How much can a new dentist expect to earn if they don't do a GPR/AEGD?

[UConnDoIt]

In today's times.

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[Ivy.ch]

It doesn’t seem like a GPR is making new grads more money. Everyone is pretty much getting deals around here which end up being around 120k salary.

 

[dentistrydmd]

If it’s production based then someone out of a residency would definitely produce more. Specifically a gpr that makes you do everything under time pressure will make you much more efficient clinician.

 

[Pablo Sanchez]

If it’s production based then someone out of a residency would definitely produce more. Specifically a gpr that makes you do everything under time pressure will make you much more efficient clinician.

If you can graduate and make $120k your first year out working as an associate under time pressure, and build up your speed for year two.

Or graduate, make $50k your first year out in a gpr under time pressure, and build up your speed for year two

Come year two, both clinicians will have built up their speed and one made $70k more their first year.

 

[dentistrydmd]

If you can graduate and make $120k your first year out working as an associate under time pressure, and build up your speed for year two.

Or graduate, make $50k your first year out in a gpr under time pressure, and build up your speed for year two

Come year two, both clinicians will have built up their speed and one made $70k more their first year.

Except in GPR your gain significantly more experience with unusual procedures (ie. medically compromised, difficult exos, endos, other surgery aka. free ce) and you make errors where it is not at a significant effect to your practice/reputation. First year out in private practice I have heard of people making 80k. Not sure it is as simple as you're making it sound.

 

[UConnDoIt]

Except in GPR your gain significantly more experience with unusual procedures (ie. medically compromised, difficult exos, endos, other surgery aka. free ce) and you make errors where it is not at a significant effect to your practice/reputation. First year out in private practice I have heard of people making 80k. Not sure it is as simple as you're making it sound.

What about people going into corporate? How much are they making?

 

[frozenicecreamDMD]

first year out (actually practice for around 10 months), on track to clear 200k+ with 180k base guarantee salary (never make below base or even near base since I join) without residence (AGED/GPR), around 40 min outside of big metroplex area as a solo doc in a 4 op practice

I can do molar endo, surgical ext, fixed and removable prosth and proficient at restorative and those PSSCs on kids. daily adjusted production is around 3k-3.5k.....some good days are 5k some super odd slow day are near 2k. The days are not super super busy with high stress. pretty okay so far.

its not about how much a dentist can earn, it is about the skills the dentist has.

and if you make 80k working as a full time dentist, then just find a practice to buy and do hygiene and take income from xray you will make the same anyways and get tons of write off.

 

[Roy Williams]

It doesn’t seem like a GPR is making new grads more money. Everyone is pretty much getting deals around here which end up being around 120k salary.

I feel like this depends on whether or not your comparing people going right out of dental school with those that do a standard aegd/gpr that does extractions/crown and bridge/medically compromised patients vs. one that is specifically implant heavy where you learn grafting, vertical sinus lifts, esthetic and clinical crown lengthening, etc.

I know some residents that have finished from programs like these and have had multiple first year job offers around 200k.

 

[frozenicecreamDMD]

I feel like this depends on whether or not your comparing people going right out of dental school with those that do a standard aegd/gpr that does extractions/crown and bridge/medically compromised patients vs. one that is specifically implant heavy where you learn grafting, vertical sinus lifts, esthetic and clinical crown lengthening, etc.

I know some residents that have finished from programs like these and have had multiple first year job offers around 200k.

i think contrary to belief, the implant cases (that require bone grafting, esthetic and clinical crown lengthening), even though high productive procedures, are not that common and require a lot of time. it is not like you will do one sinus lift and implant case everyday......and you have to wait 3-4 months for it to heal as well......for esthetic and clinical crown lengthening, this is most likely full mouth rehabs that require a lot of time to work up, plan, and deal with PITA patient complaining.

upper classmen above me get 200k offer too and the deal is you have to do bread and butter dentistry efficiently - think molar RCT/BU/Crown, surgical ext, crown and bridges, implants do come in here and there but not like everyday you slam one implant in.

 

[Roy Williams]

i think contrary to belief, the implant cases (that require bone grafting, esthetic and clinical crown lengthening), even though high productive procedures, are not that common and require a lot of time. it is not like you will do one sinus lift and implant case everyday......and you have to wait 3-4 months for it to heal as well......for esthetic and clinical crown lengthening, this is most likely full mouth rehabs that require a lot of time to work up, plan, and deal with PITA patient complaining.

upper classmen above me get 200k offer too and the deal is you have to do bread and butter dentistry efficiently - think molar RCT/BU/Crown, surgical ext, crown and bridges, implants do come in here and there but not like everyday you slam one implant in.

All I'm saying is the ceiling is not at 120k for your first job if you have adequate training to provide high quality care in areas outside of what a typical fourth year dental student would graduate with.

 

[PerioDont]

If you can graduate and make $120k your first year out working as an associate under time pressure, and build up your speed for year two.

Or graduate, make $50k your first year out in a gpr under time pressure, and build up your speed for year two

Come year two, both clinicians will have built up their speed and one made $70k more their first year.

As you go through dental school, you will realize how vastly different everyone's experience is based on the student themselves. You get out what you put in.

Similar to real life dentistry. Some people will get an excellent training in a GPR worth multiple years of practice life and some people will have wasted a year.

To answer the OP's question, some people will make much more but likely around 120k, GPR or not is a good guess for most areas of the US. You may or may not have employers that really value the GPR year.

IMO the most important reason to do a GPR is if you are not confident in yourself. Pt's can smell that from very far away and your staff will instantly. You don't want your assistants/HYG undermining you because they don't believe you are competent. and YOU need to know you are competent as well. You will still make mistakes your whole life, its just being confident in what you're doing/saying in clinic that I am referring to.

 

[yappy]

i think contrary to belief, the implant cases (that require bone grafting, esthetic and clinical crown lengthening), even though high productive procedures, are not that common and require a lot of time. it is not like you will do one sinus lift and implant case everyday.

Unless you're a specialist. Commercially speaking, the super gp concept rarely works. If you want to do high volume specialist procedures you need multiple referring centers. I agree with your point that it's difficult to justify the cost of ce and equipment for low volume specialty procedures as a gp.

 

[TanMan]

I don't understand why people assume you can't get fast and good going straight to private practice. As a GP, we have to look into aiming for the low hanging fruit - slam dunk cases that don't drop your hourly productivity AND increasing our productivity in every conceivable way. Think 8-10 minute implants, sub-20 minute molar RCTs, or sub-1 minute extractions. We don't get paid enough for complex grafting or procedures with a million follow ups. As a GP, our insurance fee schedules tend to be lower than specialists, which makes certain procedures less appealing. Tackling more complex cases in a GPR (especially medically compromised) doesn't necessarily mean more profit. We don't get paid well for diagnosis/triage, we get paid for treatment/execution.

