Another New Orthodontist Graduates with $1M+ in Student Loans

[charlestweed]

By the way, I never mentioned “associates” in my previous post for a general dentist to retire comfortably. It was hygienists (up to 4) and dental therapist(s) who work in a well established and busy practice that can make a general dentist retire comfortably. The dentist can assume the general manager position and step away from the handpiece/treatments in this scenario - so the practice leadership and style will not be like a corporate office. This is my goal down the line, maybe in 15-20 years.

This will probably work for you since you are in a less saturated area. My friend tried this and it didn’t work out well for him. He is in his early 50s. He bragged about working only 2 days/week and not having to work on weekends anymore because he hired 2 P/T associate dentists to work for him. When I met him a few months ago, he told me that he had to go back to working full time again and fired all the associate dentists, whom he had tried. According to him, these associates expected to get paid a lot but they don’t know anything…..very weak in clinical skills, lazy..... and a lot of patients complained about them. To maintain the success of your business, gotta sit down and touch your handpiece.

Also, in my experience, dentists who go back to school and specialize are either not cut out for general dentistry hustle, not good at managing staff and run an office, or simply want to make a higher baseline income. If you think majority of specialists didn’t get into their fields for monetary reasons - that would be a naive observation. These days, going back to school and specialize comes with 200-300k minimum before the compounding interest in additional debt/student loans, plus the $400-500k income potential loss as a general dentist - and most importantly TIME!. Any general dentist going back to school to specialize must think long and hard about it. Those numbers will only get worse in the future with tuition and other cost going up every year.

You are right. Practicing general dentistry is hard and stressful. It’s hard to be good and fast at every dental procedure. And if you are not good at doing general dentistry, you don’t make money. Specializing is a form of investment. And like any other investments, there are risks involved. Gotta take some risks in order to be successful. Nothing is easy in life.

To your final point, I don’t think the average undergrad comes with good grants anymore, so the “average” dental school applicant will carry some level of student loans before they get into dental school. Besides, what does the average 18 yr old know about debt? They are more worried about enjoying their youth and having fun in college. You and I and few others on this thread are the exception - we grew up differently and were more financial conscience than the average undergrad student.

This was exactly my point. You can’t just be an average student and expect to have the same level of success as a person who works harder than you and is more responsible than you. If you are more worried about enjoying your youth and having fun in college…..well, then you have to pay a heavy price for your lack of responsibility, for having no clear plan early in life. You get what you deserve. Successful people usually have qualities that others don’t have such as: hard work, self-reliance, will power, patience, self-confidence, and great communication etc. No pain, no gain.

---

Members don't see this ad.

 

[Cold Front]

Some thoughts from a practicing orthodontist who practiced during the Golden years (pre-2007), owned and started 2-3 ortho practices, purchased investment real estate, sold his practices and now works 4-5 days at a dental Corp.

1. YES. The Golden years of ortho are past us. Will they be back? Not sure. But doubtful. At one time ortho had the monopoly on straightening teeth. This does not exist now. Our patient pool is so much smaller now with so many players (Align, SDC, GPs and others doing ortho).

2. Is ortho worth over 700K? I'm not sure it is worth over 500K. It was worth it for me. I graduated with less than 100K. Maybe I was lucky. But I paid nothing for undergrad (scholarships). Went to a cheap undergrad college. Went to a cheap midwest dental school. Recieved a stipend in ortho residency. I worked a PT job during undergrad and my wife helped with bills during my ortho residency. What I see is lesser qualified students/dentists trying to BUY themselves into a profession.

3. Most orthodontists could not practice like @charlestweed . His unique perspective and work ethic allows him to prosper in a very difficult saturated ortho market. I cannot imagine young graduating orthodontists are going to set up a low budget low fee ortho practice. It's not the reason most of us went to ortho residency in the 1st place.

4. New orthodontists are going to have to diversify their employment. This is not different from the Golden years. Most orthos back then had multiple offices. Many orthos partnered up with Pedos. Many worked out of GP offices. The positive here is that their are MANY employment opportunities for orthodontists because EVERYONE wants ortho services offered in their offices. It generates revenue. I see it every where. EVERY dental office starts with their name and has BRACES at the end. Risas Dental and Braces. ColdPlay Dental and Braces. Etc. etc.

5. Orthos are going to have to travel. That's reality. I mentioned before that I started a small practice in a small town where my mother wintered. 2 and a half hours from Phx. GP begged me to use his office and see his ortho pts. There was NO orthodontist in this small town. I practiced in his office for 5 yrs, but then my main practice was getting busier .... so I discontinued that small town practice. To this day ... there is still no orthodontist at that small town. Could it support a full time ortho? No. But definitely a PT ortho. Rural areas still offer the best options for new orthos.

6. Working in Corp ortho is not bad for someone like myself (age 57). For a young ortho with large debt ... Corp ortho is one of many employment options. It's a **** show for sure, but for some sick reason .... I like it. lol.

7. As for the future of ortho. I see it becoming less and less popular as a post residency. A future orthodontist will be like prosthodontists. We'll be treating only the most difficult cases that nobody wants or can treat.

Every ortho residency should post your analysis of the profession on their website. It can’t get any more honest than that.


Sent from my iPhone using SDN mobile

 

[bracketbuster68]

Just wondering...if ortho was so bad, why is the doom and gloom rarely mentioned by recent grads or orthos young in their career?

 

[bracketbuster68]

Look at the workforce report published by the AAO and then reconsider.

I mean, the same AAO said orthos were making $440K median a few years ago so I'm not sure what that means.

