Are graduating orthodontists living in La La Land?

[Demeter]

I placed an add looking for an orthodontist at my pedo office. I received 30 resumes, but everyone is expecting these ridiculous guarantees. One guy was expecting 1300$/ day. I have never even heard of somone receiving such a high per diem salary. Another guy told me he graduated 6 months ago and has been unable to find even a part time job. And yet, he would not work for less then a 1000$/ day.

Last year when I was an associate, I received 600$ guarantee and 30% of my production. I has happy to make 1000$ on most days. Some days the schedule would fall apart, and I only made a little over my guarantee. You have to take the good with the bad.

Is 1300$/day guarantee a realistic offer for new ortho grad?

---

Members don't see this ad.

 

[ortho lurker]

Is 1300$/day guarantee a realistic offer for new ortho grad?

Yes.

 

[gryffindor]

Yes.

+1, depending on where you are. In some parts of the country, $1300 is realistic. I don't think $1000 is unreasonable either. Although if you got 30 resumes and want to low ball, there will probably be a taker.

If it makes you feel better, I get paid by the hour at one of my jobs. If the schedule falls apart, the remaining patients get rescheduled and I get sent home so the office isn't on the hook for my salary for a failed day of production. However if I'm able to stick it out for the whole 8 hours, I will get the minimum guarantee. Most weeks I average 8 hours/day and even go over a little, but I get paid if we go over so I don't mind. I've been sent home early less than 5% of the time.

 

[HALOdontist]

1300 isn't unreasonable. If your looking to hire an orthodontist then you should have enough starts lined up to keep them busy. Lets go with a low to moderate fee of 4500. If you have 1 start per day then what do you expect to be making off the orthodontist?

Lets say you're overhead is 60 percent (not great), then you've made 500 bucks on that case, a good 11 percent. Seems like even thats lowballing the orthodontist.

I realize that it doesn't work this way right off the bat, because patients don't pay uprfront, medicaid, etc. But after a while it will work that way after the practice has many patients. In the meantime you might have to bite the bullet and be in the negative while the ortho side grows.

Why not just refer the patients to a local orthodontist. Save you the trouble. You do what you do best and they'll do what they do best. You're going to hire a young graduate who comes in and may want to leave after a year or so to make more money then you are paying, then you'll hire one after another to work your patients, leaving little continuity of care and poor results for you patients. I believe it because I've seen it.

 

[ABOOrthodontist]

So how many practices have one start a day. 20-25/month and say 240/year and figuring 2 year tx time say 500 or so active px.

I will tell you..NOT many. Not in this economy with so many orthodontists. Pedo and GP are doing a lot of Ortho and invsalign. Keeping busy and profitable is the game.

A case start of 240 a year is healthy to optimistically high. Okay..maybe in lower slobovia county of rural whatever..250+ but that is the exception.

I am on the east coast metro suburbs okay. People are not paying 1000 per day. Don't believe me..go ask go find out. In fact our study club has a number of new orthodontists working say 2 days a week here and 2 days there. They do not earn 1000/day in fact << than that.

1000 per day. ?? No. No And Again No.

 

[HALOdontist]

So how many practices have one start a day. 20-25/month and say 240/year and figuring 2 year tx time say 500 or so active px.

I will tell you..NOT many. Not in this economy with so many orthodontists. Pedo and GP are doing a lot of Ortho and invsalign. Keeping busy and profitable is the game.

A case start of 240 a year is healthy to optimistically high. Okay..maybe in lower slobovia county of rural whatever..250+ but that is the exception.

I am on the east coast metro suburbs okay. People are not paying 1000 per day. Don't believe me..go ask go find out. In fact our study club has a number of new orthodontists working say 2 days a week here and 2 days there. They do not earn 1000/day in fact << than that.

1000 per day. ?? No. No And Again No.

Yes I understand people aren't paying alot of orthodontists 1000/day but it doesn't mean they aren't getting ripped off by their employers. Buying their employers their fancy cars and houses.

Thats the problem with ortho nowadays anyway, so many people starting multiple practices and basically pushing new orthodontists out of positions and areas, and then hiring for low wages that the new orthodontist must accept because they have no other options and are afraid to start new practices because when you look on google maps there are 50 orthodontists in one square mile, but in reality its 50 orthodontists working 1-2 days a week at 2-4 different locations. Doesn't make sense to me, or maybe it does, just not for me.

But back to the numbers. Its all hypothetical, but lets say you work in a practice 4 days per week, the practice starts a reasonable 150 cases a year at 4500 per case. Thats 675k of production, and lets say they pay 1000/day, giving the orthodontist 200k a year. Again lets say with an overhead of 60%, gives you a net of 270K. So the employer made 70k off the orthodontist, a good return of just over 10%. From what I've been taught and heard from colleagues 5-7% is reasonable for an employer to work off the employee and anything over is questionable.

Either way I think 1000/day is very reasonable, though not given. I mean those guys have to pay for their expensive Northeast property taxes no? and how else would they do it. You don't bank cash by paying great wages to your employees.

 

[Demeter]

1300 isn't unreasonable. If your looking to hire an orthodontist then you should have enough starts lined up to keep them busy. Typically, when a pediatric resident graduates they find an established pediatric office, where they gain an additional year of real world experience. Everything is already set up and systems are already in place. The issue for most graduating orthodontists is that they typically do not associate in another ortho office. They work for a chain or a have several part time jobs at busy dental offices that are looking to offer ortho as a new service. In an office that is not already set up for ortho it is difficult to estimate how many ortho cases there will be or to line up cases. I can't put all of the ortho referrals on hold.

Lets go with a low to moderate fee of 4500. If you have 1 start per day then what do you expect to be making off the orthodontist? Lets say you're overhead is 60 percent (not great), then you've made 500 bucks on that case, a good 11 percent. Seems like even thats lowballing the orthodontist. 11% is really not worth the hassle or risks of having an orthodontist practice in my office. Hopefully, that number is not correct, but it certainly would not be low balling anyone if the owner takes home that little.
Why not just refer the patients to a local orthodontist. I refer to a local orthodontist all the time. The problem is she only wants to see the FFS patients. I have a steady stream of both PPO and Medicaid and would like for all of my patients to get the same type of care.
Save you the trouble. You do what you do best and they'll do what they do best. The problem right now is that nearly everyone is holding on to their patient pool as much as possible. GP's that used to refer out more pedo patients are only referring out the least productive and worst behavior management cases, because they need the production. I am handing out ortho referrals left and right and I think this would be a huge boost in our office production if we were able to offer this service in house.
You're going to hire a young graduate who comes in and may want to leave after a year or so to make more money then you are paying, then you'll hire one after another to work your patients, leaving little continuity of care and poor results for you patients. I believe it because I've seen it.This is a huge concern. I get a ton applicants from California, New York etc.. and I really cannot consider them because the risk of an associate leaving town is too great. I would need to find someone local that is already situated here and is looking for an extra work.

