500k debt to an orthodontist

[armorshell]

And to add to your discussion about degrees and financially poor choices, I never understood ortho residents who wouldn't even consider the thought of moonlighting and were instead perfectly content with taking out $250K ortho debt just tacked onto their $300K dental school debt. Being an ortho resident is nothing like an OMS resident and there is definitely time to moonlight. A DDS is an extremely valuable degree that will at least earn you enough money as a resident to pay for your cost of living in most places.

LOL, even though there is "no time", lots of OMS residents still find time to moonlight. I wish was still allowed to, some programs don't allow it.

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[The Dawgfather]

LOL, even though there is "no time", lots of OMS residents still find time to moonlight. I wish was still allowed to, some programs don't allow it.

Not even during medical school? How do they monitor that?

 

[CaliDDS1986]

139k in debt after dental school is extremely low compared to national average.

Nowadays, but not when she graduated in the late 1980s

 

[armorshell]

Not even during medical school? How do they monitor that?

I don't know, nor do I care. I'm not willing to risk my residency and future career on breaking a rule.

 

[charlestweed]

http://inflation.us/videos.html

Watch College Conspiracy and tell me what you think.

I've seen many college grads who work as bartenders, waiters/waitresses, handymen etc after graduation. Many college grads can't find job and have to move back to live with their parents (http://newsfeed.time.com/2011/05/10/survey-85-of-new-college-grads-moving-back-in-with-mom-and-dad/) . None of my ortho assistants have a college degree and they make $18-25 an hour…and there is no student loan burden. No wonder why a lot of Asian parents look down on non-science majors (such as English, history, art, music etc) and only want their kids to become dentists and doctors. I tend to agree with these parents.

It's not easy to pay back $300-400k student loan by doing general dentistry 8 hours/day, 5-6 days/week (and only get paid $100-120/year). As an associate dentist, you have to deal with long work hours, overbooked appointments, PITA patients, crying kids, HMO, medicaid, rude managers, sloppy assistants, lack of dental supplies, low quality instruments etc. Not every dentist has the business skills to open up his/her own office. Yesterday, I met 2 veteran dentists who had working interview at the same dental chain where I work at. One of them graduated in 85. He sold his practice 2 years ago to work for WestCoast Dental (a dental chain) as a managing dentist. WestCoast fired him due to his poor performance and now he is looking for a job at my company. The other dentist graduated in 03. His wife is also a dentist and she only works 2 days/week. He is still searching for the right existing office to buy. In short, it is worth spending extra money to specialize after dental school.

BTW, I'm not convinced that the orthodontist to population ratio is better in any of the big four Texas cities than for SoCal.

I think this ratio is better in CA because there are more people in CA (percentage wise) who want braces than people in rural areas. More than 60% of my patients have class I occlusion and they get ortho treatments even with very slightly crooked teeth. Many adults get braces the 2nd time because they didn't wear retainers when they were younger.

 

[ortho lurker]

He sold his practice 2 years ago to work for WestCoast Dental (a dental chain) as a managing dentist. WestCoast fired him due to his poor performance and now he is looking for a job at my company.

An added reason to hedge your bets and start/purchase an office on the side while you continue to work for others. It may even be wiser to seek employment from 2-3 different employers if possible. I have seen traveling GP associates who cut their own days at their own office because it is not busy enough.

 

[charlestweed]

An added reason to hedge your bets and start/purchase an office on the side while you continue to work for others. It may even be wiser to seek employment from 2-3 different employers if possible. I have seen traveling GP associates who cut their own days at their own office because it is not busy enough.

General dentists cannot cut down too many of their own days because their business relies on walk-ins and emergencies. If a patient with a broken tooth shows up and there is no dentist there, he/she will go see another dentist down the street. It is OK for perio, ortho and OS to open 1-2 days a week because most of their patients are referred by general dentists. Specialists can book as many patients in one day as they want.

 

[Tooth]

I've seen many college grads who work as bartenders, waiters/waitresses, handymen etc after graduation. Many college grads can't find job and have to move back to live with their parents (http://newsfeed.time.com/2011/05/10/survey-85-of-new-college-grads-moving-back-in-with-mom-and-dad/) . None of my ortho assistants have a college degree and they make $18-25 an hour…and there is no student loan burden. No wonder why a lot of Asian parents look down on non-science majors (such as English, history, art, music etc) and only want their kids to become dentists and doctors. I tend to agree with these parents.