 

[Big Time Hoosier]

Youre asking why the doom and gloom is not mentioned in SDN. Well, it is mentioned in the orthodontic workforce report very explicitly: https://www.aaoinfo.org/sites/default/files/Orthodontic Workforce Report_April 2018.pdf

Wow...the average debt for new ortho grads is $420,000, but a whole 21% owe more than $600,000!

Big Hoss

 

[Cold Front]

Look at the workforce report published by the AAO and then reconsider.

From that report: Student loan debt is perhaps the most glaring issue among new and younger orthodontists. Results from the Student Loan Survey indicate the average student loan debt is $418,722 for graduates between 2008 and 2017. This equates to a monthly payment of about $4,819 at a 6.8 percent interest rate.

Average Student Loan Debt 2013-2017: $456k
Average Student Loan Debt 2008-2012: $348k

That means half of all new orthod grads today have well above $500k+ student loans. If the previous trends hold, the debt will increase by about $100k every 5 years - based on the report, probably $150k if you include the interest. Monthly payments will be above $6k a month by then too.



Sent from my iPhone using SDN mobile

 

[jda02624]

Just wondering...if ortho was so bad, why is the doom and gloom rarely mentioned by recent grads or orthos young in their career?

Maybe they're too busy calling shows like Dave Ramsey and trying to figure out how to dig themselves out of a +$1,000,000 hole?

 

[bracketbuster68]

Maybe they're too busy calling shows like Dave Ramsey and trying to figure out how to dig themselves out of a +$1,000,000 hole?

Could be. But we will never hear from the good ones

 

[Cold Front]

I mean, the same AAO said orthos were making $440K median a few years ago so I'm not sure what that means.

$440k income sounds great to pre-dents and dental students.

20 years ago, $150k in student loans and $440k income meant 1:3 debt-to-income ratio. Today, the debt quadrupled to above $500k for most new ortho grads, so the ratio now is 2:1, and will only get worse every year. Don’t fall for the income number, the more important number is the student loan debt that could require as much as $100k a year in income to just service the debt.



Sent from my iPhone using SDN mobile

 

[Cold Front]

Wow...the average debt for new ortho grads is $420,000, but a whole 21% owe more than $600,000!

Big Hoss

Another AAO report suggested that the Average resident indebtedness climbed 31% since 2013. The rise in student debt was not reflected proportionately in orthodontic fee increases. In 2011, the median orthodontic fee for adolescents was $5200, whereas, in 2016, it was $5610, a 7.9% rise. I very much doubt ortho fees will climb more than 1-2% the next decade. But I’m pretty sure the resident indebtedness will go up 4-5% just next year alone, and every year after that. Residents will never appreciate the risk of compounding interest at higher debt.


Sent from my iPhone using SDN mobile

 

[2TH MVR]

Some of you are missing the bigger point. As @Cold Front states .... it's the debt to income picture. We're picking on ortho right now because of the outragious DS debt numbers. I mean a million dollars to be come an orthodontist . If you read that AAO report on new ortho grads .... well the common theme that I see is that new orthodontists are so debt laden from DS loans that they cannot get bank loans and/or are too scared to take on new debt to buy or open their own practice. This high DS debt situation would apply to all new dentists and specialists ... not just orthodontists.

I get it. Tuition is higher now. Fewer scholarships/grants. But you predents still have choices. It starts at undergrad. DO NOT GO TO AN EXPENSIVE UNGERGRAD COLLEGE. Go to the lesser expensive state college. Have a part time job also. Make sure your grades are good so that you can get accepted to a cheaper Dental school. Hopefully in-state. It's seriously all about grades. More competitive students (better stats) have better chances at inexpensive schools. Everyone else gets screwed at those private schools (MWU, Creighton, USC, AT Stills, NYU, etc. etc.). When you graduate .... it's ALL ABOUT DEBT ... not how many implants or posterior RCTs you did. While in DS .... get a PT job. I did.

As for the field of orthodontics. Alot of negative stuff has been brought up about ortho. If you can keep your DS debt reasonable ..... Ortho is still a fine profession. I still love my profession and have ZERO regrets. But I got into ortho the RIGHT way. I earned it. I didn't sign a bunch of loans for a million dollars to buy myself a profession. To this day .... there is NO WAY I would have been a general dentist. Sorry. Just wasn't my thing. As @charlestweed has mentioned many times .... a dentist's job seems so much more stressful than that of an orthodontist.

Orthodontists will always be needed. There is no cure for crooked teeth. Everyone will be coming to us when their simple aligner treatment fails (and it will) and they need to see a specialist for proper treatment.

 

[beannaithe]

Some of you are missing the bigger point. As @Cold Front states .... it's the debt to income picture. We're picking on ortho right now because of the outragious DS debt numbers. I mean a million dollars to be come an orthodontist .

Not only that. The orthodontist went to school for 11 years and spent $1million dollars to work 6 days a week.

I repeat, He went to school for 11 years and spent $1million dollars. To. Work. 6. Days. A. Week.

It's one thing if you decide to work 6 days a week because you want to. It's another to have no choice.

 

[Cold Front]

Orthodontists will always be needed. There is no cure for crooked teeth. Everyone will be coming to us when their simple aligner treatment fails (and it will) and they need to see a specialist for proper treatment.

Invisalign is offering 50% lab fees if you can prove that the patient started treatment with any type of direct to consumer company!

The current trajectory of ortho is more and more non-orthodontist people wanting their hands in the cookie jar/ortho market. Hair and Beauty Salons now tell their customers “we can straighten your teeth” through aligners. The average adult patient does not want braces in their mouth, they want non-metal products - that’s why Aligners are booming and more affordable. Clinically speaking, it’s the wrong answer to (as you put it) crooked teeth.

