Exploring Your Options: The Different Styles of Dentistry
Introducing Dr. Gonçalo Shearman, the oral surgery and implantology specialist at Medico-Dentária, Cascais.
The difference between working as a dentist in Portugal and Switzerland.
The difference between working as a general dentist and specializing in implantology.
The difference between working in bigger and smaller dental clinics.
Tips for dentists that want to work abroad.
Dr. Gonçalo Shearman
Oral Surgery and Implantology Specialist in Cascais, Portugal
Graduated from the University of Lisbon in 2005
Specialist in Implantology and Oral Surgery since 2008
Residency on Periodontics and Prosthodontics
Dentist at Clinica Medico-Dentária in Cascais, Portugal
Cascais Villa, 2750-748 Cascais, Portugal
In Conversation with Dr. Gonçalo Shearman
Dentists must make several decisions while pursuing dentistry and throughout their careers. Should you practice as a general dentist or pursue specializations? Should you work at a small and intimate dental clinic with greater autonomy or within a large dental practice or chain? Is it worth going abroad to practice dentistry? Should you join another dental practice or start your own practice? Each individual must answer these questions for themselves because there is no singularly correct answer.
Dr. Gonçalo Shearman has an incredibly diverse profile as a dentist, having explored all the aforementioned avenues. He has practiced as a general dentist while specializing in implantology, he has worked at both small and large clinics, and he has experience working abroad. Our team at Zircon Medical recently hosted Dr. Shearman on our podcast series to discuss how younger dentists can find their calling and choose the right dental clinic, specialization, or path.
Introducing Dr. Gonçalo Shearman, the oral surgery and implantology specialist at Clinica Medico-Dentária, Cascais
Dr. Gonçalo Shearman is the oral surgery and implantology specialist at Medico-Dentaria in Cascais, Portugal. He completed his dental education from the University of Lisbon in 2005, following which he practiced general dentistry and eventually specialized in implantology and oral surgery — he has performed numerous full-mouth oral rehabilitations. While Dr. Shearman has primarily practiced dentistry in Portugal, he also spent 2 years working in the Lausanne Area, Switzerland.
Dr. Shearman displays charming candor and humor during his interview. When asked about his motivation, he says there’s nothing more agreeable than a beautiful smile, followed by an interesting observation. Most dentists are aware that patients often say, “I’ve lost a molar, but I have plenty more, so I don’t need to replace it.” However, to highlight the ludicrousness of that statement, Dr. Shearman good-naturedly answers, “well, you also have plenty of fingers, is it alright if you lose a finger or two?”
Dr. Shearman says implantology is valuable because losing a single tooth sets off a chain reaction. He sees all his patients as family members — he explains that he would treat all his family members in the same way.
The difference between working as a dentist in Portugal and Switzerland
According to Dr. Shearman, there’s a significant difference between working as a dentist in Portugal and Switzerland, most of which he attributes to the differences in lifestyles and income.
In Switzerland, most people have good earnings and wages, so they don’t view dental medicine as a luxury. Patients often visit their dentists every six months for regular dental cleanings and checkups to ensure everything is in order. Companies also oblige their workers to perform routine dental checkups. As such, patients in Switzerland don’t generally need full-arch rehabilitations because their dental health never reaches such a position.
In Portugal, about 40% of the population only visits the dentist if they have extreme toothaches or lost a tooth. As such, when patients visit the dentist in Portugal, they have to be told there’s no way to save their teeth. The dentist often needs to extract the remaining teeth to perform a full-arch rehabilitation. As such, patients in Portugal often need far more involved full-arch rehabilitations.
When Dr. Shearman worked at a fairly large dental practice in Switzerland from 2014 to 2017, he was surprised that no one offered the All-on-4 protocol, even though it’s a fairly standard dental procedure for full-mouth rehabilitation. However, in Portugal, even smaller dental clinics have dentists specializing in the All-on-4 procedure because of its frequency. Consequently, Portuguese dentists generally have more experience with complex procedures than their Swiss counterparts.
The difference between working as a general dentist and specializing in implantology
Dr. Shearman believes everyone should start as a general dentist and specialize in implantology (or other fields) after 2 to 3 years as a general dentist.
According to Dr. Shearman, when you come out of dental school, you often assume you know what you want, but you don’t. Young dentists should practice all the fields to explore their true interests. They might find they’re not particularly interested in a field that interested them initially. Conversely, they might find they’re more skilled in a different field from their primary interest. Spending 2 to 3 years as a general dentist gives everyone a strong understanding of what they want from their dental careers.
