New DDS on the Block: Private Practice Blogumentary 4
Its snowing like crazy outside
wohoo
snow day!
Im happy to be back posting on this blog for everyone. Again, thanks for all the very supportive and encouraging pms Ive received so far. I really like the feedback. Feel free to chime in on other topics you may like to hear about if you dont see them here.
So lets see
7 months have gone by and Im still standing Still going strong and feeling good.
Most of my loans have now come into repayment, so thats probably most of what Im concerned about at the time. Maybe concerned is not the right word
planning for I guess?
So my situation is as follows; I have $250,000 in Stafford/grad plus dental school loans, $25,000 in private loans and $10,000 in credit card debt, all which I plan on paying off in 10 years. My strategy here is slowly but surely. Its really nice to have the option of either switching to a 25 year schedule repayment if you need to or making interest-only payments at first while slowly switching to principal and interest. The main problem with the 25 year schedule is the amount of interest you end up racking up by dragging out your re-payment. Its pretty significant. On my loans for instance, if I decide to stretch them out to 25 years versus 10 years, Im paying 3 times as much interest on the life of the loans (which makes sense, but hits you in the face lick a sack of bricks when you see the actual numbers).
10 year repayment = $105,000 interest paid. 25 year repayment = $350,000 paid
interest alone!
My payments run roughly $3,000/month (on the 10 year schedule) for both dental school and private loans. I plan on knocking off my credit card debt in a few months, so am really not losing any sleep over them. With highest interest rates of all my debt, that is probably the prudent thing to do.
Note: As a new dentist you can expect to make roughly $10,000 per month ($7,000 after taxes), so you do your math accordingly.
On top of that, Im saving up for my wedding this summer. Now thats something that will put a strain on my finances. My student loans alone are so far pretty manageable, but once you throw in a wedding/mortgage/paying for kids, I can see how it can get tricky. Still not tossing and turning at night over anything though
its assuring to know that as my bills get bigger, so will my paycheck and income. Im not always going to be an associate. As long as I live within my very comfortable means and not go bonkers until I pay my loans off, I will be fine. Whats wrong with that?
A recurring gut-feeling I get is, what am I doing here? Why am I still an associate? Why not just go out on my own, and get things rolling? It will happen sooner or later, so why not sooner? There is so much money (and I know, responsibility and headache) to be made as an owner. Im here, working my back off for this owner, building goodwill for his practice, growing his patients and one day I will probably just pick up and leave to start my own thing. Its the sort of gut feeling I got when I signed my car lease, when I sent in my deposit in to dental school, when I submit my MATCH rank list for my GPR
I was thinking, are you sure you want to do this? I tend to doubt myself sometimes like that, which is healthy.
Perhaps another incentive I have for going out on my own is, the fact that I need more toys! My current office does not have an endo microscope (which I would love), no intraoral camera, not even electronic records. Its a pretty bare bone bread and butter practice. The guaranteed monthly salary is hard to turn away, but my thinking is if they can pay me this much on my current production, then I should be able to pay myself a whole lot more on my own, PLUS I get to do things on a whole new level. I think I can easily up my current production, once I have some real toys.
Having given it some thought, and against most common sense, Ive decided I still want to spend more time as an associate. It may be laziness (which terrifies me, the thought that I may be getting too comfortable working on salary as an associate and possibly lose track of my own vision of how I want things done)
OR
it may be that I just am not ready to go out on my own. Buying your own practice takes a lot of preparation and research obviously, but financially, can I really afford to do that now? Can I afford not to? Thats what I really do not know yet
Im not going to rush myself into answering that question just yet, but I think if Obama starts to implement new small business incentives or tax breaks or whatever, that may get me to jump in the pool. Until then, theres no rush. For now
In keeping my options open, I recently entertained an interview invitation from a broker I had worked with during my residency about a great partnership/ownership opportunity outside New Haven. It starts as a regular associateship, and slowly progresses into partnership and finally buying one of the two offices this practice currently owns. Looks good on paper. Both offices have recently undergone near total renovations, new operatories, carpeting, almost all the toys and gizmos you would think of (minus CAD/CAM). Its always inspiring to see someone doing good for themselves like this guy.