FormLabs announced a $5k small 3D printer for general dentists few days ago. It will print Aligners (among other things; dentures, crowns, etc) in minutes and another company can provide an ortho treatment plan through their orthodontists. This will hurt dental labs and the expensive E4D and Cerec market. One day 3D printers will cost as cheap as curing lights - and will bring down the Aligners (even Invisalign) prices to patients even further - orthodontists have no say in that. Meanwhile, schools are graduating new orthodontists with big debt to a market that’s totally different than you and Charles worked in as new grads.

Dentists could soon be 3D-printing your crowns, dentures and more

Formlabs points the way to the future with a new 3D printer specifically aimed at dentists

www.techradar.com

Sent from my iPhone using SDN mobile

 

[2TH MVR]

Invisalign is offering 50% lab fees if you can prove that the patient started treatment with any type of direct to consumer company!

The current trajectory of ortho is more and more non-orthodontist people wanting their hands in the cookie jar/ortho market. Hair and Beauty Salons now tell their customers “we can straighten your teeth” through aligners. The average adult patient does not want braces in their mouth, they want non-metal products - that’s why Aligners are booming and more affordable. Clinically speaking, it’s the wrong answer to (as you put it) crooked teeth.

FormLabs announced a $5k small 3D printer for general dentists few days ago. It will print Aligners (among other things; dentures, crowns, etc) in minutes and another company can provide an ortho treatment plan through their orthodontists. This will hurt dental labs and the expensive E4D and Cerec market. One day 3D printers will cost as cheap as curing lights - and will bring down the Aligners (even Invisalign) prices to patients even further - orthodontists have no say in that. Meanwhile, schools are graduating new orthodontists with big debt to a market that’s totally different than you and Charles worked in as new grads.

Dentists could soon be 3D-printing your crowns, dentures and more

Formlabs points the way to the future with a new 3D printer specifically aimed at dentists

www.techradar.com

Sent from my iPhone using SDN mobile

You're killing me Cold Front. You're killing me.

 

[Cold Front]

You're killing me Cold Front. You're killing me.

Haha! I sound like a propaganda machine.


Sent from my iPhone using SDN mobile

 

[gumtee]

Invisalign is offering 50% lab fees if you can prove that the patient started treatment with any type of direct to consumer company!

The current trajectory of ortho is more and more non-orthodontist people wanting their hands in the cookie jar/ortho market. Hair and Beauty Salons now tell their customers “we can straighten your teeth” through aligners. The average adult patient does not want braces in their mouth, they want non-metal products - that’s why Aligners are booming and more affordable. Clinically speaking, it’s the wrong answer to (as you put it) crooked teeth.

FormLabs announced a $5k small 3D printer for general dentists few days ago. It will print Aligners (among other things; dentures, crowns, etc) in minutes and another company can provide an ortho treatment plan through their orthodontists. This will hurt dental labs and the expensive E4D and Cerec market. One day 3D printers will cost as cheap as curing lights - and will bring down the Aligners (even Invisalign) prices to patients even further - orthodontists have no say in that. Meanwhile, schools are graduating new orthodontists with big debt to a market that’s totally different than you and Charles worked in as new grads.

Dentists could soon be 3D-printing your crowns, dentures and more

Formlabs points the way to the future with a new 3D printer specifically aimed at dentists

www.techradar.com

Sent from my iPhone using SDN mobile

Very sad state of affairs.
What are your feelings and thoughts regarding other specialties like endo and perio?

 

[charlestweed]

I can’t believe that some programs take 15+ residents a year. That alone should give ortho aspirants pause.

Big Hoss

This actually gives them hope, especially the ones who have lower stats and no research project. With more spots available, the chance for them to get accepted there will be higher

 

[charlestweed]

Not only that. The orthodontist went to school for 11 years and spent $1million dollars to work 6 days a week.

I repeat, He went to school for 11 years and spent $1million dollars. To. Work. 6. Days. A. Week.

It's one thing if you decide to work 6 days a week because you want to. It's another to have no choice.

But for the 3 days (out of the 6 days in a week) that he works at his own office, he pretty much sits around doing nothing all day long....it's a 2 month old office. This is easy work in comparison to doing general dentistry 8 hours/day, 5 days/week. I'd be bored to death when there's nothing for me to do all day long. If I were him, I would look for an additional P/T job to keep my mind sane.

 

[011110]

But for the 3 days (out of the 6 days in a week) where he works at his own office, he pretty much sits around doing nothing all day long....it's a 2 month old office. This is easy work in comparison to doing general dentistry 8 hours/day, 5 days/week. I'd be bored to death when there's nothing for me to do all day long. If I were him, I would look for an additional P/T job to keep my mind sane.

For everyone at home I want you to realize ortho may be easier work than general, but the hard part of dentistry is the PEOPLE.

The people will drive you insane whether you are doing reties or root canals.

 

[2TH MVR]

But for the 3 days (out of the 6 days in a week) where he works at his own office, he pretty much sits around doing nothing all day long....it's a 2 month old office.

I hope he's not sitting around doing nothing. He better be knocking on GP doors, visiting schools, flyers, mailers, internet ads, etc.

 

[bracketbuster68]

Invisalign is offering 50% lab fees if you can prove that the patient started treatment with any type of direct to consumer company!

The current trajectory of ortho is more and more non-orthodontist people wanting their hands in the cookie jar/ortho market. Hair and Beauty Salons now tell their customers “we can straighten your teeth” through aligners. The average adult patient does not want braces in their mouth, they want non-metal products - that’s why Aligners are booming and more affordable. Clinically speaking, it’s the wrong answer to (as you put it) crooked teeth.

