Travel Dentistry is a Real Thing?

This post probably isn't going to be as entertaining as usual. Mostly because it's written by me (Chad) instead of Amy, but also because it'll be more of an explanation of how I'm going about this year than a recap of our trials and tribulations. I get a lot of the same questions regarding what I'm doing for this year on the road, so I figured I'd answer them FAQ style:

1. What is travel dentistry?

Travel dentistry is NOT providing dental services out of our RV! It's the same concept as travel nursing, just not as widely known or available yet. Like most jobs in healthcare, there is demand everywhere and many practices and facilities need short-term help. Examples include covering for a doctor who is injured, out on maternity/paternity leave, gone for their annual National Guard training, or simply unable to keep up with their busy schedule.

What I am finding out this year is that one of the biggest needs nationwide is in correctional facilities, and these are perfect for locum tenens a.k.a. travel dentists (translated from Latin as "to hold the place of or substitute for"). It can be understandable that filling in short-term at a traditional private practice with an established patient base can be difficult, as the staff and patients usually have a routine. However, in places of such high need like correctional facilities and more rural areas, delivering quality care is more important than a familiar face. The key to travel dentistry is flexibility and relishing the opportunity to work in any type of environment.

2. How do you find jobs?

There are multiple locum tenens/temp agencies out there to help. Two of the larger, more well-known agencies, particularly for dentists, are Barton Associates and AMN Healthcare. There are many other smaller, more regional agencies, as well. I get assigned an agent from each company who keeps their eye out for any opportunities that fit my needs.

So far, I've only worked a job with Barton Associates and one of the smaller ones, but usually the agencies operate the same way. When my agent finds an opportunity I might like, they bring it to my attention. I decide if I'd like to "be presented" to the practice. If I say yes, my agent then presents my profile, resume, and needs to the practice. If they like what they see, a phone interview will be scheduled for me to talk directly with the practice. Then, if both myself and the practice are on board, the paperwork gets completed and I'm ready to go. Obviously, this type of work comes with its unpredictability. If my plans change or if a better fit comes along, I am allowed to back out of the position with no problems up until 30 days before the start date. Honestly, I'm not exactly sure what happens if it's less than 30 days notice -- I should probably look more into that.

There are some areas around the country where the temp agencies simply don't have anything available. Some states can have dozens of opportunities, while some states can be absolute dead zones. I'm not really sure why. For states that seem to be dead zones with the larger temp agencies, I try to find those smaller, more regional temp agencies or just do a good old-fashioned job search on Indeed. I actually found my current position with the regional jail in West Virginia through a smaller agency that had posted the job on Indeed. And when all else fails, sometimes cold calling practices in the area can also work!

3. I bet you get paid a lot, right?

Yes and no -- it depends how you look at it. From what I've heard, it seems like travel nurses get paid way more relative to their counterparts than travel dentists do. So this should not be reason enough to pursue this type of work as a dentist.

The daily pay is usually about the same as I would make in traditional private practice, maybe just slightly more. That being said, most temp agencies provide side benefits to the position based on my needs. This can include paying for travel to/from the work site (ex. flights), hotel or AirBnB, rental car, or daily mileage. Usually it's not all of the above, rather a combination. For example, they will usually cover either a rental car OR my daily mileage, but not both. Additionally, if I become licensed in a state for the sole purpose of the job, then the agency will reimburse my licensing costs if I work a certain number of days (usually 20 or 30) in that state. This can be a big deal for the states that are more expensive to get licensed in.

As I mentioned before, there are some places that have a much higher need than others. So those sites may be able to have a higher daily pay rate, or be able to do more with the side benefits because they want to minimize any barriers for me to come work there. These places are usually more rural or in "more demanding" work environments, like correctional facilities. If I'm willing to go to these places, I can earn a very competitive income.

On the flip side, though, I am paid as an independent contractor, not a W2 employee, so I will end up paying more in taxes. I also do not have traditional W2 benefits like health insurance, 401k match, continuing education, etc. This all needs to be taken into consideration. It may end up balancing out in the end.

4. Do you need to get licensed in every state?

Unfortunately, YES. This has been one of the hardest things to navigate for this year on the road. Some states make it super easy (thanks Wisconsin!) and some states are a literal nightmare (hey New Hampshire!). This can be especially hard to do when I'm working on a license application while already on the road. There have been a few times where I needed to be mailed something, such as materials for the jurisprudence (law) exam, but I had already moved from the address I had given them. So then it's a game of mail forwarding, which is no fun.