 

[charlestweed]

I placed an add looking for an orthodontist at my pedo office. I received 30 resumes, but everyone is expecting these ridiculous guarantees. One guy was expecting 1300$/ day. I have never even heard of somone receiving such a high per diem salary. Another guy told me he graduated 6 months ago and has been unable to find even a part time job. And yet, he would not work for less then a 1000$/ day.

Last year when I was an associate, I received 600$ guarantee and 30% of my production. I has happy to make 1000$ on most days. Some days the schedule would fall apart, and I only made a little over my guarantee. You have to take the good with the bad.

Is 1300$/day guarantee a realistic offer for new ortho grad?

The dental chains in CA, AZ, TX pay the ortho $1000-1500 day. At some dental chains, the orthodontists, who get paid both the base salary + bonus, can make close to $2000/day&#8230;this is why some orthos stay with these chains for 10+ years. To get paid that much, you have to see 80-100 patients a day and start 2-5 new cases a day for them. Only dental chains can pay such high salary because of the low overhead. Private ortho offices usually pay their associates a lot less. I've heard that orthos in the Northeast get paid much lower (ie 600-800 a day)&#8230;lack of dental chains? too many orthos there?

I think you will do very well by adding ortho to your practice. Splitting the production is a win-win financial agreement for both you and the associate ortho. If you provide staff, supplies and instruments, the split should be 60/40 or 70/30 or somewhere in between&#8230;.you, of course, get the higher percentage. I do ortho at my sister's office, I get 75% and my siter gets 25% because I bring my own staff (4 RDAs, 1 DA, 1 receptionist), supplies, instruments and my offfice manager handles all the insurance/medicaid billings. Make sure your office has a space for Pan/ceph machine.

It is not easy to find the right ortho who is willing to stay with you even when the initial production is low. I've met several GPs who attempt to add in-house ortho to their practices and failed&#8230;.and these GPs have to get rid of the unused ortho supplies by selling them to me. It works well for my sister and me because we are blood relative and I didn't mind getting paid $100-200 a day when we first started. It took me almost a year to earn the same amount of $$$ as the associate salary at the dental chain. Currently, I make the most $$$ at my sister office&#8230;too bad, she only has enough patients for me to be there 1 day a month.

Demeter, if I were a new grad ortho and had no other job offers, I would, without any hesitation, work at your pedo office at any rate that you offer me. After a couple of months(years) when the daily ortho production at your office reaches the range of $5-6k, I am sure you will have no problem paying the associate ortho $1300+ a day.

 

[BlueToothHunter]

I would like to let you know that in Los Angeles, California, each new job advertisement attracts over 40 applications from new orthodontic graduates, residents, and "veterans". One kid from one of the local orthodontic residency "expected" to be making $1,200/day, and working full-time. Mind you, most of these kids have NEVER worked a single day in their life for a dollar... so they have no idea.

Orthodontic average fees are dropping like flies in SoCal area: $3500 is the highest FFS, most HMOs and PPOs pay around $1500 and $2600, respectively. Denti-Cal orthodontics pays around $2600... so most offices can't be making huge profits as years before during the bubble. Most in-house orthodontists are offered $800 - $850 per diem and if you're lucky you may get over a grand. Some do offer percentage of collections, but those are slow, new start-ups where even the owner GP is suffering himself.

Right now where I work, I have about ten orthodontists within my ZIP code. A periodontist friend of mine just took over a perio office in L.A., and he's regretting his decision. The staff pay is too much of expense and he is having to pay out of his own savings. Gone are the days of traditional specialist independent offices... more like, it's one-stop shop where you get your white fillings and bleaching done together after you get your Invisalign (just to straighten teeth!) is where most average dental consumer will turn to. Oh, plus, in most areas of L.A. and O.C., the patient loyalty is almost nothing. It's the prices that people will follow and you could imagine the advertising of the price slashing seen throughout! Dentistry is definitely not what it used to be in LA LA LAND!

Yes I understand people aren't paying alot of orthodontists 1000/day but it doesn't mean they aren't getting ripped off by their employers. Buying their employers their fancy cars and houses.

Thats the problem with ortho nowadays anyway, so many people starting multiple practices and basically pushing new orthodontists out of positions and areas, and then hiring for low wages that the new orthodontist must accept because they have no other options and are afraid to start new practices because when you look on google maps there are 50 orthodontists in one square mile, but in reality its 50 orthodontists working 1-2 days a week at 2-4 different locations. Doesn't make sense to me, or maybe it does, just not for me.

But back to the numbers. Its all hypothetical, but lets say you work in a practice 4 days per week, the practice starts a reasonable 150 cases a year at 4500 per case. Thats 675k of production, and lets say they pay 1000/day, giving the orthodontist 200k a year. Again lets say with an overhead of 60%, gives you a net of 270K. So the employer made 70k off the orthodontist, a good return of just over 10%. From what I've been taught and heard from colleagues 5-7% is reasonable for an employer to work off the employee and anything over is questionable.

Either way I think 1000/day is very reasonable, though not given. I mean those guys have to pay for their expensive Northeast property taxes no? and how else would they do it. You don't bank cash by paying great wages to your employees.

 

[ortho lurker]

It's tough right now not only for new grads but also for seasoned veterans. My advice to residents is to keep in contact with your upper classmen who graduate because you may need an "in" just landing a job at a chain after graduation!

 

[charlestweed]

Yes I understand people aren't paying alot of orthodontists 1000/day but it doesn't mean they aren't getting ripped off by their employers. Buying their employers their fancy cars and houses.

