Stay away from orthodontics

[orthostr8]

Suppose a newly graduated ortho has 0 debt from school and earned a net positive (from a stipend) in residency. What would your career advice be for this individual?

The short answer: I see the previous income and lifestyle differences between ortho and dentistry becoming less so over time. So if you like ortho and can graduate with a net positive and you have similar lifestyle expectations from either career or other specialty, then go for the one you enjoy more. I mean, if you do an ortho residency instead of a GP GPR, then it's not like you wasted that much more time on the extra ortho education. Just make sure you understand the work schedule, work environment, and salary expectations in both fields.

The longer answer: Obviously it puts you in better shape, but if you plan to buy or start a practice there's still a big investment looming ahead, and it's getting more expensive with the new technology continuously coming out. Of course we all know that controlling overhead is a key, but it's not like 30 years ago where you used paper instead of computers and no one really cared or noticed. Now there's a noticeable difference between the have's and have not's, and if you're in a competitive area you can't be a have not unless you go for bargain basement fees. I think this applies to some extent to general dentistry too, but not as much, although I'm not an expert on GP trends.

What are your long term goals? Do you plan to buy or start a practice at some point or work for a corporation long term? What kind of days and hours do you want to keep? Are you a "volume" type of worker or prefer a more relaxed pace? Are you a natural businessperson and leader? Do you have a sense of marketing and social media? Are you considering ortho because of the actual procedures, supposed salary, supposed lifestyle, or all the above? How much salary are you hoping to make a year? What are your personal and family expenses looking like for the first 10 years you will be working? There are so many variables to consider and each situation is different. My colleagues with a working spouse and 1 kid are obviously in better financial shape than me with 5 kids and a very hard working, but unpaid spouse.

My point I've been trying to get across is that ortho has changed and will continue to change. You need to work harder for less money than the previous generation of orthos did, and I honestly don't know how much longer the owner/practitioner model will be sustainable. I see a slow but steady change over the next 10-20 years. And I'm concerned that currently the corporations pay a decent ortho salary because there are lots of private practices still around so they have to pay competitive wages. But once the majority of private practices are gone, I assume they will lower their wages, too. It's a simple business decision, and they have no obligation to us.

Ortho was seen for decades as a stable, predictable field. That's no longer true. Things are rapidly changing, and no one knows for sure where it's going to end up.

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[Medin2017]

This is my opinion and only my opinion...

but if I were to invest in Ortho...I would invest in:

ALGN : Summary for Align Technology, Inc. - Yahoo Finance

That's about it.

Save the money and invest into this stock.

Today's Ortho is a totally different beast from "yesterday's 90's/00's" Ortho. I really think the best way to do things is to do group practices and bring in specialists. If you are doing it for the money...there are easier ways to do it. Buy a 1 mil practice...keep it steady....7 years later you are 1 mil in equity and making 300k. You don't have to specialize to make $$$. I would only specialize if you truly love the specialty. Don't do it for the money, you will be disappointed to know that the GP business owner down the street that is 10 years younger than you...does only class 2's and crowns...does those fills/crowns crappily...works 4 days a week.... isn't as "clinically" smart as you....and brings in specialists is bringing in a bigger paycheck than you. Guarantee it.

This would be true if associate jobs weren't paying < 160k for the first few years out of school. If you go to a specialty program with a stipend (peds, omfs) you would have a net loss of like 300-400k on average during this period (60k vs 150 average for 4 years) and be only 3-4 years younger when you come out lol. Then if we based on averages (since no one knows anything about actual pay of specialists nor dentists alike), the general dentist will be at 170-190 if he's lucky enough to be an owner and the specialist will be at 300+ but with less worries of saturation, corporation, and everything else, not to mention the stability of a specialist over a general practice dentist.

But we already had this conversation before I think so I don't want to derail the thread. I will say we need more general dentists like you on these threads though, seeing as the predent section has the sky is falling syndrome and students are crying about 400k debt. If there weren't posters like you, I think this subforum would be extremely depressed all the time and there would be no light at the end of the tunnel. Feel sorry for those people honestly

 

[321931]

This would be true if associate jobs weren't paying < 160k for the first few years out of school. If you go to a specialty program with a stipend (peds, omfs) you would have a net loss of like 300-400k on average during this period (60k vs 150 average for 4 years) and be only 3-4 years younger when you come out lol. Then if we based on averages (since no one knows anything about actual pay of specialists nor dentists alike), the general dentist will be at 170-190 if he's lucky enough to be an owner and the specialist will be at 300+ but with less worries of saturation, corporation, and everything else, not to mention the stability of a specialist over a general practice dentist.

But we already had this conversation before I think so I don't want to derail the thread. I will say we need more general dentists like you on these threads though, seeing as the predent section has the sky is falling syndrome and students are crying about 400k debt. If there weren't posters like you, I think this subforum would be extremely depressed all the time and there would be no light at the end of the tunnel. Feel sorry for those people honestly

Hey we agree!!! =) I do agree with what you said. My bottom line and opinion is that if you do GP...YOU HAVE TO OWN.

With specialists...you can own...you can do corporate...you can come in to other offices and do specialty work... and still make a decent living. Ortho...I'm not really feeling it, but endo/os/pedo....it's a good investment.