FormLabs announced a $5k small 3D printer for general dentists few days ago. It will print Aligners (among other things; dentures, crowns, etc) in minutes and another company can provide an ortho treatment plan through their orthodontists. This will hurt dental labs and the expensive E4D and Cerec market. One day 3D printers will cost as cheap as curing lights - and will bring down the Aligners (even Invisalign) prices to patients even further - orthodontists have no say in that. Meanwhile, schools are graduating new orthodontists with big debt to a market that’s totally different than you and Charles worked in as new grads.

Dentists could soon be 3D-printing your crowns, dentures and more

Formlabs points the way to the future with a new 3D printer specifically aimed at dentists

www.techradar.com

Sent from my iPhone using SDN mobile

Interesting that they're printing the trays - but who is engineering and patenting (is that a word?) the attachments? Hint: it begins with In and ends with visalign.

 

[2TH MVR]

It's easy to make trays and apply braces. Much harder to actually straighten the teeth properly.

 

[charlestweed]

I hope he's not sitting around doing nothing. He better be knocking on GP doors, visiting schools, flyers, mailers, internet ads, etc.

3 days/week or 12 days/month.....that's a lot of free days in a month. After he finishes visiting all the local GP offices and doing all the things that you listed (which should only take him 1-2 months to do), then what?

My wife and I did all these (except for visiting the schools) when I first started and we both had full time associate jobs. It took me less than 8 hours to visit 6-7 different GP offices.

 

[Cold Front]

Interesting that they're printing the trays - but who is engineering and patenting (is that a word?) the attachments? Hint: it begins with In and ends with visalign.

Currently, Invisalign has over 400 patents. Patent protection does not last forever. Many of their key patents expired on the planning phase of clear aligners. From 2018 and beyond they have an average of 23 patents a year expiring.



Sent from my iPhone using SDN mobile

 

[Cold Front]

I hope he's not sitting around doing nothing. He better be knocking on GP doors, visiting schools, flyers, mailers, internet ads, etc.

He did say he is keeping himself busy... calling David Ramsey, planning for a wedding in April, etc. Sounds like more money is going out than coming in - at least for a while.


Sent from my iPhone using SDN mobile

 

[Cold Front]

Very sad state of affairs.
What are your feelings and thoughts regarding other specialties like endo and perio?

I think cost wise, Endo and perio I believe have more 2 years residency programs than ortho (which is typically a 3 yr programs these days). So debt wise, it’s little cheaper for endo and perio - but they too have rising debt every year like ortho.

I can’t speak for Perio, but I had a former associate who went back to school for Endo this year. He graduated in 2013, worked as an associate 6 years between corporate gigs and my office. He is married with 2 little ones (2 yr old and a month old baby) now. Wife looks after the kids full time. Endo program is 2 yrs, about $100k plus interest a year. Cost of living (through loans) is another $50-60k a year plus interest. So total residency debt will be closer to $350k with interest. Pre-Endo student loans were $150-200k - currently accruing interest. All in all, he will be in the hole close to $600k in student loans when he sees his first Endo case. He told me he doesn’t want to even open a practice and take out more loans in the future - and I agree with that. He said associate Endo positions offer 40% production and a typical molar Endo case can range between $900 to $1,600 depending on where you practice in the country. The northeast has the highest fees, and the south has the lowest. Not sure where he will move to practice after residency - but he can expect to make $360 to $640 a case. He will be slow the first year or 2, but after that - his speed and production will go up, and can expect a decent income, probably $400k a year as an associate contractor. Uncle Sam will take 30% of that, in some states and cities even more, and can expect to net $250-280k a year (or $20-23k a month). He plans to payoff his student loans very aggressively - maybe $10k a month. So he is down to $13k a month. Mortgage, cost of living and health insurance for a family of 4 would take another $6-8k a month depending on how demanding the kids life will be (after school programs, vacation budgets, etc). He is down to $5-7k... 401k/retirement savings, cars, miscellaneous expenses, etc could easily take another $2-4k. He could be down to couple of thousand dollars a month after all expenses are paid. He is 35 now, will graduate at about age 37. Not sure who works longer, Orthodontists or Endodontists - but assume a full retirement at age 65 - he has 28 years career left in the fuel tank to pay off $600k in student loans (closer to $800k in total payments), a mortgage, put kids (currently 2) through college (not sure what that will cost in future $ with all the insane college cost these days). He will be ok, but I can’t imagine if he did this 10 years from now - it would be a bad decision to go back to school and specialize all together.


Sent from my iPhone using SDN mobile

 

[charlestweed]

He did say he is keeping himself busy... calling David Ramsey, planning for a wedding in April, etc. Sounds like more money is going out than coming in - at least for a while.

I also got married 1 month after I finished my ortho residency. In our culture, the guests, whom we invited to our wedding, usually gave us monetary gifts. We spent around $35k for the wedding and the gift amount we received was $33k. So our net spending for the wedding was only $2k.

My wife and I owed a total of $450k in student loans. Three months later, we bought a $485k house. And a year later, we took out another $120k loan to buy an existing office for my wife. So our total debt was almost $1million. Unlike this new grad ortho, my wife and I both had F/T jobs. I traveled to 5 different offices and got paid between $750-900/day. My wife’s first job paid her $500/day. So if you do the math, our combined income came out to be slightly under $350k/year. We never felt we had a tight budget. I leased a BMW 745i for myself and a Mercedes E500 for my wife. We took vacations 1-2 times a year. We helped pay our parents’ home mortgages.