One of the biggest hurdles I've found for some states is whether or not they require fingerprints. While we were in New Hampshire in early July, I was working on my applications for both West Virginia and Minnesota. Both states required fingerprints. That should be easy to do at the same time, right? Wrong! For Minnesota, they required a paper fingerprint card to be mailed in. So I contacted the local police station, but they only offered fingerprinting services for residents of the town. I was able to find a police station a few towns away who said they could do it for me. Once I got there, the person in charge said they usually only do it for in-state agencies (i.e. NOT the Minnesota Board of Dentistry), but thankfully they helped me out anyway. I'm not really sure what I would have done if they didn't! Now for West Virginia, they required electronic fingerprinting through a specific company. Of course the closest location from Laconia, New Hampshire was 1 hour and 15 minutes south in Massachusetts, and they only had certain days/times available. I'm not sure why state boards make things way more complicated than they need to be, but I've learned to always start earlier than I think I need to for a license application.

Fortunately, there is a dental license portability agreement (click the link for more info about this) coming down the pipeline as we speak. This will allow a dentist in one state to work freely in another state that is a part of the agreement. Some of the states that have already agreed to it are ones we have plans to go to, but it will likely take awhile longer for it to actually be valid and utilized. I sure wish this happened sooner!

5. Are you going to find a job everywhere you go?

No, not necessarily. We have tentative plans to live in at least 8 states this year. I do not want to go through the licensing process, nor pay, for each one of them. I decided early on that I will only get licensed and work chairside if we are there for at least one month. There are a few places we'll only be for 2 or 3 weeks, so I figured it's probably not worth the time and effort on the front end for not much working time.

What will I do with this down time if I'm not working at a practice? That's where teledentistry comes in. I was lucky enough to find an organization in Maine to work remotely for right before we moved away. There's also the opportunity to fill any remaining down time with odd jobs that I wouldn't otherwise have time for. For me, I'm keeping my mind and schedule open for random things like dog-sitting, photography sessions, or even caddying at a nearby golf course.

All in all, my goal is to work enough chairside to still have it as my main source of income, as well as not lose any clinical skills. When we are traveling between places or staying in a place where I don't get licensed, that's when I'll take full advantage of teledentistry and other odd jobs.

Because I have no dental related photos and this post is getting very text heavy, here's a random photo from my morning commute to the jail in West Virginia, which features some of the most beautiful countryside I've ever seen:

6. What is teledentistry?

So when a patient calls me in pain on a Saturday morning, I tell them to find a mirror, a steak knife, some pliers from the garage, and run to the pharmacy for some topical anesthetic. I walk them through step by step of how to remove their painful tooth. It really is pretty easy!

All jokes aside - while there are some teledentistry companies out there that do live video visits, my job is actually asynchronous chart/x-ray reviews that I can do all on my own time. The organization I work for has a network of dental hygienists throughout Maine that see patients in schools, Head Start programs, shelters, etc. and gather x-rays and intraoral photos & videos. I review the findings and determine the patient's next step, whether it's coming in for any needed treatment, being referred to a specialist, or prescribing an antibiotic for an infection. The goal is reducing barriers for patients, mostly children, to see a dentist. This really is the perfect supplemental job for a travel dentist.

7. What are the best and worst parts of travel dentistry?

Aside from getting to travel and live in cool places, the best part of the dentistry side of it is working in various environments with different tools/materials, different staff and different patient bases. I've already learned so much about myself in terms of how I show up to these new places and gain the trust of strangers. Working with new equipment and dental materials I wouldn't otherwise use is expanding my skill set and knowledge to make me a more well-rounded clinician.

As for the worst part, I've already mentioned the licensing process, so instead I'll say that there is such limited follow up for the dentistry I do, but this obviously comes with the territory. I have no idea how long the patient's filling or crown I did will last. If I extracted all of someone's hopeless teeth, I likely won't have the time to make them their dentures, so I'll never see the end result of their rehabilitation. These downsides are honestly reason enough for me to not do travel dentistry long-term. I just have no idea if I'm actually doing good work that stands the test of time, and I can't do enough of someone's treatment plan to witness their dental transformation. Instead, I have to focus on small wins, like if I provided a positive experience, or got them out of pain, or moved them along in their dental journey in the right direction.

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I hope this provides some insight into my unique year on the road and the world of travel dentistry. It certainly is not for everyone, but for any dentist who enjoys traveling and being in different work environments, it can be a very rewarding experience. There will always be traditional, long-term private practice jobs to return to. If you're a dentist reading this, give it a try!