Thats the problem with ortho nowadays anyway, so many people starting multiple practices and basically pushing new orthodontists out of positions and areas, and then hiring for low wages that the new orthodontist must accept because they have no other options and are afraid to start new practices because when you look on google maps there are 50 orthodontists in one square mile, but in reality its 50 orthodontists working 1-2 days a week at 2-4 different locations. Doesn't make sense to me, or maybe it does, just not for me.

These orthodontists (myself included) start multiple offices because they are not able to get enough patients at 1 location. It takes a lot of effort to start an office. Whenever you start a new office location, you are taking a lot risks (rent, construction cost, business loan etc). You shouldn’t complain about these filthy rich orthos who abuse their new grad ortho associates. They are successful because they are willing to take risk. I wouldn’t be where I am today if I didn’t take risk. I become successful because I wasn’t picky about the initial job offers. Right after I finished my residency 10 years ago, I worked 6 days/ week at 3 different dental chains and 1 private office…some places paid me as low as $800 a day.

 

[ortho lurker]

Opening an ortho program at a GP or pedo office may not be as easy as it seems. There's a reason why some chains, ie. Aspen Dental, don't even hire orthodontists. The high doctor and staff salaries, supplies (bands and pliers are expensive), lab fees (most GP offices don't have a ceph x-ray so they outsource records) and headaches such as doctor turnaround, dead-beat patients who don't pay, and the dreaded: "What do I do with these active patients in braces if the ortho dept doesn't pan out?" are detriments. Also, bear in mind that not every one of those referrals that get sent out turn into starts. Often times you look at the day's schedule filled with consults and less than half show up. A reasonable estimate for conversion of actual consults-->starts may hover around 30-50% with this economy, and often times it involves negotiating the price to seal the deal. A new ortho grad probably would not get involved with a new GP ortho start up without a reasonable daily guarantee because they have no vested interest to stay there long term. The new grad ortho is also taking a risk with this start up arrangement because the completion of these active braces cases fall on their shoulders if the ortho dept shuts down (there's no guarantee that the referral orthodontists down the street will accept those transfer patients). I have heard of in-house orthodontists who stop taking new patients and are enslaved for the next 2 years at that GP office just to finish those cases, what a waste of time! As an ortho grad, if the arrangement is strictly on % of production, then you might as well start your own office if you are collecting $100-200 a day for those first few months.

 

[kato999]

I think most orthodontist expect to get 1000-1300/day simply because they feel they earned it. Most were in the top of their class and have taken on extra loans. They see the guy in the bottom of their dental class getting 600-1000k per day as a GP at this point and feel their services are worth more. I am certainly not justifying what they should make as it really depends on the market at this point.

Since invisalign has come on there are now 44K providers that provide some form of orthodontics in their practice opposed to less than 8K in 2001. Overall the the quality of orthodontics in this country has gone down along with the costs. Invisalign is encouraging GP's to correct class II's and class III's. Many are not even taking a lateral ceph. Invisalign doesn't even care if you submit a pano anymore.

I think ortho prices will continue to decline as more GP's jump into the fray. The good news is this will allow a higher percentage of patients to seek treatment.

Orthodontists will have to become ultra-efficient with low overheads to compete. We have had to lower our fees and increase direct market advertising. We have trimmed costs and have increased our number of starts by 22% last year, but I think we were in the minority of practices around us.

Although it may seem that I hate invisalign I do believe it can work well. I've treated about 160 invisalign cases since I started in 2009 and I am still learning how get the best results. I won't treat a case unless I think I can get ABO quality results the same I would with fixed appliances and this has helped minimize problems.

Anyway, to some up my rant, I think the market for orthodontists is not good, nor is it going to improve soon. I think 800-1K per day is pretty realistic, but if you want to keep your doctor you better be willing to pay more in the future or they will bolt once the economy rebounds a little.

 

[ItsGavinC]

Ortho is somewhat in the gutter here in Arizona. They are all struggling to some extent. My take on the per diem situation is that you'll know your offer is too low if nobody (who you would want working for you/with you) accepts it.

If somebody accepts it because it is the best offer they had, then it isn't too low.

As an aside: I see NO reason for you to bring an orthodontist into your practice. You can make much more money doing pedo then you'll ever make by having ortho there. Especially in this economic climate (but even if things were growing great). We looked at doing it for an office we just opened in May, but it made no sense financially.

Instead, look at opening another pedo office and hiring a pedo associate. That will make you much more money.

 

[HALOdontist]

These orthodontists (myself included) start multiple offices because they are not able to get enough patients at 1 location. It takes a lot of effort to start an office. Whenever you start a new office location, you are taking a lot risks (rent, construction cost, business loan etc). You shouldn’t complain about these filthy rich orthos who abuse their new grad ortho associates. They are successful because they are willing to take risk. I wouldn’t be where I am today if I didn’t take risk. I become successful because I wasn’t picky about the initial job offers. Right after I finished my residency 10 years ago, I worked 6 days/ week at 3 different dental chains and 1 private office…some places paid me as low as $800 a day.

Its a downward spiral that you've been thrown into. Everyone starts multiple practices everywhere and thus there aren't enough patients at one location, so every orthodontist is always on the look out for the up and coming, expansion expansion expansion. When asked what's the best way to grow a practice, the answer is open a new practice. Why not just work your practice, be good at what you do, be personable, a member of the community, etc. It doesn't work that way anymore.

I started looking in areas with a small number of orthodontists, underserved you might say, and when I began looking to buy an older orthodontists practice I learn that 2 guys were going to open new practices in the town, when they already have 3 other practices. Get the heck out of here. Do you really need that 4th office? Money money money. I think the public would be more suprised by the money hunger out there in medicine and dentistry. Now don't get me wrong I like money and I'm no saint, so what do I have to do? Well I think I'll start more practices, sounds fun. No more Mom and Pop orthodontists.

And I'm not necessarily complaining about orthodontists taking advantage of the new ortho grads as much as I'm trying to say that certain salaries are reasonable (1000-1500+) depending on the circumstance and the income being produced.

$800 per day 10 years ago is great. There are guys in the northeast offering less than that, and I saw one ad for an orthodontist at $60 bucks/hour, awful.

To the person quoting the $2600 fee for ortho that is awful. I'd have a hard time taking that plan, but beggars can't be choosers I suppose.

