residency feels, at first, like jumping forward in time. For several years, your life is governed by clinic schedules, lectures, case presentations, homework, studying for tests, and the constant back-and-forth between not knowing enough and pretending you do. Then suddenly—snap—you’re on the other side. You’re a full-fledged orthodontist, entrusted with patients, staff, referral sources, bills, and a list of responsibilities that no longer comes with an attending’s reassuring presence only a hallway away.

When I graduated, I expected the transition to be predominantly clinical: more challenging cases, faster decision-making, fewer safety nets. What I didn’t anticipate was how much the first few years would challenge me outside the operatory. These experiences were equal parts humbling, exciting, and occasionally panic-inducing. Here are some of the lessons I’ve learned since stepping into the world as “the orthodontist,” balancing confidence, the unavoidable learning curve, and the equally important work-life transitions that no one ever really prepares us for.


Ready is a moving target
We leave residency with immense technical training, but also a quiet fear: Do I really know enough?

The truth? None of us walks out knowing everything. You’re not supposed to.

Orthodontics is a profession where the learning curve doesn’t end with graduation; it simply changes shape. In residency, new information came in a structured academic way. In practice, learning comes in a different form, one that doesn’t always match what the textbook predicted.

When I first graduated, I interpreted every unexpected outcome as a sign that I was missing something big. Later, I realized that some aspects of orthodontics are simply unpredictable. Growth is not a vending machine, so it will always be uncertain; biology doesn’t care that you planned for 2 mm of differential movement. Realizing that feeling unsure shows you understand the depth of what you’re doing, not that you lack skill.


Confidence isn’t linear
I thought confidence would build in a straight upward trajectory: first month shaky, the next smoother, then eventually natural. In reality, confidence arrives in waves.

There were days when I felt unstoppable, and everything went smoothly on a case or even while explaining treatment to a patient. Then the next day, something small would rattle me, like a tooth not tracking properly, uncertainty about whether I’d chosen the correct treatment plan, or a patient asking a question I didn’t immediately have an answer to.

One of the most valuable lessons I learned was that confidence is not about having all the answers. It’s the ability to say, “Let me look into that and get back to you,” without letting shame creep in. Patients don’t expect you to be all-knowing; they expect us to care, explain, and stay composed.

Confidence also grows from consistency. The more you repeat the fundamentals—diagnosis, mechanics, communication—the less mental energy you spend on them. That frees you to think critically, troubleshoot faster, and eventually trust your instincts. But that trust builds gradually, like strengthening a muscle. Every case you finish well becomes a weight added to the bar. Every tough case you navigate becomes a rep earned.


It’s about people
Suddenly, I realized I wasn’t just an orthodontist working with biomechanics. Orthodontics is interpersonal. You become a communicator, a leader, a negotiator, a manager of expectations, and, at times, an amateur therapist.

In school, we present treatment plans to faculty. In practice, we present them to families, each with unique hopes, concerns, budget constraints, and communication styles. Learning how to tailor explanations without overcomplicating or oversimplifying is a skill. Early on, I would overshare technical details; later, I learned how to provide clarity without overwhelming.

Then there’s the team dynamic. Staff culture can make or break your day and your outcomes. As a new doctor walking into my dad’s established practice, I had to learn the personalities, strengths, and workflows already in place. At first, I thought I had to “prove” my authority; in reality, I needed to earn trust by listening, collaborating, and showing that I valued their expertise—especially because the staff had known me since I was young. It was hard to be seen as the doctor now and not only the doctor’s daughter.

One of the biggest surprises: Most of the chaos in orthodontics isn’t clinical—it’s relational. And communication is the key!


Mistakes happen: How you respond matters
No amount of training prevents mistakes. You will bond something incorrectly. You will order the wrong wire. You will overlook a rotated tooth until halfway through treatment. You will start a case and later wish you had chosen a different approach.

The first time I made an error, I felt sick. I replayed the moment over and over, imagining the worst. But there are always solutions, and the key is to not get overwhelmed. Always find support from colleagues, for example, on the Orthotown message boards, where we are free to post cases to get different points of view if we feel unsure about something.

Mistakes also sharpen our practice systems. A mislabeled scan? You change how you verify uploads. A missed elastic instruction? You revise your checklists. Each error becomes feedback that strengthens us.


Work-life balance
The clinical learning curve was tough, but the shift into real work life hit just as hard. Moving from a structured school schedule to flexible hours, weekend shifts, and financial stress can sneak up on you and wear down your boundaries before you know it.

Work-life balance isn’t about working less; it’s about putting time into your priorities. Orthodontics is a beautiful profession, but it can consume you if you let it. Looking after your personal life isn’t being lazy; we’re allowed to rest without guilt.


Referrals and relationships
When you graduate, you assume your clinical skills will speak for themselves. But patients don’t choose your office because of your school grades; usually, it’s because someone they trust recommended you. Strong referral sources often come from non-dental connections like patients, teachers, parents, friends, etc. People talk, they share experiences, and your practice grows in the most genuine way.

It’s important to build real relationships, not just hand out referral cards. Communicate clearly with dentists, colleagues, and other specialists; follow up thoughtfully; show appreciation; and be approachable and available. Not every treatment falls within your wheelhouse, and that’s exactly why referrals exist.


Growth isn’t always glamorous
Everyone loves seeing the progress of a dramatic case correction, but you can grow even from the “less exciting” situations or cases. Some cases forced me to refine my thinking. They taught me to anticipate roadblocks, communicate expectations more clearly, and adjust mechanics creatively. And also, to take advice from colleagues when sharing the case. Residency gives us lots of theory, but the real lessons come in practice.


Comparison steals confidence
Today, orthodontics operates in a world of social media, online forums, digital cases, and constant comparison. It’s easy to see a colleague’s beautifully finished case online and immediately question your own ability. I did this more often than I’d like to admit.

But comparing your Chapter 3 to someone else’s Chapter 20 is a recipe for constant insecurity and for making yourself feel less capable.

The moment I stopped measuring myself against others and started focusing on improving my work, everything changed. I approached continuing education with curiosity instead of defensiveness. I took courses not to “keep up,” but to genuinely grow. I became more open to feedback. My confidence became internal rather than dependent on external validation. This shift can make you a better orthodontist and a happier human being.


Becoming, not arriving
I still feel like I’m evolving and learning. And I hope that never stops.

I’m no longer the freshly graduated resident unsure of every decision. But I’m also not the fully realized orthodontist I will be in the future. I’m somewhere in between, growing, refining, and learning to enjoy the process.

Graduating is the end of one chapter, but it’s also the beginning of a more profound and personal one. The transition into practice reveals who you are not just as a clinician, but also as a leader, communicator, and human being. The confidence you build, the mistakes you navigate, and the boundaries you establish all shape the orthodontist you become.

If I could speak to my younger self on graduation day, I’d say this: “You don’t need to know everything right away. You’ll make mistakes, and you’ll be okay. Don’t be afraid to share or ask about a case—feedback from colleagues is a way to keep learning.”

Always keep in mind your life outside the clinic—it fuels your life inside of it. Balance is important. And enjoy the journey. Be grateful to be an orthodontist, where science, art, mechanics, and human connection all blend together, and take comfort in knowing there is always more to learn.
Author Bio
Julia Tostado Dr. Julia Tostado earned her DDS from Universidad Autónoma de Nuevo León and completed her Master of Science in orthodontics at Centro de Estudios Superiores de Ortodoncia. She currently practices at the family-owned clinic, Tostado Ortodoncia, and shares insights with the orthodontic community through her contributions on Orthotown’s social media.
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