It's not easy to pay back $300-400k student loan by doing general dentistry 8 hours/day, 5-6 days/week (and only get paid $100-120/year). As an associate dentist, you have to deal with long work hours, overbooked appointments, PITA patients, crying kids, HMO, medicaid, rude managers, sloppy assistants, lack of dental supplies, low quality instruments etc. Not every dentist has the business skills to open up his/her own office. Yesterday, I met 2 veteran dentists who had working interview at the same dental chain where I work at. One of them graduated in 85. He sold his practice 2 years ago to work for WestCoast Dental (a dental chain) as a managing dentist. WestCoast fired him due to his poor performance and now he is looking for a job at my company. The other dentist graduated in 03. His wife is also a dentist and she only works 2 days/week. He is still searching for the right existing office to buy. In short, it is worth spending extra money to specialize after dental school.



I think this ratio is better in CA because there are more people in CA (percentage wise) who want braces than people in rural areas. More than 60% of my patients have class I occlusion and they get ortho treatments even with very slightly crooked teeth. Many adults get braces the 2nd time because they didn't wear retainers when they were younger.

While the video has some obvious bias and exaggerations, it does provide a fresh and compelling argument against the current value of college education held by the majority of Americans today. No one else is calling this into question. For that, I give it kudos.

After they point out the bubble, it is easy to see. College tuition is in a classic bubble because it is subsidized by the Fed. The Fed allows people to go to college who couldn't afford it otherwise. That creates an artificially large demand because suddenly there are more people around with cash who are willing to spend it on a college degree. The same happened with the housing bubble. The Fed mandated that banks provide credit to people who otherwise would not have qualified in the name of equal opportunity housing practices. Suddenly more people than ever, who couldn't afford it previously, had money to blow on a home. This resulted in exploding home values. And let's face it, poor people aren't exactly known for making good economic decisions. But they know how to blow cash. And perhaps it's these same people who decide to go into art history or political science, etc. Perhaps you can draw a parallel of these people to those who signed on to the ARM's.

At some point, just like homes, Americans will have to determine what price a college degree is really worth. Certainly there is a limit somewhere. I suspect the bubble will burst before we are done with the current economic crisis, within the next decade.

I agree, there will be no bailout of student loans as predicted in the documentary. At least, not to the individual students who took out the loans. When people defaulted on their mortgage loans, it wasn't the individuals who got bailed out. It was the banks. Now, as the Fed is the largest guarantor of student loans, what is it supposed to do? Bail itself out?

 

[tingting]

While the video has some obvious bias and exaggerations, it does provide a fresh and compelling argument against the current value of college education held by the majority of Americans today. No one else is calling this into question. For that, I give it kudos.

After they point out the bubble, it is easy to see. College tuition is in a classic bubble because it is subsidized by the Fed. The Fed allows people to go to college who couldn't afford it otherwise. That creates an artificially large demand because suddenly there are more people around with cash who are willing to spend it on a college degree. The same happened with the housing bubble. The Fed mandated that banks provide credit to people who otherwise would not have qualified in the name of equal opportunity housing practices. Suddenly more people than ever, who couldn't afford it previously, had money to blow on a home. This resulted in exploding home values. And let's face it, poor people aren't exactly known for making good economic decisions. But they know how to blow cash. And perhaps it's these same people who decide to go into art history or political science, etc. Perhaps you can draw a parallel of these people to those who signed on to the ARM's.

At some point, just like homes, Americans will have to determine what price a college degree is really worth. Certainly there is a limit somewhere. I suspect the bubble will burst before we are done with the current economic crisis, within the next decade.

I agree, there will be no bailout of student loans as predicted in the documentary. At least, not to the individual students who took out the loans. When people defaulted on their mortgage loans, it wasn't the individuals who got bailed out. It was the banks. Now, as the Fed is the largest guarantor of student loans, what is it supposed to do? Bail itself out?

Print money.

Eventually the gov will have to print it's way out of it's obligations. The alternative would be unacceptable to most.

 

[CaliDDS1986]

Print money.

Agreed

 

[flapaTron]

None of my ortho assistants have a college degree and they make $18-25 an hour…and there is no student loan burden. No wonder why a lot of Asian parents look down on non-science majors (such as English, history, art, music etc) and only want their kids to become dentists and doctors. I tend to agree with these parents.

from my experiences, this phenomena is not limited to asians parents. rather, i would say that MOST first generation immigrant families from every culture share this view (and with good cause).

 

[Demeter]

What will the interest rate on your loans be?

FYI- 8.5% interest on 500,000$ is 42,500$ per year.
To make any headway on your loan debt you will need to pay 42,500$ on top of the 3,000$ minimal monthly payments required of you.

 

[CaliDDS1986]

What will the interest rate on your loans be?

FYI- 8.5% interest on 500,000$ is 42,500$ per year.
To make any headway on your loan debt you will need to pay 42,500$ on top of the 3,000$ minimal monthly payments required of you.

I think 6.8% is what it is currently.

 

[armorshell]

Yeah, 6.8 for Stafford's butthose have a lifetime and per loan period cap, so you'll have to do the 8.5% grad plus at some point.