 

[CanuckDDS]

Its a downward spiral that you've been thrown into. Everyone starts multiple practices everywhere and thus there aren't enough patients at one location, so every orthodontist is always on the look out for the up and coming, expansion expansion expansion. When asked what's the best way to grow a practice, the answer is open a new practice. Why not just work your practice, be good at what you do, be personable, a member of the community, etc. It doesn't work that way anymore.

I started looking in areas with a small number of orthodontists, underserved you might say, and when I began looking to buy an older orthodontists practice I learn that 2 guys were going to open new practices in the town, when they already have 3 other practices. Get the heck out of here. Do you really need that 4th office? Money money money. I think the public would be more suprised by the money hunger out there in medicine and dentistry. Now don't get me wrong I like money and I'm no saint, so what do I have to do? Well I think I'll start more practices, sounds fun. No more Mom and Pop orthodontists.

And I'm not necessarily complaining about orthodontists taking advantage of the new ortho grads as much as I'm trying to say that certain salaries are reasonable (1000-1500+) depending on the circumstance and the income being produced.

$800 per day 10 years ago is great. There are guys in the northeast offering less than that, and I saw one ad for an orthodontist at $60 bucks/hour, awful.

To the person quoting the $2600 fee for ortho that is awful. I'd have a hard time taking that plan, but beggars can't be choosers I suppose.

This is upsetting. I think good Ortho is an undervalued service. General dentists used to refer to a certain orthodontist because they got the best possible results for their patients and they trusted the orthodontists knowledge and skill. That is simply not the case anymore.

Now, the trust is in Invisalign and the almighty dollar. Patient care has gone for a ****.

Should orthodontist's get paid less than hygienists? Is that what we in the dental profession want? Soon only those in the bottom of the class (you know, the guys you wouldn't let work on your dog) will be the ones who go into post grad. ortho and we in North America will look like the British. Awesome.

 

[charlestweed]

Its a downward spiral that you've been thrown into. Everyone starts multiple practices everywhere and thus there aren't enough patients at one location, so every orthodontist is always on the look out for the up and coming, expansion expansion expansion. When asked what's the best way to grow a practice, the answer is open a new practice. Why not just work your practice, be good at what you do, be personable, a member of the community, etc. It doesn't work that way anymore.

I started looking in areas with a small number of orthodontists, underserved you might say, and when I began looking to buy an older orthodontists practice I learn that 2 guys were going to open new practices in the town, when they already have 3 other practices. Get the heck out of here. Do you really need that 4th office? Money money money. I think the public would be more suprised by the money hunger out there in medicine and dentistry. Now don't get me wrong I like money and I'm no saint, so what do I have to do? Well I think I'll start more practices, sounds fun. No more Mom and Pop orthodontists.

And I'm not necessarily complaining about orthodontists taking advantage of the new ortho grads as much as I'm trying to say that certain salaries are reasonable (1000-1500+) depending on the circumstance and the income being produced.

$800 per day 10 years ago is great. There are guys in the northeast offering less than that, and I saw one ad for an orthodontist at $60 bucks/hour, awful.

To the person quoting the $2600 fee for ortho that is awful. I'd have a hard time taking that plan, but beggars can't be choosers I suppose.

Starting multiple offices is the easiest solution to grow your business, my friend. Think about it. How can you grow your office when the local population doesn't grow and the number of practicing orthos in the area keeps on rising (due to the opening of new ortho programs)? There are only 2 possible ways for your business to grow without having to add more new offices: 1.your competitors' business fail and 2.Your patients don't wear their retainers and you have to put braces back on them again. This is the reason why I always tell the new grad not start an expensive high tech office at one location. Instead, spend the same amount and open 3-4 different offices. This way, you can attract not only more patients but also more referring GPs.

The reason I open multiple offices is I want to quit my associate job at the chains and work for myself. The 3 offices I currently own only have enough patients to keep me busy 11days/month. I still have to work 11 days/month for a dental chain.

Yeah, $800/day was a great salary 10 years ago when the dental + ortho tuitions were about 1/5 of what you, current ortho residents, have to pay right now. The point I am trying to make is in order to be successful, you must take risk and be willing accept the job offers that are not really what you expect. Having a low paying job is still better than sitting at home doing nothing.

One last point, since your $20/hr ortho assistants do most of the hard work for you, you can make very nice profit (nicer than what most GPs can make, nicer than working for a chain as in house ortho) at any ortho fee...and you don't have to work very hard. Of course, it doesn't have to be low like $2600 a case.

 

[kato999]

Starting multiple offices is the easiest solution to grow your business, my friend.

While I agree starting a new office may be a way to grow your business it sure as heck isn't the easiest. Marketing your current area, trying to bring old referral sources back into the fold, and general promotions of your practice are all ways of increasing starts without the headache of buying a new location.

The fixed monthly costs (rent/mortgage, phone, internet, utilities etc) go up the more locations you have. Unless you're able to work out of an existing office of another GP or something where you can defer some of that, you'll need to evaluate the cost/benefit of the location or you could easily lose money.

 

[gryffindor]

You're going to hire a young graduate who comes in and may want to leave after a year or so to make more money then you are paying, then you'll hire one after another to work your patients, leaving little continuity of care and poor results for you patients. I believe it because I've seen it.This is a huge concern. I get a ton applicants from California, New York etc.. and I really cannot consider them because the risk of an associate leaving town is too great. I would need to find someone local that is already situated here and is looking for an extra work.

Where are you advertising that people from opposite ends of the country come across your ad and send you resumes? Assuming you are nowhere near NY or CA, it's unreasonable to think that any of those candidates are going to move to your state and work for you. Continuity of care is big. I took over 200+ cases started by the previous doctor who gave two weeks notice and moved away. It's taken over a year to literally straighten things out and I am still dealing with the aftermath. If I quit, the office could easily find someone to hire and replace me, but honestly, the patients are not getting quality care with this revolving door of doctors. If the patients are coming from your pedo practice and you care about your office reputation, then you will be the one having to deal with poor ortho outcomes, overrun treatment times, and frustrated parents who will wonder "why did the my orthodontist leave? he was so nice!"

Are there really no other orthodontists in your area you could start a new referral relationship with? Just this one FFS lady? With all this talk of hungry orthodontists, you would think there would be someone out there happy to obtain a new referral source.

A few other things that bother me about working in a GP office - you may or may not have thought of these.