I'd definitely agree though. Keep it simple with your armamentarium. If you can accomplish the same result with 1 instrument v. 20 instruments, do it with 1. There's time inefficiency of 3-5s per instrument/bur or carpule switch. The next frontier for procedural efficiency (for me) is having two or more handpieces ready with my assistants ready to switch the burs while I'm using another one for procedures that require multiple handpieces. I'm still wasting an inordinate amount of time on these bur/carpule switches, but thankfully, with some procedures that require a curing cycle of 3-5s, I can switch during that quick cure. Now, if I use 1 second curing modes, then I potentially waste seconds per curing cycle.

Also, every extraction is an opportunity to place an immediate implant and/or grafting and/or immediate bridge.

If you're willing to move and produce, 120k is a low bar to set. To answer the OPs question, if you're in a saturated area where they can't give you enough patients or you're slow as molasses, probably 10-12k/month. If you have lots of patients + fast, at least 30k+/month. There's a limiting in these scenarios, either you, patient flow, or patient treatment conversion.

 

[mmc12]

i have read, on this forum and on dentaltown, of certain dentists only getting paid 80K during their entire first year. Not sure what they were thinking taking those jobs

 

[2TH MVR]

Just having more AEGD/GPR experience doesn't necessarily equate to higher earnings. It's like @TanMan said ..... your ability to make a certain salary is most likely up to YOU, your interpersonal skills and your environment (patient abundance).

It's kind of laughable that new grads are thinking about "super GP" procedures right out of DS or even AEGD/GPR. It takes time, experience, reps, and learning from your mistakes to gain proficiency in dentistry. Learn to be a proficient dentist 1st.

We had a couple of new grads who had AEGD/GPR experience working at the DSO I'm at. They both went on to take some 3 week implant course. Afterwards they lobbied the DSO I work at to be able to place simple implants. They wanted to make more money. The DSO said ok. Previously only the periodontist and OS were placing the implants. Well ..... after multiple screw ups the DSO pulled the plug on the "super-GPs" . Our perio and OS had to fix their implants. Now ONLY the perio and OS place the implants. PERIOD. The two young dentists left the DSO.

As for other specialty procedures. Ortho is only performed by orthodontists. We have an "exodontist" who helps the OS with surgery. Mostly extracting teeth. Interestingly.... our GPs do most of the RCT. We do not have an Endodontist.

 

[allDAT]

A residency may have little influence on your earning potential. It just depends what you learn during that year and if you get into a practice that allows you to implement it (employer and demographic dependent).

Corporate dentistry allowed me to get much faster than what a residency would have allowed - about 800 crowns and 2500 fillings in 6 months. [EDIT - Should read fixed prosth - crowns include inlays/onlays]

But...no endo, extractions, or implants.

Community health has allowed me to expand my crown and bridge (unique situation) while working on endo and extractions but still no implant placement.

Next step is private practice and learn to place single unit posterior implants in abundant bone sites.

 

[allDAT]

If you can graduate and make $120k your first year out working as an associate under time pressure, and build up your speed for year two.

Or graduate, make $50k your first year out in a gpr under time pressure, and build up your speed for year two

Come year two, both clinicians will have built up their speed and one made $70k more their first year.

This isn’t the way to look at it. Look at career earning potential. Learning to place implants during a 1 year residency will pay dividends throughout your career. Cost for an okay implant course is 15-20k + lost production from practice.

Now the question is, is a residency without implant placement worth going to? That’s personally a tough one for me and I would probably lean towards no.

 

[PerioDont]

A residency may have little influence on your earning potential. It just depends what you learn during that year and if you get into a practice that allows you to implement it (employer and demographic dependent).

Corporate dentistry allowed me to get much faster than what a residency would have allowed - about 800 crowns and 2500 fillings in 6 months.

But...no endo, extractions, or implants.

Community health has allowed me to expand my crown and bridge (unique situation) while working on endo and extractions but still no implant placement.

Next step is private practice and learn to place single unit posterior implants in abundant bone sites.

800 crowns/6 months = ~130 crowns per month, assuming M-F workdays, you did about 6 crowns a day.

2500 fillings/6 months = ~415 fillings per month, or 20 fillings a day.

They kept you nice and busy. There is absolutely no GPR that would get you this level of experience. However, the no endo/exo/implant may be a bit of deal breaker.

 

[allDAT]

800 crowns/6 months = ~130 crowns per month, assuming M-F workdays, you did about 6 crowns a day.

2500 fillings/6 months = ~415 fillings per month, or 20 fillings a day.

They kept you nice and busy. There is absolutely no GPR that would get you this level of experience. However, the no endo/exo/implant may be a bit of deal breaker.

Unfortunately yes. It was heavy HMO, absolutely back breaking work. I was there a bit longer than 6 months to be fair though, maybe 6.5 and there were some 6 day workweeks + some 9-10 hour days.

Some days 4 crowns, some days 12, never less than 2. Absolutely hated every day to be honest.

Seeing about 24 patients a day, running through lunch, and staying late, quadrant and half mouth dentistry.

I honestly hope to never work that way again. BUT it’s like going to the driving range and getting reps in.

 

[allDAT]

800 crowns/6 months = ~130 crowns per month, assuming M-F workdays, you did about 6 crowns a day.

2500 fillings/6 months = ~415 fillings per month, or 20 fillings a day.

They kept you nice and busy. There is absolutely no GPR that would get you this level of experience. However, the no endo/exo/implant may be a bit of deal breaker.

Even with that experience though, as a young grad it was not a good situation to be in but it was my only option that paid the bills at the time. I don’t recommend this type of practice to anyone.

 

[allDAT]

800 crowns/6 months = ~130 crowns per month, assuming M-F workdays, you did about 6 crowns a day.

2500 fillings/6 months = ~415 fillings per month, or 20 fillings a day.

They kept you nice and busy. There is absolutely no GPR that would get you this level of experience. However, the no endo/exo/implant may be a bit of deal breaker.

Last comment on this one. I should have written “fixed” instead of crowns, some were inlays/onlays (CEREC on site).

 

[PerioDont]

Unfortunately yes. It was heavy HMO, absolutely back breaking work. I was there a bit longer than 6 months to be fair though, maybe 6.5 and there were some 6 day workweeks + some 9-10 hour days.

Some days 4 crowns, some days 12, never less than 2. Absolutely hated every day to be honest.

Seeing about 24 patients a day, running through lunch, and staying late, quadrant and half mouth dentistry.