To the above person, the "minimum payments" include interest. The monthly payments for 500,000 would be around 6000 for a 10 year pay off and 4000 for 25 year pay off.

 

[slappysteve]

Yeah, 6.8 for Stafford's butthose have a lifetime and per loan period cap, so you'll have to do the 8.5% grad plus at some point.

To the above person, the "minimum payments" include interest. The monthly payments for 500,000 would be around 6000 for a 10 year pay off and 4000 for 25 year pay off.

btw, GradPLUS interest rate is fixed at 7.9%...not that this should influence anyone's decision to go 500k in the hole (or whatever it is on top of dschool loan).


http://studentaid.ed.gov/PORTALSWebApp/students/english/PlusLoansGradProfstudents.jsp



To the OP, you have to make the choice to do what you feel is the best for you long term, and please take the time to separate money from happiness when making your decision. like someone else said before, if you knew you'd make the same amount of money doing GP vs. doing Ortho would you still want to do ortho? every day?, for the next however many years you'll be practicing? if the answer is yes, then definitely go for it. It shouldn't matter, because you will most likely make enough money to live a comfortable life either way, but after a certain point money can only buy so much happiness (there have been studies on this, although at times we all feel like we're the exception). sure, most dental grads are young and think money is the most important factor in life (and yes, it is quite important for many of life's essentials and the additional 'comforts and securities'), but as we get older I have a strong inclination that there are other things that will matter more, and being happy in your day to day job will influence many other aspects of your life.

good luck in your decisions

 

[STOM705]

I am a foreign trained dentist from Azerbaijan. I have spended two years to solve concept of dentist life in USA but still have lots of ques. I have passed NBDE TOEFL etc. and applied this year to 10 schools. Now after reading all your posts I have really got big doubt . should I continue this costly education. In June I will graduate from Prosthodontic residency in Turkey and will back to Azerbaijan and wait for interviews. In Azerbaijan dentists almost do not pay taxes. There are not govermental insurence. So all patients have to pay chash money for their traetments. The quality of dental treatment really bad. I will be first prosthodontist in my country and probably will have lots of patients. when comparing prices I see there is not much difference between USA and Azerbaijan. My friend do FPD for 800 dollars and pay only 50 dollar to technichian and there is no taxs. Implant placement for 2000$, comp. filling for 150 $ etc in Azerbaijan. really confused about coming to USA.

 

[Tooth]

I am a foreign trained dentist from Azerbaijan. I have spended two years to solve concept of dentist life in USA but still have lots of ques. I have passed NBDE TOEFL etc. and applied this year to 10 schools. Now after reading all your posts I have really got big doubt . should I continue this costly education. In June I will graduate from Prosthodontic residency in Turkey and will back to Azerbaijan and wait for interviews. In Azerbaijan dentists almost do not pay taxes. There are not govermental insurence. So all patients have to pay chash money for their traetments. The quality of dental treatment really bad. I will be first prosthodontist in my country and probably will have lots of patients. when comparing prices I see there is not much difference between USA and Azerbaijan. My friend do FPD for 800 dollars and pay only 50 dollar to technichian and there is no taxs. Implant placement for 2000$, comp. filling for 150 $ etc in Azerbaijan. really confused about coming to USA.

Are you already in tons of debt? Why go into more debt for what appears to be equal profit potential or perhaps worse? I don't know anything about Azerbaijan but, if what you're saying is true, then I'd just stay there and practice in an affluent area.

 

[Imani]

http://www.wfaa.com/news/local/Dental-Dollars-Go-to-Hedge-Funds-123497004.html

 

[Tooth]

http://www.wfaa.com/news/local/Dental-Dollars-Go-to-Hedge-Funds-123497004.html

Wow. So they never really answered the main question. Why does medicaid in Texas cover orthodontics?

While these orthodontists are raking in the money now, I actually find this disturbing. When government gets involved with anything, it will eventually go down hill. I never imagined government offering free ortho. I'm shocked. I hope this gets nipped in the bud because, if this spreads, we'll eventually have government bureaucrats dictating ortho treatment.

 

[charlestweed]

http://www.wfaa.com/news/local/Dental-Dollars-Go-to-Hedge-Funds-123497004.html

Orthodontics is a very profitable specialty. Orthodontists don’t have to charge $4000-5000 a case in order to survive. They can still do very well by charging very low (medicaid) fee per case. No wonder why so many dental students and practicing dentists want to spcialize in ortho.

The owner, Dr. Malouf, didn’t do anything illegal. His and his wife’s 51 dental offices have helped created jobs for so many people (associate dentists, associate orthodontists, managers, assistants, lab tech, dental supply companies etc). In my opinion, this money is better spent than the stimulus money that Mr. Obama tried to spend on the “shovel-ready” jobs.