It comes at a price though. I could see the weight of owning 2 offices and the burden of that responsibility on his face. Most practice owners will complain about the business side of dentistry and running your own practice and having 2 full-time jobs, but come on
did you forget what its like to work for someone else? Its practically anyones fantasy to own their business, be their own boss and make up their own work schedule. And its not like youre doing it for free
there is a serious financial payoff to that extra effort. I have yet to see a general dentist working full-time who takes home less than $200,000. And thats after all the tax write-offs and all the business expenses. Think of it
On the other hand, I may just be naive. I wouldnt be surprised if my views change once I walk a day in their shoes. Its all about the balance
is it worth it? Do you really need that much money to be happy, and how much of your sanity and peace of mind are you willing to give up for it?
Back to this guy. His average daily production is $6,000, and regularly collects north of a million/year. By himself. No associates. But then again, hes been doing this for 25 years. Granted, not everyone is making that money
he is admittedly doing above average, but there are many stories similar to his out there. Hes no rock-star.
As an aside, I think the term million dollar practice is thrown around way too often as a marker or yard stick of exclusivity and what not for dental practices
it just doesnt seem that rare anymore. Maybe Ive just been spoiled on interviews, but Ive seen that its pretty doable with decent effort and a clear commitment to your staff and patients.
Here is a random little tidbit for you
as it turns out, specialists and GPs both make the same amount of money! Shocking? Not really
what sets dentists apart financially boils down to one dreaded word
-insert psycho screech here-
OVERHEAD!
So a GP, Endodontist and Orthodontist walk into a bar
nevermind. A GP, Endo and ortho each produce one million per year
guess who takes home most of that money? The guy with the least overhead
duh!
GP overhead: 70 cents on the dollar (takes home 30)
Endo overhead: 55 cents on the dollar (takes home 45)
Ortho overhead: 50 cents on the dollar (takes home 50)
You get the picture
slay the overhead dragon!
Alright, now for some random private practice stories and rants. My favorite part.
So, in the past few months, our periodontist decided to take the plunge and start his own gig with a friend. He will be buying into an existing practice as a partner, to eventually own the practice. Sounds like a good deal
We have been since interviewing potential candidates to fill his position, obviously. Now this is where it got kind of weird. One of the persons we interviewed had been in perio practice for 6 years since residency, and has been happy for only 2 of them. He was telling me how he personally felt perio as a field was slowly dying, and how much crap he had to put up with from general dentists whom he had worked with. This dude was seriously not happy. He seems like an easy going person, but was just not able to get a break. So what to do? Hes going back into general practice. Interesting, huh? His opinion was why should I send the patient back to the GP if Im doing the majority of the ground work? I want to have my cake and eat it. The way he was marketing himself to us was that he would be doing our perio, all while doing general dentistry where needed. Wait, waaaah
? He wants to only do crowns on crown lengthened teeth, place restorations only for implants which he has placed, manage chronic perio patients from a general dentists perspective. Im a bit lost
I think so was he. Needless to say, he was not taken very seriously. It was a bit disheartening though to see how unhappy he was and I might say even bitter about his field not providing the job security he had once hoped for. Obviously, the first thing to blame is always the economy, then the AAP, then oral surgeons
and of course
wait for it
DENTISTS.
We have since hired a new periodontist, which is already getting on my nerves
LOL! She keeps referring to herself as the surgeon. As a surgeon, I can do this or I cant do that. Someone help me! Its actually entertaining for the first few minutes to hear her talk like that, but you can imagine how it can get old pretty quick. I really appreciate her though as a colleague otherwise, and think she will do fine at our practice. Shes only at my office one day a week, and her schedule is picking up at a healthy pace. Its funny though, because they started pulling scaling/root planning patients from the hygienists schedules to keep the surgeon busy when she first started, but I guess now it is a bit better where she has a mix of other procedures planned as well. The hygienists were furious when it first happened as you can imagine. Oh, office drama
its kind of fun actually. One of the many perks of working in a group practice . Im sure this is one thing I will miss when Im at my own office.
