Office Visit: Resident On Call by Chelsea Knorr, Associate Editor, Dentaltown Magazine

Resident On Call
by Chelsea Knorr, Associate Editor, Dentaltown Magazine

Dr. Tony Cruz-McLeod, born and raised in New York, just finished his general practice residency (GPR) at King's County Hospital Center in Brooklyn, New York. Working in a hospital GPR is like boot camp for dentistry and a great way to get in gear for a successful career ahead. Herein, Cruz-McLeod tells us about his hectic life as a resident and what his plans are for the future.

Name: Tony Cruz-McLeod, DMD
Graduate From: Fairleigh Dickinson University, New Jersey - BS University of Medicine & Dentistry
of New Jersey - DMD
Position/Place: General Practice Residency at King's County Hospital Center
Practice Location: Brooklyn, New York
Practice Size: 17 chairs (7 GP, 4 OMFS, 4 Pedo/Ortho, 1 Hygiene, 1 Implant Suite)

What drew you to dentistry? What inspired your career decision?
Cruz-McLeod: My childhood dentist, Dr. Raymond Torio, was my inspiration. When I was 14 years old, he asked me what I wanted to be when I grew up. I told him I wanted to be a doctor, but I was not sure what kind yet. He asked me if I had ever considered being a dentist. Dr. Torio gave me the opportunity to come in and assist for him for a week. That week changed my life. His interaction with his patients was incredible, and dentistry allowed him to make a great living, provide a much-needed service to the community and still be home for dinner with his family. Even as a teenager I understood that sometimes people choose careers that they aren't going to be satisfied with down the road. I knew that I never wanted to be in that position.

What is it like to be a resident?
Cruz-McLeod: This residency has been one of the most challenging and rewarding experiences of my life. Sleeping on a cot in the on-call room is never fun but I love working at the hospital. It is hard work and more responsibility than being a dental school student. I see more patients in a week than I did in an entire month in dental school. I have more freedom to try new techniques and use new materials too. And if I have questions, there are attendings who can help.

What are the advantages of doing a residency?
Cruz-McLeod: A residency gave me a year to learn how to do dentistry in a real-world, fast-paced setting. In school, we had three hours to do a filling or two hours with a rubber dam. In private practice, that just doesn't cut it. We have to learn to be efficient. Residency also lets me try things that I could only read about and watch post-grads do while I was in school. I've placed about 40 implants, learned how to do crown lengthening, socket preservations, tori removal, the list goes on and on. Everything I am learning now will help me as I move forward as a dentist. Also, you get to learn how to do dentistry with an assistant! In dental school we had to do everything from set up to break down, so it's nice to have another set of hands.

What has been the most rewarding experience in your professional life?
Cruz-McLeod: Without question my most rewarding experience was walking across that stage and getting my dental school diploma. Words can't express how free I felt. There were times in dental school when I felt like that day would never come. I went back for a residency fair a few months ago, and for the first time I was able to step through the doors and not get that nervous, queasy feeling. I wasn't a student; I was a colleague.

How about the most challenging?
Cruz-McLeod: My first year I broke my right clavicle, scapula and two posterior ribs on spring break. My accident actually meant I had to repeat freshman year because I couldn't do my lab work with one arm. I was unable to drill while in physical therapy and for a while the general consensus was that I might need to look into another field. It was a setback but it gave me the opportunity to really hone my technical skills. I had to work twice as hard to prove to myself that I could overcome my injury.

How is dentistry in a hospital setting different?
Cruz-McLeod: Hospital dentistry is very high volume. We see a lot of patients. There is very little downtime. We overbook to prevent any openings in the schedule. If we happen to have a cancellation, we have to go help a co-resident, go help oral surgery, take an emergency, etc. We also have to keep in mind that most patients either have no insurance or are part of a capitation plan. We don't see many PPO patients. We also have to deal with being on call. All this said, it's absolutely worth it.

What is a typical day like?
Cruz-McLeod: Lectures start at 8 a.m. We see our first patients at 9 a.m. Most days we are on our way out the door at around 5:30 p.m. Monday is restorative. Tuesday is removable. Wednesday is endo. If I'm not on call, I get to leave when everyone is done. If I am on call, I have to sleep in the call room and work the next morning. I get to leave early, usually around 2 p.m. Most days start pretty quiet and pick up around 10 a.m. At least once a week I can look at the waiting room and think to myself "I'm never getting out of here today."

How did you learn about Dentaltown?
Cruz-McLeod: I learned about Dentaltown through one of my classmates at the University of Medicine & Dentistry of New Jersey. He was reading Dentaltown Magazine during lunch. He showed me an article that explained how to take a two-step crown impression, something a professor was describing to us days earlier. I asked him where he got this magazine and how much for the monthly subscription. He explained it was free, and that he had been a member since before dental school. He let me have his copy to read. I thumbed through it, and subscribed the next day.