In California, it is 100x more difficult to get the medicaid approval for ortho treatments and yet California faces a much worse budget crisis problem than Texas. CA income tax is almost 10%. Texas income tax is zero. No wonder why so many investors/dentists/doctors move to TX to start their business there.

 

[bsmcga0]

Orthodontics is a very profitable specialty. Orthodontists don’t have to charge $4000-5000 a case in order to survive. They can still do very well by charging very low (medicaid) fee per case. No wonder why so many dental students and practicing dentists want to spcialize in ortho.

The owner, Dr. Malouf, didn’t do anything illegal. His and his wife’s 51 dental offices have helped created jobs for so many people (associate dentists, associate orthodontists, managers, assistants, lab tech, dental supply companies etc). In my opinion, this money is better spent than the stimulus money that Mr. Obama tried to spend on the “shovel-ready” jobs.

In California, it is 100x more difficult to get the medicaid approval for ortho treatments and yet California faces a much worse budget crisis problem than Texas. CA income tax is almost 10%. Texas income tax is zero. No wonder why so many investors/dentists/doctors move to TX to start their business there.

I don't think you understand what these clinics, and other like M&M do.

Every patient gets an RPE, TPA, lower lingual holding arch because medicaid will pay extra for these (I saw a 4 bi extraction case, and they put a lower lingual holding arch in). They bill for broken brackets that did not occur, because medicaid pays extra for these. By the time you add this up it is almost $5000 per case.
Every case last 26 visits, because medicaid pays for 26 visits. A tooth that is slightly rotated is scored as ectopic eruption, because the person checking the scoring sheet doesn't now dentistry and just checks to see if the paper work is filed correctly. These clinics treat their patients like $hit so that they can make millions of dollars off tax payers, many of which can't afford ortho for their own kids.

 

[Tooth]

(I saw a 4 bi extraction case, and they put a lower lingual holding arch in)

That makes me sick. How do these people sleep at night?

 

[charlestweed]

I don't think you understand what these clinics, and other like M&M do.

Every patient gets an RPE, TPA, lower lingual holding arch because medicaid will pay extra for these (I saw a 4 bi extraction case, and they put a lower lingual holding arch in). They bill for broken brackets that did not occur, because medicaid pays extra for these. By the time you add this up it is almost $5000 per case.
Every case last 26 visits, because medicaid pays for 26 visits. A tooth that is slightly rotated is scored as ectopic eruption, because the person checking the scoring sheet doesn't now dentistry and just checks to see if the paper work is filed correctly. These clinics treat their patients like $hit so that they can make millions of dollars off tax payers, many of which can't afford ortho for their own kids.

It is fraudulent to bill the medicaid the ortho appliances that you don't actually use on your patients. I don't think big companies, like the one that was once owned by Dr. and Mrs. Malouf , would risk loosing their businesses and jail time by doing such fraudulent billings. I don't know about TX dental chains. But for the dental chains in CA, the treating orthodontist gets to dictate the treatment plan and the company can only bill according to what was written on the treatment plan sheet.

Maybe, this particular orthodontist likes to use TPA and LLA to control the posterior anchorage. Each orthodontist has his/her own way of treating the case. I took over a lot of transferred cases and I disagreed with the way other orthos used certain appliances.

 

[gryffindor]

I don't think you understand what these clinics, and other like M&M do.

Every patient gets an RPE, TPA, lower lingual holding arch because medicaid will pay extra for these (I saw a 4 bi extraction case, and they put a lower lingual holding arch in). They bill for broken brackets that did not occur, because medicaid pays extra for these. By the time you add this up it is almost $5000 per case.
Every case last 26 visits, because medicaid pays for 26 visits. A tooth that is slightly rotated is scored as ectopic eruption, because the person checking the scoring sheet doesn't now dentistry and just checks to see if the paper work is filed correctly. These clinics treat their patients like $hit so that they can make millions of dollars off tax payers, many of which can't afford ortho for their own kids.

Do they extract 4 bis because Medicaid will pay extra for those too? I don't doubt what you're writing occurs. Lots of shadiness seems to crop up when someone else is footing the bill.

 

[bsmcga0]

It is fraudulent to bill the medicaid the ortho appliances that you don't actually use on your patients. I don't think big companies, like the one that was once owned by Dr. and Mrs. Malouf , would risk loosing their businesses and jail time by doing such fraudulent billings. I don't know about TX dental chains. But for the dental chains in CA, the treating orthodontist gets to dictate the treatment plan and the company can only bill according to what was written on the treatment plan sheet.

Maybe, this particular orthodontist likes to use TPA and LLA to control the posterior anchorage. Each orthodontist has his/her own way of treating the case. I took over a lot of transferred cases and I disagreed with the way other orthos used certain appliances.

Well their non medicaid patients don't get these appliances, because with insurance you don't get to bill extra for an appliance.