 

[orthostr8]

There is no question that general dentistry and pediatric dentistry are the bedrocks for getting patients in the door. From there they can recommend specialty treatment as needed. So the smartest and simplest modern approach is to build a large dental or pedo practice within a single or multiple locations, and then bring in the specialists as needed on salary. It stinks for the specialists, though.

However, for the time being, this ignores the other aspect that GPs are doing every procedure they can and are simply not referring things out to specialists as much as they used to. So the overall volume of work for specialists is actually decreasing, not taking into account population growth. This effect varies for each specialty, of course.

 

[charlestweed]

Thanks for the info. Without knowing "Charles" at all I have a lot of respect for him just reading how dedicated he is. A few clarifications:
1. I've got 5 kids (insert your good-natured joke here......), and my wife and I are still married. She prefers when I'm not thinking about my career, though
2. I didn't quit my side corporate ortho job when I started my office. I kept it going for 6 years, slowly cutting back as my private office got busier.
3. I've spoken to guys about weekend hours. They all say it's BS, because everyone schedules for it and then cancels or no-shows, just like the day before Thanksgiving. So they schedule small things for it and it makes the patients happy, but ticks off the staff and is a basic waste of time. I want to be with my kids when they're home. When I drop dead, my tombstone isn't going to say how many kids I treated on the weekends while my kids grew up without me around. My wife and kids are my biggest investment, and most of today's patients and parents have no respect for that. They expect me to drop everything in my life for non-emergencies so that their kids don't have to miss sports practice. Again, they don't see us as "doctors treating patients." We're "service providers working for consumers." We are in the same boat as the Walmart, CVS, beauty salons, dry cleaners, and dog groomers. Some days I think those people get treated better. If you don't believe me I have screenshots of Facebook posts to prove it.
4. I work 5 days a week, but I see patients 3-3.5 days and spend the rest on non-patient matters. I don't play golf, don't own a boat, and don't drive a luxury car. I don't go on luxurious vacations. 5 kids has a way of depleting an income quickly.
5. "CharlesTweed" is definitely doing what needs to be done to get by today, but this isn't what orthodontists told people 20 years ago they would have to do. 5-7 days a week, 4 private practices, 2 corporate offices, even after 15+ years? Man, had I been told that was the norm I would have RUN away. It's not that I'm lazy.....I'm not looking to make a million a year or retire at 50. I spent more evenings up until 2am than anyone else I know. I now want to work 4 days a week and make enough to support my family and save for retirement, and live a relatively normal life while I'm young enough to appreciate my family and health. Charles works his a-- off and I respect him for it, but I didn't go to school until 30 years old and take out all of those loans to have that kind of life. I could have made myself a lot less crazy with a lot less debt to live that way.
5. I could not start an office in 2008 the way "Charles" did, with no computers, etc. I'm in a suburb of a major city, and that just won't fly, especially with patients going for multiple consults to different offices. I even lost a consult because they said the other doc told them they wouldn't need to take impressions - i.e. he has digital impressions. I don't have that or a CBCT, and I bought a used pan/ceph with a Scan-X digital scanner so I could go digital for 1/3 the price of a digital pan/ceph. I custom made the video game play area and cut the corners wherever I could. Part of the 400k was working capital. Starting an office in 2008 with paper charts in my area? I might as well drive up in a beat up Model T and use old metal ash trays as instrument cassettes and autoclave them with Purell in a tea kettle. (I'm originally from NYC so forgive my offbeat sarcasm.) I understand that can fly in some rural areas, but not where I am. And I'm not in Beverly Hills, either.
6. I tried to have PT staff for the first 7 years. Patients hated it and I couldn't find serious, good, reliable employees. Patient expectations have gone through the roof, and they don't like answering machines or an answering service. If you look at the trendy offices, even their websites have live chat so our pampered patients can speak with someone almost any time.

It's interesting seeing what CharlesTweed and 2TH MVR say. Both seem to have different practice styles and both are happy with their lot. I'm happy for you guys. I don't know what your expectations were getting into this career, but I chose ortho based on what I was told it would be, and it's not nearly close.

I choose to on weekends for several reasons:

1. It’s easier to recruit P/T assistants to come work for me. They work F/T at other offices and want an extra income by helping me on the weekends.
2. Most parents don’t want their kids to miss school. Adults patients don’t want to miss work.
3. The referring GPs appreciate the fact that I am one of the few orthos who work on weekeends.
4. Less traffic.
5. Making more $$$. With more chairside assistants, I can see 1.5-2x more patients on weekends than on weekdays. So the production for working 5 weekend days is equivalent to working 8-9 regular days.

Physicians, pharmacists, optometrists, general dentists all have to work on weekends. Why should it be different for ortho? At least I can control the hours (from 8am-12noon on Saturdays and Sundays) so I can still have time to spend with my kids. My cousin, who is a MD anesthesiologist, has to work during odd hours (ie 2am), weekends and holidays. He is envious of our dentist’s working hours.