I honestly hope to never work that way again. BUT it’s like going to the driving range and getting reps in.

sounds brutal. but you need reps at the beginning of the game. At least you know what you never want to do again.

6-8 pts per day prophy palace FFS practice is probably the lowest stress and ideal practice.

 

[dentistrydmd]

i have read, on this forum and on dentaltown, of certain dentists only getting paid 80K during their entire first year. Not sure what they were thinking taking those jobs

It’s called LA and NYC

 

[dentistrydmd]

Last comment on this one. I should have written “fixed” instead of crowns, some were inlays/onlays (CEREC on site).

How long were your cerec onlay/inlay appointments?? This number sounds a little high to me...

 

[Pablo Sanchez]

This isn’t the way to look at it. Look at career earning potential. Learning to place implants during a 1 year residency will pay dividends throughout your career. Cost for an okay implant course is 15-20k + lost production from practice.

Now the question is, is a residency without implant placement worth going to? That’s personally a tough one for me and I would probably lean towards no.

We can agree to disagree here, but if it costs $15-20k for an implant course, in addition to lost production, that doesn't come close to the $70k extra you make that first year. And if you invest that $70k at a 10% return it is $4 million come your mid 60s. I'm not saying your approach is wrong, but different things work for different people. Personal preference here, but I'd rather get into practice ownership ASAP doing bread and butter dentistry so that I can collect off of hygiene while I continue to expand my skill set.

It is also important to consider how much one is really learning from a single year GPR where they place implants. It is unlikely that you place implants on day one of residency, and after one year one isn't likely to be competent or proficient at placing implants. Even if all of the placed implants integrate, that is only half the picture. Those placed at the end of the semester will not be restored by the same provider. Long term complications will never be seen. So whether you do a GPR or not, it takes years to become proficient in implant placement.

Tl,dr: There isn't a single answer for everyone. Some people need that extra year in a structured environment, and some would prefer that extra year of earned income. You have to evaluate your priorities and make the decision yourself. I think far too many people do a GPR because they aren't really sure what to do next.

 

[allDAT]

How long were your cerec onlay/inlay appointments?? This number sounds a little high to me...

Depends on the day and our capacity. For crowns we always tempted and brought them back because we were too busy to wait for the oven. For inlays and onlays we used a material that didn’t need to be baked, I can’t remember it’s name.

Patients didn’t have appointment times per say...basically everyone was scheduled for 50-60 minutes no matter what we needed to do and we’d just slam the schedule. Some patients would be waiting an hour as I ran behind. We did have an EF that helped to take some impressions as needed. I did have 5-7 dental chairs to myself so there was room to run around and put people waiting. It was common to have 4-5 patients at the same time.

Numb op 1, numb op 2, prep op 1, numb op 3, prep op 2, numb up 4, prep op 3 and so on and so on.

 

[dentistrydmd]

Depends on the day and our capacity. For crowns we always tempted and brought them back because we were too busy to wait for the oven. For inlays and onlays we used a material that didn’t need to be baked, I can’t remember it’s name.

Patients didn’t have appointment times per say...basically everyone was scheduled for 50-60 minutes no matter what we needed to do and we’d just slam the schedule. Some patients would be waiting an hour as I ran behind. We did have an EF that helped to take some impressions as needed. I did have 5-7 dental chairs to myself so there was room to run around and put people waiting. It was common to have 4-5 patients at the same time.

Numb op 1, numb op 2, prep op 1, numb op 3, prep op 2, numb up 4, prep op 3 and so on and so on.

So assistant would take the scan and plan the crown/onlay for you? And you had multiple scanners available?
I’m just wondering because it seems wild to me to have an assembly line like that going with so little patient interaction

 

[PerioDont]

Depends on the day and our capacity. For crowns we always tempted and brought them back because we were too busy to wait for the oven. For inlays and onlays we used a material that didn’t need to be baked, I can’t remember it’s name.

Patients didn’t have appointment times per say...basically everyone was scheduled for 50-60 minutes no matter what we needed to do and we’d just slam the schedule. Some patients would be waiting an hour as I ran behind. We did have an EF that helped to take some impressions as needed. I did have 5-7 dental chairs to myself so there was room to run around and put people waiting. It was common to have 4-5 patients at the same time.

Numb op 1, numb op 2, prep op 1, numb op 3, prep op 2, numb up 4, prep op 3 and so on and so on.

That sounds like a madhouse for a new grad lol

 

[TanMan]

Depends on the day and our capacity. For crowns we always tempted and brought them back because we were too busy to wait for the oven. For inlays and onlays we used a material that didn’t need to be baked, I can’t remember it’s name.

Patients didn’t have appointment times per say...basically everyone was scheduled for 50-60 minutes no matter what we needed to do and we’d just slam the schedule. Some patients would be waiting an hour as I ran behind. We did have an EF that helped to take some impressions as needed. I did have 5-7 dental chairs to myself so there was room to run around and put people waiting. It was common to have 4-5 patients at the same time.

Numb op 1, numb op 2, prep op 1, numb op 3, prep op 2, numb up 4, prep op 3 and so on and so on.

This is definitely an inspirational story that people should be looking up to. Assembly line efficiency with FFS/PPO fees resulting in high productivity.

 

[allDAT]

That sounds like a madhouse for a new grad lol

It was terrible and I have some scars to prove it (had to settle a claim so that's stuck around and is in the national practitioner data bank).

 

[PerioDont]

This is definitely an inspirational story that people should be looking up to. Assembly line efficiency with FFS/PPO fees resulting in high productivity.

I see what you are saying TanMan but the imo this is not a good style for the vast majority of new grads or even many seasoned practitioners.

Maybe because I just haven't seen it, I find it hard to believe that clinical quality isn't compromised doing this type of dentistry. Of course there are exceptions like yourself and probably @Cold Front and others.

I just think for the average dentist they would be more inclined to just cement that crown with the questionable margin, or let the filling thats not really what you want it to be go because you have so many more patients to see. I'm sure it is profitable though.

 

[allDAT]

So assistant would take the scan and plan the crown/onlay for you? And you had multiple scanners available?
I’m just wondering because it seems wild to me to have an assembly line like that going with so little patient interaction

So, I'll try to expand upon this since some people may be interested.

First..HMOs pay you basically nothing after the cap check. I had some plans paying just $55 for a surgical extraction. Most of the crowns were $400. I was compensated at $500/day or 25% of adjusted production if I average $2500/day (If I remember correctly there was a $500 cap between the 2k and $2500 in favor of the owner but I might be misremembering). Reaching #2500 was unbelievably hard to do because exams are free, prophies are free, anterior resins pay almost nothing. My average fee for a class II resin was less than $80. So....I basically had to do 6 crowns a day to get to $2400 in adjusted production, then add in resins. Trying to make a living like this isn't even worth it. But...I did learn a ton and I did learn that this isn't a good way to practice, but if you want to do it here's how they ran the ship.