I interviewed at these places, and now I see their transfers, the orthos are told to place these appliances on mediicaid, but not insurance. and how does the state prove the patient did not have a broken bracket???

I know some have been investigated by the state, but they plead ignorance and get a slap on the wrist, it is ridiculous

 

[charlestweed]

I interviewed at these places, and now I see their transfers, the orthos are told to place these appliances on mediicaid, but not insurance. and how does the state prove the patient did not have a broken bracket???

Then it is these associate orthodontists' fault, not the chain owner's fault. These orthodontists are adults, have formal training, and have dental license. They can make their own decision. If they are not comfortable with the chain they work for, they can always walk away. I don't think all the associate orthos who work at the Malouf's dental chain are unethical like what you described.

It is not easy to prove if the ortho appliances are necessary or not. As I mentioned before, each ortho has his/her own way of treating the patients. Some "non-extraction" orthos routinely use RPE on many of their patients. Dr. Dischinger uses Herbst on the majority of his patients. I have not use the Herbst since I graduated. That doesn't mean that the other orthos are wrong and I am right, and vice versa.

 

[bsmcga0]

Then it is these associate orthodontists’ fault, not the chain owner’s fault. These orthodontists are adults, have formal training, and have dental license. They can make their own decision. If they are not comfortable with the chain they work for, they can always walk away. I don’t think all the associate orthos who work at the Malouf’s dental chain are unethical like what you described.

It is not easy to prove if the ortho appliances are necessary or not. As I mentioned before, each ortho has his/her own way of treating the patients. Some “non-extraction” orthos routinely use RPE on many of their patients. Dr. Dischinger uses Herbst on the majority of his patients. I have not use the Herbst since I graduated. That doesn’t mean that the other orthos are wrong and I am right, and vice versa.

and then why do they treat their medicaid vs insurance patient different,

 

[charlestweed]

and then why do they treat their medicaid vs insurance patient different,

Where is the source? Is it from the same liberal press that published the above article…the same liberal press that tends to hate the rich successful doctors and dentists?

So I guess you disagreed with my statement above. And you think that all orthodontists who work at the M&M dental chain are all evil people because they cooperate with the chain owner by using unnecessary ortho appliances on the medicaid patients.

If it was so easy to get the Texas medicaid to pay for ortho tx and if I were one of these associate orthodontists, I would quit the job and start my own private ortho office. I would sign up for medicaid and not having to worry about getting referrals from GPs. I would still make a lot of money without having to use "unneeded" appliances such as RPE, TPA, quad, herbst etc. Most dental chains in California charge, on the average, $3500 a case and medicaid only pay them $3000 a case (and CA medicaid doesn't pay for bracket repairs)….and these dental chains are making bank.

 

[charlestweed]

Do they extract 4 bis because Medicaid will pay extra for those too? I don't doubt what you're writing occurs. Lots of shadiness seems to crop up when someone else is footing the bill.

In CA, the medicaid patient, who is qualified for ortho tx and needs bicuspid extraction, has to pay for the ortho extraction. Medicaid only pays for extraction of an infectious tooth.

 

[8 SNAKE]

In short, it is worth spending extra money to specialize after dental school.

You seem to take some of the worst scenarios from general dentistry to "prove" your points about why specializing rocks. I'm glad that you enjoy your chosen profession, but in my opinion your blatant bias and skewed examples detract from the otherwise valuable input that you give.

 

[bsmcga0]

Where is the source? Is it from the same liberal press that published the above article…the same liberal press that tends to hate the rich successful doctors and dentists?

So I guess you disagreed with my statement above. And you think that all orthodontists who work at the M&M dental chain are all evil people because they cooperate with the chain owner by using unnecessary ortho appliances on the medicaid patients.

If it was so easy to get the Texas medicaid to pay for ortho tx and if I were one of these associate orthodontists, I would quit the job and start my own private ortho office. I would sign up for medicaid and not having to worry about getting referrals from GPs. I would still make a lot of money without having to use “unneeded” appliances such as RPE, TPA, quad, herbst etc. Most dental chains in California charge, on the average, $3500 a case and medicaid only pay them $3000 a case (and CA medicaid doesn’t pay for bracket repairs)….and these dental chains are making bank.

I am the source, a gun totting republican. I interviewed at one of these places, I filled in one day per week for 2 months when one of these docs got sick. I have mutual friends and talk to these docs over drinks.

In Texas, all the chains do this. It is the doctors and office managers fault. Of course the doctors should walk, but they move here and sign a contract. It is easy to say they should just open their own office, buy many of these docs aren't from the area, plan on moving away after awhile, and have huge debts already.

But in the end, it will be the docs that do it the right way, and the patients that truly need medicaid (though I guess that is only 50% of the people actually on medicaid) because it is about to be cut, myself and the the pedo in my town will not be able to accept medicaid after the cuts.