What has Dentaltown done for your profession life?
Cruz-McLeod: It has definitely helped my career because I became a subscriber while in school, and as such, I was able to incorporate Dentaltown's knowledge into my clinical learning experience. I would read about new products and see if we had them in the dispensary, just to try. I would read discussions on different ways to do a procedure or different ways to approach a case, and would apply what I read to the patients I had to treat. While learning the basics, I was able to integrate techniques and ideals early, and I feel like that helped me gain a better foundation. My favorite feature is the message boards. It's like having a round table discussion on an interesting case/topic, without having to leave my apartment. I get to learn from the experiences of established dentists.

You attended Townie Meeting in 2013. Would you recommend Townie Meeting to your peers? What's in it for the young dentist?
Cruz-McLeod: I would absolutely recommend it! The lectures were great and the social aspect is a definite draw. I got to meet and rub elbows with dentists from all different backgrounds - some had just started out like me, some had been in private practice for years, and they all had interesting stories and perspectives on the business. I met a dentist who had just opened his third office, a dentist who works for Indian Health Service, and a dentist who's looking to retire after 35 years, and this was just at breakfast on the first day. I get to find out what concerns the private practice dentist, what I can expect in the future. The Townie Meeting gave me a lot to look forward to.

What are your concerns for the graduating dentist?
Cruz-McLeod: I would say the graduating dentist needs to start figuring out how he/she will plan to retire one day. I realize that might sound crazy, but it's true. If we do not start planning for it now, when we get to that age, there will be nothing there to fall back on. There are dentists who are still working well into their 60s and 70s because they cannot afford to retire and maintain their lifestyle. I don't want to have to work at that age. I've already started putting money aside, investing and building a foundation so that when the time comes I can be a grandparent first, dentist second.

What advice would you give to new grads?
Cruz-McLeod: Dental school teaches you the basics, but when you graduate you have to learn how to really do dentistry. So my advice is to have an open mind and be ready to try new things. Some professors will swear that their way is the only way to do something, but there are so many different techniques that might work better for you. Be willing to learn even though school is over.

Looking ahead, what would you like to see dentistry do in terms of the way it operates as a profession in the next five to 10 years?
Cruz-McLeod: I would like to see dentistry serve underprivileged areas. I know we have to make a living and a lot of capitation plans do not pay well, but there is a large population that does not receive proper dental education and cannot afford proper dental treatment. The number of people without dental insurance is astounding, and if people knew the importance of hygiene and took more preventive measures for their oral health, there wouldn't be so many issues with insurance. Minor dental afflictions don't hurt people financially as much as the root canal, crown, bridge, surgery, etc.

What is your favorite procedure or part of dentistry?
Cruz-McLeod: I really enjoy placing implants. I feel like it is one of the best services we can provide patients. Obviously at a residency, implant dentistry is cheaper than in private practice but I'd love to one day have a practice where I can place and restore implants at affordable prices. It's also not a difficult or time-consuming procedure. The hardest part is the planning, the surgery itself takes about 20 minutes and the patients are usually very satisfied.

How do you spend your time when you're not working?
Cruz-McLeod: Sometimes I get together with college or dental school friends and go out for dinner and drinks. Most days though, I'd rather just stay at home with my fiancée, Ashley. We live in Brooklyn and our apartment is very cozy, so most times we just relax there. It's nice to come home to her after a long day at work. We usually cook together (that means I make the salad), eat together, and then watch TV. When we do go out, we either take the train to Manhattan or stay in Brooklyn. There are so many fantastic restaurants to choose from. I also like to go to the gym regularly and watch sports when I can.

Dr. Cruz-McLeod's Top Three
Orascoptic HiRes 2, 2.5x Magnification
"I've been using these loupes since day one of clinic. I don't go a day without them. The only procedure I do without loupes is extractions. I love them because dentistry is taxing on the body and I don't want to have a hunchback. If I could change anything I'd add a light or up the magnification to 3x or 3.5x."
Sirona Digital X-rays
"In dental school we didn't have digital X-rays. We had to develop the films manually. I love digital because they're quicker and they help with patient case acceptance. I can pull up an X-ray of a bombed out molar, maximize it on the computer screen and show the patient why he needs a root canal. It gives the patient a visual while I'm explaining treatment."
Root ZX II Apex Locator
"The apex locator makes root canal therapy so much more efficient. I recently started hooking my apex locator up to my rotary files - this way I'm instrumenting while finding working length. It hasn't failed me so far and is a great time saver. After residency I'll invest in a system with apex capabilities built in."

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