There are 2 physical offices about 4 miles apart (this is important). 3 full-time dentists (5 days a week each + some Saturdays), 4 full-time hygienists. Dentists do prophies with an RDA, hygienists do prophies if their patient cancels (frees up time for the dentist), but otherwise RDHs are for SRPs and perio maintenance.

Schedule 3 columns:

Column 1 = 4-6 patients, fixed prosth only (2 in the AM and 2 in the PM).
Column 2 = Operative, 8 patients 50-60 minute slots regardless of 1 filling or a whole quad.
Column 3 = Exams and prophies 1 patient per hour on the hour.

On the schedule each day is 8 + 8 + 4 = 20 patients or up to 8 + 8 +6 = 22
The plan each day was to then add more patients or convert those in column 2 to do same-day treatment.

Column 4 = overflow
Column 5 = overflow

Each column is an operatory.
There is a room for x-rays which is basically a closet but that adds 1 chair for you to put a human in while you work them up and helps with overflow so they don't feel like they're waiting as long as they really are. When we're way behind, take x-rays slower.

The plan is to run behind and be busy. Remember HMO patients are 100% insurance-driven because they're assigned to the office so a meet and greet isn't necessary.

Every room has an identical setup.

You need good assistants who are willing to hustle. You do this by finding people motivated by money and offering a production-based bonus to them. They will then pressure the dentist to go faster, do more, squeeze something else into the schedule, stay late, and miss lunch.

For a prophy, the RDA coronal polishes, flosses, OHI, etc. Dentist hand scales or uses cavitron. Quick prophy completed. RDH can jump in to hand scale PRN if the dentist is busy.

When you diagnosed treatment, you said - "Bill, you have some cavities here, here, and here. You need X, Y, Z. Janet (treatment plan coordinator) is going to tell you how you can get this work done, and if you have any questions, let Janet know and she'll come to get me." The last part is very important...The patient is told to wait until he speaks with Janet before asking questions. This allows the dentist to avoid being bogged down by questions during a treatment plan presentation and get back to work. If the patient has questions, he'll ask Janet and she'll answer them. If she can't answer them, she'll come to get the dentist...but patients almost never have questions for the dentist in this scenario.

At this point, Janet is asking the patient if they'd like to get started today. If they agree, the patient is now in the overflow column and the room was usually set up in less than 10 minutes. This is totally doable because we did 2 things...fillings and crowns. Every single setup was exactly the same except for the bur blocks and impression materials. Cord and hemodent came with fillings because you might need it for a class VI etc. So they had 3 cassettes - hygiene, exams, fillings and crowns. If we planned an extraction it became a bit of a cluster because there wasn't a setup for an extraction and instruments were bagged individually. We weren't there to do extractions, we were there to do fillings and crowns. Extraction - referred. Endo - referred. Implants - referred. All to in-house specialists.

Back to the 2 offices...there were 2 offices, about 4 miles apart. 3 assistants per doctor per day (which is 1 for each scheduled column) + 1 floater per doctor at each office to help with overflow, take x-rays, man sterilization. 1 assistant was assigned as the dentist's lead assistant, she was there during all treatment and would be your shadow. She didn't set up the room, she didn't clean up the room, she didn't take x-rays. She followed the dentist. What happens when you do this is that the assistant knows exactly what you need when you need it. You don't have to ask for anything, it just appears. The other 2 assistants, helped with prophies, helped clean up and set up, and entertain patients. The 4th assistant was the floater and we each had one....so when 1 dentist was really busy and we needed help...there was another floater at the 2nd office who would be available. She would drive down, help us catch up, and then go back to her primary office. So if I had a crazy morning, I might have 6 assistants, but if I had a lighter morning by their standards I may only have 3 because the other office needed my floater.

Again with the 2nd office. 1 RDA was an RDAEF so she could take final impressions. So if my schedule was heavy with crown and bridge, she'd be with me in the morning, and then if my schedule was light with crown and bridge in the afternoon, she'd go to the other office to help the dentist whose schedule was heavy with crown and bridge in the afternoon. Having an RDAEF in CA makes is so I can numb, prep, leave. So an appointment that should take about 45-50 minutes of my time, now takes 30 because I don't have to take the impression or check the temp.

Again with the 2nd office so close by...We had 1 dentist and 1 RDH at office #1 (7 chairs), and 2 dentists with 3 RDHs at office 2 (14 chairs) if I remember correctly. With 2 offices, if 1 of the dentists diagnosed treatment and the patient wanted to do it today, or if one of the patients with the hygienists had treatment already in the plan and wanted to do it today but the dentists at one office couldn't accommodate the patient...they were told to drive over the other office to see Dr. So and So to do it today. This is how the schedule was always full. If the patient is in the chair, they've already taken time off work, if you can see them or you can send them to someone else who will see them, they'll probably say yes. So 2 offices so close together was a huge advantage here.

And after all that . We had 1 Bluecam at office #1 and 1 Omnicom at office 2...but if office #1 needed both they'd send them there. If office #2 needed both, they'd send them there. So if you really needed 2, you could do it. And yes, the assistants scanned, I approved the margin, and we let the computer design the restoration - there's not time in this type of setup to fiddle with the design. Mark the margin, click design, click mill. Relyx unicem for a self adhesive resin cement. Valo curing lights for fast curing. No sectional matrixes, just tofflemires. Sectional matrixes are too slow to put in.

 

[TanMan]

So, I'll try to expand upon this since some people may be interested.

First..HMOs pay you basically nothing after the cap check. I had some plans paying just $55 for a surgical extraction. Most of the crowns were $400. I was compensated at $500/day or 25% of adjusted production if I average $2500/day (If I remember correctly there was a $500 cap between the 2k and $2500 in favor of the owner but I might be misremembering). Reaching #2500 was unbelievably hard to do because exams are free, prophies are free, anterior resins pay almost nothing. My average fee for a class II resin was less than $80. So....I basically had to do 6 crowns a day to get to $2400 in adjusted production, then add in resins. Trying to make a living like this isn't even worth it. But...I did learn a ton and I did learn that this isn't a good way to practice, but if you want to do it here's how they ran the ship.

There are 2 physical offices about 4 miles apart (this is important). 3 full-time dentists (5 days a week each + some Saturdays), 4 full-time hygienists. Dentists do prophies with an RDA, hygienists do prophies if their patient cancels (frees up time for the dentist), but otherwise RDHs are for SRPs and perio maintenance.