 

[ortho lurker]

Don't worry people, the Texas dental medicaid system will become more HMO-like in the next few years and the gold rush will be over. Out-of-state recent ortho grads will move back to their home state (ie. California) and complain about the competition there, or move to the next gold rush....Alaska?

 

[charlestweed]

I am the source, a gun totting republican. I interviewed at one of these places, I filled in one day per week for 2 months when one of these docs got sick. I have mutual friends and talk to these docs over drinks.

In Texas, all the chains do this. It is the doctors and office managers fault. Of course the doctors should walk, but they move here and sign a contract. It is easy to say they should just open their own office, buy many of these docs aren't from the area, plan on moving away after awhile, and have huge debts already.

But in the end, it will be the docs that do it the right way, and the patients that truly need medicaid (though I guess that is only 50% of the people actually on medicaid) because it is about to be cut, myself and the the pedo in my town will not be able to accept medicaid after the cuts.

Yeah, it is not right for me to criticize some of the young new grad orthodontists who tried to boost the production by using the “unneeded” ortho appliances on the medicaid patients. On the one hand, they have to support their family and pay back the student loans and on the other hand, they have to protect their fragile associate jobs by making the dental chain owners happy. I know I am no saint. If I were in their shoes, I would probably have fallen into this trap as well. I didn’t have to go through the same hardships that most new grads have to go through right now. I graduated at the time when there was a huge shortage of orthos in CA, when the unemployment rate was below 6%, and when CA only accepted its own board (no WREB, no reciprocity). And my wife is also a specialist.

If Texas medicaid was more strict like CA medicaid, none of these incidents would have happened.

 

[KristopherTruth]

Yeah, it is not right for me to criticize some of the young new grad orthodontists who tried to boost the production by using the “unneeded” ortho appliances on the medicaid patients. On the one hand, they have to support their family and pay back the student loans and on the other hand, they have to protect their fragile associate jobs by making the dental chain owners happy. I know I am no saint. If I were in their shoes, I would probably have fallen into this trap as well. I didn’t have to go through the same hardships that most new grads have to go through right now. I graduated at the time when there was a huge shortage of orthos in CA, when the unemployment rate was below 6%, and when CA only accepted its own board (no WREB, no reciprocity). And my wife is also a specialist.

If Texas medicaid was more strict like CA medicaid, none of these incidents would have happened.

All this talk about extra loans, crappy economy, and dental mills sucks. Why dentistry then? Why not medicine?

 

[amalgamator42]

I thought I wanted to do medicine in undergrad. I have no doctors in my family so I shadowed general practitioners, surgeons, and they ALL said the same thing. Don't do it! The lifestyle sucks, the wages are just OK and you are restricted by insurance to the point that it influences every decision you make. Most doctors think dentists have it made...

 

[KristopherTruth]

I thought I wanted to do medicine in undergrad. I have no doctors in my family so I shadowed general practitioners, surgeons, and they ALL said the same thing. Don't do it! The lifestyle sucks, the wages are just OK and you are restricted by insurance to the point that it influences every decision you make. Most doctors think dentists have it made...

So it seems that everyone is unhappy. I think the grass is greener on the other side for most people. I think the only thing that Dentistry offers is the ability (one day) to pay off all your debts and be a small business owner. I don't think autonomy will be provided at all in Medicine and you might get it in dentistry if your debt free someday. If your debt strapped then your still working for the system and you still have to play the game.

 

[boomchakalak]

Understandable, but if ortho programs continue to open a situation similar to graduating law students may occur. A graduating certificate with no job, and heaps of loan money. I am more or less playing devil's advocate, but I appreciate all of the responses.

I'd say the best thing that you can do is watch your finances and take steps to cover yourself and your family prior to accumulating so much debt. What I would do in your position is work for a year or two as a GP, pay down my debt, then apply to ortho.

 

[yappy]

GUYS & GALS! Debt is a huge deal. But I have been thinking alot about access to care for patients and ways that dentists & doctors can improve their financial situation.

What if dentists received tax deductions on their income by seeing medicaid/medicare patients?

For example, a dentist treats a medicaid/medicare patient for the market rate of 100 dollars. But, medicaid only pays 50 dollars. In this situation at the end of the year the difference (50 dollars) is knocked off of the dentist/doctors taxable income.

Do you guys think we can make this law if the ADA and AMA team up?

 

[8 SNAKE]

Do you guys think we can make this law if the ADA and AMA team up?

Zero chance of that happening.

 

[yappy]

Why do you believe that? The AMA part or the tax deduction idea?

Zero chance of that happening.

 

[8 SNAKE]

Why do you believe that? The AMA part or the tax deduction idea?

Think about the politics of what you're proposing. Congress is never going to pass legislation that gives rich doctors and dentists tax breaks to see low-income patients.