1) Room arrangements. I waste a lot of time trekking through doors going from room to room. The open bay arrangement exists in ortho for a reason. You may have an open bay in your Pedo office so this may not apply. At the same time, GP chairs are really annoying. I don't need most of the features on the chair to do a wire change and they usually get in my way. These items aren't a big deal when I don't have many patients, but they definitely slow me down when we have a ton of patients and I'm trying to be efficient.

2) Assistants & Front Desk. If your assistants are used to assisting pedo and GP only, it will take time to train them to catch on to ortho. I work in a GP office once a month where it has taken me a year to teach my assistant to take off color ties and learn the names of the instruments and supplies (she works assisting GP full time and helps me the one time a month I am there). We are so busy when I'm there, I don't have time to teach her how to place wires. She was just getting the hang of placing colors on the brackets but now she is out on maternity leave. The last two months I've been stuck with any random assistant the office assigns me and it's like starting back at square one. The only thing they can do is turn over the chairs and take alginate impressions. I'm stuck doing EVERYTHING else if any of us are going to go home at a reasonable time. I still want to pull my hair out when trying to teach the front desk about ortho "emergencies" and the difference between an ortho adjustment and retainer check. They are so focused on the pedo/GP functions of their jobs, they have a hard time incorporating ortho because ortho schedules differently than pedo/GP.

 

[Demeter]

Starting multiple offices is the easiest solution to grow your business, my friend. Think about it. How can you grow your office when the local population doesn’t grow and the number of practicing orthos in the area keeps on rising

Charlestweed, I think your business plan of having multiple, small low-overhead offices is absolutely brilliant. Some people find a way to thrive in a difficult economic climate. I wish I had done the same. I have a 2700sqft office, and I use about half of it. I thought I wanted to have multiple associates in my office, now I wish I had a smaller one with a lower overhead.The problem is, I look at my office and see three empty operatories plumbed and ready to go.

 

[Demeter]

This is my take on per diem guarantees:
A guarantee is a measure of how much risk the owner is willing to take. It is not necessarily an indicator of how much production the associate can make.
The lower the guarantee, the lower the risk for the owner and the greater the risk for the associate. There needs to be a proper balance for this relationship to work out.

For associates that are looking for an office, my advise would be to look for an office that is willing to provide a reasonable guarantee. This way you can count on the office being busy enough to provide you with a decent amount of production, so that you can earn your paycheck. Rule number one is you have to earn your keep. You need to produce more then your take home, otherwise there is no reason for your existence in another person's office.

This may sound counterintuitive, but I would avoid the high guarantee offers. They can be the demise of a solid job opportunity.

Let's say you found a job that guarantees you 1300$/day.You think, hey now I got it made. But, what do you think will happen the day when pumps break down and the owner realizes that only has he lost 5000$ in the production, plus staff expense and normal overhead, but now he also cut a check for 1300$ to his associate. What happens when the schedule falls apart because the schools changed the TASS testing date, or everyone cancelled because the kids had halloween parties they could not miss, or the flu has everyone sick. Do you think the owner is going to continue writing checks for 1300$. No, he is going to say, "Man, I am sorry to tell you this, but this is not working out". That happened to me. The job was good. On most days I earned more then my guarantee, but on the few days when I could not produce my keep due to the schedule etc... I got let go. The next round, I stopped worrying about the guarantee and started looking at real parameters such as new patients, average production per day, collections etc...

 

[rav4182]

hey i might sound like a total noob but can someone please explain how your able to open up multiple offices at the same time? wouldn't each office cost rent, equipment, staff, etc. how much debt would that be and how long would it take to even pay off?

 

[ortho lurker]

.

 

[charlestweed]

Charlestweed, I think your business plan of having multiple, small low-overhead offices is absolutely brilliant. Some people find a way to thrive in a difficult economic climate. I wish I had done the same. I have a 2700sqft office, and I use about half of it. I thought I wanted to have multiple associates in my office, now I wish I had a smaller one with a lower overhead.The problem is, I look at my office and see three empty operatories plumbed and ready to go.

Thanks, man. This isn’t a brilliant idea. I spent as little as possible because I was afraid of failure. I really admire the successful orthos who invest a lot of $$$ for their nice state-of-the-art offices and charge $6-8k a case. I just don’t have the gut and the business skills to do that.

 

[charlestweed]

hey i might sound like a total noob but can someone please explain how your able to open up multiple offices at the same time? wouldn't each office cost rent, equipment, staff, etc. how much debt would that be and how long would it take to even pay off?

No, I didn’t start multiple offices at the same time. After the success of the first office, I decided to start a 2nd office and cut down my associate days at a dental chain. It took me 6+ years to set up 3 offices. The 3rd one is actually an existing practice that I purchased from a retiring ortho 2 years ago. All 3 of my offices are very small (990-1400 square feet). The combined rent for all 3 is only $6500/month. No, I didn’t have to hire additional staff nor I had to buy new instruments…my assistants and office manager travel from office to office with me and they also carry the ortho instruments with them.

 

[ItsGavinC]

hey i might sound like a total noob but can someone please explain how your able to open up multiple offices at the same time? wouldn't each office cost rent, equipment, staff, etc. how much debt would that be and how long would it take to even pay off?

Rent is SO cheap now it's amazing. We just opened a new office last year (pedo not ortho) and the overhead is basically in the ballpark of $1k a day. That includes staff, supplies, rent, cleaning, phone, internet, etc. Does not include marketing though.

I'm a huge fan of this mentality. Low overhead means you can produce less and still take home a fair amount. Higher overhead can be a more nicely decorated office, but it also means you are paying for it with each paycheck.

To each his own.

 

[GTFOOMICT]

I say the new orthodontists are out of line. You're a new grad. I don't care that you put in your 2-3 years of residency. You don't deserve the same income that established practitioners have. You're not as business savy. You're not as good at communicating with the GPs. You're not as good with the patients. You're not as good at marketing. You're not as good at selecting your location. And lastly, you're not as good clinically. You DO have the foundation to be just as good or better.

I really hope this attitude is in the minority of new ortho grads. To start out a GREAT career so bitter would be a shame. Hopefully it's our generation's debt that is pushing these salary requests and not an entitlement attitude. I can understand the financial stress, I've run my own numbers..... You have to start somewhere though.

Charlestweed seems like a Doc I need to meet though.

 

[gryffindor]

Let's look at this issue over time.