4 years later, I started my first office but I still kept my F/T jobs at the corp offices. I worked on Saturdays and Sundays at my own office. And on some weekdays, right after I finished my associate job at the corp at 6pm, I went straight to my own office to see patients until 9pm. To save $$$ on staff, my wife helped me both in the front and back. At that time, our daughter was only 2 years old…we usually brought her to work with us….my new born son stayed home with the nanny. When we were busy and we worked hard for ourselves, we never felt lazy nor tired. It’s a good feeling to see our practices prosper. Having a busy schedule every day is a good thing.

Because of the constant cashflow from my and my wife's associate jobs while waiting for my new practice to grow, we never felt we had tight budget. We have actually had very comfortable lifestyle since our graduations....it keeps on getting better.

 

[ToothJockey]

He told me he doesn’t want to even open a practice and take out more loans in the future - and I agree with that. He said associate Endo positions offer 40% production and a typical molar Endo case can range between $900 to $1,600 depending on where you practice in the country. The northeast has the highest fees, and the south has the lowest. Not sure where he will move to practice after residency - but he can expect to make $360 to $640 a case.

Why is it so unpopular to purchase a practice when you are in big debt? I would assume if you already owe 500k+ then you might as well jump into the deep end of the pool and try to maximize your income by owning a practice. Your friend could be making 60+% production in his own practice instead of 40% since Endo overhead is generally low.

 

[Cold Front]

Why is it so unpopular to purchase a practice when you are in big debt? I would assume if you already owe 500k+ then you might as well jump into the deep end of the pool and try to maximize your income by owning a practice. Your friend could be making 60+% production in his own practice instead of 40% since Endo overhead is generally low.

It depends on many factors, but I think the biggest factor is age. I have a friend from dental school who went directly to ortho residency and graduated in his late 20’s (single, no relationships, no kids, etc) back in 2013 with over $600k+ in student loans. He opened a new office from scratch (I’m guessing another $300k+) and struggled in the beginning, which is common for a new specialty practices - not sure how his practice is doing now (he still single, no kids), he is in his late 30’s now.

Coming out of school with big debt and opening a new practice in your late 30’s could give anyone a pause - specially if you are married with kids. The time and energy kids need is very high, and opening a new office would create more stress (and less sleep). Overall, it’s down to your body and mental energy to do both - but it’s a lot easier to do it when you are in your 20’s than 30’s in my opinion. That 10 years head start can make a big difference - in energy, which helps with paying off debt sooner and keeping up with any family demands easier.


Sent from my iPhone using SDN mobile

 

[Cold Front]

I traveled to 5 different offices... my wife helped me both in the front and back. At that time, our daughter was only 2 years old…we usually brought her to work with us….my new born son stayed home with the nanny.

I don’t think that hustle is common anymore. You had crazy energy and a very supporting and active wife. Younger dentists/specialists are not like you/us. I wasn’t born in this country, I’m guessing you came to the US as a kid? But on average, first generation migrants generally hustle more than their friends or colleagues who were born (and their parents) in this country. I still hustle today even though I have far less debt, own established offices, etc. than a new grad with more debt and no assets.


Sent from my iPhone using SDN mobile

 

[2TH MVR]

Why is it so unpopular to purchase a practice when you are in big debt? I would assume if you already owe 500k+ then you might as well jump into the deep end of the pool and try to maximize your income by owning a practice. Your friend could be making 60+% production in his own practice instead of 40% since Endo overhead is generally low.

When I graduated in 1993 .... your decisions were easy for you. Almost EVERYONE (specialists and GPs) typically had a goal of owning your own practice within a yr or 2 of graduating. I did not want to work for anyone. Straight out of school .... I associated with an ortho for 6 months, but the deal to buy her practice fell through. 6 months later I bought into an ortho partnership. The owner ortho carried my buy in debt. 18 months later I bought out the senior ortho for a pre-determined price decided at the start of the ortho partnership. The point of this is that the owner ortho carried my initial debt. I never had to discuss anything with the banks even though my DS debt was around 100K. Today lenders are a little more concerned with excessive DS debt. I mentioned previously that when I sold my ortho practice (2 locations) .... I was not asking for alot of money since both offices had revenue that had plateaued. Plenty of lookers, but many of the potential young orthos could not secure financing due to their negative net worth (high DS loans).

So this excessive dental school debt (>350K) has single handedly made it more difficult for indebted dentists to pursue ownership (which is why most of us went to dental school) and the Dental Corps have plenty of dentists to work for them. I believe it gets worse the longer a young dentist waits to own. If it was me coming out of DS. FIND THE RIGHT LOCATION. Avoid the saturated areas. Go rural. And secure that practice. A practice is an investment. Plenty of business write-offs, deductions, etc. etc. If you procrastinate ... it seems to get tougher and tougher to make that leap into ownership.

 

[Cold Front]

I believe it gets worse the longer a young dentist waits to own. If it was me coming out of DS. FIND THE RIGHT LOCATION. Avoid the saturated areas. Go rural. And secure that practice. A practice is an investment. Plenty of business write-offs, deductions, etc. etc. If you procrastinate ... it seems to get tougher and tougher to make that leap into ownership.

It’s interesting that everyone was shooting to open an office when you graduated... how times have changed! According to the ADA, dentists in solo practices in 2017 between ages 35 to 44 hit an all time low at 40%, while dentists younger than 35 also declined to 21% in 2017. So there is now an 80% odds that a dentist will not own a solo practice under age 35, and 60% odds under age 45. You would have to be above age 50 to see favorable odds (above 50%) to own a solo practice.