Schedule 3 columns:

Column 1 = 4-6 patients, fixed prosth only (2 in the AM and 2 in the PM).
Column 2 = Operative, 8 patients 50-60 minute slots regardless of 1 filling or a whole quad.
Column 3 = Exams and prophies 1 patient per hour on the hour.

On the schedule each day is 8 + 8 + 4 = 20 patients or up to 8 + 8 +6 = 22
The plan each day was to then add more patients or convert those in column 2 to do same-day treatment.

Column 4 = overflow
Column 5 = overflow

Each column is an operatory.
There is a room for x-rays which is basically a closet but that adds 1 chair for you to put a human in while you work them up and helps with overflow so they don't feel like they're waiting as long as they really are. When we're way behind, take x-rays slower.

The plan is to run behind and be busy. Remember HMO patients are 100% insurance-driven because they're assigned to the office so a meet and greet isn't necessary.

Every room has an identical setup.

You need good assistants who are willing to hustle. You do this by finding people motivated by money and offering a production-based bonus to them. They will then pressure the dentist to go faster, do more, squeeze something else into the schedule, stay late, and miss lunch.

For a prophy, the RDA coronal polishes, flosses, OHI, etc. Dentist hand scales or uses cavitron. Quick prophy completed. RDH can jump in to hand scale PRN if the dentist is busy.

When you diagnosed treatment, you said - "Bill, you have some cavities here, here, and here. You need X, Y, Z. Janet (treatment plan coordinator) is going to tell you how you can get this work done, and if you have any questions, let Janet know and she'll come to get me." The last part is very important...The patient is told to wait until he speaks with Janet before asking questions. This allows the dentist to avoid being bogged down by questions during a treatment plan presentation and get back to work. If the patient has questions, he'll ask Janet and she'll answer them. If she can't answer them, she'll come to get the dentist...but patients almost never have questions for the dentist in this scenario.

At this point, Janet is asking the patient if they'd like to get started today. If they agree, the patient is now in the overflow column and the room was usually set up in less than 10 minutes. This is totally doable because we did 2 things...fillings and crowns. Every single setup was exactly the same except for the bur blocks and impression materials. Cord and hemodent came with fillings because you might need it for a class VI etc. So they had 3 cassettes - hygiene, exams, fillings and crowns. If we planned an extraction it became a bit of a cluster because there wasn't a setup for an extraction and instruments were bagged individually. We weren't there to do extractions, we were there to do fillings and crowns. Extraction - referred. Endo - referred. Implants - referred. All to in-house specialists.

Back to the 2 offices...there were 2 offices, about 4 miles apart. 3 assistants per doctor per day (which is 1 for each scheduled column) + 1 floater per doctor at each office to help with overflow, take x-rays, man sterilization. 1 assistant was assigned as the dentist's lead assistant, she was there during all treatment and would be your shadow. She didn't set up the room, she didn't clean up the room, she didn't take x-rays. She followed the dentist. What happens when you do this is that the assistant knows exactly what you need when you need it. You don't have to ask for anything, it just appears. The other 2 assistants, helped with prophies, helped clean up and set up, and entertain patients. The 4th assistant was the floater and we each had one....so when 1 dentist was really busy and we needed help...there was another floater at the 2nd office who would be available. She would drive down, help us catch up, and then go back to her primary office. So if I had a crazy morning, I might have 6 assistants, but if I had a lighter morning by their standards I may only have 3 because the other office needed my floater.

Again with the 2nd office. 1 RDA was an RDAEF so she could take final impressions. So if my schedule was heavy with crown and bridge, she'd be with me in the morning, and then if my schedule was light with crown and bridge in the afternoon, she'd go to the other office to help the dentist whose schedule was heavy with crown and bridge in the afternoon. Having an RDAEF in CA makes is so I can numb, prep, leave. So an appointment that should take about 45-50 minutes of my time, now takes 30 because I don't have to take the impression or check the temp.

Again with the 2nd office so close by...We had 1 dentist and 1 RDH at office #1 (7 chairs), and 2 dentists with 3 RDHs at office 2 (14 chairs) if I remember correctly. With 2 offices, if 1 of the dentists diagnosed treatment and the patient wanted to do it today, or if one of the patients with the hygienists had treatment already in the plan and wanted to do it today but the dentists at one office couldn't accommodate the patient...they were told to drive over the other office to see Dr. So and So to do it today. This is how the schedule was always full. If the patient is in the chair, they've already taken time off work, if you can see them or you can send them to someone else who will see them, they'll probably say yes. So 2 offices so close together was a huge advantage here.

And after all that . We had 1 Bluecam at office #1 and 1 Omnicom at office 2...but if office #1 needed both they'd send them there. If office #2 needed both, they'd send them there. So if you really needed 2, you could do it. And yes, the assistants scanned, I approved the margin, and we let the computer design the restoration - there's not time in this type of setup to fiddle with the design. Mark the margin, click design, click mill. Relyx unicem for a self adhesive resin cement. Valo curing lights for fast curing. No sectional matrixes, just tofflemires. Sectional matrixes are too slow to put in.

Even with the HMO-upsells, it's only 400 dollars a crown!? That's terrible production. I would imagine that with that volume of crowns/indirects that they could squeeze more out of the rooms by having more scanners and convert directfills to indirect. New generation of CADCAM materials allow for porcelain inlay/onlay without the baking time as they are classified as porcelain, rather than composite. We were barely getting by with 6 scanners and 6 mills, I can only imagine trying to share 2 scanners between 2 offices.

I see what you are saying TanMan but the imo this is not a good style for the vast majority of new grads or even many seasoned practitioners.

Maybe because I just haven't seen it, I find it hard to believe that clinical quality isn't compromised doing this type of dentistry. Of course there are exceptions like yourself and probably @Cold Front and others.

I just think for the average dentist they would be more inclined to just cement that crown with the questionable margin, or let the filling thats not really what you want it to be go because you have so many more patients to see. I'm sure it is profitable though.

I would think that going slow would just age the dentist much faster and make them complacent to not being as efficient to their full potential. Sometimes, the best training is getting thrown to the wolves. I will say that over time, my clinical quality has improved, and what we can expect from newgrads is clinical acceptability, but in higher volumes. With newgrads, they can either take the path of getting better through volume or through slowness. I advocate volume, as I believe it's a faster way to clinical excellence.

I'm sick of direct restorations, lol. I only tolerate them now because I can still execute most of them quickly. Probably going to start doing inlays on cases that will take more than 3-5 minutes to restore. Fills/periodic exams have become the bane of my existence.