I graduated a couple of years before you. My ortho program didn’t have any fancy gadget. The program director made us do everything: making all ortho appliances, working without an assistant, hand-tracing the cephs, cleaning our own chairs and the lab area, calling patients, discussing tx and payment plan with patients etc. I am glad I learned to do things the hard way. When I got my first job at a busy corp office, it was an easy transition. When I started my first office in 2006, I bought the same analog PC1000 pan/ceph machine (from pancorp.com) that my ortho program used. Until now, I continue to run all my practices the same way the orthodontists in the 80s and 90s did. If it ain’t broke, don’t fix it. Paper charts are much more efficient. I can write faster than I can type. The entire 24 month tx can be summarized in 1 sheet of paper. I can easily go back to find out when the RPE was delivered etc. None of my patients has asked me why I don’t use digital x ray or why I don’t have intraoral scanner. All they care about is good treatment result at affordable price.

 

[charlestweed]

I don't know what region you're in, but the going rate in my area is $5000 for standard treatment. You've chosen to charge less and work with volume as you've chosen to charge a low fee and see a lot of patients. There's no right or wrong, both ways can work depending on the region and the doc.

I am so curious where you did your residency, as your financial expectations were by far the lowest I've ever heard from an orthodontist.

I'm in my lower 40's. As far as your workload due to worries about your family getting by should something happen to you, isn't that what insurance is for? I've got a $3,000,000 life insurance policy until I'm 65 - don't tell my wife It costs me less than $3000 a year. And there's disability insurance, too. You are constantly pushing yourself to the max. If you are a workaholic and go nuts if you're not working, then great. But otherwise I think you can let off the throttle a little.

My practices are in Southern Cal. If you have no problem getting the patients to accept treatments at $5k, then that's good for you. Don’t lower the fee. Most of my patients can’t afford that fee. I keep the overhead low so I can pass on the low cost tx to my patients and compete against the nearby corp offices. With 40% overhead, I can easily bring home 2-3 times more than what I make at my associate job.

I came to this country with nothing. I’d lived in poverty during my HS, college, dental school years. I’d never made more than $6/hour before I became a dentist. When I did my GPR and got paid $2k on my first paycheck, I was so happy. So a 6-figure income seemed very big to me at that time.

I have both life (1mil policy) and disability (get $5k/month if I become disabled) insurances but these are not enough. My wife only works 2-3 days/week, 2-3 hours a day so she can spend time teaching the kids. I don’t want my wife to get out of her semi-retire mode and start working full time again if something happens to me. I work hard and invest now (when I am still healthy) because I want my wife and kids continue to have the same lifestyle that they currently enjoy even when I can no longer practice orthodontics. Who knows what will happen to the specialty in future? Saving enough money makes me worry less about the future competitions, invisalign, GPs stop referring etc.

 

[charlestweed]

It's this time of year to go begging the referring GPs again. My staff will have to delivery these gift bags to our referring GPs later today. They already delivered first 2 batches of gifts last week. And this is the last batch.

 

[orthostr8]

I

My practices are in Southern Cal. If you have no problem getting the patients to accept treatments at $5k, then that's good for you. Don’t lower the fee. Most of my patients can’t afford that fee. I keep the overhead low so I can pass on the low cost tx to my patients and compete against the nearby corp offices. With 40% overhead, I can easily bring home 2-3 times more than what I make at my associate job.

I came to this country with nothing. I’d lived in poverty during my HS, college, dental school years. I’d never made more than $6/hour before I became a dentist. When I did my GPR and got paid $2k on my first paycheck, I was so happy. So a 6-figure income seemed very big to me at that time.

I have both life (1mil policy) and disability (get $5k/month if I become disabled) insurances but these are not enough. My wife only works 2-3 days/week, 2-3 hours a day so she can spend time teaching the kids. I don’t want my wife to get out of her semi-retire mode and start working full time again if something happens to me. I work hard and invest now (when I am still healthy) because I want my wife and kids continue to have the same lifestyle that they currently enjoy even when I can no longer practice orthodontics. Who knows what will happen to the specialty in future? Saving enough money makes me worry less about the future competitions, invisalign, GPs stop referring etc.

Given how you describe your background, I understand your outlook much better. I did not grow up wealthy by any means, more like average middle class, but definitely not poverty. So like most kids I aspired to have more than my parents, as did they. And I knew I would have to work hard to do that. For 20 years I worked my tail off and sacrificed a lot in terms of family and taking care of myself, and thought once I paid my dues it would then work out and I could scale back, given the cushy description of ortho everyone told. I knew I could not maintain that type of workload long term. So now I'm pretty burnt out mentally, physically, and financially, but given the changes in the field I actually need to find more income. Oops.

Your mindset also strengthens my hunch that with the changes in our field you will see a changing demographic going on in who goes to dental school, as middle and upper class Americans are going to aim for fields they think are rosier, such as finance. I think this is already happening in medical school.

Your insurance broker recommended with 1mil for life? It just sounds low.

I know we're getting off topic, but young aspiring docs should be aware of these things as they will need it too.

 

[InformMe123]

If even ortho doesn't provide guaranteed high stable income and laidback lifestyle then not sure what else. Any other suggestions?

 

[321931]

If even ortho doesn't provide guaranteed high stable income and laidback lifestyle then not sure what else. Any other suggestions?

Do not go into healthcare looking for laidback lifestyle. I'm saving you 8 years worth of schooling.

