Okay, so no full arch, but molar endo and multiple crown preps take time. No one does any of this in 10 minutes. That’s all I’m saying. I have auto notes, but an initial exam takes chair time as well. All I am trying to bring up is some of your posts over simplified the actual day to day work. Unless you are only doing simple procedures. Not high paying work.
Btw, implant placement is more complex than u are making it sound. Punch holes hide bone defects and without a CT u are essentially blind. Second stage grafting takes time as well.
That is true, mostly fills, extractions, single unit crowns are 5-10 mins. That was just an example of a 1 hour time slot; for RCT's and other longer procedures, those time slots can take 1 column, 2-3 hours depending on how many are back to back. This isn't easy work.
Implant placement can go from slam dunk all the way to WTF just happened. It's not always easy. I advocate GP's to do the easy ones and send the hard ones to the surgeons (no bone, sinus lifts, problematic medical histories, etc...) I'd agree that a CT is always prudent, even for a single unit, to identify any aberrant anatomy or defects. We do almost all of our implants guided and flapless whenever possible. Only time that I don't use guided is for immediate placement since the remaining bone will dictate my primary stability or whether I'll have to abort, graft, and see them in a few months. I'll still take a CT pre-op.
I consider myself pretty fast and efficient and good at running multiple chairs. But there is absolutely no way in hell i can run 4 dentist chairs plus 4 hygiene recall chairs. I honestly think there is no way either given that even for hygiene recall you’d want to greet the patient, take a good hard and soft tissue look, and examine the radiographs and go over any questions the hygienist/patient may have. That alone for each patient should take about 10 minutes of dentist chair time for a quality exam.
As for a 45 min molar rct/bu/crown, that’s also extremely suspect. Any competent dentist should know that the key to a good molar (or any) Endo is to find all canals, do thorough debridement, rinse repeatedly and thoroughly, and get a good fill. The buildup also has to be done incrementally to minimized the c factor and also ensure a good seal. The crown might be the easiest part but in certain mouths where opening is limited and tongue is in the way it can also be hard. The disinfection process alone should take at least15 minutes for the hypochlorite to soak and disinfect. An Endo activator can assist but time duration is still a critical factor.
This guy Tanman if I recall has actually shown photos of his putative cars. I am firmly in the camp of the Millionaire Next Door philosophy. The truly wealthy don’t flaunt their wealth and it’s the stealth wealth guys that have the real money. JMHO.
If you've done enough endos, you eventually get proficient at reading the pulpal floor and doing it mostly by feel. I find that finding the canals is not the hard part, the hardest part is getting good isolation when you got multiple walls broken down and you have to place a sub-G buildup before placing that rubber dam. You typically get a lot of bleeding, and you have to work really fast or else you're going to get stuck managing hemostasis for awhile.
I used to use the endoactivator, which is awesome for anteriors, but I use an Er:Yag laser to do PIPS and that really cleans the canals and gets at the lateral canals when present. There's a few ways I speed up the disinfection process.. heated 8.25% NaOCl (heat + conc speeds up disinfection), simultaneous irrigation and instrumentation with hypo (more contact time while cleaning organic/inorganic debris), QMix at the end (EDTA/CHX, single step). Have I ever had a bleach accident? Nope. Are my endos perfect 100% of the time? Nope. However, it's bad business if they fail, but we're not a machine shop with 100% predictability. We want to achieve perfection, but the mouth is a continually changing and dynamic environment. Dental school will have you believe that everything should last forever and if you follow their steps, it will. In reality, things happen and from a business perspective, you gotta do things fast and well. Otherwise, you'll have a lot of failures that will clog up your system over time.
These implications that there's no other way to do it but a certain way (when it comes to clinical or business) is also a dangerous line of thinking. If you cannot think outside the box or innovate, you will be left behind or remain stagnant. As clinicians, we should always think about what we're doing, why we're doing it, AND how we can improve upon it. I think we tend to forget about the last part.
On the "millionaire next door" philosophy, I used to believe that because it made me feel good about saving up every last penny I had. When I think about it more, there's a few aspects that made me rethink my position, but also think about why people believed in the unassuming millionaire next door. To have wealth and material things are two separate but connected aspects of the true wealth of an individual. A person can go out and buy or lease all the nice things that they want, but they aren't wealthy because it's all a show. That's why during income tax refund season, I see a lot more 3 series bimmers that are typically leases out on the road. On the flipside, you could have a next door neighbor that drives a Yugo but has millions from their frugal lifestyle. These are the two extremes and I think that philosophy makes us feel bad about our consumerism and rethink about wealth accumulation. However, as dentists, we are in a unique position that we earn more than most people. We will hit a limit at some point where we have enough wealth that it's redundant to keep saving all of it and trying to be as frugal as possible. What's the difference in the lifestyle of 10MM v. 100MM? Not enough for me to keep busting my ass and see my youthful years go away. When the years of my youth are gone and I have a massive pile of cash and wealth, can I carry that to any supposed afterlife? Am I going to give that to my kids, donate it to charity, or academic institution? Enjoy life while you're still young, I used to think I wanted to die working. My father was like that, and he got sick. It's these life changing moments that change your perspective on life. I'm only spending money that I can afford to spend/lose nor am I overextending myself to live a lifestyle I cannot afford. However, if you have the money to live a nice lifestyle, why not? Besides, my car is a practical car... very good gas mileage, safe to drive, and I can haul toilet paper and paper towels from Costco, haha.
Also, I think there's an inverse distribution and you might just be seeing part of the curve on the idea of wealthy. There's those silent millionaires, but those aren't the truly truly wealthy. However, I cannot generalize that the extremely wealthy are all flashy either, you'll have your mix of both, but those that have their wealth in the 8 figures (haven't met 9+ figure people that I know of yet) tend to have the nicer things in life.
TL;DR: Save up, but enjoy life while you're still young. Spend what you can afford.
PS: Another expensive hobby, guns! God, I love Texas