 

[allDAT]

Even with the HMO-upsells, it's only 400 dollars a crown!? That's terrible production. I would imagine that with that volume of crowns/indirects that they could squeeze more out of the rooms by having more scanners and convert directfills to indirect. New generation of CADCAM materials allow for porcelain inlay/onlay without the baking time as they are classified as porcelain, rather than composite. We were barely getting by with 6 scanners and 6 mills, I can only imagine trying to share 2 scanners between 2 offices.

Yes, fees were that low with an upsell. You can see the type of fees we can deal with here: https://www.caldental.net/wp-conten...amily-Dental-Plan-Benefits-and-Copayments.pdf

 

[TanMan]

Yes, fees were that low with an upsell. You can see the type of fees we can deal with here: https://www.caldental.net/wp-conten...amily-Dental-Plan-Benefits-and-Copayments.pdf

I figure you guys would charge non-standard dental codes that I've seen at other places such as irrigation fee, porcelain upgrade fees, etc.

 

[PerioDont]

So, I'll try to expand upon this since some people may be interested.

First..HMOs pay you basically nothing after the cap check. I had some plans paying just $55 for a surgical extraction. Most of the crowns were $400. I was compensated at $500/day or 25% of adjusted production if I average $2500/day (If I remember correctly there was a $500 cap between the 2k and $2500 in favor of the owner but I might be misremembering). Reaching #2500 was unbelievably hard to do because exams are free, prophies are free, anterior resins pay almost nothing. My average fee for a class II resin was less than $80. So....I basically had to do 6 crowns a day to get to $2400 in adjusted production, then add in resins. Trying to make a living like this isn't even worth it. But...I did learn a ton and I did learn that this isn't a good way to practice, but if you want to do it here's how they ran the ship.

There are 2 physical offices about 4 miles apart (this is important). 3 full-time dentists (5 days a week each + some Saturdays), 4 full-time hygienists. Dentists do prophies with an RDA, hygienists do prophies if their patient cancels (frees up time for the dentist), but otherwise RDHs are for SRPs and perio maintenance.

Schedule 3 columns:

Column 1 = 4-6 patients, fixed prosth only (2 in the AM and 2 in the PM).
Column 2 = Operative, 8 patients 50-60 minute slots regardless of 1 filling or a whole quad.
Column 3 = Exams and prophies 1 patient per hour on the hour.

On the schedule each day is 8 + 8 + 4 = 20 patients or up to 8 + 8 +6 = 22
The plan each day was to then add more patients or convert those in column 2 to do same-day treatment.

Column 4 = overflow
Column 5 = overflow

Each column is an operatory.
There is a room for x-rays which is basically a closet but that adds 1 chair for you to put a human in while you work them up and helps with overflow so they don't feel like they're waiting as long as they really are. When we're way behind, take x-rays slower.

The plan is to run behind and be busy. Remember HMO patients are 100% insurance-driven because they're assigned to the office so a meet and greet isn't necessary.

Every room has an identical setup.

You need good assistants who are willing to hustle. You do this by finding people motivated by money and offering a production-based bonus to them. They will then pressure the dentist to go faster, do more, squeeze something else into the schedule, stay late, and miss lunch.

For a prophy, the RDA coronal polishes, flosses, OHI, etc. Dentist hand scales or uses cavitron. Quick prophy completed. RDH can jump in to hand scale PRN if the dentist is busy.

When you diagnosed treatment, you said - "Bill, you have some cavities here, here, and here. You need X, Y, Z. Janet (treatment plan coordinator) is going to tell you how you can get this work done, and if you have any questions, let Janet know and she'll come to get me." The last part is very important...The patient is told to wait until he speaks with Janet before asking questions. This allows the dentist to avoid being bogged down by questions during a treatment plan presentation and get back to work. If the patient has questions, he'll ask Janet and she'll answer them. If she can't answer them, she'll come to get the dentist...but patients almost never have questions for the dentist in this scenario.

At this point, Janet is asking the patient if they'd like to get started today. If they agree, the patient is now in the overflow column and the room was usually set up in less than 10 minutes. This is totally doable because we did 2 things...fillings and crowns. Every single setup was exactly the same except for the bur blocks and impression materials. Cord and hemodent came with fillings because you might need it for a class VI etc. So they had 3 cassettes - hygiene, exams, fillings and crowns. If we planned an extraction it became a bit of a cluster because there wasn't a setup for an extraction and instruments were bagged individually. We weren't there to do extractions, we were there to do fillings and crowns. Extraction - referred. Endo - referred. Implants - referred. All to in-house specialists.

Back to the 2 offices...there were 2 offices, about 4 miles apart. 3 assistants per doctor per day (which is 1 for each scheduled column) + 1 floater per doctor at each office to help with overflow, take x-rays, man sterilization. 1 assistant was assigned as the dentist's lead assistant, she was there during all treatment and would be your shadow. She didn't set up the room, she didn't clean up the room, she didn't take x-rays. She followed the dentist. What happens when you do this is that the assistant knows exactly what you need when you need it. You don't have to ask for anything, it just appears. The other 2 assistants, helped with prophies, helped clean up and set up, and entertain patients. The 4th assistant was the floater and we each had one....so when 1 dentist was really busy and we needed help...there was another floater at the 2nd office who would be available. She would drive down, help us catch up, and then go back to her primary office. So if I had a crazy morning, I might have 6 assistants, but if I had a lighter morning by their standards I may only have 3 because the other office needed my floater.

Again with the 2nd office. 1 RDA was an RDAEF so she could take final impressions. So if my schedule was heavy with crown and bridge, she'd be with me in the morning, and then if my schedule was light with crown and bridge in the afternoon, she'd go to the other office to help the dentist whose schedule was heavy with crown and bridge in the afternoon. Having an RDAEF in CA makes is so I can numb, prep, leave. So an appointment that should take about 45-50 minutes of my time, now takes 30 because I don't have to take the impression or check the temp.

Again with the 2nd office so close by...We had 1 dentist and 1 RDH at office #1 (7 chairs), and 2 dentists with 3 RDHs at office 2 (14 chairs) if I remember correctly. With 2 offices, if 1 of the dentists diagnosed treatment and the patient wanted to do it today, or if one of the patients with the hygienists had treatment already in the plan and wanted to do it today but the dentists at one office couldn't accommodate the patient...they were told to drive over the other office to see Dr. So and So to do it today. This is how the schedule was always full. If the patient is in the chair, they've already taken time off work, if you can see them or you can send them to someone else who will see them, they'll probably say yes. So 2 offices so close together was a huge advantage here.

