Offering low fee is not good enough. You still have to provide excellent care so your patients refer their friends and relatives to you. You can survive without the GP referrals but you can’t survive without word-of- mouth referrals.
I had same worries like you when I graduated. That’s why I didn’t start my own office until 4 years later. We, orthos, are very lucky that we can still keep our associate jobs while starting our new office. Having a stable income from my associate job really helped reduce the stress of running my own office at the beginning when I didn't have a lot of patients. The general dentists cannot do that.
Unfortunately, my employer isn't as friendly to this scenario as others. My employer has made it quite clear that they do not want to employ orthos who are doing that. There were additional contractual penalties if I tried to hire any of my team members to work with me in my own office. So don't take it for granted if your employer is allowing you to do that.
Oh, I see. I guess the reason they have that restriction is they are able to give you a FT job and want your full commitment. Most places here in CA only have enough patients to hire us a few days a month and we have to travel to other offices (including our own offices) in order to get FT hours. That's why most employers here don't have that restriction.....because if they did, no one would work for them.
I wish it was that simple, and when I was in college and dental school I thought it was. You simply can't compare a hard working individual with 3 jobs and little education trying to make ends meet, to a person with extensive education owning and operating a business. While the latter is obviously overall better off, but that person invested a lot of time, money, and RISK. All of those years of investment in time and finances leads to a lot of debt, and an expectation of an income that allows a certain level of lifestyle, which at least for me did NOT include yachts, luxury cars, or exotic travel. I'm fine driving a Honda and taking a nice family road trip, staying at modest inexpensive homes I find on AirBNB. I DID expect to have a pleasant work schedule and a healthy balance between my family and career. But after you put in all of that effort, you find out that tax law discriminates against small business owners, especially those with educational and business related debt. You find out that a lot of what you were told about your profession is rapidly changing, some arguing for the better and others arguing for the worse. There are lots of variables that determine how each one of us perceives the changes, and this forum really brings that point home. There's no one answer that fits all of us, and I hope you find out that everything you hoped for and expected comes true. Spoiler alert.........it usually doesn't, but most of us come to terms with reality and make it work anyways. For most, it means rolling up our sleeves and rolling with the punches, while a very small minority decide they want to and are able pursue something else. And a certain number gives up and pursues self destruction. Take good enough care of yourself and you'll stick around long enough to see it all.
Well written. We use to tell underclassmen "get some hours before telling me how life is". That poster looks foolish.
Easier said than done. That's like saying "If you can offer $6 filet mignon and lobster dinners, you'll be busy", " If you can sell $15,000 Lexus 300s, you'll be insanely busy." As a start-up that could be deadly advice for your practice.
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Exactly.Somewhat off topic, but related to noobs giving advice. At my Corp job yesterday .... one of the ortho asst's (2 yrs of experience) came into my office and told me that he did not agree with a clinical decision I had made. I looked for the right words to say to him, but an asst with 2 yrs of ortho experience telling a seasoned orthodontist with 26 plus yrs of experience including treating thousands of patients, hiring and training 100s of assts, and purchasing 1 ortho practice, buying a 3000sq foot office condo and resultant costs to build that ortho office and starting 3 ortho practices from scratch. I thanked him for his concern and .........the rest was behind closed doors.
As others have stated. If you choose to provide commentary. Preface your post with your experience and acknowledge some respect to those experienced dental veterans. If you have none (business and practice management experience) .... maybe you should say on the sidelines and learn from others. This is not a game for these orthos trying to make it in the business and personal world. They're giving you a glimpse into the real world financial struggles of being a dentist and running a small business.
You can make it work but not the traditional ways in the most populated areas unless you want to struggle for a long time. The problem with orthodontics is that for having so many "smart" people in the profession, we really don't know how to think. We see something working or appear to be working and we copy every detail of it. The public gives you zero credit for being a clone of another orthodontist.
Do you actually read what people write or just glance at it, make your assumptions, and shoot from the hip?
I agree, that' the advice I give kids when they ask.
You're the man.....not sure how you have time to straighten teeth with all of the business related stuff you have had going on in just 12 years. I've also been out 12 years. I worked for corporate and also started one office, and dabbled with starting two low risk satellites before deciding to concentrate on my primary location and try to make it the best it can be. The jury is still out whether I was right.
Yeah it' quite the wake up call isn' it, people alot of times don't realize owning a dental office is a small business in a very unforgiving way.