Most new grads today with big debt will have to wait 2-3 decades to own their own solo office, while most future new grads (10 years from now) will have to wait even longer, or will give up the idea all together. So, since 1990, we went from almost everyone wanting to open their own solo office, to almost no one wanting to open their own solo office in a decade or so, if this downward trend continues.

Source: Solo vs. group – where are dentists going?


Sent from my iPhone using SDN mobile

 

[charlestweed]

I don’t think that hustle is common anymore. You had crazy energy and a very supporting and active wife. Younger dentists/specialists are not like you/us. I wasn’t born in this country, I’m guessing you came to the US as a kid? But on average, first generation migrants generally hustle more than their friends or colleagues who were born (and their parents) in this country. I still hustle today even though I have far less debt, own established offices, etc. than a new grad with more debt and no assets.


Sent from my iPhone using SDN mobile

It’s actually very common among the people, whom I was surrounded with….my parents, my dental school classmates, my sister, my wife, sister in law, my brother in law….they are all Asians. I hustled because I wanted to become rich fast. I felt starting a career at the age of 29 was already too late. Many of my GP friends, who didn’t have to spend 2-3 extra years for post grad residency, already had nice houses and cars. And like them, I wanted to have a luxurious lifestyle, to eat at nice restaurants, to drive nice cars, to live in a big house etc….and I wanted all of these ASAP, and not in 4-5 more years. So I couldn’t just sit around doing nothing and expected to have all these luxury items. Yup, that’s the price you have to pay for being a show off.

I've always had positive view about my job. At one point, I worked 7 days/week but I didn't feel I was forced to do this. It's the opposite.... I felt very lucky to have plenty of works to keep myself busy and to make $$$. Even during the golden years of ortho, I knew many new grads ortho who were struggling to find F/T jobs. I brought my daughter to work not because we didn’t have anybody to take care of her. We had a live-in nanny at home. I brought my daughter to work because missed her and I wanted to see her face while I treated my patients. There are not a lot of jobs out there that allow me to bring kids to work. Being an owner, I can do whatever I want.

 

[beannaithe]

Why is it so unpopular to purchase a practice when you are in big debt? I would assume if you already owe 500k+ then you might as well jump into the deep end of the pool and try to maximize your income by owning a practice. Your friend could be making 60+% production in his own practice instead of 40% since Endo overhead is generally low.

I'm not an owner, but I think it could difficult to get financing for another large amount due to debt to income ratio. I informally asked some questions from a bank about buying a practice when I first got out of school (this was post 2008 recession). I was told to pay down more of my debt (only at $275k) and plan to work a side job. The banker told me some people take a while to take a salary (the money to pay mortgage, student loan debt, eat, etc) and have to put a lot of the money back into the practice/loan repayment. Often, it's just easier to work as an associate for a while. There's no headache from staff management, insurance headaches, ordering supplies, and general overhead. It's show up, do dentistry and go home. Granted, you make less, but it's less headache overall.

Not to mention, starting up/running a practice takes time. There are so many hours in the day when you have to deal with family and your practice. I imagine trying to pay off $1mil+ in student loan/practice debt while doing a start-up and working 6 days a week would be enough to burn anyone out eventually. And then, there's kids. They take up a lot of time too. There isn't enough energy for everything.

 

[Cold Front]

And then, there's kids. They take up a lot of time too. There isn't enough energy for everything.

If anyone with $1M+ debt in student loans builds a new practice and have kids on top of those - they will probably never going to see the light of day again (maybe not again, but a very long time). Assuming there is no other financial support other than dentistry income and the spouse looks after the kids full time.

Sent from my iPhone using SDN mobile

 

[charlestweed]

If your plan is to work for someone else forever, then you shouldn't consider dentistry because you will be no different than a pharmacist/optometrist who works at walmart....the salary will eventually hit the limit. Can't be rich working for someone else forever. Can't be rich, if you say no to everything: no to taking risk, no to working on the weekends, no to accepting insurances, no to working long and late hours etc....then a person to blame is nobody else (not the school that charges a lot of money, not the government that gives you loans) but you yourself. A dental practice doesn't have to cost $500k to build. One can have a nice one for under $150k. There is no reason to spend 8 hours/day, 5 days/week to work at a brand new office that doesn't have a lot of patients....need to find a P/T associate job to supplement the income.

If you wait for your practice to pick up then have kids, then you may never have kids....the older you get the less fertile you will be. There shouldn't be any problem having kids while running a practice. Most successful people can do it and so can you. Your assistants work harder than you, make much less money than you, and they have kids too. It's actually better to work hard when the kids are 1-2 yo. By the time they reach the school age, your practice will become more established and you will have more time to spend with your kids.

 

[Cold Front]

Your assistants work harder than you, make much less money than you, and they have kids too. It's actually better to work hard when the kids are 1-2 yo. By the time they reach the school age, your practice will become more established and you will have more time to spend with your kids.

I went through many assistants, maybe 20+, and about half of them were grandparents by age 40. They had kids when they were teens, and their kids still lived with them (and their grandkids) and never had enough savings and struggled to keep up with all the generational cost that fell on their shoulders... shared cars, constantly stressed about their paychecks and so on. The same pressure applies to many dentists too - some of which I have mentioned in a previous post. Not every family functions like an Asian family and pull all their resources together and live well beyond their means.

Having kids is a great responsibility, and not many can provide the full responsibly to be a good parent, including the successful people - even though anyone can have a child. The trend of people delaying marriage and having no/less kids is a testament to that.


