Endodontics Future

[allDAT]

So. To get this back on topic.

Are Endodontists doing alot of implants?

Not in my experience but I personally wish they would. I think that would be a great service for general dentists to be able to lean on.

The best setup in my opinion though is a perio/endo sharing an office space.

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[P7898]

Dude…I WISH my endo would place implants. That would be absolutely amazing. Why not have them extract and graft a tooth that they determine is not restorable? If the GP can place the implant, then it’s ready for them. If they can’t, I’d let the endo do it and restore the crown. No big deal. Saves everyone time.

Eh one way to look at it I guess. But I am sending the tooth already to Endo because I know it’s restorable.

 

[MidwestOwl]

Dude…I WISH my endo would place implants. That would be absolutely amazing. Why not have them extract and graft a tooth that they determine is not restorable? If the GP can place the implant, then it’s ready for them. If they can’t, I’d let the endo do it and restore the crown. No big deal. Saves everyone time.

you will be surprised regarding how many GPs, especially the younger ones, are placing implants these days. If endo started to place implants, they will be quickly blacklisted by GPs - unless the endo guys practice in podunk, america. Also, endo will not be as good as perio or OMFS at placing implants - if the implants fail, the endo will have lots of explanation to do...

 

[redchesus]

I lol'd to this. If my Endodontists placed implants I would not refer to him. He is supposed to be the master of saving teeth (he is thank god). But really the last thing I want to do is send a #14 RCT to my endo buddy and get back an implant with a sinus lift lol

This is exactly why... it's not a good practice builder. IMO the choice to be a specialist means to limit your scope, if you want to dabble in all sorts of things you gotta go back to being a GP.

 

[somefuturedoc]

Dude…I WISH my endo would place implants. That would be absolutely amazing. Why not have them extract and graft a tooth that they determine is not restorable? If the GP can place the implant, then it’s ready for them. If they can’t, I’d let the endo do it and restore the crown. No big deal. Saves everyone time.

Maybe the endo should restore the implant too and save even more time

 

[Big Time Hoosier]

But I am sending the tooth already to Endo because I know it’s restorable.

This.

The dentist planning to restore the tooth should have made this determination.

Big Hoss

 

[nobeldds]

This.

The dentist planning to restore the tooth should have made this determination.

Big Hoss

This is true, but unfortunately there are so many that “refer to endo to check restorability”

It seemed like implant placement by endodontists was a brief trend that peaked about 10 years ago and has since died due to lack of interest and GP pushback.

I think it makes sense for the endodontist to offer extraction and bone grafting for those cases where the patient is in pain but has a tooth indicated for extraction. It’s a sad day when the patient has been waiting days/weeks to see the endo for an uncomfortable tooth (which is now painful) just to be sent back to their GP (or an OS) for extraction.

 

[Big Time Hoosier]

I think it makes sense for the endodontist to offer extraction and bone grafting for those cases where the patient is in pain but has a tooth indicated for extraction.

But it makes no sense to an endodontist because it completely disrupts their workflow. Same reason orthodontists aren’t doing their own premolar extractions.

Big Hoss

 

[2TH MVR]

But it makes no sense to an endodontist because it completely disrupts their workflow. Same reason orthodontists aren’t doing their own premolar extractions.

Big Hoss

This is true, but unfortunately there are so many that “refer to endo to check restorability”

It seemed like implant placement by endodontists was a brief trend that peaked about 10 years ago and has since died due to lack of interest and GP pushback.

I think it makes sense for the endodontist to offer extraction and bone grafting for those cases where the patient is in pain but has a tooth indicated for extraction. It’s a sad day when the patient has been waiting days/weeks to see the endo for an uncomfortable tooth (which is now painful) just to be sent back to their GP (or an OS) for extraction.

I agree with @nobeldds .
The welfare of the patient should over-ride workflow disruption and potential referral issues with the referring dentist. A simple call to the referring dentist suggesting that the tooth is unrestorable. Pt in severe pain. Best to extract and bone graft to help pt NOW. Send patient back to GP for restoration.