And after all that . We had 1 Bluecam at office #1 and 1 Omnicom at office 2...but if office #1 needed both they'd send them there. If office #2 needed both, they'd send them there. So if you really needed 2, you could do it. And yes, the assistants scanned, I approved the margin, and we let the computer design the restoration - there's not time in this type of setup to fiddle with the design. Mark the margin, click design, click mill. Relyx unicem for a self adhesive resin cement. Valo curing lights for fast curing. No sectional matrixes, just tofflemires. Sectional matrixes are too slow to put in.

I never understood HMO plans. How much is the owner taking home for being an HMO provider?

just like you outlined you need extreme efficiency for minimum production. our d school fees are literally higher than the ones you quoted.

I'm thinking you may even be better off in some states doing Medi as compared to HMOs

 

[frozenicecreamDMD]

I actually cringe when I read the HMO office working condition above. it is good you leave now but you had to settle a claim just within 6 month of practicing? that will affect your malpractice premium forever in the near future and you have to disclose it every time as well.

If I were a brand new grad, I will just move away from big city or drive 1 hour each way to find another office....this is not worth it....the way dentistry is done is too rushed and there is no patient relationship at all. and when someone sues you, they will consider how much they like you or you are there purely for money.

most patients think dentists are money hungry and make too much money and readily sue. but in offices where dentists try to build relationships with patients, when things go south, pts complain but will not sue (at least this is what I believe).

dentistry has a lot of small issue complications but as long as you show you care for the patients, they will not be mad and throw you under the bus.

but again, it is california lol...the state run to the ground with a bunch of ppl who do not wanna work and wanna receive government hand outs.

 

[charlestweed]

I never understood HMO plans. How much is the owner taking home for being an HMO provider?

just like you outlined you need extreme efficiency for minimum production. our d school fees are literally higher than the ones you quoted.

I'm thinking you may even be better off in some states doing Medi as compared to HMOs

Being an HMO provider, you get a fixed monthly payment for each patient even if the patient doesn’t show up to get dental tx at your office. So during the Covid shutdown, the owners who signed up for HMO plans, still got paid for staying home. The goal is to do as little work as possible so you have more time to treat other patients. If a pt has a lot of cavities, don’t spend a lot of time to fill all the cavities in 1 visit. Fill the tooth with the largest deepest lesion first and then fill smaller cavities at future visits. If a pt needs a crown, try to convince the pt to upgrade to porcelain crown…..and if the cavity extends to the gum line, refer to the in-house perio for crown-lengthening (HMOs pay the specialists more). For ortho, try to convince the patients to upgrade to ceramic brackets.

Working at an HMO office, you have to know how to tx plan the cases in order to get paid. For the doctors to be able to tell which patients have HMOs, the corp offices, where I work at, put a red sticker on their charts. Medicaid patients have a different color sticker on their charts. And PPO patients have a different color sticker on their charts.

 

[allDAT]

I actually cringe when I read the HMO office working condition above. it is good you leave now but you had to settle a claim just within 6 month of practicing? that will affect your malpractice premium forever in the near future and you have to disclose it every time as well.

If I were a brand new grad, I will just move away from big city or drive 1 hour each way to find another office....this is not worth it....the way dentistry is done is too rushed and there is no patient relationship at all. and when someone sues you, they will consider how much they like you or you are there purely for money.

most patients think dentists are money hungry and make too much money and readily sue. but in offices where dentists try to build relationships with patients, when things go south, pts complain but will not sue (at least this is what I believe).

dentistry has a lot of small issue complications but as long as you show you care for the patients, they will not be mad and throw you under the bus.

but again, it is california lol...the state run to the ground with a bunch of ppl who do not wanna work and wanna receive government hand outs.

It will stick around for a long time. My malpractice premiums did not rise. I did everything right, documented the case well, and was making every effort to do right by the patient. But at the end of the day, the patient knew she had an opportunity to get paid and she pursued legal action. We (my carrier and I) decided to settle because I was young and was really in over my head at this time in my life. We also had no support from the owner. The stress of the situation was challenging to manage. It took almost a year to resolve, by the time it was done, I had already left this office.

I was more or less chewed up and a spit out right out of school. But....I’m a much more resilient person because of it.

 

[allDAT]

I figure you guys would charge non-standard dental codes that I've seen at other places such as irrigation fee, porcelain upgrade fees, etc.

I didn't have the chops for that. I coded what I did, nothing more and nothing less. The specialists had their list of codes.

 

[frozenicecreamDMD]

It will stick around for a long time. My malpractice premiums did not rise. I did everything right, documented the case well, and was making every effort to do right by the patient. But at the end of the day, the patient knew she had an opportunity to get paid and she pursued legal action. We (my carrier and I) decided to settle because I was young and was really in over my head at this time in my life. We also had no support from the owner. The stress of the situation was challenging to manage. It took almost a year to resolve, by the time it was done, I had already left this office.

I was more or less chewed up and a spit out right out of school. But....I’m a much more resilient person because of it.

if you did everything right and document well you should fight it. a settlement by you and the carrier means something is off.

now its easier to look back but you should have quit after 1-2 months. this is my third job in my 10 month practicing as a dentist (first one last 2 months, second part time one day a week one concurrently with the first one, quit both to join the third job, so far im here for 7 months already)

I worked at heavy HMO office (the one day a week) and I realize the patients in these type of settings are very very cheap. they complain and moan about anything and everything and do not take care of themselves and always blame on someone else when things go wrong.

also, working at HMO or cheapo places you also attract a lot of litigious patients who look to sue and do not wanna pay. somewhere along the line, the money you get paid is not worth it to treat the patients you describe. you can work the medicaid mill and still get paid better. you effectively treat patients like tools here they are just objects for you to put work on to get paid. this is no way dentistry should be practice and a young brand new grad to start at this place is just terrible.

it is not worth it to do 3+ crown a day with a bunch of fills to average 2k a day.

 

[allDAT]

if you did everything right and document well you should fight it. a settlement by you and the carrier means something is off.

now its easier to look back but you should have quit after 1-2 months. this is my third job in my 10 month practicing as a dentist (first one last 2 months, second part time one day a week one concurrently with the first one, quit both to join the third job, so far im here for 7 months already)

I worked at heavy HMO office (the one day a week) and I realize the patients in these type of settings are very very cheap. they complain and moan about anything and everything and do not take care of themselves and always blame on someone else when things go wrong.

also, working at HMO or cheapo places you also attract a lot of litigious patients who look to sue and do not wanna pay. somewhere along the line, the money you get paid is not worth it to treat the patients you describe. you can work the medicaid mill and still get paid better. you effectively treat patients like tools here they are just objects for you to put work on to get paid. this is no way dentistry should be practice and a young brand new grad to start at this place is just terrible.

it is not worth it to do 3+ crown a day with a bunch of fills to average 2k a day.