Sent from my iPhone using SDN mobile

 

[charlestweed]

I went through many assistants, maybe 20+, and about half of them were grandparents by age 40. They had kids when they were teens, and their kids still lived with them (and their grandkids) and never had enough savings and struggled to keep up with all the generational cost that fell on their shoulders... shared cars, constantly stressed about their paychecks and so on. The same pressure applies to many dentists too - some of which I have mentioned in a previous post. Not every family functions like an Asian family and pull all their resources together and live well beyond their means.

Having kids is a great responsibility, and not many can provide the full responsibly to be a good parent, including the successful people - even though anyone can have a child. The trend of people delaying marriage and having no/less kids is a testament to that.


Sent from my iPhone using SDN mobile

The majority of my patients are from low income Hispanic families. They are great parents. Despite having low incomes and living paycheck to paycheck, they manage to pay for ortho tx not only one child but for every child in the family. Many of them have 4-5 kids. To be successful at whatever you do, you need to take some responsibility and stop making up excuses.

 

[Cold Front]

The majority of my patients are from low income Hispanic families. They are great parents. Despite having low incomes and living paycheck to paycheck, they manage to pay for ortho tx not only one child but for every child in the family. Many of them have 4-5 kids. To be successful at whatever you do, you need to take some responsibility and stop making up excuses.

This is comparing apples to oranges. We practice in different parts of the country/states and our staff and patients are in different demographics.

Out of curiosity, I have read a lot on demographics and trends in population in this country and all over the world for many years. From my understanding, at least in this county, life choices has a lot to do with the individual’s socioeconomic status, their cultural beliefs and faith towards a family. Many communities, regardless of their socioeconomic status, will have more children due to their faith and their cultural beliefs. Majority of Hispanics generally fall into this category. No matter what their paycheck will be, kids will be in the picture early in their life - because of god, the church and their core and central values. This also applies to the general public, the more religious you are, the institution of your faith demands children to be an aspect of their life. Typically these communities live in rural areas, or relocated to urban communities as adults. Nothing wrong with that, because I too grew up in a tribe and religion driven background. If you remove faith (not necessarily that they are atheists) and rural upbringing from the picture - which are both on the rise, you are left with just the socioeconomic status - and the walls in an individual’s life would mostly be colleagues/co-workers/friends/etc. Such circles do not create “the tribal pressure” between themselves - and usually see life with a different purpose and different priorities. To them, life is more about what matters more to the individual than what others would like to see in that individual. Many do have kids, but they don’t see kids as central as individuals who are more faith and cultural driven.

For example, 100 years ago, 65% of all Catholics lived in Europe and European population was rising fast - while today, it’s down to about 20% and Europe is not having kids (not because of money) but mostly because faith pressure is fading in Europe. The opposite is true in Latin America - they were 20% of all Catholics, and now about half of all Catholics in the world live over there; multi-children individuals are very unbiquitous, even for that segment of the US population, specially in California which has a very large Latino population.

So it’s not about excuses or running away from responsibilities - it’s the beliefs and faith for many that leaves them little choice to have a say what they want, including children. While others are free of the pressures to conform and lead their lives to the best of their circumstances.


Sent from my iPhone using SDN mobile

 

[2TH MVR]

The majority of my patients are from low income Hispanic families. They are great parents. Despite having low incomes and living paycheck to paycheck, they manage to pay for ortho tx not only one child but for every child in the family.

I agree with what you said here. I also treat mostly this demographic. But everything is relative. What is considered low income here in the States is probably middle or even higher income in Mexico. I work with predominantly Hispanic employees. I sometimes feel bad for the low wages these hard working Hispanics make, but as for as I can tell ... they are an extremely happy group of people and are grateful for their jobs and benefits.

What was this thread about again?

 

[charlestweed]

In dentistry, you have to sit down to perform the procedure in order to get paid.The more procedures you perform, the more offices you travel to work at, and the more days you work per month, the more money you make and the faster you will pay off debts. It's simple math. Sitting around doing nothing and complaining about everything will get you nowhere. Since you made a mistake for accumulating $1million in debt, which could have been avoided, you need to be more proactive at fixing your mistake. Everybody makes mistakes in life. And mistakes help people learn. It's not a terrible mistake when you are still young and have full of energery to work 6-7 days/week. If you can't pay back $1 million loan and own a house with the income you've earned for working for 35-40 years as an orthodontist, then there must be something wrong with you.

 

[Cold Front]

What was this thread about again?

Ortho schools are bankrupting future grads.

 

[deleted903013]

Ortho schools are bankrupting future grads.

If only you could declare bankruptcy on your student loans

 

[charlestweed]

So you think it's OK for the orthodontists and dentists to file bankruptcy? It's Ok that the hardworking taxpayers like you and your parents have to bail them out for their bad decisions? It's ok to bail them out so they don't have to work 6 days/week and on weekends?

So now the orthodontic programs are the evil institutions? Then why beg them to accept you? Blame, blame, blame.... and it's never your fault.

 

[deleted903013]

Do you also hold that argument for any kind of bankruptcy? Small business, big business, banks, etc bankruptcies?

I'd much rather bail out financially illiterate 20 somethings who were told by an entire generation they had to go to college than Donald Trump who declared bankruptcy multiple times. I'd rather spend money bailing out student loans so my generation can have children than give foreign aid and bomb countries. Student loans are ruining my generation and it's an absolute travesty.

 

[Cold Front]

So you think it's OK for the orthodontists and dentists to file bankruptcy? It's Ok that the hardworking taxpayers like you and your parents have to bail them out for their bad decisions? It's ok to bail them out so they don't have to work 6 days/week and on weekends?

So now the orthodontic programs are the evil? Then why beg them to accept you? Blame, blame, blame.... and it's never your fault.