 

[redchesus]

I agree with @nobeldds .
The welfare of the patient should over-ride workflow disruption and potential referral issues with the referring dentist. A simple call to the referring dentist suggesting that the tooth is unrestorable. Pt in severe pain. Best to extract and bone graft to help pt NOW. Send patient back to GP for restoration.

In an ideal world yes but the reality is most GPs would want to do that ext/graft themselves

 

[Big Time Hoosier]

I agree with @nobeldds .
The welfare of the patient should over-ride workflow disruption and potential referral issues with the referring dentist. A simple call to the referring dentist suggesting that the tooth is unrestorable. Pt in severe pain. Best to extract and bone graft to help pt NOW. Send patient back to GP for restoration.

It’s not just a workflow disruption, it’s also a quality of care issue. Would you rather have a surgical extraction and bone grafting done by someone who does it only on the rare circumstance or someone who does it on the regular and is proficient? I know my answer.

This goes along with endo making the call if a tooth is restorable. My friend went to endo right out of school. I remember him talking to me about someone asking him if a tooth was restorable. He told me he was thinking, “I’ve only done like 20 crowns in dental school, how am I supposed to know if the tooth is restorable?” He could tell them about the prognosis of the endo, but what does he know about the prognosis of that buildup and crown?

Big Hoss

 

[yappy]

In an ideal world yes but the reality is most GPs would want to do that ext/graft themselves

Who cares? Give the patient both options and let them decide.

 

[redchesus]

Who cares? Give the patient both options and let them decide.

That’s just not how referral-based specialty practices work but good luck with that I guess… if you have the privilege of not caring what your referring docs think then by all means

 

[cmsmith85]

It’s not just a workflow disruption, it’s also a quality of care issue. Would you rather have a surgical extraction and bone grafting done by someone who does it only on the rare circumstance or someone who does it on the regular and is proficient? I know my answer.

This goes along with endo making the call if a tooth is restorable. My friend went to endo right out of school. I remember him talking to me about someone asking him if a tooth was restorable. He told me he was thinking, “I’ve only done like 20 crowns in dental school, how am I supposed to know if the tooth is restorable?” He could tell them about the prognosis of the endo, but what does he know about the prognosis of that buildup and crown?

Big Hos

It depends on the endodontist. Lots of us practiced for years before starting residency. I've done thousands of extractions before starting residency, so I'd be more than ok doing surgical extractions and bone grafting if needed. It's the only part of general dentistry I actually miss. The same goes with restorability. I know what is and isn't restorable. That would be the extent of it for me though. No way I'm gonna be placing implants.

 

[dentalWorks]

So. To get this back on topic.

Are Endodontists doing alot of implants?

I don't know any

 

[BigDreams3]

I work Corp ortho now after years of private practice.
Your figure of the daily minimum does not include bonuses. The bonuses makes all the difference. If you are a new grad with decent abilities. Work 5 days per week. You can make before tax ..... easily 400K and higher. This compensation does not include the affordable heath insurance, free CE, free malpractice premiums, PTO (not generous at my DSO). These benefits can easily add another 2-3K per month to your bottom line.

The ortho jobs are out there. At this point in my life .... a stress free Corp job is nice.

Pardon my ignorance for this question if I say anything that is bad but if you don’t mind me asking what is the problem with corp then? It seems like a pretty good deal for everyone especially the specialists. Very fair pay, good Work/Life Balance (depending on the corp), and the potential for very high income if that is something you want through buy in opportunities/partial ownership (equity). Again I apologize if I’m missing something but I do wonder about that if everything I read about corps is true. Again I understand dentistry is all about the autonomy and being a businessman is 100% better than being an employee, but do you feel like corp is as bad as people make it out to be. I’ve read a lot of posts from you as you along with charlestweed, futuredent, and bighoss are the SDN legends I tend to see on every thread haha! But I would love to get your two cents on this as it seems like you have a somewhat favorable view of corp dentistry.