You're giving awesome advice. The only caveat is if you have kids and by the time you are actually working the family expenses make it difficult to find money to set aside for retirement. It's funny you mention 42, as that's my age. I utilized the 401k at my previous corporate gig and still now maximize my IRA contributions for my spouse and I every year, but it's still pennies for what we're going to need. Especially given the ballooning health care expenses for the aging and the looming collapse of Medicare and Social Security, which is projected to become insolvent right about when I would likely retire. Great Ponzi schemes, though, with today's deserving seniors being assisted with my taxed income that isn't being invested for me and will run out by the time I'm supposed to collect it.
Hmmmmm. Well, if your question was one step back, I would have simply stayed out of health care, but you cleverly worded your question to avoid that reply, so I'm stuck answering your real question.
I'm going off the topic a little, but this is good stuff for us to discuss. Great point for mentioning the idea of trying to get a group practice. However, I think it is much more realistic to try partnering with graduating pediatric dentists than GP's. If you have a group ortho/pedo practice, or even a shared space that to an outsider doesn't seem like a group practice, you have a fighting chance that outside GP's will still refer to you. If you're in a group practice with GP's, the outside GP's won't refer at all. This may still be a moot point given the decreasing rate at which GP's refer ortho patients in general. And many pedo residencies are teaching their residents to do their own ortho. If you are going the group practice route and are getting a large group together that would have enough ortho to keep you busy, gosh that's a big practice and I don't see how a bunch of recent grads are going to be able to start that from scratch and build it up quickly, or have enough money to buy something that large. You're thinking along the right lines, as the old patient supply lines no longer exist, but I don't think we have yet figured out the magical pill.You're welcome.
Yes on being an Orthodontist. No regrets at all. I can't complain since I caught a little of the good old days (early 90's, early 00). Ortho is easy on the body and IMO less stressful than doing GP procedures.
What would I have done differently? Maybe practice in a smaller community although I do love the Phoenix/Scottsdale area. Best advice: Start a group practice with some GP's, Pedo. For years I tried this, but trying to get everyone to do this was difficult. Dentists just have this mindset to do things solo. If I was a 3rd year or 4th year ortho res ... I would be in touch with some Pediatric 3rd or 4th yrs residents with a plan to start a group practice. At the same time .... talk to some 3rd or 4th year GP students also. All these potential partners would be at the same school if you attended a traditional dental school. It's much easier to have 3,4,5 dentists help to finance a building than being a solo. Shared facility. Mutual referrals. Shared costs and overhead. Camaraderie. Win-win. Yes ... I realize that the ortho is on the receiving end of this, but an orthodontic practice brings in a lot of patients that do not have a GP. The ortho can refer the adults to the GP. Kids go to the Pedo. Practicing on your own, in your little confined space, being responsible for EVERYTHING is not fun. A serious lack of camaraderie.
The other regret was that since I did practice in the swinging 90's-00's ..... my two practices were TOO big and overhead intensive. This really hurt the last 8-10 years. I couldn't move the one office since it was housed in my own building. The other was right next to a GP buddy, so I was very hesitant to move.
No regrets.
Thanks, I'm 45 and I wish someone told me alot of this stuff at 26, that's what people neglect, although you make 200k good money, taxes, sl, practice note, malpractice, license fees, and nowwwww we get to family, you know house mortgage, vacations with family, Medical insurance for family of 4 can run up to 1600 a mnth easily. As you see when it' all said and done you are living a very upper middle class life. Continue to sock away in your Ira, also if you can put money away in taxable accounts not just retirement. The nice thing about ortho is it seems you can practice for a long time.
So true. I was thinking about the rent and increased costs this morning. Every year I have to earn more just to stay the same. My office has either increased or decreased by 20% every year. There is no such thing as getting to a good place and holding steady. I was trying to figure out my next "gimmick" to grow 20% in 2018 and "will it work?"
No, I wouldn’t do anything differently. I keep practicing ortho the same low cost way that I was taught 15+ years ago (traditional brackets and wires) until I retire. There are enough low income patients (and this population is growing rapidly) to keep me busy. I didn’t need to do any demographic study to find out where the high income earners live. I just set up my shops next to the corp offices and compete against them. I don’t mind losing patients to other private ortho offices because they have better newer equipment than mine and because they offer invisalign tx and my offices don’t. Why pay $2000 in lab fee when I can get a full set of brackets for $20? The profit margin is the same even when I charge $2k less. And it’s also much easier for the patients to accept tx when it’s $2k cheaper. One thing I love about ortho is the full autonomy. It makes no sense to let Invisalign company dictating the lab fees, the numbers of cases I have to treat in order to become an elite provider, and the type of intraoral scanner I have to buy etc.
You are in a much better financial shape than when I was at your age. At 30, I had close to $1 million in debts (student loan, home mortgage, 2 leased cars etc). I didn’t start my own practice until I was 33. In 15-16 more years, when you reach my age, you will be ahead of where I am now.