Charles, no one said anything about bail out. Even the law doesn’t permit that. And that working 6 days a week or 7 days a week suggestion..., have you ever wondered how did the high debt crisis get here in the first place? The short answer is, organizations like the ADA that bankrolls on dental application fees from pre-dental students while pretending to be advocating for future dentists are not TRULY advocating but their own interests. Why don’t we ask every new new grad today if the ADA - who claims to represent them, could have done anything before they about to be drowned in debt for the majority of their career?

I personally would boycott any institution or organization that markets itself to represent dentists without knowing and addressing the most important issues that are important to young future dentists. It’s a shame really, and I have no regrets joining the ADA or paying any alumni fees for that matter - because my money would never go to issues that many dentists would like to see addressed.


Sent from my iPhone using SDN mobile

 

[charlestweed]

Do you also hold that argument for any kind of bankruptcy? Small business, big business, banks, etc bankruptcies?

Yes. I hate all forms of bailouts. You take out loan and you are obligated to pay it back. That's why I buy disability and life insurance....in case I can no longer work.

 

[charlestweed]

Charles, no one said anything about bail out. Even the law doesn’t permit that. And that working 6 days a week or 7 days a week suggestion..., have you ever wondered how did the high debt crisis get here in the first place? The short answer is, organizations like the ADA that bankrolls on dental application fees from pre-dental students while pretending to be advocating for future dentists are not TRULY advocating but their own interests. Why don’t we ask every new new grad today if the ADA - who claims to represent them, could have done anything before they about to be drowned in debt for the majority of their career?

I personally would boycott any institution or organization that markets itself to represent dentists without knowing and addressing the most important issues that are important to young future dentists. It’s a shame really, and I have no regrets joining the ADA or paying any alumni fees for that matter - because my money would never go to issues that many dentists would like to see addressed.


Sent from my iPhone using SDN mobile

I thought the rise in studdent loan debt has been caused by a combination of the government that keeps giving out "blank checks" to students and schools that know that the students are desperate to get in and continue to raise tuitions every year.

I think (and this is just my personal opinion) another reason, beside making huge profit, why ADA allows new schools to open and existing schools to expand their class size is to improve "access to care." Most private dental and orthodontic offices refuse to treat low income patients and don't accept a lot of insurance plans and medicaid. So many low income patients and patients with HMO plans will have to go to get tx at cheaper places (ie in Tijuana, at governement run dental clinics, at the corp offices etc). Because schools keeps pumping out more new grads every year, future private practice dentists will have no other choices but eventually do what I am doing right now (charging low fees, accepting medicaid, working on weekends etc) in order to survive the competitions and to pay back their debts. More competitions among dentists = more choices for the patients.

I think with the rise in student loan debts and increase in competition, the students who plan to apply for dental schools, need to go to forums like this one or talk to their local dentists to learn about some of the pros and cons about the profession...and then they can decide for themselves. In order to have similar lifestyle as the older grad dentists, today new grads will have to work twice as hard because 1/2 of their incomes will have to go toward paying back the student loans. So if one doesn't mind working 6-7days week, then dentistry should be fine for them. My younger brother, who is a GI doc, works 10+ hours a day and he thinks he has the best job in the world....it's because he gets paid very well. Different people have different work values.

 

[gryffindor]

Charles, no one said anything about bail out. Even the law doesn’t permit that. And that working 6 days a week or 7 days a week suggestion..., have you ever wondered how did the high debt crisis get here in the first place? The short answer is, organizations like the ADA that bankrolls on dental application fees from pre-dental students while pretending to be advocating for future dentists are not TRULY advocating but their own interests. Why don’t we ask every new new grad today if the ADA - who claims to represent them, could have done anything before they about to be drowned in debt for the majority of their career?

The government stepped in and messed with student loans in 2007. That is the exact moment when all colleges and universities, not just dental schools, began raising tuition and spending like mad. Private lenders also left the student loan arena. You can't blame the ADA for this one. It came straight from the elected officials in Washington.

 

[Cold Front]

I why ADA allows new schools to open and existing schools to expand their class size is to improve "access to care." Most private dental and orthodontic offices refuse to treat low income patients and don't accept a lot of insurance plans and medicaid.

The ADA accredited 10 dental schools in the last 10 years. It’s about to accredit another school next year - Univ of Texas El Paso. They have allowed foreign countries to have ADA accredited schools.

During the 2018-19 academic year, there were 25,381 students enrolled (the highest level in history) in predoctoral dental education programs, up from 25,010 the prior year. Those additional 400+/- new students generated an additional $40M+/- between the schools in just 1 year. The class of 2018 had 6,305 graduates, up from 6,238 in 2017. Class of 2019 will be even higher. All these numbers help increase the ADA bottom line - more schools to accredit, more income streams, more ADEA application fees, and so on. Yet, the ADA thinks we/dentists are not paying into their cause with membership dues. They throw annual conventions, sell merchandise, offer disability and life insurances, get a cut from almost every dental toothpaste and other products with ADA logo on it, and many more other sources of income. It’s rotten from the head down.

In 2018, the ADA researched “the timing of decision to pursue career in dentistry” from applicants. About half of respondents said “before or during high school”. Think about that for a second. If you include by junior year of college (before age 20), that number jumps to over 70%. This motivates schools to increase their fees every year because they can project and see into the future (and know) that this is a very a difficult trend to change. If you had 70% of the applicants over the age of 30 - you would have the opposite effect, and schools would know they will have difficulty filling seats. Because someone over 30 is wise enough to know what “debt to income ratio” means.


Sent from my iPhone using SDN mobile