I also see little sense it lumping the ADA and AMA together. In my opinion, the last thing dentists want is for the ADA to follow the path that the AMA has taken through the years.

 

[yappy]

I agree with your last point. But I think you can package this policy in ways that the public will find more savory. I debated this topic in a poli sci class and won.

I focused on the issue of patients not being treated due to being passed over for better insured patients, then the insolvency of entitlements.

I then explained how the tax payer would be getting a better deal by comparing the efficiency of tax breaks to doctors for services VS. the additional tax revenue needed to fully fund the entitlements. Think about every dollar going towards health care services VS. health care + bureaucracy.

One day it will be passed and you'll think "d*mn, way to go yappy".

Think about the politics of what you're proposing. Congress is never going to pass legislation that gives rich doctors and dentists tax breaks to see low-income patients.

I also see little sense it lumping the ADA and AMA together. In my opinion, the last thing dentists want is for the ADA to follow the path that the AMA has taken through the years.

 

[charlestweed]

What if dentists received tax deductions on their income by seeing medicaid/medicare patients?

For example, a dentist treats a medicaid/medicare patient for the market rate of 100 dollars. But, medicaid only pays 50 dollars. In this situation at the end of the year the difference (50 dollars) is knocked off of the dentist/doctors taxable income.

Do you guys think we can make this law if the ADA and AMA team up?

Since there are plenty of dentists and doctors who accept medicaid, there is no reason for the government to give tax break to those who treat the medicaid patients.

All dental chain clinics accept medicaid and cheap HMO plans. And there are plenty of these clinics in my state. I accept medicaid not because I have a big heart and I want to help low income people. I accept medicaid because I want as many people to come to my office as possible….free advertisement.

 

[NoPresident]

Since there are plenty of dentists and doctors who accept medicaid, there is no reason for the government to give tax break to those who treat the medicaid patients.

All dental chain clinics accept medicaid and cheap HMO plans. And there are plenty of these clinics in my state. I accept medicaid not because I have a big heart and I want to help low income people. I accept medicaid because I want as many people to come to my office as possible….free advertisement.

This statement is not factually true. According to a study Pew Charitable Trusts published last year, 38.1% of Medicaid-enrolled children in 2007 received needed dental services. The chief complaint by far was the lack of dentist's in their area (including chain clinics which aren't everywhere) who don't accept Medicaid. Moreover "nine states report fewer than three in 10 children ages 1 to 18 receiving any dental care in 2007, and three—Delaware,
Florida and Kentucky—show fewer than one in four children receiving care."

There very much is a lack of dentists in many areas of the country that accept Medicaid; why they don't and how to fix the problem, I agree, is a very complex problem.

Source: http://www.pewcenteronthestates.org/costofdelay/

 

[charlestweed]

This statement is not factually true. According to a study Pew Charitable Trusts published last year, 38.1% of Medicaid-enrolled children in 2007 received needed dental services. The chief complaint by far was the lack of dentist's in their area (including chain clinics which aren't everywhere) who don't accept Medicaid. Moreover "nine states report fewer than three in 10 children ages 1 to 18 receiving any dental care in 2007, and three—Delaware,
Florida and Kentucky—show fewer than one in four children receiving care."

There very much is a lack of dentists in many areas of the country that accept Medicaid; why they don't and how to fix the problem, I agree, is a very complex problem.

Source: http://www.pewcenteronthestates.org/costofdelay/

They can get treatments in dental schools. I did my ortho residency in KY and my ortho program accepts medicaid. In fact, it is easier for medicaid patients in KY to get approval for braces treatment than in CA.

 

[hot]

most of you don't realize that maybe the reason these clinics make so much money is because they are the only orthodontists that see these medicaid populations. think about it, if you have no other competition, then of course you will do well. i don't think they are intentionally doing harm. i wouldn't make assumptions.

 

[yappy]

Charlestweed was just giving his reasoning and describing his position down their in CA. I agree with your point though; if given the option dentists will prefer to fill their chairs with higher paying insurance/cash patients rather than Medicaid/Care patients. I'm assuming this is also true in medicine.

That was exactly my point. Gen X/Gen Y > Baby boomers in terms of population. As X and Y age and procreate they will begin to use more and more of the finite medical services, increasing political pressure to not break the bank but also increase access to care. Hence, my provider tax write off plan.

If the ADA and AMA are not for advancing and protecting dental and medical professions what are they good for?

most of you don't realize that maybe the reason these clinics make so much money is because they are the only orthodontists that see these medicaid populations. think about it, if you have no other competition, then of course you will do well. i don't think they are intentionally doing harm. i wouldn't make assumptions.

 

[GTFOOMICT]

AMA..........what are they good for?.

NOTHING.