Dr. Shearman also believes working as a general dentist is crucial to develop a holistic understanding of all aspects of dentistry. “When you try to do a filling after 10 years of ostracisation in the specialized work,” he said, “you won’t be comfortable.” While Dr. Shearman believes specializing is important, it should be pushed off to a later stage. He cites he knows several dentists who eventually struggle with basic dental procedures, like fillings, because they’ve isolated themselves in their specialization.
Another strong reason to practice general dentistry is to maintain perspective. To illustrate this point, Dr. Shearman cites his own example. “I only did full-arch rehabilitations, so I would often transform every patient’s case into a full-arch rehabilitation, even though that’s not always necessary,” he says honestly. He elaborates that it’s important to distance yourself from the problem, allowing you to explore the issue from all angles and provide the ideal recommendation. He believes that understanding and perspective comes through general dentistry.
(Zircon Medical recently also published a more detailed article on choosing the right dental specialty, based on an interview with Dr. Onur Polat.)
The difference between working in bigger and smaller dental clinics
Dr. Shearman believes both bigger and smaller dental clinics have their unique advantages and drawbacks, but he generally favors smaller clinics.
Patients favor larger clinics because they offer a sense of uniformity and security. They’re also suitable for patients that travel frequently, because they can start their treatment in one location, such as Switzerland, and finish the treatment at the clinic’s Portugal location. However, bigger chains compartmentalize the various aspects of dentistry, such as hygiene, cavities, implants, etc. Patients often need to consult 5 to 6 dentists for one treatment. This can be fairly invasive because the mouth is a sensitive and private region, and the prospect of showing your mouth to multiple people (none of whom you have a personal bond with) isn’t pleasant.
Alternatively, smaller dental clinics and private practices are far more intimate, focused on forging a personal bond with the patient. The dentists in private practices see the patient through most of their dental treatments. And if they need difficult implants, bone grafting, wisdom teeth extraction, and other complex procedures, they can refer the patient to a specialist. However, dentists in smaller clinics are often averse to referring patients for fear of losing the patients. Dr. Shearman is candid about the fact that he doesn’t know how to overcome that challenge. While both big and small clinics have problems, Dr. Shearman still prefers working with a small team of dentists.
Tips for dentists that want to work abroad
Dr. Gonçalo Shearman believes dentists must consider two crucial factors when considering working abroad — language and the host country’s requirements.
Dr. Shearman emphatically states that communication is the most important consideration for dentists that try working abroad. Communication is fundamental. Dentists need to accurately communicate with their patients without intermediary mediums. They must also provide all necessary precautionary tips. He cites the adage, “everything prior to treatment is cautionary, and everything after is an excuse” to display the importance of timely communication of information. If the dentist doesn’t communicate the necessary information at the right time, they could be in trouble.
When Dr. Shearman worked in Switzerland, he assumed his French was passable, but he soon realized it was awful. He had to communicate with his patients via his assistant, which led to a complex and ineffective chain of information between him and his patients. He also believes it’s important to speak the host country’s native language or the patients’ mother tongues. No matter how comfortable one might be with multiple languages, they prefer being treated in their mother tongue.
On the technical side, Dr. Shearman emphasizes the need to familiarize yourself with the host country’s regulations. For dentists working within the EU, they can generally move to other EU countries without any problems. However, if a dentist were to move to the United States, they’d have to complete 1 to 2 years of non-paid internships even if they have 20 years of experience and maybe even pay for dental school. So the dentist must be extremely familiar with the host country’s requirements when considering working abroad.
Tips for young dentists just starting off
When asked to offer some tips for younger dentists, Dr. Shearman had four clear pieces of advice — relentless training, patience, artistic skills, and communication.
You must practice a lot, visit different dentists, develop different points of view, and attend residencies. If possible, you should also go to other countries for new opportunities that might not be available in your country.
Dr. Shearman believes patience is one of the most underrated yet important qualities, something he’s still working on.
Dr. Shearman says there’s not enough focus on how dentistry is an art form. Beyond technical skills, dentists must also hone their artistic instincts to provide cosmetically appealing outcomes.
Dentists must understand their patients’ psychology and communicate effectively.