What Ive learned
Once a patient is numb (and I mean fully numb), they will usually forgive and forget however many or what kind of injections it took to get them there. If they have a good experience, in terms of not feeling anything during the procedure itself, they really dont mind much after that. All my patients get palatal injections for any maxillary tooth. Doesnt matter whether its a root canal or a class one restoration. You can thank me later for that little tip. It sometimes is uncomfortable during the infiltration, but they always walk out with a smile on their face, and remember little of it once theyre numb. Needless to say, all mandibular teeth get IA, lingual and sometimes long buccal blocks. Once you start doing infiltrations on posterior mandibular teeth, I have found that it is really a hit or miss. The soft tissue usually gets numb, but the teeth are not fully there. You will still every now and then get that one sensitive spot on the tooth until you go back and do the block.
Be nice to your patients. I mean seriously, be nice. Take the time to listen to what they say (uninterrupted) and actually repeat their main concern back to them in your own words. Dont jump the gun or assume you know what they need. Try to discern what they want, and present it to them in the context of what they need. That in of itself is an art of communication.
Patients tend to translate confidence, good communication skills and was a great guy
to competence. That is how they really judge us. I cannot tell you how many times a patient will sing words and verses of praise about their previous dentist, and how he/she was such a great dentist, and did amazing work
and Im sitting there staring at the FMX thinking to myself, are you freakin kidding me? You paid this guy for his work
lol. Ok, maybe Im being a bit harsh, but it never ceases to amaze me how much terrible dentistry is done by great dentists! I really have no reason to believe the last dentist was doing anything less than their best effort, and probably was working to the extent of their abilities. But still
It frustrates me that dentists that go over and beyond clinically and truly do exceptional work, are rarely recognized by patients, just because patients simply cannot tell the difference. The endodontist who took his time, over 2 appointments and spent 2 hours locating all 4 canals in a maxillary molar, using a rubber dam, is often perceived or translated by the patient to took him forever and was slow. On the flipside, the general dentist who quits at 3 canals, barely does any cleaning and shaping and fills short (with no rubber dam mind you) BUT completes the whole thing in an hour, is such a wonderful dentist. Ugh
Patients LOVE post-op calls. Extractions, root canals and crowns all get post-op calls the next day, just to make sure you are healthy and are feeling OK after yesterdays procedure. It works like a charm
Every. Single. Time.
It really does not take a whole lot to be a good dentist in the eyes of your patients. Im always surprised. I cannot reiterate this enough, just be honest, sincere in having their best interest and do no harm (emphasis on do no harm). Its pretty simple.
Level with your patients, be honest. When you break a file during root canal treatment, dont brush it under the rug. It is probably one of the more difficult aspects of practice, but hey, it beats telling them that their relative or loved one died on your operating table. Calmly explain to the patient that this is one of the limitations of our instruments, and make your decision on whether it needs to be retrieved by a specialist or whether its safe to watch.
When you cant see all your margins on that impression, explain to the patient why you need to re-take it. Dont send it to the lab and hope they can fudge it.
When that curved apical 1/3 root tip snaps off, and you think it needs to be retrieved, take the time to explain it to your patient what happened -despite your best efforts- and why you believe they need to see a specialist for further treatment. Of course, all this is assuming you are working within your comfort zone and are not taking on cases which should otherwise be referred out.
Set your patients expectations to favor your own success (without obviously misleading them). Your patients problem is not your own, and you should not make it your problem. If a patient breaks a tooth or needs a root canal and asks you if can fix it, and you fail to do so, it rightly becomes your problem. You failed to fix it in their eyes for whatever reasons. Then you start apologizing, feeling guilty, yada, yada, yada. However
If a patient asks you to fix their tooth, and you explain to them that their tooth is damaged and you will try to save it for them
oh boy, what a difference!
Setting lower than realistic expectations, while working towards higher than realistic outcomes. You'll always be a hero!
Ok, Ive run my big mouth quite a bit this time. Ill stop here.
More to come