 

[2TH MVR]

Pardon my ignorance for this question if I say anything that is bad but if you don’t mind me asking what is the problem with corp then? It seems like a pretty good deal for everyone especially the specialists. Very fair pay, good Work/Life Balance (depending on the corp), and the potential for very high income if that is something you want through buy in opportunities/partial ownership (equity). Again I apologize if I’m missing something but I do wonder about that if everything I read about corps is true. Again I understand dentistry is all about the autonomy and being a businessman is 100% better than being an employee, but do you feel like corp is as bad as people make it out to be. I’ve read a lot of posts from you as you along with charlestweed, futuredent, and bighoss are the SDN legends I tend to see on every thread haha! But I would love to get your two cents on this as it seems like you have a somewhat favorable view of corp dentistry.

Your post is not ignorant. A valid observation.

I practiced during a time when Corp dentistry was just starting out. So I'm biased towards private practice. But that was years ago. Times have changed. I believe that it is easier to own/start a private practice in the rural areas. But the same cannot be said for the saturated, urban areas where so many new dentists want to live.

Corp Dentistry is everywhere. In Arizona .... Corp big boxes (PDS, Gentle Dentle, Western Dental, Bright Now, Perfect Teeth, etc. etc.. Corps acting like private practices (Heartland Dental Corp, etc.). You've got smaller private Corp entities (Risas Dental, Somos Dental, Premier Ortho, etc. etc.). Most of these Corps hired dentists as employees. Now I'm seeing partial ownership into these Corp entities like Pacific Dental Services. From what I've heard ..... even in these partial ownership schemes ... the Corps still have majority control.

To summarize. Yes. Corp dentistry has made it possible for a new grad to have many opportunities at employment. Specialist pay is definitely better than the GP pay (in Corp). Corp dentistry has also made it possible for older dentists (I'll be 60 in a few months) to earn a good salary, bonuses and benefits. I cannot complain. I am treated very well at my Corp. But. Originally. I and others went into dentistry for lifestyle which involves being your own boss. Your own practice. Be a boss. Build equity. If I wanted to be an employee ... I would have chosen medicine. Although being an orthodontist isn't bad.

 

[New_Vegas]

Pardon my ignorance for this question if I say anything that is bad but if you don’t mind me asking what is the problem with corp then? It seems like a pretty good deal for everyone especially the specialists. Very fair pay, good Work/Life Balance (depending on the corp), and the potential for very high income if that is something you want through buy in opportunities/partial ownership (equity). Again I apologize if I’m missing something but I do wonder about that if everything I read about corps is true. Again I understand dentistry is all about the autonomy and being a businessman is 100% better than being an employee, but do you feel like corp is as bad as people make it out to be. I’ve read a lot of posts from you as you along with charlestweed, futuredent, and bighoss are the SDN legends I tend to see on every thread haha! But I would love to get your two cents on this as it seems like you have a somewhat favorable view of corp dentistry.

I spoke to a recent graduate who works for corporate. She is getting pressured to do procedures she isn't comfortable with. They made her do molar endo (she just graduated last year), and she didn't want to. Their hand was heavy, and she ended up doing the case, which she was nervous about all week. They chastise her when she refers things out. A tooth was suspected to be cracked, and she referred to endo. The corp wasn't happy about that. Not all are this bad, but for the most part corporations are cancer.

I work for a corp on the weekends for extra money. The one I work for is pretty desperate for employees, so I pretty much told them I only want to do bread and butter dentistry stuff which they are ok with. The pay is pretty good because it's production based, so it's good if you can keep up with a fast pace. But because it's corporate, employees are constantly quitting, so they are often training new assistants who can't take very good x-rays and such. Which gets pretty frustrating.