When asked about his future goals, Dr. Shearman states he’d like to eventually “rule a kingdom of his own.” He’s been working at his current dental practice for 15 years, and he’d like to eventually take over the mantle as the senior dentist so that he can call the shots. He charmingly quips that he’s kinda’ waiting for the senior dentist’s retirement like Prince Charles waiting for the Queen’s retirement. His goal is to eventually have a place of his own, and that’s what he’s working on.
You can find Dr. Gonçalo Shearman at Clinica Medico-Dentária in Cascais, Portugal. You can also listen to him in our Zircon Medical podcast or continue reading for a detailed article on choosing whether to join a large or small dental clinic.
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Making a Decision: Big or Small Dental Clinic?
An independent article by the Zircon Medical Team
Dentists are faced with numerous questions and decisions when starting their dental careers. One of those decisions is regarding the nature of the dental practice they join. Some join smaller dental clinics and private practices because of their intimate nature, close working relationships, and a closer relationship with patients. And others join larger dental practices because of their assumed status and security. However, when it comes to dental practices, bigger isn’t necessarily better, as Dr. Shearman succinctly highlighted during his interview.
This article further explores the differences between working at big and small dental clinics, helping you choose the ideal clinic for you.
Learning & Training
When asked to offer tips for younger dentists, most established dentists emphasize the need to shadow experienced dentists. In dentistry, most young dentists gain experience and hands-on experience at their first dental practice. As such, you should ask yourself whether you stand to learn more at a smaller dental practice or a larger practice.
In smaller settings, you’ll have the opportunity to develop a close relationship with one or two dentists, shadowing them in most of their work. Larger settings generally lack such personal intimacy, but you get the chance to work with multiple dentists, thus learning from the best dentists across various specializations.
Finally, it depends on your personal style and preferences. Do you want to learn in a fast-paced environment where you can work with numerous dentists and specializations, or would you rather develop a strong personal bond with one or two dentists who take you under their wings?
Number of Colleagues
When choosing the ideal dental office, you must also consider the team size — larger dental practices naturally have a larger number of dentists and staff.
Dentists who prefer large offices say they enjoy learning from many colleagues and having more people to lean on. However, that also means you have to deal with more personalities, learn to navigate interpersonal relationships and office dynamics, all while honing your dental skills and experience. Dental offices with larger teams also tend to have more turnover, which means you may not have the opportunity to forge strong bonds.
Dentists that prefer smaller settings say they enjoy working with a small but close group of individuals. Private dental practices can also feel like a family — in fact, dentists working in small clinics often describe their staff and colleagues as family. Due to the close-knit setting, smaller clinics also have limited turnover. However, people working in small offices usually know all about everyone else’s business and habits, so you can’t count on the anonymity that comes with numbers.
You should also consider whether you prefer a fast-paced working environment or something more leisurely. Larger dental practices have a larger number of dentists, which, in turn, also means a larger number of patients. They usually have a fast-paced environment wherein you have to see patients in quick succession with little break in between appointments. However, you also get the opportunity to learn more, attend more procedures, and develop a wider set of skills because there are more patients.
Smaller dental practices have fewer dentists and, in turn, fewer patients. This allows them to slow down and take their time with each patient. Instead of rushing from one appointment to the next, dentists in smaller clinics can let their patients exceed their allotted time. This gives dentists far more control over the clinic’s organization and more one-on-one time with patients. However, you might also need to wait long periods to perform different treatments, and many of the complex procedures might be referred elsewhere.
You need to consider if you intend on specializing in a particular field of dentistry, such as implantology, down the line. If so, you should either find a small dental practice specializing in implantology or a larger chain.
Larger dental practices usually have experts for each aspect of dentistry, from dental hygienists for cleanings all the way to dental surgeons for full-mouth rehabilitation. As such, if you want to specialize in a particular field, you can rest assured you’ll find dentists specializing in that area, under whose guidance you can learn more. You can also explore all your options for specialization, developing an all-around understanding of what you want.
Smaller dental practices don’t have experts on all specializations. As such, your learning and experience might be restricted to the treatments offered in that particular clinic. This can be a problem because young dentists should generally explore all their options before deciding on a specialization. The alternative is to find a dental clinic specializing in the area you’d like to explore, such as implantology, but that also risks pigeon-holing you into a particular area.
There’s no clear answer when choosing a particular type of dental clinic — both large and small clinics have their unique advantages and drawbacks. As such, you should consider all the factors mentioned above and your personality to make the correct decision.