I attended a business-related ortho meeting two years ago when I was still a resident. The speakers were discussing hiring and firing. During the break, I went to the restroom and there was a woman complaining about how associates these days demand too much money. She went on to say that at her first job, she "only" got $350 a day. I took note of the name on her name tag and looked her up later. She finished residency in 1991 and must have been working somewhere in the Chicago area based on her school and location. In 2001, charlestweed was at $800/day in California. In 2011, I think $1000+ is a reasonable expectation for an associate, especially if you want that person to stick around.

 

[CanuckDDS]

I say the new orthodontists are out of line. You're a new grad. I don't care that you put in your 2-3 years of residency. You don't deserve the same income that established practitioners have. You're not as business savy. You're not as good at communicating with the GPs. You're not as good with the patients. You're not as good at marketing. You're not as good at selecting your location. And lastly, you're not as good clinically. You DO have the foundation to be just as good or better.

I really hope this attitude is in the minority of new ortho grads. To start out a GREAT career so bitter would be a shame. Hopefully it's our generation's debt that is pushing these salary requests and not an entitlement attitude. I can understand the financial stress, I've run my own numbers..... You have to start somewhere though.

Charlestweed seems like a Doc I need to meet though.

I completely think that this is the root cause of the salary demands. It blows having the debt that new grads have. If older practitioners can't see that then they are very near sighted. I don't think it is a sense of entitlement at all on the part of new ortho grads (or new GP's for that matter). It is just a reality of post grad education.

 

[jsmars03]

I think it is important to put in some context with this argument. Many of these new grads (specialist or GP) have 0 money 300k+ in student loans (Within the next few years I believe this will be the norm) which is a little more than 3200 a month for ten years. They also have families. They want to give the best living possible for them, and want to save up and buy a house and have their shot at the american dream.

 

[Demeter]

I completely think that this is the root cause of the salary demands. It blows having the debt that new grads have. If older practitioners can't see that then they are very near sighted. I don't think it is a sense of entitlement at all on the part of new ortho grads (or new GP's for that matter). It is just a reality of post grad education.

Some grads have an unbelievable amount of debt. I can't imagine the stress this must place on a new grad to land a high paying job.

I'm not exactly sure what you meant when you wrote:" If older practitioners can't see that then they are very near sighted". I interpret this to mean, that older practitioners should be sympathetic to the new grads financial plight, and should pay them a higher salary to help them pay off an enormous debt.

This is a business. I have my own debt to worry about. If you think that the older practitioners are going to pay more to a guy that has twice the debt as the next applicant, you are not being realistic.

 

[ItsGavinC]

I think it is important to put in some context with this argument. Many of these new grads (specialist or GP) have 0 money 300k+ in student loans (Within the next few years I believe this will be the norm) which is a little more than 3200 a month for ten years.

LOL, I have around $380k and that is around $3000 a month for 30 years!

 

[3rdmolarslayer]

and some people would say that orthodontist make more than oral surgeons?
Not at $1000/day...I can tell you that!

 

[ObviousGuy]

and some people would say that orthodontist make more than oral surgeons?
Not at $1000/day...I can tell you that!

This is so true.

I moonlight as a resident and make more than 1000 a day take home...and I am only keeping a resident's percentage of what I produce.

Why not make it an entitlement issue? If someone wants to go to extra schooling/residency then they should be able to demand more. If you don't want to pay it and still want an ortho associate..then either increase the offered salary or keep holding out for the sucker who wants to work for peanuts.

 

[GTFOOMICT]

and some people would say that orthodontist make more than oral surgeons?
Not at $1000/day...I can tell you that!

Our income is next. Perio and GPs are all over implants.

 

[ortho lurker]

and some people would say that orthodontist make more than oral surgeons?
Not at $1000/day...I can tell you that!

Who says orthos do it for the money #1? I think the top reason is so that they can surf the web and play games on their smartphones while the work is being done (even as an associate). Heck, you really don't even have to put on a glove for most procedures.

 

[CanuckDDS]

Some grads have an unbelievable amount of debt. I can't imagine the stress this must place on a new grad to land a high paying job.

I'm not exactly sure what you meant when you wrote:" If older practitioners can't see that then they are very near sighted". I interpret this to mean, that older practitioners should be sympathetic to the new grads financial plight, and should pay them a higher salary to help them pay off an enormous debt.

This is a business. I have my own debt to worry about. If you think that the older practitioners are going to pay more to a guy that has twice the debt as the next applicant, you are not being realistic.

You are right "this is a business" and new ortho grads are asking for guarantees because they are looking out for their own best interests, not your best interest right? If they feel that $1300/day is what they are worth, or the amount that'll help them pay off their STUDENT debt within the next 50 years then they are not in La La land. They are being "business" savvy.

Hopefully, you can find a situation that works out for you. But I wouldn't want to work for someone that doesn't seem to value my education, training, and expertise (and I'm not saying that you don't, but just that it may seem that way to the applicant). It just doesn't seem like a good situation to want to get involved with.

When I was a GP, my boss paid me well. He could've got away with paying me less, but he appreciated what I brought to the practice. We are still friends and I would help him out in any situation. He still did OK for himself even after helping a lowly new grad (like me) pay off my debt, he still drives a 911 and I don't think paying me an extra % or 2 had hurt his bottom line. In fact it may have helped, I worked my ass off for him, covered the clinic when he needed to run and I send all people who ask me "do you know a good dentist in the area" to him.

That is what I meant.

 

[drgoro]

Buddy of mine (ortho), just landed $1000/day and some additional percentage (not quite sure how much of what), but he was out of work for 5 mnths before this, doing crappy part time gigs.

 

[Demeter]

either increase the offered salary or keep holding out for the sucker who wants to work for peanuts.

I am not looking for a sucker. Let me tell you want those jobs sound like.

The owner wants you to do all the low productive work and he wants to see all the cash patients, or the productive procedures. That is a sh$t job.

The practice owner wants you to hang around in case emergency patients show up. He asks you to go out into the community and recruit your own new patients. That is a Sh$T job.

When you are paid only a per diem guarantee and you realize that your take home is small % of what you produced, that's when you know that you became the sucker.

600$/day guarantee just for walking in the door, plus a fair % of the money produced is definately not peanuts.