 

[orthostr8]

Do not go into healthcare looking for laidback lifestyle. I'm saving you 8 years worth of schooling.

Rainee is the speaking the truth. Everyone used to say orthodontics, dermatology, or ophthalmology and you have it made. I'm not hearing that anymore. You go into medicine these days because you love it and it's decent money, not for a great lifestyle or great money.

 

[Medin2017]

Rainee is the speaking the truth. Everyone used to say orthodontics, dermatology, or ophthalmology and you have it made. I'm not hearing that anymore. You go into medicine these days because you love it and it's decent money, not for a great lifestyle or great money.

ehhh it's still great money unless you're in a bunch of debt b/c you couldn't get scholarships or go to a state school. And medicine is always good money just not always the best lifestyle unless you're smart/hard working enough to match something cush

 

[orthostr8]

ehhh it's still great money unless you're in a bunch of debt b/c you couldn't get scholarships or go to a state school. And medicine is always good money just not always the best lifestyle unless you're smart/hard working enough to match something cush

And please tell me what your background and current status is that makes you qualified to give that misleading assessment

 

[Medin2017]

And please tell me what your background and current status is that makes you qualified to give that misleading assessment

because 3-400k is like top 1-2% of American incomes? Background is irrelevant to know this fact, and anyone disputing it is privileged beyond their understanding. Also because I come from an area of highly educated people and whenever someone throws out "just go into computer science for money bro" I just laugh my ass off. The people working at fb and google were miles ahead of the people going to respectable (i.e. top 10 med schools) in terms of both work ethic and intelligence and I know at least 5-10 people working at those places. They wiped the floor with the kids who went to top 10 med schools at my magnet high school. There aren't many jobs in the world where you can make 3-400 just by spending an extra 8 years memorizing powerpoints I hate to tell you, and I would wager that a sizeable chunk of med students and dental students couldn't do better if they entered another field (again, unless they chose to go to a 400k+ school).

 

[charlestweed]

...Not sure how Charlestweed does it with no modern stuff, but it obviously works for him. He works hard and realizes that high overhead is a killer.

The orthodontists, who practiced in the 80s and 90s, didn’t have any of these modern stuff and yet they were able to handle the same high volume of patients per day and provide the same high quality care for their patients as what today's younger grads can with their modern stuff. If things (alginate/PVS impressions, film xray, twin brackets, niti wires etc) have been proven to work well, there’s no reason to change them. Those sale reps just want your hard earned money.

The 2 corp offices that I currently for lack the modern stuff as well. How about your corp offices? Do they provide you with all the modern stuff? I remember when I bought an existing ortho office in 2009, I got a bunch of fancy TMA wires and copper Niti wires that the seller left behind. I didn’t know what to do with these wires because I got used to working without them. So I sold them on Ebay.

Just sold both of my private practices to a younger orthodontist (mid to late 30's). I will continue to work for the corp office 3-4 days per week. It is SO EASY working for a corp office. No real stress. Just show up and do my job. I plan on doing this for another 10 years and then call it quits. I own the real estate (condo building) on one of the practices, so I will be enjoying passive income there from the new owner's lease payments. In a year ... I plan to downsize our Scottsdale home.

Congrats on your office sale! You are one of the few orthos who agree with me that working for a corp is easy and not too bad. You can still provide quality care for your patients here at the corp office. Many new grads think these corp offices are evil places and that one should stay as far away from them as possible.

Really enjoy reading your posts, 2TH MVR.

 

[Medin2017]

Congrats on your office sale! You are one of the few orthos who agree with me that working for a corp is easy and not too bad. You can still provide quality care for your patients here at the corp office. Many new grads think these corp offices are evil places and that one should stay as far away from them as possible.

Really enjoy reading your posts, 2TH MVR.

new grads (for general anyway) just see corporations as an obstacle to their own private practice from what I've seen. And end of the good old days if you will

 

[orthostr8]

because 3-400k is like top 1-2% of American incomes? Background is irrelevant to know this fact, and anyone disputing it is privileged beyond their understanding. Also because I come from an area of highly educated people and whenever someone throws out "just go into computer science for money bro" I just laugh my ass off. The people working at fb and google were miles ahead of the people going to respectable (i.e. top 10 med schools) in terms of both work ethic and intelligence and I know at least 5-10 people working at those places. They wiped the floor with the kids who went to top 10 med schools at my magnet high school. There aren't many jobs in the world where you can make 3-400 just by spending an extra 8 years memorizing powerpoints I hate to tell you, and I would wager that a sizeable chunk of med students and dental students couldn't do better if they entered another field (again, unless they chose to go to a 400k+ school).

Nice how you just blew off the question. So I looked at some of your posts and it seems you are a dental student. I wish you the best of luck, but if you think you can chime in and give certain, expert advice in the presence of numerous docs in their 40's and 50's with real life experience in the field, the only thing that outdoes your lack of experience and knowledge is your ego and arrogance.

 

[Medin2017]

Nice how you just blew off the question. So I looked at some of your posts and it seems you are a dental student. I wish you the best of luck, but if you think you can chime in and give certain, expert advice in the presence of numerous docs in their 40's and 50's with real life experience in the field, the only thing that outdoes your lack of experience and knowledge is your ego and arrogance.