 

[Torshammer]

What is the average gross and net incomes for a small endo office in California? Say like 1 doctor/2 assistants/3 chairs

 

[BigDreams3]

But. Originally. I and others went into dentistry for lifestyle which involves being your own boss. Your own practice. Be a boss. Build equity. If I wanted to be an employee ... I would have chosen medicine

Awesome! Thank you so much for the insight! But I wanted to ask you I believe the lifestyle to income ratio is still better as an employee in dentistry than medicine (can elect to work 40 or less hours in dentistry with still great pay/lifestyle) Would you agree with that statement or do you believe it is based on the corp? Especially in a field like ortho which is not very difficult on the body. Again thank you so much it means a lot that you and other senior (but still youthful😉😁) dentists are able to impart wisdom on the field!

 

[MidwestOwl]

What is the average gross and net incomes for a small endo office in California? Say like 1 doctor/2 assistants/3 chairs

Some endo will tell you that they are doing well with just about 700-800k collection ( I think 700k is kind of low). Some like my previous boss aint happy with their 1.5m so it varies. I just bought my practice last year...I will probably collect about 1.2mish this year....my practice is not in cali though

 

[zriceman]

Some endo will tell you that they are doing well with just about 700-800k collection ( I think 700k is kind of low). Some like my previous boss aint happy with his 1.5m so it varies. I just bought my practice last year...I will probably collect about 1.2mish for this year....my practice is not in cali though

Congratulations on becoming an owner. Did you go through a broker like Radman to find your practice?

 

[MidwestOwl]

Congratulations on becoming an owner. Did you go through a broker like Radman to find your practice?

yeah, being an owner is nice but much more stress especially staff issues...

 

[MidwestOwl]

What is the average gross and net incomes for a small endo office in California? Say like 1 doctor/2 assistants/3 chairs

here are some of the ads from radman and white for offices in cali. i personally think, 800k in collection is low. with Cali tax, you probably dont keep much... but whatever
alifornia, Wine Country (#969) SOLD

• Well established solo practice for sale. Area has scenic diversity with mountains, ocean, redwoods, valleys and vineyards
• 3 ops with 2 scopes, digital, PBS Endo and CBCT
• Prior 3 years average collections = $875k. 95% fee for service. Thorough transition planned.
• Enjoy world renowned wine and food all year long!

California, Los Angeles area (#981) SOLD

• Solo practice for sale in an affluent highly desired residential community close to Los Angeles
• Longstanding and thriving practice with 3 operatories, scope, digital and PBS Endo
• Quality staff in place with a full transition to a new owner

California, Northern (#945) SOLD

• Very profitable solo practice for sale
• 3 equipped operatories, 2 add’l plumbed, scopes, Schick digital, TDO
• Referrals are loyal and strong
• Collections of $800k with low overhead

California, Wine Country (#942) SOLD

• Solo practice for sale in highly desirable area
• 3 ops, scope, digital and CBCT
• Highly experienced staff
• Collections just over $700k and all fee for service!

 

[peppershayker]

Why are people so set on talking about the failing nature of being an endodontist? Every single metric about the US population points to the fact that we will have a very old population by the year 2040. I imagine with an aging population there will naturally be a lot more decay that occurs within their teeth. I also imagine that they will be much less willing to get implants done as it is more costly and takes a much longer time to complete and anecdotally speaking my grandparents hate anything that requires them to leave the house for any extended period of time. Meanwhile root canals are a very quick operation and have a very short recovery time as well. I am a predental student but I just wanted to gain some insight on this. Mainly I wanted to hear what everyone's opinions are about this as it seems like the entire narrative around SDN and reddit is that endo or specialization in general is this futile endeavor. I feel as though endodontistry is here to stay and will always be a top specialty program to specialize in along with peds, OMFS, and ortho but obviously my knowledge is very limited compared to the practicing dentists/specialists here. Thanks in advance for all the insight!

Endo is going nowhere my friend. Except getting busier as CBCT allows you to detect more asymptomatic lesion.