Do some reading on the internet from various sources. It's an awful organization that has fallen apart. They are in bed with all the wrong people.

Very few practicing physicians are members. Heavy medical student, resident, and old dudes.

We, as dentists, want NOTHING to do with the AMA.

Support your local, state, and national ADA, and question them if you don't like what is happening.

I've seen enough of medicine to know we have it GREAT.

 

[jirotrom]

There are some very thoughtful and wise answers here, not all advocating the same path. I am tax attorney/financial consultant married to a doctor, so I see a lot of dental/medical practices, some run very well, some not so well. The early days are going to matter a lot to you since the earliest money you save is the most valuable, from a purely financial standpoint. You should not be overpaying taxes, but you probably will, since so few dentists are focused on this (LARGE) detail. Personally, in my practice, I see this all the time. Docs making really good money and paying far to much of what they earn to the government for the lack of knowledge that the corporations have.

You could, with diligence, beat the system to some extent, by practicing smart. Leverage yourself to the max--not by going in debt, but by maximizing the time you do what ONLY you can do. Hygenists and ortho techs (if that is what you call them???) make good money for their dentists, as do associates, and a great bookkeeper is a prize. The more of your time you can free to practice, the better. Your assistants, advisors, etc. have to be totally focused on your bottom line.

If you have the stomach for starting your own practice, or even buying into a practice, this can be done without more borrowing, perhaps by funding the retirement of the exiting dr. using a defined benefit plan. More patients stay, the buy-in is deductible, the exiting dr. can work part-time and transisiton patients to you.

My (patient/payor) experience with ortho is that all my younger sisters got some, so did all my kids (4), whether they needed it or not (!) and that all the teeth have moved again among my entire yuppie generation who are often going back and starting over, or those who didn't get the perfect smile now want one even at what you would consider an advanced age. However, there is a lot of advertising on billboards--still my dentist clients don't advertise and are doing very well.

I would side with the advice about passion. Love to go to work? Good life. Hate to go to work, not so good, will affect every other thing you do. Yes, 500K is huge for startup. Obscene, really. But that is also why it is licensed. Also, choose reasonably when you choose a practice location--there is a reason Walmart made it big from Bentonville, Arkansas! Some of my most financially successful dmds, dds, mds, dos, are in really rural areas, and I mean VERY successful, well over $1M year and could do more if they chose to work more. So, you have two reasonable choices: find the best job you can ($) now and work like crazy to pay down the debt, then do ortho, or go ahead, take the leap of faith and if you are sure you are going to love it, they really will come. My kids really really disliked the personality of our ortho, but all the dentists said his work was the best, so I forced them there. Interestingly I was given two names repeatedly by friends and I picked the one with the training credentials.

Bankruptcy does not discharge student debt. I have a daughter starting law school, in spite of the "job market"--she has a different plan than "get a job". She is also choosing schools by which one is giving her the best deal, between scholarships, living expenses, and where she wants to live. You mentioned "some of the programs". I am sorry to say that most people don't care where you went to prof school, so long as you passed the tests, so pick a cheap one and get the same degree. One last item of advice. In the south we always say you can marry more in a minute than you can make in a lifetime, so...do that, or buy a tiny house (small is the new big), live frugally, and happily, and you can do this, if you want to.

In retrospect, what would you have done if you could now do over? That answer will tell you a lot. As I told my daughter about law school when she complained that it will take another 3 years and she will be 28 when she finishes, you will be 28 in three years anyway...going to school is rather a nice way to spend a lot of your life for some of us. My husband got his first post-training job at age 39, and honestly some of the best times we had were when we were "poor". I think there may be, after a threshold, an inverse relationship between $ & happiness, and I DO money for others, every day, all day...it complicates your life a lot, because the more you have, you know, the more you have to lose, and that has made many a doctor miserable. Especially because so many foolishly hate insurance!

Good luck in your decision. "Things are in the saddle and ride mankind." R.W. Emerson Doing beats having. So would you do it again?

Brilliant post!

 

[8 SNAKE]

I agree with your last point. But I think you can package this policy in ways that the public will find more savory. I debated this topic in a poli sci class and won.

I focused on the issue of patients not being treated due to being passed over for better insured patients, then the insolvency of entitlements.

I then explained how the tax payer would be getting a better deal by comparing the efficiency of tax breaks to doctors for services VS. the additional tax revenue needed to fully fund the entitlements. Think about every dollar going towards health care services VS. health care + bureaucracy.

One day it will be passed and you'll think "d*mn, way to go yappy".

With all due respect, winning a debate in poly sci class is a far cry from the real world. I'd love to be wrong here, but I stand by my original post. We are not going to see new tax breaks for rich doctors and physicians to see medicare/medicaid patients. Congress barely avoided massive cuts to physician reimbursement for the same thing, so to think a pay hike is coming would be very illogical.