I'm just laughing at you thinking medicine isn't good money. Also I'm not the one worried about the field and complaining about my current status or future but you do you

 

[orthostr8]

I'm just laughing at you thinking medicine isn't good money. Also I'm not the one worried about the field and complaining about my current status or future but you do you

I'm on here so that intelligent young people get accurate info on the state of the profession. If you feel it doesn't apply to you then good for you and the best of luck. But for you to be answering people's questions and giving advice to others telling them that things are just sweet and that they're going to make good money after school is something you are simply not qualified to talk about. It's like a preschooler telling people what college is going to be like. You are doing your potential future peers a premeditated disservice.

 

[Medin2017]

I'm on here so that intelligent young people get accurate info on the state of the profession. If you feel it doesn't apply to you then good for you and the best of luck. But for you to be answering people's questions and giving advice to others telling them that things are just sweet and that they're going to make good money after school is something you are simply not qualified to talk about. It's like a preschooler telling people what college is going to be like. You are doing your potential future peers a premeditated disservice.

still don't get how 300-400 + in med isn't great money which is the claim you made. If a college person said something like that I wouldn't fault a preschooler for correcting them. Unless you think giving misinformation is doing someone a service. Just because you don't like how ortho is going doesn't mean you should be making sweeping claims about something you have just as little experience as I do.

 

[LFA20]

still don't get how 300-400 + in med isn't great money which is the claim you made. If a college person said something like that I wouldn't fault a preschooler for correcting them. Unless you think giving misinformation is doing someone a service. Just because you don't like how ortho is going doesn't mean you should be making sweeping claims about something you have just as little experience as I do.

But he is an orthodontist... and you are just a first year dental student...

 

[CaliDDS1986]

@orthostr8 sent u a PM

 

[Medin2017]

But he is an orthodontist... and you are just a first year dental student...

I guess once I'm a dentist or omfs I'll have more experience in optometry than a dental student

 

[InformMe123]

I seriously cant think of another alternative to ortho and other certain med/dental specialties that can top them in income/lifestyle/stability

 

[DDS2017]

I seriously cant think of another alternative to ortho and other certain med/dental specialties that can top them in income/lifestyle/stability

Dermatologist

 

[Orthodontist1982]

Lol epic thread revival.

I started the thread 3 years ago.

Just to throw another wrench in this thread. I’m not an orthodontist.

Just a GP who was jealous I couldn’t get into ortho. I actually have no idea the current market of ortho. Shows you can’t go believing everything you read on the the internet.

 

[charlestweed]

If even ortho doesn't provide guaranteed high stable income and laidback lifestyle then not sure what else. Any other suggestions?

Sorry, nothing's guaranteed. You can't expect everything to be handed to you. You've got to make a bit of effort. An ortho certificate is simply a piece of paper that allows you to advertise yourself as orthodontist. Graduating from a 2 or 3 year ortho program doesn't make you a competent orthodontist. And you can't be a successful orthodontist if you are not competent. You have to learn by getting several jobs (a chain or at a private ortho office, or at a GP office etc)...don't be picky. With the jobs you have, you will make several clinical mistakes but you will learn from those mistakes. You will improve your speed and efficiency. When your patients (and the referral GPs) recognize your clinical skills, they will refer more and more patients to you and that's how you grow your practice. Reputation is not built overnight.

 

[321931]

Sorry, nothing's guaranteed. You can't expect everything to be handed to you. You've got to make a bit of effort. An ortho certificate is simply a piece of paper that allows you to advertise yourself as orthodontist. Graduating from a 2 or 3 year ortho program doesn't make you a competent orthodontist. And you can't be a successful orthodontist if you are not competent. You have to learn by getting several jobs (a chain or at a private ortho office, or at a GP office etc)...don't be picky. With the jobs you have, you will make several clinical mistakes but you will learn from those mistakes. You will improve your speed and efficiency. When your patients (and the referral GPs) recognize your clinical skills, they will refer more and more patients to you and that how you grow your practice. Reputation is not built overnight.

+1. Many young dentists believe that their piece of paper: DDS, or Specialist earns them the right to a 32 hour work week making 200k.

Wrong.

You still have to work HARD to make it work. You enter a group practice as a specialist...you get the crap cases from the old guys until they retire...then you pass the **** on to the new guy who buys in.

You start-up...it takes years before you even get a cash flow.

You start-up as a specialist? You are begging GP's for referrals. Better stuff that top 1% ego down to get them referrals.

You work for someone else...you just get the pass downs and the crap from everyone until maybe you prove competant.

You buy a practice? You are property of the bank and will be paying them for 7-10 years.

It's a hard reality that alot of new grads go through. Always nice to see them be humbled up 6-12 months later after they have been through the ringer... It's a great "I told you so" moment.

 

[Steins;Gate]

I look forward to working my tail off regardless as a GP or ortho. I enjoy the challenge.

 

[hahadino2771]

Residents | Georgia School of Orthodontics

18 residents per year.
54 residents total. It is actually bigger than the big H-dental school in Boston, which has class size of 35.

is ortho school a new trend?

 

[charlestweed]

I look forward to working my tail off regardless as a GP or ortho. I enjoy the challenge.