I was offered the same,when I gradated from pedo. I was smart enough to look past the low guarantee and see a solid opportunity. When I went to the OR, I would produce 12,000$. Other days, 5K doing sedations/exams. 30% of that is a decent pay check. Some days were slow, and I earned a little more than my guarantee. Overall, this was an awesome job. I am glad that I did not walked away, because there was no 1000$ guarantee.

 

[gryffindor]

600$/day guarantee just for walking in the door, plus a fair % of the money produced is definately not peanuts.

I was offered the same,when I gradated from pedo. I was smart enough to look past the low guarantee and see a solid opportunity. When I went to the OR, I would produce 12,000$. Other days, 5K doing sedations/exams. 30% of that is a decent pay check. Some days were slow, and I earned a little more than my guarantee. Overall, this was an awesome job. I am glad that I did not walked away, because there was no 1000$ guarantee.

I have never heard of a decent ortho job being offered for $600/day guarantee. Surely if you can offer an orthodontist a monetary situation similar to what you got to as a pedodontist and deliver on it, then a (smart) hungry associate will stick around. But is this realistic? You need to close on a 5K case for ortho or else you get nothing. If you don't close on a 5K full treatment case then your only other option is a 1K phase one case. There is no in-between treatment plan between a phase 1 and phase 2 case like there could be in a restorative pedo treatment plan. The only way for an ortho to produce 12K is to start at least 1 - 2 cases/day plus all the residual adjustments coming in from the previous cases started. If you can produce the patient flow to make it happen then great for both parties involved! But please look at it carefully or else you will get a revolving door of associates which may not bring the best reputation to the pedo side of your practice.

 

[charlestweed]

Who says orthos do it for the money #1? I think the top reason is so that they can surf the web and play games on their smartphones while the work is being done (even as an associate). Heck, you really don't even have to put on a glove for most procedures.

Working at a dental chain would be very boring if I didn’t carry a smartphone and a laptop with me. Instead of putting on the gloves, an ortho friend of mine uses a disposable tongue depressor to retract the patient’s cheek and so he can check the occlusion. Quick, cheap and easy. These tongue depressors cost a lot less than the latex gloves.

 

[charlestweed]

So how many practices have one start a day. 20-25/month and say 240/year and figuring 2 year tx time say 500 or so active px.

I will tell you..NOT many. Not in this economy with so many orthodontists. Pedo and GP are doing a lot of Ortho and invsalign. Keeping busy and profitable is the game.

A case start of 240 a year is healthy to optimistically high. Okay..maybe in lower slobovia county of rural whatever..250+ but that is the exception.

If I only had 1 start a day (or 500 active patients) at my practice, I wouldn’t work 4-5 days a week and only see 20 patients a day. 3 starts a day is my goal. With the current 700+ active patients (all 3 of my offices combined), I only have to work 11 days/month. I see 60-80 patients a day with the help of 4-5 ortho RDAs. I don’t really need to hire a new grad ortho and pay him/her 1000+ a day….and I don't have to deal with the associate ortho's different treatment philosophies.

Because the ortho RDAs can do all the work for their orthodontist bosses, most private ortho practices don’t have to hire the ortho associates to handle high patient load. Most good paying ortho associate jobs can only be found at non-ortho practices such as dental chains, GP practices, Pedo practices etc.

There are 2 options for new ortho grads:
1. Decline low paying job offers and file for unemployment and student loan deferment.
2. Accept any job offer. Work for a boss (a dental chain, GP, or Pedo) who doesn’t value your experience, expertise and training. You can use the $$$ you earn to set up your own practice and become your own boss sooner than the guys who choose the option 1.

 

[ItsGavinC]

This is so true.

I moonlight as a resident and make more than 1000 a day take home...and I am only keeping a resident's percentage of what I produce.

Why not make it an entitlement issue? If someone wants to go to extra schooling/residency then they should be able to demand more. If you don't want to pay it and still want an ortho associate..then either increase the offered salary or keep holding out for the sucker who wants to work for peanuts.

Pay has little to do with the amount of schooling you went through. It's mostly based on market conditions and supply/demand. If your services are in demand you can charge a lot.

An associate has to make money for the owner, and this applies to any specialty. 10 years of residency and no patients coming into your office means you are making no money. Nobody owes you money because you went to school.

 

[ObviousGuy]

Pay has little to do with the amount of schooling you went through. It's mostly based on market conditions and supply/demand. If your services are in demand you can charge a lot.

An associate has to make money for the owner, and this applies to any specialty. 10 years of residency and no patients coming into your office means you are making no money. Nobody owes you money because you went to school.

I agree. Let me also clarify though for reading comprehension skills.

These applicants are probably thinking that this pedo office does have the volume to pay them 1300 a day. If Demeter doesn't have that volume then he should look at other applicants who will accept less, or make another offer he is willing to pay and the bartering can go from there. Obviously getting a doctorate and PhD in art history doesn't entitle you to making 6 figures right out of school. You are however entitled to demand more money than someone with less training than you, which was what I stated in my post. When done with residency I won't work for less than XXX,XXX guaranteed. I worked too long and too hard to be worth less, which is what I am entitled to think and demand.

 

[redrocksdentist]

"Yeah, $800/day was a great salary 10 years ago when the dental + ortho tuitions were about 1/5 of what you, current ortho residents, have to pay right now. The point I am trying to make is in order to be successful, you must take risk and be willing accept the job offers that are not really what you expect. Having a low paying job is still better than sitting at home doing nothing. "


This is great advice and should be simply followed. The other issue you mention is the rising tuitions/ monthly loan repayments. With tuition on the rise and the economy sputtering, things like the military and NHSC for GPs and Pedos is all the more important to stay financially free and competitive. Imagine 4-6 years down the road you are student loan debt free? That would be near impossible going the private practice route in any field. The market and the government are changing the game, adapt and overcome.

Wealth is built slowly until a critical mass is reached and then your income really starts to build but it all starts with accepting what you are starting with.

 

[ortho lurker]

The other problem facing new grads these days is that you have long term goals of starting an office for long term stability while also having short term goals of settling down and getting a house after 10+ years of school. You need savings, 2 years proof of income, and a steady monthly income to make payments for a house (you can defer student loans but for a mortgage it will be called foreclosure if you fall behind). If you start an office right after residency, don't work, or work for not enough it will delay this dream of owning a home until later.