I agree with you, but it's over now.

A settlement doesn't mean as much as you think though. I've been through it, I've lost a lot of sleep, 5 years later all is still well. I could have fought it, but I don't know what would have happened if I did.

 

[allDAT]

I never understood HMO plans. How much is the owner taking home for being an HMO provider?

just like you outlined you need extreme efficiency for minimum production. our d school fees are literally higher than the ones you quoted.

I'm thinking you may even be better off in some states doing Medi as compared to HMOs

Honestly, I think it worked out very well financially for the owner but the numbers suggest he made a few hundred grand a year off of RDH production each year.

 

[schmoob]

As mentioned, a lot of it is self drive. I didn’t do a GPR and went right into an associateship. I had a family to support so GPR wasn’t an option.
I was significantly out producing my fellow associate who had completed a GPR. Surgical extractions, molar endo, lots of fixed.
If I wasn’t sure about something I would research it. Believe it or not I would refer to my dental school textbooks. Molar endo re-treat within my first few months of graduating.

It’s all about confidence. If you need a GPR to gain that confidence then I would absolutely recommend it. If you are a bit more self driven and do not want the structure of a PG program, then by all means jump right in and get to work. Have confidence in your education but also know your limitations.

 

[wannagiveup]

150k ish if you go corprate.

 

[AONLINE]

Aspen in the Midwest: $600/day. Private practice in big metro Texas: 120k. Both are actual offers that my D4 classmates have signed - no GPR.

 

[Alpha Centauri]

It’s all about confidence. If you need a GPR to gain that confidence then I would absolutely recommend it. If you are a bit more self driven and do not want the structure of a PG program, then by all means jump right in and get to work. Have confidence in your education but also know your limitations.

Yup. I know I need a GPR. I don't regret dedicating a year away while my roommate goes straight out to corporate. He is going to be a great dentist and he is consistently reading and studying new techniques and research (As am I, he is simply better than I am).

Meanwhile there is probably 75% of my class I wouldn't trust giving me a prophy. Is it because of COVID? Maybe, but there are also plenty of people who do not know important general dentistry knowledge, such as the difference between luting and bonding (IE, which cement to use), what a comprecap is, immediate dentin sealing, and why you can give a painless injection with carbocaine and not lidocaine.

I need the extra experience and there is no shame in that. I love dental materials and techniques, and seeing how people across the country practice dentistry differently than I do. There are things I hate about dentistry because they don't make sense to me (logically), and then there are things that I simply am not good at just yet.

It almost seems as if many people just show up to clinic and have faculty members "finish up" since they are too lazy to try on their own. I don't care about how much my income will be in my X year out of school. I already know all will be well. It's not bad that people are pessimistic on here, but it should absolutely scare off the people who are taking out 400k plus in debt (as an investment in themselves) if they don't even care about trying to learn something new from each procedure.

 

[frozenicecreamDMD]

I agree with you, but it's over now.

A settlement doesn't mean as much as you think though. I've been through it, I've lost a lot of sleep, 5 years later all is still well. I could have fought it, but I don't know what would have happened if I did.

oh so you are already out 5 years and this is just a reflection on first year. if so that is good for you then. yes, HMO offices you either gamble your ethic away to make production or you quit. there is no way you can upgrade all those MO, DO, MOD to inlays and onlays unnecessarily because the size are small and you can do a direct restoration unless it is a redo and bigger and then inlays and onlays are indicative.

 

[Cold Front]

Aspen in the Midwest: $600/day. Private practice in big metro Texas: 120k. Both are actual offers that my D4 classmates have signed - no GPR.

When I graduated in 2010, the offers were EXACTLY the same. I believe the same offers will be made to new grads 10 years from now.

Any discussion on incomes, specially first year out of school, should be had with inflation in mind. I have a friend who went back to school to specialize in Endo couple of years ago, to boost his GP income from $180k to $400k a year. He is graduating this summer. Not only did he forfeit 2 years of general dentist income ($400k) and took more debt in student loans ($300k), his goal to make $400k/year in Endo back in 2019 is actually worth little less today - maybe $380k and declining due to inflation. Exhibit A: Housing cost. Exhibit B: Everything else has gone up. Inflation is the invisible tax.

 

[2TH MVR]

if you did everything right and document well you should fight it. a settlement by you and the carrier means something is off.

Most of the time ... a settlement is just the right financial choice. A settlement is not an admission of guilt. Check with your insurance carrier. Many insurance companies retain the right to make the decision to settle unilaterally. Many, many yrs ago ... I was involved in a frivolous suit. Patient claimed I gave her TMJ lol. This patient had a pattern of suing others. I had good malpractice insurance through the AAO. Nothing out of pocket. My insurance carrier actually allowed me to make the decision to settle or not. After being dragged through the mud for almost 12 months. The mental strain. Reviewing what would happen if I did go to trial and LOSE. If I lost ...... the amount of the payout could be much. much higher than what a settlement would have been. Also .... here's the catch. My AAO insurance company would drop me and I would have to pay HIGHER premiums with another company. If I settled .... my insurance company would retain me and my rate would only go up a little amount. Patient wanted $150,000. We settled at $23,000. A relatively small amount.

Funny thing. An Oral surgeon then treated her for "TMJ". She sued the oral surgeon.

. I don't care about how much my income will be in my X year out of school. I already know all will be well. It's not bad that people are pessimistic on here, but it should absolutely scare off the people who are taking out 400k plus in debt (as an investment in themselves) if they don't even care about trying to learn something new from each procedure.

Yep. Just do YOU. I've never been a fan of lost opportunity costs. Money is nice, but life experiences are what really matters. Who cares if your classmate gets a jump on you in the working world. Some of my best FUN memories are from my undergrad college years. Once I went to DS .... it was like going to work. Then you go to work after graduating. No one can predict the future. All you can control is what you do in the PRESENT. I prefer the journey over the destination. You can't measure yourself with how much money you have. There will ALWAYS be someone with more money than you.

When I graduated in 2010, the offers were EXACTLY the same. I believe the same offers will be made to new grads 10 years from now.

. Inflation is the invisible tax.

Yep. My pay rate is the SAME for the last 4 yrs of working for this DSO. If I want to make more money ... I need to work harder (more starts). I remember in private practice .... we would analyze our fee schedule and RAISE the fees every year to counter inflation. When offices lower their fees .... its the double whammy. Higher inflation. Lower revenue.

Working as an employee is not going to build wealth unless you place your discretionary money into equities or investments.