I don’t work as hard as you think I do. Ortho is NOT a very physically demanding job. I don’t feel exhausted at the end of the day even when I see 5-6 times more patients per day than the GPs. It’s also a lot easier than doing fillings or RCT’s or crown preps etc. If you calculate the amount of time the doctor spends on each patient and the fee the doctor collects from the patient, nothing can beat ortho.

I guess the reason I have more positive view about my profession than many of my ortho colleagues feel about theirs is I am lucky to have both my own practices and a P/T corp job…they complement each other. With my own offices, I am less afraid of being let go by the corp office…nobody at the corp can tell me what to do. And when my own practices don’t get a lot of starts (especially during the slow months of Nov through Feb), I am not worried because I have a guaranteed income from my P/T job at the corp. Working at a corp office is like having a vacation. I have to bring a laptop and book to kill time in the morning, when most kids are at school. That’s why I’ve kept the corp job for so long.

 

[Likkriue]

Rainee is the speaking the truth. Everyone used to say orthodontics, dermatology, or ophthalmology and you have it made. I'm not hearing that anymore. You go into medicine these days because you love it and it's decent money, not for a great lifestyle or great money.

You are delusional. "Decent money", who are you Donald Trump?
Making over 200-300k a year is "decent money"?
Jesus Christ.

I am in no way condoning going into 1 million dollars debt to get any degree however if you could get those degrees at a cost no higher than twice your yearly income that's fine. EG maximum 400k to make 200k a year is fine.

Average household salary in the US is a little above 50k a year. Get out of that little hole and meet reality.

 

[321931]

Edit: You aren’t wrong but you are misunderstood. When you factor in the student loans and then a practice loan... you will make “decent money” after taxes eat you alive. Count on the stress to also give your gut a one two punch after years of working. Associating sucks for most people so they take on a practice loan to achieve that 4 day week 200k dream. Doable but more debt.

The engineer or comp sci guy who came out with minimal undergrad loans doing 6 figures in Silicon Valley is much much much better off then any healthcare professional.

The only thing healthcare has going for it is job security and a solid income once everything is paid off.

It’s hard to imagine that 200k is “decent money” but once you earn it and have to pay everyone else off you will understand young one what I’m talking about.

 

[Likkriue]

Gotta factor in that not everyone would be good at comp sci or engineering. I did that stuff in high school and almost dropped out.

I agree it's a ton to work to get the feet steady. But personally anything about 50k a year seems pretty good compared to 80% of the world that make less than 50 dollars a day.

Once you've been through the gutter you will know what I'm talking about. My mom used to make 4 dollars an hour in illegal sweatshops. I'll take being in 200k debt(which I'm projected to have) making 100k a year over that any day.

 

[321931]

Gotta factor in that not everyone would be good at comp sci or engineering. I did that stuff in high school and almost dropped out.

I agree it's a ton to work to get the feet steady. But personally anything about 50k a year seems pretty good compared to 80% of the world that make less than 50 dollars a day.

Once you've been through the gutter you will know what I'm talking about. My mom used to make 4 dollars an hour in illegal sweatshops. I'll take being in 200k debt(which I'm projected to have) making 100k a year over that any day.

Fair enough my parents were immigrants and working the difficult jobs to.

I guess it’s all relative but in all honesty, the money is decent. To be making 200-300k you have to go into practice debt which can be 500k for a startup with zero cash flow or 1 mil for a practice that is doing well.

The bottom line after debts are paid off isn’t that great. It’s decent.

I have a lot of friends that graduated 7-8 years ago and started at tech companies. They have started with salaries of 100k... but with bonus and stock options easy 200k or more.

8 years later after making their money without any debt... I graduate and go into large debt to make a practice work. They are light years ahead of me in net worth. By the time you graduate from dental school which is in 4 years, your tech friends will most likely have a diversified portfolio and making dentist OWNER salary before you have even gotten your license.

See the difference? Huge but I guess you gotta do what ya like. Don’t do it for the money. If you want to, then there are way better options. My gym trainer opened his own LLC and his overhead is literally 0. Pretty sure he takes home more money then me with zero liability or education. Plumbing? Electrician? Specialized IT? SEO LLC all profitable.

But in the end, I agree it’s all relative, dentistry isn’t a bad gig it’s good job with decent money if you don’t buy into fancy gadgets get divorced and live beyond your means. I went into dentistry primarily for the money and was dissapointed for the most part but still happy that I did it. It’s a hard job.

 

[oralcare123]

Fair enough my parents were immigrants and working the difficult jobs to.

I guess it’s all relative but in all honesty, the money is decent. To be making 200-300k you have to go into practice debt which can be 500k for a startup with zero cash flow or 1 mil for a practice that is doing well.

The bottom line after debts are paid off isn’t that great. It’s decent.

I have a lot of friends that graduated 7-8 years ago and started at tech companies. They have started with salaries of 100k... but with bonus and stock options easy 200k or more.

8 years later after making their money without any debt... I graduate and go into large debt to make a practice work. They are light years ahead of me in net worth. By the time you graduate from dental school which is in 4 years, your tech friends will most likely have a diversified portfolio and making dentist OWNER salary before you have even gotten your license.