 

[Demeter]

The other problem facing new grads these days is that you have long term goals of starting an office for long term stability while also having short term goals of settling down and getting a house after 10+ years of school. You need savings, 2 years proof of income, and a steady monthly income to make payments for a house (you can defer student loans but for a mortgage it will be called foreclosure if you fall behind). If you start an office right after residency, don't work, or work for not enough it will delay this dream of owning a home until later.

Yes, this is true. That's Life. I paid 400,000$ to start up my office. My wife is constantly asking me if we can finally get a new house. Nope. I made a little profit the 1st year of my start up and plan to send a check to knock down my loan. I will sleep better at night when I don't have a huge debt on my back. The dream house will have to wait.

 

[charlestweed]

. I paid 400,000$ to start up my office.

Wow, $400k….did that include working capital? Adding ortho specialty to your pedo practice is the right thing to do. There are 3 plumbed and unused operatories in your office….why not let the ortho use them? The profit earned from the in-house ortho (me) and perio (my wife) is almost enough for my sister (our GP boss) to pay the rent, staff salaries, and dental supplies. Whatever my sister produces at her office is pretty much pure profit. Because of this additional income, my sister never feels stress even when she only has 1-2 patients on her appt book.

I made a little profit the 1st year of my start up and plan to send a check to knock down my loan. I will sleep better at night when I don't have a huge debt on my back. The dream house will have to wait.

A lot of people (my patients’ parents and dental colleagues) ask me why do I work for some one else (a dental chain) when I already have 3 very busy ortho offices. My answer to their question is I can’t be my own boss when I still owe the bank money. Paying off my student loans, business loans, and car loans was one of my (and my wife’s) biggest accomplishments. However, I will only quit my associate job when my home loan is paid off and I become debt-free.

 

[scandalouslj]

Charlestweed, I do agree that opening multiple offices is one way to go and is a great way as long as you dont get too thin. We have a ortho here that has something like 10 offices. He is only at each office like 2-3 days a month. While this would seem great as they are low overhead offices, it is actually hurting him more than helping him. Patients that are interested in work dont want to wait 2-3 weeks to get a consult, and then what happens when that day doesnt work for the patient or parent. Then they have to wait even longer, not to mention what happens if they have a bracket break, lose their retainer, have a wire poking them? Because of all this, most of us GP's are referring to the local orthodontist that is there all the time and this guy is losing his shirt. I also dont want to refer my patients to some "affordable dentures" type place. Now this really depends on the type of area you are in, but I live in a higher income area, and my patients expect nice offices and the newest technology. Because of this there are definitely other ways to get more patients instead of multiple locations, you just have to find the proper niche, lower prices, extended hours, newest technologies, etc, etc. This is no different than any GP office that may be facing competition on ever corner. You now longer have the specialists that can just sit around and expect referrals.

Now with salaries, this is my perspective- coming from a biased general dentist. Everyone is struggling-I graduated 3 years ago and I have tons of GP friends who can barely find jobs, even at the chains. Meanwhile there are 10 new dental school slated to open in the next 5 years. I have friends in Dallas that are getting 1K a day being orthos. I also talked to an ortho in Atlanta who said got over 100 applications the last time he was hiring. Now I understand ortho's spent extra time, money and were probably top of their class in school. And for that I do think they are entitled to higher pay. But I think over 1K a day straight out of school does not justify that. I went to private school and most of us came out at over 300K in loans. At a GP salary I can easily pay that over 30 years, it comes out to around $1500 a month. A lot of GP's these days are doing GPR's or AEGD's so really ortho's are only spending 1 more year in school, so the lost time is not that much more. Most Gp's are starting with a guarantee of $400-$500 a day. And a year later arent doing better than $600-700 a day. So an ortho asking for $1000-$1300 a day (or $300-$600 a day more) is ridiculous in my mind. Working at 4 days a week just taking the $300 more a day equates to $57,000 more a year than a GP, making that extra 100K of schooling more than easy to pay off within 2-3 years. All of this with a new grad who is straight out of school and cant prove he can produce, may leave shortly, has assistants doing 90% of the work, and the hosts of other risks, just doesnt justify it in my mind.

 

[charlestweed]

Charlestweed, I do agree that opening multiple offices is one way to go and is a great way as long as you dont get too thin. We have a ortho here that has something like 10 offices. He is only at each office like 2-3 days a month. While this would seem great as they are low overhead offices, it is actually hurting him more than helping him. Patients that are interested in work dont want to wait 2-3 weeks to get a consult, and then what happens when that day doesnt work for the patient or parent. Then they have to wait even longer, not to mention what happens if they have a bracket break, lose their retainer, have a wire poking them? Because of all this, most of us GP's are referring to the local orthodontist that is there all the time and this guy is losing his shirt. I also dont want to refer my patients to some "affordable dentures" type place. Now this really depends on the type of area you are in, but I live in a higher income area, and my patients expect nice offices and the newest technology. Because of this there are definitely other ways to get more patients instead of multiple locations, you just have to find the proper niche, lower prices, extended hours, newest technologies, etc, etc. This is no different than any GP office that may be facing competition on ever corner. You now longer have the specialists that can just sit around and expect referrals.

I don’t think this orthodontist is doing poorly. I think he’s doing exceptionally well . With 10 offices, he probably doesn’t need the referrals from the GPs. If the fees are reasonable most patients don’t mind waiting 2-3 weeks for the appointment. Why do you think people waiting in line to get braces at the ortho residency programs? Because the fees are cheap and they also accept medicaid.

I practice in the lower income area and I love it. I get more respect from the patients (mostly Asian and Hispanic) and they value my treatment decisions. Many local GPs complain to me that the orthos they referred to in the past charge too much….and they are very excited and that I open up shop near their practices.

To make up for the fewer work days at my practice, I see all of my patients every 4 weeks so I can take care of loose brackets and poking wires etc. Most orthodontists see patients every 6-8 weeks. Hi Tech gadgets are cool but they don’t help improve the tx outcomes. Unlike other specialties, orthodontics is an art and beautiful tx outcomes depend on the orthodontist’s clinical skills…not on the type of material they use. There are orthos who spend over an hour to do a consultation and still don’t know what to do. And there are orthos who only look at the pt’s mouth for a couple of minute and know exactly what need to be done for the patient.

In my opinion, 10 offices are way too many. I only need one more office and I am done with the business expansion.