See the difference? Huge but I guess you gotta do what ya like. Don’t do it for the money. If you want to, then there are way better options. My gym trainer opened his own LLC and his overhead is literally 0. Pretty sure he takes home more money then me with zero liability or education. Plumbing? Electrician? Specialized IT? SEO LLC all profitable.

But in the end, I agree it’s all relative, dentistry isn’t a bad gig it’s good job with decent money if you don’t buy into fancy gadgets get divorced and live beyond your means. I went into dentistry primarily for the money and was dissapointed for the most part but still happy that I did it. It’s a hard job.

Do your friends work a couple of days a week to make those money and did you count income from the sale of your practice as a part of your net worth?

 

[charlestweed]

Do your friends work a couple of days a week to make those money and did you count income from the sale of your practice as a part of your net worth?

Toward the end of your career, you won’t make as much as what you make right now due to health issue. Some of your patients will leave you. Your equipment get older. Therefore, your practice won’t worth as much by the time you try to sell it. I purchased an office from a retired ortho for only $165k.

 

[charlestweed]

It depends on a lot of things: where you live, married vs single, kids vs no kid, having a spouse who works vs stay home mom (or dad) etc. An annual income of $200k is not much if you live here in CA. After paying fed and state income taxes, you’ll bring home around $140k/year or around $12k/month, which is not enough if you have all these expenses to pay:

-Cheapest health insurance (Bronze plan) for a family of 4: $1200/month…..and it increases every year.

-Home mortgage + prop tax + insurance for a 500k house: $4000/month

-Car + life + disability+ malpractice insurances: $1000/month

-Monthly payments for a $400k student loan (30yr payment plan): $2500/month


You are fine if you are single. If you are married and have 1-2 kids, your spouse needs to work as well....and must have a happy marriage.

 

[321931]

It depends on a lot of things: where you live, married vs single, kids vs no kid, having a spouse who works vs stay home mom (or dad) etc. An annual income of $200k is not much if you live here in CA. After paying fed and state income taxes, you’ll bring home around $140k/year or around $12k/month, which is not enough if you have all these expenses to pay:

-Cheapest health insurance (Bronze plan) for a family of 4: $1200/month…..and it increases every year.

-Home mortgage + prop tax + insurance for a 500k house: $4000/month

-Car + life + disability+ malpractice insurances: $1000/month

-Monthly payments for a $400k student loan (30yr payment plan): $2500/month


You are fine if you are single. If you are married and have 1-2 kids, your spouse needs to work as well....and must have a happy marriage.

Don’t forget about the practice loan. A dentist in his early 30s is effectively starting at easily negative ——1mil net worth and an interest rate of 4-5% on practice loan/ 6-7% in student loans.

While my other engineer or tech friends have been getting diversified returns on their portfolio is +3-5% while maxing their 401k for the past 4-6 years while I was in school/bumbling about associateships. They are growing money and earning a positive net worth. Light years ahead in worth. What’s funny is most people that aren’t educated on these kind of things would pick a 200k income over a 150k with stock options job/retirement accounts automatically without taking into account interest, investment and taxes. They see the big number but that doesn’t tell the whole story. I’ve got friends in other healthcare jobs that make 200k with 6 weeks pto, pension and 401k. That just doesn’t exist in dentistry. You take off 6 weeks and you re practice income will drop dramatically.

Anyways if you stay true and steady on dentistry you will make it out with some decent gains. But there are way easier routes to making an income.

 

[kingme23]

^ Grass is always greener I guess. There aren’t many jobs that match dentistry as far as income potential with the same amount of hours and being your OWN boss. Plumber/electrician/ etc have much lower chance of succeeding like a dental office and still require lots of capital to get started. Tech jobs usually cap out way lower than dentistry, not even close. You think dental school is competitive try getting one of the few tech jobs that do match dentistry in terms of income. Don’t know where you live but everywhere I’ve been, dentists drive nicer cars, live in nicer homes, have all kids college paid for, spend the weekend on the boat, etc. Can’t say the same for most of the other professions that have been stated.

 

[Str82th]

income potential

It really is only potential, and just like every other profession, program, school - anything, we live on a bell curve.

ETA- I’m not saying stay away, just that one should be realistic as to what the cost of dentistry truly is. I feel bad for the corporate dentists I see. They pigeon-hole themselves, mostly because private practice docs don’t want to hire them. It is hard to be financially free as a corporate GP.

 

[LFA20]

^ Grass is always greener I guess. There aren’t many jobs that match dentistry as far as income potential with the same amount of hours and being your OWN boss. Plumber/electrician/ etc have much lower chance of succeeding like a dental office and still require lots of capital to get started. Tech jobs usually cap out way lower than dentistry, not even close. You think dental school is competitive try getting one of the few tech jobs that do match dentistry in terms of income. Don’t know where you live but everywhere I’ve been, dentists drive nicer cars, live in nicer homes, have all kids college paid for, spend the weekend on the boat, etc. Can’t say the same for most of the other professions that have been stated.

Yeah... those dentists graduated 20 years ago. Cost of education back then is a lot less..

 

[kingme23]

Yeah... those dentists graduated 20 years ago. Cost of education back then is a lot less..

True but not everyone nowadays goes to a private school coming out with 500k loans. With the newer technologies, younger dentists are able to do more profitable procedures than older docs could. If they have a reasonable amount of debt, the difference from an older dentist isn’t as dramatic as you make it sound.

 

[321931]

I’m sorta curious on how that works? As a owner how can I employ these new technologies to become more profitable and keep overhead down.

 

[kingme23]

I’m sorta curious on how that works? As a owner how can I employ these new technologies to become more profitable and keep overhead down.

WaveOne endo like multiple successful people on here have commented before. Implant CE and materials can be profitable if you do enough of them. Part of it is the technology, but probably more importantly is the fact that newer grads are much more aggressive at furthering their skill set after school and doing more specialty procedures that older dentists usually wouldn’t do.

 

[CaliDDS1986]

WaveOne endo like multiple successful people on here have commented before. Implant CE and materials can be profitable if you do enough of them. Part of it is the technology, but probably more importantly is the fact that newer grads are much more aggressive at furthering their skill set after school and doing more specialty procedures that older dentists usually wouldn’t do.

This is my experience and purely anecdotal:

Younger GPs (myself included) have been pressured and sometimes duped into thinking the latest technology can help specialty procedures. With all the student loans, companies market them to GPs. Why not they figure, you got to pay off your loans and the corps want the money. With endo, wave one and all 1 file systems help you work quicker, which doesn’t help the prognosis of endo. I’ve had tons of failures using these systems and now I have to refer to endo for a retreat on a 1 year old RCT. Dentistry as a whole is just going down a very dark place right now.

 

[InformMe123]

Grass is always greener, there are many engineers/techs who do decide to change and apply to dental school. Thing is to get those good jobs in engineering/tech mean getting jobs at Microsoft, Apple, etc. which are VERY competitive. Not only that but you gotta work very hard and spend 8+ hours each day in front of the computer to move up. Not to mention there is chance of losing your job. The only bad thing in dentistry I would argue is high debt incurred. That being said, if you are bright and hardworking and want to have less debt stress then I would suggest looking into the military or NHSC scholarship and be debt-free.

 

[gn4]

I seriously cant think of another alternative to ortho and other certain med/dental specialties that can top them in income/lifestyle/stability

My brother is a Dermatologist and he has a nice lifestyle and income. His wife is an anesthesiologist and she thinks her lifestyle is nice and she has a nice income. My partner is an Emergency doc and has a nice lifestyle/income. Pretty sure radiology has a nice income/lifestyle as well.

 

[321931]

WaveOne endo like multiple successful people on here have commented before. Implant CE and materials can be profitable if you do enough of them. Part of it is the technology, but probably more importantly is the fact that newer grads are much more aggressive at furthering their skill set after school and doing more specialty procedures that older dentists usually wouldn’t do.

So those are interesting arguments that will be countered with these cold hard facts.

It doesn't matter if you do an endo with normal files (50 cents multiple uses) versus a motor file (20$)...you still will get reimbursed the SAME 600...800$ amount by insurance companies. The goal of running a successful practice is to keep your overhead down. NO associateship is going to supply 20$ motor files...they will supply normal files. All the endodontists I work with use normal files and normal condensing technique...Why? Because it works and its cheap and efficient.

Implant and CE are only relevant if you do enough of them and are in the market FOR THEM. Meaning most practices do 1 restoration of implants a week or even less. That's a normal GP load. If you are only restoring 1-2 a week...there is no way to justify placing implants and the cost associated with them. CBCT and the startup costs. It's very easy to say place implants make money but that is not the reality. Including when you have to deal with complications and the various crappy jobs that GP's have done which results in lawsuits. If you open in a retirement community and just take cash on rich older FFS retirees...then you got yourself a good niche... but people have already setup shop there. If you are thinking of doing it in middle class America with PPO fees...good luck. If you are lower class America... don’t even bother.

Technology is not the way to go in order to become more profitable. New grads can barely cut a class 2 or do fills correctly for 1-2 years...reason why more older docs don't do more specialty work is because they see the profitably of just sticking with simple GV black techniques and marketing their practice that way...or bringing specialists in to do their work. Also older doctors have seen their failures. If you fail a rct on a patient with 4 family members... they might lose faith and go elsewhere. Do you know the difficulty in retaining patients and getting np with their familie in? The loss of one family charts hugely outweighs the endo you did for 600. Plus I can bet you if they referred their neighbors and close friends and your endo fails...you might lose more then JUST one family. Unless you are in the business of fill/drill/stick patient with a bill and no refunds no exceptions then I say go for it but I don't think that is the best business model. I have family members in my office that bring in 10 people. Their extended family and then their relatives to. It's just way to much risk and waste of time to do specialty work unless you are hyper confident it will work, and are willing to refund the money if it fails. This is business 101 not dentistry 101 which they don't teach in schools.

In my experience, I used to do molar endo with rotary and I used to dabble in implants. Now I’m in the process of bringing in specialists to do the work for me. I still do oral surgery as its much easier to do a "good" job. OS its either in or its out...Endo...it has to last 5-10 years and if it fails...smart patient's are going to be asking questions. Why incur the liability?

 

[2TH MVR]

Technology cannot make up for poor clinical skills and lack of experience.